HomeMy WebLinkAbout321441
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Agreement No. 15-259
AGREEMENT
THIS AGREEMENT is made and entered into this~ day of July 2015, by and between the
COUNTY OF FRESNO, a political subdivision of the State of California, hereinafter referred to as
"COUNTY", and FRESNO COUNTY HISPANIC COMMISSION ON ALCOHOL AND DRUG ABUSE
SERVICES, INC., whose service address is 1414 West Kearney Boulevard, Fresno, CA 93706, and remit to
address is 1803 Broadway Street, Fresno, CA 93721, hereinafter referred to as "PROVIDER".
WITNESSETH:
WHEREAS, COUNTY, through its Department of Behavioral Health (DBH), Contracts Division-
Substance Use Disorder (SUD) Services, has determined there is a need for certain Fresno County
residents to receive residential alcohol and substance use disorder treatment services for monolingual
Spanish-speaking men; and
WHEREAS, COUNTY is authorized to contract with privately operated agencies for the
provision of alcohol and substance use disorder treatment services, pursuant to Title 9, Division 4 of the
California Code ofRegulations and Division 10.5 (commencing with section 11750) ofthe California
Health and Safety Code; and
WHEREAS, PROVIDER is willing and able to provide these services required by COUNTY,
pursuant to the terms and conditions of this Agreement.
NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties
hereto agree as follows:
1. SERVICES
PROVIDER shall perform all services and fulfill all responsibilities for the provision of long-
term residential substance use disorder services for adult males, as identified in COUNTY's Request for
Proposal (RFP) No. 952-5338, dated March 6, 2015, Addendum No. One (1) dated April1, 2015,
hereinafter collectively referred to as COUNTY's revised RFP No. 952-5338 and PROVIDER's response to
said RFP, dated April 3, 2015, all incorporated herein by reference and made part ofthis Agreement.
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Additionally,PROVIDER shall perform all services and fulfill all responsibilities in a
manner consistent with the objectives and client outcomes identified in Exhibit A,"Scope of Work",
attached hereto and by this reference incorporated herein.
In the event of any inconsistency among these documents,the consistency shall be resolved
by giving precedence in the following priority: 1) to this Agreement,including all Exhibits;2) to the revised
RFP No.952-5338;3) to the response to the revised RFP No.952-5338.
PROVIDER must provide all necessary data to allow the COUNTY to bill Medi-Cal and/or
any other third-party source,for services and meet State and Federal reporting requirements.The necessary
data can be provided by a variety of means,including but not limited to: 1)direct data entry into
COUNTY'S information system,2)providing an electronic file compatible with COUNTY'S information
system, or 3)integration between COUNTY'S information system and PROVIDER'S information system(s).
COUNTY encourages PROVIDER to adopt and maintain Electronic Health Records (EHR)
that meet the requirements of the Health Information Technology for Economic and Clinical Health Act
(HITECH),part of the American Recovery and Reinvestment Act (ARRA)of 2009.PROVIDER shall bear
the costs associated with penalties and/or fines for non-compliance with the regulation.
2.TERM
This Agreement shall become effective on the 1st day of July,2015,and shall terminate on
the 30th day of June, 2018. This Agreement shall automatically be extended for two (2) twelve (12) month
periods, upon the terms and conditions herein set forth, unless written notice of non-renewal is given by
either PROVIDER or COUNTY no later than thirty (30) days prior to the renewal period.
3.TERMINATION
A.NON-ALLOCATION OF FUNDS - The terms of this Agreement,and the services
to be provided thereunder, are contingent on the approval of funds by the appropriating government agency.
Should sufficient funds not be allocated,the services provided may be modified,or this Agreement
terminated,at any time by giving the PROVIDER thirty (30) days advance written notice.
B.BREACH OF CONTRACT -COUNTY may immediately suspend or terminate this
Agreement in whole or in part, where in the determination of COUNTY there is:
1)An illegal or improper use of funds;
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2) A failure to comply with any term of this Agreement;
3) A substantially incorrect or incomplete report submitted to COUNTY;
4)Improperly performed service.
In no event shall any payment by COUNTY constitute a waiver by COUNTY of any breach
of this Agreement or any default which may then exist on the part of the PROVIDER. Neither shallsuch
payment impair or prejudice any remedy available to COUNTY with respect to the breach or default.
COUNTY shall have the right to demand of the PROVIDER the repayment to COUNTY of any funds
disbursed to the PROVIDER under this Agreement, which in the judgment of COUNTY were not expended
in accordance with the terms of this Agreement. The PROVIDER shall promptly refund any such funds
upon demand.
C.WITHOUT CAUSE -Under circumstances other than those set forth above,this
Agreement maybe terminated by COUNTY upongivingthirty(30)days advance written notice ofan
intention to terminate to PROVIDER.
4.COMPENSATION
COMPENSATION -For claims submitted for services rendered under this Agreement,
COUNTYagreesto pay PROVIDERand PROVIDERagreesto receive Seventy-Sixand 08/100 Dollars
($76.08) per bed day for a daily allocated bed average of 7 beds per twelve (12) month period. The daily
allocated bed average is defined as the number of beds allocated to this Agreement on a daily basis or is
also defined as the number of participants that can be served per day. Annual reimbursement per bed per
dayshallnotexceedthe above-stated dailyrate regardless of thetotal maximum compensation ofthis
Agreement.Annual increases ofno more than 1.5%ofthe previous year'scostper daily bed rate will be
reimbursed to PROVIDER per Exhibit B.
A. For the period July 1,2015 through June 30,2016,in no event shall the maximum
compensationunderthis Agreement for Substance Use Disorder Servicesexceed One Hundred Ninety-
Four Thousand Three Hundred Ninety-Three and No/100 Dollars ($194,393.00).
1) For the period July 1,2016 through June 30,2017,in no event shall the
maximum compensation under this Agreement for Substance Use Disorder Services exceed One
HundredNinety-SevenThousand Three HundredNine and No/100 Dollars ($197,309.00).
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2) For the period July 1,2017 through June 30,2018,in no event shall the
maximum compensation under this Agreement for Substance Use Disorder Services exceed Two
Hundred Thousand Two Hundred Sixty-Nine and No/100 Dollars ($200,269.00).
3) For the period July 1,2018 through June 30,2019,in no event shall the
maximum compensation under this Agreement for Substance Use Disorder Services exceed Two
Hundred Three Thousand Two Hundred Seventy-Three and No/100 Dollars ($203,273.00).
4)For the period July 1,2019 through June 30.2020,in no event shall the
maximum compensation under this Agreement for Substance Use Disorder Services exceed Two
Hundred Six Thousand Three Hundred Twenty-Two and No/100 Dollars ($206,322.00).
B. The contract maximum amount ($1,001,566.00)as identified in this agreement and
in Exhibit B may be reduced based upon State,Federal,and local funding availability.In the event of
such action,the COUNTY'S DBH Director or designee shall notify the PROVIDER in writing of the
reduction in the maximum amount within thirty (30)days.
In the event that funding for these services is delayed by the State Controller,COUNTY
may defer payment to PROVIDER.The amount of the deferred payment shall not exceed the amount of
funding delayed by the State Controller to the COUNTY.The period of time of the deferral by
COUNTY shall not exceed the period of time of the State Controller's delay of payment to COUNTY
plus forty-five (45)days.
C.PAYMENTS -PROVIDER may not exceed the above stated maximum allocated
bed days for the department.PROVIDER shall complete the year end cost report in accordance to
Section Thirty-seven (37),RECORDS,Subsection C of this Agreement at the end of the fiscal year to
reflect the actual cost and reimbursement for services provided.Regardless of the contract maximum,
PROVIDER will be reimbursed only for costs up to the negotiated bed day rate herein.Within forty-five
(45) days of the reconciliation by COUNTY.PROVIDER shall make payment to COUNTY or
COUNTY shall reimburse PROVIDER as appropriate.
Payment by COUNTY shall be in arrears,based on PROVIDER'S monthly invoices
submitted for services provided during the preceding month,within forty-five (45) days after receipt and
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verification of PROVIDER'S monthly invoices by COUNTY'S DBH, Contracts Division - SUD
Services.
For services rendered herein, PROVIDER shall assure that an on-going quality assurance
component is in placeand is occurring.PROVIDER shallassurethat clinical records foreach participant
are of suchdetail and length that a review of said record will verify that appropriateserviceswere
provided.If the record is unclear, incomplete,and/or indicatesthat appropriate serviceswerenot
provided, COUNTY reserves the right to withhold payment for the applicable unit(s)of service. It is
understoodthat all expenses incidental to PROVIDER'S performanceof services underthis Agreement
shall be borne by PROVIDER. If PROVIDER should fail to comply with any provision of this
Agreement,COUNTY shall be relieved of its obligation for further compensation. PROVIDER'S and
COUNTY'S obligations underthis section shall survive the termination of this Agreementwith respectto
services provided during the term of this Agreement without regard to the cause of termination of this
Agreement.
D.PUBLIC INFORMATION -PROVIDER shall disclose its funding source in all
public information; however, this requirement of disclosure of funding source shall not be required in
spot radio or television advertising.
E. LOBBYING ACTIVITY -PROVIDER shall not directly or indirectly use any of
the funds provided under this Agreement for publicity, lobbying, or propaganda purposes designed to
support or defeat legislation pending before the Congress of the United States or the Legislature of the
State of California.
F.POLITICAL ACTIVITY -PROVIDER shall not directly or indirectly use any of
the funds under this Agreement for any political activity or to further the election or defeat of any
candidate for public office.
G.FUNDING SOURCES - It shall be the obligation of PROVIDER to determine and
claim all revenue possible from private pay sources and third party payers.PROVIDER shall not use any
funds under this Agreement for services covered by Drug Medi-Cal or other health insurance for eligible
beneficiaries.PROVIDER shall claim all Drug Medi-Cal covered services for eligible beneficiaries
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through the Drug Medi-Cal claiming process. COUNTY will only reimburse PROVIDER for services
rendered that are not covered by Drug Medi-Cal,other insurance or other revenue sources.
PROVIDER shall not use any funds under this Agreement to the extent that a
participant is eligible for Medi-Cal,insurance or other revenue reimbursement for services rendered.
Any revenues generated by PROVIDER in excess of the amounts budgeted in this
Agreement may be utilized to expand/enhance the services during COUNTY'S fiscal years in which
revenues are collected or in the following COUNTY fiscal year.Additional revenues will be considered
separate and distinct from COUNTY'S payment to PROVIDER.The manner and means of service
expansion/enhancement shall be subject to the prior written approval of COUNTY'S DBH Director or
her designee.PROVIDER shall disclose all sources of revenue to COUNTY.Under no circumstances
will COUNTY funded staff time be used for fund-raising purposes.
H.COST OF LIVING ADJUSTMENT -PROVIDER shall not utilize any funds
provided under this Agreement for cost of living adjustments to PROVIDER'S employee compensation
in excess of what is approved in the budget submitted with the RFP response.
I.PROVIDER agrees to limit annual administrative costs paid through this
Agreement to a maximum of fifteen percent (15%)of the total annual program budget.Administrative
costs include all non-direct service personnel such as executive directors,clerical staff and fiscal staff
and identified corporate overhead.Employee benefits shall not exceed twenty percent (20%)of total
salaries for those employees working under this Agreement.Benefits shall include health insurance,
retirement,life insurance,and other optional benefits.Failure to conform to this provision will be
grounds for contract termination at the option of the County of Fresno, DBH Director or her designee.
This Section Four (4) shall in no way be construed to classify PROVIDER or PROVIDER'S officers, agents
and employees as an officer,agent,servant,employee,joint venture,partner,or associate of COUNTY,
pursuant to Section Seven (7).
5.INVOICING
PROVIDER shall invoice COUNTY by the twentieth (20th)day of each month for actual
services rendered in the previous month in accordance with the budget projections specified in Exhibit B,
attached hereto and incorporated herein by this reference.
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Invoices shall be submitted via email to SAS@co.fresno.ca.us,Subject:Attn:Staff Analyst,
as indicated in Section Seventeen (17),hereinbelow.Invoices shallbe accompanied bya monthly
participant roster and other reports and documentation as indicated in Section Seventeen (17).These will be
in a form and in such detail as acceptable to COUNTY'S DBH - SUD Services. No reimbursement for
services shall be made until the invoice is received, reviewed and approved by COUNTY'S DBH-SUD
Services.
If an invoice is incorrect or is otherwise not in proper form or substance, COUNTY'S DBH,
Director or designee shall have the right to withhold payment as to only that portion of the invoicethat is
incorrector improperafter five (5)days priornoticeto PROVIDER. PROVIDER agreesto continueto
provide services for a period of ninety (90) days after notification of an incorrect or improper invoice. If
after said ninety (90) day period said invoice(s)is still not corrected to COUNTY'S DBH,Director's or
designee's satisfaction, COUNTY'S DBH, Directoror designee may elect to terminate this Agreement,
pursuant to the termination provisions stated in Section Three (3)of this Agreement.In addition.
PROVIDER shall submit all invoices to COUNTY'S DBH,for services provided within ninety(90)days
after each twelve (12)month period expires or this Agreement is terminated.If invoices are not submitted
within ninety (90) days after each twelve (12)month period expires or this Agreement is terminated,
COUNTY'S DBH shall have the right to deny payment on such invoices.
General ledgers for services provided during each twelve (12)month period must be received
within sixty (60) days. If general ledgers are not submitted within sixty (60) days after each twelve (12)
month period expires, or this Agreement is terminated,COUNTY'S DBH shall have the right to deny
payment on such invoices.
6.PROHIBITION ON PUBLICITY
None of the funds, materials,property or services provided directly or indirectly under this
Agreement shall be used for PROVIDER'S advertising,fundraising, or publicity (i.e., purchasing of
tickets/tables,silent auction donations,etc.) for the purpose of self-promotion.Notwithstanding the above,
publicity of the services described in Section One (1)of this Agreement shall be allowed as necessary to
raise public awareness about the availability of such specific services when approved in advance by the
Director or designee, and at a cost as provided in Exhibit B for such items as written/printed materials, the
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useof media (i.e.,radio,television,newspapers)andanyother related expense(s).
7.INDEPENDENT CONTRACTOR
Inperformanceof the work,dutiesand obligationsassumedby PROVIDER underthis
Agreement,it is mutually understood and agreed that PROVIDER,including anyandallofthe
PROVIDER'S officers,agents,and employees willat alltimesbeactingand performing asan independent
contractor,and shall actinan independent capacity andnotasan officer,agent,servant,employee,joint
venturer,partner,or associate of the COUNTY.Furthermore,COUNTYshall havenorightto control or
superviseor directthe manneror methodby whichPROVIDER shall perform itsworkand function.
However,COUNTYshallretainthe rightto administerthis Agreementso asto verifythat PROVIDERis
performing its obligations in accordance with the terms and conditions thereof.
PROVIDERand COUNTYshallcomplywithall applicableprovisionsof lawandtherules
and regulations,if any,of governmental authorities having jurisdiction over matters the subject thereof.
Because of its status asan independent contractor,PROVIDER shall have absolutely no right
to employment rights and benefits available to COUNTY employees.PROVIDER shall be solely liable and
responsible for providing to,oron behalfof,its employees all legally-required employee benefits.In
addition,PROVIDER shallbe solely responsible andsave COUNTY harmless from all matters relating to
payment of PROVIDER'S employees,including compliance with Social Security withholding andallother
regulationsgoverningsuchmatters. It is acknowledgedthat duringthe termof this Agreement,PROVIDER
may be providing services to others unrelated to the COUNTY or to this Agreement.
8.CONFLICT OF INTEREST
No officer,agent,or employeeof COUNTY whoexercisesany function or responsibility for
planning and carrying out the services provided under this Agreement shall have any direct or indirect
personal financial interest in this Agreement. PROVIDER shall comply with all Federal, Stateof
California,and localconflict of interestlaws,statutes,and regulations,which shallbe applicable to all
parties and beneficiaries under this Agreement and any officer, agent, or employee of COUNTY.
9.DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable ifthe PROVIDER is operating as a corporation(a for-profit
or non-profit corporation) or if during the term of this agreement, the PROVIDER changes its statusto
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operate as a corporation.
Members ofthe PROVIDER'S Board of Directors shall disclose any self-dealing
transactions thattheyarea party to while PROVIDER is providing goods or performing services under this
agreement.A self-dealing transaction shall mean a transaction to which the PROVIDER isa party and in
which one or more of its directors has a material financial interest.Members of the Board of Directors shall
disclose any self-dealing transactions that they are a party toby completing and signing a Self-Dealing
Transaction Disclosure Form (Exhibit C)and submitting ittothe COUNTY prior to commencing with the
self-dealing transaction or immediately thereafter.
10.PROPERTY OF COUNTY
PROVIDER shall submit purchase invoices forthe purchase of any fixed assets with their
monthly invoices.All purchases over Five Thousand and No/100 Dollars ($5,000.00),and certain purchases
under Five Thousand and No/100 Dollars ($5,000.00) such as fans, calculators, cameras, VCRs, DVDsand
other sensitive items as determined by COUNTY'S DBH Director,or designee,made during the life of this
Agreement shall be identified as fixed assets withan assigned COUNTY Accounting Inventory Number.
These fixed assets shall be retained by COUNTY,as COUNTY property,intheeventthis Agreement is
terminated or upon expiration ofthis Agreement.PROVIDER agrees to participate inan annual inventory
of all COUNTYfixedassetsand shall be physicallypresentwhen fixedassetsarereturnedto COUNTY'S
possession atthe termination or expiration ofthis Agreement.PROVIDER is responsible for returning to
COUNTY all COUNTY owned fixed assets,orthe monetary value ofsaid fixed assets if unable to produce
the fixedassetsat the expirationor terminationof this Agreement.
11.MODIFICATION
Any matters of this Agreement may be modified from time to time by the written consentof
all the parties without, in any way, affecting the remainder.
In addition, changes to this Agreement, in whole or in part, which are necessaryfor
compliancewith State of Californiaand Federallaw,shall be made bywrittenamendmentand executed by
COUNTY'S DBH Director or designee and PROVIDER.
The COUNTY'S DBH Directoror designee may modify the maximum amount to be
consistentwith availableStateand Federal funding,as statedin SectionFour(4) inthis agreement.
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12.NON-ASSIGNMENT
Neither party shall assign, transfer or sub-contract this Agreement nor their rights or duties
under this Agreement without the prior written consent of the other party.
13.HOLD HARMLESS
PROVIDER agrees to indemnify, save, hold harmless, and at COUNTY'S request, defend
the COUNTY, its officers, agents, and employees from any and all costs and expenses, damages, liabilities,
claims, and losses occurring or resulting to COUNTY in connection with the performance,or failure to
perform, by PROVIDER,its officers, agents, or employees under this Agreement, and from any and all
costs and expenses, damages, liabilities, claims, and losses occurring or resulting to any person, firm, or
corporation who may be injured or damaged by the performance,or failure to perform,of PROVIDER,its
officers, agents, or employees under this Agreement.
14.INSURANCE
Without limiting the COUNTY'S right to obtain indemnification from PROVIDER or any
third parties,PROVIDER,at its sole expense, shall maintain in full force and effect, the following insurance
policies or a program of self-insurance,including but not limited to, an insurance pooling arrangement or
Joint Powers Agreement (JPA)throughout the term of the Agreement:
A.COMMERCIAL GENERAL LIABILITY
Commercial General Liability Insurance with limits of not less than One Million
Dollars ($1,000,000.00)per occurrence and an annual aggregate of Two Million Dollars ($2,000,000.00).
This policy shall be issued on a per occurrence basis.COUNTY may require specific coverages including
completed operations,products liability,contractual liability,Explosion-Collapse-Underground,fire legal
liability or any other liability insurance deemed necessary because of the nature of this contract.
B.AUTOMOBILE LIABILITY
Comprehensive Automobile Liability Insurance with limits for bodily injury of not
less than Two Hundred Fifty Thousand Dollars ($250,000.00)per person, Five Hundred Thousand Dollars
($500,000.00)per accident and for property damages of not less than Fifty Thousand Dollars ($50,000.00),
or such coverage with a combined single limit of Five Hundred Thousand Dollars ($500,000.00). Coverage
should include owned and non-owned vehicles used in connection with this Agreement.
