HomeMy WebLinkAbout32061Agreement No.15-215
1 AGREEMENT
2 This Agreement is made and entered into this~ day of ZJ ~ , 2015, by and
3 between the COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter
4 referred to as "COUNTY", and TURNING POINT OF CENTRAL CALIFORNIA, INC., a private
5 non-profit, 501 (c) (3) Corporation, whose address is P.O. Box 7447, Visalia, CA 93290, hereinafter
6 referred to as "CONTRACTOR".
7 WI T N E S S E T H:
8 WHEREAS, COUNTY, through its Department of Behavioral Health (DBH), is in need of a
9 qualified agency to operate a Full-Service Partnership (FSP) program to provide comprehensive
1 0 mental health, housing, and community supports to adults and older adults with a serious mental
11 illness (SMI); and
12 WHEREAS, COUNTY, through its DBH, is a Mental Health Plan (MHP) as defined in Title 9
13 of the California Code of Regulations (C.C.R.), Section 1810.226; and
14 WHEREAS, CONTRACTOR is qualified and willing to operate said FSP and provide services
15 pursuant to the terms and conditions of this Agreement.
16 NOW, THEREFORE, in consideration of their mutual covenants and conditions, the
1 7 parties hereto agree as follows:
1. SERVICES 18
19 A. CONTRACTOR shall perform all services and fulfill all responsibilities as set
2 0 forth in Exhibit A, "MHSA Full Service Partnership Services Program Scope of Work," attached hereto
21 and by this reference incorporated herein and made part of this Agreement. In addition, all services
22 shall be performed in accordance with Exhibit B, "Full Service Partnership Service Delivery Model,"
2 3 attached hereto and by this reference incorporated herein.
24 B. CONTRACTOR shall also perform all services and fulfill all responsibilities as
25 specified in COUNTY's Request for Proposal (RFP) No. 952-5329 dated January 26,2015, and
26 Addendum No. One (1) to COUNTY's RFP No. 952-5329 dated February 23,2015, herein
27 collectively referred to as COUNTY's Revised RFP, and CONTRACTOR's response to said Revised
2 8 RFP dated March 5, 2015, all incorporated herein by reference and made part ofthis Agreement. In
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COUNTY OF FRESNO
Fresno, CA
1 the event of any inconsistency among these documents, the inconsistency shall be resolved by giving
2 precedence in the following order of priority: 1) to this Agreement, including all Exhibits; 2) to the
3 Revised RFP; and 3) to the Response to the Revised RFP. A copy of COUNTY's Revised RFP No.
4 952-5329 and CONTRACTOR's response thereto shall be retained and made available during the
5 term ofthis Agreement by COUNTY's DBH Contracts Division.
6 C. It is acknowledged by all parties hereto that COUNTY's DBH Contracts
7 Division unit shall monitor the FSP Program operated by CONTRACTOR, in accordance with Section
8 Fourteen (14) of this Agreement.
9 D. CONTRACTOR shall participate in monthly, or as needed, workgroup meetings
1 0 consisting of staff from COUNTY's D BH to discuss MHSA requirements, data reporting, training,
11 policies and procedures, overall program operations and any problems or foreseeable problems that
12 may arise.
13 E. It is acknowledged that upon execution of this Agreement, CONTRACTOR will
14 provide FSP services, as identified and incorporated herein, at the following location: 258 N.
15 Blackstone Avenue, Fresno, CA 93701. Any change to CONTRACTOR's location ofthe service site
16 must be made with thirty (30) days advance written notice to COUNTY's DBH Director or designee
17 and only upon written approval from COUNTY's DBH Director or designee.
18 F. CONTRACTOR shall maintain requirements as an organizational provider
19 throughout the term of this Agreement, as described in Section Seventeen (17) of this Agreement. If
2 0 for any reason, this status is not maintained, COUNTY may terminate this Agreement pursuant to
21 Section Three (3) of this Agreement.
22 G. CONTRACTOR agrees that prior to and while providing services under the
23 terms and conditions of this Agreement, CONTRACTOR shall have staff hired and in place for
2 4 program services and operations or COUNTY may, in addition to other remedies it may have, suspend
2 5 referrals or terminate this Agreement, in accordance with Section Three (3) of this Agreement.
26 2. TERM
2 7 This Agreement shall become effective on the 1st day of July, 2015, and shall terminate
2 8 on the 30th day of June, 2018.
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CO UNIT OF FRESNO
Fresno, CA
1 Effective July 1st, 2018, this Agreement, subject to satisfactory outcomes performance
2 and subject to available funding each year, shall be extended for two (2) additional twelve (12) month
3 periods upon the same terms and conditions herein set forth, unless written notice of non-renewal is
4 given by COUNTY or CONTRACTOR or COUNTY's DBH Director or designee, not later than sixty
5 (60) days prior to the close of the current Agreement term.
6 3. TERMINATION
7 A. Non-Allocation of Funds-The terms ofthis Agreement, and the services to be
8 provided thereunder, are contingent on the approval of funds by the appropriating government agency.
9 Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
10 terminated at any time by giving the CONTRACTOR thirty (30) days advance written notice.
11 B. Breach of Contract -The COUNTY may immediately suspend or terminate this
12 Agreement in whole or in part, where in the determination of the COUNTY there is:
13 1) An illegal or improper use of funds;
14 2) A failure to comply with any term of this Agreement;
15 3) A substantially incorrect or incomplete report submitted to the COUNTY;
16 4) Improperly performed service.
17 In no event shall any payment by COUNTY constitute a waiver by COUNTY of
18 any breach of this Agreement or any default which may then exist on the part of CONTRACTOR.
19 Neither shall such payment impair or prejudice any remedy available to the COUNTY with respect to
20 the breach or default. COUNTY shall have the right to demand ofthe CONTRACTOR the repayment
21 to the COUNTY of any funds disbursed to CONTRACTOR under this Agreement, which in the
22 judgment ofthe COUNTY were not expended in accordance with the terms ofthis Agreement.
2 3 CONTRACTOR shall promptly refund any such funds upon demand or, at the COUNTY's option, such
2 4 repayment shall be deducted from future payments owing to CONTRACTOR under this Agreement.
2 5 C. Without Cause -Under circumstances other than those set forth above, this
2 6 Agreement may be terminated by CONTRACTOR or COUNTY or COUNTY's DBH Director, or
2 7 designee, upon the giving of sixty ( 60) days advance written notice of an intention to terminate.
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COUNTY OF FRESNO
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1 4. COMPENSATION
2 COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
3 compensation in accordance with the budget attached hereto and referenced herein as Exhibit C.
4 A. Maximum Contract Amount --The maximum amount under this Agreement for
5 the period July 1, 2015 through June 30, 2016 shall not exceed Four Million One Hundred Thirteen
6 Thousand One Hundred Twenty-Two and NollOO Dollars ($4,113,122.00).
7 For the period July 1, 2015 through June 30, 2016, it is understood by
8 CONTRACTOR and COUNTY that CONTRACTOR estimates to generate One Million Nine
9 Hundred Seventy-Two Thousand Six Hundred Ten and NollOO Dollars ($1,972,610.00) in Medi-Cal
10 Federal Financial Participation (FFP), Sixty-Five Thousand and No/1 00 Dollars ($65,000.00) from the
11 collection of client rents, and Two Million Seventy-Five Thousand Five Hundred Twelve and No/1 00
12 Dollars ($2,075,512.00) in MHSA Community Services and Supports (CSS) to offset
13 CONTRACTOR's program costs. The maximum amount ofMHSA funds paid by COUNTY to
14 CONTRACTOR for the period July 1, 2015 through June 30, 2016 should not exceed Two Million
15 Seventy-Five Thousand Five Hundred Twelve and No/100 Dollars ($2,075,512.00).
16 The maximum amount for the period July 1, 2016 through June 30, 2017 shall not
17 exceed Four Million Ninety-Four Thousand One Hundred Forty-Seven and No/Dollars ($4,094,147).
18 For the period July 1, 2016 through June 30, 2017, it is understood by
19 CONTRACTOR and COUNTY that CONTRACTOR estimates to generate One Million Nine Hundred
2 0 Forty-Nine Thousand Eight Hundred Forty Nine and No/1 00 Dollars ($1 ,949,849.00) in Medi-Cal
21 FFP, Sixty-Five Thousand and No/100 Dollars ($65,000) from the collection of client rents, and Two
2 2 Million Seventy-Nine Thousand Two Hundred Ninety Eight and Noll 00 Dollars ($2,079,298.00) in
23 MHSA CCS to offset CONTRACTOR's program costs. The maximum amount ofMHSA funds paid
2 4 by COUNTY to CONTRACTOR for the period July 1, 2016 through June 30, 2017 should not exceed
2 5 Two Million Seventy-Nine Thousand Two Hundred Ninety-Eight and Noll 00 Dollars ($2,079,298.00).
2 6 The maximum amount for the period July 1, 2017 through June 30, 2018 shall not
27 exceed Four Million Ninety-Four Thousand One Hundred Forty-Seven and No/100 Dollars
28 ($4,094,147.00).
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COUNTY OF FRESNO
Fresno, CA
1 For the period July 1, 2017 through June 30, 2018, it is understood by
2 CONTRACTOR and COUNTY that CONTRACTOR estimates to generate One Million Nine
3 Hundred Twenty-Two Thousand Five Hundred Thirty-Six and No/100 Dollars ($1,922,536.00) in
4 Medi-Cal FFP, Sixty-Five Thousand and NollOO Dollars ($65,000) from the collection of client rents,
5 and Two Million One Hundred Six Thousand Six Hundred Eleven and NollOO Dollars
6 ($2,106,611.00) in MHSA CCS to offset CONTRACTOR's program costs. The maximum amount of
7 MHSA funds paid by COUNTY to CONTRACTOR for the period July 1, 2017 through June 30, 2018
8 should not exceed Two Million One Hundred Six Thousand Six Hundred Eleven and Noll 00 Dollars
9 ($2,106,611.00).
1 0 The maximum amount for the period July 1, 2018 through June 30, 2019 shall not
11 exceed Four Million Two Hundred Fifteen Thousand Two Hundred Fifty-Nine and Noll 00 Dollars
12 ($4,215,259.00).
13 For the period July 1, 2018 through June 30, 2019, it is understood by
14 CONTRACTOR and COUNTY that CONTRACTOR estimates to generate One Million Nine Hundred
15 Thirteen Thousand Four Hundred Thirty-One and No/100 Dollars ($1,913,431.00) in Medi-Cal FFP,
16 Sixty-Five Thousand and Noll 00 Dollars ($65,000) from the collection of client rents, and Two
17 Million Two Hundred Thirty-Six Thousand Eight Hundred Twenty-Eight and No/100 Dollars
18 ($2,236,828.00) in MHSA CCS to offset CONTRACTOR's program costs. The maximum amount of
19 MHSA funds paid by COUNTY to CONTRACTOR for the period July 1, 2018 through June 30,2019
2 0 should not exceed Two Million Two Hundred Thirty-Six Thousand Eight Hundred Twenty-Eight and
21 Noll 00 Dollars ($2,236,828.00).
2 2 The maximum amount for the period July 1, 2019 through June 30, 2020 shall not
23 exceed Four Million Three Hundred Thirty-Six Thousand Three Hundred Seventy-One and No/100
2 4 Dollars ($4,336,371.00).
25 For the period July 1, 2019 through June 30, 2020, it is understood by
2 6 CONTRACTOR and COUNTY that CONTRACTOR estimates to generate One Million Eight
27 Hundred Ninety-Five Thousand Two Hundred Twenty-Three and NollOO Dollars ($1,895,223.00) in
2 8 Medi-Cal FFP, Sixty-Five Thousand and Noll 00 Dollars ($65,000) from the collection of client rents,
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1 and Two Million Three Hundred Seventy-Six Thousand One Hundred Forty-Eight and No/100 Dollars
2 ($2,376,148.00) in MHSA CCS offset CONTRACTOR's program costs. The maximum amount of
3 MHSA funds paid by COUNTY to CONTRACTOR for the period July 1, 2019 through June 30, 2020
4 should not exceed Two Million Three Hundred Seventy-Six Thousand One Hundred Forty-Eight and
5 No/100 Dollars ($2,376,148.00)
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B. If CONTRACTOR fails to generate the Medi-Cal FFP and/or client rent
reimbursement amounts set forth hereinabove, the COUNTY shall not be obligated to pay the
difference between these estimated amounts and the actual amounts generated.
It is further understood by COUNTY and CONTRACTOR that any Medi-Cal
FFP and client rent reimbursements above the amounts stated herein will be used to directly offset the
COUNTY's contribution ofMHSA funds identified in Exhibit C. The offset of funds will also be
clearly identified in monthly invoices received from CONTRACTOR as further described in Section
Five (5) of this Agreement.
Travel shall be reimbursed based on actual expenditures and mileage
reimbursement shall be at CONTRACTOR's adopted rate per mile, not to exceed the IRS published
rate.
Payment shall be made upon certification or other proof satisfactory to
COUNTY's DBH that services have actually been performed by CONTRACTOR as specified in this
Agreement.
C. It is understood that all expenses incidental to CONTRACTOR's performance of
services under this Agreement shall be borne by CONTRACTOR. If CONTRACTOR fails to comply
with any provision ofthis Agreement, COUNTY shall be relieved of its obligation for further
compensation.
D. Payments shall be made by COUNTY to CONTRACTOR in arrears, for services
provided during the preceding month, within forty-five (45) days after the date of receipt 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 for monthly
program costs, as identified in Exhibit C, in the performance of this Agreement and shall be
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COUNTY OF FRESNO
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1 documented to COUNTY on a monthly basis by the fifteenth (15th) of the month following the month
2 of said expenditures. The parties acknowledge that the CONTRACTOR will be performing hiring,
3 training, and credentialing of staff, configuring the facility and office space, and obtaining site
4 certification from the COUNTY Mental Health Plan (Mental Health Plan).
5 CONTRACTOR shall submit to the COUNTY by the tenth (15th) of each month a
6 detailed general ledger (GL), itemizing costs incurred in the previous month. Failure to submit GL
7 reports and supporting documentation shall be deemed sufficient cause for COUNTY to withhold
8 payments until there is compliance, as further described in Section Five (5) herein.
9 E. COUNTY shall not be obligated to make any payments under this Agreement if
10 the request for payment is received by COUNTY more than sixty (60) days after this Agreement has
11 terminated or expired.
12 All final claims, including actual cost per unit, and/or any final budget
13 modification requests shall be submitted by CONTRACTOR within sixty (60) days following the final
14 month of service for which payment is claimed. No action shall be taken by COUNTY on claims
15 submitted beyond the sixty (60) day closeout period. Any compensation which is not expended by
16 CONTRACTOR pursuant to the terms and conditions of this Agreement shall automatically revert to
17 COUNTY.
18 F. The services provided by CONTRACTOR under this Agreement are funded in
19 whole or in part by the State of California. In the event that funding for these services is delayed by the
20 State Controller, COUNTY may defer payments to CONTRACTOR. The amount of the deferred
21 payment shall not exceed the amount of funding delayed by the State Controller to the COUNTY. The
22 period of time of the deferral by COUNTY shall not exceed the period of time of the State Controller's
2 3 delay of payment to COUNTY plus forty-five ( 45) days.
2 4 G. CONTRACTOR shall be held financially liable for any and all future
2 5 disallowances/audit exceptions due to CONTRACTOR's deficiency discovered through the State audit
2 6 process and COUNTY utilization review during the course of this Agreement. At COUNTY's
2 7 election, the disallowed amount will be remitted within forty-five ( 45) days to COUNTY upon
2 8 notification or shall be withheld from subsequent payments to CONTRACTOR. CONTRACTOR shall
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1 not receive reimbursement for any units of services rendered that are disallowed or denied by the
2 Fresno County Mental Health Plan (Mental Health Plan) utilization review process or through the
3 DHCS cost report audit settlement process for Medi-Cal eligible clients.
4 H. It is understood by CONTRACTOR and COUNTY that this Agreement is funded
5 with mental health funds to serve individuals with SMI, many of whom have co-occurring substance
6 use disorders. It is further understood by CONTRACTOR and COUNTY that funds shall be used to
7 support appropriately integrated services for co-occurring substance use disorders in the target
8 population, and that integrated services can be documented in crisis assessments, interventions, and
9 progress notes documenting linkages.
5. INVOICING 10
11 A. CONTRACTOR shall invoice COUNTY in arrears by the fifteenth (15th) day of
12 each month for the prior month's actual services rendered to DBHinvoices@co.fresno.ca.us. After
13 CONTRACTOR renders service to referred clients, CONTRACTOR will invoice COUNTY for
14 payment, certify the expenditure, and submit electronic claiming billing directly into COUNTY's
15 billing system (AVATAR) for the DHCS reimbursements for all clients, including those eligible for
16 Medi-Cal as well as those that are not eligible for Medi-Cal, including contracted cost per unit and
17 actual cost per unit. COUNTY must pay CONTRACTOR before submitting a claim to DHCS for
18 Federal reimbursement for Medi-Cal eligible clients.
19 B. At the discretion of COUNTY's DBH Director, or designee, if an invoice is
20 incorrect or is otherwise not in proper form or substance, COUNTY's DBH Director, or designee,
21 shall have the right to withhold payment as to only that portion of the invoice that is incorrect or
22 improper after five (5) days prior notice to CONTRACTOR. CONTRACTOR agrees to continue to
2 3 provide services for a period of ninety (90) days after notification of an incorrect or improper invoice.
2 4 If after the ninety (90) day period, the invoice(s) is still not corrected to COUNTY DBH's
25 satisfaction, COUNTY's DBH Director, or designee, may elect to terminate this Agreement, pursuant
2 6 to the termination provisions stated in Section Three (3) of this Agreement. In addition, for invoices
2 7 received ninety (90) days after the expiration of each term of this Agreement or termination of this
2 8 Agreement, at the discretion of COUNTY's DBH Director, or designee, COUNTY's DBH shall have
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1 the right to deny payment of any additional invoices received.
2 c. Monthly invoices shall include a client roster, identifying volume reported by
3 payer group clients served (including third party payer of services) by month and year-to-date,
4 including percentages.
5 D. CONTRACTOR shall submit monthly invoices and general ledgers that itemize
6 the line item charges for monthly program costs (per applicable budget, as identified in Exhibit C),
7 including the cost per unit calculation based on clients served within that month, and excluding
8 lobbying costs. The invoices and general ledgers will serve as tracking tools to determine if
9 CONTRACTOR's program costs are in accordance with its budgeted cost, and cost per unit
1 0 negotiated by service modes compared to actual cost per unit, as set forth in Exhibit C. The actual
11 cost per unit will be based upon total costs and total units of service. It will also serve for the
12 COUNTY to certify the public funds expended for purposes of claiming federal reimbursement for
13 the cost ofMedicaid services and activities. CONTRACTOR shall remit to COUNTY on a quarterly
14 basis, a summary report of total operational costs and volume of service unit to report the actual costs
15 per unit compared to the negotiated rate, as identified in Exhibit C, to report interim cost per unit.
16 The quarterly reports will be used by COUNTY to ensure compliance with federal reimbursements
1 7 certified public expenditures.
18 E. CONTRACTOR must report all third party collections from other funding
19 sources such as Medicare, private insurance, client private pay or any other third party. COUNTY
2 0 expects the invoice for reimbursement to equal the amount due CONTRACTOR less any funding
21 sources not eligible for federal reimbursement.
22 F. CONTRACTOR will remit annually within ninety (90) days from June 30, a
2 3 schedule to provide the required information on published charges (PC) for all authorized services.
24 The published charge listing will serve as a source document to determine the CONTRACTOR's
2 5 usual and customary charge prevalent in the public mental health sector that is used to bill the general
2 6 public, insurers or other non-Medi-Cal third party payers during the course of business operations.
27 G. CONTRACTOR shall submit monthly staffing reports that identify all direct
2 8 service and support staff, applicable licensure/certifications, and full time hours worked to be used as
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1 a tracking tool to determine if CONTRACTOR's program is staffed according to the Agreement
2 requirements.
3 H. CONTRACTOR must maintain such financial records for a period of seven (7)
4 years or until any dispute, audit or inspection is resolved, whichever is later. CONTRACTOR will be
5 responsible for any disallowances related to inadequate documentation.
6 I. CONTRACTOR is responsible for collection and managing data in a manner to
7 be determined by DHCS and the Mental Health Plan in accordance with applicable rules and
8 regulations. COUNTY electronic billing system is a critical source of information for purposes of
9 monitoring and obtaining reimbursement. CONTRACTOR must attend COUNTY's Business Office
10 training on equipment reporting for assets, intangible and sensitive minor assets, Avatar claiming
11 module and related cost reporting.
12 J. CONTRACTOR shall submit electronic billing for services directly into
13 COUNTY's billing module (AVATAR) within ten (10) calendar days from the date services were
14 rendered. DHCS' FFP reimbursement for Medi-Cal specialty mental health services is based on
15 public expenditures certified by the CONTRACTOR. CONTRACTOR must submit a signed
16 certified public expenditure report, with each respective monthly invoice. DHCS expects the claim
17 for reimbursement to equal the amount the COUNTY paid the CONTRACTOR for the service
18 rendered less any funding sources not eligible for Federal reimbursement.
19 K. CONTRACTOR must provide all necessary data to allow the COUNTY to bill
2 0 Medi-Cal, and any other third-party source, for services and meet State and Federal reporting
21 requirements. The necessary data can be provided by a variety of means, including but not limited to:
22 1) direct data entry into COUNTY's information system; 2) providing an electronic file compatible
23 with COUNTY's information system; or 3) integration between COUNTY's information system and
24 CONTRACTOR's information system(s).
25 L. If a Medi-Cal client has dual coverage, such as other health coverage (OHC) or
2 6 Medicare, the CONTRACTOR will be responsible for billing the carrier and obtaining a
2 7 payment/denial or have validation of claiming with no response ninety (90) days after the claim
2 8 was mailed before the service can be entered into AVATAR. CONTRACTOR must report all third
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1 party collections for Medicare, third party or client pay or private pay in each monthly invoice and
2 in the cost report that is required to be submitted. A copy of explanation of benefits or CSM 1500
3 is required as documentation. CONTRACTOR must comply with all laws and regulations
4 governing Medicare program, including, but not limited to: 1) the requirement of the Medicare
5 Act, 42 U.S.C. section 1395 et seq; and 2) the regulation and rules promulgated by the Centers for
6 Medicare and Medicaid Services as they relate to participation, coverage and claiming
7 reimbursement. CONTRACTOR will be responsible for compliance as of the effective date of each
8 federal, state or local law or regulation specified.
9 M. Data entry shall be the responsibility of the CONTRACTOR. The data for
10 billing must be reconciled by the CONTRACTOR to the monthly invoices submitted for payment.
11 COUNTY shall monitor the number and dollar amount of services entered into AVA TAR. Any and
12 all audit exceptions resulting from the provision and billing of Medi-Cal services by CONTRACTOR
13 shall be the sole responsibility of the CONTRACTOR. CONTRACTOR will comply with all
14 applicable policies, procedures, directives and guidelines regarding the use of COUNTY's billing
15 system.
16 N. Medi-Cal Certification and Mental Health Plan Compliance
17 CONTRACTOR will establish and maintain Medi-Cal certification or become
18 certified within ninety (90) days ofthe effective date ofthis Agreement through COUNTY to provide
19 reimbursable services to Medi-Cal eligible adult clients. In addition, CONTRACTOR shall work
20 with the COUNTY's DBH Managed Care and Business Office to execute the process ifnot currently
21 certified by COUNTY for credentialing of staff. During this process, the CONTRACTOR will obtain
2 2 a legal entity number established by the DHCS, a requirement for maintaining organizational
2 3 provider status throughout the term of this Agreement. CONTRACTOR will be required to become
2 4 Medi-Cal certified prior to providing services to Medi-Cal eligible clients and seeking reimbursement
25 in COUNTY's billing system. CONTRACTOR will not be reimbursed by COUNTY for any Medi-
2 6 Cal services rendered prior to certification.
2 7 Medi-Cal billing shall be in accordance with the Mental Health Plan.
2 8 CONTRACTOR must comply with the "Fresno County Mental Health Plan Compliance Program and
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1 Code of Conduct" set forth in Exhibit D, attached hereto and incorporated herein by reference and
2 made part of this Agreement.
