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Agreement No . 20-238
AGREEMENT
THIS AGREEMENT is made and entered into this~ day of _...,.J....,uo .... e~--· 2020 , by and
between the COUNTY OF FRESNO , a Political Subdivision of the State of California, hereinafter
referred to as "COUNTY", and CENTRAL STAR BEHAVIORAL HEAL TH, Inc. a for-profit
organization , whose address is 1501 Hughes Way , Suite 150 , Long Beach , CA 9081 O, hereinafter
referred to as "CONTRACTOR," collectively , "the parties ."
WITNESS ETH:
WHEREAS , COUNTY , through its Department of Behavioral Health (DBH), is in need of a
qualified agency to operate its sixteen ( 16) bed acute inpatient psychiatric health facility (PHF) to
provide inpatient psychiatric services to adolescent youth , twelve (12) years up to eighteen (18) years
of age , who may be admitted on a voluntary or involuntary bas is and may include Medi-Cal
beneficiaries, Medicare and Medicare/Medi-Cal beneficiaries , indigent /uninsured consumers , and
juvenile inmates who are referred by DBH , a contract prov ider with the DBH , or hospital emergency
room , other County departments and other agencies ;
WHEREAS , COUNTY , through its Department of Behavioral Health (DBH), is a Mental Health
Plan (MHP) as defined in Title 9 of the California Code of Regulations (C.C.R.), Section 1810.226 ;
and
WHEREAS , CONTRACTOR is qualified and willing to operate said PHF pursuant to the terms
and conditions of this Agreement.
NOW, THEREFORE , in consideration of their mutual covenants and conditions , the parties
hereto agree as follows :
1. SERVICES
A. CONTRACTOR shall perform all services and fulfill all responsibilities as set forth
in Exhibit A , "Scope of Work ," attached hereto and by this reference incorporated herein and made
part of this Agreement.
B. CONTRACTOR shall adhere to the COUNTY adopted Target Population
outlined in Exhibit A , "Scope of Work".
Ill
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Fresno , CA
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C. CONTRACTOR shall also perform all services and fulfill all responsibilities as
specified in COUNTY’s Request for Proposal (RFP) No. 20-015 dated September 24, 2019, and
Addendum No. One (1) to COUNTY’S RFP No. 20-015 dated October 23, 2019, herein collectively
referred to as COUNTY’s Revised RFP, and CONTRACTOR’s Response to said Revised RFP dated
November 6, 2019, all incorporated herein by reference and made part of this Agreement. In the
event of any inconsistency among these documents, the inconsistency shall be resolved by giving
precedence in the following order of priority: 1) to this Agreement, including all Exhibits, 2) to the
Revised RFP, 3) to the Response to the Revised RFP. A copy of COUNTY’s Revised RFP No. 20-
015 and CONTRACTOR’s Response thereto shall be retained and made available during the term of
this Agreement by COUNTY’s DBH Contracts Division.
D. CONTRACTOR shall align programs, services, and practices with the vision,
mission, and guiding principles of the DBH, as further described in Exhibit B, “Fresno County
Department of Behavioral Health Guiding Principles of Care Delivery”, attached hereto and by this
reference incorporated herein and made part of this Agreement.
E. It is acknowledged by all parties hereto that COUNTY’s DBH Administrative Unit
shall monitor the PHF operated by CONTRACTOR, in accordance with Section Fourteen (14) of this
Agreement.
F. CONTRACTOR shall participate in monthly, or as needed, workgroup meetings
consisting of staff from COUNTY’s DBH Administrative Unit to discuss PHF requirements, data
reporting, training, policies and procedures, overall program operations and any problems or
foreseeable problems that may arise.
G. CONTRACTOR shall execute a mutually agreeable lease agreement with
COUNTY for the lease of COUNTY-owned property located at 4411 E. Kings Canyon, Fresno, CA
93702 as the site for CONTRACTOR’s provision of PHF services under this Agreement. If
CONTRACTOR or CONTRACTOR’s affiliate fails to accomplish these tasks prior to providing
services under this Agreement, COUNTY may, in addition to other remedies it may have, suspend
referrals or terminate this Agreement, in accordance with Section Three (3) of this Agreement. The
COUNTY is exploring possible alternative locations for its programs currently located on the
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COUNTY’s University Medical Center (UMC) Campus at 4411 E. Kings Canyon, Fresno, CA 93702.
CONTRACTOR will be expected to work with COUNTY in relocation of the Adolescent Youth PHF
services in the event that a different site is identified during the term of this Agreement. It is
anticipated that the CONTRACTOR would be able to communicate with COUNTY and perform a
walk-through of any new identified site to address facility design, etc.
H. CONTRACTOR shall maintain requirements as an organizational provider
throughout the term of this Agreement, as described in Section Seventeen (17) of this Agreement. If
for any reason, this status is not maintained, COUNTY may terminate this Agreement pursuant to
Section Three (3) of this Agreement.
I. CONTRACTOR agrees that prior to, and while providing services under the
terms and conditions of this Agreement, CONTRACTOR shall have staff hired and in place for
program services and operations or COUNTY may, in addition to other remedies it may have,
suspend referrals or terminate this Agreement, in accordance with Section Three (3) of this
Agreement.
J. It is acknowledged by all parties hereto that COUNTY’s DBH shall be responsible
for COUNTY DBH-approved facility improvements to the Adolescent Youth PHF. Payments for
COUNTY DBH-approved improvements to the PHF will be funded by the COUNTY’s DBH. Said
improvements shall be at the discretion of the COUNTY’S DBH Director or designee. Improvements
stated herein shall mean those improvements to the PHF designed to assist with the operation of the
PHF.
K. It is acknowledged by all parties hereto that building maintenance and utilities for
the PHF will be provided by COUNTY and COUNTY will invoice CONTRACTOR for said services as
further described in Section Five (5) of this Agreement.
2. TERM
This Agreement shall become effective on July 1, 2020 and shall terminate on June 30,
2023.
This Agreement, subject to satisfactory outcomes performance and subject to adequate
funding each year, may be extended for two (2) additional twelve (12) month periods upon the written
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approval of both parties not later than sixty (60) days prior to the close of the then current Agreement
term. The COUNTY’s DBH Director, or designee, is authorized to execute such written approval on
behalf of COUNTY based on CONTRACTOR’s satisfactory outcomes performance.
3. TERMINATION
A. Non-Allocation of Funds - The terms of this Agreement, and the services to be
provided thereunder, is 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 CONTRACTOR 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;
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 CONTRACTOR. Neither
shall such payment impair or prejudice any remedy available to COUNTY with respect to the breach
or default. The COUNTY shall have the right to demand of the CONTRACTOR the repayment to the
COUNTY of any funds disbursed to CONTRACTOR under this Agreement, which in the judgment of
COUNTY were not expended in accordance with the terms of this Agreement. The CONTRACTOR
shall promptly refund any such funds upon demand or at COUNTY’s option, such repayment shall be
deducted from future payments owing to CONTRACTOR under this Agreement.
C. Without Cause - Under circumstances other than those set forth above, this
Agreement may be terminated by COUNTY or CONTRACTOR upon the giving of sixty (30) days
advance written notice of an intention to terminate.
4. COMPENSATION
COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
compensation in accordance with the Budget as set forth in Exhibit C, attached hereto and by this
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reference in corporated herein and made part of this Agreement.
The COUNTY and CONTRACTOR agree that the CONTRACTOR will actively solicit
and contract with other entities/agencies for bed placement at the PHF at no cost to the COUNTY.
CONTRACTOR will provide the COUNTY, in writing, a list of secured contracts with hospitals, other
agencies, and counties utilizing the PHF. COUNTY shall pay the CONTRACTOR for operational costs
less any beds purchased and/or utilized and charged to other outside agencies.
A. Annual Compensation Amounts
The maximum amount for the period of July 1, 2020 through June 30, 2021 shall
not exceed Five Million, Three Hundred Seven Thousand, Six Hundred Forty-One and No/100 Dollars
($5,307,641.00).
The maximum amount for the period of July 1, 2021 through June 30, 2022 shall
not exceed Five Million, Four Hundred Thirty-Eight Thousand, Nine Hundred Fourteen and No/100
Dollars ($5,438,914.00).
The maximum amount for the period of July 1, 2022 through June 30, 2023 shall
not exceed Five Million, Six Hundred Two Thousand, Eighty-Four and and No/100 Dollars
($5,602,084.00).
If performance standards are met and this Agreement is extended for an
additional twelve (12) month renewal period beginning July 1, 2023 through June 30, 2024, the
maximum amount payable to CONTRACTOR for said period shall not exceed Five Million, Seven
Hundred Seventy Thousand, One Hundred Forty-Four and No/100 Dollars ($5,770,144.00).
If performance standards are met and this Agreement is extended for an
additional twelve (12) month renewal period beginning July 1, 2024 through June 30, 2025, the
maximum amount payable to CONTRACTOR for said period shall not exceed Five Million, Nine
Hundred Forty-Three Thousand, Two Hundred Forty-Nine and No/100 Dollars ($5,943,249.00).