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C.PROFESSIONAL LIABILITY
If PROVIDER employs licensedprofessionalstaff,(e.g.,Ph.D.,R.N.,L.C.S.W.,L
M.F.T.) in providing services, Professional Liability Insurance with limits of not less than One Million
Dollars ($1,000,000.00)per occurrence,Three Million Dollars ($3,000,000.00)annual aggregate.
PROVIDERagreesthat it shall maintain,at itssole expense,in full force andeffectfora period ofthree(3)
years following the termination ofthis Agreement,oneor more policies of professional liability insurance
with limits of coverage as specified herein.
D.WORKER'S COMPENSATION
A policyof Worker's Compensation insurance asmaybe required bythe California
Labor Code.
PROVIDERshallobtainendorsementsto the CommercialGeneralLiabilityinsurance
naming the County of Fresno,its officers,agents,and employees,individually and collectively,as additional
insured,butonly insofar asthe operations under this Agreement are concerned.Such coverage for
additional insured shall apply as primary insurance andanyother insurance,or self-insurance,maintained by
COUNTY,itsofficers,agentsand employeesshallbe excess onlyand not contributingwith insurance
provided under PROVIDER'S policies herein.This insurance shallnotbe cancelled or changed without a
minimum of thirty (30) days advance written notice given to COUNTY.
Within thirty (30) days from the date PROVIDER signs this Agreement, PROVIDER shall
provide certificates of insurance and endorsements as statedaboveforallofthe foregoing policies,as
required herein, to the County of Fresno,Department of Behavioral Health,Contracts Division - Substance
Use Disorder Services at 3133 N.Millbrook Ave.,Fresno,California,93703.Attention:SUD Services Staff
Analyst,statingthatsuch insurance coverages havebeen obtained andare infull force;thatthe County of
Fresno,its officers,agentsand employees willnotbe responsible forany premiums onthe policies;thatsuch
Commercial General Liability insurance names the County of Fresno, its officers, agents and employees,
individually and collectively,as additional insured,butonly insofarasthe operations underthis Agreement
are concerned; that such coverage for additional insured shall apply as primary insurance and any other
insurance,or self-insurance,maintainedby COUNTY, its officers,agentsand employees,shall beexcess
only and not contributing with insurance provided under PROVIDER'S policies herein; and that this
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insuranceshallnot be cancelledor changedwithouta minimum of thirty(30)daysadvance,written notice
given to COUNTY.
In the event any PROVIDER fails to keep in effect at all times insurance coverage as herein
provided, COUNTY may, in addition to other remedies it may have, suspend or terminate this Agreement
with PROVIDER upon the occurrence of such event.
All policies shall be with admitted insurers licensed to do business in the State of California.
Insurancepurchased shall be from companies possessing a current A.M. Best, Inc. rating of A FSC VIIIor
better.
15.SUBCONTRACTS
PROVIDER shall be required to assume full responsibility for all services and activities
covered by this Agreement, whether or not PROVIDER is providing services directly. Further,
PROVIDER shall be the sole point of contactwithregardto contractualmatters,includingpaymentof any
and all charges resulting from this Agreement.
If PROVIDER should propose to subcontract with one or more third parties to carry out a
portion of services covered by this Agreement, any such subcontract shall be in writing and approved as to
form and content by COUNTY'S DBH Director or designee prior to execution and implementation.
COUNTY'S DBH Director or designee shall have the right to reject any such proposed subcontract. Any
such subcontract together with all activities by or caused by PROVIDER shall not require compensation
greater than the total budget contained herein. An executed copy of any such subcontract shall be received
by COUNTY before any implementation and shall be retained by COUNTY.PROVIDER shall be
responsible to COUNTY for the proper perfomiance of any subcontract. Any subcontractor shall be subject
to the same terms and conditions that PROVIDER is subject to under this Agreement.
It is expressly recognized that PROVIDER cannot engage in the practice of medicine. Ifany
medical services are to be provided in connection with the services under this Agreement,such medical
services shall be performed by an independent contract physician.In this instance,the requirements of the
Confidential Medical Information Act (Civil Code 56 et seq.) shall be met.
If PROVIDER hires an independent contract physician,PROVIDER shall require and
ensure that such independent contract physician carries Professional Liability (Medical Malpractice)
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Insurance,with limits of not less than One Million Dollars ($1,000,000.00)per occurrence,Three Million
Dollars ($3,000,000.00)annual aggregate.
16.NO THIRD PARTY BENEFICIARIES
Itis understood and agreed by and between the parties that the services provided by
PROVIDER for COUNTY herein are solely for the benefit of the COUNTY,and that nothing in this
Agreement is intended to confer on any person other than the parties hereto any right under orby reason of
this Agreement.
17.REPORTS—SUBSTANCE USE DISORDER SERVICES
PROVIDER shall submit all information anddata required by State,including,butnot
limited to the following:
A.Drug and Alcohol Treatment Access Report (DATAR)and Provider Waiting List
Record (WLR)inan electronic format provided bythe State anddueno later than five (5)days after the
preceding month;and
B.CALOMS TREATMENT -Submit CalOMS treatment admission,discharge,annual
update,and "provider activity report"record inan electronic format through COUNTY'S SAIS system,and
ona schedule as determined bythe COUNTY which complies withState requirements fordata content,data
quality,reporting frequency,reporting deadlines,and report method and due no later than five (5)days after
the conclusion ofthe preceding month.All CalOMS admissions,discharges,and annual updates must be
enteredintothe COUNTY'SCalOMSsystemwithintwenty-four(24) hours of occurrence;and
C.PROVIDER shall submit to COUNTY monthly fiscal andall program reports within
twenty (20)daysoftheendofeach month.PROVIDER shall submit a complete and accurate year-end cost
report for each fiscal year affected by this Agreement,following the end of each fiscal year affected by this
Agreement.Ifthecost report indicates an amount due COUNTY,PROVIDER shall submit payment with
the report.Ifan amount isdue PROVIDER,COUNTY shall reimburse PROVIDER within forty-five (45)
days of receiving and accepting the year-end cost report.PROVIDER shall also furnish to COUNTY such
statements,records,reports,data, and informationas COUNTY mayrequestpertainingto matterscovered
bythis Agreement.All reportssubmittedbyPROVIDER to COUNTY must be typewritten.
D.COST REPORTS -On an annual basis for each fiscal year ending June 30th,
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PROVIDER shall submit a complete and accurate detailed cost report(s).Cost reports must be submitted to
the COUNTY asa hard copy with a signed cover letter and an electronic copy bythedue date.Submittal
must also include any requested support documents such as general ledgers.All reports submitted by
PROVIDER to COUNTY mustbe typewritten.COUNTY will issue instructions for completion and
submittal ofthe annual cost report,including therelevantcostreport template(s)anddue dates.Allcost
reports mustbe prepared in accordance with Generally Accepted Accounting Principles.Unallowable costs
suchas lobbying or political donations mustbe deducted from thecostreportandall invoices.Ifthe
PROVIDER does not submit thecost report bythedue date,including any extension period granted by the
COUNTY,the COUNTY maywithholdpaymentofpending invoices untilthecost report(s)hasbeen
submitted andclears COUNTY deskauditfor completeness and accuracy.
1)NON-PMC FUNDING SOURCES -PROVIDER willbe required to submit
a cost report on a form(s)approved by the COUNTY to reflect actual costs and reimbursement for services
provided through funding sources otherthan DMC.Contracts that include a negotiated rateperunitof
servicewillbe reimbursed onlyforthecostsofapprovedunitsof serviceuptothe negotiated unitof service
rate approved inthe Agreement,regardless ofthe contract maximum.Ifthecostreport indicates an amount
due to COUNTY,PROVIDERshallsubmitpaymentwiththe report.Ifan amount isdue to PROVIDER
COUNTY shall reimburse PROVIDER within forty-five (45)daysof receiving and accepting the year-end
cost report.
2) MULTIPLEFUNDING SOURCES- PROVIDERwhohas multiple
agreements forthesame services provided atthesame location where at least oneofthe Agreements is
funded through DMC andtheother funding isother federal or county realignment funding willbe required
to completeDMCcostreportsand COUNTYapprovedcostreports. SuchAgreementswill be settledfor
actualcostsin accordancewith Medicaidreimbursementrequirementsas specifiedin TitleXIXor TitleXXI
of the Social Security Act; Title 22, and the State's Medicaid Plan.
Duringthe term ofthis Agreementand thereafter,COUNTYand PROVIDERagreeto settle
dollar amounts disallowed or settled in accordance withDHCSand COUNTY audit settlement findings
related to the DMC and realignment reimbursements. DHCS audit process is approximately eighteen (18)to
thirty-six (36)months followingthe closeof the Statefiscalyear. COUNTYmay chooseto appealDHCS
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settlement results and therefore reserves the right to defer payback settlement with PROVIDER until
resolution of the appeal.
In the event that PROVIDER fails to provide such reports or other information required
hereunder, it shall be deemed sufficient cause for the COUNTY to withhold monthly payments untilthere is
compliance. In addition, the PROVIDER shall provide written notification and explanation to the
COUNTY within fifteen (15)days of any funds received from another source to conduct the same services
covered by this Agreement.
18.EVALUATION -MONITORING
OUTCOMES -COUNTY'S DBH Director,or designee, and the California Department of
Health Care Services (DHCS) or their designees shall monitor and evaluate the performance of PROVIDER
under this Agreement to determine to the best possible degree the success or failure of the services provided
under this Agreement.At the discretion of the COUNTY,a subcontractor may be obtained by the
COUNTY to independently evaluate and monitor the performance of the PROVIDER.PROVIDER shall
participate in the evaluation of the program as needed,at the discretion of COUNTY.
COUNTY shall recapture from PROVIDER the value of any services or other expenditures
determined to be ineligible based on the COUNTY or State monitoring results. At the discretion of the
COUNTY,recoupment can be made through a future invoice reduction or reimbursement by the
PROVIDER.
PROVIDER shall participate in a program review of the program at least yearly or more
frequently, or as needed, at the discretion of COUNTY.The PROVIDER agrees to supply all information
requested by the COUNTY,DHCS,and/or the subcontractor during the program evaluation,monitoring,
and/or review.
19.DATA SECURITY
For the puipose of preventing the potential loss,misappropriation or inadvertent access,
viewing,use or disclosure of COUNTY data including sensitive or personal client information;abuse of
COUNTY resources;and/or disruption to COUNTY operations,individuals and/or agencies that enter into a
contractual relationship with the COUNTY for the purpose of providing services under this Agreement must
employ adequate data security measures to protect the confidential information provided to PROVIDER by
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the COUNTY,including butnot limited tothe following:
A.PROVIDER-OWNED MOBILE,WIRELESS,OR HANDHELD DEVICES
PROVIDER maynot connect to COUNTY networks via personally-owned mobile,
wireless or handheld devices,unless the following conditions aremet:
1)PROVIDER has received authorization by COUNTY for telecommuting
purposes;
2) Currentvirusprotectionsoftwareis in place;
3) Mobile device has the remote wipe feature enabled; and
4) A secure connection is used.
B.PROVIDER-OWNED COMPUTERS OR COMPUTER PERIPHERALS
PROVIDER maynot bring PROVIDER-owned computers or computer peripherals
into the COUNTY for use without prior authorization from the COUNTY'S Chief Information Officer,
and/or designee(s),including but not limited to mobile storage devices.If data is approved tobe transferred,
data must be stored ona secure server approved bythe COUNTY and transferred by means ofa Virtual
Private Network (VPN)connection,or another type of secure connection.Said data must be encrypted.
C.COUNTY-OWNED COMPUTER EQUIPMENT
PROVIDER or anyone having an employment relationship withthe COUNTY may
not use COUNTY computers or computer peripherals on non-COUNTY premises without prior
authorization fromthe COUNTY'S Chief Information Officer,and/or designee(s).
D.PROVIDER maynot store COUNTY'S private,confidential or sensitive dataonany
hard-disk drive,portable storage device,or remote storage installation unless encrypted.
E.PROVIDER shall be responsible to employ strict controls to ensure the integrity and
security of COUNTY'S confidential information andto prevent unauthorized access,viewing,use or
disclosure ofdata maintained in computer files,program documentation,data processing systems,data files
anddata processing equipment which stores or processes COUNTY data internally and externally.
F.Confidential clientinformationtransmittedto one partyby the other bymeansof
electronic transmissions mustbe encrypted according to Advanced Encryption Standards (AES)of 128 BIT
or higher. Additionally, a password or pass phrase must be utilized.
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G.PROVIDER 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 processingequipment
which stores or processes COUNTY data internally or externally.
H.COUNTY shall provide oversight to PROVIDER'S response to all incidents arising
from a possible breach of security related to COUNTY'S confidential client information provided to
PROVIDER.PROVIDER will be responsible to issue any notification to affected individuals as required
by law or as deemed necessary by COUNTY in its sole discretion.PROVIDER will be responsible for all
costs incurred as a result of providing the required notification.
20.INTERIM SERVICES
PROVIDER must adhere to the Negotiated Net Amount contract requirement to provide
Interim Services in the event that an individual must wait to be placed in treatment.
Interim Substance Abuse Services means services that are provided until an individual is
admitted to a substance abuse treatment program.The purposes of the services are to reduce the adverse
health effects of such abuse,promote the health of the individual,and reduce the risk of transmission of
disease. At a minimum,interim services include counseling and education about HIV and tuberculosis (TB),
about the risks of needle-sharing,the risks of transmission to sexual partners and infants, and about steps that
can be taken to ensure the HIV and TB transmission does not occur,as well as referral for HIV or TB
treatment services if necessary.For pregnant women,interim services also include counseling on the effects
of alcohol and drug use on the fetus, as well as referral for prenatal care.
Records must indicate evidence that Interim Services have been provided and documentation
will be reviewed for compliance.
21.REFERENCES TO LAWS AND RULES
In the event any law,regulation,or policy referred to in this Agreement is amended during
the term thereof,the parties hereto agree to comply with the amended provision as of the effective date of
such amendment.
22.STATE ALCOHOL AND DRUG REQUIREMENTS
A.INDEMNIFICATION
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The PROVIDER agrees to indemnify,defend and save harmless the State, its
officers, agents and employees from any and all claims and losses accruing or resulting to any and all
contractors, subcontractors, materialmen, laborers and any other person, firm or corporation furnishing or
supplying work, services, materials or supplies in connection with the performance of this Agreement and
from any and all claims and losses accruing or resulting to any person, firm or corporation who may be
injured or damaged by the PROVIDER in the performance of this Agreement.
B.INDEPENDENT CONTRACTOR
The PROVIDER and the agents and employees of PROVIDER,in the performance
of this Agreement, shall act in an independent capacity and not as officers or employees or agents of State of
California.
C.CONTROL REQUIREMENTS
This Agreement is subject to all applicable Federal and State laws and regulations.
The provisions of this Agreement are not intended to abrogate any provisions of law or regulation existing or
enacted during the term of this Agreement.
D.NON -DISCRIMINATION PROVISION
1)Eligibility for Services
PROVIDER shall prepare and make available to COUNTY and to the public
all eligibility requirements to participate in the program plan set forth in PROVIDER'S response to the RFP.
No person shall, because of ethnic group identification,age, sex, 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.
2)Employment Opportunity
PROVIDER shall comply with COUNTY policy, and the Equal Employment
Opportunity Commission guidelines,which forbids discrimination against any person on the grounds of
race, color,national origin,sex,religion,age,disability status,or sexual preference in employment practices.
Such practices include retirement,recruitment advertising,hiring, layoff,termination,upgrading, demotion,
transfer,rates of pay or other forms of compensation,use of facilities,and other terms and conditions of
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employment.
3)Suspension of Compensation
Ifan allegation of discrimination occurs, COUNTY may withhold all further
funds, until PROVIDER 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.
4)NEPOTISM
Except by consent of COUNTY'S Department of Behavioral Health Director,
or designee,no personshall be employedby PROVIDER who is relatedby bloodor marriageto, or whois
a member of the Board of Directors or an officer of PROVIDER.
E.CONFIDENTIALITY
PROVIDER shall conform to and COUNTY shall monitor compliance with all State
of Californiaand Federalstatutesand regulationsregarding confidentiality,includingbutnotlimitedto
confidentiality of information requirements at Part 2, Title 42, Code of Federal Regulations; California
Welfare and Institutions Code,sections 14100.2,11977,11812,5328;Division 10.5 and 10.6 of the
California Health and Safety Code; Title 22, California Code of Regulations, section 51009;and Division 1,
Part 2.6,Chapters 1-7 of the California Civil Code.
F.REVENUE COLLECTION POLICY
PROVIDER shall conform to all policies and procedures regarding revenue
collection issued by the State under the provisions of the Health and Safety Code, Division 10.5.
G.EXPENDITURE OF STATE GENERAL AND FEDERAL FUNDS
PROVIDER agrees that all funds paid out by the State shall be used exclusively for
providing alcohol and/or drug program services,administrative costs, and allowable overhead.
H.ACCESS TO SERVICES
PROVIDER shall provide accessible and appropriate services in accordance with
Federal and State statutes and regulations to all eligible persons.
I.REPORTS
PROVIDER agrees to participate in surveys related to the performance of this
Agreement and expenditure of funds and agrees to provide any such information in a mutually agreed upon
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format.
J.AUDITS
All State and Federal funds furnished to the PROVIDER(S) pursuant to this
Agreement along with related patient fees, third party payments,or other related revenues and funds
commingled with the foregoing funds are subject to audit by the State. The State may audit all alcohol and
drug program revenue and expenditures contained inthis Agreement forthe purpose of establishing thebasis
for the subsequent year's negotiation.
K.RECORDS MAINTENANCE
1)PROVIDER shall maintain books,records,documents,and other evidence
necessary to monitor and audit this Agreement.
2)PROVIDER shall maintain adequate program and fiscal records relating to
individuals served under the terms of this Agreement, as required, to meet the
needs of the State in monitoring quality, quantity, fiscal accountability, and
accessibility of services.Information on each individual shall include, but not
be limited to, admission records, patient and participant interviews and
progress notes, and records of service provided by various service locations,
in sufficient detail to make possible an evaluation of services provided and
compliance with this Agreement.
23.HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY and PROVIDER each consider and represent themselves as covered entities as
defined by the U.S.Health Insurance Portability and Accountability Act of 1996,Public Law 104-
191(HIPAA)and agree to use and disclose protected health information as required by law.
COUNTY and PROVIDER acknowledge that the exchange of protected health
information between them is only for treatment,payment,and health care operations.
COUNTY and PROVIDER intend to protect the privacy and provide for the security of
Protected Health Information (PHI)pursuant to the Agreement in compliance with HIPAA,the Health
Information Technology for Economic and Clinical Health Act,Public Law 111-005 (HITECH),and
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regulations promulgated thereunder by the U.S.Department of Health and Human Services (HIPAA
Regulations) and other applicable laws.
As part ofthe HIPAA Regulations,the Privacy Rule and the Security Rule require
PROVIDER toenter into a contract containing specific requirements prior to the disclosure of PHI,asset
forth in,butnot limited to,Title 45,Sections 164.314(a),164.502(e)and 164.504(e)ofthe Code of
Federal Regulations (CFR).
24.CONFIDENTIALITY
Allservices performed by PROVIDERunderthis Agreement shallbeinstrict conformance
with all applicable Federal,State of California and/or local laws and regulations relating to confidentiality,
including butnot limited to,California Civil Code section 56et seq..California Welfare and Institutions
Code sections 5328,10850 and 14100.2,Healthand SafetyCode sections 11977 and 11812,22 California
Code of Regulations section 51009,and 42 Code of Federal Regulations sections 2.1 et seq.PROVIDER
shallsubmitto COUNTY'S monitoring of said compliance withall Stateand Federal statutes and
regulations regarding confidentiality.PROVIDER shall ensure that no list of persons receiving services
under this contract is published,disclosed,or used foranyother purpose except forthe direct administration
of the program or other uses authorized by law that are not in conflict with requirements for confidentiality.
Except as otherwise provided in this Agreement,PROVIDER,as a Business Associate of
COUNTY,mayuseor disclose protected health information ("PHI")to perform functions,activities or
services fororon behalfof COUNTY,as specified inthis Agreement,provided thatsuchuseor disclosure
shall not violate the Health Insurance Portability and Accountability Act (HIPAA),U.S.C.1320d et seq.,and
its implementing regulations including butnot limited to45 C.F.R.Parts 142,160,162,and 164 (hereafter
known as"the Privacy and Security Rules").The uses and disclosures of PHI may notbe more expansive
than those applicable to COUNTY,asthe "Covered Entity"under the Privacy Rule,except as authorized for
management, administrative or legal responsibilities of the Business Associate.