3 Medi-Cal can be billed for direct specialty mental health services of unlicensed
4 staff as long as the individual is approved as an organizational provider by the Mental Health Plan, is
5 supervised by licensed staff, works within his/her scope and only bills Medi-Cal for allowable
6 specialty mental health services. It is understood that each claim is subject to audit for compliance
7 with Federal and State regulations, and that COUNTY may be making payments in advance of said
8 review. In the event that a Medi-Cal billable service is disapproved, COUNTY may, at its sole
9 discretion, withhold compensation or set off from other payments due the amount of said disapproved
10 services. CONTRACTOR shall be responsible for audit exceptions to ineligible dates of services or
11 incorrect application of utilization review requirements.
12 6. INDEPENDENT CONTRACTOR
13 In performance of the work, duties, and obligations assumed by CONTRACTOR under
14 this Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of
15 CONTRACTOR's officers, agents, and employees will at all times be acting and performing as
16 independent contractors, and shall act in an independent capacity and not as an officer, agent, servant,
17 employee, joint venture, partner, or associate ofthe COUNTY. Furthermore, COUNTY shall have no
18 right to control or supervise or direct the manner or method by which CONTRACTOR shall perform
19 its work and function. However, COUNTY shall retain the right to administer this Agreement so as to
2 0 verify that CONTRACTOR is performing its obligations in accordance with the terms and conditions
21 thereof. CONTRACTOR and COUNTY shall comply with all applicable
2 2 provisions of law and the rules and regulations, if any, of governmental authorities having jurisdiction
23 over matters which are directly or indirectly the subject ofthis Agreement.
2 4 Because of its status as an independent contractor, CONTRACTOR shall have absolutely
2 5 no right to employment rights and benefits available to COUNTY employees. CONTRACTOR shall
2 6 be solely liable and responsible for providing to, or on behalf of, its employees all legally-required
2 7 employee benefits. In addition, CONTRACTOR shall be solely responsible and save COUNTY
2 8 harmless from all matters relating to payment of CONTRACTOR's employees, including compliance
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1 with Social Security, withholding, and all other regulations governing such matters. It is acknowledged
2 that during the term of this Agreement, CONTRACTOR may be providing services to others unrelated
3 to the COUNTY or to this Agreement.
4 7. MODIFICATION
5 Any matters of this Agreement may be modified from time to time by the written
6 consent of all the parties without, in any way, affecting the remainder.
7 Notwithstanding the above, changes to line items in the budget, as set forth in Exhibit C,
8 that do not exceed ten percent ( 1 0%) of the total maximum compensation payable to CONTRACTOR,
9 and changes to the volume of units of services/types of service units to be provided as set forth in
10 Exhibit C, may be made with the written approval of COUNTY's DBH Director or designee and
11 CONTRACTOR. Said budget line item and service volume/types of service units changes shall not
12 result in any change to the maximum compensation amount payable to CONTRACTOR, as stated
13 herein.
14 8. NON-ASSIGNMENT
15 No party shall assign, transfer or subcontract this Agreement nor their rights or duties
16 under this Agreement without the prior written consent of COUNTY and CONTRACTOR.
17 9. HOLD-HARMLESS
18 CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request,
19 defend COUNTY, its officers, agents and employees from any and all costs and expenses, including
2 0 attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to COUNTY
21 in connection with the performance, or failure to perform, by CONTRACTOR, its officers, agents or
2 2 employees under this Agreement, and from any and all costs and expenses, including attorney fees and
2 3 court costs, damages, liabilities, claims and losses occurring or resulting to any person, firm or
2 4 corporation who may be injured or damaged by the performance, or failure to perform, of
2 5 CONTRACTOR, its officers, agents or employees under this Agreement.
2 6 CONTRACTOR agrees to indemnify COUNTY for Federal and/or State of California audit
2 7 exceptions resulting from noncompliance herein on the part of the CONTRACTOR.
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1 10. INSURANCE
2 Without limiting the COUNTY's right to obtain indemnification from CONTRACTOR
3 or any third parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect the
4 following insurance policies throughout the term of this Agreement:
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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.
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 Five Hundred Thousand Dollars ($500,000). Coverage
should include owned and non-owned vehicles used in connection with this
Agreement.
Real and Personal Property
CONTRACTOR 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 purchased and owned property, at a minimum,
as discussed in Section Twenty-Seven (27) of this Agreement.
All Risk Property Insurance
CONTRACTOR will provide property coverage for the full replacement value of
the County's Personal Property in the possession of CONTRACTOR 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.
Professional Liability
If CONTRACTOR 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
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COUN1Y OF FRESNO
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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.
Worker's Compensation
A policy of Worker's Compensation Insurance as may be required by the
California Labor Code.
CONTRACTOR 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 the COUNTY, its officers, agents and employees shall be excess only and not
contributing with insurance provided under the 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 CONTRACTOR signs this Agreement,
CONTRACTOR shall provide certificates of insurance and endorsements as stated above for all ofthe
foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health, 3133
N. Millbrook Avenue, Fresno, California, 93703, Attention: Mental Health Contracts Section, 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 the COUNTY, its officers, agents
and employees, shall be excess only and not contributing with insurance provided under
CONTRACTOR's policies herein; and that this insurance shall not be cancelled or changed without a
minimum ofthirty (30) days advance, written notice given to COUNTY.
In the event CONTRACTOR fails to keep in effect at all times insurance coverage as
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1 herein provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate
2 this Agreement upon the occurrence of such event.
3 All policies shall be with admitted insurers licensed to do business in the State of
4 California. Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating of
5 A FSC VII or better.
6 11. LICENSES/CERTIFICATES
7 Throughout each term of this Agreement, CONTRACTOR and CONTRACTOR's staff
8 shall maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary
9 for the provision of the services hereunder and required by the laws and regulations of the United States
1 0 of America, State of California, the County of Fresno, and any other applicable governmental agencies.
11 CONTRACTOR shall notify COUNTY immediately in writing of its inability to obtain or maintain
12 such licenses, permits, approvals, certificates, waivers and exemptions irrespective of the pendency of
13 any appeal related thereto. Additionally, CONTRACTOR and CONTRACTOR's staff shall comply
14 with all applicable laws, rules or regulations, as may now exist or be hereafter changed.
15 12. RECORDS
16 CONTRACTOR shall maintain records in accordance with Exhibit E, "Documentation
1 7 Standards for Client Records", attached hereto and by this reference incorporated herein and made part
18 of this Agreement. During site visits, COUNTY shall be allowed to review records of services
19 provided, including the goals and objectives of the treatment plan, and how the therapy provided is
2 0 achieving the goals and objectives.
13. REPORTS 21
22 A. Cost Report-CONTRACTOR agrees to submit a complete and accurate
2 3 detailed cost report on an annual basis for each fiscal year ending June 30th in the format prescribed
2 4 by the DHCS for the purposes of Short Doyle Medi-Cal reimbursements and total costs for programs.
2 5 Each cost report will be the source document for several phases of settlement with the DHCS for the
2 6 purposes of Short Doyle Medi-Cal reimbursement. CONTRACTOR shall report costs under their
2 7 approved legal entity number established during the Medi-Cal certification process. The information
2 8 provided applies to CONTRACTOR for program related costs for services rendered to Medi-Cal and
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1 non Medi-Cal. The CONTRACTOR will remit a schedule to provide the required information on
2 published charges (PC) for all authorized services. The report will serve as a source document to
3 determine their usual and customary charge prevalent in the public mental health sector that is used to
4 bill the general public, insurers or other non-Medi-Cal third party payers during the course of
5 business operations. CONTRACTOR must report all collections for Medi-Cal/Medicare services and
6 collections. CONTRACTOR shall also submit with each cost report a copy of the CONTRACTOR's
7 general ledger that supports revenues and expenditures. CONTRACTOR must also include a
8 reconciled detailed report of the total units of services rendered under this Agreement compared to
9 the units of services entered by CONTRACTOR into COUNTY's data system.
10 Cost reports must be submitted to the COUNTY as a hard copy with a signed
11 cover letter and electronic copy of the completed DHCS cost report form along with requested
12 support documents following each fiscal year ending June 30th. During the month of September of
13 each year this Agreement is effective, COUNTY will issue instructions of the annual cost report
14 which indicates the training session, DHCS cost report template worksheets, and deadlines to submit
15 as determined by the State annually. Remit the hard copies ofthe cost reports to County of Fresno,
16 Attention: Cost Report Team, P.O. Box 45003, Fresno, CA 93718. Remit the electronic copy or any
17 inquiries to DBHcostreportteam@co.fresno.ca.us.
18 All cost reports must be prepared in accordance with Generally Accepted
19 Accounting Principles (GAAP) and Welfare and Institutions Code§§ 5651(a)(4), 5664(a), 5705(b)(3)
20 and 5718(c). Unallowable costs such as lobby or political donations must be deducted on the cost
21 report and invoice reimbursements.
22 If the CONTRACTOR does not submit the cost report by the deadline, including
23 any extension period granted by the COUNTY, the COUNTY may withhold payments of pending
2 4 invoicing under compensation until the cost report has been submitted and clears COUNTY desk
2 5 audit for completeness.
26 B. Settlements with State Department of Health Care Services (DHCS)
27 During the term ofthis Agreement and thereafter, COUNTY and
2 8 CONTRACTOR agree to settle dollar amounts disallowed or settled in accordance with DHCS and
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1 COUNTY audit settlement findings related to the Medi-Cal and realignment reimbursements.
2 CONTRACTOR will participate in the several phases of settlements between COUNTY,
3 CONTRACTOR and DHCS. The phases of initial cost reporting for settlement according to State
4 reconciliation of records for paid Medi-Cal services and audit settlement are: DHCS audit: 1) initial
5 cost reporting-after an internal review by COUNTY, the COUNTY files cost report with DHCS on
6 behalf of the CONTRACTOR's legal entity for the fiscal year; 2) Settlement -State reconciliation of
7 records for paid Medi-Cal services, approximately eighteen (18) to thirty-six (36) months following
8 the State close of the fiscal year, DHCS will send notice for any settlement under this provision will
9 be sent to the COUNTY; and 3) Audit Settlement-DHCS audit. After final reconciliation and
10 settlement, COUNTY and/or DHCS may conduct a review of medical records, cost report along with
11 support documents submitted to COUNTY in initial submission to determine accuracy and may
12 disallow cost and/or unit of service reported on the CONTRACTOR's legal entity cost report.
13 COUNTY may choose to appeal and therefore reserves the right to defer payback settlement with
14 CONTRACTOR until resolution ofthe appeal. DHCS Audits will follow federal Medicaid
15 procedures for managing overpayments.
16 If at the end of the Audit Settlement, the COUNTY determines that it overpaid
17 the CONTRACTOR, it will require the CONTRACTOR to repay the Medi-Cal related
18 overpayment back to the COUNTY.
19 Funds owed to COUNTY will be due within forty-five (45) days of notification
2 0 by the COUNTY, or COUNTY shall withhold future payments until all excess funds have been
21 recouped by means of an offset against any payments then or thereafter owing to CONTRACTOR
2 2 under this or any other Agreement.
23 C. Monthly Reports-CONTRACTOR shall submit a monthly report to the County
2 4 that will include, but not be limited to dollars billed for Medi-Cal and MHSA (non Medi-Cal) clients;
2 5 actual expenses; the number of clients served/anticipated to be served; utilization of services by
2 6 clients; and staff composition. This report will be due within thirty (30) days after the last day of the
2 7 previous month or payments may be delayed. CONTRACTOR will utilize a computerized tracking
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1 system with which outcome measures and other relevant client data, such as demographics, will be
2 maintained.
3 D. Outcome Reports-CONTRACTOR shall submit to COUNTY's DBH service
4 outcome reports as requested by DBH. Outcome reports and outcome requirements are subject to
5 change at COUNTY DBH's discretion.
6 E. Additional Reports-CONTRACTOR shall also furnish to COUNTY such
7 statements, records, reports, data, and other information as COUNTY's DBH may request pertaining
8 to matters covered by this Agreement. In the event that CONTRACTOR fails to provide such reports
9 or other information required hereunder, it shall be deemed sufficient cause for COUNTY to withhold
10 monthly payments until there is compliance. In addition, CONTRACTOR shall provide written
11 notification and explanation to COUNTY within five (5) days of any funds received from another
12 source to conduct the same services covered by this Agreement.
13 F. FSP Data Collection and Reporting to DHCS -CONTRACTOR shall report
14 client/partner information and outcomes of the FSP program directly into the FSP Data Collection
15 and Reporting (DCR) system. Data shall be submitted through an online interface using forms set
16 forth in Exhibit F, attached hereto and by this reference incorporated herein and made part of this
17 Agreement.
18 G. Progress Report Updates-CONTRACTOR shall complete Progress Report
19 updates according to DHCS regulations, in the form set forth in Exhibit G, attached hereto and by this
20 reference incorporated herein and made part ofthis Agreement. CONTRACTOR shall submit the
21 required progress updates, as shown in Exhibit G, to COUNTY's DBH Mental Health Contracts
22 Division for review.
2 3 CONTRACTOR shall submit to COUNTY's DBH by the Fifteenth (15th) of each month
2 4 all monthly activity, outcome and budget reports for the preceding month. CONTRACTOR shall
2 5 also provide records of rents collected from each consumer and include the consumer's name, date of
2 6 birth and social security number. All data transmitted must be in strict conformance with Section
27 Nineteen (19) and Section Twenty (20) ofthis Agreement.
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1 14. MONITORING
2 CONTRACTOR agrees to extend to COUNTY's staff, COUNTY's DBH Director and
3 DHCS, or their designees, the right to review and monitor records, programs or procedures, at any
4 time, in regard to clients, as well as the overall operation of CONTRACTOR's programs, in order to
5 ensure compliance with the terms and conditions ofthis Agreement.
6 15. REFERENCES TO LAWS AND RULES
7 In the event any law, regulation, or policy referred to in this Agreement is amended
8 during the term thereof, the parties hereto agree to comply with the amended provision as of the
9 effective date of such amendment.
10 16. COMPLIANCE WITH STATE REQUIREMENTS
11 CONTRACTOR recognizes that COUNTY operates its mental health programs under
12 an agreement with DHCS, and that under said agreement the State imposes certain requirements on
13 COUNTY and its subcontractors. CONTRACTOR shall adhere to all State requirements, including
14 those identified in Exhibit H, "State Mental Health Requirements", attached hereto and by this
15 reference incorporated herein and made part of this Agreement.
16 17. COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
17 CONTRACTOR shall be required to maintain organizational provider certification by
18 Fresno County. CONTRACTOR must meet Medi-Cal organization provider standards as listed in
19 Exhibit I, "Medi-Cal Organizational Provider Standards", attached hereto and by this reference
2 0 incorporated herein and made part of this Agreement. It is acknowledged that all references to
21 Organizational Provider and/or Provider in Exhibit I shall refer to CONTRACTOR. In addition,
22 CONTRACTOR shall inform every client of their rights under the COUNTY's Mental Health Plan as
2 3 described in Exhibit J, "Fresno County Mental Health Plan Grievances and Incident Reporting",
2 4 attached hereto and by this reference incorporated herein. CONTRACTOR shall also file an incident
2 5 report for all incidents involving clients, following the Protocol for Completion of Incident Report and
2 6 using the "Incident Report Worksheet" both identified in Exhibit K, attached hereto and by this
2 7 reference incorporated herein and made part of this Agreement, or a protocol and worksheet presented
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1 18. CONFIDENTIALITY
2 All services performed by CONTRACTOR under this Agreement shall be in strict
3 conformance with all applicable Federal, State of California and/or local laws and regulations relating
4 to confidentiality.
5 19. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
6 COUNTY and CONTRACTOR each consider and represent themselves as covered
7 entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public
8 Law 104-191(HIPAA) and agree to use and disclose Protected Health Information (PHI) as required
9 by law.
10 COUNTY and CONTRACTOR acknowledge that the exchange of PHI between them is
11 only for treatment, payment, and health care operations.
12 COUNTY and CONTRACTOR intend to protect the privacy and provide for the
13 security of PHI pursuant to the Agreement in compliance with HIP AA, the Health Information
14 Technology for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations
15 promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA Regulations)
16 and other applicable laws.
1 7 As part of the HIP AA Regulations, the Privacy Rule and the Security Rule require
18 CONTRACTOR to enter into a contract containing specific requirements prior to the disclosure of
19 PHI, as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the
20 Code ofFederal Regulations (CFR).
21 20. DATA SECURITY
22 For the purpose of preventing the potential loss, misappropriation or inadvertent access,
2 3 viewing, use or disclosure of COUNTY data including sensitive or personal client information; abuse
2 4 of COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies that
2 5 enter into a contractual relationship with the COUNTY for the purpose of providing services under
2 6 this Agreement must employ adequate data security measures to protect the confidential information
2 7 provided to CONTRACTOR by the COUNTY, including but not limited to the following:
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COUNTY OF FRESNO
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A. CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
CONTRACTOR may not connect to COUNTY networks via personally-owned
mobile, wireless or handheld devices, unless the following conditions are met:
1. CONTRACTOR has received authorization by COUNTY for
5 telecommuting purposes;
Current virus protection software is in place; 6
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Mobile device has the remote wipe feature enabled; and
A secure connection is used.
B. CONTRACTOR-Owned Computers or Computer Peripherals
10 CONTRACTOR may not bring CONTRACTOR-owned computers or computer
11 peripherals into the COUNTY for use without prior authorization from the COUNTY's Chief
12 Information Officer, and/or designee(s), including but not limited to mobile storage devices. If data is
13 approved to be transferred, data must be stored on a secure server approved by the COUNTY and
14 transferred by means of a Virtual Private Network (VPN) connection, or another type of secure
15 connection. Said data must be encrypted.
16 C. COUNTY-Owned Computer Equipment
17 CONTRACTOR, including its subcontractors and employees, may not use
18 COUNTY computers or computer peripherals on non-COUNTY premises without prior authorization
19 from the COUNTY's Chieflnformation Officer, and/or designee(s).
20 D. CONTRACTOR may not store COUNTY's private, confidential or sensitive
21 data on any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
22 E. CONTRACTOR shall be responsible to employ strict controls to ensure the
2 3 integrity and security of COUNTY's confidential information and to prevent unauthorized access,
2 4 viewing, use or disclosure of data maintained in computer files, program documentation, data
2 5 processing systems, data files and data processing equipment which stores or processes COUNTY
2 6 data internally and externally.
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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 pass phrase must be utilized.
G. CONTRACTOR 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 information
provided to CONTRACTOR. CONTRACTOR 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 will be responsible for all costs incurred as a result of providing the required
notification.
21. NON-DISCRIMINATION
15 During the performance of this Agreement CONTRACTOR shall not unlawfully
16 discriminate against any employee or applicant for employment, or recipient of services, because of
17 race, religion, color, national origin, ancestry, physical disability, medical condition, marital status,
18 age or sex, pursuant to all applicable State of California and Federal statutes and regulations.
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22. TAX EQUITY AND FISCAL RESPONSIBILITY ACT
To the extent necessary to prevent disallowance of reimbursement under section 1861(v)
21 (1) (I) ofthe Social Security Act, (42 U.S.C. § 1395x, subd. (v)(l)[I]), until the expiration offour (4)
2 2 years after the furnishing of services under this Agreement, CONTRACTOR shall make available,
23 upon written request of the Secretary ofthe United States Department of Health and Human Services,
24 or upon request ofthe Comptroller General ofthe United States General Accounting Office, or any of
2 5 their duly authorized representatives, a copy of this Agreement and such books, documents, and
2 6 records as are necessary to certify the nature and extent of the costs of these services provided by
2 7 CONTRACTOR under this Agreement. CONTRACTOR further agrees that in the event
2 8 CONTRACTOR carries out any of its duties under this Agreement through a subcontract, with a value
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1 or cost ofTen Thousand and No/100 Dollars ($10,000.00) or more over a twelve (12) month period,
2 with a related organization, such Agreement shall contain a clause to the effect that until the expiration
3 of four ( 4) years after the furnishing of such services pursuant to such subcontract, the related
4 organizations shall make available, upon written request of the Secretary of the United States
5 Department of Health and Human Services, or upon request of the Comptroller General of the United
6 States General Accounting Office, or any of their duly authorized representatives, a copy of such
7 subcontract and such books, documents, and records of such organization as are necessary to verify
8 the nature and extent of such costs.
9 23. SINGLE AUDIT CLAUSE
10 A. If any CONTRACTOR expends Five Hundred Thousand Dollars ($500,000.00)
11 or more in Federal and Federal flow-through monies, CONTRACTOR agrees to conduct an annual
12 audit in accordance with the requirements of the Single Audit Standards as set forth in Office of
13 Management and Budget (OMB) Circular A-133. CONTRACTOR shall submit said audit and
14 management letter to COUNTY. The audit must include a statement of findings or a statement that
15 there were no findings. If there were negative findings, CONTRACTOR shall include a corrective
16 action plan signed by an authorized individual. CONTRACTOR agrees to take action to correct any
1 7 material non-compliance or weakness found as a result of such audit. Such audits shall be delivered to
18 COUNTY's DBH Business Office for review within nine (9) months ofthe end of any fiscal year in
19 which funds were expended and/or received for the program. Failure to perform the requisite audit
2 0 functions as required by this Agreement may result in COUNTY performing the necessary audit tasks,
21 or at COUNTY's option, contracting with a public accountant to perform said audit, or may result in
2 2 the inability of COUNTY to enter into future agreements with CONTRACTOR. All audit costs related
2 3 to this Agreement are the sole responsibility of CONTRACTOR.
24 B. A single audit report is not applicable if CONTRACTOR's Federal contracts do
2 5 not exceed the Five Hundred Thousand Dollars ($500,000.00) requirement or CONTRACTOR's only
2 6 funding is through Medi-Cal. If a single audit is not applicable, a program audit must be performed
2 7 and a program audit report with management letter shall be submitted by CONTRACTOR to
2 8 COUNTY as a minimum requirement to attest to CONTRACTOR's solvency. Said audit reports shall
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1 be delivered to COUNTY's DBH Business Office for review no later than nine (9) months after the
2 close of the fiscal year in which the funds supplied through this Agreement are expended. Failure to
3 comply with this Act may result in COUNTY performing the necessary audit tasks or contracting with
4 a qualified accountant to perform said audit. All audit costs related to this Agreement are the sole
5 responsibility of CONTRACTOR who agrees to take corrective action to eliminate any material
6 noncompliance or weakness found as a result of such audit. Audit work performed by COUNTY
7 under this Section shall be billed to the CONTRACTOR at COUNTY's cost, as determined by
8 COUNTY's Auditor-Controller/ Treasurer-Tax Collector.
9 C. CONTRACTOR shall make available all records and accounts for inspection by
1 0 COUNTY, the State of California, if applicable, the Comptroller General of the United States, the
11 Federal Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a
12 period of at least three (3) years following final payment under this Agreement or the closure of all
13 other pending matters, whichever is later.
14 24. COMPLIANCE
15 CONTRACTOR agrees to comply with COUNTY's Contractor Code of Conduct and
16 Ethics and the COUNTY's Compliance Program in accordance with Exhibit D. Within thirty (30)
17 days of entering into this Agreement with the COUNTY, CONTRACTOR shall have all of
18 CONTRACTOR's employees, agents and subcontractors providing services under this Agreement
19 certify in writing, that he or she has received, read, understood, and shall abide by the Contractor
20 Code of Conduct and Ethics. CONTRACTOR shall ensure that within thirty (30) days ofhire, all
21 new employees, agents and subcontractors providing services under this Agreement shall certify in
2 2 writing that he or she has received, read, understood, and shall abide by the Contractor Code of
2 3 Conduct and Ethics. CONTRACTOR understand that the promotion of and adherence to the code of
2 4 Conduct and Ethics is an element in evaluating the performance of CONTRACTOR and its
2 5 employees, agents and subcontractors.
2 6 Within thirty (30) days of entering into this Agreement, and annually thereafter, all
2 7 employees, agent and subcontractors providing services under this Agreement shall complete general
2 8 compliance training and appropriate employees, agents and subcontractors shall complete
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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
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, Fresno, California
93703. CONTRACTOR 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.
25. ASSURANCES
10 In entering into this Agreement, CONTRA TOR certifies that it nor any of its officers are
11 not currently excluded, suspended, debarred, or otherwise ineligible to participate in the Federal
12 Health Care Programs: that it or any of its officers have not been convicted of a criminal offense
13 related to the provision of health care items or services; nor have they been reinstated to participate in
14 the Federal Health Care Programs after a period of exclusion, suspension, debarment, or ineligibility.