B. Total Maximum Compensation Amounts
In no event shall the total maximum compensation amount under this Agreement
for the period beginning July 1, 2020 through June 30, 2023 exceed Sixteen Million, Three Hundred
Forty-Eight Thousand, Six Hundred Thirty-Nine and No/100 Dollars ($16,348,639.00).
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If performance standards are met and this Agreement is extended for an
additional twelve (12) month term pursuant to Section 3, TERM, herein, then in no event shall the
total maximum compensation amount under this Agreement beginning July 1, 2020 through June 30,
2024 exceed Twenty-Two Million, One Hundred Eighteen Thousand, Seven Hundred Eighty-Three
and No/100 Dollars ($22,118,783.00).
If performance standards are met and this Agreement is extended for an
additional twelve (12) month term pursuant to Section 3, TERM, herein, then in no event shall the
total maximum compensation amount under this Agreement beginning July 1, 2020 through June 30,
2025 exceed Twenty-Eight Million, Sixty-Two Thousand, Thirty-Two and No/100 Dollars
($28,062,032.00).
C. Prior to March 1st of each fiscal year, CONTRACTOR may provide to COUNTY’s
DBH an updated budget and budget narrative in the format identified in Exhibit C for the upcoming
twelve (12) month period. Each budget shall require justification by the CONTRACTOR, and
approval of COUNTY’s DBH Director, or designee, prior to April 1st for the upcoming twelve (12)
month period covered by said budget. If said budget is not received by the March 1st due date, the
budget as attached to this Agreement for the upcoming twelve (12) month period will remain, as
shown in Exhibit C. The amount of said approved budget shall not exceed the maximum
compensation for the then current Agreement period.
D. If CONTRACTOR fails to generate the Medi-Cal revenue
as set forth in Exhibit C, the COUNTY shall not be obligated to pay the difference between these
estimated amounts and the actual amounts generated. It is further understood by COUNTY and
CONTRACTOR that any Medi-Cal revenue above the amounts stated herein will be used to directly
offset the COUNTY’s contribution of COUNTY funds identified in Exhibit C. The offset of funds will
also be clearly identified in monthly invoices received from CONTRACTOR as further described in
Section Five (5) of this Agreement.
E. Travel shall be reimbursed based on actual expenditures and mileage
reimbursement shall be at CONTRACTOR’s adopted rate per mile, not to exceed the Federal Internal
Revenue Services (IRS) published rate for the then current year.
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F. It is understood that all expenses incidental to CONTRACTOR’s performance of
services under this Agreement shall be borne by CONTRACTOR. If CONTRACTOR fails to comply
with any provision of this Agreement, COUNTY shall be relieved of its obligation for further
compensation.
G. Payments shall be made by COUNTY to CONTRACTOR in arrears, for services
provided during the preceding month, within forty-five (45) days after the date of receipt and approval
by COUNTY of the monthly invoicing as described in Section Five (5) herein. Payments shall be
made after receipt and verification of actual expenditures incurred by CONTRACTOR for monthly
program costs, as identified in Exhibit C, in the performance of this Agreement and shall be
documented to COUNTY on a monthly basis by the tenth (10th) of the month following the month of
said expenditures. The parties acknowledge that the CONTRACTOR will be performing hiring,
training, and credentialing of staff, and the COUNTY will be performing additional staff credentialing to
ensure compliance with State and Federal regulations.
H. COUNTY shall not be obligated to make any payments under this Agreement if
the request for payment is received by COUNTY more than sixty (60) days after this Agreement has
terminated or expired.
I. All final invoices shall be submitted by CONTRACTOR within sixty (60) days
following the final month of service for which payment is claimed. No action shall be taken by
COUNTY on invoices submitted beyond the sixty (60) day closeout period. Any compensation which
is not expended by CONTRACTOR pursuant to the terms and conditions of this Agreement shall
automatically revert to COUNTY.
J. The services provided by CONTRACTOR under this Agreement are funded in
whole or in part by the State of California. In the event that funding for these services is delayed by
the State Controller, COUNTY may defer payments to CONTRACTOR. 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.
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K. CONTRACTOR shall be held financially liable for any and all future
disallowances/audit exceptions due to CONTRACTOR’s deficiency discovered through the State audit
process and COUNTY utilization review during the course of this Agreement. At COUNTY’s election,
the disallowed amount will be remitted within forty-five (45) days to COUNTY upon notification or shall
be withheld from subsequent payments to CONTRACTOR. CONTRACTOR shall not receive
reimbursement for any units of services rendered that are disallowed or denied by the Fresno County
Mental Health Plan (Mental Health Plan) utilization review process or through the State Department of
Health Care Services (DHCS) cost report audit settlement process for Medi-Cal eligible clients.
Notwithstanding the above, COUNTY must notify CONTRACTOR prior to any State audit process
and/or COUNTY utilization review. To the extent allowable by law, CONTRACTOR shall have the
right to be present during each phase of any State audit process and/or COUNTY utilization review
and shall be provided all documentation related to each phase of any State audit process and/or
COUNTY utilization review. Additionally, prior to any disallowances/audit exceptions becoming final,
CONTRACTOR shall be given at least ten (10) business days to respond to such proposed
disallowances/audit exceptions.
L. It is understood by CONTRACTOR and COUNTY that this Agreement is funded
with mental health funds to serve individuals with serious emotional disturbances (SED).
5. INVOICING
A. COUNTY’S DBH shall invoice CONTRACTOR by the fifth (5th) day of each month
for the prior month’s expenditures for building maintenance and utilities for the PHF. CONTRACTOR
shall provide payment for these expenditures to COUNTY’s Fresno County Department of Behavioral
Health, Accounts Receivable, P.O. Box 712, Fresno, CA 93717-0712, Attention: Business Office,
within forty-five (45) days after the date of receipt by CONTRACTOR of the monthly invoicing
provided by COUNTY.
B. CONTRACTOR shall invoice COUNTY in arrears by the tenth (10th) day of each
month for the prior month’s actual services rendered to DBH-Invoices@fresnocountyca.gov,
DBHInvoiceReview@fresnocountyca.gov, DBHContractedServicesDivision@fresnocountyca.gov and
carbon copy email to the currently assigned DBH Mental Health Contracts Staff Analyst. After
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CONTRACTOR renders service to referred clients, CONTRACTOR will invoice COUNTY for
payment, certify the expenditure, and submit electronic claiming billing directly into COUNTY’s
electronic health records system for all clients, including those eligible for Medi-Cal as well as those
that are not eligible for Medi-Cal, including contracted cost per unit and actual cost per unit.
COUNTY must pay CONTRACTOR before submitting a claim to DHCS for Federal and State
reimbursement for Medi-Cal eligible clients.
C. CONTRACTOR shall submit to the COUNTY by the tenth (10th) of each month a
detailed general ledger (GL) itemizing costs incurred in the previous month. CONTRACTOR will also
submit Profit and Loss (P&L) statement and all other supporting documentation requested by the
COUNTY in order to process each invoice for payment along with the GL. Failure to submit GL
reports, P&L statement and other supporting documentation shall be deemed sufficient cause for
COUNTY to withhold payments until there is compliance.
D. CONTRACTOR shall submit monthly invoices and general ledgers that itemize
the line item charges for monthly program costs per applicable budget, as identified in Exhibit C,
including the cost per unit calculation based on clients served within that month, and excluding
unallowable costs. Unallowable costs such as lobbying or political donations must be deducted from
the monthly invoice reimbursements. The invoices and general ledgers will serve as tracking tools to
determine if CONTRACTOR’s program costs are in accordance with its budgeted cost, and cost per
unit negotiated by service modes compared to actual cost per unit, as set forth in Exhibit C. The
actual cost per unit will be based upon total costs and total units of service. It will also serve for the
COUNTY to certify the public funds expended for purposes of claiming Federal and State
reimbursement for the cost of Medi-Cal services and activities. CONTRACTOR shall remit to
COUNTY on a quarterly basis, a summary report of total operational costs and volume of service
units to report the actual costs per unit compared to the negotiated rate, as identified in Exhibit C, to
report the interim cost per unit. The quarterly reports will be used by COUNTY to ensure compliance
with Federal and State reimbursements certified public expenditures.
E. Monthly invoices shall include a client roster, identifying volume reported by
payer group clients served (including third party payer of services) by month and year-to-date,
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including percentages.