PROVIDERshallnotuseor further disclose PHIotherthanas permitted or required bythis
Agreement,or as required by law.
PROVIDER shall implement administrative,physicalandtechnicalsafeguardsthat
reasonably and appropriately protectthe confidentiality,integrityand availability of PHIthat it creates,
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receives,maintains,or transmits on behalf of COUNTY.
PROVIDER shall ensure that any agent, including a subcontractor to whom PROVIDER
provides PHI received from COUNTY,orto whomPROVIDERprovides PHI whichis created on behalfof
COUNTY,agrees tothe same restrictions and conditions that apply to PROVIDER with respect to such
information.
PROVIDER shall report to COUNTY'S Department of Behavioral Health (DBH) Director
or designeein writingwithinfive (5) workingdays of any securityincident of whichPROVIDER becomes
aware.Itis understood thatifthe security incident isnot corrected within sixty (60)days of PROVIDER'S
written notification to COUNTY'S DBH Director,PROVIDER acknowledges thatthe COUNTY'S DBH
Director or designee may terminate this Agreement in accordance to Section.Three (3)ofthis Agreement if
COUNTY'S DBH Director, or designee,determines that PROVIDER has violated a material term of this
Agreement.
PROVIDER shall provide access, at the request of COUNTY,and in the time and manner
designated by COUNTY,to PHIina designated recordset(as defined in45 C.F.R.§164.501),toan
individual orto COUNTY inorderto meetthe requirements of45 C.F.R.§164.524 regarding access by
individuals to their PHI.
PROVIDER shall make anyamendment(s)to PHIina designatedrecordsetat the requestof
COUNTY,and inthe timeand mannerdesignatedby COUNTY in accordancewith45 C.F.R. §164.526.
PROVIDER shallprovideto COUNTY or to an individual,ina time and manner designated
by COUNTY,informationcollectedinaccordancewith 45 C.F.R. §164.528,to permitCOUNTYto
respond to a request by the individual for an accounting of disclosures of PHI in accordance with 45 C.F.R.
§164.528.
PROVIDER shall make internal records related to the use,disclosure, and privacy protection
of PHI received from COUNTY,or created/received by PROVIDER on behalf of COUNTY,available to
COUNTY or to the Secretary of the United States Department of Health and Human Servicesfor purposes
of investigatingor auditing COUNTY'S compliance with the Health Insurance Portabilityand
Accountability Act, in a time and manner designated by COUNTY or the Secretary.
PROVIDER shall,if feasible,return or destroy all PHI received from COUNTY'S DBH. or
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created or received by PROVIDER on behalf of COUNTY'S DBH upon expiration or termination of this
Agreement. Inthe event that PROVIDER deems this infeasible, PROVIDER shall notify COUNTY'S
DBHofthe conditionsthat makereturnor destructioninfeasible,and uponmutualagreementofthe parties
that return or destruction is infeasible, extend the protections of this Agreement to the PHI in order to limit
future disclosures of PHI by PROVIDER.
The parties agree to take such action as is necessary to amend this Agreement as necessary
for COUNTY'S DBH to comply with the requirements of the Privacy and Security Rules and the
implementingregulations. Any such changes may be made with the written approval of COUNTY'S
Compliance Privacy Officer or designee, and/or the Security Officer or designee should the SecurityOfficer
obtain such authority from the Board of Supervisors.
PROVIDER shall mitigate, to the extent practicable,any harmful effect that is known to
PROVIDER of a use or disclosure of PHI by PROVIDER in violation of the requirements of this
Agreement.
25.CULTURAL COMPETENCY
As related to Cultural and Linguistic Competence:
A.Compliance with Title 6 of the Civil Rights Act of 1964 (42 U.S.C. Section 2000d.
and 45 C.F.R. Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial
assistance from discriminating against persons based on race, color, national origin, sex, disability or
religion. This is interpreted to mean that a limited English proficient (LEP) individual is entitled to equal
access and participation in federally funded programs through the provision of comprehensive and quality
bilingual services.
B. Policies and procedures for ensuring access and appropriate use of trained
interpreters and material translation services for all LEP consumers, including, but not limited to, assessing
the cultural and linguistic needs of its consumers,training of staff on the policies and procedures,and
monitoring its language assistance program. The PROVIDER'S procedures must include ensuring
compliance of any sub-contracted providers with these requirements.
C.PROVIDER assurances that minors shall not be used as interpreters.
D.PROVIDER shall provide and pay for interpreting and translation services to persons
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participating in PROVIDER'S services who have limited or no English language proficiency,including
services to persons who are deaf or blind.Interpreter and translation services shall be provided as necessaiy
to allow such participants meaningful access to the programs,services and benefits provided by
PROVIDER. Interpreterand translationservices,includingtranslation of PROVIDER'S"vital documents"
(those documents that contain information thatis critical for accessing PROVIDER'S services orare
required by law)shall be provided to participants atnocosttothe participant.PROVIDER shall ensure that
any employees,agents,subcontractors,or partners who interpret or translate for a program participant,or
who directly communicate witha program participant ina language other than English,demonstrate
proficiency inthe participant's language andcan effectively communicate any specialized terms and
concepts peculiar to PROVIDER'S services.
E. In compliance withthe State mandated Culturally and Linguistically Appropriate
Servicesstandardsas publishedbythe Officeof MinorityHealth,PROVIDER must submitto COUNTY
for approval,within 60days from dateof contract execution,PROVIDER'S planto address all fifteen
national cultural competency standards asset forth inthe "National Standards on Culturally and
Linguistically Appropriate Services"(CLAS),attached hereto as Exhibit D,and incorporated herein by this
reference.County's annual on-site review of PROVIDER shall include collection of documentation to
ensure all national standards are implemented.PROVIDER may solicit complimentary assistance from
OnTrack Consulting (http://ontrackconsulting.org/news/culturally-linguistically-appropriate-services)for
training inplan development.Asthe national competency standards are updated,PROVIDER'S plan must
be updated accordingly.
26.SINGLE AUDIT CLAUSE
A. If PROVIDERexpends SevenHundredFiftyThousandDollars ($750,000.00)or
morein Federaland Federal flow-through monies,PROVIDERagreesto conductan annualauditin
accordancewith the requirementsof the SingleAudit Standardsas set forthin Officeof Managementand
Budget(OMB)Circular A-133.PROVIDERshall submitsaidauditand managementletterto COUNTY.
The audit must include a statement of findings or a statement that there were no findings. Ifthere were
negative findings,PROVIDERmust includea correctiveactionplan signed byan authorized individual.
PROVIDER agrees to take action to correct any material non-compliance or weakness found as a result of
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such audit.Such audit shall be delivered to COUNTY'S Department of Behavioral Health,Business Office
for review within nine (9)months of the end of any fiscal year in which funds were expended and/or
received for the program.Failure to perform the requisite audit functions as required by this Agreement may
result in COUNTY performing the necessary audit tasks,orat COUNTY'S option,contracting with a public
accountant to perform said audit,or,may result inthe inability of COUNTY to enter into future agreements
with PROVIDER.All audit costs related to this Agreement are the sole responsibility of PROVIDER.
B. A single audit report is not applicable if PROVIDER'S Federal contracts do not
exceed the Seven Hundred Fifty Thousand Dollars ($750,000.00)requirement or PROVIDER'S only
funding is through Drug related Medi-Cal.Ifa single audit is not applicable,a program audit must be
performed and a program audit report with management letter shall be submitted by PROVIDER to
COUNTY asa minimum requirement to attest to PROVIDER'S solvency.Said audit report shall be
delivered to COUNTY'S Department of Behavioral Health, Business Office for review, no later than nine
(9)months afterthecloseofthe fiscal yearin which the funds supplied through this Agreement are
expended.Failure to comply withthisActmayresultin COUNTY performing the necessary audit tasks or
contracting with a qualified accountant to perform said audit.All audit costs related tothis Agreement are
the sole responsibility of PROVIDER who agrees totake corrective action to eliminate any material
noncompliance or weakness foundasa resultof such audit.Auditwork performed by COUNTY underthis
section shall be billed tothe PROVIDER at COUNTY'S cost,as determined by COUNTY'S Auditor-
Controller/Treasurer-Tax Collector.
C. PROVIDERshallmake availableall recordsandaccountsfor inspection by
COUNTY, the State of California, if applicable, the Comptroller General of the United States,the Federal
Grantor Agency,oranyoftheirduly authorized representatives,atall reasonable times fora period ofat
least three(3)years following final payment under this Agreement orthe closure ofallother pending
matters,whichever is later.
27.TAX EQUITY AND FISCAL RESPONSIBILITY ACT
To the extent necessaryto preventdisallowance of reimbursementundersection 1861(v)(1)
(I)ofthe Social Security Act,(42 U.S.C.§1395x,subd.(v)(l)[I]),until the expiration of four(4)years after
the furnishing of services under this Agreement,PROVIDER shall make available,upon written request of
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the Secretary of the United States Department of Health and Human Services, or upon request of the
Comptroller General of the United States General Accounting Office, or any of their duly authorized
representatives,a copy of this Agreement and such books, documents, and records as are necessaryto certify
the nature and extent of the costs of these services provided by PROVIDER under this Agreement.
PROVIDER further agrees that in the event PROVIDER carries out any of its duties under this Agreement
through a subcontract,with a value or cost of Ten Thousand and No/100 Dollars ($10,000.00)or more over
a twelve (12)month period,with a related organization,such Agreement shall contain a clause to the effect
that until the expiration of four (4) years after the furnishing of such services pursuant to such subcontract,
the related organizations shall make available,upon written request of the Secretary of the United States
Department of Health and Human Services,or upon request of the Comptroller General of the United States
General Accounting Office, or any of their duly authorized representatives,a copy of such subcontract and
such books,documents,and records of such organization as are necessary to verify the nature and extent of
such costs.
28.COMPLIANCE WITH LAWS AND POLICIES
PROVIDER shall comply with all applicable rules and regulations set forth in Titles 9 and
22 of the California Code of Regulations,and California Health and Safety Code section 11750 et seq.
PROVIDER shall comply with any other Federal and State laws or guidelines applicable to PROVIDER'S
perfomiance under this Agreement or any local ordinances,regulations,or policies applicable.Such
provisions include, but are not restricted to:
A.PROVIDER agrees to limit administrative cost to a maximum of fifteen percent
(15%)of the total program budget and to limit employee benefits to a maximum of twenty percent (20%o)of
total salaries for those employees working under this Agreement during the term of this Agreement. Failure
to conform to this provision will be grounds for contract termination at the option of COUNTY.
B.PROVIDER shall provide that each client's ability to pay for services is determined
by the use of the method approved by COUNTY.
C.PROVIDER shall establish and use COUNTY'S approved method of determining
and collecting fees from clients.
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D. PROVIDERshall furnish client records in accordance withthe applicable Federal
and State regulations,andwiththe Standards for Alcohol and Drug Treatment Programs set forth bythe
State Department of Alcohol and Drug Programs, including in such records a treatment plan for each client,
and evidence of each service rendered.
E.PROVIDER shall submit accurate, complete and timely claims and cost reports,
reporting only allowable costs.
F.PROVIDER shall comply with statistical reporting and program evaluationsystems
as provided in State of California regulations and in this Agreement.
G.PROVIDER shall comply with requirements contained in the COUNTY'S Net
Negotiated Amount (NNA) Agreement with the State of California, Department of Alcohol and Drug
Programs, by this reference incorporated herein, until such time that a new NNA Agreement is established.
Upon amendment of the County NNA Agreement by the County and the State, the terms of the amended
NNA Agreement shall automatically be incorporated into this Agreement.
29.FEDERAL CERTIFICATIONS
Certification Regarding Debarment,Suspension,Ineligibility and Voluntary Exclusion
Lower Tier Covered Transactions.
A. DBH and PROVIDER recognize that Federal assistance funds will be used under the
terms of this Agreement. For purposes of this section, DBH will be referred to as the "prospective recipient".
B. This certification is required by the regulations implementing Executive Order
12549,Debarment and Suspension,29 CFR Part 98,section 98.510,Participants'responsibilities.The
regulations were published as Part VII of the May 26,1988 Federal Register (pages 19160-19211).
1)The prospective recipient of Federal assistance funds certifies by entering this
Agreement,that neither it nor its principals are presently debarred,suspended,proposed for debarment,
declared ineligible,or voluntarily excluded from participation in this transaction by any Federal department
or agency.
2) The prospective recipient of funds agrees by entering into this Agreement,
that it shall not knowingly enter into any lower tier covered transaction with a person who is debarred,
suspended,declared ineligible,or voluntarily excluded from participation in this covered transaction,unless
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authorized by the Federal department or agency with which this transaction originated.
3) Where the prospective recipient of Federal assistance funds isunable to
certify to any of the statements in this certification,such prospective participant shall attach an explanation
to this Agreement.
4) The prospective recipient shall provide immediate written noticeto DBH ifat
any time prospective recipient learns that its certification in this clause of this Agreement was erroneous
when submitted or hasbecome erroneous byreasonofchanged circumstances.
5) The prospective recipient further agrees thatby entering this Agreement,it
will include a clause identical to this clause of this Agreement,and titled "Certification Regarding
Debarment,Suspension,Ineligibility and Voluntary Exclusion LowerTier Covered Transactions",inall
lower tier covered transactions and in all solicitations for lower tier covered transactions.
6) The certification inthisclauseof this Agreement isa material representation
of fact upon which reliance was placed by COUNTY when this transaction was entered into.
30.CLEAN AIR AND WATER
In the event funding under this Agreement exceeds one hundred thousand dollars
($100,000.00),the PROVIDER must comply with all applicable standards,orders,or requirements issued
under section 306of theCleanAirAct(42 U.S.C.1857 (h)),section 506of theCleanWaterAct (33 U.S.C.
1368),Executive Order 11738,and Environmental Protection Agency Regulations (40CFRpart 32).
31.SMOKING PROHIBITION REQUIREMENTS
PROVIDER shall comply with Public Law 103-227,also known as the Pro-Children Act of
1994 (20 USC Section 6081,et seq.), and with California Labor Code Section 6404.5, the California Smoke-
Free Workplace Law.
32-ENERGY EFFICIENCY
The PROVIDER must complywith the mandatorystandardsand policies relating to energy
efficiency whichare contained inthestateenergy conservation plan issued in compliance with Energy
Policy and Conservation Act (Pub. L. 94 163).
33.REPORTING REQUIREMENTS,COPYRIGHT AND PATENTS
The awarding agency's reporting requirements are stated in this Agreement. The awarding
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agency's requirements and regulations pertaining to copyright and rights in data,and patent rights with
respect to any discovery or invention which arise oris developed in the course ofor under this Agreement (if
any), are likewise stated in this Agreement.
34.NON-DISCRIMINATION PROVISION
A.ELIGIBILITY FOR SERVICES -PROVIDER shall prepare,prominently post inits
facility,and make available to the DBH Director or designee and to the public all eligibility requirements to
participate in the program funded under this Agreement.PROVIDER shall not unlawfully discriminate in
the provision of services because of race,color,creed,national origin,gender,age,or physical or mental
disability as provided by State of California and Federal law in accordance with Title VI of the Civil Rights
Act of 1964 (42 USC section 2000(d));Age Discrimination Act of 1975 (42 USC section 1681);
Rehabilitation Act of 1973 (29 USC section 794);Education Amendments of 1972 (20 USC section 1681);
Americans with Disabilities Act of 1990 (42 USC section 12132);Title 45,Code of Federal Regulations,
Part 84;provisions of the Fair Employment and Housing Act (California Government Code section 12900);
and regulations promulgated thereunder (Title2,CCR,section 7285.0);Title2,Division 3,Article 9.5 ofthe
California Government Code commencing with section 11135;and Title 9,Division 4,Chapter 6of the
California Code of Regulations commencing with section 10800.
B. EQUAL OPPORTUNITY - PROVIDER shall comply with CaliforniaGovernment
Code,section 12990 and California Codeof Regulations,TitleII,Division 4, Chapter5, in matters related to
the development,implementation,and maintenance of a nondiscrimination program.PROVIDER shall not
discriminate against any employee or applicant for employment because of race,religion,color,national
origin,physical or mental disability,marital status,gender,or age.Such practices include retirement,
recruitment,advertising,hiring,layoff,termination,upgrading,demotion,transfer,rates ofpayor other
forms of compensation,useof facilities,andothertermsand conditions of employment.PROVIDER
agrees to postin conspicuous places,notices available to all employees and applicants for employment
setting forththe provisions of the Equal Opportunity Act (42 USC section 2000(e)) in conformance with
Federal Executive Order No.11246.PROVIDER agrees to comply with the provisions of the
Rehabilitation Act of 1973 (29 USC Section 794).
C.SUSPENSION OF COMPENSATION - If an allegation of discrimination occurs,
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DBH may withhold all further funds, until PROVIDER can show by clear and convincing evidenceto the
satisfaction of DBH that funds provided under this Agreement were not used in connectionwith the alleged
discrimination.
D.NEPOTISM -Except by consent of the DBH Director or designee,no person shall
be employed by PROVIDER who is related by blood or marriage to or who is a member of the Board of
Directors or an officer of PROVIDER.
E.NEW FACILITIES AND DISABILITY ACCESS -New facilities shall be
wheelchair accessible and provide access to the disabled,consistent with Title 9,California Code of
Regulations,section 10820.If a new facility will be utilized, a plan ensuring accessibility to the disabled
must be developed.DBH shall assess,monitor,and document PROVIDER'S compliance with the
Rehabilitation Act of 1973 and Americans with Disabilities Act of 1990 to ensure that
recipients/beneficiaries and intended recipients/beneficiaries of services are provided services without regard
to physical or mental disability and that PROVIDER has provided a facility accessible to the physically
disabled.
35.ASSURANCES
In entering into this Agreement,PROVIDER certifies that it is not currently excluded,
suspended,debarred,or otherwise ineligible to participate in the Federal Health Care Programs:that it has
not been convicted of a criminal offense related to the provision of health care items or services;nor has it
been reinstated to participation in the Federal Health Care Programs after a period of exclusion, suspension,
debarment, or ineligibility. If COUNTY learns, subsequent to entering into a contract, that PROVIDER is
ineligible on these grounds,COUNTY will remove PROVIDER from responsibility for, or involvement
with, COUNTY'S business operations related to the Federal Health Care Programs and shall remove such
PROVIDER from any position in which PROVIDER'S compensation, or the items or services rendered,
ordered or prescribed by PROVIDER may be paid in whole or part, directly or indirectly, by Federal Health
Care Programs or otherwise with Federal Funds at least until such time as PROVIDER is reinstatedinto
participation in the Federal Health Care Programs. Further the PROVIDER agrees to the Disclosure of
Criminal History and Civil Actions and Certification regarding debarment suspension and other
responsibility mattersprimarycovered transactions;PROVIDER must signan appropriate Certification
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regarding debarment,suspension,and other responsibility matters,attached hereto as Exhibit E,incorporated
herein by reference and made part of this Agreement.
A. If COUNTY has notice that PROVIDER has been charged with a criminal offense
related to any Federal Health Care Program, or is proposed for exclusion during the term on any contract,
PROVIDER and COUNTY shall take all appropriate actions to ensure the accuracy of any claims submitted
to any Federal Health Care Program.At its discretion given such circumstances,COUNTY may request
that PROVIDER cease providing services until resolution of the charges or the proposed exclusion.
B.PROVIDER agrees that all potential new employees of PROVIDER or
subcontractors of PROVIDER who, in each case, are expected to perform professional services under this
Agreement, will be queried as to whether (1) they are now or ever have been excluded, suspended, debarred,
or otherwise ineligibleto participate in the Federal Health Care Programs; (2) they have been convictedof a
criminal offense related to the provision of health care items or services; and or (3) they have been reinstated
to participation in the Federal Health Care Programs after a period of exclusion, suspension, debarment, or
ineligibility.
1)In the event the potential employee or subcontractor informs PROVIDER
that he or she is excluded, suspended, debarred or otherwise ineligible, or has been convicted of a criminal
offense relating to the provision of health care services, and PROVIDER hires or engages such potential
employeeor subcontractor,PROVIDER will ensurethat saidemployeeor subcontractordoesno work,
either directly or indirectly relating to services provided to COUNTY.