15 If COUNTY learns, subsequent to entering into this Agreement, that CONTRACTOR is ineligible on
16 these grounds, COUNTY will remove CONTRACTOR from responsibility for, or involvement with,
17 COUNTY's business operations related to the Federal Health Care Programs and shall remove such
18 CONTRACTOR from any position in which CONTRACTOR's compensation, or the items or services
19 rendered, ordered or prescribed by CONTRACTOR may be paid in whole or part, directly or
2 0 indirectly, by Federal Health Care Programs or otherwise with Federal Funds at least until such time
21 as CONTRACTOR is reinstated into participation in the Federal Health Care Programs.
2 2 A. If COUNTY has notice that CONTRACTOR has been charged with a
2 3 criminal offense related to any Federal Health Care Programs, or proposed for exclusion during the
2 4 term on any contract, CONTRACTOR and COUNTY shall take all appropriate actions to ensure the
2 5 accuracy of any claims submitted to any Federal Health Care Program. At its discretion given such
2 6 circumstances, COUNTY may request that CONTRACTOR cease providing services until resolution
2 7 of the charges or the proposed exclusion.
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1 B. CONTRACTOR agrees that all potential new employees of CONTRACTOR or
2 subcontractors of CONTRACTOR who, in each case, are expected to perform professional services
3 under this Agreement, will be queried as to whether (1) they are now or ever have been excluded,
4 suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2)
5 they have been convicted of criminal offense related to the provision of health care items or services;
6 and or (3) they have been reinstated to participate in the Federal Health Care Programs after a period
7 of exclusion, suspension, debarment, or ineligibility.
8 1. In the event the potential employee or subcontractor informs
9 CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible, or has been
10 convicted of a criminal offense relating to the provision of health care services, and CONTRACTOR
11 hires or engages such potential employee or subcontractor, the CONTRACTOR will
12 ensure that said employee or subcontractor does no work, either directly or indirectly relating to
13 services provided to COUNTY.
14 2. Notwithstanding the above, COUNTY at its discretion may terminate this
15 Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
16 defined by COUNTY) that no excluded, suspended or otherwise ineligible employee of
17 CONTRACTOR will perform work, either directly or indirectly, relating to services provided to
18 COUNTY. Such demand for adequate assurance shall be effective upon a time frame to be
19 determined by COUNTY to protect the interests of COUNTY clients.
20 C. CONTRACTOR shall verify (by asking the applicable employees and
21 subcontractors) that all current employees and existing subcontractors who, in each case, are expected
22 to perform professional services under this Agreement: (1) are not currently excluded, suspended,
2 3 debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2) have not been
2 4 convicted of a criminal offense related to the provision of health care items or services; and (3) have
2 5 not been reinstated to participate in the Federal Health Care Programs after a period of exclusion,
2 6 suspension, debarment, or ineligibility. In the event any existing employee or subcontractor informs a
2 7 CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible to participate
2 8 in the Federal Health Care Programs, or has been convicted of a criminal offense relating to the
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1 provision of heath care services, CONTRACTOR will ensure that said employee or subcontractor
2 does no work, either direct or indirect, relating to services provided to COUNTY.
3 1. CONTRACTOR agrees to notify COUNTY immediately during the term
4 ofthis Agreement whenever CONTRACTOR learns that an employee or subcontractor who, in each
5 case, is providing professional services under Section One (1) ofthis Agreement is excluded,
6 suspended, debarred or otherwise ineligible to participate in the Federal Health Care Programs, or is
7 convicted of a criminal offense relating to the provision of health care services.
8 2. Notwithstanding the above, COUNTY at its discretion may terminate this
9 Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
10 defined by COUNTY) that no excluded, suspended or otherwise ineligible employee or subcontractor
11 of CONTRACTOR will perform work, either directly or indirectly, relating to services provided to
12 COUNTY. Such demand for adequate assurance shall be effective upon a time frame to be
13 determined by COUNTY to protect the interests of COUNTY clients.
14 D. CONTRACTOR agrees to cooperate fully with any reasonable requests for
15 information from COUNTY which may be necessary to complete any internal or external audits
16 relating to CONTRACTOR's compliance with the provisions of this Section.
17 E. CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty
18 imposed upon COUNTY by the Federal Government as a result of CONTRACTOR's violation of
19 CONTRACTOR's obligations as described in this Section.
20 26. PROHIBITION ON PUBLICITY
21 None of the funds, materials, property or services provided directly or indirectly under
2 2 this Agreement shall be used for CONTRACTOR's advertising, fundraising, or publicity (i.e.,
· 2 3 purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self-promotion.
24 Notwithstanding the above, publicity ofthe services described in Section One (1) ofthis Agreement
2 5 shall be allowed as necessary to raise public awareness about the availability of such specific services
2 6 when approved in advance by COUNTY's DBH Director or designee and at a cost to be provided in
2 7 Section Four ( 4) of this Agreement for such items as written/printed materials, the use of media (i.e.,
2 8 radio, television, newspapers) and any other related expense(s).
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1 27. PROPERTY OF COUNTY
2 A. COUNTY and CONTRACTOR recognize that fixed assets are tangible and
3 intangible property obtained or controlled under COUNTY's Mental Health Plan for use in operational
4 capacity and will benefit COUNTY for a period more than one (1) year. Depreciation ofthe qualified
5 items will be on a straight-lien basis.
6 For COUNTY purposes, fixed assets must fulfill three qualifications:
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Asset must have life span of over one year.
The asset is not a repair part.
The asset must be valued at or greater than the capitalization thresholds
for the asset type:
Asset type
• land
• buildings and improvements
• infrastructure
• be tangible
o equipment
o vehicles
• or intangible asset
o Internally generated software
o Purchased software
o Easements
o Patents
• and capital lease
Threshold
$0
$100,000
$100,000
$5,000
$100,000
$5,000
Qualified fixed asset equipment is to be reported and approved by COUNTY. If
it is approved and identified as an asset it will be tagged with a COUNTY program number. A Fixed
Asset Log will be maintained by COUNTY's Asset Management System and inventoried annually
until the asset is fully depreciated. During the terms of this Agreement, CONTRACTOR's fixed
assets may be inventoried in comparison to COUNTY's DBH Asset Inventory System.
B. Certain purchases under Five Thousand and No/1 00 Dollars ($5,000.00) but
28 more than One Thousand and No/100 Dollars ($1,000.00) with over one (1) year life span, and are
mobile and high risk of theft or loss are sensitive assets. Such sensitive items are not limited to
-29 -
COUN1Y OF FRESNO
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1 computers, copiers, televisions, cameras and other sensitive items as determined by COUNTY's DBH
2 Director or designee. CONTRACTOR maintains a tracking system on the items and are not required
3 to be capitalized or depreciated. The items are subject to annual inventory for compliance.
4 C. Assets shall be retained by COUNTY, as COUNTY property, in the event this
5 Agreement is terminated or upon expiration of this Agreement. CONTRACTOR agrees to participate
6 in an annual inventory of all COUNTY fixed and inventoried assets. Upon termination of this
7 Agreement, CONTRACTOR shall be physically present when fixed and inventoried assets are
8 returned to COUNTY possession. CONTRACTOR is responsible for returning to COUNTY all
9 COUNTY owned undepreciated fixed and inventoried assets, or the monetary value of said assets if
1 0 unable to produce the assets at the expiration or termination of this Agreement.
11 CONTRACTOR further agrees to the following:
12 1. To maintain all items of equipment in good working order and condition,
13 normal wear and tear excepted;
14 2. To label all items of equipment with COUNTY assigned program number,
15 to perform periodic inventories as required by COUNTY and to maintain an inventory list showing
16 where and how the equipment is being used in accordance with procedures developed by COUNTY.
17 All such lists shall be submitted to COUNTY within ten (1 0) days of any request therefore;
18 3. To report in writing to COUNTY immediately after discovery, the loss or
19 theft of any items of equipment. For stolen items, the local law enforcement agency must be contacted
2 0 and a copy of the police report submitted to COUNTY
21 D. The purchase of any equipment by CONTRACTOR with funds provided
22 hereunder shall require the prior written approval of COUNTY's DBH Director or designee, shall fulfill
23 the provisions ofthis Agreement as appropriate, and must be directly related to CONTRACTOR's
24 services or activity under the terms ofthis Agreement. COUNTY's DBH may refuse reimbursement for
2 5 any costs resulting from equipment purchased, which are incurred by CONTRACTOR, if prior written
2 6 approval has not been obtained from COUNTY's DBH Director or designee.
27 E. CONTRACTOR must obtain prior written approval form COUNTY's DBH
2 8 whenever there is any modification or change in the use of any property acquired or improved, in whole
-30 -
COUN1Y OF FRESNO
Fresno, CA
1 or in part, using funds under this Agreement. If any real or personal property acquired or improved with
2 said funds identified herein is sold and/or is utilized by CONTRACTOR for a use which does not
3 qualify under this program, CONTRACTOR shall reimburse COUNTY in an amount equal to the
4 current fair market value of the property, less any portion thereof attributable to expenditures of non-
S program funds. These requirements shall continue in effect for the life of the property. In the event the
6 program is closed out, the requirements for this Section shall remain in effect for activities or property
7 funded with said funds, unless action is taken by the State government to relieve COUNTY of these
8 obligations.
9
10
11
27. CULTURAL COMPETENCY
As related to Cultural and Linguistic Competence, CONTRACTOR shall comply with:
A. Title 6 ofthe Civil Rights Act of 1964 (42 U.S.C. section 2000d, and 45 C.F.R.
12 Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial assistance
13 from discriminating against persons based on race, color, national origin, sex, disability or religion.
14 This is interpreted to mean that a limited English proficient (LEP) individual is entitled to equal access
15 and participation in federally funded programs through the provision of comprehensive and quality
16 bilingual services.
17 B. Policies and procedures for ensuring access and appropriate use of trained
18 interpreters and material translation services for all LEP clients, including, but not limited to, assessing
19 the cultural and linguistic needs of its clients, training of staff on the policies and procedures, and
20 monitoring its language assistance program. The CONTRACTOR's procedures must include ensuring
21 compliance of any sub-contracted providers with these requirements.
CONTRACTOR shall not use minors as interpreters. 22
23
C.
D. CONTRACTOR shall provide and pay for interpreting and translation services to
2 4 persons participating in CONTRACTOR's services who have limited or no English language
2 5 proficiency, including services to persons who are deaf or blind. Interpreter and translation services
2 6 shall be provided as necessary to allow such participants meaningful access to the programs, services
2 7 and benefits provided by CONTRACTOR. Interpreter and translation services, including translation
28 of CONTRACTOR's "vital documents" (those documents that contain information that is critical for
-31 -
COUN1Y OF FRESNO
Fresno, CA
1 accessing CONTRACTOR's services or are required by law) shall be provided to participants at no
2 cost to the participant. CONTRACTOR shall ensure that any employees, agents, subcontractors, or
3 partners who interpret or translate for a program participant, or who directly communicate with a
4 program participant in a language other than English, demonstrate proficiency in the participant's
5 language and can effectively communicate any specialized terms and concepts peculiar to
6 CONTRACTOR's services.
7 E. In compliance with the State mandated Culturally and Linguistically Appropriate
8 Services standards as published by the Office of Minority Health, CONTRACTOR must submit to
9 COUNTY for approval, within sixty (60) days from date of contract execution, CONTRACTOR's
10 plan to address all fifteen national cultural competency standards as set forth in the "National
11 Standards on Culturally and Linguistically Appropriate Services (CLAS)"
12 http://minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdf. COUNTY's annual on-site review of
13 CONTRACTOR shall include collection of documentation to ensure all national standards are
14 implemented. As the national competency standards are updated, CONTRACTOR's plan must be
15 updated accordingly.
16 28. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST
17 INFORMATION
18 This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal agent,
19 or managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101
20 455.104, and 455.106(a)(1),(2).
21 In accordance with C.P.R., Title 42 §§ 455.101,455.104,455.105 and 455.106(a)(1),(2),
2 2 the following information must be disclosed by CONTRACTOR by completing Exhibit L
2 3 "Disclosure of Ownership and Control Interest Statement", attached hereto and by this reference
2 4 incorporated herein and made part of this Agreement. CONTRACTOR shall submit this form to
2 5 COUNTY's DBH within thirty (30) days of the effective date of this Agreement. Additionally,
2 6 CONTRACTOR shall report any changes to this information within thirty-five (35) days of
2 7 occurrence by completing Exhibit L, "Disclosure of Ownership and Control Interest Statement."
2 8 Submissions shall be scanned pdf copies and are to be sent via email to
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COUNTY OF FRESNO
Fresno, CA
1 DBHAdministration@co.fresno.ca.us attention: Contracts Administration.
2 29. DISCLOSURE OF CRIMINAL HISTORY & CIVIL ACTIONS
3 CONTRACTOR is required to disclose if any ofthe following conditions apply to them,
4 their owners, officers, corporate managers or partners (hereinafter collectively referred to as
5 "CONTRACTOR"):
6 A. Within the three-year period preceding the Agreement award, CONTRACTOR
7 has been convicted of, or had a civil judgment tendered against it for:
8 1. Fraud or criminal offense in connection with obtaining, attempting to
9 obtain, or performing a public (federal, state, or local) transaction or contract under a public
1 0 transaction;
11 Violation of a federal or state antitrust statute;
12
2.
3. Embezzlement, theft, forgery, bribery, falsification, or destruction of
13 records; or
14 4. False statements or receipt of stolen property.
15 B. Within a three-year period preceding their Agreement award, CONTRACTOR
16 has had a public transaction (federal, state, or local) terminated for cause or default.
17 Disclosure of the above information will not automatically eliminate CONTRACTOR
18 from further business consideration. The information will be considered as part of the determination
19 of whether to continue and/or renew the Contract and any additional information or explanation that a
2 0 CONTRACTOR elects to submit with the disclosed information will be considered. If it is later
21 determined that the CONTRACTOR failed to disclose required information, any contract awarded to
2 2 such CONTRACTOR may be immediately voided and terminated for material failure to comply with
2 3 the terms and conditions of the award.
2 4 CONTRACTOR must sign a "Certification Regarding Debarment, Suspension, and
2 5 Other Responsible Matters -Primary Covered Transactions" in the form set forth in Exhibit M
2 6 attached hereto and by this reference incorporated herein. Additionally CONTRACTOR must
27 immediately advise the COUNTY in writing if, during the term ofthe Agreement: (1)
2 8 CONTRACTOR becomes suspended, debarred, excluded or ineligible for participation in federal or
-33 -
COUNTY OF FRESNO
Fresno, CA
1 state funded programs or from receiving federal funds as listed in the excluded parties list system
2 (http://www.sam.gov); or (2) any of the above listed conditions become applicable to
3 CONTRACTOR. CONTRACTOR shall indemnify, defend and hold the COUNTY harmless for any
4 loss or damage resulting from a conviction, debarment, exclusion, ineligibility or other matter listed in
5 the signed "Certification Regarding Debarment, Suspension, and other Responsible Matters.
6 30. COMPLAINTS
7 CONTRACTOR shall log complaints and the disposition of all complaints from a client
8 or a client's family. CONTRACTOR shall provide a copy of the detailed complaint log entries
9 concerning COUNTY-sponsored clients to COUNTY at monthly intervals by the tenth (lOth) day of
1 0 the following month, in a format that is mutually agreed upon. Besides the detailed complaint log,
11 CONTRACTOR shall provide details and attach documentation of each complaint with the log.
12 CONTRACTOR shall post signs informing clients of their right to file a complaint or grievance.
13 CONTRACTOR shall notify COUNTY of all incidents reportable to state licensing bodies that affect
14 COUNTY clients within twenty-four (24) hours of receipt of a complaint.
15 Within ten (1 0) days after each incident or complaint affecting COUNTY -sponsored
16 clients, CONTRACTOR shall provide COUNTY with information relevant to the complaint,
17 investigative details of the complaint, the complaint and CONTRACTOR's disposition of, or
18 corrective action taken to resolve the complaint. In addition, CONTRACTOR shall inform every
19 client of their rights as set forth in Exhibit L. CONTRACTOR shall file an incident report for all
2 0 incidents involving clients, following the Protocol and using the Worksheet identified in Exhibit K.
21 31. DISCLOSURE OF SELF-DEALING TRANSACTIONS
22 This provision is only applicable if the CONTRACTOR is operating as a corporation (a
2 3 for-profit or non-profit corporation) or if during the term of this agreement, the CONTRACTOR
2 4 changes its status to operate as a corporation.
25 Members ofthe CONTRACTOR's Board ofDirectors shall disclose any self-dealing
2 6 transactions that they are a party to while CONTRACTOR is providing goods or performing services
2 7 under this agreement. A self-dealing transaction shall mean a transaction to which the
2 8 CONTRACTOR is a party and in which one or more of its directors has a material financial interest.
-34 -
COUN1Y OF FRESNO
Fresno, CA
1 Members ofthe Board of Directors shall disclose any self-dealing transactions that they are a party to
2 by completing and signing a "Self-Dealing Transaction Disclosure Form" (Exhibit N attached hereto
3 and by this reference incorporated herein and made part of this Agreement) and submitting it to the
4 COUNTY prior to commencing with the self-dealing transaction or immediately thereafter.
5 32. AUDITS AND INSPECTIONS
6 The CONTRACTOR shall at any time during business hours, and as often as the
7 COUNTY may deem necessary, make available to the COUNTY for examination all of its records and
8 data with respect to the matters covered by this Agreement. The CONTRACTOR shall, upon request
9 by the COUNTY, permit the COUNTY to audit and inspect all such records and data necessary to
10 ensure CONTRACTOR's compliance with the terms ofthis Agreement.
11 If this Agreement exceeds Ten Thousand and Noll 00 Dollars ($10,000.00),
12 CONTRACTOR shall be subject to the examination and audit of the State Auditor for a period of
13 three (3) years after final payment under contract (Government Code section 8546.7).
14 33. NOTICES
15 The persons having authority to give and receive notices under this Agreement and their
16 addresses include the following:
17
18
19
20
21
22
23
24
25
26
27
28
COUNTY
Director, Fresno County
Department of Behavioral Health
4441 E. Kings Canyon Rd
Fresno, CA 93 702
CONTRACTOR
Chief Executive Officer
Turning Point of Central California
P.O. Box 7447
Visalia, CA 93290-7447
Any and all notices between the COUNTY and the CONTRACTOR 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.
34. GOVERNING LAW
Venue for any action arising out of or related to this Agreement shall only be in Fresno
County, California.
The rights and obligations of the parties and all interpretation and performance of this
-35 -
COUNTY OF FRESNO
Fresno, CA
1 Agreement shall be governed in all respects by the laws of the State of California.
2 35. ENTIRE AGREEMENT
3 This Agreement, including all Exhibits between CONTRACTOR and COUNTY, RFP
4 No. 952-5329, and response to RFP No. 952-5329 with respect to the subject matter hereof and
5 supersedes all previous agreement negotiations, proposals, commitments, writings, advertisements,
6 publications, and understandings of any nature whatsoever unless expressly included in this
7 Agreement.
8 Ill
9 Ill
10 Ill
11 Ill
12 Ill
13 Ill
14 Ill
15 Ill
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19 Ill
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21 Ill
22 Ill
23 Ill
24 Ill
25 Ill
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27 Ill
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COUNTY OF FRESNO
Fresno,CA
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and
year first hereinabove written.
ATTEST:
CONTRACTOR:
TURNING POINT OF
CENTRAL CALIFORNIA
By F$!77
Print Name: 0.-JeJ/ Efo
Title: C£f)
ChiefExecutive Officer, or
President, or any Vice President
By~~~--.::...__ __ _
PrintName: foucc_ '"/Y/-r
Title: cP:::.o
Secretary (of Corporation), or
any Assistant Secretary, or
ChiefFinancial Officer, or
any Assistant Treasurer
Mailing Address:
P.O. Box 7447
Visalia, CA 93290-7447
Phone No.: (559) 732-8086 Ext. 140
Contact: Chief Executive Officer
COUNTY OF FRESNO
By~~~~UL~~~~~~v~
Chairman, Board of Supervisors
Date: ~ c1 f/J)}S 1
BERNICE E. SEIDEL, Clerk
Board of Supervisors
PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
-37 -
COUNTY OF FRESNO
Fresno, CA
1 APPROVED AS TO LEGAL FORM:
2 DANIEL C. CEDERBORG, COUNTY COUNSEL
: By ;j
--~~----~+-------------
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13
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15
APPROVED AS TO ACCOUNTING FORM:
VICKI CROW, C.P.A., AUDITOR-CONTROLLER/
TREASURER-TAX COLLECTOR
16 REVIEWED AND RECOMMENDED
FOR APPROVAL:
17
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By~~
Dawan Utecht, Director
Department of Behavioral Health
Fund/Subclass: 0001/10000
Account/Program: 7294/0
Organization: 56304531
Fiscal Year (FY)
FY 2015-16
FY 2016-17
FY 2017-18
FY 2018-19
FY 2019-20
[em]
Program Cost
$4,113,122
$4,094,147
$4,094,147
$4,215,259
$4,336,371
-38 -
COUN1Y OF FRESNO
Fresno,CA
ORGANIZATION:
ADDRESS:
SITE ADDRESS:
SERVICES:
PROJECT DIRECTOR:
Phone Number:
CONTRACT PERIOD:
CONTRACT AMOUNT:
Fiscal Year
2015-16
2016-17
2017-18
2018-19
2019-20
SCHEDULE OF SERVICES:
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Turning Point of Central California
P.O. Box 7447, Visalia CA 93290-7447
258 N. Blackstone Avenue, Fresno, CA 93701
Exhibit A
Page 1 of25
Comprehensive Mental Health, Housing, and Community Supports for
Seriously Mentally Ill (SMI) Adults
Sharon Ross
(559) 221-5191
July 1, 2015-June 30, 2018, with two (2) twelve (12) month renewal options
Total Contract
4, 113,122
4,094,147
4,094,147
4,215,259
4,336,371
MHSA CSS Funds
2,075,512
2,079,298
2,106,611
2,236,828
2,376,148
Medi-Cal FFP
1,972,610
1,949,849
1,922,536
1,913,431
1,895,223
Client Rents
65,000
65,000
65,000
65,000
65,000
CONTRACTOR staff shall be available to provide services to clients twenty-four (24) hours per day, seven (7)
days per week.
TARGET POPULATION:
Participation for CONTRACTOR's Full Service Partnership (FSP) program is on a client voluntary basis. The
target population to be served under this Agreement includes clients 18 years of age and older from Fresno
County who meet the requirements for Serious Mental Illness (SMI), are not currently serviced, and meet one
or more of the following criteria:
• Homelessness;
• At risk of homelessness -such as youth aging out of foster care or persons coming out of jail;
• Involved in the criminal justice system (including adults with child protection issues); and/or
• Frequent users of hospital and/or emergency room services as the primary resource for mental health
treatment
2! are underserved and at risk of:
• Homelessness -such as persons living in institutions or nursing homes;
• Criminal justice involvement; and/or
• Institutionalization.
While referrals can be made from various sources, approval of client entry into the FSP program will be made
by the County.
PROJECT DESCRIPTION:
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Exhibit A
Page2 of25
The <?o~n~'s FSP Prog~am is a '\~hatever-it-takes_" prowam working toward ending homelessness, frequent
hosprtahzatJons, and/or rncarceratrons for adults wrth Serrous Mental Illness (SMI). This program will provide
comprehensive mental health, housing, and community supports to 300 adults and older adults with an SMI
with the goal of supporting the client in recovery and self-sufficiency. Services shall be provided utilizing the
Assertive Community Treatment (ACT) model and be strength-based, client-directed, co-occurring capable,
and employ psychosocial rehabilitation and recovery model principles.
The FSP program shall be a partnership between the CONTRACTOR and the Department of Behavioral
Health (DBH), with the CONTRACTOR providing multi-level services directed toward the individual needs of
the enrollees. Services and supports provided by the CONTRACTOR shall include, but shall not be limited
to: assessments, therapy, medication support, personal service coordination, crisis management,
rehabilitation services, employment and education, advocacy and linkage to community resources.