F. If CONTRACTOR chooses to utilize the COUNTY’s electronic health record
(EHR) system (currently “AVATAR”, the DBH contracted EHR system) method as their own full EHR,
COUNTY’s DBH shall invoice CONTRACTOR in arrears by the fifth (5th) day of each month for the
prior month’s hosting fee for access to the COUNTY’s EHR in accordance with the fee schedule as
set forth in Exhibit D, “Electronic Health Records Software Charges” attached hereto and
incorporated herein by reference. COUNTY shall invoice CONTRACTOR annually for the annual
maintenance and licensing fee for access to the COUNTY’s EHR in accordance with the fee schedule
as set forth in Exhibit D. CONTRACTOR shall provide payment for these expenditures to Fresno
County Department of Behavioral Health, Accounts Receivable, P.O. Box 712, Fresno, CA 93717-
0712, Attention: Business Office, within forty-five (45) days after the date of receipt by
CONTRACTOR(S) of the invoicing provided by COUNTY
G. Operational period invoices, July 1, 2020 through June 30, 2025, shall include a
client roster identifying bed utilization unit/bed volume reported by payer group for clients served
(including clients from other agencies and third-party payer of services) by month and year-to-date.
H. At the discretion of COUNTY’s DBH Director, or designee, if an invoice is
incorrect or is otherwise not in proper form or substance, COUNTY’s DBH Director, or designee, shall
have the right to withhold payment as to only that portion of the invoice that is incorrect or improper
after five (5) days prior notice to CONTRACTOR. CONTRACTOR agrees to continue to provide
services for a period of ninety (90) days after notification of an incorrect or improper invoice. If after
the ninety (90) day period, the invoice(s) is still not corrected to COUNTY’s DBH satisfaction,
COUNTY’s DBH Director, or designee, may elect to terminate this Agreement, pursuant to the
termination provisions stated in Section Three (3) of this Agreement. In addition, for invoices
received ninety (90) days after the expiration of each term of this Agreement or termination of this
Agreement, at the discretion of COUNTY’s DBH Director, or designee, COUNTY’s DBH shall have
the right to deny payment of any additional invoices received.
I. CONTRACTOR must report all third-party collections from other funding
sources such as Medicare, private insurance, client private pay or any other third party. COUNTY
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expects the invoice for reimbursement to equal the amount due CONTRACTOR less any funding
sources not eligible for federal reimbursement.
J. CONTRACTOR will remit annually within ninety (90) days from June 30, a
schedule to provide the required information on published charges for all authorized services. The
publish charge listing will serve as a source document to determine their usual and customary charge
prevalent in the public mental health sector that is used to bill the general public, insurers or other
non-Medi-Cal third party payors during the course of business operations.
K. CONTRACTOR shall submit monthly staffing report that identifies all direct
service and support staff, applicable licensure/certifications, and full time equivalent (FTE) hours
worked to be used as a tracking tool to determine if CONTRATOR’s program is staffed according to
the Agreement requirements.
L. CONTRACTOR must maintain such financial records for a period of seven (7)
years or until any dispute, audit or inspection is resolved, whichever is later. CONTRACTOR will be
responsible for any disallowances related to inadequate documentation.
M. CONTRACTOR is responsible for collection and managing data in a manner to
be determined by DHCS and Mental Health Specialty plan in accordance with applicable rules and
regulations. COUNTY EHR is a critical source of information for purposes of monitoring service
volume and obtaining reimbursement. CONTRACTOR must attend COUNTY’s Business Office
training on equipment reporting for assets, intangible and sensitive minor assets, COUNTY’s EHR
system and related cost reporting.
N. CONTRACTOR shall submit service data into COUNTY’s EHR
system within thirty (30) calendar days from the date services were rendered. Federal and State
reimbursement for Medi-Cal specialty mental health services is based on public expenditures certified
by the CONTRACTOR. CONTRACTOR must submit a signed certified public expenditure report,
with each respective monthly invoice. DHCS expects the claims for Federal and State
reimbursement to equal the amount the COUNTY paid the CONTRACTOR for the service rendered
less any funding sources not eligible for Federal and State reimbursement.
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O. CONTRACTOR must provide all necessary data to allow the COUNTY to bill
Medi-Cal, and any other third-pary 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 EHR; 2) providing an electronic file compatible with COUNTY’s
EHR system; or 3) integration between COUNTY’s EHR system and CONTRACTOR’s information
system(s).
P. If a client has other health coverage (OHC) such as private insurance, or Federal
Medicare, the CONTRACTOR will be responsible for billing the carrier and obtaining a payment,
denial, or have validation of claiming with no response ninety (90) days after the claim was mailed,
before the service can be entered into the COUNTY’s EHR system. A copy of explanation of benefits
or CMS 1500 is required as documentation. CONTRACTOR must report all revenue collection from
OHC, third party, client-pay, or private-pay in each monthly invoice and in the cost report that is
required to be submitted. CONTRACTOR shall submit monthly invoices for reimbursement that equal
the amount due CONTRACTOR less any funding sources not eligible for Federal and State
reimbursement. CONTRACTOR must comply with all laws and regulations governing the Federal
Medicare program, including, but not limited to: 1) the requirement of the Medicare Act, 42 U.S.C.
section 1395 et seq; and 2) the regulation and rules promulgated by the Centers for Medicare and
Medicaid Services as they relate to participation, coverage, and claiming reimbursement.
CONTRACTOR will be responsible for compliance as of the effective date of each Federal, State, or
local law or regulation specified.
Q. Data entry into COUNTY’s EHR system shall be the responsibility of the
CONTRACTOR. The direct specialty mental health services data must be reconciled by the
CONTRACTOR to the monthly invoices submitted for payment. COUNTY shall monitor the volume of
services and cost of services entered into the COUNTY’s EHR system. Any and all audit exceptions
resulting from the provision and reporting of Medi-Cal services by CONTRACTOR shall be the sole
responsibility of the CONTRACTOR. CONTRACTOR will comply with all applicable policies,
procedures, directives and guidelines regarding the use of COUNTY’s EHR system. If
CONTRACTOR elects to use their own EHR system, the EHR must have Certification Commission
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for Healthcare Information Technology (CCHIT) certification for Security Access Control, Audit and
Authentication. CONTRACTOR’s billers in the EHR system will need to sign an Electronic Signature
Certification (ESR).
R. Medi-Cal Certification and Mental Health Plan Compliance
CONTRACTOR will establish and maintain Medi-Cal certification or become
certified within ninety (90) days of the effective date of this Agreement through COUNTY to provide
reimbursable services to Medi-Cal eligible clients. In addition, CONTRACTOR shall work with the
COUNTY’s DBH to execute the process if not currently certified by COUNTY for credentialing of staff.
During this process, the CONTRACTOR will obtain a legal entity number established by the DHCS,
as this is a requirement for maintaining Mental Health Plan organizational provider status throughout
the term of this Agreement. CONTRACTOR will be required to become Medi-Cal certified prior to
providing services to Medi-Cal eligible clients and seeking reimbursement from the COUNTY.
CONTRACTOR will not be reimbursed by COUNTY for any services rendered prior to certification.
CONTRACTOR shall provide specialty mental health services in accordance with
the COUNTY’s Mental Health Plan. CONTRACTOR must comply with the “Fresno County Mental
Health Plan Compliance Program and Code of Conduct” set forth in Exhibit E, attached hereto and by
this reference incorporated herein and made part of this Agreement.
CONTRACTOR may provide direct specialty mental health services using
unlicensed staff as long as the individual is approved as a provider by the Mental Health Plan, is
supervised by licensed staff, works within his/her scope, and only delivers allowable specialty mental
health services. It is understood that each claim is subject to audit for compliance with Federal and
State regulations, and that COUNTY may be making payments in advance of said review. In the
event that a service is disapproved, COUNTY may, at its sole discretion, withhold compensation or
set off from other payments due the amount of said disapproved services. CONTRACTOR shall be
responsible for audit exceptions to ineligible dates of services or incorrect application of utilization
review requirements.
6. INDEPENDENT CONTRACTOR
In performance of the work, duties, and obligations assumed by CONTRACTOR under
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this Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of
CONTRACTOR’s officers, agents, and employees will at all times be acting and performing as
independent CONTRACTOR, and shall act in an independent capacity and not as an officer, agent,
servant, employee, joint venture, partner, or associate of COUNTY. Furthermore, COUNTY shall
have no right to control or supervise or direct the manner or method by which CONTRACTOR shall
perform its work and function. However, COUNTY shall retain the right to administer this Agreement
so as to verify that CONTRACTOR is performing their obligations in accordance with the terms and
conditions thereof. CONTRACTOR and COUNTY shall comply with all applicable provisions of law
and the rules and regulations, if any, of governmental authorities having jurisdiction over matters
which are directly or indirectly the subject of this Agreement.
Because of its status as an independent contractor, CONTRACTOR shall have absolutely no
right to employment rights and benefits available to COUNTY employees. CONTRACTOR shall be
solely liable and responsible for providing to, or on behalf of, its employees all legally required
employee benefits. In addition, CONTRACTOR shall be solely responsible and save COUNTY
harmless from all matters relating to payment of CONTRACTOR’s employees, including compliance
with Social Security, withholding, and all other regulations governing such matters. It is
acknowledged that during the term of this Agreement, CONTRACTOR may be providing services to
others unrelated to COUNTY or to this Agreement.
7. MODIFICATION
Any matters of this Agreement may be modified from time to time by the written consent
of all the parties without, in any way, affecting the remainder.