2) Notwithstanding the above, COUNTY at its discretion mayterminatethis
Agreementin accordancewith SectionThree (3) ofthis Agreement,or requireadequate assurance (as
definedbyCOUNTY)that no excluded,suspendedor otherwiseineligibleemployeeor subcontractor of
PROVIDER will performwork, eitherdirectlyor indirectly,relatingto servicesprovidedto COUNTY.
Such demand for adequate assurance shall be effective upon a time frame to be determined by COUNTYto
protect the interests of COUNTY consumers.
C.PROVIDER shall verify (by asking the applicable employees and subcontractors)
that allcurrentemployeesand existing subcontractors who, ineach case,areexpectedto perform
professional services under this Agreement (1)arenot currently excluded,suspended,debarred,or otherwise
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ineligible to participate in the Federal Health Care Programs;(2) have not been convicted of a criminal
offense related to the provision of health care items or services;and (3) have not been reinstated to
participation in the Federal Health Care Program after a period of exclusion,suspension, debarment, or
ineligibility.In the event any existing employee or subcontractor informs PROVIDER that he or she is
excluded,suspended,debarred or otherwise ineligible to participate in the Federal Health Care Programs,or
has been convicted of a criminal offense relating to the provision of health care services,PROVIDER will
ensure that said employee or subcontractor does no work,either direct or indirect,relating to services
provided to COUNTY.
1)PROVIDER agrees to notify COUNTY immediately during the term of this
Agreement whenever PROVIDER learns that an employee or subcontractor who, in each case, is providing
professional services under this Agreement is excluded,suspended,debarred or otherwise ineligible to
participate in the Federal Health Care Programs, or is convicted of a criminal offense relatingto the
provision of health care services.
2)Notwithstanding the above,COUNTY at its discretion may terminate this
Agreement in accordance with the Termination Section of this Agreement, or require adequate assurance (as
defined by COUNTY)that no excluded, suspended or otherwise ineligible employee or subcontractor of
PROVIDER will perform work, either directly or indirectly, relating to services provided to COUNTY.
Such demand for adequate assurance shall be effective upon a time frame to be determined by COUNTY to
protect the interests of COUNTY consumers.
D.PROVIDER agrees to cooperate fully with any reasonable requests for information
from COUNTY which may be necessary to complete any internal or external audits relatingto
PROVIDER'S compliance with the provisions of this Section.
E.PROVIDER agrees to reimburse COUNTY for the entire cost of any penalty
imposeduponCOUNTY bythe FederalGovernmentas a resultof PROVIDER'S violationof
PROVIDER'S obligations as described in this Section.
36.AUDITS AND INSPECTIONS
The PROVIDER shall at any time during business hours, and as often as the COUNTY may
deem necessary,make availableto the COUNTY forexaminationall of itsrecordsanddatawith respect to
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the matters covered by this Agreement. The PROVIDER shall, upon request by the COUNTY, permitthe
COUNTY to audit and inspect all of such records and data necessary to ensure PROVIDER'S compliance
with the terms of this Agreement.
If this Agreement exceeds ten thousand dollars ($10,000.00),PROVIDER shall be subjectto
the examination and audit of the Auditor General for a period of three (3) years after final payment under
contract (Government Code Section 8546.7).
Notwithstanding the provisions stated in Section Two (2)of this Agreement, it is
acknowledged bythe partiesheretothatthis Agreementshallcontinuein fullforceandeffectuntilallaudit
proceduresand requirementsas statedin this Agreementhave been completedto the reviewand satisfaction
of COUNTY.PROVIDER shall bear all costs in connection with or resulting from any audit and/or
inspections including, but not limited to, actual costs incurred and the payment of any expenditures
disallowedby either COUNTY,State,or Federal governmental entities,includinganyassessed interest and
penalties.
37.RECORDS
A.RECORD ESTABLISHMENT AND MAINTENANCE -PROVIDER shall
establish and maintain records in accordance with State and Federal rules and regulations in addition to those
requirements prescribed by COUNTY with respect to all matters covered by this Agreement. Exceptas
otherwise authorized by COUNTY, PROVIDER shall retain all other records for a period of five (5)years
afterreceivingthe final paymentunderthis Agreementor the earlierterminationof this Agreement,or until
State and/or Federal audit findings applicable to such services are resolved, whichever is later.
B.DOCUMENTATION -PROVIDER shall maintain adequate records in sufficient
detailto makepossiblean evaluationof services,and containallthe data necessaryin reportingtothe State
of Californiaand/or Federal agency.Allclient recordsshallbe maintainedpursuantto applicable Stateof
California and Federal requirements concerning confidentiality.
C.REPORTS -PROVIDER shall submit to COUNTY monthly fiscal and all program
reports as further described in Section Seventeen (17).PROVIDER shall submit a complete and accurate
year-end cost report foreach fiscal year affected bythis Agreement,following theendof each fiscal year
affected bythis Agreement.PROVIDERshallalso furnish to COUNTY such statements,records,reports,
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data,and informationas COUNTY mayrequestpertainingto matterscoveredbythis Agreement.All
reports submitted by PROVIDER to COUNTY must be typewritten.
D.SUSPENSION OF COMPENSATION - In the event that PROVIDER fail to
provide reports specified inthis Agreement,itshallbe deemed sufficient causefor COUNTY to withhold
payments until there is compliance.
E.DISALLOWANCES - Payments by COUNTY shall be in arrears, for services
provided during the preceding month,within forty-five (45)days after receipt,verification and approval of
PROVIDER invoices by COUNTY'S DBH-SAS.Ifpayment for services are denied or disallowedby
State; and subsequently resubmitted to COUNTY by PROVIDER, the disallowed portion will be withheld
from the next reimbursement to the PROVIDER until COUNTY has received reimbursement from State for
said services.
F.CLIENT CONFIDENTIALITY -PROVIDER shall conform to and COUNTY shall
monitor compliance withall Stateand Federal statutes and regulations regarding confidentiality,including
but not limitedto confidentiality of information requirements of 42 Code of Federal Regulations §2.1 et
seq.,Welfare and Institutions Code §§5328,10850 and 14100.2,Healthand Safety Code§§11977 and
11812,Civil Code,Division 1, Part 2.6, and 22 California Code of Regulations §51009.
38.NOTICES
The personsand theiraddresseshavingauthorityto giveand receivenoticesunderthis
Agreement include the following:
COUNTY PROVIDER
Director, Fresno County Executive Director
Department of Behavioral Health Fresno County Hispanic Commission
4441 East Kings Canyon 1803 Broadway St.
Fresno,CA 93702 Fresno,CA 93721
Anyand all notices between theCOUNTYandthePROVIDER provided foror permitted
underthis Agreement orby lawshallbein writingandshallbe deemed dulyservedwhen personally
delivered tooneofthe parties,orin lieuofsuch personal services,when deposited inthe United States Mail,
postage prepaid, addressed to such party.
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39.CHANGE OF LEADERSHIP
In the event of any change in the status of PROVIDER'S leadership or management,
PROVIDER shall provide written notice to COUNTY within thirty (30) days from the date of change. Such
notification shall include any new leader or manager's name, address and qualifications. "Leadership or
management"shall include any employee,member,or owner of PROVIDER who either a) directs
individuals providing services pursuant to this Agreement,b)exercises control over the manner in which
services are provided,or c) has authority over PROVIDER'S finances.
40.CHARITABLE CHOICE
PROVIDER may not discriminate in its program delivery against a client or potential client
on the basis of religion or religious belief, a refusal to hold a religious belief, or a refusal to actively
participate in a religious practice.Any specifically religious activity or service made available to individuals
by the PROVIDER must be voluntary as well as separate in time and location from County funded activities
and services.PROVIDER shall inform County as to whether it is faith-based.If PROVIDER identifies as
faith-based it must submit to Substance Abuse Services a copy of its policy on referring individuals to
alternate treatment PROVIDER,and include a copy of this policy in its client admission forms. The policy
must inform individuals that they may be referred to an alternative provider if they object to the religious
nature of the program,and include a notice to Substance Abuse Services.Adherence to this policy will be
monitored during annual site reviews, and a review of client files. If PROVIDER identifies as faith-based,
by July 1 of each year PROVIDER will be required to report to Substance Abuse Services the number of
individuals who requested referrals to alternate providers based on religious objection.
41.LICENSING-CERTIFICATES
Throughout each term of this Agreement,PROVIDER and PROVIDER'S staff shall
maintain all necessary licenses, permits, approvals,certificates,waivers and exemptions necessary for the
provision of the services hereunder and required by the laws and regulations of the United Statesof
America, State of California,the County of Fresno, and any other applicable governmental agencies.
PROVIDER shall notify COUNTY immediately in writing of its inability to obtain or maintain such
licenses,permits,approvals,certificates,waiversandexemptionsirrespectiveof the pendencyof any appeal
related thereto. Additionally,PROVIDER and PROVIDER'S staff shall comply with all applicablelaws,
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rules or regulations, as may now exist or be hereafterchanged.
42.AOD CERTIFICATION
A. The COUNTY requiresall COUNTYcontractedprovidersof Alcohol and Other
Substance Use Disorder treatment services to obtain the California Department of Alcohol and Drug
Program's (ADP)Alcohol andOtherDrug Program (AOD)Certification.The AOD Certification Standards
will apply to all residential and outpatient treatment modalities.The purpose ofthe AOD Certification
Standardsisto ensurean acceptablelevel of servicequalityis providedto program participants.
B.PROVIDER shall provide proof of a completed application for AOD Certificationto
the CountywithinThirty(30) days fromthe executiondateof this Agreementwith the COUNTY.A copy
of the AOD Certification shall be submitted to the COUNTY when approved by the California Department
of Alcohol Drug Programs.
C. This AOD Certification requirement applies to every primary treatment facility
operated bythe PROVIDER.PROVIDER is not required to obtain a separate AOD Certification for
satellite sites associated with PROVIDER'S primary treatment facility.Satellite sites are expectedto operate
withinthe sameAOD Certificationguidelinesand maintainthe same standardsasthe PROVIDER'S related
primary site.PROVIDERS whose agencies are nationally accredited withthe Joint Commission on
Accreditation of HealthCare Organizations (JCAFIO)or the Commission on Accreditation of Rehabilitative
Facilities (CARF)are exempt from this requirement of AOD Certification.PROVIDER shall submit a copy
of their JCAHO or CARF accreditation to the COUNTY within Thirty (30) days from the date this
Agreement is executed.PROVIDER shall notify COUNTY ifatanytimetheir JCAHO or CARF
accreditation lapses or becomes invalid duetoany reason during thetermofthis Agreement.PROVIDER
shall apply with State ADP for AOD Certification iftheir JAHCO or CARF accreditation lapses or becomes
invalid and shall submit acopyofthe completed application for AOD Certification tothe COUNTY within
Thirty (30)days from the date the JAHCO or CARF accreditation lapses or becomes invalid.
D. COUNTY shall terminate this Agreement immediately in the event any of the
following occurs:
1)PROVIDER fails to submit acopyofthe completed application for AOD
Certification,ora copy of either their JCAHO or CARF accreditation within Thirty (30)days from the
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execution date of this Agreement with the COUNTY.
2) PROVIDER'S applicationfor AOD Certificationisdeniedbythe California
Department of Alcohol and Drug Programs.
3) PROVIDER failsto submitto the COUNTY a copyof theAOD Certification
within Thirty (30)daysafterbeing approved bythe California Department of Alcohol andDrug Programs,
or certification is not maintained throughout the contract period.
4) PROVIDER fails to applyforAOD Certification withStateADPor fails to
submittothe COUNTY a copyofthe completed application forAOD Certification within Thirty (30)days
after the JAHCO or CARF accreditation lapses or becomes invalid.
43.COMPLAINTS
PROVIDER shall log complaintsandthe disposition of all complaintsfroma consumerora
consumer's family.PROVIDER shall provide a summary ofthe complaint log entries concerning
COUNTY-sponsored consumers to COUNTY at monthly intervals bythe fifteenth (15th)dayofthe
following month,ina format thatis mutually agreed upon.PROVIDER shall post signs informing
consumer oftheir right to file a complaint or grievance.PROVIDER shall notify COUNTY ofall incidents
reportable to state licensing bodies that affect COUNTY consumers within twenty-four (24)hours of receipt
of a complaint.
Within fifteen (15)days aftereach incident or complaint affecting COUNTY-sponsored
consumers,PROVIDER shall provide COUNTY with information relevant tothe complaint,investigative
details of the complaint,the complaint and PROVIDER'S disposition of,or corrective action taken to resolve
the complaint.
44.DRUG FREE WORKPLACE
PROVIDER shall comply withthe requirements ofthe Drug-Free Work Place Actof 1990
(California Government Code section 8350).
45.CHILD ABUSE REPORTING
PROVIDERshall utilize a procedure acceptable tothe COUNTY to ensure thatallof
PROVIDER'S employees,volunteers,consultants,subcontractors or agents performing services under this
Agreement shall report all known or suspected child abuse or neglect to one or more of the agencies set forth
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in Penal Code section 11165.9.This procedure shall include having all of PROVIDER'S employees,
volunteers,consultants,subcontractors or agents performing services under this Agreement sign a statement
that he or she knows of and will comply with the reporting requirements set forth in Penal Code section
11166.The statement to be utilized by PROVIDER for reporting is set forth in Exhibit F, attachedhereto
and by this reference incorporated herein.
46.GOVERNING LAW:
Venuefor any actionarisingout of or relatedto this Agreementshallonlybe in Fresno
County, California.
Therightsand obligations of the parties andall interpretation and performance ofthis
Agreement shall be governed inall respects bythe laws ofthe State of California.
47.ENTIRE AGREEMENT:
This Agreement,including all Exhibits,COUNTY'S Revised RFPNo.952-5338_and
PROVIDER'S responses thereto,constitutes theentire Agreement between PROVIDERand COUNTY
with respect tothe subject matter hereofand supersedes all previous agreement negotiations,proposals,
commitments,writings,advertisements,publications,and understandings ofany nature whatsoever unless
expressly included in this Agreement.
///
///
///
///
///
///
///
///
///
///
///
///
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IN WITNESS WHEREOF,the parties hereto have executed this Agreement asofthe day
and year first hereinabove written.
ATTEST:
CONTRACTOR:
FRESNO COUNTY HISPANIC COMMISSION,INC.
By:v A^W"^
Print Name:Ma66(L-/WiW^O
Title:CH&tPMAAj
Chairman of Board,or President,
or any Vice President
By:
Print Name:hmMiricjO £.CLpcUQ
Title:£x<egj{uAf Litter jt)J
Secretary (of Corporation),or
any Assistant Secretary,or
Chief Financial Officer,or
any Assistant Treasurer
Mailing Address:
1803 Broadway Street
Fresno,CA 93721
Contact:Executive Director
PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
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APPROVED AS TO ACCOUNTING FORM:
VICKI CROW, C.P.A., AUDITOR-CONTROLLER/
2 TREASURER-TAX COLLECTOR
3
: By: ~ 'fCa-i f=
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APPROVED AS TO LEGAL FORM: 8 DANIEL C. CEDERBORG, COUNTY COUNSEL
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13 REVIEWED AND RECOMMENDED FOR
14 APPROVAL:
15
16By:~~
17 DA WAN UTECHT, Director
Department of Behavioral Health
18
19 The following is for COUNTY's use:
20
21
Fund/Subclass:
Organization: 22
23 FY 2015-16
FY 2016-17
24 FY 2017-18
FY 2018-19
FY 2019-20 25
0001/10000
56302081
$194,393.00
$197,309.00
$200,269.00
$203,273.00
$206,322.00
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Account/Program: 7294/0
yl
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COUNTY OF FRESNO
By:~~~~~~~~~~~
DEBORAH A. POOCHIGIAN, C
Board of Supervisors
BERNICE E. SEIDEL, Clerk
Board of Supervisors
~ \ t . By:~~'4J•~
Exhibit A-Scope of Work
Page 1 of 17
SCOPE OF WORK
A.Service Expectations
Over more than a quarter century the Hispanic Commission has adhered to its mission to
rid the incidence of substance and it consequences among the at risk population in Fresno
County despite opportunities and invitations to do otherwise.The goal remains to provide
currently licensed long-term residential alcohol/drug free oriented/participant driven services to
individuals and their families residing in Fresno County affected by the consequences of alcohol
and drug abuse.These services are designed to:
•Identify and develop an understanding of the Substance Use Disorder (SUD)and how it
leads to relapse.
•Provide individual and group treatment and psycho-educational sessions that will assist
monolingual clients.
•Explore family/support system dynamics and how they relate to addiction,recovery and
relapse potential.
•Incorporate personal and community support systems supporting a productive,
alcohol/drug-free lifestyle.
• Approximately 90%)of the clients will havean understandingof how additionmanifests
itself in his life.
• Assist clients prior to discharge in to the community by developing a continuing care plan
that includes support and mutual help groups and other ancillary services such as
housing, access to vocational training,employment,child care, family reunification,
medical care, mental health care legal aid,welfare services and other supportive services
designed to help in the recovery process.
The outcomes of these services are designed to bring:
• Approximately90% of clients will, when interviewedby a counselor,be able to identify
the emotional,social,and/or other issues that increase his vulnerability to relapse.
• Approximately70% or more of the clients and their families will be able to identifyand
practice healthy forms of interaction that can support long term sobriety.
• Approximately 99%of clients who complete the program will receive a continuous care
plan and referrals so that all required supportive sources can be accessed.
• Approximately60 %or more of clients who complete the program will report themselves
to be substance free within 1 year of the completing of the residential services.
Developinga healthy recreationalschedule is an important element of recoverywhich
helps clients become involved in activities thatarenot associated withtheir addictions.The
Hispanic Commission's programs address this through daily exercises and recreational activities
Exhibit A-Scope of Work
Page 2 of 17
at the treatment center.Equally important,in terms of recreational activities,is the establishment
of good leisure time habit. Once clients have stopped using substances,individuals in the early
stages of recovery frequently have difficulty adjusting to extended periods of time on the hands
in which they have nothing to do and boredom is a frequent precursor to lapses and relapses.
The Hispanic Commission helps clients plan leisure time so that exercise and sober social
activities become regular parts of their lives.Sober social activities are structured through
AA/NA,and other alumni groups.
B.General Requirements
1.Structured Activities Used to Support Stated Objectives
The Hispanic Commission currently offers residential treatment services to Latinos in
Fresno County at Nuestra Casa, a nonprofit recovery home that facilitates the recovery process
through highly structured services delivered in a home environment.This program takes place in
three Phases:
• Phase I is designed to introduce the client to the nature of addiction.This phase also
explores culture and gender as these two forces interact to produce addiction.
• Phase II begins after the client has completed the first 30-day treatment component. The
program seeks to stabilize the client and begins to address his life forces which can have
an impact upon the recovery process.
• Phase III prepares the client for his transition out of the safety of the program into an
outpatient program at which point he is expected to function independently within his
home and community while maintaining a substance free life utilizing his support system.
2.Residential Program Services Offered are delivered within a gender and culture specific
framework.They include:
•Comprehensive assessment using ASI.
• Short-term therapy to address current and/or impending crises.
•Individual,group and family sessions (both process and education).
•Comprehensive case management and active referral.
•Transportation,food, and housing.
•Nutrition Education.
•HIV education and testing.
•Other services as needed.
Exhibit A-Scope of Work
Page 3 of 17
The Hispanic Commission is currently licensed to provide 16 beds for this residential
program.Staffing levels will be monitored to ensure that they meet the CA Code of Regulations,
Title 9, Chapter 11;Division 4, Chapter 5; and/or State of CA Health and Human Services
Agency's Department of Health Care Services,Alcohol and/or other Drugs Certification
Standards for Residential and Outpatient Services.
The agency utilizes targeted case management in order to coordinate schedules. The
Care Schedule includes "free" time slots that have been specifically created in order to allow
time for the inclusion and integration of additional support services.Electronic case
management technology is used to assist in the coordination of multiple schedules.