Additional support includes any direct assistance necessary to ensure that clients obtain the basic
necessities of daily life, such as food, clothing, transportation, housing, personal hygiene, medical services,
and other financial support. It is expected that each client approved to enter the program wi II be offered the
full array of services and supports, including three (3) face-to-face contacts per week, or as clinically
appropriate. County staff shall oversee program outcomes, reporting, client referrals and contract
monitoring. All client referrals will be approved by the Fresno County Mental Health Director or designee.
Staff to client ratio shall not fall below 1:10 or exceed 1:15. CONTRACTOR shall provide 35.00 Full Time
Equivalent (FTE) staff, further described in Exhibit C, "Budget Summary", dedicated to the FSP program.
CONTRACTOR staffing shall include a contract with the equivalent of 1.00 FTE Psychiatrist to meet with
clients on a monthly basis (at minimum) or as needed.
PROGRAM OBJECTIVES AND DELIVERABLES -FSP:
The following items listed below represent FSP program goals to be achieved by CONTRACTOR. The
programs success will be based on the number of goals it can achieve, resulting from performance outcomes.
The CONTRACTOR will utilize a computerized tracking system with which outcome measures and other
relevant client data, such as demographics, will be maintained.
1. Reduce frequency of hospitalizations for each client. CONTRACTOR will provide, through client self-
reporting, most recent 12 month history for each client which will be used as baseline data. Each client
will show a 70% reduction in hospitalization after one year of receiving services or upon discharge.
Reports and data will be submitted on a monthly basis.
2. Reduce frequency of homelessness for each client. CONTRACTOR will provide most recent 12 month
history for each client which will be used as baseline data. Each client will show an 80% reduction in
days spent homeless after one year of receiving services or upon discharge. Each client will obtain and
maintain stable housing after one year of receiving services or upon discharge. Reports and data will be
submitted on a monthly basis.
3. Reduce frequency of incarceration for each client. CONTRACTOR will provide, through client self-
reporting, most recent 12 month history for each client which will be used as baseline data. Each client
will show an 80% reduction in days spent incarcerated after one year of receiving services. Each
additional year will show an additional 5% reduction. Reports and data will be submitted on a monthly
basis.
4. CONTRACTOR will provide each client with the appropriate level of housing support, reflective of client's
needs. Each client in need of housing will receive assistance in housing placement and support -
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Exhibit A
Page3 of25
including emergency housing -contingent upon level of need and independent functioning. Each client
will have stable housing upon discharge. Reports and data will be submitted on a monthly basis.
5. CONTRACTOR will provide services to the satisfaction of clients and will address any reported
complaints. Satisfaction surveys will be made available and reviewed regularly; a bi-annual
Performance Outcome Improvement survey will be provided to clients; and complaint forms and
grievance forms will be made easily available to clients. Reports and data will be submitted on a monthly
or annual basis, respectively.
6. CONTRACTOR will provide a level of service and support that reflect each client's needs. Each client
will increase their level of functioning and, within one year of treatment (or as clinically appropriate), will
transition to a lower level of service within the program. Reports and data will be submitted on a monthly
basis.
7. CONTRACTOR will provide services helping each client to achieve a level of recovery, stability, and
independence that will allow transition to the least restrictive level of care possible. Written reports will
be submitted on a quarterly basis.
8. CONTRACTOR shall work with clients to assist them in setting their goals and generating a Plan of Care
which includes personalized wellness goals for each client. These goals will be evaluated, monitored,
and adjusted regularly. Written reports will be submitted on a quarterly basis.
9. CONTRACTOR shall establish and maintain collaborative relationships with agencies and individuals
who have frequent contact with hospitalized, homeless, or incarcerated adults. Examples of
collaborative relationships include local law enforcement agencies, Veterans Administration, Marjorie
Mason Center, Fresno County Human Services Departments, churches, acute psychiatric facilities,
schools, community centers, etc. Letters of introduction, including description of services and how to
contact the FSP program shall be distributed to potential partners.
10. CONTRACTOR will complete quarterly reports, as mandated by the State for FSPs. Reports shall be
made directly into the FSP Data Collection and Reporting (OCR) system.
11. Direct Services productivity rate is expected to be at a minimum of seventy-five percent (75%) and
reported in writing at regularly scheduled meetings with the Department.
12. CONTRACTOR will identify services provided to each client on a monthly basis, as needed by the
Department, including recreational and social activities and linkages provided to clients such as the
County's Job Option Program. This information will be provided to the designated Division Manager in a
monthly report.
CONTRACTOR'S RESPONSIBILITIES:
CONTRACTOR shall operate the FSP program by utilizing the Assertive Community Treatment (ACT) model
of care to provide services to adult clients with SMI who are frequent users of hospital/crisis services and
therefore, are at risk of hospitalization, incarceration, and homelessness. CONTRACTOR shall:
A. Coordinate with law enforcement and courts services, as needed.
B. Be available to provide the following services, including but not limited to:
• Personal service coordination and supportive counseling;
•
•
•
•
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Exhibit A
Page 4 of25
Ongoing assessment of the client's mental illness symptoms and response to treatment;
Education of the client regarding his/her mental illness and the effects (including side effects) of
prescribed medications;
Symptom management efforts directed to helping the client identify the symptoms and their
occurrence patterns, and development of methods (internal, behavioral, adaptive) to lessen their
effects;
Provision, both on planned and on an "as needed" basis, of such psychological support as is
necessary to help clients accomplish their personal goals and cope with the stresses of day-to-
day living.
C. Be available to provide crisis assessment and intervention twenty-four (24) hours per day, seven (7)
days per week throughout the year, including telephone and face-to-face contact as needed. The
following crisis response measures shall also be followed:
• Response to crisis shall be rapid and flexible;
• When crisis housing is necessary for short-term care and inpatient treatment (either voluntary or
involuntary), the staff shall collaborate with the treatment staff in such facilities. Support shall be
provided to the maximum extent possible, including accompanying the client to the facility,
remaining with the client during assessment, and beginning the process of planning with the client
for discharge to the community as soon as possible;
D. Provide services in the areas of medication prescription, administration, monitoring, and
documentation.
• The Psychiatrist shall assess each client's mental illness symptoms and behavior and prescribe
appropriate medication, regularly review and document symptoms as well as the client's response
to the prescribed medications, educate the client and family members, and monitor, treat and
document any medication side effects.
• The nurse shall establish medication policies and procedures which identify processes to
administer medications, train other team members, and assess regularly other team members'
competency in this area.
• All FSP team staff shall assess and document client's mental illness symptoms and behavior in
response to medication and shall monitor for medication side-effects during the provision of
observed self-administration and during ongoing face-to-face contacts.
• Regarding residents of Residential Care Facilities, the team shall collaborate with staff at these
facilities to ensure clients at these locations are taking prescribed medications and the staff is
monitoring their response to the medication(s). Furthermore the staff shall review the facility
records (after receiving written consent from the client) and shall regularly collaborate with facility
staff about treatment plans, goals, objectives and interventions.
E. Provide whatever direct assistance is necessary and reasonable to ensure that the client obtains the
basic necessities of daily life, such as food, housing, clothing, medical services, and other financial
support.
F. Ensure that each FSP Team member shall have, in their possession, during regular working hours
(and appropriate on-call hours) an adequate amount of financial resources to make emergency
purchases of food, shelter, clothing, prescriptions, transportation, or other items for consumers, as
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Exhibit A
Page 5 of25
needed. The team shall have access to larger flexible funding accounts for assistance with housing
deposits, furniture purchases, and other items, with sound accounting practices for recording and
monitoring the use of these funds.
G. Assist the client with establishing a payee or payee service. The FSP team may utilize client
assistance funds to assist clients with short-term loans or grants, as necessary. The team shall link
clients to appropriate social services, provide transportation as necessary, and link the client to
appropriate legal advocacy representation.
H. Provide training, instruction, support and assistance to the client in developing personal skills,
including but not limited to, the ability to:
• Carry out personal hygiene tasks;
• Perform household chores, including housekeeping, cooking, laundry and shopping;
• Develop or improve money management skills;
• Use community transportation; and
• Locate, finance and maintain safe, clean and affordable housing.
I. Develop and support the client's participation in recreation, social activities, and relationships.
Priority shall be given to supporting clients in establishing positive social relationships in normative
community settings. Staff shall assist clients in establishing positive social relationships and
participating in social/recreational activities in the community. Such services shall include, but not be
limited to, assisting clients in:
• Developing social skills and the skills and other skills needed to develop meaningful personal
relationships;
• Planning appropriate and productive use of leisure time including familiarizing clients with
available social and recreational opportunities;
• Interacting with landlords, neighbors and others effectively and appropriately;
• Developing assertiveness and self-esteem; and
• Using existing self-help centers, groups, spiritual, and recreational groups to combat isolation and
withdrawal experienced by many persons coping with severe mental illness.
J. Provide alcohol, tobacco and drug abuse services for co-occurring clients, as clinically appropriate
and in accordance with harm reduction principles. This will include, but is not limited to individual and
group interventions to assist clients in:
• Identifying alcohol, tobacco, and drug abuse effects and patterns;
• Recognizing interactive effects of alcohol, tobacco, and drug use, psychiatric symptoms and
psychotropic medications;
• Developing coping skills and alternatives to minimize alcohol, tobacco and drug use;
• Achieving periods of abstinence and/or decreased risk behaviors and increased stability;
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
• Attending appropriate recovery or self-help meetings: and
• Achieving an alcohol and drug free lifestyle, as desired.
Exhibit A
Page 6 of25
K. Act to minimize the client's involvement in the criminal justice system, with services to include, but not
be limited to;
• Helping the client identify precipitants to client's criminal involvement;
• Providing necessary treatment, support and education to help eliminate unlawful activities or
criminal involvement that may be a consequence of the client's mental illness; and
• Collaborating with police, court personnel, and jail/prison officials to ensure appropriate
collaboration and clinical support through the legal processes.
L. Assist the client, family and other members of the client's social network to relate in a positive and
supportive manner through such means as:
• Education about the client's severe mental illness and their role in the therapeutic process and
treatment services and supports;
• Supportive counseling;
• Intervention to resolve conflict;
• Referral, as appropriate, of the family to therapy, self-help and other family support services; and
M. Coordinate with other community mental health and non-mental health providers, as well as other
medical professionals. Staff shall provide the following functions for all clients served:
• Development of formal and informal affiliations with other human service providers including,
mental health, physical health care, addiction treatment providers, and inpatient units;
• Involvement of other pertinent agencies, the client's family, and members of the client's social
network in the coordination of the assessment, and in the development, implementation and
revision of service plans;
• Advocacy and assistance to clients to obtain needed benefits and services, such as supplemental
security income, general relief, housing subsidies, food stamps, medical assistance, and legal
services;
• Coordination of meetings of the client's service providers in the community;
• Maintenance of ongoing communication with all other agencies serving the client, including
hospitals, primary care physicians, rehabilitation services and housing providers as required;
• Maintenance of working relationships with other community services, such as education, law
enforcement and social services;
• Maintenance of the clinical treatment relationship with the client on a continuing basis whether the
client is in the hospital, in the community, involved with other agencies or the criminal justice
system; and
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Exhibit A
Page 7 of25
• Methods for service coordination and communication between the team and other service
providers serving the same clients shall be developed and implemented consistent with Fresno
County confidentiality rules.
N. Monitor service outcomes to determine if the client has meaningful use of their time, stays in school
or maintains employment, has reduced numbers of hospitalizations, incarcerations, and periods of
homelessness. The DBH will use State identified criteria for measuring these outcomes. The
treatment team will be monitored to ensure appropriate service delivery and adherence to MHSA
philosophies.
0. Provide comprehensive services, including intensive mental health treatment, rehabilitation, and case
management with the goal of increasing adaptive functioning in the community and preventing
unnecessary re-admissions to Institutes of Mental Disease (I MD), acute inpatient facilities, or other
higher levels of care.
P. Meet with DBH on a monthly basis, or more often as agreed upon, for contract and performance
monitoring.
Employment and Education
FSP program will assist the client in accessing and participating in the employment and education programs
offered in the community, as appropriate.
In order to facilitate client participation in community education and employment programs FSP shall include,
but is not limited to:
• Collaboration with and education of community providers as it relates to client's mental illness,
abilities, levels of functioning, educational and employment interest, and potential effects of the
client's mental health symptoms on participation, in education and work;
• Encouragement and individual rehabilitation related to the integration, practicing, follow through
and problem solving as it relates to continued education and employment
• Individual supportive counseling and education to assist the client, his/her family, and support
system in identifying, managing, and coping with the symptoms of mental illness that may
interfere with his/her work or education experience;
• On-the-job or work-related crisis intervention;
• Crisis intervention in the educational setting;
• Work/education-related supportive services, such as assistance with grooming and personal
hygiene, securing appropriate clothing, wake-up calls, and transportation; and
• The team staff shall also link with the supportive services offered through "The Center" for
additional and ongoing support related to education and employment.
Housing
The FSP team will empower clients to take an active role in the recovery process. The FSP team will
provide housing options and maintain clients in maintaining a stable residence by providing needed services,
accessing resources, and encouraging clients to be independent, productive and responsible.
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Exhibit A
Page 8 of25
1. The team shall provide whatever direct assistance is necessary to ensure that the client obtains the
basic necessities of daily life, including but not limited to:
• Safe, clean, affordable housing;
• Food and clothing;
• Medical and dental services; and
• Securing appropriate financial support, which may include Supplemental Security Income (SSI),
Social Security Disability Insurance (SSDI), General Relief (GR), and money management or
payee services.
2. The CONTRACTOR shall ensure that team members have rapid access to flexible spending funds
for items such as security deposits, furniture, and/or other items required for independent living.
3. The CONTRACTOR will provide housing services, as needed, to ensure that clients maintain their
housing. The vendor shall provide:
• Training and assistance to client in locating, securing and inhabiting housing which is appropriate to
their level of functioning;
• Training and instruction, including individual support, problem solving, skill development, modeling
and supervision, in the home and in community settings, to teach the client to manage finances and
maintain safe, clean, affordable housing;
• Supportive and independent housing for the client with the goal to have every client in secure
housing that is appropriate for his/her level of ability and need that is sustainable, as soon as
reasonable possible;
4. The CONTRACTOR will establish a program to provide rent subsidies for independent housing
needed while developing a plan for sustainable housing based on client need and ability.
Levels of Care
Services are designed in a framework which allows the client to move fluidly through four different levels of
care as the client's individual recovery and wellness dictates. The four levels of care, from the highest level
of intensity to the lowest are: Engagement and Stabilization, Recovery and Discovery, Empowerment and
Strength, and Forward Bound. The client's level of care will be reviewed at a minimum of every six (6)
months from the last level review and may be reviewed at any time treatment dictates.
A. Level1-Engagement and Stabilization: includes outreach to the referred client in hospital, jails, and
community, intake, and beginning support and service.
• Engagement Services-Engagement will be attempted as often as needed, meeting the client
where they are at and will be provided by different members of the treatment team, including the
Peer Support Specialist and Personal Services Coordinator/Case Managers through direct client
contact. Services will be delivered in a culturally and linguistically appropriate manner through direct
face-to-face contact with the client and with client's family/support person, when appropriate.
• Intake Services -A one-time service when the client first enters the program. The intake process
includes client education regarding their behavioral health rights, and the distribution and reception
of all necessary County and MHSA information and documents and will meet all Federal, State, and
County requirements. Services will be presented to the client in such a way as to not overwhelm the
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Exhibit A
Page 9 of25
client. Depending upon the client's current level of functioning, the intake process can be broken
into several appointments. Once a client has given consent to treatment, treatment services can
then begin to be delivered and will not be dependent upon completion of the remaining intake
paperwork. If it is determined that the client is in need of housing, placement will take place
immediately.
• Mental Health Assessment -This service will be provided by the Mental Health Professional. The
mental health assessment gathers information to diagnose any mental disorder that the client may
have, as well as helping client to determine goals and identify strengths the client has to help reach
their desired goals. A reassessment is conducted on an annual basis or as needed.
• Plan of Care -A treatment plan will be developed by the Mental Health Professional based on the
assessment and in collaboration with the client and/or family (based on client preference for family
involvement). The treatment plan is completed once a year at a minimum; however it can be
reformulated in collaboration with the client whenever a client's treatment goals change.
• Individual Service and Support Plan (I SSP) -After the assessment is completed, the clinician will
meet with the client's assigned program team members to discuss the treatment needs and desires
of the client. Over the course of several weeks, an Individual Service and Support Plan (I SSP) will
be created by the Personal Service Coordinator/Case Manager in collaboration with the client,
client's family (based on client preference for family involvement), and other agencies that have
shared responsibility for services and/or support of the client. The I SSP is a fluid tool which will be
visited a minimum of once every six (6) months through client's enrollment in the program.
• Individual Therapy-This service will be provided by the Mental Health Professional. The client and
therapist work together using multiple evidenced based therapy practices to support the client in
working towards a reduction in problematic behavioral health symptoms and an increase in positive
life changes. The client will be offered individual therapy once a week or as individual needs dictate.
If client chooses not to receive individual therapy during this level, it will continue to be offered
throughout the client's enrollment in the program.
• Family/Partner Therapy-The provision of family/partner therapy to assist the entire family system in
identifying strengths and goals, improving understanding of mental health symptoms and resulting
behaviors, and finding ways for the entire family system to collaboratively support each other. The
client will be offered family/partner therapy once a week or as individual needs dictate. If client
chooses not to receive family/partner therapy during this level, it will continue to be offered
throughout the client's enrollment in the program.
• Medication and Support
o Psychiatric Assessment/Evaluation -Provided by the Licensed Psychiatrist, upon enrollment, to
determine need for medication services to assist in the reduction of symptoms of mental illness.
Major activities include: medication evaluation, medication prescription, medication monitoring,
individual client education, identification of side effects, side effect management, and ongoing
collaboration with the treatment team. Client will be scheduled with the Psychiatrist once a
month or as needed.
o Medication Management -Conducted monthly during appointment with Licensed Psychiatrist
and assisted by nursing staff.
o Psychiatric Consultations -This is ongoing with client's treatment team and in close
collaboration with the RN and other nursing staff. There will be regularly scheduled weekly
appointments and emergency consultation on an as needed basis.
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Exhibit A
Page 10 of25
o Injectable Medication Services -Dispensed by the program nursing staff, as ordered by the
Psychiatrist for the client. Nursing staff will monitor the ongoing use, effectiveness, and side-
effects of the medication. These medications are prescribed in accordance with the client's
acceptance of this medication regime. Injectable medication education and monitoring will be
provided at least one to two times per month and additionally as needed depending upon the
medication requirements.
o Medication Education -Provided by both the Psychiatrist and nursing staff throughout client's
enrollment in the program. Information will be formatted and presented in an understandable
manner that allows for well-informed choices. Information will include but not be limited to side
effects of the prescribed medications, information regarding interactions with co-occurring
disorders, alternatives to medication, and symptom management. Staff will respect client's
cultural and personal preferences in this area.
o Monitoring Medication Delivery and Labs -Ordered by Psychiatrist and monitored by nursing
staff. The program will provide a secluded, sterile environment that is designated to perform
clients' lab draws in order to reduce mental health symptoms that can be aggravated when
clients are required to submit to necessary medical procedures in an unfamiliar setting.
o Integration with Primary Care-As part of integrated care, the nurse will offer and assist the
clients in scheduled a Primary Care Physician (PCP) appointment within 30 days of program
enrollment. All clients, regardless of insurance benefits or ability to pay, will be linked to PCP for
physical health evaluation within 30 days of enrollment in the program. If client does not wish to
engage in this linkage, staff will continue to educate client on the importance of primary care and
continue to offer linkage to PCP. Program staff will accompany client to PCP appointments, as
needed.
o Nursing Support-Nursing staff will meet with client whenever the client is scheduled to meet
with the Psychiatrist and will provide support and education, assistance in obtaining medication,
and education on how the client may obtain medication on his/her own. The client will have
regularly scheduled appointments twice a month (one of which will be delivered in the
community, when possible).
• Rehabilitation Services
o Case Management -Provided by the Personal Service Coordinator/Case Manager. Case
management services will be delivered in the community and at the program office. The client
will receive services which will assist them in gaining access to needed Medi-Cal eligibility,
medical, social, housing, educational, and other services driven by the collaborative treatment
plan and ISSP. Case Manager shall assist clients to accomplish and gain increasing
independence in performing daily living tasks to enable them to continue to live in the
community. Transportation and assistance in accessing other resources will be ensured by the
Personal Services Coordinator/Case Manager. These services will be delivered face-to-face
with the client individually three (3) to five (5) times a week or as needed.
o Wellness and Recovery Services -Training and support across multiple domains, with the goal
of allowing the client to improve and practice well ness tools. Program staff will provide
instruction, modeling, and support one-on-one in the course of daily events in the natural setting
to manage day-to-day life and promote increased efficacy and self-sufficiency. These services
will be delivered face-to-face with the client three (3) times a week (at minimum) or as needed.
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Exhibit A
Page 11 of25
o Advocacy Services -Assisting the client in receiving appropriate financial assistance based
upon their mental illness disabilities, securing an apartment or other proper living
accommodation, and assisting the client in reconnecting with social goals and functions. These
services will be provided, as needed, throughout the client's enrollment in the program.
o Transportation Services -Assisting the client with developing a means for stable transportation
and transporting clients as needed. This service will be provided as needed throughout the
client's enrollment in the program.
o Securing Legal Documents -Assisting the client in acquiring basic legal documents such as a
California identification card, birth certificate, and SSA cards. This service will be provided, as
needed, throughout the client's enrollment in the program.
o Entitlements/Benefits -Clients will be supported by a Case Manager in applying for all
appropriate entitlements, within 30 days of entry into the program. This service will also be
provided, as needed, throughout the client's enrollment in the program.
o Criminal Justice Services-Provided by the Criminal Justice Mental Health Specialist who will
assist the client in resolving all criminal justice involvement, work cooperatively with law
enforcement, the Courts, and Probation departments, and act as an advocate and liaison for the
client. These services will be provided, as needed, throughout the client's enrollment in the
program.
o Fresno County Behavioral Health Court <BHC) Support -The Criminal Justice Mental Health
Specialist will attend Fresno County Behavioral Health Court with the clients. This service will be
provided, as needed, throughout the client's enrollment in the program.
o Housing -Clients who enroll in the program in need of emergency housing will be placed
immediately and will continue to be linked to safe, comfortable, and affordable housing
throughout enrollment in the program. Program staff will provide ongoing monitoring of client's
housing needs and independent living abilities.
o Dual Diagnosis Services -Delivery of services and approaches for clients with coexisting
substance use disorders. These services can also be provided with family, a support person,
and in a group environment per client preference. These services can be provided throughout
client's enrollment in program.
o Peer/Social Activities -Activities focusing on socialization which will assist the client in social
development and help prepare the client for Well ness and Recovery groups. Clients will be
encouraged to participate in existing peer support activities at the program site and in the
community. Peer support services will be promoted in a manner that encourages client
responsibility and participation in their own recovery and in a manner that helps new clients
understand and combat stigmatization against mental illness and to reduce their own self-
imposed stigma. Staff will assist program clients to develop their own formal and informal
support groups as well as access existing community groups. Peer activities will be offered at all
levels of care.
o Linkage to Community Resources -Clients will be assisted with referral and linkages to
community supports throughout enrollment, as needed.
o Crisis Intervention Services-The treatment team will be available to respond 24/7, including the
ability to respond in the community and in person when appropriate. Both nursing staff and
psychiatric staff will be available for crisis consultation, as needed. There will be a 24/7 on-call
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Exhibit A
Page 12 of25
crisis line answered by the Program Director, Program Supervisor, Personal Service Coordinator
Supervisor, or Clinicians. If it is determined that a crisis will not pass, the client will be supported
through hospitalization. If client is incarcerated, the Jail Psychiatric Unit will be contacted and all
medication regiment information will be provided.
o Other Crisis Services-The treatment team will be available to respond 24/7, to other crisis
faced by the client. These crises include but are not limited to: being stranded without
transportation, experiencing a physical health emergency, experiencing exacerbated behavioral
health symptoms, running out of needed medications, unexpected immediate/urgent housing
need, roommate/family conflicts requiring support, experiencing heightened anxiety or fears
surrounding safety, experiencing physical threats to safety.