Notwithstanding the above, minor changes to services, staffing, and daily bed rates, to
be provided as set forth in Exhibit C and responsibilities of the CONTRACTOR, as needed, with no
change in maximum compensation, may be made by written approval of COUNTY’s DBH Director, or
designee. Changes to accommodate changes in the laws relating to mental health treatment, may be
made with the signed written approval of COUNTY’s DBH Director, or designee, and CONTRACTOR
through an amendment approved by COUNTY’s Counsel and the COUNTY’s Auditor-Controller’s
Office.
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In addition, changes to expense category (i.e., Salary & Benefits, Facilities/Equipment,
Operating, Financial Services, Special Expenses, Fixed Assets, etc.) subtotals in the budgets, and
changes to the volume of units of services/types of service units to be provided as set forth in Exhibit
C, that do not exceed ten percent (10%) of the maximum compensation payable to the
CONTRACTOR may be made with the written approval of COUNTY’s DBH Director, or designee.
Changes to the expense categories in the budget that exceed ten percent (10%) of the maximum
compensation payable to the CONTRACTOR, may be made with the signed written
approval of COUNTY’s DBH Director, or designee, through an amendment approved by COUNTY’s
Counsel and COUNTY’s Auditor-Controller’s Office.
Said modifications shall not result in any change to the annual maximum compensation
amount payable to CONTRACTOR, as stated in this Agreement.
8. NON-ASSIGNMENT
No party shall assign, transfer or subcontract this Agreement nor their rights or duties
under this Agreement without the prior written consent of COUNTY and CONTRACTOR.
9. HOLD-HARMLESS
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request,
defend COUNTY, its officers, agents and employees from any and all costs and expenses, including
attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to
COUNTY in connection with the performance, or failure to perform, by CONTRACTOR, its officers,
agents or employees under this Agreement, and from any and all costs and expenses, including
attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to any
person, firm or corporation who may be injured or damaged by the performance, or failure to perform,
of CONTRACTOR, their officers, agents or employees under this Agreement.
CONTRACTOR agrees to indemnify COUNTY for Federal and/or State of California
audit exceptions resulting from noncompliance herein on the part of CONTRACTOR.
10. INSURANCE
Without limiting COUNTY's right to obtain indemnification from CONTRACTOR or any
third parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect the following
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insurance policies throughout the term of this Agreement:
A. Commercial General Liability
Commercial General Liability Insurance with limits of not less than Two Million
Dollars ($2,000,000) per occurrence and an annual aggregate of Five Million
Dollars ($5,000,000). This policy shall be issued on a per occurrence basis.
COUNTY may require specific coverage including completed operations, product
liability, contractual liability, Explosion, Collapse, and Underground (XCU), fire
legal liability or any other liability insurance deemed necessary because of the
nature of the Agreement.
B. Automobile Liability
Comprehensive Automobile Liability Insurance with limits no less than One
Million Dollars ($1,000,000) per accident for bodily injury and property damage.
Coverage should include any automobile used in connection with this
Agreement. If CONTRACTOR employees are not covered by CONTRACTOR’s
automobile liability insurance policy, CONTRACTOR shall ensure that each
employee as part of this Agreement procures and maintains their own private
automobile coverage in force during the term of this Agreement, at the
employee’s sole cost and expense.
C. Real and Personal Property Insurance
CONTRACTOR shall maintain a policy of insurance for all risk personal property
coverage which shall be endorsed naming the County of Fresno as an additional
loss payee. The personal property coverage shall be in an amount that will cover
the total of the County purchased and owned property, at a minimum, as
discussed in Section Twenty (21) of this Agreement.
All Risk Property Insurance
As applicable, CONTRACTOR will provide property coverage for the full
replacement value of the County’s personal property in the possession of
Contractor and/or used in the execution of this Agreement. County will be
identified on an appropriate certificate of insurance as the certificate holder and
will be named as an Additional Loss Payee on the Property Insurance Policy.
D. Professional Liability
If CONTRACTOR employs licensed professional staff (e.g. Ph.D., R.N.,
L.C.S.W., L.M.F.T.) in providing services, Professional Liability Insurance with
limits of not less than One Million Dollars ($1,000,000) per occurrence, Three
Million Dollars ($3,000,000) annual aggregate. CONTRACTOR agrees that it
shall maintain, at its sole expense, in full force and effect for a period of five (5)
years following the termination of this Agreement, one or more policies of
professional liability insurance with limits of coverage as specified herein.
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E. Worker's Compensation
A policy of Worker's Compensation Insurance as may be required by the
California Labor Code.
F. Child Abuse/Molestation and Social Services Coverage
Each CONTRACTOR shall have either separate policies or an umbrella policy
with endorsements covering Child Abuse/Molestation and Social Services
Liability coverage or have a specific endorsement on their General Commercial
liability policy covering Child Abuse/Molestation and Social Services Liability.
The policy limits for these policies shall be One Million Dollars ($1,000,000) per
occurrence with a Two Million Dollars ($2,000,000) annual aggregate. The
policies are to be on a per occurrence basis.
G. Cyber Liability
Cyber Liability Insurance, with limits not less than Two Million Dollars
($2,000,000) per occurrence or claim, Two Million Dollars ($2,000,000)
aggregate. Coverage shall be sufficiently broad to respond to the duties and
obligations as is undertaken by CONTRACTOR in this Agreement and shall
include, but not be limited to, claims involving infringement of intellectual
property, including but not limited to infringement of copyright, trademark, trade
dress, invasion of privacy violations, information theft, damage to or destruction
of electronic information, release of private information, alteration of electronic
information, extortion and network security. The policy shall provide coverage for
breach response costs as well as regulatory fines and penalties as well as credit
monitoring expenses with limits sufficient to respond to these obligations.
H. Waiver of Subrogration
Cyber CONTRACTOR hereby grants to COUNTY a waiver of any right to
subrogation which any insurer of said CONTRACTOR may acquire against the
COUNTY by virtue of the payment of any loss under such insurance.
CONTRACTOR agrees to obtain any endorsement that may be necessary to
affect this waiver of subrogation, but this provision applies regardless of whether
or not the COUNTY has received a waiver of subrogation endorsement from the
insurer.
CONTRACTOR shall obtain endorsements to the Commercial General Liability
insurance naming the County of Fresno, its officers, agents, and employees, individually and
collectively, as additional insured, but only insofar as the operations under this Agreement are
concerned. Such coverage for additional insured shall apply as primary insurance and any other
insurance, or self-insurance, maintained by COUNTY, its officers, agents and employees shall be
excess only and not contributing with insurance provided under CONTRACTOR’S policies herein.
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This insurance shall not be cancelled or changed without a minimum of thirty (30) days advance
written notice given to COUNTY.
Within thirty (30) days from the date CONTRACTOR signs this Agreement,
CONTRACTOR shall provide certificates of insurance and endorsements as stated above for all of
the foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health,
1925 E. Dakota Ave., Fresno, CA 93726, Attention: Contracted Services Division, stating that such
insurance coverages have been obtained and are in full force; that the County of Fresno, its officers,
agents and employees will not be responsible for any premiums on the policies; that such
Commercial General Liability insurance names the County of Fresno, its officers, agents and
employees, individually and collectively, as additional insured, but only insofar as the operations
under this Agreement are concerned; that such coverage for additional insured shall apply as primary
insurance and any other insurance, or self-insurance, maintained by COUNTY, its officers, agents
and employees, shall be excess only and not contributing with insurance provided under
CONTRACTOR’s policies herein; and that this insurance shall not be cancelled or changed without a
minimum of thirty (30) days advance, written notice given to COUNTY.
In the event CONTRACTOR fails to keep in effect at all times insurance coverage as
herein provided, COUNTY may, in addition to other remedies it may have, suspend or terminate this
Agreement upon the occurrence of such event.
All policies shall be with admitted insurers licensed to do business in the State of
California. Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating
of A FSC VII or better.
11. LICENSES/CERTIFICATES
Throughout each term of this Agreement, CONTRACTOR and CONTRACTOR’s staff
shall maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions
necessary for the provision of the services hereunder and required by the laws and regulations of the
United States of America, State of California, the County of Fresno, and any other applicable
governmental agencies. CONTRACTOR shall notify COUNTY immediately in writing of its inability to
obtain or maintain such licenses, permits, approvals, certificates, waivers and exemptions irrespective
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of the pendency of any appeal related thereto. Additionally, CONTRACTOR and CONTRACTOR’s
staff shall comply with all applicable laws, rules or regulations, as may now exist or be hereafter
changed.
12. RECORDS
CONTRACTOR shall maintain records in accordance with Exhibit F, “Documentation
Standards for Client Records”, attached hereto and by this reference incorporated herein and made
part of this Agreement. During site visits, COUNTY shall be allowed to review records of services
provided, including the goals and objectives of the treatment plan, and how the therapy provided is
achieving the goals and objectives. The client record shall begin with registration and intake and
include client authorizations, assessments, plans of care, and progress notes, as well as other
documents as approved by the COUNTY’s DBH. All mental health records shall be considered the
property of the COUNTY and shall be retained by the COUNTY upon termination or expiration of this
Agreement.