Utilizing a culture and gender specific curriculum individual,group and family
counseling is provided to clients inour residential program.Each of these sessions are designed
to address enduring aspects of the recovery process from different perspectives. The individual
counseling sessions allow the client and the counselor to uncover antecedents of the abuse
problem from the perception of the client.In contrast,the group counseling sessions provide an
objective,more holistic view of addiction based on multiple perspectives.Lastly,the family
sessions provide an opportunity for the client and his familyto begin the process of reunification
and rebuilding.
Fresno County Hispanic Commission provides a range of services that are designed to
identify and address not merely intra-psychic forces that provoke and sustain drug use, but also
the environmental forces that can challenge the recovery process as well. Thus, the program
offers crisis intervention services with trained counselors who can provide temporary resolution
to immediate crises. Additionally, the Commission assists each client in qualifying for and
receiving all supportive services for which he is eligible. Counselors very critically begin
planning for the release of the client to an outpatient program at least one month before
discharge. The client is also assisted in finding housing and in obtaining other needed resources.
Finally,aftercare services are provided to assist each client in obtaining employment and in
remaining sober.
During the treatment process,the client's vocation and educational interests are explored.
By the end of the 90-day residential program, the men are either linked to education and training
programs or are gainfully employed. During the course of the residential program, highly
selective recreational and socialization experiences are introduced to support the overall
treatment process.The Hispanic Commission includes socializing and recreational activities
such as volleyball,soccer,basketball,walks, table games and other low impact physical
activities to reinforce the concepts of discipline,teamwork,and excellence.
While in residential treatment,the clients are provided full room and board. All meals
are nutritious in content and balanced to the major food groups.Drug screening is used to
ensurecompliance with the recovery process.Program staff screens saliva and urine specimens
to insure clients are drug free.
Exhibit A-Scope of Work
Page 4 of 17
3. The Hispanic Commission's Intake Procedures:
• Clients may call or walk into the agency from 8:00 am and 5:00 pm seven days a
week,as the agency is open 24/7.
• A triage form is completed on all clients to collect pertinent data to determine of he
meets criteria for services.If he does not fall into the target population or meet the
program guidelines,a referral will be made to appropriate service.If the client
qualifies, he will be admitted and a file will be opened. Clients who do not qualify
are those who exhibit dangerous behavior,are not ambulatory,or need immediate
medical attention. Clients will be scheduled for an initial interview appointment to
assess needs and qualifications.An intake is done at a later time when it has been
determined this is the appropriate program for the participant.
• A person experiencing a crisis (suicidal,homicidal,acutely,psychotic,or severely
depressed/anxious)will be treated immediately or referred to a crisis stabilization
team depending on the severity of the crisis.
•
•
•
The intake process will give priority access to the target population,which are those
monolingual men experiencing a predominant involvement with alcohol or other
drugs.
Admission or placement on waiting list is based on the availability of beds for county
sponsored residents.This process does not apply to insurance or private pay clients.
Throughout the period between intake and commencement of services,the client will
maintain weekly contact with case manager or primary therapist.
The intake process will include:a comprehensive assessment interview (ASI),a
psycho-social assessment,a psychiatric evaluation,physical/health,STDs,HIV
screening,and financial assessment to determine ability to pay.
A Treatment Plan and a Coordination Plan will be developed as well as Progress
Notes to monitor participant.
Unless crisis intervention is required,all intake forms will be completed within 24
hours.Signatures on consent forms and other intake forms will be obtained and a
client file initiated.
A TB test will be done for all participants within three days of admission and physical
exam will be completed for those clients applying for disability.
Clients needing mental health services will be referred for mental health evaluations
as appropriate and appointments made. A physical screening and a mental health
examination will be scheduled.Qualified staff will evaluate the results.
Exhibit A-Scope of Work
Page 5 of 17
Alldata from physical screenings willbe reviewed andall medical problems willbe referred
to a physician.All data from the mental health assessments will be reviewed and signed by a
mental health professional.
4.Admission Criteria
Admission is voluntary.
Clients must be alcohol and drug free for 72 hours prior to admission.
Clients must be ambulatory.
Clients must be 18 years old or older.
Primary problem is substance use disorder.
Clients must be Spanish speaking.
Clients must be willing to accept program rules.
Clients must have no history of excessive violence.
Physical or mental disabilities must not prevent clients from participation in program.
Pending legal problems must not prevent client's participation in treatment.
The Hispanic Commission will admit all men that wish to be admitted who are capable
and willing to abide by the program's requirements.Persons with communicable diseases must
provide a letter of recommendation from a physician.Injection drug users and all other drug
users will be viewed as priority clients.
5.SUD,MHS,or Medical Referrals
The Nuestra Casa program links clients with other related services as needed.The
services may include a culturally appropriate residential/inpatient care program,medical service,
co-occurring disorders and mental health care.These referrals are active referrals and include
follow-up.
The Hispanic Commission will also include referrals to physicians for physical
diagnoses.
6.Residential Services
The Hispanic Commission's residential services will be organized in accordance with the
requirements set forth in the RFP.Approximately 16 beds are available at the Nuestra Casa
Recovery home for referred clients,with 7 proposed for County use.Nuestra Casa will provide
twenty (20)hours per week of group and individual interventions (Monday through Friday)and
Exhibit A-Scope of Work
Page 6 of 17
an additional six (6)hours on weekends.Residential treatment will consist of the following
service components.
7.Assessment and Treatment Planning
The Counselorand Clinical Supervisor will considerthe totalityof all participants'needs
(substance use, legal,family,social,psychological,health,housing,education,vocational,and
safety)and develop individual service plansthat provide the competencies eachclient requires in
orderto achieve and maintain abstinence and live a healthy,productive life in their community.
Treatment planning begins at the timethat participant is assessed and admitted intothe program.
The Senior Counselor will conduct a psychosocial assessment, Addiction Severity Index (ASI)
and the Hispanic Commission interview protocol. Following the assessment and a review of
records provided by the referring entity, program staff will meet with participant and develop
and individual treatment plan. The initial treatment plan will become the guide for each client's
treatment,recovery service and eventual discharge plan. Plans will contain measurable goals,
time limited objectives, and activities designed to help clients meet their individual goals and
objectives. Service plans will evolve and staff and clients amend them to reflect changing
conditions resulting from each individual's treatment process,meeting objective,the appearance
of new information arising from ongoing assessment, change in treatment status, and changing
living situation or employment.Plan amendments will address any lack of progress, any lapse or
relapse,or other situations which may require new directions in services and supervision.
Each resident will have a plan containing:
•The treatment plan and signed release of information form.
• Plan amendments to be reviewed at least bi-weekly by the Senior Counselor and the
client.
•Authorization of communications (ROI)between treatment staff,family members,
superior court,probation,and other service providers.
• A record of services to which clients are referred,including whether appointments are
kept and when available,the results of these referrals.
•Counseling notes -notes from probation contacts,a record of transfers to other
settings.
•Record of transfers to other settings-re-incarcerations,program terminations,etc.
•Discharge plans that summarize progress made and recommendation s for the future
treatment including continued 12-step meetings,alumni activities and legal
compliance.
Exhibit A-Scope of Work
Page 7 of 17
The Senior Counselor and participant will sign all treatment,aftercare,exit plans and
amendments.The original documents will remain inthe master file and a copy will be given to
the client.
Nuestra Casa treatment features include case management, coordination with other
Fresno County services,residential therapeutic treatment,vocational services,job search and
referrals to counseling.Staff also coordinates with local service providers to ensure participants
with mental health andother issues schedule and keep appointments as scheduled.Many clients
also require parenting training,domestic violence or anger management counseling,all of which
are provider through referral to other agencies.Twelve step or other peer support activitieswill
complementtreatment. Nuestra Casaoffers onsite AA/NA meetings3 days per week.
Counselors will also discuss other needs and forms of support clients might benefit from.
This may include referrals for cultural specific services like LGBTQ or HIV/AIDS support
groups, prevention, education, confidential testing, counseling, HIV, or spiritual counseling.
8.Case Management
The overarching program goal is to provide participants with knowledge,emotional and
spiritual growth,life skills, and competencies that clients will need to maintain abstinence and
lead healthy productive,self-sufficient lives. Case management will bring all of the necessary
supportive elements together to ensure that each participant receives the services required to
succeed in his recovery.The case management provided will include a holistic view of the
participant,addressing not only substance abuse,but educational,family, social,housing,and
other needs to help participants achieve self-sufficiency.Counselors will intervene,when
appropriate,utilizing a strength-based orientation that considers an individual's and a family's
strengths to help participants remain abstinent and direct resources to address their needs.
Improvisation,community collaboration,and resource coordination are the cornerstones of
successful case management and our program will utilize these tools. Case management
activities will include evaluation,assessment,service planning,review,coordination with other
providers,and encouraging client feedback on the effectiveness of treatment.
9.Coordination
The Hispanic Commission will work closely with the County and others providers to
coordinate clients'treatment planning and services.Copies of Treatment Plans and
modification,discharge,and continuing care plans will be sent to all required stakeholders.At
intake collaborators will be involved to provide insight into client needs,risks,and behaviors to
complete treatment plans.In the event a client's drug test comes back positive or he leaves
treatment,the referring entity will be notified within 24 hours.Other areas in which
coordination is essential include:
Exhibit A-Scope of Work
Page 8 of 17
•Coordination with appropriate services to ensure clients with co-occurring disorders
or otherissues schedule and attend counseling sessions;
• Coordinationwith the other FresnoCounty program services;
• Coordinationwith mentalhealth counselinggroups for clients;
•Coordination with organizations to ensure individuals with HIV/AIDS,Hepatitis C,
TB,andother communicable diseases receive the care and medication required for
their condition.
• Coordinationof step-upsand step-downsin treatment with other stakeholders;
• Coordinationof dischargeplanningand communitycare.
10.Drug Testing
The Hispanic Commission will provide random drug testing to all clients utilizing DOT
approved instant drug screening devices manufactured by MedTox Diagnostic. These devices
test for Amphetamine,Cocaine,Opiates,Benzodyazepines and Marijuana and other drugs.
Results are documented in each client's file.Positive findings are reported immediately to the
referring agency followed by a staffing with program personnel and representatives from the
referring agency. Once recommendations are received appropriate action is taken.
11.Crisis Intervention
Staff of the Hispanic Commission's programs receive initial and annual follow-up
training in evaluating and providing crisis intervention.Staff is trained to evaluate situations to
determine the nature of the crises (emotional, physical, or spiritual) and to intervene
appropriately. They are trained to know when and how to intervene directly and when outside
intervention is needed.Staff is fully trained when to call 911,crisis hotlines,as well as on-call
staff and therapists. Training also teaches staff how to avoid making a situation worse or
creating additional harm through a failed intervention.
12.Referrals
Referrals for other services are integrated into the residential treatment program. Clients
will take part in the standard residential program,as well as specialized groups and individual
counseling designed for substance abusers at risk of criminal activity. These include: During the
substance abuse services,Counselors will refer clients to service providers indicated in their
treatment plans and make follow-up contacts to ensure that they keep their appointments and,
when indicated, discuss the services (subject to confidentiality limits) with the other providers.
In some cases,referrals will be arranged and carried out by the Hispanic Commission.Referrals
will include:benefits eligibility and application,housing,vocational counseling,education (i.e.,
Exhibit A-Scope of Work
Page 9 of 17
community college or university enrollments),domestic violence and anger management
counseling,financial assistance,legal counsel,family services,medical and mental health
services.
Clients with Co-occurring disorders will be referred to a Clinical Psychologist and other
mental health professionals in the community.The Hispanic Commission will place heavy
emphasis on vocational preparation to help participants find work because clients often have
poor work histories.Most referrals will also be enrolled in anger management,domestic
violence, and parenting skills workshops.
13.Treatment Program Accessibility and Compliance with the Americans for Disability Act
All of the Hispanic Commission's programs will continue to comply with the ADA
requirements.
C.Target Population:
The clients served by the Hispanic Commission include the following:
•Monolingual Spanish-speaking men with substance use disorders;
•
•
•
Spanish-speaking clients who have co-occurring substance abuse/dependence and
mental health disorders;
Residents of Fresno County;and
Underserved populations such as the disabled and low-income individuals.
E.Minimum Duration and Intensity
The Hispanic Commission will provide a minimum of twenty (20) hours SUD-focused
face-to-face individual and group activity for each client scheduled from Mondays through
Fridays and a minimum of six (6) hours of face-to-face individual and group activity scheduled
on Saturday and/or Sunday for a total of 26 hours per week.Face-to-face individual sessions are
one-on-one (counselor/client).Group sessions include a minimum of 2 and a maximum of 12
individuals.Records will be kept to clearly identify the hours of SUD-focused individual and
group activity for clients each week.
A large amount of research documents that any delay in the treatment process can have
serious consequences for the entire recovery path. While this is true for all substance-dependent
populations,it is particularly relevant for Latinos.Consequently the Hispanic Commission will
systematically manage enrollment levels in order to reduce waiting lists.The treatment program
is specifically designed with a Latino cultural orientation.As such,the activities are primarily
geared to assist Latinos with their recovery from any substance-related problems and prepare
Exhibit A-Scope of Work
Page 10 of 17
them to challenge other life problems.Any individual experiencing a predominate involvement
with alcoholism or drug use or related problems and who is willing to comply with the program's
requirements will be eligible for participation in the program. No individual will be admitted
who, in the judgment of personnel:
•Exhibits behavior dangerous to staff or others;
• Is not ambulatory;
• Requires immediate medical evaluation and medical or nursing care;
• Has a history of felony charges related to bodily harm or assault;
All individuals screened by the Counselor or Clinical Supervisor that meet the criteria
will be accepted and listed in the Hispanic Commission's manual files and in an electronic
database after the screening process is complete and they have been found eligible. The intake
process focuses on an assessment of the participant's service needs. Participants will be
provided with all forms, financial agreements, rules and regulations, person rights, etc., which
specify conditions under which they may be terminated from the program. The grounds for
termination include arriving at the program while under the influence of drugs or alcohol,
violence or threats of violence against other participants or staff, and possession or concealment
of firearms,explosives or other weapons. After the screening process the log/file will be
generated and those placed on the waiting list are asked to call the Hispanic Commission on a
daily basis.
The Hispanic Commission follows the protocols recommended by the DBH Provider
Waiting List as required by Title 45, Code of Federal Regulations,§96.126 (C). Specific forms
are completed to track the person's name,telephone,first letter of the applicants name, gender of
applicant (1 for male, 2 for female),and the birth date of the applicant MMDDYY.Other
information includes status specific to drug and alcohol usage,Medi-Cal eligibility and SSI/SSP
benefits,services requested,date entered or removed from the waiting list, days on the waiting
list,referral to interim services,and reason removed from waiting list.Completed forms will be
submitted to the County on a monthly basis and copies will be retained at the program site.
Waiting list priorities are the same as the admission priorities indicated above.The Case
Manager and/or Counselors not only ask applicants to call in daily,staff also call them weekly to
update them regarding their status and to keep them interested.The agency will serve all persons
Exhibit A-Scope of Work
Page 11 of 17
deemed eligible for the program and who are committed to the treatment program.An individual
is removed from the waiting list only after he enters into treatment or indicates that treatment is
no longer desired.
F.Counseling Services
The Fresno HispanicCommission's treatment approachprovidesresidentialtreatment
services to Latino males following these guidelines:
1.Outreach must be intensive and persuasive in order to convince clients that a residential
program can benefit them. Potential clients must be at a point in their substance abuse
cyclethat they feel a need for help in overcomingtheir dependency.
2. The residential staff should be primarily male since Latino males are sometimes hesitant
to accept assistance from a female.
3. Services offered must be designed to address multiple Substance Use Disorders (SUD),
with alcohol which is often the primary substance. The treatment program must be
structured to allow men to discuss their feelings, believes, attitudes, and opinions without
fear of censor.
4. Group sessions encourage participants to identify and resolve alcohol and other drug
related problems,to examine personal attitudes and behaviors and provide support for
positive change in lifestyle leading to recovery.
5.Private counseling is available on a scheduled basis and as needed for each client.
6.Family members and significant others will be required to participate in family sessions.
Under the direction of Program Director and Clinical Supervisor,the Fresno Hispanic
Commission's program for Latino clients is designed to place trained counselors and clients into
a therapeutic climate that totally moves the client away from SUD's for a period of up to 90
days.During this time period,the program addresses all physical needs of the client from food
and shelter to medical needs. The cognitive behavioral program employs professionals and
paraprofessionals who are nurturing,caring and yet disciplined and structured.
The treatment environment includes individual and group therapy sessions that openly
and honestly address critical,social and cultural values.All paraprofessionals involved receive
training so that they can use cognitive behavioral counseling techniques,complete a treatment
plan and,facilitate group interaction.
The program also provides a range of support services.These include medical and
mental health consultation,educational training,recreational therapy,career and job training and
Exhibit A-Scope of Work
Page 12 of 17
other services such as self-help groups (12-step program and or church support systems)as
critical components of the services offered.
Individual counseling sessions play an important role in the treatment system.They
provide a forum in which to discuss critical issues,manage short-term crises,and explore
personal resources such as family issues.Sessions are both regularly scheduled and impromptu.
Independent of format,these sessions help keep participants focused on recovery or issues clients
may be reluctant to bring up in groups. Each client receives a minimum of one half-hour of
individual counseling per month.Clients with urgent needs,as well as those preparing to be
discharged,generally receive additional counseling as needed.
Job preparation is important to help clients with little if any formal employment
experience to develop realistic work expectations and identify jobsor careers they enjoy and in
which they can take excel.Vocational assistance challenges poor behaviors such as
helplessness,dishonesty,and criminality by helping clients understand the connection between
work and self-determination.The agency believes that regular wages lead to security and
dignity.Vocational services begin with an assessment of the client's interests,work history,
educational level,hobbies and aptitudes.The process helps clients develop occupational plans
and mediate behaviors such as lack of punctuality,poor work habits and personal motivation,
which are associated with substance abuse.The Hispanic Commission also addresses basics
such as the need to get a driver's license and proper identification,how to find jobs,fill out
applications, schedule appointment,how to dress for an interview, how to conduct oneself at an
interview (verbal language, i.e., the need to make eye contact, how to sit, how to address the
interviewer).These subjects are followed by more advanced concepts:how to construct a budget
and manage money,securing an apartment,subscribing to utilitiesand openinga bank account.
Mock interviews and role-play simulations play a major role in helping residents acquire new
skills.Participants are assigned tasks and responsibilities in the process like setting up and
breakingdown group meeting spaces, cleaningand maintenance,helping in the kitchen,ant other
tasks which help to build self-esteem,address interpersonal problem solving,and aide in team
building.Onceclientsmasterthe basics,theyare referred to key community programs.
G.Psycho Educational Groups
Individual and group sessions will be scheduled to provide for a wide varietyof psycho
educational counseling designed to meet the needs of individual clients. These sessions may
address issues like physical, emotional,social,psychological and cultural effectsof co-occurring
substance abuse/dependence and mental health disorders;life skills and resources; domestic
violence; self-help philosophy and how to develop peer support.
The activities of the staff and volunteers consist of effective intervention on behalf of the
targeted monolingual Hispanic population at the points of crisis within the alcohol and drug
abuse cycle. These points of impact include the courts and the justice system, detox and
emergency facilities, impacted families,employment related agencies and church organizations.
Exhibit A-Scope of Work
Page 13 of 17
Education groups are conducted by the counselor in a lecture format following the
culture-specific treatment curriculum.These materials explore substance abuse from a
biological,psychological,family,social,and spiritual perspective.The groups address the
physical,social,psychological,emotional and cultural effects of alcohol and drug use on the
well-being of not only the clients, but also, their families.Relations with others are discussed as
a path to recovery or relapse depending on the natureof the relationship.The role of stressand
anger management is presented as a tool to advance recovery.Both self-help philosophy and
peer support are discussed as critical elements of recovery.Educational/vocational training are
integrated into the curriculum.
The curriculum is supplemented by a journal book, which contains written exercises that
clients complete away from the group. Participants present their exercises and discuss them with
group members.The Hispanic Commission uses Spanish language of the journal exercises that
enable individuals with limited literacy skills in either language to formulate verbal responses
that they can then present to the group.