• Level Transition Criteria-a client will be objectively stable in the following domains for at least six
(6) months before transition to Level 2 (Recovery and Discovery)
o Client has begun to show engagement in the program. (For at least three (3) months, the client
will have successfully attended all scheduled psychiatric, nursing and therapy appointments (or
cancelled appropriately); will have participated in case management contact in the community at
an appropriate level; and will have several instances of initiating contact with the treatment
team.)
o Client crisis or crisis visits will have decreased during the last six (6) months.
o Client has been hospitalized less than once in the last six (6) months.
o Client has not been incarcerated in the last six (6) months.
o Housing in the community has remained stable for a minimum of three (3) months.
o Client has been able to consistently access food and clothing resources with or without the
assistance of the case manager.
o Medication concerns have been addressed and client adheres to medication regime in
accordance with individual level of functioning. (Some clients will choose not to take medication
and not taking medication, alone, will not prevent transition.)
o Client has applied to all appropriate entitlements and finances have begun to stabilize.
o Client will have been referred to Primary Care Physician and any medical concerns will be
addressed.
o LOCUS indicates a lower level of care.
B. Level 2 -Recovery and Discovery: focus on recovery and wellness goals and begins to focus on
stabilization across multiple domains. Some of the areas of focus are: self-discovery/increased
awareness and insight into mental health, sustained management of mental health symptoms, exploring
education and employment goals, increased socialization skills, permanent housing, and increased
engagement in individual recovery. This is the level where the majority of the stabilization work will be
addressed and there are many tasks to be completed. This is expected to be the longest level of care
due to the nature of the tasks to be completed. A client's participation in this level will be reviewed, at
minimum, every six (6) months. Services at this level remain frequent and the expectation is that there
will be increased client engagement and participation in a variety of services.
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Exhibit A
Page 13 of25
• Mental Health Reassessment -A reassessment is conducted on an annual basis or as needed.
• Plan of Care -The treatment plan is completed once a year at a minimum; however it can be
reformulated in collaboration with the client whenever a client's treatment goals change.
• Individual Service and Support Plan (I SSP)-The I SSP is a fluid tool which will be visited a minimum
of once every six (6) months through client's enrollment in the program.
• Individual Therapy-At this level, the client will be offered individual therapy, bi-weekly. Crisis
therapy is always available.
• Family/Partner Therapy-At this level, the client will be offered family/partner therapy, bi-weekly.
• Group Therapy-At this level, clients will be offered group therapy in accordance to the client's
preference and level of functioning.
• Medication and Support
o Psychiatric Assessment/Evaluation -At this level, client will be scheduled with the Psychiatrist
twice monthly or as needed.
o Medication Management -Conducted twice monthly during appointment with licensed
Psychiatrist and assisted by nursing staff.
o Psychiatric Consultations -This is ongoing with client's treatment team and in close
collaboration with the RN and other nursing staff. There will be regularly scheduled weekly
appointments and emergency consultation on an as needed basis.
o Injectable Medication Services -Medication and monitoring will be provided at least one to two
times monthly and additionally as needed depending on medication requirements.
o Medication Education -Education will be offered throughout the client's enrollment in the
program.
o Monitoring Medication Delivery and Labs -These services will be offered throughout the client's
enrollment in the program.
o Integration with Primary Care-If a client has been successfully linked to a Primary Care
Physician (PCP), follow-up and collaboration will be ongoing. If a client has not yet accepted
linkage, ongoing effort will be continued. Program staff will accompany client to PCP
appointments, as needed.
o Nursing Support-Nursing staff will meet with client whenever the client is scheduled to meet
with the Psychiatrist. At this level of care, nursing staff will have a regularly scheduled
appointment with the client a minimum of once per month or as needed.
• Rehabilitation Services
o Case Management-Services will be delivered face-to-face with the client a minimum of three
(3) times a week or as often as needed.
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Exhibit A
Page 14 of25
o Well ness and Recovery Services -These services will be delivered face-to-face with the client a
minimum of three (3) times a week or as needed.
o Advocacy Services-These services will be provided, as needed, throughout the client's
enrollment in the program.
o Transportation Services-This service will be provided as needed throughout the client's
enrollment in the program.
o Securing Legal Documents-At this level, staff will assist clients in following up on tasks not yet
completed.
o Entitlements/Benefits-This service will also be provided, as needed, throughout the client's
enrollment in the program.
o Criminal Justice Services -These services will be provided, as needed, throughout the client's
enrollment in the program.
o Fresno County Behavioral Health Court (BHC) Support-This service will be provided, as
needed, throughout the client's enrollment in the program.
o Housing -Housing services will be provided throughout all levels of care.
o Dual Diagnosis Services -These services can be provided throughout client's enrollment in
program.
o Peer/Social Activities -At this level, clients will be invited to participate in the leadership of these
activities, dependent upon individualized level of functioning. Peer activities will be offered at all
levels of care.
o Wellness and Recovery Groups -At this level, it is anticipated that the client's level of
functioning will tolerate attendance at wellness and recovery groups. These groups will remain
voluntary throughout all the levels of care and client can attend as often as they desire.
o Education and Employment Services -At this level, the client will be assessed for their ability to
seek and maintain employment or pursue formal or vocational education. Client will be
encouraged to participate at an appropriate level based upon assessment and client
individualized needs.
o Linkage to Community Resources -Clients will be assisted with referral and linkages to
community supports throughout enrollment, as needed.
o Crisis Intervention Services -The treatment team will be available to respond 24/7 to crisis a
client may face.
o Other Crisis Services -The treatment team will be available to respond 24/7 to personal and
emergency crisis a client may face.
• Level Transition Criteria -a client will be objectively stable in the following domains for at least six
(6) months before transition to Level3 (Empowerment and Strength)
o Client has shown engagement and progress in the program and community.
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
o No Client crisis or crisis visits in the last three (3) months.
o Client has not been hospitalized in the last six (6) months.
o Client has not been incarcerated in the last six (6) months.
Exhibit A
Page 15 of25
o Housing in the community remained stable for a minimum of six (6) months and is self-
sustaining.
o Client has been able to consistently access food and clothing resources and is self-sustaining.
o Medications are stable and self-administered/monitored and the client adheres to an appropriate
medication regimen. (Some clients will choose not to take medication and not taking
medication, alone, will not prevent transition.)
o Monthly income is stable and self-sustaining (Medi-Cai/SSI) or stable financial arrangement is in
place.
o Client has been successfully linked to community resources and/or has an understanding of how
to access these resources.
o Client has been given the opportunity to become involved in education or employment and works
towards those goals and is accessing these services.
o Client is able to attend pertinent appointments without assistance.
o Client has begun to learn to advocate for themselves in the community.
o LOCUS indicates a lower level of care
C. Level3-Empowerment and Strength: maximizes focus on recovery and wellness goals. In this level, a
client will have experienced sustained stability and will be well on the way to independent living. This
level will provide less intensive services as it allows a client to practice independence and experience
life with their own strengths. An additional focus in this level will be educating the client on how to have
their needs met through community resources and to be aware of where to find help when needed.
This level works to assure that the stabilization gained in the previous level is maintained. There is now
a decrease in the number of case management, physician, therapist, and nursing contacts based upon
the individualized functioning of the client. It is anticipated that housing is stable, and the client has
made progress in the management of mental health symptoms (with or without medication support).
The client is now encouraged to move closer to independence utilizing the client's own strengths.
• Mental Health Reassessment -A reassessment is conducted on an annual basis or as needed.
• Plan of Care -The treatment plan is completed once a year at a minimum; however it can be
reformulated in collaboration with the client whenever a client's treatment goals change.
• Individual Service and Support Plan (I SSP} -The I SSP is a fluid tool which will be visited a minimum
of once every six (6) months through client's enrollment in the program.
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Exhibit A
Page 16 of25
• Individual Therapy-At this level, the client will offered individual therapy, bi-monthly and can be
reduced to once a month, at client's preference.
• Family/Partner Therapy-At this level, the client will be offered family/partner therapy once a month,
at client's preference.
• Group Therapy-At this level, clients will be offered group therapy in accordance to the client's
preference and level of functioning.
• Medication and Support
o Psychiatric Assessment/Evaluation -At this level, client will be scheduled with the Psychiatrist
once every three months, or as needed.
o Medication Management-Conducted once every three months during appointment with
Licensed Psychiatrist and assisted by nursing staff.
o Psychiatric Consultations -This is ongoing with client's treatment team and in close
collaboration with the RN and other nursing staff. There will be regularly scheduled weekly
appointments and emergency consultation on an as needed basis.
o Injectable Medication Services-Medication and monitoring will be provided at least one to two
times monthly and additionally as needed depending on medication requirements.
o Medication Education -Education will be offered throughout the client's enrollment in the
program.
o Monitoring Medication Delivery and Labs -These services will be offered throughout the client's
enrollment in the program.
o Integration with Primary Care-It is anticipated that, at this level, the client has been
successfully linked to primary care and will know how to access services independently. Clients
will be encouraged to perform these tasks independently, in preparation for the final level of
service.
o Nursing Support-Nursing staff will meet with client whenever the client is scheduled to meet
with the Psychiatrist. At this level of care, nursing staff will have a regularly scheduled
appointment with the client a minimum of once per month or as needed.
• Rehabilitation Services
o Case Management -Services will be delivered face-to-face with the client a minimum of two (2)
times a week or as often as needed.
o Wellness and Recovery Services -These services will be delivered face-to-face with the client a
minimum of two (2) times a week or as needed.
o Advocacy Services -At this level of care, it is anticipated that the client has learned to advocate
in the community and will be encouraged to do so, independently.
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Exbibit A
Page 17 of25
o Transportation Services -At this level of care, it is anticipated that the client will already have
developed a means for stable transportation and will be able to manage most of transportation
without assistance. However, assistance will continue to be provided, as needed.
o Securing Legal Documents-At this level, staff will assist clients in following up on tasks not yet
completed.
o Entitlements/Benefits-This service will also be provided, as needed, throughout the client's
enrollment in the program.
o Criminal Justice Services-These services will be provided, as needed, throughout the client's
enrollment in the program.
o Fresno County Behavioral Health Court (BHC) Support -This service will be provided, as
needed, throughout the client's enrollment in the program.
o Housing -Housing services will be provided throughout all levels of care.
o Dual Diagnosis Services-These services can be provided throughout client's enrollment in
program.
o Peer/Social Activities -Clients will continue to be invited to participate, per client's preference.
Peer activities will be offered at all levels of care.
o Wellness and Recovery Groups -These groups will remain voluntary throughout all levels of
care and client can attend as often as desired.
o Education and Employment Services -At this level, it is anticipated that the client is pursuing
educational or employment goals, if that is their desire. Client will continue to be supported in
pursuing these goals.
o Linkage to Community Resources-At this level, clients will have been educated on how to
access community resources. It is anticipated that the client will be able to access community
resources independently and will attempt to do so. Clients will be assisted with this as needed,
regardless of level of care.
o Crisis Intervention Services-The treatment team will be available to respond 24/7 to crisis a
client may face.
o Other Crisis Services -The treatment team will be available to respond 24n to personal and
emergency crisis a client may face.
• Level Transition Criteria -a client will be objectively stable in the following domains for at least six
months before transition to Level 4 (Forward Bound)
o Client has shown engagement and progress in the program and community.
o No Client crisis or crisis visits in the last three (3) months.
o Client has not been hospitalized in the last six (6) months.
o Client has not been incarcerated in the last six (6) months.
Mental Health Services Act (MHSA}
Full Service Partnership (FSP) Program
Scope of Work
Exhibit A
Page 18 of25
o Housing in the community remained stable for a minimum of six (6) months and is self-
sustaining.
o Client has been able to consistently access food and clothing resources and is self-sustaining.
o Medications are stable and self-administered/monitored and the client adheres to an appropriate
medication regimen. (Some clients will choose not to take medication and not taking
medication, alone, will not prevent transition.)
o Monthly income is stable and self-sustaining (Medi-Cai/SSI) or stable financial arrangement is in
place.
o Client has been successfully linked to community resources and/or has an understanding of how
to access these resources.
o Client has been given the opportunity to become involved in education or employment and works
towards those goals and is accessing these services.
o Client is able to attend pertinent appointments without assistance.
o Client is able to advocate for themselves in the community, when appropriate.
o Client no longer requires services beyond medication monitoring, therapy, and groups.
o LOCUS indicates a lower level of care
D. Level4-Forward Bound: intended to be a safety net and monitoring level of services. When a client
has successfully transitioned to this level, it is assumed that the client has reached baseline and is
stable across multiple domains. The client has learned recovery and wellness goals and has achieved
some success at mastering independent living goals. At this level, the client is provided with a safety
net of services while they are attempting to assert their independence and receive services in the
community. This level of care will mirror the less intensive services that a client will be transitioned to
and will allow a client to adjust to less program contact, while becoming engaged in other community
services. Client will be supported throughout the transition to another provider.
• Mental Health Reassessment -A reassessment is conducted on an annual basis or as needed.
• Plan of Care -The treatment plan is completed once a year at a minimum; however it can be
reformulated in collaboration with the client whenever a client's treatment goals change.
• Individual Service and Support Plan (I SSP> -Most of the goals of the I SSP are anticipated to have
been reached or on track to be reached. The focus of the ISSP now becomes stability in the
community.
• Individual Therapy-At this level, termination of therapy will begin. The timing of termination will be
decided upon in collaboration with the therapist and client.
• Family/Partner Therapy-At this level, termination of family/partner therapy will begin. The timing of
termination will be decided upon in collaboration with the therapist and client/family/partner.
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
• Group Therapy-At this level, clients will begin to transition out of group therapy.
• Medication and Support
Exhibit A
Page 19 of25
o Psychiatric Assessment/Evaluation -Client will continue to be scheduled with the Psychiatrist
once every three months, or as needed.
o Medication Management-Conducted once every three months during appointment with
Licensed Psychiatrist and assisted by nursing staff.
o Psychiatric Consultations -This is ongoing with client's treatment team and in close
collaboration with the RN and other nursing staff. There will be regularly scheduled weekly
appointments and emergency consultation on an as needed basis.
o Injectable Medication Services -Medication and monitoring will be provided at least one to two
times per month and additionally as needed depending on medication requirements.
o Medication Education -Education will be offered throughout the client's enrollment in the
program.
o Monitoring Medication Delivery and Labs -These services will be offered throughout the client's
enrollment in the program.
o Integration with Primary Care-It is anticipated that, at this level, the client has been
successfully linked to primary care and will know how to access services independently.
o Nursing Support-Nursing staff will meet with client whenever the client is scheduled to meet
with the Psychiatrist. At this level of care, nursing staff will have a regularly scheduled
appointment with the client a minimum of once per month or as needed.
• Rehabilitation Services
o Case Management-Services will be delivered face-to-face with the client a minimum one (1)
time a week.
o Well ness and Recovery Services -These services will be delivered face-to-face with the client
one (1) time a week.
o Advocacy Services -At this level of care, it is anticipated that the client has learned to advocate
in the community and will do so independently.
o Transportation Services -At this level of care, it is anticipated that the client will already have
developed a means for stable transportation and will be able to manage most of transportation
without assistance.
o Securing Legal Documents-At this level, it is anticipated that all legal documents will be
acquired.
o Entitlements/Benefits -At this level, it is anticipated that all entitlements have been applied for
have been received or on track for obtaining.
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Exhibit A
Page 20 of25
o Criminal Justice Services-These services will be provided, as needed, throughout the client's
enrollment in the program.
o Fresno County Behavioral Health Court (BHC) Support-This service will be provided, as
needed, throughout the client's enrollment in the program.
o Housing-Housing services will be provided throughout all levels of care.
o Dual Diagnosis Services -These services can be provided throughout client's enrollment in
program.
o Peer/Social Activities-Clients will continue to be invited to participate, per client's preference.
Peer activities will be offered at all levels of care.
o Wellness and Recovery Groups -These groups will remain voluntary throughout all levels of
care and client can attend as often as desired. This will be an opportunity for the transitioning
client to have closure with the other clients.
o Transition Group -This group will be targeted for clients who are transitioning out of the
program within the next three months and will allow clients to have peer support in the transition
process.
o Education and Employment Services -At this level, it is anticipated that the client will pursue
these goals independently.
o Linkage to Community Resources -At this level, clients will have been educated on how to
access community resources.
o Crisis Intervention Services -The treatment team will be available to respond 24n to crisis a
client may face.
o Other Crisis Services -The treatment team will be available to respond 24/7 to personal and
emergency crisis a client may face.
• Level Transition Criteria -the expected time frame for this level is 3 months, however as long as the
transition is not complete the client will remain in this level.
o Client has been stabilized across multiple domains and has been referred to another provider.
o There are no hospitalizations, no incarcerations, no homelessness, and no client crisis.
o Housing in the community has remained stable.
o There are no medication concerns.
o LOCUS indicates a lower level of care.
E. Supported Services: At all four levels of care, clients will be provided with four additional levels of
supported services (as needed):
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Exhibit A
Page 21 of25
• Hospitalization/Post Hospitalization Support Level -provided whenever a client is placed in an
inpatient psychiatric setting or evaluated and discharged without admission. These services will be
delivered directly by a number of members of the treatment team and will be coordinated by the
client's primary case manager. Services at this support level include:
o When client's hold is being written by program staff, the client is asked if he/she would like any
family/support person to be contacted. (This is part of the 5150 advisement)
o The inpatient hospital is contacted and collateral information is given as well as circumstances of
the initiation of the hold.
o The primary case manager maintains contact with the hospital throughout the client's stay and
discharge planning begins immediately.
o If the client has given permission for family/support person involvement, collateral services will
be offered to the family/support person during this time.
o A case staffing will take place to determine the options of placement and treatment for the client
upon the client's discharge. If appropriate, the involved family/support person will be invited to
this case staffing.
o During the time the client is placed in hospital, a member of the treatment team will maintain
contact with the client, letting the client's level of functioning dictate the frequency of these
contacts.
o Upon discharge from the hospital, the treatment staff will insure the client is transported to the
appropriate destination and that housing arrangements have been made.
o After discharge, a Psychiatrist appointment will be made for the medication regime to be
evaluated with the client.
o After discharge, a case staffing with the client's team will take place. The purpose of the staffing
is to identify triggers that resulted in the homelessness and to determine ways to provide more
support for the client. This will be an opportunity to explore what is/isn't working in the treatment
plan. The level of care will also be evaluated.
o Client will be included in this staffing and client input will be valued. If the client chooses not to
attend this staffing, the results of the staffing will be discussed with client and the client's input
sought at that time.
o Client's support persons will also be invited (with client's permission) to the staffing and their
respective inputs will be valued.
o Service contact and delivery is increased to five (5) times per week for a minimum of three (3)
weeks. This will be face-to-face contact when possible.
o Client's placement will be reevaluated and steps taken to make sure the client is in the least
restrictive and most appropriate housing available. It may be determined that a higher or lower
level of housing supervision is appropriate. It may be determined that the same level of housing
in a different location is appropriate.
o After three (3) weeks, there will be another staffing where the client and family/support are
invited to attend. At this meeting, it will be decided if the current level of care is appropriate or if
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Exhibit A
Page 22 of25
there are changes needed to be made. Any adjustments to the Individual Services and Support
Plan (I SSP) will be made at this time.
• Incarceration/Post Incarceration Support Level-provided whenever a client is incarcerated or
evaluated and discharged without admission. Services will be delivered directly by the Criminal
Justice Mental Health Specialist and coordinated by the client's primary case manager, while the
client is incarcerated. Upon discharge from the jail, all appropriate team members will deliver
services to client and to client's family/partner (per client preference). Services in this support level
include:
o Criminal Justice Mental Health will visit client in jail as soon as possible.
o Criminal Justice Mental Health will act as a court liaison to assist and support the client.
o Criminal Justice Mental Health will work collaboratively with the client's primary case manager so
that the client will have weekly contact, engagement, and support (if incarcerated for 7 days or
more)
o After release, a Psychiatrist appointment will be made immediately for the medication regime to
be evaluated with the client.
o After release, a case staffing with the client's team will take place. The purpose of the staffing is
to identify triggers that resulted in the incarceration and to determine ways to provide more
support for the client. This will be an opportunity to explore what is/isn't working in the treatment
plan.
o Client will be included in this staffing and client input will be valued. If the client chooses not to
attend this staffing, the results of the staffing will be discussed with client and the client's input
sought at that time.
o Client's support persons and/or probation officer will also be invited (with client's permission) to
the staffing and their respective inputs will be valued.
o Housing services will be adjusted to the client's need.
o Client will be encouraged to attend appropriate groups and seek counseling services at the
program.
o Staff will work closely with the courts and probation to insure that the client is cooperating to the
best of client's ability.
• Homelessness Support Level -provided whenever a client becomes homeless. Services will be
delivered by treatment team and will be coordinated by the client's primary case manager in
collaboration with the housing coordinator. Services at this support level include:
o Emergency case staffing with client (and client family, if appropriate). Case Manager and
Housing Coordinator will explore housing options available for client.
o Client will be offered and linked to emergency or temporary housing.
o The circumstances which resulted in the client becoming homeless will be explored and the
client will be supported and educated on how to maintain housing, as needed.
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Exhibit A
Page 23 of25
o If the client has given permission for family/support person involvement, collateral services will
be offered to the family/support person during this time.
o A Psychiatrist appointment will be made for the medication regime to be evaluated with the
client.
o A case staffing with the client's team will take place. The purpose of the staffing is to identify
triggers that resulted in the homelessness and to determine ways to provide more support for
the client. This will be an opportunity to explore what is/isn't working in the treatment plan. The
level of care will also be evaluated.
o Client will be included in this staffing and client input will be valued. If the client chooses not to
attend this staffing, the results of the staffing will be discussed with client and the client's input
sought at that time.
o Client's support persons will also be invited (with client's permission) to the staffing and their
respective inputs will be valued.
o Service contact and delivery is increased to three (3) times per week for a minimum of three (3)
weeks. This will be face-to-face contact when possible.
o Client's placement will be reevaluated and steps taken to make sure the client is in the least
restrictive and most appropriate housing available. It may be determined that a higher or lower
level of housing supervision is appropriate. It may be determined that the same level of housing
in a different location is appropriate.
o After three (3) weeks, there will be another staffing where the client and family/support are
invited to attend. At this meeting, it will be decided if the current level of care is appropriate or if
there are changes needed to be made. Any adjustments to the Individual Services and Support
Plan (I SSP) will be made at this time.
• Dual Diagnosis Support Level -provided when a client has a co-existing substance use disorder
and agrees to dual diagnosis services. Treatment will be available continuously regardless of
client's readiness for abstinence or ability to participate. Services at this support level include;
o Emergency case staffing with client (and client family, if appropriate). Case Manager and Dual
Diagnosis Specialist will explore treatment options available for client.
o Client will be offered and linked to substance abuse treatment based on client's acceptance of
these services.
o Client's housing options will be explored and change made, as appropriate.
o After the treatment option has been accessed, a case staffing with the client's team will take
place. The purpose of the staffing is to identify triggers and to determine ways to provide more
support for the client. This will be an opportunity to explore what is/isn't working in the treatment
plan. The level of care will also be evaluated.
o Client will be included in this staffing and client input will be valued. If the client chooses not to
attend this staffing, the results of the staffing will be discussed with client and the client's input
sought at that time.
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Exhibit A
Page 24 of25
o Client's support persons will also be invited (with client's permission) to the staffing and their
respective inputs will be valued.
o A Psychiatrist appointment will be made for the medication regime to be evaluated with the
client.
o Service contact and delivery is maintained while client is in residential treatment. This will be
face-to-face contact when possible.
o Client's placement will be reevaluated and steps taken to make sure the client is in the least
restrictive and most appropriate housing available. It may be determined that a higher or lower
level of housing supervision is appropriate. It may be determined that the same level of housing
in a different location is appropriate.
o After three (3) weeks, there will be another staffing where the client and family/support are
invited to attend. At this meeting, it will be decided if the current level of care is appropriate or if
there are changes needed to be made. Any adjustments to the Individual Services and Support
Plan (I SSP) will be made at this time.