13. REPORTS
A. Cost Reports
CONTRACTOR agrees to submit a complete and accurate detailed cost report
on an annual basis for each fiscal year ending June 30th in the format prescribed by the DHCS for
the purposes of Short Doyle Medi-Cal reimbursements and total costs for programs. The cost report
will be the source document for several phases of settlement with the DHCS for the purposes of Short
Doyle Medi-Cal reimbursement. CONTRACTOR shall report costs under their approved legal entity
number established during the Medi-Cal certification process. The information provided applies to
CONTRACTOR for program related costs for services rendered to Medi-Cal and non Medi-Cal. The
CONTRACTOR will remit a schedule to provide the required information on published charges (PC)
for all authorized services. The report will serve as a source document to determine their usual and
customary charge prevalent in the public mental health sector that is used to bill the general public,
insurers or other non-Medi-Cal third party payors during the course of business operations.
CONTRACTOR must report all collections for Medi-Cal/Medicare services and collections. The
CONTRACTOR shall also submit with the cost report a copy of the CONTRACTOR’s GL that
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supports revenues and expenditures and reconciled detailed report of reported total units of services
rendered under this Agreement to the units of services reported by CONTRACTOR to COUNTY’S
EHR system.
Cost Reports must be submitted to the COUNTY as a hard copy with a signed
cover letter and electronic copy of completed DHCS cost report form along with requested support
documents following each fiscal year ending June 30th. During the month of September of each year
this Agreement is effective, COUNTY will issue instructions of the annual cost report which indicates
the training session, DHCS cost report template worksheets, and deadlines to submit as determine by
State annually. Remit hard copy of cost report to County of Fresno, Attention: Cost Report Team, PO
BOX 45003, Fresno CA 93718. Remit the electronic copy or any inquiries to
DBHCostReportTeam@fresnocountyca.gov.
All Cost Reports must be prepared in accordance with General Accepted
Accounting Principles (GAAP) and Welfare and Institutions Code §§ 5651(a)(4), 5664(a), 5705(b)(3)
and 5718(c). Unallowable costs such as lobby or political donations must be deducted on the cost
report and invoice reimbursements.
If the CONTRACTOR does not submit the cost report by the deadline, including
any extension period granted by the COUNTY, the COUNTY may withhold payments of pending
invoicing under compensation until the cost report has been submitted and clears COUNTY desk
audit for completeness
B. Settlements with State Department of Health Care Services (DHCS)
During the term of this Agreement and thereafter, COUNTY and CONTRACTOR
agree to settle dollar amounts disallowed or settled in accordance with DHCS audit settlement
findings related to the Medi-Cal and realignment reimbursements. CONTRACTOR will participate in
the several phases of settlements between COUNTY/CONTRACTOR and DHCS. The phases of
initial cost reporting for settlement according to State reconciliation of records for paid Medi-Cal
services and audit settlement-State DHCS audit: 1) initial cost reporting - after an internal review by
COUNTY, the COUNTY files cost report with DHCS on behalf of the CONTRACTOR’s legal entity for
the fiscal year; 2) Settlement – State reconciliation of records for paid Medi-Cal services,
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approximately eighteen (18) to thirty-six (36) months following the State close of the fiscal year,
DHCS will send notice for any settlement under this provision will be sent to the COUNTY; 3) Audit
Settlement - DHCS audit. After final reconciliation and settlement DHCS may conduct a review of
medical records, cost report along with support documents submitted to COUNTY in initial
submission to determine accuracy and may disallow cost and/or unit of service reported on the
CONTRACTOR’s legal entity cost report. COUNTY may choose to appeal and therefore reserves the
right to defer payback settlement with CONTRACTOR until resolution of the appeal. DHCS Audits
will follow federal Medicaid procedures for managing overpayments.
If at the end of the Audit Settlement, the COUNTY determines that it overpaid
the CONTRACTOR, it will require the CONTRACTOR to repay the Medi-Cal related overpayment
back to the COUNTY.
Funds owed to COUNTY will be due within 45 days of notification by the
COUNTY, or COUNTY shall withhold future payments until all excess funds have been recouped by
means of an offset against any payments then or thereafter owing to CONTRACTOR under this or
any other Agreement.
C. Outcome Reports
CONTRACTOR shall submit to COUNTY’s DBH service outcome reports as
requested by COUNTY’s DBH. Outcome reports and outcome requirements are subject to change at
COUNTY DBH’s discretion.
D. Additional Reports
CONTRACTOR shall also furnish to COUNTY such statements, records, reports,
data, and other information as COUNTY’s DBH may request pertaining to matters covered by this
Agreement. In the event that CONTRACTOR fails to provide such reports or other information
required hereunder, it shall be deemed sufficient cause for COUNTY to withhold monthly payments
until there is compliance. In addition, CONTRACTOR shall provide written notification and
explanation to COUNTY within five (5) days of any funds received from another source to conduct the
same services covered by this Agreement.
///
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E. Quarterly Report Progress Updates
CONTRACTOR shall complete Quarterly Report Progress updates according to
DHCS regulations, in the form set forth in Exhibit G and G-1, DHCS 1010 form and Quarterly
Progress Reporting, attached hereto and by this reference incorporated herein and made part of this
Agreement. CONTRACTOR shall utilize the Quarterly Progress Report as shown in Exhibit G, to
submit the required Quarterly Report Progress updates. Quarterly reports shall be submitted to
COUNTY’s DBH Contracts Division for review within thirty (30) days of the end of each quarter.
F. Daily Census Reports
CONTRACTOR will submit a copy of admitted clients on a daily basis to
COUNTY’s DBH Director, and/or designee, identifying clients by DHCS number, Social Security
number, date of birth, age, length of stay, DSM V Diagnosis, housing status, and financial status such
as Medi-Cal and/or general relief, identify clients primary physician status, and identify discharged
clients in a format acceptable to COUNTY’S DBH Director, or designee. Said daily census reports
shall accompany each monthly invoice submitted by CONTRACTOR.
14. MONITORING
CONTRACTOR agrees to extend to COUNTY’s staff, COUNTY’s DBH Director, or
designee, and DHCS, or their designees, the right to review and monitor records, services or
procedures, at any time, in regard to clients, as well as the overall operation of CONTRACTOR’s
performance, in order to ensure compliance with the terms and conditions of this Agreement.
15. 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.
16. COMPLIANCE WITH STATE REQUIREMENTS
CONTRACTOR recognizes that COUNTY operates its mental health programs under an
agreement with DHCS, and that under said agreement the State imposes certain requirements on
COUNTY and its subcontractors. CONTRACTOR shall adhere to all State requirements, including
those identified in Exhibit H, “State Mental Health Requirements”, attached hereto and by this
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reference incorporated herein and made part of this Agreement.
17. COMPLIANCE WITH STATE MEDI-CAL REQUIREMENTS
CONTRACTOR shall be required to maintain Medi-Cal organizational provider
certification by COUNTY’s Managed Care. CONTRACTOR must meet Medi-Cal organization
provider standards as listed in Exhibit I, “Medi-Cal Organizational Provider Standards”, attached
hereto and by this reference incorporated herein and made part of this Agreement. It is
acknowledged that all references to Organizational Provider and/or Provider in Exhibit I shall refer to
CONTRACTOR.
In addition, CONTRACTOR shall inform every client of their rights under the COUNTY’s
MHP as described in Exhibit J, “Fresno County Mental Health Plan Grievances and Appeals
process,” attached hereto and by this reference incorporated herein and made part of this
Agreement.
CONTRACTOR shall also file an incident report for all incidents involving clients,
following the COUNTY DBH’s “Incident Reporting and Intensive Analysis” policy and procedure guide
and using the “Incident Report” worksheet identified in Exhibit K, attached hereto and by this
reference incorporated herein and made part of this Agreement, or a protocol and worksheet
presented by CONTRACTOR that is accepted by COUNTY’s DBH Director, or designee.
18. CONFIDENTIALITY
All services performed by CONTRACTOR under this Agreement shall be in strict
conformance with all applicable Federal, State of California and/or local laws and regulations relating
to confidentiality.
19. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY and CONTRACTOR each consider and represent themselves as covered
entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law
104-191(HIPAA) and agree to use and disclose Protected Health Information (PHI) as required by
law.
COUNTY and CONTRACTOR acknowledge that the exchange of PHI between them is
only for treatment, payment, and health care operations.
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COUNTY and CONTRACTOR intend to protect the privacy and provide for the
security of 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 regulations
promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA Regulations)
and other applicable laws.
As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
CONTRACTOR to enter into a contract containing specific requirements prior to the disclosure of
PHI, as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the
Code of Federal Regulations (C.F.R.).