Peer groups provide a supportive environment in which participants can collectively
bring about changes in their attitudes and behaviors. Peer groups rely on the group process to
promote openness as well as insight among participants.Groups are direct, but not
confrontational,and no participants or staff is allowed to belittle another client.Peer groups
feature joint problem-solving exercises and can be very flexible, enabling staff to structure them
to meet emerging needs, move forward or backward, to respond to changes in the emotional
dynamics of the group. Peer groups provide an opportunity for members to serve as role models,
and the process helps participants share the personal impact of substance abuse on themselves
and their families
Peer associations are a strong force in the initiation of drug use. Similarly, treatment
programs support the recovery process through the use of peer associations.Staff will utilize
group treatment plans in order to integrate peer support into the treatment program. Space will
be shared with AA and NA in order to make peer support and self-help easily available.
Cultural competency is not merely a program component for the Hispanic Commission
but an operational principal expressed by the phrase "la Cultura Cura ".At its roots,alcoholism
and drug addiction destroys the web of solidarity that nurtures and maintains individuals,
families and communities.Alcoholism drowns the values and behavior characteristics of a
culture. The Hispanic Commission services are designed to lead clients to the harmony of a
sober life style by bringing about restoration and healing in a culturally specific context.
Cultural Principles:The Hispanic Commission team has integrated five basic cultural
principles into its treatment approach:
Family:The extended network of blood and fraternal relations.This traditional support system
is weakened by addiction related behavior and requires mending and restoration.
Exhibit A-Scope of Work
Page 14 of 17
Respect:The reciprocal difference and appreciative inquiry for mutual wellbeing.It is a truism
within the Hispanic culture that "respect"for self and the rights of others is the basis of peace.
Respeto is the ointment for interpersonal conflicts,which are one of the most damaging
consequences of addiction.
Education:Education is not limited to schooling,but includes traditional "knowledge"acquired
from elders and mentors.Respected elders are frequently referred toas '"maestro"and their
advice is solicited respectfully.
Work:The obligation that one should be involved in activities generating value,helping others,
creating beauty,fostering life,and providing for ones charges.This isnot limited to
employment,although that is a significantcomponent for most adults.
Spirituality:Best described asa sense ofthe individual's relationship toall creation and all
beings -a reverence for all life.This is not limited to formal religion which is merely an
expression of spirituality.
Relapse
Relapse is part of the recovery process. In a controlled environment such as this
program,the Hispanic Commission does not normally encounter alcohol and other drug use by
clients.Clients may at times encounter opportunities for alcohol or drug use when they leave the
treatment facilities to apply for work or receive other services.The Hispanic Commission
addresses relapse prevention in individual and group counseling throughout the course of
treatment.Relapse prevention is addressed not only in prevention groups,but also in education,
health,re-entry and virtually any group or individual session in which it is relevant.Staff helps
participants identify the circumstances and behaviors that lead to substance useand develop new
positive responses to these events.The Hispanic Commission helps clients develop clean and
sober social support networks and participate in AA, NA and alumni groups in addition to
treatment and recovery services to help them remain abstinent following discharge.Relapse
prevention activities at discharge focuses onjobs,housing,family issues,and independent living.
Exhibit A-Scope of Work
Page 15 of 17
H.Length of Treatment
Phase I:Probation-30 Days.
•Assessment;Orientation;Individual treatment plan: Familyhistory.
• No phone calls for 30 days or visitors.
•Steps to recover;Introduction to AA/NA;Self-Acceptance,Change;Discovering your
comfort zone.
Phase II:Transitional:Blackout Period -30-40 days.
•Passes are issued in accompaniment with family members;three phone callsper
week;job search after 30 days includephone calls and mailingresumes.
• Cultural stresses and conflict; communication; the physical effects of alcohol and
drugs;problem solving; bad influences;stress management; livingsober;violence
and abuse;refusal skills;alternatives to drugs;self assertion;incest;responsibility;
health impactsof drugs and alcohol; parents,children and siblings
STDs and HIV/AIDS;Relapse Prevention;AA/NA.
Phase HI:Transitional:40-60 Days.
• Four hour passes issued on Saturdays; one daily phone call to family orjob search.
•Self-discipline;peer influence;spirituality,co-dependency;personal recovery
planning;trust and mistrust; nutrition; strategies for amelioratingrelapse triggers;life
and coping skills;assignment to aftercare treatment modality; coordination with
parole;identification of social service needs; family issues.
The Hispanic Commission utilizes the American Society of Addition Medicine (ASAM)
criteria with it clients at Nuestra Casa. The ASAM criteria provide separate placement criteria
for adolescents and adults to create comprehensive and individualized treatment plans. The
treatment plans are developed through a multidimensional patient assessment over five broad
levels of treatment that are based on the degree of direct medical management, the structure,
safety and security provided, and the intensity of treatment services provided. The six
dimensions of multidimensional assessment are:
1.Acute Intoxication and/or Withdrawal Potential.
2.Biomedical Conditions and Complications.
3.Emotional,Behavioral,or Cognitive Conditions and Complications.
4.Readiness to Change
5.Relapse,Continued Use,or Continued Problem Potential.
Exhibit A-Scope of Work
Page 16 of 17
6.Recovery Living Environment.
The Hispanic Commission is proposing 60 days of residential treatment to clients divided
into a three-phase program. Peers and staff will review progress and make their decisionsbased
upon the client's attitude toward others,progress on therapeutic issues,honesty in dealing with
issues,and openness in the group discussion.The requirements of program graduation are to
have completed the curriculum, to be in good standing with one's peers and staff, and have
completed the requirements of each phase. A graduation ceremony will be held at the end of the
program to commemorate each client's completion of treatment.
The minimum length of primarytreatment will not be less then one day and the treatment
plan will be designed not to exceed 60 days.During the first 45 days discharge planning will
developed and if additional days are needed beyond 60 days a request will be made to the
Behavioral Health Contracts Division prior to the client's 45th day of service.
A daily census will be maintained for all clients including all the statistics required by
Fresno County and the State of California including complete records of services, referral
services, and progress notes of all counseling services. In addition the Commission has
established and will continue to adhere to its Continuous Quality Improvement, Utilization
Review and Cultural Competence Plans copies of each are included in this proposal.
A continuing care plan will be drawn up for each client. The plan will list each client's
unmet needs, risks, and strengths and weave them into a blueprint for the client to follow and
remain abstinent. All clients will participate in AA/NA and other peer support/self help
activities during treatment and will be expected to continue activities during care. The Hispanic
Commission will attempt to integrate unemployed clients and those with little ability to pay for
services into continuing care treatment slots supported by other funding sources. The agency
will work with other outpatient providers to find accessible treatment slots. The Hispanic
Commission will coordinate discharge planning and have copies of each client's signed
discharge plan. For Services other that AOD treatment,staff will contact providers of those
services (subject to signed client consent forms and/or Qualified Service Agreements)to let them
know that the client is leaving treatment effective on a certain date and to make sure that other
providers begin to work with participants to insure their continued participation in physical and
mental health,educational,social and other services.
I.Outcomes
Given that the agency serves a high-risk population with serious addiction,physical and
mental health,and vocational problems,the Hispanic Commission is proposing the following
performance outcome objections:
•Ninety percent of clients will remain in treatment for a minimum of 60 days.
•Eighty percent of clients will successfully complete the 60-day treatment program.
Exhibit A-Scope of Work
Page 17 of 17
•Seventy-five percent of clients will be employed at the time they complete treatment.
The Hispanic Commission will work closely with other providers to transition clients
from the residential level of service to a lower level of outpatient service.Contact will be
maintained with the outpatient service provider to monitor the client's success in terms of
abstinence from AOD use,criminal involvement,employment,social support,treatment needs,
and CFS involvement.Required outcomes will be measured at intake,discharge and post
treatment (one year follow-up).Data will be collected and reported to the County as required.
Timeline:
Outcomes for each client will be measured
1.At intake
2. At discharge - either 60-90 days.
3.12 months after discharge.
Measured outcomes will include:
•Abstinence from AOD use.
•Criminal involvement.
•Employement status.
•CPS involvement.
•Social support/connections.
•Treatment of co-occurring disorders.
J.Key Staffing Requirement
Staffing: All staffing requirements called for in the RFP are met by the Commission staff.
Language:All staff associated withthe ResidentialServicewill be fluent in Spanishwhich
is their "Language of Comfort" as well as that of the clients. This ability provides staffwith
cultural awareness of the meaning, idioms, slang usage, and various contexts in which the
Spanish language is used and avoids the confusion and miscommunication associated with direct
translation of English into Spanish.
FRESNO COUNTY
FY 2015-2016 BUDGET
BUDGET JUSTIFICATION NARRATIVE
Exhibit B
Page 1 of 20
PERSONNEL/SALARIES Annual Salary and FTE equivalence as in budqet.
Annual (12 Month)%of FTE dedicated
Budget Categories-Line Item Description Salary for this to this proqram
Executive Director $4,500 7%
Office Manager $3,500 7%
Clinical Supervisor $15,000 70%
Counselor $15,000 70%
Attendant $8,500 70%
Attendant $8,500 70%
Attendant $8,500 70%
Attendant $8,500 70%
Attendant $10,000 70%
Position descriptions submitted with proposal.
PAYROLL TAXES TOTAL
EMPLOYEE BENEFITS
TOTAL
INSURANCE List the following insurance categories:
0251 -Workers Compensation Insurance -
0252 - Liability Insurance-
0253 -Insurance Other -
COMMUNICATIONS 0301 -Telecommunications/data lines -
0302 -Answering Service -
OFFICE EXPENSE 0351-Office Supplies:Includes Items necessary to carry out the daily
activities to accomplish the program goals and objectives including paper,filing
supplies,pens,pencils,scissors,and other supplies.
0352 -Social/Rec,Workbooks.-
0353-Printing/Reproduction includes items such as the printing of business
cards,program pamphlets,position vacancy advertising and other materials
related to the program.
0354 -Publications -
0355 -Legal Notices/Advertising -
EQUIPMENT List the following equipment categories and provide a brief description for each
category:
0401 -Purchase of Equipment -
0402 -Equipment Rent/Lease-
0403-Equipment Maintenance:minor equipment repair for copier and
vehicle maintenance.
FACILITIES List the following facilities categories and provide a brief description for each
category:
0451 -Rent/Lease Building -
0452 -Facilities Maintenance -
0453 -Utilities -
FRESNO COUNTY
FY 2015-2016 BUDGET
BUDGET JUSTIFICATION NARRATIVE
Exhibit B
Page 2 of 20
TRAVEL Listthe following travel categories and provide a briefdescription for each
category:
0501 -Staff Mileage -
0502 -Staff Travel (Out of County) -
0503 -Staff Training/Registration -
0504 -Transportation -
PROGRAM SUPPLIES List the following programsupplies categories and providea briefdescription
for each category:
0551 -Program Supplies -Client Incentives
0552 -Program Supplies -Curriculum
0553 -Program Supplies -Food
CONSULTANCY Listthe following consulting categories and provide a briefdescription for each
category:
0601 -Consultant Services -
0602 -Contracted Services -
FISCAL AND AUDITS Listthe following fiscal and audits categories and provide a briefdescription for
each category:
0651 -Accounting/Bookkeeping -
0652 -External Audit -
OTHER COSTS Listthe following categories and provide a briefdescription for each category:
0701 -Indirect Costs -
0702 -Licenses/Taxes -
0703 -County Administration Fee -
0749-Other Costs -Other business services such as applicant TB tests,
drug screens,and other program-related items that don't necessarily fitinto
another line item.
REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the
revenue offsets expenditures for the existing/proposed program:
3120-Drug Medi-Cal -
Mental Health Medi-Cal -
3130-State Grant-
3140 -Private Donations -
3150-Client Fees-
Fiscal Year:
Provider Name:
Program:
Mailing Address:
Street Address:
Phone Number:
2015-2016
No. of Budgeted FTE Administration:
FRESNO COUNTY
PERSONNEL BUDGET
Direct Sen/ice:
Submitted by:
Date:
Approved by:
Signature:
Date:
Fax Number:
E-Mail Address:
Exhibit B
Page 3 of 20
Budget Categories-
Line Item Description
Annual
(12-Month)
%of FTE
dedicated to
%Time dedicated
to services
Proposed Program Budget
SAPTF jnding Other Funding Other Funding Total Proposed Budget
(Must be Itemized)Salary this program Admin.Direct Admin.Direct Admin.Direct Admin.Direct Admin.Direct
PERSONNEL/SALARIES
0101 Executive Director $4,500 7%100%$4,500 $4,500
0102 Office Manager $3,500 7%100%$3,500 $3,500
0103 Clinical Supervisor $15,000 70%20%80%$3,000 $12,000 $3,000 $12,000
0104 Counselor $15,000 70%100%$15,000 $15,000
0105 Attendant $8,500 70%100%$8,500 $8,500
0106 Attendant $8,500 70%100%$8,500 $8,500
0107 Attendant $8,500 70%100%$8,500 $8,500
0108 Attendant $8,500 70%100%$8,500 $8,500
0109 Attendant $10,000 70%20%80%$2,000 $8,000 $2,000 $8,000
0111
0112
0113
0114
0115
0116
0117
0118
0119
0120
0121
0122
0123
0124
0125
0126
0127
0128
0129
0130
SALARIES TOTAL $13,000 $69,000 $13,000 |$69,000
PAYROLL TAXES
0151 State Unemployment Insurance $301 $1,599 $301 $1,599
0152 F.I.CA./O.A.S.D.I.$995 $5,279 $995 |$5,279
0153 State Disability Insurance
0154 Workers'Compensation Insurance
PAYROLL TAXES TOTAL $1,296 $6,878 $1,296 $6,878
EMPLOYEE BENEFITS
0201 Health Insurance $1,000 $9,000 $1,000 $9,000
0202 Life Insurance
0203 Retirement
0204 Benefits Other -Specify
EMPLOYEE BENEFITS TOTAL $1,000 $9,000 $1,000 $9,000
TAXES &BENEFITS TOTAL $2,296 $15,878
TOTAL PERCENT OF BENEFITS TO SALARIES 8%13%
Provider Name:
Program:
Date:
FRESNO COUNTY
FY 2015-2016 BUDGET
Approved by:
Date:
Exhibit B
Page 4 of 20
Budget Categories-Line Item Description SAPT Funding Other Funding Other Funding Proposed Program
(Must Be Itemized)Budget Budget Budget Budget
SALARY,PAYROLL TAX,AND EMPLOYEE BENEFITS TOTAL $100,173 $0 $0 $100,173
INSURANCE
0251 Worker's Compensation Insurance $6,700 $6,700
0252 Liability Insurance $2,500 $2,500
0253 Insurance Other-Specify $0
INSURANCE TOTAL $9,200 $0 $0 $9,200
COMMUNICATIONS
0301 Telecommunications/data lines $4,200 $4,200
0302 Answering Service $0
COMMUNICATIONS TOTAL $4,200 $0 $0 $4,200
OFFICE EXPENSE
0351 Office Supplies $1,000 $1,000
0352 Soc Rec,Workbooks $0
0353 Printing/Reproduction $500 $500
0354 Publications $0
0355 Legal Notices/Advertising $0
OFFICE EXPENSE TOTAL $1,500 $0 $0 $1,500
EQUIPMENT
0401 Purchase of Equipment $0
0402 Equipment Rent/Lease $5,200 $5,200
0403 Equipment Maintenance $1,000 $1,000
EQUIPMENT TOTAL $6,200 $0 $0 $6,200
FACILITIES
0451 Rent/Lease Building $14,700 $14,700
0452 Facilities Maintenance $7,350 $7,350
0453 Utilities $6,000 $6,000
FACILITIES TOTAL $28,050 $0 $0 $28,050
TRAVEL COSTS
0501 Staff Mileage $750 $750
0502 Staff Travel (Out of County)$0
0503 Staff Training/Registration $1,000 $1,000
0504 Transportation $1,250 $1,250
TRAVEL COSTS TOTAL $3,000 $0 $0 $3,000
PROGRAM SUPPLIES
0551 Program Supplies-Client Incentives $0
0552 Program Supplies-Curriculum $4,200 $4,200
0553 Program Supplies-Food $28,000 $28,000
PROGRAM SUPPLIES TOTAL $32,200 $0 $0 $32,200
CONSULTANCY
0601 Consultant Services $500 $500
0602 Contracted Services $2,500 $2,500
CONSULTANCY TOTAL $3,000 $0 $0 $3,000
FISCAL AND AUDITS
0651 Accounting/Bookkeeping $1,500 $1,500
0652 External Audit $1,000 $1,000
FISCAL AND AUDITS TOTAL $2,500 $0 $0 $2,500
OTHER COSTS
0701 Indirect Costs $4,000 $4,000
0702 Licenses/Taxes $0
0703 County Administration Fee $2,500 $2,500
0749 Other Business Services $500 $500
OTHER COSTS TOTAL $7,000 $0 $0 $7,000
TOTAL PROGRAM EXPENDITURES $197,023 $0 $0 $197,023
REVENUE/MATCH
3120 Medi-Cal $0
3130 State Grant $0
3140 Private Donations $0
3150 Client Fees $2,630 $2,630
REVENUE/MATCH TOTAL $2,630 $0 $0 $2,630
NET PROGRAM BUDGET $194,393 $0 $0 $194,393
Exhibit B
Page 5 of 20
FRESNO COUNTY
FY 2016-2017 BUDGET
BUDGET JUSTIFICATION NARRATIVE
PERSONNEL/SALARIES
PAYROLL TAXES TOTAL
EMPLOYEE BENEFITS
TOTAL
INSURANCE
COMMUNICATIONS
OFFICE EXPENSE
EQUIPMENT
FACILITIES
Annual Salary and FTE equivalence as in
Budget Categories-Line ItemDescription
budget.
Annual (12 Month)
Salary for this
Executive Director
Office Manager
Clinical Supervisor
Counselor
Attendant
Attendant
Attendant
Attendant
Attendant
Position descriptions submitted with proposal.
Listthe following insurance categories:
0251 -Workers Compensation Insurance •
0252 - Liability Insurance-
0253 -Insurance Other -
0301 -Telecommunications/data lines •
0302 - Answering Service -
$4,500
$3,500
$15,000
$15,000
$9,000
$9,000
$9,000
$9,000
$10,500
%of FTE dedicated
to this program
7%
7%
70%
70%
70%
70%
70%
70%
70%
0351-Office Supplies: Includes Items necessary to carry out the daily
activities to accomplishthe program goals and objectives including paper,filing
supplies,pens,pencils,scissors,and other supplies.
0352 -Social/Rec,Workbooks.-
0353-Printing/Reproduction includes items such as the printing of business
cards,program pamphlets,position vacancy advertising and other materials
related to the program.
0354 -Publications -
0355 -Legal Notices/Advertising
Listthe following equipment categories and provide a briefdescription for each
0401 -Purchase of Equipment -
0402 -Equipment Rent/Lease-
0403-Equipment Maintenance:minor equipment repair for copier and
Listthe following facilities categories and provide a brief description for each
0451 -Rent/Lease Building -
FRESNO COUNTY
FY 2016-2017 BUDGET
BUDGET JUSTIFICATION NARRATIVE
Exhibit B
Page 6 of 20
0452 -Facilities Maintenance -
0453 -Utilities -
TRAVEL List the following travel categories and provide a brief description for each
0501 -Staff Mileage -
0502 -Staff Travel (Out of County)-
0503 -Staff Training/Registration -
0504 -Transportation -
PROGRAM SUPPLIES List the following program supplies categories and provide a brief description
0551 -Program Supplies -Client Incentives
0552 -Program Supplies -Curriculum
0553 -Program Supplies -Food
CONSULTANCY List the following consulting categories and provide a brief description for each
0601 -Consultant Services -
0602 -Contracted Services -
FISCAL AND AUDITS List the following fiscal and audits categories and provide a brief description for
0651 -Accounting/Bookkeeping -
0652 -External Audit -
OTHER COSTS List the following categories and provide a brief description for each category:
0701 -Indirect Costs -
0702 -Licenses/Taxes -
0703 -County Administration Fee -
0749-Other Costs -Other business services such as applicant TB tests,
drug screens,and other program-related items that don't necessarily fitinto
another line item.
REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the
3120-Drug Medi-Cal-
Mental Health Medi-Cal -
3130-State Grant-
3140 -Private Donations -
3150-Client Fees-
Fiscal Year:
Provider Name:
Program:
Mailing Address:
Street Address:
Phone Number:
2016-2017
No. of Budgeted FTE Administration:
FRESNO COUNTY
PERSONNEL BUDGET
Direct Service:
Submitted by:
Date:
Approved by:
Signature:
Date:
Fax Number:
E-Mail Address:
Exhibit B
Page 7 of 20
Budget Categories-
Line Item Description
Annual
(12-Month)
%Of FTE
dedicated to
%Time dedicated
to services
Proposed Program Budget
SAPT Funding Other Funding Other Funding Total Proposed Budget
(Must be Itemized)Salary this program Admin.Direct Admin.Direct Admin.Direct Admin.Direct Admin Direct
PERSONNEUSALARIES
0101 Executive Director $4,500 7%100%$4,500 $4,500
0102 Office Manager $3,500 7%100%$3,500 $3,500
0103 Clinical Supervisor $15,000 70%20%80%$3,000 $12,000 $3,000 $12,000
0104 Counselor $15,000 70%100%$15,000 $15,000
0105 Attendant $9,000 70%100%$9,000 $9,000
0106 Attendant $9,000 70%100%$9,000 $9,000
0107 Attendant $9,000 70%100%$9,000 $9,000
0108 Attendant $9,000 70%100%$9,000 $9,000
0109 Attendant $10,500 70%20%80%$2,100 $8,400 $2,100 $8,400
0110
0111
0123
0124
0125
0126
0127
0128
0129
0130
SALARIES TOTAL $13,100 $71,400 $13,100 |$71,400
PAYROLL TAXES
0151 State Unemployment Insurance $295 $1,605 $295 $1,605
0152 F.I.C.A./O.A.S.D.I.$1,002 $5,462 $1,002 |$5,462
0153 State Disability Insurance
0154 Workers'Compensation Insurance
PAYROLL TAXES TOTAL $1,297 $7,067 $1,297 $7,067
EMPLOYEE BENEFITS
0201 Health Insurance $1,000 $9,000 $1,000 $9,000
0202 Life Insurance
0203 Retirement
0204 Benefits Other -Specify
EMPLOYEE BENEFITS TOTAL $1,000 $9,000 $1,000 $9,000
TAXES &BENEFITS TOTAL $2,297 $16,067
TOTAL PERCENT OF BENEFITS TO SALARIES 8%13%
Provider Name:
Program:
Date:
FRESNO COUNTY
FY 2016-2017 BUDGET
Approved by:
Date:'
Exhibit B
Page 8 of 20
BudgetCategories-Line Item Description
(Must Be Itemized)
SAPT Funding
Budget
Other Funding
Budget
Other Funding
Budget
Proposed Program
BudgetSALARY,PAYROLL TAX, AND EMPLOYEE BENEFITS TOTAL $102,864 $6 $0 $102,864
INSURANCE
0251 Worker's Compensation Insurance
0252 Liability Insurance
0253 Insurance Other-Specify
$6,801
$2,500
$6,801
$2,500
$0
INSURANCE TOTAL $9,301 $0 $0 $9,301
COMMUNICATIONS
0301 Telecommunications/data lines
0302 Answering Service
$4,263 $4,263
$0
COMMUNICATIONS TOTAL $4,263 $0 $0 $4,263
OFFICE EXPENSE
0351 Office Supplies
0352 Soc Rec,Workbooks
0353 Printing/Reproduction
0354 Publications
0355 Legal Notices/Advertising
$1,000
$500
$1,000
$0
$500
$0
$0
OFFICE EXPENSE TOTAL $1,500 $0 $0 $1,500
EQUIPMENT
0401 Purchase of Equipment
0402 Equipment Rent/Lease
0403 Equipment Maintenance
$5,200
$1,000
$0
$5,200
$1,000
EQUIPMENT TOTAL $6,200 $0 $0 $6,200
FACILITIES
0451 Rent/Lease Building
0452 Facilities Maintenance
0453 Utilities
$14,700
$7,350
$6,090
$14,700
$7,350
$6,090
FACILITIES TOTAL $28,140 $0 $0 $28,140
TRAVEL COSTS
0501 Staff Mileage
0502 Staff Travel (Out of County)
0503 Staff Training/Registration
0504 Transportation
$750
$1,000
$1,269
$750
$0
$1,000
$1,269
TRAVEL COSTS TOTAL $3,019 $0 $0 $3,019
PROGRAM SUPPLIES
0551 Program Supplies-Client Incentives
0552 Program Supplies-Curriculum
0553 Program Supplies-Food
$4,200
$28,454
$0
$4,200
$28,454
PROGRAM SUPPLIES TOTAL $32,654 $0 $0 $32,654
CONSULTANCY
0601 Consultant Services
0602 Contracted Services
$500
$2,538
$500
$2,538
CONSULTANCY TOTAL $3,038 $0 $0 $3,038
FISCAL AND AUDITS
0651 Accounting/Bookkeeping
0652 External Audit
$1,500
$1,000
$1,500
$1,000
FISCAL AND AUDITS TOTAL $2,500 $0 $0 $2,500
OTHER COSTS
0701 Indirect Costs
0702 Licenses/Taxes
0703 County Administration Fee
0749 Other Business Services
$3,500
$2,500
$500
$3,500
$0
$2,500
$500
OTHER COSTS TOTAL $6,500 $0 $0 $6,500
TOTAL PROGRAM EXPENDITURES $199,979 $0 $0 $199,979
REVENUE/MATCH
3120 Medi-Cal
3130 State Grant
3140 Private Donations
3150 Client Fees $2,670
$0
$0
$0
$2,670REVENUE/MATCH TOTAL |$2,670 $0 J $0 |$2,670
NET PROGRAM BUDGET $197,309 |$0 $0 $197,309
Exhibit B
Page 9 of 20
FRESNO COUNTY
FY 2017-2018 BUDGET
BUDGET JUSTIFICATION NARRATIVE
PERSONNEL/SALARIES
PAYROLL TAXES TOTAL
EMPLOYEE BENEFITS
TOTAL
INSURANCE
COMMUNICATIONS
OFFICE EXPENSE
EQUIPMENT
Annual Salary and FTE equivalence as in
Budget Categories-LineItem Description
budget.
Annual (12 Month)
Salary for this
Executive Director
Office Manager
Clinical Supervisor
Counselor
Attendant
Attendant
Attendant
Attendant
Attendant
Position descriptions submitted with proposal.
List the following insurance categories:
0251 -Workers Compensation Insurance •
0252 - Liability Insurance-
0253 -Insurance Other -
0301 -Telecommunications/data lines
0302-Answering Service -
$4,500
$3,500
$15,000
$15,000
$9,500
$9,500
$9,500
$9,500
$11,000
%of FTE dedicated
to this program
7%
7%
70%
70%
70%
70%
70%
70%
70%
0351-Office Supplies: Includes Items necessary to carryout the daily
activities to accomplish the program goals and objectives including paper,filing
supplies,pens,pencils,scissors,and other supplies.
0352 -Social/Rec,Workbooks.-
0353-Printing/Reproduction includes items such as the printing of business
cards,program pamphlets,position vacancy advertising and other materials
related to the program.
0354 -Publications -
0355 -Legal Notices/Advertising
Listthe following equipment categories and provide a briefdescription for each
category:
0401 -Purchase of Equipment -
0402 -Equipment Rent/Lease-
0403-Equipment Maintenance:minor equipment repair for copier and
vehicle maintenance.
FACILITIES
TRAVEL
FRESNO COUNTY
FY 2017-2018 BUDGET
BUDGET JUSTIFICATION NARRATIVE
Exhibit B
Page 10 of 20
List the following facilities categoriesand provide a brief description for each
category:
0451 -Rent/Lease Building -
0452 -Facilities Maintenance -
0453 -Utilities -
List the following travel categories and provide a brief description for each
0501 - Staff Mileage-
0502 - Staff Travel (Out of County) -
0503 - Staff Training/Registration -
0504 -Transportation -
PROGRAM SUPPLIES List the following program supplies categories and provide a brief description
0551 -Program Supplies -Client Incentives
0552 -Program Supplies -Curriculum
0553 -Program Supplies -Food
CONSULTANCY
FISCAL AND AUDITS
OTHER COSTS
REVENUE/MATCH
List the following consulting categories and provide a brief description for each
0601 -Consultant Services -
0602 -Contracted Services -
List the following fiscal and auditscategories and provide a brief description for
0651 -Accounting/Bookkeeping-
0652 -External Audit -
List the following categoriesand provide a brief description for each category:
0701 -Indirect Costs -
0702 -Licenses/Taxes -
0703 -County Administration Fee -
0749-Other Costs - Other business services such as applicant TB tests,
drug screens,and other program-related items that don't necessarily fit into
another line item.
Please identifyall anticipated funding sources and distinguish whether the
3120-Drug Medi-Cal-
Mental Health Medi-Cal -
3130-State Grant-
3140 -Private Donations -
3150-Client Fees-
Fiscal Year:
Provider Name:
Program:
Mailing Address:
Street Address:
Phone Number:
2017-2018
No. of Budgeted FTE Administration:
FRESNO COUNTY
PERSONNEL BUDGET
Direct Service:
Submitted by:
Date:
Approved by:
Signature:
Date:
Fax Number:
E-Mail Address:
Exhibit B
Page 11 of 20
Budget Categories-
Line Item Description
Annual
(12-Month)
%of FTE
dedicated to
%Time dedicated
to services
Proposed Program Budget
SAPTF jnding Other Funding Other Funding Total Proposed Budget
(Must be Itemized)Salary this program Admin.Direct Admin.Direct Admin Direct Admin.Direct Admin.Direct
PERSONNELVSALARIES
0101 Executive Director $4,500 7%100%$4,500 $4,500 $0
0102 Office Manager $3,500 7%100%$3,500 $3,500 $0
0103 Clinical Supervisor $15,000 70%20%80%$3,000 $12,000 $3,000 $12,000
0104 Counselor $15,000 70%100%$15,000 $0 $15,000
0105 Attendant $9,500 70%0%100%$9,500 $0 $9,500
0106 Attendant $9,500 70%0%100%$9,500 $0 $9,500
0107 Attendant $9,500 70%0%100%$9,500 $0 $9,500
0108 Attendant $9,500 70%0%100%$9,500 $0 $9,500
0109 Attendant $11,000 70%20%80%$2,200 $8,800 $2,200 $8,800
0110
0111
0112
0113
0114
0115
0116
0117
0118
0119
0120
0121
0122
0123
0124
0125
0126
0127
0128
0129
0130
SALARIES TOTAL $13,200 $73,800 $0 $0 $0 $0 $13,200 |$73,800
PAYROLL TAXES
0151 State Unemployment Insurance $288 $1,612 $288 $1,612
0152 F.I.C.A./O.A.S.DI.$1,010 $5,646 $1,010 $5,646
0153 State Disability Insurance $0 $0
0154 Workers'Compensation Insurance $0 $0
PAYROLL TAXES TOTAL $1,298 $7,258 $0 $0 $0 $0 $1,298 $7,258
EMPLOYEE BENEFITS
0201 Health Insurance $1,000 $9,000 $1,000 $9,000
0202 Life Insurance $0 $0
0203 Retirement $0 $0
0204 Benefits Other -Specify $0 $0
EMPLOYEE BENEFITS TOTAL $1,000 $9,000 $0 $0 $0 $0 $1,000 $9,000
TAXES &BENEFITS TOTAL $2,298 $16,258
TOTAL PERCENT OF BENEFITS TO SALARIES 8%12%
Provider Name:
Program:
Date:
FRESNO COUNTY
FY 2017-2018 BUDGET
Approved by:
Date:"
Exhibit B
Page 12 of 20
Budget Categories-Line Item Description
(Must Be Itemized)
SAPT Funding
Budget
Other Funding
Budget
Other Funding
Budget
Proposed Program
Budget
SALARY,PAYROLL TAX, AND EMPLOYEE BENEFITS TOTAL $105,556 $0 $0 $105,556
INSURANCE
0251 Worker's Compensation Insurance
0252 Liability Insurance
0253 Insurance Other-Specify
$6,903
$2,500
$6,903
$2,500
$0
INSURANCE TOTAL $9,403 $0 $0 $9,403
COMMUNICATIONS
0301 Telecommunications/data lines
0302 Answering Service
$4,327 $4,327
$0
COMMUNICATIONS TOTAL $4,327 $0 $0 $4,327
OFFICE EXPENSE
0351 Office Supplies
0352 Soc Rec,Workbooks
0353 Printing/Reproduction
0354 Publications
0355 Legal Notices/Advertising
$1,000
S500
$1,000
so
$500
$0
SO
OFFICE EXPENSE TOTAL $1,500 $0 $0 $1,500
EQUIPMENT
0401 Purchase of Equipment
0402 Equipment Rent/Lease
0403 Equipment Maintenance
$5,200
$1,000
$0
$5,200
51,000
EQUIPMENT TOTAL $6,200 $0 $0 $6,200
FACILITIES
0451 Rent/Lease Building
0452 Facilities Maintenance
0453 Utilities
$14,700
$7,350
$6,181
$14,700
$7,350
$6,181
FACILITIES TOTAL $28,231 $0 $0 $28,231
TRAVEL COSTS
0501 Staff Mileage
0502 Staff Travel (Out of County)
0503 Staff Training/Registration
0504 Transportation
$750
$1,000
$1,288
$750
$0
$1,000
$1,288
TRAVEL COSTS TOTAL $3,038 $0 $0 $3,038
PROGRAM SUPPLIES
0551 Program Supplies-Client Incentives
0552 Program Supplies-Curriculum
0553 Program Supplies-Food
$4,200
$28,949
$0
$4,200
$28,949
PROGRAM SUPPLIES TOTAL $33,149 $0 $0 $33,149
CONSULTANCY
0601 Consultant Services
0602 Contracted Services
$500
$2,576
$500
$2,576
CONSULTANCY TOTAL $3,076 $0 $0 $3,076
FISCAL AND AUDITS
0651 Accounting/Bookkeeping
0652 External Audit
$1,500
$1,000
$1,500
$1,000
FISCAL AND AUDITS TOTAL $2,500 $0 $0 $2,500
OTHER COSTS
0701 Indirect Costs
0702 Licenses/Taxes
0703 County Administration Fee
0749 Other Business Services
$3,000
$2,500
$500
$3,000
$0
$2,500
$500
OTHER COSTS TOTAL $6,000 $0 $0 $6,000
TOTAL PROGRAM EXPENDITURES $202,980 $0 $0 $202,980
REVENUE/MATCH
3120 Medi-Cal
3130 State Grant
3140 Private Donations
3150 Client Fees $2,711
$0
$0
$0
$2,711
REVENUE/MATCH TOTAL $2,711 $0 $0 $2,711
NET PROGRAM BUDGET $200,269 $0 $0 $200,269
FRESNO COUNTY
FY 2018-2019 BUDGET
BUDGET JUSTIFICATION NARRATIVE
Exhibit B
Page 13 of 20
PERSONNEL/SALARIES Annual Salary and FTE equivalence as in budqet.
Annual (12 Month)%of FTE dedicated
Budget Categories-Line Item Description Salary for this to this proqram
Executive Director $4,500 7%
Office Manager $3,500 7%
Clinical Supervisor $15,000 70%
Counselor $15,000 70%
Attendant $10,000 70%
Attendant $10,000 70%
Attendant $10,000 70%
Attendant $10,000 70%
Attendant $11,500 70%
Position descriptions submitted with proposal.
PAYROLL TAXES TOTAL
EMPLOYEE BENEFITS
TOTAL
INSURANCE List the following insurance categories:
0251 -Workers Compensation Insurance -
0252 - Liability Insurance-
0253 -Insurance Other -
COMMUNICATIONS 0301 -Telecommunications/data lines -
0302 -Answering Service -
OFFICE EXPENSE 0351-Office Supplies:Includes Items necessary to carry out the daily
activities to accomplish the program goals and objectives including paper,filing
supplies,pens,pencils,scissors,and other supplies.
0352 -Social/Rec,Workbooks.-
0353-Printing/Reproduction includes items such as the printing of business
cards,program pamphlets,position vacancy advertising and other materials
related to the program.
0354 -Publications -
0355 -Legal Notices/Advertising -
EQUIPMENT List the following equipment categories and provide a brief description for each
category:
0401 -Purchase of Equipment -
0402 -Equipment Rent/Lease-
0403-Equipment Maintenance:minor equipment repair for copier and
vehicle maintenance.
FACILITIES List the following facilities categories and provide a brief description for each
category:
0451 -Rent/Lease Building -
0452 -Facilities Maintenance -
0453 -Utilities -
TRAVEL List the following travel categories and provide a brief description for each
0501 -Staff Mileage -
0502 -Staff Travel (Out of County)-
0503 -Staff Training/Registration -
0504 -Transportation -
FRESNO COUNTY
FY 2018-2019 BUDGET
BUDGET JUSTIFICATION NARRATIVE
Exhibit B
Page 14 of 20
PROGRAM SUPPLIES List the following program supplies categories and provide a brief description
0551 -Program Supplies -Client Incentives
0552 -Program Supplies -Curriculum
0553 -Program Supplies -Food
CONSULTANCY List the following consulting categories and provide a brief description for each
0601 -Consultant Services -
0602 -Contracted Services -
FISCAL AND AUDITS List the following fiscal and audits categories and provide a brief description for
0651 -Accounting/Bookkeeping -
0652 -External Audit -
OTHER COSTS List the following categories and provide a brief description for each category:
0701 -Indirect Costs -
0702 -Licenses/Taxes -
0703 -County Administration Fee -
0749-Other Costs -Other business services such as applicant TB tests,
drug screens,and other program-related items that don't necessarily fit into
another line item.
REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the
3120-Drug Medi-Cal-
Mental Health Medi-Cal -
3130-State Grant-
3140 -Private Donations -
3150-Client Fees-
Fiscal Year:
Provider Name:
Program:
Mailing Address:
Street Address:
Phone Number:
2018-2019
No. of Budgeted FTE Administration:
FRESNO COUNTY
PERSONNEL BUDGET
Direct Service:
Submitted by
Date
Approved by
Signature:
Date:
Fax Number:
E-Mail Address:
Exhibit B
Page 15 of 20
Budget Categories-
Line Item Description
Annual
(12-Month)
%of FTE
dedicated to
%Time dedicated
to services
Proposed Program Budget
SAPT Funding Other Funding Other Funding Total Proposed Budget
(Must be Itemized)Salary this program Admin.Direct Admin.Direct Admin Direct Admin.Direct Admin.Direct
PERSONNEL/SALARIES
0101 Executive Director $4,500 7%100%$4,500 $4,500 $0
0102 Office Manager $3,500 7%100%$3,500 $3,500 $0
0103 Clinical Supervisor $15,000 70%20%80%$3,000 $12,000 $3,000 $12,000
0104 Counselor $15,000 70%100%$15,000 $0 $15,000
0105 Attendant $10,000 70%0%100%$10,000 $0 $10,000
0106 Attendant $10,000 70%0%100%$10,000 $0 $10,000
0107 Attendant $10,000 70%0%100%$10,000 $0 $10,000
0108 Attendant $10,000 70%0%100%$10,000 $0 $10,000
0109 Attendant $11,500 70%20%80%$2,300 $9,200 $2,300 $9,200
0110 $0 $0
0111 $0 $0
0112 $0 $0
0113 $0 $0
0114 $0 $0
0115 $0 $0
0116 $0 $0
0117 $0 $0
0118 $0 $0
0119 $0 $0
0120 $0 $0
0121 $0 $0
0122 $0 $0
0123 $0 $0
0124 $0 $0
0125 $0 $0
0126 $0 $0
0127 $0 $0
0128 $0 $0
0129 $0 $0
0130 $0 $0
SALARIES TOTAL $13,300 $76,200 $0 $0 $0 $0 $13,300 |$76,200
PAYROLL TAXES
0151 State Unemployment Insurance $282 $1,618 $282 $1,618
0152 F.I C.A./O.A.S D.I.$1,017 $5,829 $1,017 $5,829
0153 State Disability Insurance $0 $0
0154 Workers'Compensation Insurance $0 $0
PAYROLL TAXES TOTAL $1,300 $7,447 $0 $0 $0 $0 $1,300 $7,447
EMPLOYEE BENEFITS
0201 Health Insurance $1,000 $9,000 $1,000 $9,000
0202 Life Insurance $0 $0
0203 Retirement $0 $0
0204 Benefits Other -Specify $0 $0
EMPLOYEE BENEFITS TOTAL $1,000 $9,000 $0 $0 $0 $0 $1,000 $9,000
TAXES &BENEFITS TOTAL $2,300 $16,447
TOTAL PERCENT OF BENEFITS TO SALARIES 8%12%
Provider Name:
Program:
Date:
FRESNO COUNTY
FY 2018-2019 BUDGET
Approved by:
Date:"
Exhibit B
Page 16 of 20
Budget Categories-Line Item Description
(Must Be Itemized)
SAPT Funding
Budget
Other Funding
Budget
Other Funding
Budget
Proposed Program
BudgetSALARY,PAYROLL TAX, AND EMPLOYEE BENEFITS TOTAL $108,247 $0 $0 $108,247
INSURANCE
0251 Worker's Compensation Insurance
0252 Liability Insurance
0253 Insurance Other-Specify
$7,006
$2,500
$7,006
$2,500
$0
INSURANCE TOTAL $9,506 $0 $0 $9,506
COMMUNICATIONS
0301 Telecommunications/data lines
0302 Answering Service
$4,392 $4,392
$0
COMMUNICATIONS TOTAL $4,392 $0 $0 $4,392
OFFICE EXPENSE
0351 Office Supplies
0352 SocRec,Workbooks
0353 Printing/Reproduction
0354 Publications
0355 Legal Notices/Advertising
$1,000
$500
$1,000
$0
$500
$0
$0
OFFICE EXPENSE TOTAL $1,500 $0 $0 $1,500
EQUIPMENT
0401 Purchase of Equipment
0402 Equipment Rent/Lease
0403 Equipment Maintenance
$5,200
$1,000
$0
$5,200
$1,000
EQUIPMENT TOTAL $6,200 $0 $0 $6,200
FACILITIES
0451 Rent/Lease Building
0452 Facilities Maintenance
0453 Utilities
$14,700
$7,350
$6,274
$14,700
$7,350
$6,274
FACILITIES TOTAL $28,324 $0 $0 $28,324
TRAVEL COSTS
0501 Staff Mileage
0502 Staff Travel (Out of County)
0503 Staff Training/Registration
0504 Transportation
$750
$1,000
$1,307
$750
$0
$1,000
$1,307
TRAVEL COSTS TOTAL $3,057 $0 $0 $3,057
PROGRAM SUPPLIES
0551 Program Supplies-Client Incentives
0552 Program Supplies-Curriculum
0553 Program Supplies-Food
$4,200
$29,483
$0
$4,200
$29,483
PROGRAM SUPPLIES TOTAL $33,683 $0 $0 $33,683
CONSULTANCY
0601 Consultant Services
0602 Contracted Services
$500
$2,614
$500
$2,614
CONSULTANCY TOTAL $3,114 $0 $0 $3,114
FISCAL AND AUDITS
0651 Accounting/Bookkeeping
0652 External Audit
$1,500
$1,000
$1,500
$1,000
FISCAL AND AUDITS TOTAL $2,500 $0 $0 $2,500
OTHER COSTS
0701 Indirect Costs
0702 Licenses/Taxes
0703 County Administration Fee
0749 Other Business Services
$2,500
$2,500
$500
$2,500
SO
$2,500
$500
OTHER COSTS TOTAL $5,500 $0 $0 $5,500
TOTAL PROGRAM EXPENDITURES $206,023 $0 $0 $206,023
REVENUE/MATCH
3120 Medi-Cal
3130 State Grant
3140 Private Donations
3150 Client Fees $2,750
$0
$0
$0
$2,750
REVENUE/MATCH TOTAL $2,750 |$0 |$0 $2,750 |
NET PROGRAM BUDGET | $203,273 | $0 $0 $203,273
Exhibits
Page 17 of 20
FRESNO COUNTY
FY 2019-2020 BUDGET
BUDGET JUSTIFICATION NARRATIVE
PERSONNEL/SALARIES
PAYROLL TAXES TOTAL
EMPLOYEE BENEFITS
TOTAL
INSURANCE
COMMUNICATIONS
OFFICE EXPENSE
EQUIPMENT
Annual Salary and FTE equivalence as in
Budget Categories-Line ItemDescription
budget.
Annual (12 Month)
Salary for this
Executive Director
Office Manager
Clinical Supervisor
Counselor
Attendant
Attendant
Attendant
Attendant
Attendant
Position descriptions submitted with proposal.
Listthe following insurance categories:
0251 -Workers Compensation Insurance •
0252 - Liability Insurance-
0253 -Insurance Other -
0301 -Telecommunications/data lines •
0302-Answering Service-
$4,500
$3,500
$15,000
$15,000
$10,500
$10,500
$10,500
$10,500
$12,000
%of FTE dedicated
to this program
7%
7%
70%
70%
70%
70%
70%
70%
70%
0351-Office Supplies: Includes Items necessary to carry out the daily
activitiesto accomplish the programgoals and objectives including paper,filing
supplies,pens,pencils,scissors,and other supplies.
0352 -Social/Rec,Workbooks.-
0353-Printing/Reproduction includes items such as the printingof business
cards,program pamphlets,position vacancy advertising and other materials
related to the program.
0354 -Publications -
0355 -Legal Notices/Advertising
Listthe following equipment categories and provide a brief description for each
category:
0401 -Purchase of Equipment -
0402 -Equipment Rent/Lease-
0403-Equipment Maintenance:minor equipment repair for copier and
vehicle maintenance.
FRESNO COUNTY
FY 2019-2020 BUDGET
BUDGET JUSTIFICATION NARRATIVE
Exhibit B
Page 18 of 20
FACILITIES List the following facilities categories and provide a brief description for each
category:
0451 -Rent/Lease Building -
0452 -Facilities Maintenance -
0453 -Utilities -
TRAVEL List the following travel categories and provide a brief description for each
0501 -Staff Mileage -
0502 -Staff Travel (Out of County)-
0503 -Staff Training/Registration -
0504 -Transportation -
PROGRAM SUPPLIES List the following program supplies categories and provide a brief description
0551 -Program Supplies -Client Incentives
0552 -Program Supplies -Curriculum
0553 -Program Supplies -Food
CONSULTANCY List the following consulting categories and provide a brief description for each
0601 -Consultant Services -
0602 -Contracted Services -
FISCAL AND AUDITS List the followingfiscal and audits categories and provide a brief description for
0651 -Accounting/Bookkeeping -
0652 -External Audit -
OTHER COSTS List the following categories and provide a brief description for each category:
0701 -Indirect Costs -
0702 -Licenses/Taxes -
0703 -County Administration Fee -
0749-Other Costs -Other business services such as applicant TB tests,
drug screens,and other program-related items that don't necessarily fit into
another line item.
REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the
3120-Drug Medi-Cal-
Mental Health Medi-Cal -
3130-State Grant-
3140 -Private Donations -
3150-Client Fees-
Fiscal Year:
Provider Name:
Program:
Mailing Address:
Street Address:
Phone Number:
2019-2020
No. of Budgeted FTE Administration:
FRESNO COUNTY
PERSONNEL BUDGET
Direct Service:
Submitted by:
Date:
Approved by:
Signature:
Date:
Fax Number:
E-Mail Address:
Exhibit B
Page 19 of 20
Budget Categories-
Line Item Description
Annual
(12-Month)
%of FTE
dedicated to
%Time dedicated
to services
Proposed Program Budget
SAPT Funding Other Funding Other Funding Total Proposed Budget
(Must be Itemized)Salary this program Admin.Direct Admin.Direct Admin Direct Admin.Direct Admin.Direct
PERSONNEL/SALARIES
0101 Executive Director $4,500 7%100%$4,500 $4,500 $0
0102 Office Manager $3,500 7%100%$3,500 $3,500 $0
0103 Clinical Supervisor $15,000 70%20%80%$3,000 $12,000 $3,000 $12,000
0104 Counselor $15,000 70%100%$15,000 $0 $15,000
0105 Attendant $10,500 70%0%100%$10,500 $0 $10,500
0106 Attendant $10,500 70%0%100%$10,500 $0 $10,500
0107 Attendant $10,500 70%0%100%$10,500 $0 $10,500
0108 Attendant $10,500 70%0%100%$10,500 $0 $10,500
0109 Attendant $12,000 70%20%80%$2,400 $9,600 $2,400 $9,600
0110 $0 $0
0111 $0 $0
0112 $0 $0
0113 $0 $0
0114 $0 $0
0115 $0 $0
0116 $0 $0
0117 $0 $0
0118 $0 $0
0119 $0 $0
0120 $0 $0
0121 $0 $0
0122 $0 $0
0123 $0 $0
0124 $0 $0
0125 $0 $0
0126 $0 $0
0127 $0 $0
0128 $0 $0
0129 $0 $0
0130 $0 $0
SALARIES TOTAL $13,400 $78,600 $0 $0 $0 $0 $13,400 |$78,600
PAYROLL TAXES
0151 State Unemployment Insurance $284 $1,616 $284 $1,616
0152 F.I.CA./O.A.S.D.I.$1,025 $6,013 $1,025 $6,013
0153 State Disability Insurance $0 $0
0154 Workers'Compensation Insurance $0 $0
PAYROLL TAXES TOTAL $1,310 $7,628 $0 $0 $0 $0 $1,310 $7,628
EMPLOYEE BENEFITS
0201 Health Insurance $1,000 $9,000 $1,000 $9,000
0202 Life Insurance $0 $0
0203 Retirement $0 $0
0204 Benefits Other -Specify $0 $0
EMPLOYEE BENEFITS TOTAL $1,000 $9,000 $0 $0 $0 $0 $1,000 $9,000
TAXES &BENEFITS TOTAL $2,310 $16,628
TOTAL PERCENT OF BENEFITS TO SALARIES 7%11%|
Provider Name:
Program:
Date:
FRESNO COUNTY
FY 2019-2020 BUDGET
Approved by:
Date:
Exhibit B
Page 20 of 20
Budget Categories-Line Item Description
(Must Be Itemized)
SAPT Funding
Budget
Other Funding
Budget
Other Funding
Budget
Proposed Program
Budget
SALARY,PAYROLL TAX, AND EMPLOYEE BENEFITS TOTAL $110,938 $0 $0 $110,938
INSURANCE
0251 Worker's Compensation Insurance
0252 Liability Insurance
0253 Insurance Other-Specify
$7,111
$2,500
$7,111
$2,500
$0
INSURANCE TOTAL $9,611 $0 $0 $9,611
COMMUNICATIONS
0301 Telecommunications/data lines
0302 Answering Service
$4,458 $4,458
$0
COMMUNICATIONS TOTAL $4,458 $0 $0 $4,458
OFFICE EXPENSE
0351 Office Supplies
0352 Soc Rec,Workbooks
0353 Printing/Reproduction
0354 Publications
0355 Legal Notices/Advertising
$1,000
$500
$1,000
$0
$500
$0
$0
OFFICE EXPENSE TOTAL $1,500 $0 $0 $1,500
EQUIPMENT
0401 Purchase of Equipment
0402 Equipment Rent/Lease
0403 Equipment Maintenance
$5,200
$1,000
$0
$5,200
$1,000
EQUIPMENT TOTAL $6,200 $0 $0 $6,200
FACILITIES
0451 Rent/Lease Building
0452 Facilities Maintenance
0453 Utilities
$14,700
$7,350
$6,368
$14,700
$7,350
$6,368
FACILITIES TOTAL $28,418 $0 $0 $28,418
TRAVEL COSTS
0501 Staff Mileage
0502 Staff Travel (Out of County)
0503 Staff Training/Registration
0504 Transportation
$750
$1,000
$1,327
$750
$0
$1,000
$1,327
TRAVEL COSTS TOTAL $3,077 $0 $0 $3,077
PROGRAM SUPPLIES
0551 Program Supplies-Client Incentives
0552 Program Supplies-Curriculum
0553 Program Supplies-Food
$4,200
$30,058
$0
$4,200
$30,058
PROGRAM SUPPLIES TOTAL $34,258 $0 $0 $34,258
CONSULTANCY
0601 Consultant Services
0602 Contracted Services
$500
$2,653
$500
$2,653
CONSULTANCY TOTAL $3,153 $0 $0 $3,153
FISCAL AND AUDITS
0651 Accounting/Bookkeeping
0652 External Audit
$1,500
$1,000
$1,500
$1,000
FISCAL AND AUDITS TOTAL $2,500 $0 $0 $2,500
OTHER COSTS
0701 Indirect Costs
0702 Licenses/Taxes
0703 County Administration Fee
0749 Other Business Services
$2,000
$2,500
$500
$2,000
$0
$2,500
$500
OTHER COSTS TOTAL $5,000 $0 $0 $5,000
TOTAL PROGRAM EXPENDITURES $209,113 $0 $0 $209,113
REVENUE/MATCH
3120 Medi-Cal
3130 State Grant
3140 Private Donations
3150 Client Fees $2,791
$0
$0
$0
$2,791
REVENUE/MATCH TOTAL $2,791 $0 $0 $2,791
NET PROGRAM BUDGET $206,322 $0 I $0 $206,322
Exhibit C
Page 1 of 2
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as "County"),
members of a contractor's board of directors (hereinafter referred to as "County Contractor"),must
disclose any self-dealing transactions that they are a party to while providing goods,performing
services,or both for the County.A self-dealing transaction is defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest"
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member's name,job title (if applicable),and date this disclosure is being made.
(2)Enter the board member's company/agency name and address.
(3)Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County.At a minimum,include a description of the following:
a. The name of the agency/company with which the corporation has the transaction;and
b. The nature of the material financial interest in the Corporation's transaction that the
board member has.
(4)Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3)and (4).
(1)Company Board Member Information:
/W/^fc /^z^XVName:Date:^2^/5-job Title:[5er.rei-^-r^
(2)Company/Agency Name and Address:
^ce^NoCoaN^j M(5-p^(c (o^^^Sioaj
(3)Disclosure (Please describe the nature of the self-dealing transaction you are a party to):
Exhibit C
Page 2 of 2
(4) Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a):
/I'/l
(5)Authorized Signature
Signature:U^a-dc c Date:5-^o-(^
The National CLAS Standards
Exhibit D
Page 1 of 2
The National Standards for Culturally and Linguistically Appropriate Services in Health and
Health Care (The National CLAS Standards)aim to improve health care quality and advance health
equity byestablishing a framework for organizations to serve the nation's increasingly diverse
communities.
Principal Standard
1)Provide effective,equitable,understandable and respectful quality care and services that are
responsive to diverse cultural health beliefs and practices,preferred languages,health literacy and
other communication needs.
Governance,Leadership and Workforce
2)Advance and sustain organizational governance and leadership that promotes CLAS and health
equity through policy,practices and allocated resources.
3) Recruit,promote and support a culturally and linguistically diverse governance,leadership and
workforce that are responsive to the population in the service area.
4)Educate and train governance,leadership and workforce in culturally and linguistically appropriate
policies and practices on an ongoing basis.
Communication and Language Assistance
5) Offer language assistance to individuals who have limited English proficiency and/or other
communication needs,at no cost to them,to facilitate timely access to all health care and services.
6)Inform all individuals of the availability of language assistance services clearly and in their
prefened language,verbally and in writing.
7) Ensure the competence of individuals providing language assistance,recognizing that the use of
untrained individuals and/or minors as interpreters should be avoided.
8) Provide easy--to understand print and multimedia materials and signage in the languages
commonly used by the populations in the service area.
Engagement,Continuous Improvement and Accountability
9) Establish culturally and linguistically appropriate goals, policies and management accountability,
and infuse them throughout the organizations'planning and operations.
Exhibit D
Page 2 of 2
10)Conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-
related measures into assessment measurement and continuous quality improvement activities.
11)Collect,and maintain accurate and reliable demographic data to monitor and evaluate the impact
of CLAS on health equity and outcomes and to inform service delivery.
12)Conduct regular assessments of community health assets and needs and use the results to plan
and implement services that respond to the cultural and linguistic diversity of populations in the
service area.
13)Partner with the community to design,implement and evaluate policies,practices and services to
ensure cultural and linguistic appropriateness.
14)Create conflict-and grievance-resolution processes that are culturally and linguistically
appropriate to identify,prevent and resolve conflicts or complaints.
15)Communicate the organization's progress in implementing and sustaining CLAS to all
stakeholders,constituents and the general public.
Exhibit E
Page 1 of 3
DISCLOSURE -CRIMINAL HISTORY &CIVIL ACTIONS:
In their proposal,the bidder is required todisclose if any ofthe following conditions apply to
them,theirowners,officers,corporate managers and partners (hereinafter collectively
referred to as "Bidder"):
•Within the three-year period preceding the proposal,they have been convicted of, or
had a civil judgment rendered against them for:
o fraud or a criminal offense inconnection with obtaining, attempting to obtain, or
performing a public (federal,state,or local)transaction or contract under a
public transaction;
o violation of a federal or state antitrust statute;
o embezzlement,theft, forgery, bribery, falsification, or destruction of records;or
o false statements or receipt of stolen property
•Within a three-year period preceding their proposal, they have had a publictransaction
(federal,state,or local)terminated for cause or default.
Disclosure of the above information will not automatically eliminate a Bidder from
consideration.The information will be considered as part of the determination of whether to
award the contract and any additional information or explanation that a Bidder elects to submit
with the disclosed information will be considered.If it is later determined that the Bidder failed
to disclose required information,any contract awarded to such Bidder may be immediately
voided and terminated for material failure to comply with the terms and conditions of the
award.
Any Bidderwho is awarded a contract must sign an appropriate Certification Regarding
Debarment,Suspension,and Other Responsibility Matters,pages 2 and 3 of this Exhibit,
Additionally,the Bidder awarded the contract must immediately advise the County in writing if,
during the term of the agreement:(1) Bidder becomes suspended,debarred,excluded or
ineligible for participation infederal or state funded programs or from receiving federal funds
as listed inthe excluded parties list system (http://www/epls/qov);or (2) any of the above
listed conditions become applicable to Bidder. The Bidder will indemnify,defend and hold the
County harmless for any loss or damage resulting from a conviction,debarment,exclusion,
ineligibility or other matter listed inthe signed Certification Regarding Debarment,
Suspension,and Other Responsibility Matters.
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Exhibit E
Page 2 of 3
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
iater 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.
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CERTIFICATION
Exhibit E
Page 3 of 3
(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)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.
ftfiakL Uc-Z^E^j/Seccefrcra FffsMO foa^H^^Tc Co^
(Printed Name &Title)'(Name of Agency or Company)
Signature:v ,/)Date:^(J
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Exhibit F
NOTICE OF CHILD ABUSE REPORTING LAW
The undersignedhereby acknowledgesthat Penal Code section 11166 and the
contractual obligations between County of Fresno (COUNTY)and PROVIDER(S)
related to provision of alcohol and drug abuse treatment services for Fresno County
residents,require thatthe undersigned report all known or suspected child abuse or
neglect tooneor more ofthe agencies set forth in Penal Code (P.C.)section (§)11165.9.
For purposes of the undersigned'schildabuse reporting requirements,-'child
abuse or neglect"includes physical injury inflicted by other than accidental means upon a
child by another person,sexual abuse as defined in P.C.§11165.1,neglect as defined in
P.C.§11165.2,willful cruelty or unjustifiable punishment as defined in P.C.§11165.3,
and unlawful corporal punishment or injuryas definedin P.C.§11165.4.
A childabusereportshallbe madewheneverthe undersigned,in hisor her
professional capacity or within the scope of his orher employment,has knowledge ofor
observes a child whom the undersigned knows or reasonably suspects has been the victim
of child abuse or neglect.(P.C §11166.)The child abuse report shall be made to any
police department or sheriffs department (not including a school district police or
security department),orto any county welfare department,including Fresno County
Department of Children and Family Services'24 Hour CARELINE.(See PC §11165.9.)
For purposes of childabuse reporting,a "reasonable suspicion"means that it is
objectively reasonable fora person to entertain a suspicion,based upon facts that could
causea reasonable personina like position,drawing,when appropriate,on hisor her
training and experience,to suspect child abuse or neglect.The pregnancy ofa child does
not,inandof itself,constitute abasisfor reasonable suspicion of sexual abuse.(P.C.
§11166(a)(1).)
Substantial penalties maybe imposed for failure to complywiththesechildabuse
reporting requirements.
Further information and a copy ofthelawmaybe obtained from the department
head or designee.
Ihavereadand understand the above statement and agree to comply withthe
child abuse reporting requirements.
b £2>-IS
SIGNATURE /J DATE
0980fadx