COUNTY RESPONSIBILITIES:
COUNTY shall:
1. Provide oversight (through the County Department of Behavioral Health (DBH) and the DBH Contracted
Services Division Manager or designee of the CONTRACTOR's FSP program. In addition to contract
monitoring of program, oversight includes, but not limited to, coordination with the State Department of
Health Care Services, Mental Health Services Act in regard to program administration and outcomes.
2. Assist the CONTRACTOR in making linkages with the total mental health system. This will be
accomplished through regularly scheduled meetings as well as formal and informal consultation
3. Participate in evaluating the progress of the overall program and the efficiency of collaboration with the
vendor staff and will be available to the contractor for ongoing consultation.
4. Receive and analyze statistical data outcome information from vendor throughout the term of contract on
a monthly basis. DBH will notify the vendor when additional participation is required. The performance
outcome measurement process will not be limited to survey instruments but will also include, as
appropriate, client and staff interviews, chart reviews, and other methods of obtaining required
information.
5. Recognize that cultural competence is a goal toward which professionals, agencies, and systems should
strive. Becoming culturally competent is a developmental process and incorporates at all levels the
importance of culture, the assessment of cross-cultural relations, vigilance towards the dynamics that
result from cultural differences, the expansion of cultural knowledge, and the adaptation of services to
meet culturally-unique needs. Offering those services in a manner that fails to achieve its intended
result due to cultural and linguistic barriers is not cost effective. To assist the vendor efforts towards
cultural and linguistic competency, DBH shall provide the following at no cost to vendor(s):
A. Technical assistance to vendor regarding cultural competency requirements and sexual orientation
training.
Mental Health Services Act (MHSA)
Full Service Partnership (FSP) Program
Scope of Work
Exhibit A
Page 25 of25
B. Mandatory cultural competency training including sexual orientation and sensitivity training for DBH
and vendor personnel, at minimum once per year. COUNTY will provide mandatory training
regarding the special needs of this diverse population and will be included in the cultural
competence training(s). Sexual orientation and sensitivity to gender differences is a basic cultural
competence principle and shall be included in the cultural competency training. Literature suggests
that the mental health needs of lesbian, gay, bisexual, transgender (LGBT) individuals may be at
increased risk for mental disorders and mental health problems due to exposure to societal
stressors such as stigmatization, prejudice and anti-gay violence. Social support may be critical for
this population. Access to care may be limited due to concerns about providers' sensitivity to
differences in sexual orientation.
C. Technical assistance for vendor in translating behavioral health and substance abuse services
information into DBH's threshold languages (Spanish, Laotian, Cambodian and Hmong).
Translation services and costs associated will be the responsibility of the vendor.
FULL SERVICE PARTNERSHIP SERVICE DELIVERY MODEL
Exhibit B
Page 1 of4
On August 1, 2005 the Department of Mental Health approved a Three-Year Program and
Expenditure Plan Requirements document for fiscal years 2005/06, 2006/06 and 2007/08. This
document outlines requirements for Full Service Partnership collaborations and can be found in
its entirety at http://www.dmh.ca.gov/MHSA/docs/CSSfinal 8.1.05.pdf.
Full Service Partnerships (FSP) are designed as a partnership between enrollees and the
service provider. The FSP service delivery ethic incorporates recovery and cultural competence
into the services and supports offered to consumers. In this partnership, the service provider
commits to do "whatever it takes" and to "meet the client where they are" in order to assist the
enrollee achieve their personal recovery/resiliency and wellness goals.
1. The Target Population is consistent with the population identified in the Fresno
County MHSA Community Planning Process
The target population must meet requirements for SMI/SED diagnosis; and must address
reduction of specific ethnic disparities, as indicated in the MHSA Community Services and
Supports proposal on which the RFP is based.
The target population will include individuals who are not currently served
and meet one or more of the following criteria:
• Homeless
• At risk of homelessness -such as youth aging out of foster care or
• persons coming out of jail
• Involved in the criminal justice system (including adults with child
• protection issues)
• Frequent users of hospital and emergency room services
Q! are so underserved that they are at risk of:
• Homelessness -such as persons living in institutions or nursing homes
• Criminal justice involvement
• Institutionalization
Diagnoses that serve as criteria for inclusion in the target population will be based on definitions
found in 5600.3 California Welfare and Institutions code defining severe mental disorder. The
operational definition of "diagnosis" for programs serving the chronically homeless may also
include: co-occurring disorders, personality disorders, general anxiety/mood disorders, and
Post Traumatic Stress Disorder).
2. FSP Program Components:
All MHSA FSP Programs must include the following in their program descriptions
• Providers who are part of the multidisciplinary, community based "treatment"
teams serve as an ally to the consumer's recovery process. The partnership allows
clients and family members opportunities for informed choice
0302 b dbh
o The team description must demonstrate commitment and capacity to do
"whatever it takes" to assist the enrolled member, specifically:
Exhibit B
Page 2 of4
FULL SERVICE PARTNERSHIP SERVICE DELIVERY MODEL
•
•
•
•
•
•
•
Low staff to client ratio (approximately 1 :12; or the ratio that has been
specified in the RFP's statement of work)
24/7 availability of the multidisciplinary team;
Team culture is created where each member of the team knows each
client and the clients are familiar with each member of the team.
Members of the team speak the client's language, are familiar with
community resources that reflect the healing beliefs of the client's culture,
and are positioned to assist the client make meaningful connection with
those resources.
Crisis response comes from a person known to the client.
Staff is given the administrative flexibility and flex-funding to connect
consumers with non-mental health services and same day needs.
Examples include: Housing; Primary Care; Dual Disorder Services,
Education Services and Supports; Vocational services and supports;
Payee services/benefits advocacy; Community recreational activities
(YMCA classes, libraries, movie theaters); Social Services, Food,
Transportation, and Clothing.
Availability of Integrated Dual Diagnosis Treatment or other dual recovery
intervention that will provide effective treatment for the target population.
• Outreach and engagement. The team's outreach and engagement strategy must be
voluntary and driven by the values of client culture. This means that consumers will be
engaged "where they are" in terms of their community location, their need for clinical and
non-clinical services/supports and their phase of recovery. Outreach workers will have
culturally competent language skills and will function as an ally to the consumer's
decision to receive services. Peer Support will be included in the outreach and
engagement of new clients.
• Procedures for enrollment and dis-enrollment will be easily understood, clearly
communicated and non-coercive. Enrollment is voluntary. A condition of enrollment is
that the client indicates that they want services from the assertive-community treatment
model team.
• Each adult, older adult, and transition age youth enrollee must have a Personal
Service Coordinator (PSC). The PSC is an ally to the enrollee and acts as a "single
point of responsibility" within the multidisciplinary team for coordinating services and
supports. " Personal Service Coordinators (PSCs) for adults -case managers for
children and youth-must have a caseload that is low enough so that: (1) their
availability to the individual and family is appropriate to their service needs, (2) they are
able to provide intensive services and supports when needed, and (3) they can give the
individual served and/or family member considerable personal attention ... PSCslcase
managers must be culturally competent, and know the community resources of the
client's racial ethnic community." (Source: DMH Planning Requirements. Section Ill
Identifying Populations for Full Service Partnerships. Aug 2005)
• Each enrollee must have an Integrated Services and Supports Plan that is
developed with their Personal Services Coordinator. This I SSP is a planning tool
that builds on the consumer's strengths. It includes goals and provides a map of the
0302 b dbh
FULL SERVICE PARTNERSHIP SERVICE DELIVERY MODEL
Exhibit B
Page 3 of4
steps that the enrollee identifies as necessary to move along his/her recovery path.
"Integrated Services and Supports Plans must operationalize the five fundamental
concepts (identified listed in section three of this Exhibit) and should reflect community
collaboration, be culturally competent, be client/family driven with a
wei/ness/recovery/resiliency focus and they must provide an integrated service
experience for the client/family. In addition, the /SSP will be person/child-centered, and
give individuals and their families' sufficient information to allow them to make informed
choices about the services in which they participate. Services should also include
linkage to, or provision of, all needed services or benefits as defined by the client and or
family in consultation with the PSC/case manager. This includes the capability of
increasing or decreasing service intensity as needed." (Source: DMH Planning
Reguirements. Section Ill Identifying Populations for Full Service Partnerships. Aug
2005)
• Peer support services will be made available to the client. At least two staff (a
minimum of 1 FTE) who acts in peer support roles will be employed in each MHSA
program.
o The enrollee is given significant access to peer recovery and self-help services.
Tools such as Advanced Directives are made available to adult and older adult
clients, and Wellness Recovery Action Plans (WRAP) are made available to
adult, transition age youth and older adult clients.
o Peer Counselors are included as equal partners in the multidisciplinary team, and
play a critical role in developing the recovery culture and client orientation of the
team.
3. The Five (5) Core MHSA Concepts are embedded in each program
Concept 1: Recovery/resiliency orientation:
FSPs will embody the values of recovery and resiliency (i.e., hope, personal
responsibility, self-advocacy, choice, respect) and the program principles of recovery
and resiliency, including:
• Client-driven goal setting and Individualized Services and Supports Plans
• Providers are allies to the client's recovery process.
• A harm-reduction approach to substance abuse that encourages recovery
and abstinence but does not penalize consumers or withdraw help from them
if they are using.
• A built in understanding and expectation of setbacks as part of recovery.
• Links to a range of services that are part of the consumers "pathway to
wellness" (i.e., employment, health care, peer support, housing, medications,
food and clothing)
FSPs will collaborate with the MHSA Family Education Center which makes support
services available to family members and the MHSA Wellness Recovery Resource Hub
which makes wellness recovery training and technical assistance available to FSP staff.
Concept 2: Cultural Competence Orientation: The program's structure, staffing and
service delivery values will reflect the cultural values and orientation of the program's
target populations.
0302 b dbh
Exhibit B
Page 4 of 4
FULL SERVICE PARTNERSHIP SERVICE DELIVERY MODEL
The ~SP program will embod_y principals of cultural competence including:
• Drverse staff, representatrve of the primary ethnic groups to be reached through the
program
• Staff trained regarding common access barriers for racial and ethnic groups targeted
(including the impact of housing discrimination)
• Links to community-based organizations that share the healing beliefs and practices
of ethnic communities served by the FSP.
The FSP program must also be able to deal with gender and sexual orientation diversity.
Training in sensitivity to gender and sexuality issues is a key component for staff on the
Team.
Concept 3: Community Collaboration: FSP Collaborations ensure that community
resources are made available to enrollees. These collaborations include subcontracts
between the vendor and other agencies, memoranda of understanding with community
non-profits and businesses regarding providing services to clients, and informal
relationships built between FSP staff and community stakeholders that result in
improved access and decreased discrimination.
Concept 4: Client/Family Driven program: In FSPs, the Integrated Services and
Supports Plan (I SSP) is used by adult clients and families of children and youth to
identify their needs and preferences which lead to the services and supports that will be
most effective for them. Providers work in full partnership with clients to develop these
ISSPs. Their needs and preferences drive the policy and financing decisions that affect
them.
Concept 5: Integrated Service Experience: FSP programs were incorporated into the
MHSA to ensure that these dollars funded "integrated service experiences." This means
that services are "seamless" to clients and that clients do not have to negotiate multiple
agencies and funding sources to get critical needs met and to move towards recovery
and develop resiliency. Services are delivered, or at a minimum, coordinated through a
single agency or a system of care. The integrated service experience centers on the
individual/family, uses a strength-based approach, and includes multi-agency programs
and joint planning to best address the individual/family's needs using the full range of
community-based treatment, case management, and interagency system components
required by children/transition age youth/adults/older adults.
0302 b dbh
Adult Full Service Partnership Program
Turning Point of Central California, Inc.
Fiscal Year 2015-16
Budget Categories -
Line Item Description (Must be itemized) FTE% Admin.
PERSONNEL SALARIES:
0001 Program Director!Team Leader 100.00
0002 Assistant Program Director 100.00
0003 Psychiatrist 100.00
0004 Personal Services Coordinator Supervisor 100.00
0005 Dual Diagnosis Mental Health Specialist 300.00
0006 Education & Employment Mental Health Spec. 300.00
0007 Criminal Justice/Group Facilitator MHS 200.00
0008 Parent Partner/Consumer Advocate PSC 300.00
0009 Peer Specialist Personal Services Coordinator 100.00
0010 Personal Services Coordinator (PSC) 600.00
0011 Mental Health Professionals 300.00
0012 Peer Support Specialist 200.00
0013 Registered Nurse 100.00
0014 LVN 200.00
0015 Housing Coordinator 100.00
0016 Secretary/Medical Records/Billing/Bookkeeper 400.00
· SALARY TOTAL 3500.00
PAYROLL TAXES:
0030 OASDI
0031 FICA/MEDICARE
0032 SUI
PAYROLL TAX TOTAL
EMPLOYEE BENEFITS:
0040 Retirement
0041 Workers Compensation
0042 Health Insurance (medical, vision, life, dental}
EMPLOYEE BENEFITS TOTAL
SALARY & BENEFITS GRAND TOTAL
$0
$0
$0
Exhibit C
Page 1 of20
Total Proposed Budget
Direct Total
$89,939 $89,939
$80,936 $80,936
$370,240 $370,240
$48,752 $48,752
$138,300 $138,300
$138,300 $138,300
$92,200 $92,200
$116,373 $116,373
$38,791 $38,791
$232,746 $232,746
$221,517 $221,517
$61,381 $62,381
$73,839 $73,839
$97,480 $97,480
$47,790 $47,790
$151,410 $151,410
$1,999,994 $1,999,994
$22,830 $22,830
$101,920 $101,920
$28,990 $28,990
$153,740 $153,740
$24,528 $24,528
$12,800 $12,800
$357,448 $357,448
$394,776 $394,776
$2,548,510
FACILITIES/EQUIPMENT EXPENSES·
1010 Rent/lease Building
1011 Rent/lease Equipment/Maintenance
1012 Utilities
1013 Building Maintenance
1014 Equipment purchase
FACILITY/EQUIPMENT TOTAL
OPERATING EXPENSES·
1060 Telephone
1061 Security
1062 Postage
1063 Printing/Reproduction
1064 Publications
1065 legal Notices/Advertising/Recruiting
1066 Office Supplies & Equipment
1067 Household Supplies
1068 Building Insurance
1069 Program Supplies -Therapeutic
1070 licenses
1071 Transportation of Clients
1072 Staff Mileage/vehicle maintenance/lease
1073 Staff Travel (Out of County)
1074 Staff Training/Registration
1075 lodging
1076 Depreciation
1077 Client Activities/Recreation
OPERATING EXPENSES TOTAL
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping
1081 External Audit
1082 liability Insurance
1083 Administrative Overhead
1084 Payroll Services
1085 Professional liability Insurance
FINANCIAL SERVICES TOTAL
Exhibit C
Pagel of20
$49,336
$7,000
$32,272
$16,250
$0
$104,858
$22,800
$1,250
$1,250
$6,000
$3,500
$1,500
$10,000
$5,000
$5,500
$5,000
$1,500
$0
$123,080
$5,500
$12,000
$0
$1,380
$15,000
$220,260
$0
$2,500
$5,500
$536,494
$0
$0
$544,494
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)
1091 Translation Services
1092 Medication Supports
SPECIAL EXPENSES TOTAL
FIXED ASSETS·
1190 Computers & Software
1191 Furniture & Fixtures
FIXED ASSETS TOTAL
NON MEDI-CAL CLIENT SUPPORT EXPENSES:
2000 Client Housing Support Expenditures (SFC 70)
2001 Client Housing Operating Expenditures (SFC 71)
2002.1 Clothing, Food & Hygiene (SFC 72)
2002.2 Client Transportation & Support (SFC 72)
2002.3 Education Support (SFC 72)
2002.4 Employment Support (SFC 72)
2002.5 Respite Care (SFC 72)
2002.6 Household Items
2002.7 Utility Vouchers (SFC 72)
2002.8 Child Care (SFC 72)
NON MEDI-CAL CLIENT SUPPORT TOTAL
Exhibit C
Page3 of20
$0
$6,000
$81,000
$87,000
$10,500
$9,000
$19,500
$520,000
$8,000
$29,000
$18,000
$6,000
$3,000
$0
$1,500
$1,500
$1,500
$588,500
TOTAL PROGRAM EXPENSES $4,113,122
Units of
MEDI-CAL REVENUE: Service
3000 Mental Health Services (Individual/Family/Group Therapy) 105,525
3100 Case Management 194,005
3200 Crisis Services 11,549
3300 Medication Support 176,640
3400 Collateral 11,878
3500 Plan Development 5,888
3600 Assessment 14,943
3700 Rehabilitation 820,317
Estimated Medi-Cal Billing Totals 1,340,745
Estimated % of Federal Financial Participation Reimbursement
(50%) Regular M/C Title XIX
Estimated% of ACA Aid Codes Reimbursement (100%)
MEDI-CAL REVENUE TOTAL
OTHER REVENUE·
4000 Other -Client Rents
OTHER REVENUE TOTAL
MHSAFUNDS·
5000 Prevention & Early Intervention Funds
5100 Community Services & Supports Funds
5200 Innovation Funds
5300 Workforce Education & Training Funds
MHSA FUNDS TOTAL
Exhibit C
Page 4 of20
Rate $Amount
$2.12 $223,713
$1.45 $281,307
$2.81 $32,453
$3.90 $688,896
$2.12 $25,181
$2.12 $12,483
$2.12 $31,679
-$1,739,072
$3,034,784
70.00% $1,062,174
30.00% $910,435
$1,972,610
$65,000
$65,000
$0
$2,075,512
$0
$0
$2,075,512
TOTAL PROGRAM REVENUE $4,113,122
Budget Categories -
Adult Full Service Partnership Program
Turning Point of Central California, Inc.
Fiscal Year 2016-17
Line Item Description (Must be itemized) FTE% Admin.
PERSONNEL SALARIES:
0001 Program Directorffeam Leader 100.00
0002 Assistant Program Director 100.00
0003 Psychiatrist 100.00
0004 Personal Services Coordinator Supervisor 100.00
0005 Dual Diagnosis Mental Health Specialist 300.00
0006 Education & Employment Mental Health Spec. 300.00
0007 Criminal Justice/Group Facilitator MHS 200.00
0008 Parent Partner/Consumer Advocate PSC 300.00
0009 Peer Specialist Personal Services Coordinator 100.00
0010 Personal Services Coordinator (PSC) 600.00
0011 Mental Health Professionals 300.00
0012 Peer Support Specialist 200.00
0013 Registered Nurse 100.00
0014 LVN 200.00
0015 Housing Coordinator 100.00
0016 Secretary/Medical Records/Billing/Bookkeeper 400.00
SALARY TOTAL 3500.00 $0
PAYROLL TAXES:
0030 OASDI
0031 FICA/MEDICARE
0032 SUI
PAYROLL TAX TOTAL $0
EMPLOYEE BENEFITS:
0040 Retirement
0041 Workers Compensation
0042 Health Insurance (medical, vision, life, dental)
EMPLOYEE BENEFITS TOTAL $0
SALARY & BENEFITS GRAND TOTAL
ExhibitC
Page 5 of20
Total Proposed Budget
Direct Total
$89,939 $89,939
$80,936 $80,936
$370,240 $370,240
$48,752 $48,752
$138,300 $138,300
$138,300 $138,300
$92,200 $92,200
$116,373 $116,373
$38,791 $38,791
$232,746 $232,746
$221,517 $221,517
$61,381 $62,381
$73,839 $73,839
$97,480 $97,480
$47,790 $47,790
$151,410 $151,410
$1,999,994 $1,999,994
$22,830 $22,830
$101,920 $101,920
$28,990 $28,990
$153,740 $153,740
$24,528 $24,528
$12,800 $12,800
$357,448 $357,448
$394,776 $394,776
$2,548,510
FACILITIES/EQUIPMENT EXPENSES·
1010 Rent/Lease Building
1011 Rent/Lease Equipment/Maintenance
1012 Utilities
1013 Building Maintenance
1014 Equipment purchase
FACILITY/EQUIPMENT TOTAL
OPERATING EXPENSES·
1060 Telephone
1061 Security
1062 Postage
1063 Printing/Reproduction
1064 Publications
1065 Legal Notices/Advertising/Recruiting
1066 Office Supplies & Equipment
1067 Household Supplies
1068 Building Insurance
1069 Program Supplies -Therapeutic
1070 Licenses
1071 Transportation of Clients
1072 Staff Mileage/vehicle maintenance/lease
1073 Staff Travel (Out of County)
1074 Staff Training/Registration
1075 Lodging
1076 Depreciation
1077 Client Activities/Recreation
OPERATING EXPENSES TOTAL
FINANCIAL SERVICES EXPENSES·
1080 Accounting/Bookkeeping
1081 External Audit
1082 Liability Insurance
1083 Administrative Overhead
1084 Payroll Services
1085 Professional Liability Insurance
FINANCIAL SERVICES TOTAL
Exhibit C
Page 6 of20
$49,336
$7,000
$32,272
$16,250
$0
$104,858
$22,800
$1,250
$1,250
$6,000
$3,500
$1,500
$10,000
$5,000
$5,500
$5,000
$1,500
$0
$123,080
$5,500
$12,000
$0
$1,380
$15,000
$220,260
$0
$2,500
$5,500
$534,019
$0
$0
$542,019
SPECIAL EXPENSES {Consultant/Etc.):
1090 Consultant (network & data management)
1091 Translation Services
1092 Medication Supports
SPECIAL EXPENSES TOTAL
FIXED ASSETS:
1190 Computers & Software
1191 Furniture & Fixtures
FIXED ASSETS TOTAL
NON MEDI-CAL CLIENT SUPPORT EXPENSES·
2000 Client Housing Support Expenditures (SFC 70)
2001 Client Housing Operating Expenditures (SFC 71)
2002.1 Clothing, Food & Hygiene {SFC 72)
2002.2 Client Transportation & Support {SFC 72)
2002.3 Education Support (SFC 72)
2002.4 Employment Support (SFC 72)
2002.5 Respite Care (SFC 72)
2002.6 Household Items
2002.7 Utility Vouchers {SFC 72)
2002.8 Child Care (SFC 72)
NON MEDI-CAL CLIENT SUPPORT TOTAL
Exhibit C
Page 7 of20
$0
$6,000
$81,000
$87,000
$3,000
$0
$3,000
$520,000
$8,000
$29,000
$18,000
$6,000
$3,000
$0
$1,500
$1,500
$1,500
$588,500
TOTAL PROGRAM EXPENSES $4,094,147
Units of
MEDI-CAL REVENUE: Service
3000 Mental Health Services (Individual/Family/Group Therapy) 105,525
3100 Case Management 194,005
3200 Crisis Services 11,549
3300 Medication Support 176,640
3400 Collateral 11,878
3500 Plan Development 5,888
3600 Assessment 14,943
3700 Rehabilitation 820,317
Estimated Medi-Cal Billing Totals 1,340,745
Estimated % of Federal Financial Participation Reimbursement
(50%) Regular M/C Title XIX
Estimated% of ACA Aid Codes Reimbursement (100% Year 2016, 95% 2017)
MEDI-CAL REVENUE TOTAL
OTHER REVENUE·
4000 Other -Client Rents
OTHER REVENUE TOTAL
MHSA FUNDS·
5000 Prevention & Early Intervention Funds
5100 Community Services & Supports Funds
5200 Innovation Funds
5300 Workforce Education & Training Funds
MHSA FUNDS TOTAL
Exhibit C
Page 8of20
Rate $Amount
$2.12 $223,713
$1.45 $281,307
$2.81 $32,453
$3.90 $688,896
$2.12 $25,181
$2.12 $12,483
$2.12 $31,679
~ $1,739,072
$3,034,784
70.00% $1,062,174
30.00% $887,674
$1,949,849
$65,000
$65,000
$0
$2,079,298
$0
$0
$2,079,298
TOTAL PROGRAM REVENUE $4,094,147
Adult Full Service Partnership Program
Turning Point of Central California, Inc.
Fiscal Year 2017-18
Budget Categories -
Line Item Descri~tion (Must be itemized) FTE% Admin.