20. DATA SECURITY
For the purpose of preventing the potential loss, misappropriation or inadvertent access,
viewing, use or disclosure of COUNTY data including sensitive or personal client information; abuse
of COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies that
enter into a contractual relationship with the COUNTY for the purpose of providing services under this
Agreement must employ adequate data security measures to protect the confidential information
provided to CONTRACTOR by the COUNTY, including but not limited to the following:
A. CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
CONTRACTOR may not connect to COUNTY networks via personally-owned
mobile, wireless or handheld devices, unless the following conditions are met:
1) CONTRACTOR has received authorization by COUNTY for
telecommuting purposes;
2) Current virus protection software is in place;
3) Mobile device has the remote wipe feature enabled; and
4) A secure connection is used.
B. CONTRACTOR-Owned Computers or Computer Peripherals
CONTRACTOR may not bring CONTRACTOR-owned computers or computer
peripherals into the COUNTY for use without prior authorization from the COUNTY’s Chief
Information Officer, and/or designee(s), including but not limited to mobile storage devices. If data is
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approved to be transferred, data must be stored on a secure server approved by the COUNTY and
transferred by means of a Virtual Private Network (VPN) connection, or another type of secure
connection. Said data must be encrypted.
C. COUNTY-Owned Computer Equipment
CONTRACTOR may not use COUNTY computers or computer peripherals on
non-COUNTY premises without prior authorization from the COUNTY’s Chief Information Officer,
and/or designee(s).
D. CONTRACTOR may not store COUNTY’s private, confidential or sensitive data
on any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
E. CONTRACTOR shall be responsible to employ strict controls to ensure the
integrity and security of COUNTY’s confidential information and to prevent unauthorized access,
viewing, use or disclosure of data maintained in computer files, program documentation, data
processing systems, data files and data processing equipment which stores or processes COUNTY
data internally and externally.
F. Confidential client information transmitted to one party by the other by means of
electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of
128 BIT or higher. Additionally, a password or pass phrase must be utilized.
G. CONTRACTOR is responsible to immediately notify COUNTY of any violations,
breaches or potential breaches of security related to COUNTY’s confidential information, data
maintained in computer files, program documentation, data processing systems, data files and data
processing equipment which stores or processes COUNTY data internally or externally.
H. COUNTY shall provide oversight to CONTRACTOR’s response to all incidents
arising from a possible breach of security related to COUNTY’s confidential client information
provided to CONTRACTOR. CONTRACTOR will be responsible to issue any notification to affected
individuals as required by law or as deemed necessary by COUNTY in its sole discretion.
CONTRACTOR will be responsible for all costs incurred as a result of providing the required
notification.
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21. PROPERTY OF COUNTY
A. COUNTY and CONTRACTOR recognizes that fixed assets are tangible and
intangible property obtained or controlled under COUNTY’s Mental Health Plan for use in operational
capacity and will benefit COUNTY for a period more than one year. Depreciation of the qualified items
will be on a straight-line basis.
For COUNTY purposes, fixed assets must fulfill three qualifications:
1. Asset must have life span of over one year.
2. The asset is not a repair part.
3. The asset must be valued at or greater than the capitalization thresholds
for the asset type.
Asset type Threshold
land $0
buildings and improvements $100,000
infrastructure $100,000
be tangible $5,000
o equipment
o vehicles
or intangible asset $100,000
o Internally generated software
o Purchased software
o Easements
o Patents
and capital lease $5,000
Qualified fixed asset equipment is to be reported and approved by COUNTY. If it
is approved and identified as an asset, it will be tagged with a COUNTY program number. A “Fixed
Asset Log”, attached hereto as Exhibit L and by this reference incorporated herein and made part of
this Agreement, will be maintained by COUNTY’s Asset Management System and annual inventoried
until the asset is fully depreciated. During the terms of this Agreement, CONTRACTOR’s fixed assets
may be inventoried in comparison to COUNTY’s DBH Asset Inventory System.
B. Certain purchases less than Five Thousand and No/100 Dollars ($5,000.00) but
more than One Thousand and No/100 Dollars ($1,000.00), with over one-year life span, and are
mobile and high risk of theft or loss are sensitive assets. Such sensitive items are not limited to
computers, copiers, televisions, cameras and other sensitive items as determined by COUNTY’s DBH
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Director, or designee. CONTRACTOR maintains a tracking system on the items and are not required
to be capitalize or depreciated. The items are subject to annual inventory for compliance.
C. Assets shall be retained by COUNTY, as COUNTY property, in the event this
Agreement is terminated or upon expiration of this Agreement. CONTRACTOR agrees to participate
in an annual inventory of all COUNTY fixed and inventoried assets. Upon termination or expiration of
this Agreement CONTRACTOR shall be physically present when fixed and inventoried assets are
returned to COUNTY possession. CONTRACTOR is responsible for returning to COUNTY all
COUNTY owned undepreciated fixed and inventoried assets, or the monetary value of said assets if
unable to produce the assets at the expiration or termination of this Agreement.
CONTRACTOR further agrees to the following:
1. To maintain all items of equipment in good working order and condition,
normal wear and tear is expected;
2. To label all items of equipment with COUNTY assigned program number,
to perform periodic inventories as required by COUNTY and to maintain an inventory list showing
where and how the equipment is being used, in accordance with procedures developed by COUNTY.
All such lists shall be submitted to COUNTY within ten (10) days of any request therefore; and
3. To report in writing to COUNTY immediately after discovery, the lost or
theft of any items of equipment. For stolen items, the local law enforcement agency must be
contacted, and a copy of the police report submitted to COUNTY.
D. The purchase of any equipment by CONTRACTOR with funds provided
hereunder shall require the prior written approval of COUNTY’s DBH, shall fulfill the provisions of this
Agreement as appropriate, and must be directly related to CONTRACTOR’s services or activity under
the terms of this Agreement. COUNTY’s DBH may refuse reimbursement for any costs resulting from
equipment purchased, which are incurred by CONTRACTOR, if prior written approval has not been
obtained from COUNTY.
E. CONTRACTOR must obtain prior written approval from COUNTY’s DBH
whenever there is any modification or change in the use of any property acquired or improved, in
whole or in part, using funds under this agreement. If any real or personal property acquired or
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improved with said funds identified herein is sold and/or is utilized by CONTRACTOR for a use which
does not qualify under this program, CONTRACTOR shall reimburse COUNTY in an amount equal to
the current fair market value of the property, less any portion thereof attributable to expenditures of
non-program funds. These requirements shall continue in effect for the life of the property. In the
event the program is closed out, the requirements for this Section shall remain in effect for activities
or property funded with said funds, unless action is taken by the State government to relieve
COUNTY of these obligations.
22. NON-DISCRIMINATION
During the performance of this Agreement, CONTRACTOR and its subcontractors shall
not deny the contract’s benefits to any person on the basis of race, religious creed, color, national
origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital
status, sex, gender, gender identity, gender expression, age, sexual orientation, or military and
veteran status, nor shall they discriminate unlawfully against any employee or applicant for
employment because of race, religious creed, color, national origin, ancestry, physical disability,
mental disability, medical condition, genetic information, marital status, sex, gender, gender identity,
gender expression, age, sexual orientation, or military or veteran status. CONTRACTOR shall ensure
that the evaluation and treatment of employees and applicants for employment are free of such
discrimination.
CONTRACTOR and subcontractors shall comply with the provisions of the Fair
Employment and Housing Act (Gov. Code §12800 et seq.), the regulations promulgated thereunder
(Cal. Code Regs., tit. 2, §11000 et seq.), the provisions of Article 9.5, Chapter 1, Part 1, Division 3,
Title 2 of the Government Code (Gov. Code §11135-11139.5), and the regulations or standards
adopted by the awarding state agency to implement such article. CONTRACTOR shall permit access
by representatives of the Department of Fair Employment and Housing and the awarding state
agency upon reasonable notice at any time during the normal business hours, but in no case less
than twenty-four (24) hours’ notice, to such of its books, records, accounts, and all other sources of
information and its facilities as said Department or Agency shall require to ascertain compliance with
this clause. CONTRACTOR and its subcontractors shall give written notice of their obligations under
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this clause to labor organizations with which they have a collective bargaining or other agreement.
(See Cal. Code Regs., tit. 2, §11105) CONTRACTOR shall include the Non-Discrimination and
compliance provisions of this clause in all subcontracts to perform work under this Agreement.
23. TAX EQUITY AND FISCAL RESPONSIBILITY ACT
To the extent necessary to prevent disallowance of reimbursement under section
1861(v) (1) (I) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[I]), until the expiration of
four (4) years after the furnishing of services under this Agreement, CONTRACTOR 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 this Agreement and such
books, documents, and records as are necessary to certify the nature and extent of the costs of these
services provided by CONTRACTOR under this Agreement. CONTRACTOR further agrees that in
the event CONTRACTOR 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.