PERSONNEL SALARIES:
0001 Program Director/T earn leader 100.00
0002 Assistant Program Director 100.00
0003 Psychiatrist 100.00
0004 Personal Services Coordinator Supervisor 100.00
0005 Dual Diagnosis Mental Health Specialist 300.00
0006 Education & Employment Mental Health Spec. 300.00
0007 Criminal Justice/Group Facilitator MHS 200.00
0008 Parent Partner/Consumer Advocate PSC 300.00
0009 Peer Specialist Personal Services Coordinator 100.00
0010 Personal Services Coordinator (PSC) 600.00
0011 Mental Health Professionals 300.00
0012 Peer Support Specialist 200.00
0013 Registered Nurse 100.00
0014 LVN 200.00
0015 Housing Coordinator 100.00
0016 Secretary/Medical Records/Billing/Bookkeeper 400.00
SALARY TOTAL 3500.00
PAYROLL TAXES:
0030 OASDI
0031 FICA/MEDICARE
0032 SUI
PAYROLL TAX TOTAL
EMPLOYEE BENEFITS:
0040 Retirement
0041 Workers Compensation
0042 Health Insurance (medical, vision, life, dental)
EMPLOYEE BENEFITS TOTAL
SALARY & BENEFITS GRAND TOTAL
$0
$0
$0
Exhibit C
Page 9 of20
Total Proposed Budget
Direct Total
$89,939 $89,939
$80,936 $80,936
$370,240 $370,240
$48,752 $48,752
$138,300 $138,300
$138,300 $138,300
$92,200 $92,200
$116,373 $116,373
$38,791 $38,791
$232,746 $232,746
$221,517 $221,517
$61,381 $62,381
$73,839 $73,839
$97,480 $97,480
$47,790 $47,790
$151,410 $151,410
$1,999,994 $1,999,994
$22,830 $22,830
$101,920 $101,920
$28,990 $28,990
$153,740 $153,740
$24,528 $24,528
$12,800 $12,800
$357,448 $357,448
$394,776 $394,776
$2,548,510
FACILITIES/EQUIPMENT EXPENSES·
1010 Rent/Lease Building
1011 Rent/Lease Equipment/Maintenance
1012 Utilities
1013 Building Maintenance
1014 Equipment purchase
FACILITY/EQUIPMENT TOTAL
OPERATING EXPENSES·
1060 Telephone
1061 Security
1062 Postage
1063 Printing/Reproduction
1064 Publications
1065 Legal Notices/Advertising/Recruiting
1066 Office Supplies & Equipment
1067 Household Supplies
1068 Building Insurance
1069 Program Supplies -Therapeutic
1070 Licenses
1071 Transportation of Clients
1072 Staff Mileage/vehicle maintenance/lease
1073 Staff Travel (Out of County)
1074 Staff Training/Registration
1075 Lodging
1076 Depreciation
1077 Client Activities/Recreation
OPERATING EXPENSES TOTAL
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping
1081 External Audit
1082 Liability Insurance
1083 Administrative Overhead
1084 Payroll Services
1085 Professional Liability Insurance
FINANCIAL SERVICES TOTAL
Exhibit C
Page 10 of20
$49,336
$7,000
$32,272
$16,250
$0
$104,858
$22,800
$1,250
$1,250
$6,000
$3,500
$1,500
$10,000
$5,000
$5,500
$5,000
$1,500
$0
$123,080
$5,500
$12,000
$0
$1,380
$15,000
$220,260
$0
$2,500
$5,500
$534,019
$0
$0
$542,019
SPECIAL EXPENSES (ConsultanUEtc.):
1090 Consultant (network & data management)
1091 Translation Services
1092 Medication Supports
SPECIAL EXPENSES TOTAL
FIXED ASSETS:
1190 Computers & Software
1191 Furniture & Fixtures
FIXED ASSETS TOTAL
NON MEDI-CAL CLIENT SUPPORT EXPENSES·
2000 Client Housing Support Expenditures (SFC 70)
2001 Client Housing Operating Expenditures (SFC 71)
2002.1 Clothing, Food & Hygiene (SFC 72)
2002.2 Client Transportation & Support (SFC 72)
2002.3 Education Support (SFC 72)
2002.4 Employment Support (SFC 72)
2002.5 Respite Care (SFC 72)
2002.6 Household Items
2002.7 Utility Vouchers (SFC 72)
2002.8 Child Care (SFC 72)
NON MEDI-CAL CLIENT SUPPORT TOTAL
Exhibit C
Page 11 of20
$0
$6,000
$81,000
$87,000
$3,000
$0
$3,000
$520,000
$8,000
$29,000
$18,000
$6,000
$3,000
$0
$1,500
$1,500
$1,500
$588,500
TOTAL PROGRAM EXPENSES $4,094,147
Units of
MEDI-CAL REVENUE: Service
3000 Mental Health Services (Individual/Family/Group Therapy} 105,525
3100 Case Management 194,005
3200 Crisis Services 11,549
3300 Medication Support 176,640
3400 Collateral 11,878
3500 Plan Development 5,888
3600 Assessment 14,943
3700 Rehabilitation 820,317
Estimated Medi-Cal Billing Totals 1,340,745
Estimated % of Federal Financial Participation Reimbursement
(50%} Regular M/C Title XIX
Estimated% of ACA Aid Codes Reimbursement (95% Year 2017, 94% 2018)
MEDI-CAL REVENUE TOTAL
OTHER REVENUE:
4000 Other -Client Rents
OTHER REVENUE TOTAL
MHSA FUNDS·
5000 Prevention & Early Intervention Funds
5100 Community Services & Supports Funds
5200 Innovation Funds
5300 Workforce Education & Training Funds
MHSA FUNDS TOTAL
Exhibit C
Page 12 of20
Rate $Amount
$2.12 $223,713
$1.45 $281,307
$2.81 $32,453
$3.90 $688,896
$2.12 $25,181
$2.12 $12,483
$2.12 $31,679
-$1,739,072
[,i; ;;,,i'",">j~~~ $3,034,784
70.00% $1,062,174
30.00% $860,361
$1,922,536
$65,000
$65,000
$0
$2,106,611
$0
$0
$2,106,611
TOTAL PROGRAM REVENUE $4,094,147
Adult Full Service Partnership Program
Turning Point of Central California, Inc.
Fiscal Year 2018-19
Budget Categories -
Line Item Descrir:>tion_(Must be itemized} FTE% Admin.
PERSONNEL SALARIES:
0001 Program Directorffeam Leader 100.00
0002 Assistant Program Director 100.00
0003 Psychiatrist 100.00
0004 Personal Services Coordinator Supervisor 100.00
0005 Dual Diagnosis Mental Health Specialist 300.00
0006 Education & Employment Mental Health Spec. 300.00
0007 Criminal Justice/Group Facilitator MHS 200.00
0008 Parent Partner/Consumer Advocate PSC 300.00
0009 Peer Specialist Personal Services Coordinator 100.00
0010 Personal Services Coordinator (PSC) 600.00
0011 Mental Health Professionals 300.00
0012 Peer Support Specialist 200.00
0013 Registered Nurse 100.00
0014 LVN 200.00
0015 Housing Coordinator 100.00
0016 Secretary/Medical Records/Billing/Bookkeeper 400.00
SALARY TOTAL 3500.00
PAYROLL TAXES:
0030 OASDI
0031 FICA/MEDICARE
0032 SUI
PAYROLL TAX TOTAL
EMPLOYEE BENEFITS:
0040 Retirement
0041 Workers Compensation
0042 Health Insurance (medical, vision, life, dental)
EMPLOYEE BENEFITS TOTAL
SALARY & BENEFITS GRAND TOTAL
$0
$0
$0
Exhibit C
Page 13 of20
Total Proposed Budget
Direct Total
$92,637 $92,637
$83,364 $83,364
$381,347 $381,347
$50,215 $50,215
$142,449 $142,449
$142,449 $142,449
$94,966 $94,966
$119,864 $119,864
$39,955 $39,955
$239,728 $239,728
$228,163 $228,163
$63,222 $63,222
$76,054 $76,054
$100,404 $100,404
$49,224 $49,224
$155,952 $155,952
$2,059,994 $2,059,994
$23,515 $23,515
$104,978 $104,978
$29,860 $29,860
$158,352 $158,352
$25,264 $25,264
$13,184 $13,184
$368,171 $368,171
$406,619 $406,619
$2,624,965
FACILITIES/EQUIPMENT EXPENSES·
1010 Rent/Lease Building
1011 Rent/Lease Equipment/Maintenance
1012 Utilities
1013 Building Maintenance
1014 Equipment purchase
FACILITY/EQUIPMENT TOTAL
OPERATING EXPENSES·
1060 Telephone
1061 Security
1062 Postage
1063 Printing/Reproduction
1064 Publications
1065 Legal Notices/ Advertising/Recruiting
1066 Office Supplies & Equipment
1067 Household Supplies
1068 Building Insurance
1069 Program Supplies -Therapeutic
1070 Licenses
1071 Transportation of Clients
1072 Staff Mileage/vehicle maintenance/lease
1073 Staff Travel (Out of County)
1074 Staff Training/Registration
1075 Lodging
1076 Depreciation
1077 Client Activities/Recreation
OPERATING EXPENSES TOTAL
FINANCIAL SERVICES EXPENSES·
1080 Accounting/Bookkeeping
1081 External Audit
1082 Liability Insurance
1083 Administrative Overhead
1084 Payroll Services
1085 Professional Liability Insurance
FINANCIAL SERVICES TOTAL
Exhibit C
Page 14 of20
$50,816
$7,000
$33,240
$16,738
$0
$107,794
$23,484
$1,288
$1,250
$6,000
$3,500
$1,500
$10,300
$5,150
$5,665
$5,150
$1,500
$0
$126,772
$5,500
$12,000
$0
$1,380
$15,450
$225,889
$0
$2,500
$5,665
$549,816
$0
$0
$557,981
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)
1091 Translation Services
1092 Medication Supports
SPECIAL EXPENSES TOTAL
FIXED ASSETS·
1190 Computers & Software
1191 Furniture & Fixtures
FIXED ASSETS TOTAL
NON MEDI-CAL CLIENT SUPPORT EXPENSES·
2000 Client Housing Support Expenditures (SFC 70)
2001 Client Housing Operating Expenditures (SFC 71)
2002.1 Clothing, Food & Hygiene (SFC 72)
2002.2 Client Transportation & Support (SFC 72)
2002.3 Education Support (SFC 72)
2002.4 Employment Support (SFC 72)
2002.5 Respite Care (SFC 72)
2002.6 Household Items
2002.7 Utility Vouchers {SFC 72)
2002.8 Child Care (SFC 72)
NON MEDI-CAL CLIENT SUPPORT TOTAL
Exhibit C
Page 15 of20
$0
$6,180
$83,430
$89,610
$3,000
$0
$3,000
$535,600
$8,240
$29,870
$18,540
$6,180
$3,090
$0
$1,500
$1,500
$1,500
$606,020
TOTAL PROGRAM EXPENSES $4,215,259
Units of
MEDI-CAL REVENUE: Service
3000 Mental Health Services (Individual/Family/Group Therapy) 105,525
3100 Case Management 194,005
3200 Crisis Services 11,549
3300 Medication Support 176,640
3400 Collateral 11,878
3500 Plan Development 5,888
3600 Assessment 14,943
3700 Rehabilitation 820,317
Estimated Medi-Cal Billing Totals 1,340,745
Estimated % of Federal Financial Participation Reimbursement
(50%) Regular M/C Title XIX
Estimated% of ACA Aid Codes Reimbursement (94% Year 2018, 93% 2019)
MEDI-CAL REVENUE TOTAL
OTHER REVENUE·
4000 Other -Client Rents
OTHER REVENUE TOTAL
MHSA FUNDS·
5000 Prevention & Early Intervention Funds
5100 Community Services & Supports Funds
5200 Innovation Funds
5300 Workforce Education & Training Funds
MHSA FUNDS TOTAL
Exhibit C
Page 16 of20
Rate $Amount
$2.12 $223,713
$1.45 $281,307
$2.81 $32,453
$3.90 $688,896
$2.12 $25,181
$2.12 $12,483
$2.12 $31,679
-$1,739,072
$3,034,784
70.00% $1,062,174
30.00% $851,257
$1,913,431
$65,000
$65,000
$0
$2,236,828
$0
$0
$2,236,828
TOTAL PROGRAM REVENUE $4,215,259
Budget Categories -
Adult Full Service Partnership Program
Turning Point of Central California, Inc.
Fiscal Year 2019-20
Line Item Description (Must be itemized) FTE% Admin.
PERSONNEL SALARIES:
0001 Program DirectorfTeam Leader 100.00
0002 Assistant Program Director 100.00
0003 Psychiatrist 100.00
0004 Personal Services Coordinator Supervisor 100.00
0005 Dual Diagnosis Mental Health Specialist 300.00
0006 Education & Employment Mental Health Spec. 300.00
0007 Criminal Justice/Group Facilitator MHS 200.00
0008 Parent Partner/Consumer Advocate PSC 300.00
0009 Peer Specialist Personal Services Coordinator 100.00
0010 Personal Services Coordinator (PSC) 600.00
0011 Mental Health Professionals 300.00
0012 Peer Support Specialist 200.00
0013 Registered Nurse 100.00
0014 LVN 200.00
0015 Housing Coordinator 100.00
0016 Secretary/Medical Records/Billing/Bookkeeper 400.00
SALARY TOTAL 3500.00 $0
PAYROLL TAXES:
0030 OASDI
0031 FICA/MEDICARE
0032 SUI
PAYROLL TAX TOTAL $0
EMPLOYEE BENEFITS:
0040 Retirement
0041 Workers Compensation
0042 Health Insurance (medical, vision, life, dental)
EMPLOYEE BENEFITS TOTAL $0
SALARY & BENEFITS GRAND TOTAL
Exhibit C
Page 17 of20
Total Proposed Budget
Direct Total
$95,335 $95,335
$85,792 $85,792
$392,454 $392,454
$51,677 $51,677
$146,598 $146,598
$146,598 $146,598
$97,732 $97,732
$123,355 $123,355
$41,118 $41,118
$246,711 $246,711
$234,808 $234,808
$65,064 $65,064
$78,269 $78,269
$103,329 $103,329
$50,657 $50,657
$160,495 $160,495
$2,119,994 $2,119,994
$24,200 $24,200
$108,035 $108,035
$30,729 $30,729
$162,964 $162,964
$26,000 $26,000
$13,568 $13,568
$378,895 $378,895
$418,463 $418,463
$2,701,421
FACILITIES/EQUIPMENT EXPENSES·
1010 Rent/Lease Building
1011 Rent/Lease Equipment/Maintenance
1012 Utilities
1013 Building Maintenance
1014 Equipment purchase
FACILITY/EQUIPMENT TOTAL
OPERATING EXPENSES·
1060 Telephone
1061 Security
1062 Postage
1063 Printing/Reproduction
1064 Publications
1065 Legal Notices/ Advertising/Recruiting
1066 Office Supplies & Equipment
1067 Household Supplies
1068 Building Insurance
1069 Program Supplies -Therapeutic
1070 Licenses
1071 Transportation of Clients
1072 Staff Mileage/vehicle maintenance/lease
1073 Staff Travel (Out of County)
1074 Staff Training/Registration
1075 Lodging
1076 Depreciation
1077 Client Activities/Recreation
OPERATING EXPENSES TOTAL
FINANCIAL SERVICES EXPENSES·
1080 Accounting/Bookkeeping
1081 External Audit
1082 Liability Insurance
1083 Administrative Overhead
1084 Payroll Services
1085 Professional Liability Insurance
FINANCIAL SERVICES TOTAL
Exhibit C
Page 18 of20
$52,296
$7,000
$34,208
$17,225
$0
$110,729
$24,168
$1,325
$1,250
$6,000
$3,500
$1,500
$10,600
$5,300
$5,830
$5,300
$1,500
$0
$130,465
$5,500
$12,000
$0
$1,380
$15,900
$231,518
$0
$2,500
$5,830
$565,613
$0
$0
$573,943
SPECIAL EXPENSES (Consultant/Etc.):
1090 Consultant (network & data management)
1091 Translation Services
1092 Medication Supports
SPECIAL EXPENSES TOTAL
FIXED ASSETS:
1190 Computers & Software
1191 Furniture & Fixtures
FIXED ASSETS TOTAL
NON MEDI-CAL CLIENT SUPPORT EXPENSES·
2000 Client Housing Support Expenditures (SFC 70)
2001 Client Housing Operating Expenditures (SFC 71)
2002.1 Clothing, Food & Hygiene (SFC 72)
2002.2 Client Transportation & Support (SFC 72)
2002.3 Education Support (SFC 72)
2002.4 Employment Support (SFC 72)
2002.5 Respite Care (SFC 72)
2002.6 Household Items
2002.7 Utility Vouchers (SFC 72)
2002.8 Child Care (SFC 72)
NON MEDI-CAL CLIENT SUPPORT TOTAL
Exhibit C
Page 19of20
$0
$6,360
$85,860
$92,220
$3,000
$0
$3,000
$551,200
$8,480
$30,740
$19,080
$6,360
$3,180
$0
$1,500
$1,500
$1,500
$623,540
TOTAL PROGRAM EXPENSES $4,336,371
Units of
MEDI-CAL REVENUE: Service
3000 Mental Health Services (Individual/Family/Group Therapy) 105,525
3100 Case Management 194,005
3200 Crisis Services 11,549
3300 Medication Support 176,640
3400 Collateral 11,878
3500 Plan Development 5,888
3600 Assessment 14,943
3700 Rehabilitation 820,317
Estimated Medi-Cal Billin Totals 1,340,745
Estimated % of Federal Financial Participation Reimbursement
(50%) Regular M/C Title XIX
Estimated% of ACA Aid Codes Reimbursement 93% Year 2019, 90%2020
MEDI-CAL REVENUE TOTAL
OTHER REVENUE·
4000 Other -Client Rents
OTHER REVENUE TOTAL
MHSA FUNDS·
5000 Prevention & Early Intervention Funds
5100 Community Services & Supports Funds
5200 Innovation Funds
5300 Workforce Education & Training Funds
MHSA FUNDS TOTAL
Exhibit C
Page20 of20
Rate $Amount
$2.12 $223,713
$1.45 $281,307
$2.81 $32,453
$3.90 $688,896
$2.12 $25,181
$2.12 $12,483
$2.12 $31,679
$1,739,072
$3,034,784
70.00% $1,062,174
30.00% $833,048
$1,895,223
$65,000
$65,000
$0
$2,376,148
$0
$0
$2,376,148
TOTAL PROGRAM REVENUE $4,336,371
Exhibit D
Page 1 of3
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTORCODEOFCONDUCTANDETHICS
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:
I. 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 of3
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.
I 0. 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 ifthey become or may become an Ineligible person
and therefore excluded from participation in the Federal Health Care Programs.
Exhibit D
Page 3 of3
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: 0 Psychiatrist 0 Psychologist 0 LCSW 0 LMFT
Signature : ______________ _ Date : _/ __ /_
For Group or Organizational Providers
GroupiOrg. Name (print):----------------
Employee Name (print):----------------
Discipline: 0 Psychiatrist 0 Psychologist 0 LCSW 0 LMFT
0 Other:. _______________ _
Job Title (if different from Discipline): __________ _
Signature: Date: I I --------------
Documentation Standards For Client Records
Exhibit E
Page 1 of3
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
I. 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 five axis diagnosis from the most current DSM, or a diagnosis from the most current lCD,
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
eli ent' s condition.
• Client conditions will be assessed at least annually and, in most cases, at more frequent
intervals.
B. Client Plans
I. Client plans will:
0374 d dbh
• have specific observable and/or specific quantifiable goals
• identify the proposed type(s) of intervention
• have a proposed duration ofintervention(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
Exhibit E
Page 2 of3
* when the client plan is used to establish that the services are provided under the direction of an
approved category of staff, and ifthe 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
I. 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
• 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
0374 d dbh
2. Timeliness/Frequency of Progress Notes:
Exhibit E
Page 3 of3
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
0374 d dbh
FULL SERVICE PARTNERSHIP
Adult Partnership Assessment Form
FOR AGES 26-59 YEARS
PARTNERSHIP INFORMATION
County
CSI County Client Number (CCN)
County Partner ID (optional)
Partner's First Name
Partner's Last Name
Partnership Date (mm/dd/yyyy)
Partner's Date of Birth (mm/ddlyyyy)
Who referred the partner? (mark one)
r Self
r Family Member (e.g., parent, guardian, sibling, aunt,
uncle, grandparent, child)
r Significant Other (e.g., boyfriend I girlfriend, spouse)
r Friend I Neighbor (i.e., unrelated other)
r School
r Primary Care I Medical Office
ADMINISTRATIVE INFORMATION
PARTNERSHIP STATUS
Provider Number I NPI (Optional)
Full Service Partnership Program ID
Partnership Service Coordinator ID
PROGRAM INFORMATION
In which additional program(s) is the partner CURRENR Y
involved? (mark all that apply)
A82034
Governor's Homeless Initiative (GHI)
MHSA Housing Program
r Emergency Room
r Mental Health Facility I
Community Agency
r Social Services Agency
r Substance Abuse Treatment
Facility I Agency
r Faith-based Organization
r Other County I Community
Agency
r
r
r
*
*
*
*
*
Exhibit F
Page I ofl6
ADULT PAF
5/1/07
r Homeless Shelter
r Street Outreach
r Jail I Prison
r Acute Psychiatric I State
Hospital
r Other
*
*
1
Exhibit F
Page 2 of 16
RESIDENTIAL INFORMATION -includes hosQitalization and incarceration
DURING
DURING THE THE PAST
YESTERDAY PAST12 12 PRIOR TO
MONTHS MONTHS THE LAST
SETTING TONIGHT
(as of11:59 INDICATE THE INDICATE 12
p.m the day THE MONTHS
BEFORE TOTAL TOTAL (mark all #
partnership) OCCURRENCES
#DAYS that apply)
(must=
365 days)
GENERAL LIVING ARRANGEMENT
In an apartment or house alone I with spouse I partner I
minor children I other dependents I roommate -must hold (~ (~ D D r
lease or share in rent I mortgage
With one or both biological/ adoptive parents (~ (~ D D r
With adult family member(s) other than parents \ \ D D I
Single Room Occupancy (must hold lease)
,~ (~ D D r
SHELTER/H~ELESS
Emergency Shelter I Temporary Housing (includes people (~ (~ D D r
living with friends but paying no rent)
Homeless (includes people living in their cars) ( D D r
SUPERVISED PLACEMENT
Unlicensed but supervised individual placement (includes r• ( D D I \
paid caretakers, personal care attendants}
Assisted Living Facility ( -~ ( D D r
Unlicensed but supervised congregate placement (includes (~ c· D D r
group living homes, sober living homes)
Licensed Community Care Facility (Board and Care)
(~ ( D D I
HOSPITAL
Acute Medical Hospital r ( D D I
Acute Psychiatric Hospital/ Psychiatric Health Facility (PHF)
(~ (~ D D r
State Psychiatric Hospital (
~ ( D D r
RESIDEN11AL PROGRAM
Licensed Residential Treatment (includes crisis, short-term, D D long-term, substance abuse, dual diagnosis residential ,~ (~ I \
programs)
Skilled Nursing Facility (physical) (~ (~ D D I
Skilled Nursing Facility (psychiatric) (~ ( -~ D D r
Long-Term Institutional Care [Institution for Mental Disease ( D D r
(IMD), Mental Health Rehabilitation Center (MHRC)]
2
RESIDI:NTIAL INFORMATIQN -includes hospitalization and incarceration (Continued)
JUSTICE PLACEMENT
Jail r r
Prison
OTHER
Other r r
Unknown r r
EDUCATION
Highest level of education completed:
D
D
D
D
Exhibit F
Page 3 of 16
D
D
D
D
r
r
r
r
r No High School Diploma I No GED r Associate's Degree (e.g., A.A., A.S.) I Technical or Vocational
Degree
r GED Coursework
r High School Diploma I GED
r Some College I Some Technical or Vocational
Training
For the educational settings below, indicate where the
partner .....
Not in school of any kind
High School/ Adult Education
Technical/ Vocational School
Community College I 4 year College
Graduate School
Other
( Bachelor's Degree (e.g., B.A., B.S.)
( Master's Degree (e.g., M.A., M.S.)
r Doctoral Degree (e.g., M.D., Ph.D.)
was DURING THE PAST 12
MONTHS
#of weeks
D
D
D
D
D
D
Does one of the partner's current recovery goals include any kind of
education at this time? rYes (No
is CURRENTLY
(mark all that apply)
r
r
r
r
r
r
3
EMPLOYMENT
ExhibitF
Page4ofl6
EMPLOYMENT DURING THE PAST 12 MONTHS
Indicate the partner's employment status ...
Competitive Employment:
Paid employment in the community in a position that is also open to individuals
without a disability.
Supported Employment:
Competitive Employment (see above) with ongoing on-site or off-site job-related
support services provided.
Transitional Employment I Enclave:
Paid jobs in the community that are 1} open only to individuals with a disability AND
2) are either time-limited for the purpose of moving to a more permanent job OR are
part of a group of disabled individuals who are working as a team in the midst of
teams of non-disabled individuals who are performing the same work.
Paid In-House Work (Sheltered Workshop I Work Experience I Agency-Owned Business):
Paid jobs open only to program participants with a disability. A Sheltered Workshop
usually offers sub-minimum wage work in a simulated environment. A Work
Experience (Adjustment) Program within an agency provides exposure to the
standard expectations and advantages of employment. An Agency-Owned Business
serves customers outside the agency and provides realistic work experiences and
can be located at the program site or in the community.
Non-paid (Volunteer) Work Experience:
Non-paid (volunteer) jobs in an agency or volunteer work in the community that
provides exposure to the standard expectations of employment.
Other Gainful/ Employment Activity:
Any informal employment activity that increases the partner's income (e.g., recycling,
gardening, babysitting) OR participation in formal structured classes and I or
workshops providing instruction on issues pertinent to getting a job. (Does NOT
include such activities as panhandling or illegal activities such as prostitution.)
Unemployed
#OF
WEEKS
AVERAGE AVERAGE
HOURS per HOURLY
WEEK WAGE
...__ _ __.1 ..... 1 _ ___,I $.__1 _ ___.
..__ _ __,1._1 --~
4
CURRENT EMPLOYMENT
Indicate the partner's employment status ...
Competitive Employment:
Paid employment in the community in a position that is also open to individuals without a
disability.
Supported Employment:
Competitive Employment (see above) with ongoing on-site or off-site job-related support
services provided.
Transitional Employment I Enclave:
Paid jobs in the community that are 1) open only to individuals with a disability AND 2)
are either time-limited for the purpose of moving to a more permanent job OR are part of
a group of disabled individuals who are working as a team in the midst of teams of non-
disabled individuals who are performing the same work.
Paid In-House Work (Sheltered Workshop I Work Expertence I Agency..Qwned Business):
Paid jobs open only to program participants with a disability. A Sheltered Workshop
usually offers sub-minimum wage work in a simulated environment. A Work Experience
(Adjustment) Program within an agency provides exposure to the standard expectations
and advantages of employment. An Agency-Owned Business serves customers outside
the agency and provides realistic work experiences and can be located at the program
site or in the community.
Non-paid (Volunteer) Work Experience:
Non-paid (volunteer) jobs in an agency or volunteer work in the community that provides
exposure to the standard expectations of employment.
Other Gainful/ Employment Activity:
Any informal employment activity that increases the partner's income (e.g., recycling,
gardening, babysitting) OR participation in formal structured classes and I or workshops
providing instruction on issues pertinent to getting a job. (Does NOT include such
activities as panhandling or illegal activities such as prostitution.)
The partner is not employed at this time.
Does one of the partner's current recovery goals include any kind of
employment at this time?
r
rYes I No
AVERAGE
HOURS per
WEEK
Exhibit F
PageS ofl6
AVERAGE
HOURLY WAGE
$1'-------'
$1'-------..J
5
SOURCES OF FINANCIAL SUPPORT
Indicate all the sources of financial support used to meet the needs of the partner:
Partner's Wages
Partner's Spouse I Significant Other's Wages
Savings
Other Family Member I Friend
Retirement I Social Security Income
Veteran's Assistance Benefits
Loan I Credit
Housing Subsidy
General Relief I General Assistance
Food Stamps
Temporary Assistance for Needy Families (TANF)
Supplemental Security Income I State Supplementary Payment (SSII SSP) Program
Social Security Disability Insurance (SSDI)
State Disability Insurance (SDI)
American Indian Tribal Benefits (e.g., per capita, revenue sharing, trust disbursements)
Other
No Financial Support
DURING THE
PAST 12 MONTHS
(mark all that
apply)
r
r
r
r
r
r
r
r
r
r
r
r
r
r
r
r
r
ExhibitF
Page 6 of 16
CURRENTLY
(mark all that
apply)
r
r
r
r
r
r
r
r
r
r
r
r
r
r
r
r
r
6
LEGAL ISSUES I DESIGNATIONS
JUSTICE SYSTEM INVOLVEMENT
ARREST INFORMATION
Indicate the number of times the partner was arrested DURING THE PAST 12 MONTHS: L.l _____ _.
Was the partner arrested anytime PRIOR TO THE LAST 12 MONTHS?
PROBATION INFORMATION
Is the partner CURRENTLY on probation?
Was the partner on probation DURING THE PAST 12 MONTHS?
Was the partner on probation anytime PRIOR TO THE LAST 12 MONTHS?
PAROLE INFORMATION
Was the partner on any kind of parole DURING THE PAST 12 MONTHS?
Was the partner on any kind of parole anytime PRIOR TO THE LAST 12 MONTHS?
CONSERVATORSHIP I PAYEE INFORMATION
CONSERVATORSHIP INFORMATION
Is the partner CURRENTLY on conservatorship?
Was the partner on conservatorship DURING THE PAST 12 MONTHS?
Was the partner on conservatorship anytime PRIOR TO THE LAST 12 MONTHS?
PAYEE INFORMATION
Does the partner CURRENTLY have a payee?
Did the partner have a payee DURING THE PAST 12 MONTHS?
Did the partner have a payee anytime PRIOR TO THE LAST 12 MONTHS?
CUSTODY INFORMATION
Indicate the total number of children the partner has who are CURRENlL Y:
Placed on W & I Code 300 Status:
(Dependent of the court)
Placed in Foster Care:
Legally Reunified with partner:
Adopted out:
r Yes r No
r Yes r No
r Yes r No
rYes r No
r Yes r No
r Yes r No
rYes r No
rYes r No
rYes r No
r Yes r No
r Yes r No
rYes r No
Exhibit F
Page 7of16
7
EMERGENCY INTERVENTION
Exhibitf
Page 8 of 16
Please indicate the number of emergency interventions (e.g., emergency room visit, crisis stabilization unit) the partner had
DURING THE PAST 12 MONTHS that were:
Physical Health Related
Mental Health I Substance Abuse Related
HEALTH STATUS
Does the partner have a primary care physician CURRENTLY?
{Yes r No
Did the partner have a primary care physician DURING THE PAST 12 MONTHS? {Yes r No
SUBSTANCE ABUSE
In the opinion of the partnership service coordinator. has the partner ever had a co-r Yes r No
occurring mental illness and substance use problem?
In the opinion of the partnership service coordinator, does the partner CURRENTLY have r Yes r No
an active co-occurring mental illness and substance use problem?
Is the partner CURRENTLY receiving substance abuse services? r Yes r No
COUNTY USE QUESTIONS
COUNTY USE QUESTIONS
To be tracked on the KEY EVENT TRACKING form:
County Use Field # 1
County Use Field # 2
County Use Field # 3
To be tracked on the QUARTERLY ASSESSMENT form:
County Use Field # 1
County Use Field # 2
County Use Field # 3
VALUES
8
PARTNER$HIP INFORMATION
County
CSI County Client Number (CCN)
County Partner ID (optional)
FULL SERVICE PARTNERSHIP
Adult Key Event Tracking Form
FOR AGES 26-59 YEARS
•
Partner's First Name •
Partner's Last Name •
Date Completed (mm/dd/yyyy) •
Partner's Date of Birth (mm/dd/yyyy) •
CHANGE IN ADMINISTRATIVE INFORMATION Ski this section if there are no chan es
PARTNERSHIP STATUS
Date of Provider Number Change (mm/dd/yyyy):
/NPI
NEW Provider Number:
/NPI
Date of Full Service Partnership Program ID Change
(mm/dd/yyyy):
NEW Full Service Partnership Program ID:
Date of Partnership Service Coordinator ID Change
(mm/dd/yyyy):
NEW Partnership Service Coordinator ID:
ExhibitF
n .. n .-e r. -.,.
ADULT KET
5/1/07
1
CHANG!:: IN ADMINISTRATIVE INFORMATION (Skip this ~lion ifth~trl! af'l! noch41ng1t5) (Continued)
Date of Partnership Status Change (mm/dd/yyyy):
Indicate NEW partnership status:
ExhibitF
Page 10 of 16
r Discontinuation /Interruption of Full Service Partnership and I or community services I program (indicate reason below)
r Reestablishment of Full Service Partnership and I or community services I program
If there is a DISCONTINUATION I INTERRUPTION of Full Service Partnership and I or community
services I program, indicate the reason (mark one):
r Target population criteria are not met.
r Partner decided to discontinue Full Service Partnership participation after partnership established.
r Partner moved to another county I service area.
r After repeated attempts to contact partner, s/he cannot be located.
r Community services I program interrupted -Partner's circumstances reflect a need for residential/ institutional mental
health services at this time [such as an Institution for Mental Disease (I MD), Mental Health Rehabilitation Center (MHRC),
State Hospital].
r Community services 1 program interrupted -Partner will be serving JAIL sentence.
r Community services I program interrupted -Partner will be serving PRISON sentence.
r Partner has successfully met his I her goals such that discontinuation of Full Service Partnership is appropriate.
r Partner is deceased.
PROGRAM INFORMATION
Program Name
AB2034
Governor's Homeless Initiative (GHI)
MHSA Housing Program
Date of Program Change
(mm/ddlyyyy) Currently Involved?
r Now enrolled in the AB2034 Program
r No longer participating in the AB2034 Program
r Now enrolled in the GHI Program
r No longer participating in the GHI Program
r Now enrolled in the MHSA Housing Program
r No longer participating in the MHSA Housing
Program
2
Exhibit F
Page II ofl6
RESIDENTIAL INFORMATION -includes hospitalization and incarceration (Skip this section if there are no changes)
Date of Residential Status Change (mm/dd/yyyy):
SEmNG
GENERAL LIVING ARRANGEMENT
In an apartment or house alone I with spouse I partner I minor children I
other dependents I roommate -must hold lease or share in rent I mortgage
With one or both biological I adoptive parents
With adult family member(s) other than parents
Single Room Occupancy (must hold lease)
SHELTER I HOMELESS
Emergency Shelter I Temporary Housing (includes people living with friends
but paying no rent)
Homeless (includes people living in their cars)
SUPERVISED PLACEMENT
Unlicensed but supervised individual placement (includes paid caretakers,
personal care attendants)
Assisted Living Facility
Unlicensed but supervised congregate placement (includes group living
homes, sober living homes)
Licensed Community Care Facility (Board and Care)
HOSPITAL
Acute Medical Hospital
Acute Psychiatric Hospital/ Psychiatric Health Facility (PHF)
State Psychiatric Hospital
RESIDENTIAL PROGRAM
Licensed Residential Treatment (includes crisis, short-term, long-term,
substance abuse, dual diagnosis residential programs)
Skilled Nursing Facility (physical)
Skilled Nursing Facility (psychiatric)
Long-Term Institutional Care [Institution for Mental Disease (IMD), Mental
Health Rehabilitation Center (MHRC)]
JUSTICE PLACEMENT
Jail
OTHER
Other
Unknown
Indicate the new residential status (mark one):
(~
c·
(~
3
EDUCATION (Skip this section if there are no changes)
GRADE LEVEL INFORMATION
Date of Grade Level Completion (mm/dd/yyyy):
Level of education completed:
Exhibit F
Page 12 ofl6
r No High School Diploma I No GED r Associate's Degree (e.g., A.A., A.S.) I Technical or Vocational
Degree
r GED Coursework
r High School Diploma I GED
r Bachelor's Degree (e.g., B.A., B.S.)
r Master's Degree (e.g., M.A., M.S.)
r Some College I Some Technical or Vocational
Training
r Doctoral Degree (e.g., M.D., Ph.D.)
EDUCATIONAL SETTING INFORMATION
Date of Educational Setting Change (mm/dd/yyyy):
If there are any educational setting changes, indicate ALL new
and ongoing statuses including those previously reported.
Not in school of any kind
High School/ Adult Education
Technical/ Vocational School
Community College I 4 year College
Graduate School
Other
If stopping school, did the partner complete a class and/or
program?
Does one of the partner's current recovery goals include any
kind of education at this time?
rYes r No
rYes r No
Setting
r
r
r
r
r
r
4
EMPLOYMENT (Skio this section if there are no chanaes)
Date of Employment Change (mm/ddlyyyy):
CURRENT EMPLOYMENT
If there are any changes to the partner's employment, Indicate ALL new and ongoing
statuses Including those previously reported.
Competitive Employment:
Paid employment in the community in a position that is also open to individuals without a
disability.
Supported Employment:
Competitive Employment (see above) with ongoing on-site or off-site job-related support
services provided.
Transitional Employment I Enclave:
Paid jobs in the community that are 1) open only to individuals with a disability AND 2)
are either time-limited for the purpose of moving to a more permanent job OR are part of
a group of disabled individuals who are working as a team in the midst of teams of non-
disabled individuals who are performing the same work.
Paid In-House Work (Sheltered Workshop I Work Experience I Agency-Owned Business):
Paid jobs open only to program participants with a disability. A Sheltered Workshop
usually offers sub-minimum wage work in a simulated environment. A Work Experience
(Adjustment) Program within an agency provides exposure to the standard expectations
and advantages of employment. An Agency-Owned Business serves customers outside
the agency and provides realistic work experiences and can be located at the program
site or in the community.
Non-paid (Volunteer) Work Experience:
Non-paid (volunteer) jobs in an agency or volunteer work in the community that provides
exposure to the standard expectations of employment.
Other Gainful/ Employment Activity:
Any informal employment activity that increases the partner's income (e.g., recycling,
gardening, babysitting) OR participation in formal structured classes and I or workshops
providing instruction on issues pertinent to getting a job. (Does NOT include such
activities as panhandling or illegal activities such as prostitution.)
The partner is not employed at this time.
Does one of the partner's current recovery goals include any
kind of employment at this time?
r
(Yes I No
AVERAGE
HOURS per
WEEK
Exhibit F
Page 13 of 16
AVERAGE
HOURLY WAGE
$1L-_ ____,
$L-I ----~
sL..I __ _.
sL..I __ _.
5
LEGAL ISSUES I DESIGNATIONS Ski this section if there are no chan es
ARREST INFORMA llON
Date Partner Arrested (mm/ddlyyyy):
PROBA llON INFORMA llON
Date of Probation Status Change (mmlddlyyyy):
Indicate new probation status:
CONSERVATORSHIP IN FORMA llON
Date of Conservatorship Status Change (mm/ddlyyyy):
Indicate new conservatorship status:
PAYEE IN FORMA llON
Date of Payee Status Change (mm/ddlyyyy):
Indicate new payee status:
r Removed from Probation
r Placed on Probation
r Removed from conservatorship
r Placed on conservatorship
r Removed from payee status
r Placed on payee status
EMERGENCY INTERVENTION Ski this section if there are no chan es
Date of Emergency Intervention (mm/ddlyyyy):
Indicate the type of emergency intervention: (e.g., emergency room
visit, crisis stabilization unit)
COUNTY USE QUESTIONS _LSkio this section if there are no chamteU.
r Physical Health Related
r Mental Health I Substance Abuse
Related
ExhibitF
Page 14 ofl6
COUNTY USE QUESTIONS
DATE of CHANGE
(mm/dd/yyyy) NEW VALUE
County Use Field # 1
County Use Field # 2
County Use Field # 3
6
PARTNERSHIP INFORMATION
County
CSI County Client Number (CCN)
County Partner 10 (optional)
Partner's First Name
Partner's Last Name
Date Completed (mm/ddlyyyy)
Partner's Date of Birth (mm/ddlyyyy)
SOURCES OF FINANCIAL SUPPORT
FULL SERVICE PARTNERSHIP
Adult Quarterly Assessment Form
FOR AGES 26-59 YEARS
Indicate all the sources of financial support used to meet the needs of the partner:
Partner's Wages
Partner's Spouse I Significant Other's Wages
Savings
Other Family Member I Friend
Retirement I Social Security Income
Veteran's Assistance Benefits
Loan I Credit
Housing Subsidy
General Relief I General Assistance
Food Stamps
Temporary Assistance for Needy Families (TANF)
Supplemental Security Income I State Supplementary Payment (SSII SSP) Program
Social Security Disability Insurance (SSDI)
State Disability Insurance (SOl)
American Indian Tribal Benefits (e.g., per capita, revenue sharing, trust disbursements)
Other
No Financial Support
*
*
*
*
*
ExhibitF
lnurf3M
5/1/07
CURRENTI.Y
(mark all that apply)
r
r
I
r
r
r
I
r
r
r
I
r
r
r
I
I
r
1
LEGAL ISSUES I DESIGNATIONS
CUSTODY INFORMATION
Indicate the total number of children the partner has who are CURRENTLY:
Placed on W & I Code 300 Status:
(Dependent of the court)
Placed in Foster Care:
Legally Reunified with partner:
Adopted out:
HEALTH STATUS
Does the partner have a primary care physician CURRENTLY?
SUBSTANCE ABUSE
rYes ! No
In the opinion of the partnership service coordinator, does the partner CURRENTLY have r Yes r No
an active co-occurring mental illness and substance use problem?
Is the partner CURRENTLY receiving substance abuse services?
COUNTY USE QUESTIONS
COUNTY USE QUESTIONS
County Use Field # 1
County Use Field # 2
County Use Field # 3
rYes r No
NEW VALUE
Exhibit F
Page 16 of 16
2
PROGRAM OUTCOMES
PROGRESS REPORTS
Exhibit G
Page 1 of2
The following items listed below represent program goals to be achieved by the
selected contractor, in addition to contractor-developed outcomes. The program's
success will be based on the number of goals it can achieve, resulting from
performance outcomes. The selected contractor will utilize a computerized tracking
system with which outcome measures and other relevant client data, such as
demographics, will be maintained.
1. Reduction in frequency of hospitalizations for each client. Each client will show
a 70% reduction in hospitalization after one year of receiving services, or upon
discharge. Reports and data will be submitted on a monthly basis.
2. Reduction in frequency of homelessness for each client. Each client will show
an 80% reduction in days spent homeless after one year of receiving services
or upon discharge. Reports and data will be submitted on a monthly basis.
3. Reduction in frequency of incarceration for each client. Each client will show an
80% reduction in days spent incarcerated, after one year of receiving services.
Each additional year will show an additional 5% reduction. Reports and data
will be submitted on a monthly basis.
4. Provision of the appropriate level of housing support, reflective of each client's
needs. Each client in need of housing will receive assistance in housing
placement and support -including emergency housing -contingent upon level
of need and independent functioning. Each client will have stable housing upon
discharge. Reports and data will be submitted on a monthly basis.
5. Provision of satisfactory services as demonstrated through satisfaction surveys,
complaint forms, grievance forms, and a bi-annual Performance Outcome
Improvement survey. Reports and data will be submitted on a monthly or
annual basis, respectively.
6. Provision of services and support that are reflective of each client's needs.
Each client will increase their level of functioning and, within one year of
treatment (or as clinically appropriate), will transition to a lower level of service
within the program. Reports and data will be submitted on a monthly basis.
7. Provision of services helping each client to achieve a level of recovery, stability,
and independence that will allow transition to the least restrictive level of care
possible. Written reports will be submitted on a quarterly basis.
8. Provision of services which will assist clients in setting their goals and
generating a Plan of Care which includes personalized well ness goals. These
goals will be evaluated, monitored, and adjusted regularly. Written reports will
be submitted on a quarterly basis.
9. Collaborative relationships established and maintained with agencies and
individuals who have frequent contact with hospitalized, homeless, or
incarcerated adults.
Exhibit G
Page2 of2
10. Contractor will complete quarterly reports, as mandated by the State for FSPs.
Reports shall be made directly into the FSP Data Collection and Reporting
(OCR) system.
11. Direct Services productivity rate is expected to be at a minimum of seventy-five
percent (75%) and reported in writing at regularly scheduled meetings within
the Department.
12. Services provided to each client will be identified on a monthly basis, as
needed by the Department, including recreational and social activities and
linkages provided to clients such as the County's Job Option Program. This
information will be provided to the designated Division Manager in a monthly
report.
Reporting Documents:
Annual, Quarterly, and monthly reports requested by the County, and utilized by the
Contractor to measure program goals/success are to be developed by the Contractor
and approved by the Department of Behavioral Health (DBH) Director and/or designee.
Additional program outcomes developed by County and/or Contractor will be established
and approved by DBH during the term of the Agreement.
STATE MENTAL HEALTH REQUIREMENTS
Exhibit H
Page I of2
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
AJI (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 141 00.2, 11977, 11812, 5328; Division
10.5 and 10.6 ofthe California Health and Safety Code; Title 22, California Code
of Regulations, section 51 009; 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
0374 fdbh
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 H
Page 2 of2
rates of pay or other forms of compensation, use of facilities, and other
terms and conditions of employment.
C. Suspension of Compensation
If an allegation of discrimination occurs, COUNTY may withhold all
further funds, until CONTRACTOR can show clear and convincing
evidence to the satisfaction of COUNTY that funds provided under this
Agreement were not used in connection with the alleged discrimination.
D. Nepotism
Except by consent of COUNTY's Department of Behavioral Health
Director, or designee, no person shall be employed by CONTRACTOR
who is related by blood or marriage to, or who is a member of the Board
of Directors or an officer of CONTRACTOR.
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
0374 fdbh
Medi-Cal Organizational Provider Standards
EXHIBIT I
Page 1 of2
I. 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 staffto 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 I, 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 I
Page 2 of2
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 ofthe community.
Fresno County Mental Health Plan
Grievances
Exhibit J
Page I of2
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 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. Box45003
Fresno, CA 93718-9886
(800) 654-3937 (for more information)
(559) 488-3055 (TIY)
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.
Exhibit J
Page 2 of2
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 90 calendar days of the date of the receipt
of the non-approval of payment.
The MHP shall have 60 calendar days from its receipt of the appeal to inform the
provider in writing of the decision, including a statement of the reasons for the
decision that addresses each issue raised by the provider, and any action
required by the provider to implement the decision.
If the appeal concerns a denial or modification of payment authorization request,
the MHP utilizes a Managed Care staff who was not involved in the initial denial
or modification decision to determine the appeal decision.
If the Managed Care staff reverses the appealed decision, the provider will be
asked to submit a revised request for payment within 30 calendar days of receipt
of the decision
Other complaints -if there are other issues or complaints, which are not related
to payment authorization issues, providers are encouraged to send a letter of
complaint to the MHP. The provider will receive a written response from the
MHP within 60 calendar days of receipt of the complaint. The decision rendered
buy the MHP is final.
FRESNO COUNTY MENTAL HEALTH PLAN
GRIEVANCES AND INCIDENT REPORTING
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
Exhibit K
Page 1 of2
• 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
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)
Exhibit K
Page 2 of2
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 0 inconsequential 0 consequential 0 death 0 not applicable 0 unknown 0
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
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. ldenti in Information
Name of entity D!BIA
Address (number, street) City
CLIA number Taxpayer ID number (EIN) Telephone number
ZIP code
Exhibit L
Page 1 of3
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
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) .......... .
YES NO
0 0
0 0
0 0
Ill. 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: o Sole proprietorship o Partnership CJ Corporation
D Unincorporated Associations o Other (specify)---------
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under "Remarks."
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
{Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers .......................................................................................................... . D D
NAME ADDRESS PROVIDER NUMBER
Exhibit L
Page 2 of3
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 es, list name, address of co ration, and EIN.
Name EIN
Address (number. name) City State
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
ZIP COde
I'" Address (number, name) I City State I ZIP COde
Exhibit L
Page 3 of3
YES NO
a a
a a
a a
a a
a a
a a
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) TiDe
Signature Date
Remarks
Exhibit M
Page I of2
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.
CERTIFICATION
ExhibitM
Page 2 of2
(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:
(Printed Name & Title)
Date:
(Name of Agency or
Company)
SElf-DEAUNG TRANSACOON DISCLOSURE FORM
Exhibit N
Page I of2
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 o 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).
(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)
Exhibit N
Page 2 of2
(4) Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a)
(5) Authorized Signature
Signature: I Date: I