24. SINGLE AUDIT CLAUSE
A. If CONTRACTOR expends Seven Hundred Fifty Thousand and No/100
Dollars ($750,000.00) or more in Federal and Federal flow-through monies, CONTRACTOR agrees
to conduct an annual audit in accordance with the requirements of the Single Audit Standards as set
forth in Office of Management and Budget (OMB) Circular A-133. CONTRACTOR shall submit said
audit and management letter to COUNTY. The audit must include a statement of findings or a
statement that there were no findings. If there were negative findings, CONTRACTOR must include a
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corrective action plan signed by an authorized individual. CONTRACTOR agrees to take action to
correct any material non-compliance or weakness found as a result of such audit. Such audit shall be
delivered to COUNTY’s DBH Business Office for review within nine (9) months of the end of any fiscal
year in which funds were expended and/or received for the program. Failure to perform the requisite
audit functions as required by this Agreement may result in COUNTY performing the necessary audit
tasks, or at COUNTY’s option, contracting with a public accountant to perform said audit, or may
result in the inability of COUNTY to enter into future agreements with CONTRACTOR. All audit costs
related to this Agreement are the sole responsibility of CONTRACTOR.
B. A single audit report is not applicable if CONTRACTOR’s Federal contracts do
not exceed the Five Hundred Thousand and No/100 Dollars ($500,000.00) requirement or
CONTRACTOR’s only funding is through Drug-related Medi-Cal. If a single audit is not applicable, a
program audit must be performed and a program audit report with management letter shall be
submitted by CONTRACTOR to COUNTY as a minimum requirement to attest to CONTRACTOR’s
solvency. Said audit report shall be delivered to COUNTY’s DBH Business Office for review, no later
than nine (9) months after the close of the fiscal year in which the funds supplied through this
Agreement are expended. Failure to comply with this act may result in COUNTY performing the
necessary audit tasks or contracting with a qualified accountant to perform said audit. All audit costs
related to this Agreement are the sole responsibility of CONTRACTOR who agrees to take corrective
action to eliminate any material noncompliance or weakness found as a result of such audit. Audit
work performed by COUNTY under this section shall be billed to the CONTRACTOR at COUNTY’s
cost, as determined by COUNTY’s Auditor-Controller/Treasurer-Tax Collector.
C. CONTRACTOR shall make available all records and accounts for inspection by
COUNTY, the State of California, if applicable, the Comptroller General of the United States, the
Federal Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a
period of at least three (3) years following final payment under this Agreement or the closure of all
other pending matters, whichever is later.
///
///
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25. COMPLIANCE
CONTRACTOR agrees to comply with the COUNTY’s Contractor Code of Conduct and
Ethics and the COUNTY’s Compliance Program in accordance with Exhibit E. Within thirty (30) days
of entering into the agreement with the COUNTY, CONTRACTOR shall have all of CONTRACTOR’s
employees, agents and subcontractors providing services under this Agreement certify in writing, that
he or she has received, read, understood, and shall abide by the Contractor Code of Conduct and
Ethics. CONTRACTOR shall ensure that within thirty (30) days of hire, all new employees, agents
and subcontractors providing services under this Agreement shall certify in writing that he or she has
received, read, understood, and shall abide by the Contractor Code of Conduct and Ethics.
CONTRACTOR understands that the promotion of and adherence to the Code of Conduct is an
element in evaluating the performance of CONTRACTOR and its employees, agents and
subcontractors.
Within thirty (30) days of entering into this Agreement, and annually thereafter, all
employees, agents and subcontractors providing services under this Agreement shall complete
general compliance training and appropriate employees, agents and subcontractors shall complete
documentation and billing or billing/reimbursement training. All new employees, agents and
subcontractors shall attend the appropriate training within 30 days of hire. Each individual who is
required to attend training shall certify in writing that he or she has received the required training. The
certification shall specify the type of training received and the date received. The certification shall be
provided to the COUNTY’s Compliance Officer at 1925 E. Dakota Aveue, Fresno, CA 93726.
CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty imposed upon
COUNTY by the Federal Government as a result of CONTRACTOR’s violation of the terms of this
Agreement.
26. ASSURANCES
In entering into this Agreement, CONTRACTOR certifies that it nor any of its officers are
not currently excluded, suspended, debarred, or otherwise ineligible to participate in the Federal
Health Care Programs: that it or any of its officers have not been convicted of a criminal offense
related to the provision of health care items or services; nor has it or its officers been reinstated to
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participation in the Federal Health Care Programs after a period of exclusion, suspension, debarment,
or ineligibility. If COUNTY learns, subsequent to entering into a contract, that CONTRACTOR is
ineligible on these grounds, COUNTY will remove CONTRACTOR from responsibility for, or
involvement with, COUNTY’s business operations related to the Federal Health Care Programs and
shall remove such CONTRACTOR from any position in which CONTRACTOR’s compensation, or the
items or services rendered, ordered or prescribed by CONTRACTOR may be paid in whole or part,
directly or indirectly, by Federal Health Care Programs or otherwise with Federal Funds at least until
such time as CONTRACTOR is reinstated into participation in the Federal Health Care Programs.
A. If COUNTY has notice that CONTRACTOR or its officers 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, CONTRACTOR and COUNTY shall take all appropriate actions to ensure the
accuracy of any claims submitted to any Federal Health Care Program. At its discretion given such
circumstances, COUNTY may request that CONTRACTOR cease providing services until resolution
of the charges or the proposed exclusion.
B. CONTRACTOR agrees that all potential new employees of CONTRACTOR or
subcontractors of CONTRACTOR who, in each case, are expected to perform professional services
under this Agreement, will be queried as to whether (1) they are now or ever have been excluded,
suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2)
they have been convicted of a criminal offense related to the provision of health care items or
services; and or (3) they have been reinstated to participation in the Federal Health Care Programs
after a period of exclusion, suspension, debarment, or ineligibility.
1. In the event the potential employee or subcontractor informs
CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible, or has been
convicted of a criminal offense relating to the provision of health care services, and CONTRACTOR
hires or engages such potential employee or subcontractor, CONTRACTOR will ensure that said
employee or subcontractor does no work, either directly or indirectly relating to services provided to
COUNTY.
2. Notwithstanding the above, COUNTY at its discretion may terminate this
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Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance
(as defined by COUNTY) that no excluded, suspended or otherwise ineligible employee or
subcontractor of CONTRACTOR 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.
C. CONTRACTOR shall verify (by asking the applicable employees and
subcontractors) that all current employees and existing subcontractors who, in each case, are
expected to perform professional services under this Agreement: (1) are not currently excluded,
suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2)
have not been convicted of a criminal offense related to the provision of health care items or services;
and (3) have not been reinstated to participation in the Federal Health Care Program after a period of
exclusion, suspension, debarment, or ineligibility. In the event any existing employee or
subcontractor informs CONTRACTOR that he or she is excluded, suspended, debarred or otherwise
ineligible to participate in the Federal Health Care Programs, or has been convicted of a criminal
offense relating to the provision of health care services, CONTRACTOR will ensure that said
employee or subcontractor does no work, either direct or indirect, relating to services provided to
COUNTY.
1. CONTRACTOR agrees to notify COUNTY immediately during the term of
this Agreement whenever CONTRACTOR learns that an employee or subcontractor who, in each
case, is providing professional services under section (1) this Agreement is excluded, suspended,
debarred or otherwise ineligible to participate in the Federal Health Care Programs, or is convicted of
a criminal offense relating to the provision of health care services.
2. Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with the Termination Section (3) of this Agreement, or require adequate
assurance (as defined by COUNTY) that no excluded, suspended or otherwise ineligible employee or
subcontractor of CONTRACTOR 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.
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D. CONTRACTOR agrees to cooperate fully with any reasonable requests for
information from COUNTY which may be necessary to complete any internal or external audits
relating to CONTRACTOR’s compliance with the provisions of this Section.
E. CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty
imposed upon COUNTY by the Federal Government as a result of CONTRACTOR’s violation of
CONTRACTOR’s obligations as described in this Section.
27. PROHIBITION ON PUBLICITY
None of the funds, materials, property or services provided directly or indirectly under
this Agreement shall be used for CONTRACTOR’s advertising, fundraising, or publicity (i.e.,
purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self-promotion.
Notwithstanding the above, publicity of the services described in Section One (1) of this Agreement
shall be allowed as necessary to raise public awareness about the availability of such specific
services when approved in advance by COUNTY’s DBH Director, or designee, and at a cost to be
provided in Section Four (4) of this Agreement for such items as written/printed materials, the use of
media (i.e., radio, television, newspapers) and any other related expense(s).
28. COMPLAINTS
CONTRACTOR shall log complaints and the disposition of all complaints from a client or
a client’s family. CONTRACTOR shall provide a copy of the detailed complaint log entries concerning
COUNTY-sponsored clients to COUNTY at monthly intervals by the tenth (l0th) day of the following
month, in a format that is mutually agreed upon. In addition, CONTRACTOR shall provide details and
attach documentation of each complaint with the log. CONTRACTOR shall post signs informing
clients of their right to file a complaint or grievance.
CONTRACTOR shall notify COUNTY of all incidents reportable to State licensing bodies
that affect COUNTY clients within twenty-four (24) hours of receipt of a complaint. Within ten (10)
days after each incident or complaint affecting COUNTY-sponsored clients, CONTRACTOR shall
provide COUNTY with information relevant to the complaint, investigative details of the complaint, the
complaint and CONTRACTOR's disposition of, or corrective action taken to resolve the complaint. In
addition, CONTRACTOR shall inform every client of their rights as set forth in Exhibit J.
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29. CULTURAL COMPETENCY
As related to Cultural and Linguistic Competence, CONTRACTOR shall comply with:
A. 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. CONTRACTOR’s procedures must
include ensuring compliance of any sub-contracted providers with these requirements.
C. CONTRACTOR shall not use minors as interpreters.
D. CONTRACTOR shall provide and pay for interpreting and translation services to
persons participating in CONTRACTOR’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 necessary to allow such participants meaningful access to the programs,
services and benefits provided by CONTRACTOR. Interpreter and translation services, including
translation of CONTRACTOR’s “vital documents” (those documents that contain information that is
critical for accessing CONTRACTOR’s services or are required by law) shall be provided to
participants at no cost to the participant. CONTRACTOR shall ensure that any employees, agents,
subcontractors, or partners who interpret or translate for a program participant, or who directly
communicate with a program participant in a language other than English, demonstrate proficiency in
the participant's language and can effectively communicate any specialized terms and concepts
peculiar to CONTRACTOR’s services.
E. In compliance with the State mandated Culturally and Linguistically Appropriate
Services standards as published by the Office of Minority Health, CONTRACTOR must submit to
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COUNTY for approval, within sixty (60) days from date of contract execution, CONTRACTOR’s plan
to address all fifteen (15) national cultural competency standards as set forth in the “National
Standards on Culturally and Linguistically Appropriate Services (CLAS)”, Exhibit M and Exhibit M-1,
“Cultural Competence Form”, attached hereto and by this reference incorporated herein and made a
part of this Agreement. COUNTY’s annual on-site review of CONTRACTOR shall include collection
of documentation to ensure all national standards are implemented. As the national competency
standards are updated, CONTRACTOR’s plan must be updated accordingly.
30. COMPREHENSIVE CONTINUOUS INTEGRATED SYSTEM OF CARE
CONTRACTOR shall integrate mental health and substance use disorder through
comprehensive continuous integrated systems of care for the life span of those served and to work
as partners with a shared vision: to create a coordinated and comprehensive system of service
delivery. The CONTRACTOR shall perform the following:
A. Demonstrate familiarity with the COUNTY Comprehensive Continuation
Integrated System of Care (CCISC) consensus document and with the process of CCISC
implementation, both in terms of county level activities, as well as the continuous quality
improvement process that each program organizes in order to make progress toward co-occurring
disorder capability. Conduct an ongoing agency self-survey using the COMPASSTM (Co-Morbidity
Program Audit and Self-Survey for behavioral health services), using the recommended focus
group process to engage staff of all levels in the conversation.
///
B. Identify a Change Agent to represent the program, and support that Change
Agent to participate actively in the COUNTY Change Agent team. The role of the Change Agent is
to provide training and supervision in accordance with the principles of the CCISC model in order to
establish and enhance dual diagnosis competency in program staff and to provide consultation to
facilitate development and implementation of quality improvement action planning to establish and
enhance dual diagnosis capability in the program as a whole.
C. Develop a formal written Continuous Quality Improvement (CQI) action plan to
identify measurable objectives toward the achievement of Co-Occurring Disorders (COD) capability
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that will be addressed by the program during the contract period. These objectives should be
achievable and realistic for the program, based on the self-assessment and the program priorities,
but need to include attention to making progress on the following issues, at minimum (as outlined in
the Charter):
1. Welcoming policies, practices, and procedures related to the
engagement of individuals with co-occurring issues and disorders;
2. Removal or reduction of access barriers to admission based on co-
occurring diagnosis or medication;
3. Improvement in routine integrated screening, and identification in the
data system of how many consumers served have co-occurring issues;
4. Developing the goal of basic co-occurring competency for all treatment
staff, regardless of licensure or certification; and
5. Documentation of coordination of care with collaborative mental health
and/or substance use disorder providers for each client.
31. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST INFORMATION
This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal agent, or
managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101 455.104,
and 455.106(a)(1),(2).
In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2),
the following information must be disclosed by CONTRACTOR by completing Exhibit N, “Disclosure
of Ownership and Control Interest Statement”, attached hereto and by this reference incorporated
herein and made part of this Agreement. CONTRACTOR shall submit this form to the Department of
Behavioral Health within thirty (30) days of the effective date of this Agreement. Additionally,
CONTRACTOR shall report any changes to this information within thirty-five (35) days of occurrence
by completing Exhibit N, “Disclosure of Ownership and Control Interest Statement.” Submissions
shall be scanned pdf copies and are to be sent via email to DBHAdministration@fresnocountyca.gov
attention: Contracts Administration and to DBHContractedServicesDivision@fresnocountyca.gov.
COUNTY may deny enrollment or terminate this Agreement where any person with a
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five percent (5%) or greater direct or indirect ownership interest in CONTRACTOR(S) has been
convicted of a criminal offense related to that person’s involvement with the Medicare, Medicaid, or
Title XXI program in the last ten (10) years.
32. DISCLOSURE – CRIMINAL HISTORY AND CIVIL ACTIONS
CONTRACTOR is required to disclose if any of the following conditions apply to them,
their owners, officers, corporate managers and partners (hereinafter collectively referred to as
“CONTRACTOR”):
A. Within the three-year period preceding the Agreement award, they have been
convicted of, or had a civil judgment rendered against them for:
1. Fraud or a criminal offense in connection with obtaining, attempting to
obtain, or performing a public (federal, state, or local) transaction or
contract under a public transaction;
2. Violation of a federal or state antitrust statute;
3. Embezzlement, theft, forgery, bribery, falsification, or destruction of
records; or
4. False statements or receipt of stolen property.
B. Within a three-year period preceding their Agreement award, they have had a
public transaction (federal, state, or local) terminated for cause or default.
Disclosure of the above information will not automatically eliminate
CONTRACTOR from further business consideration. The information will be considered as part of
the determination of whether to continue and/or renew the Contract and any additional information
or explanation that a CONTRACTOR elects to submit with the disclosed information will be
considered. If it is later determined that the CONTRACTOR failed to disclose required information,
any contract awarded to such CONTRACTOR may be immediately voided and terminated for
material failure to comply with the terms and conditions of the award.
CONTRACTOR must sign a “Certification Regarding Debarment, Suspension,
and Other Responsibility Matters- Primary Covered Transactions” in the form set forth in Exhibit O,
attached hereto and by this reference incorporated herein and made part of this Agreement.
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Additionally, CONTRACTOR must immediately advise the COUNTY in writing if, during the term of
this Agreement: (1) CONTRACTOR becomes suspended, debarred, excluded or ineligible for
participation in federal or state funded programs or from receiving federal funds as listed in the
excluded parties’ list system; or (2) any of the above listed conditions become applicable to
CONTRACTOR.
CONTRACTOR shall indemnify, defend and hold the COUNTY harmless for any
loss or damage resulting from a conviction, debarment, exclusion, ineligibility or other matter listed in
the signed Certification Regarding Debarment, Suspension, and Other Responsibility Matters.
33. DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the CONTRACTOR is operating as a corporation (a
for-profit or non-profit corporation) or if during the term of this Agreement, the CONTRACTOR
changes its status to operate as a corporation.
Members of the CONTRACTOR’s Board of Directors shall disclose any self-dealing
transactions that they are a party to while CONTRACTOR is providing goods or performing services
under this agreement. A self-dealing transaction shall mean a transaction to which the
CONTRACTOR is a party and in which one or more of its directors has a material financial interest.
Members of the Board of Directors shall disclose any self-dealing transactions that they are a party to
by completing and signing a Self-Dealing Transaction Disclosure Form, Exhibit P, attached hereto
and by this reference incorporated herein and made part of this Agreement and submitting it to the
COUNTY prior to commencing with the self-dealing transaction or immediately thereafter.
34. CHILD ABUSE REPORTING ACT
CONTRACTOR shall establish a procedure acceptable to the COUNTY’s DBH Director
or his or her designee, to ensure that all of the CONTRACTOR’s employees, consultants,
subcontractors or agents described in the Child Abuse Reporting Act, section 1116 et seq. of the
Penal Code, and performing services under this Agreement shall report all known or suspected child
abuse or neglect to a child protective agency as defined in Penal Code section 11165.9. This
procedure shall include:
A. A requirement that all CONTRACTOR’s employees, consultants, subcontractors
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or agents performing services shall sign a statement that he or she knows of and will comply with the
reporting requirements as defined in Penal Code section 11166(a), identified in Exhibit Q, Notice of
Child Abuse Reporting Acknowledgement Form, attached hereto and incorporated herein by reference
and made part of this Agreement.
B. Establishing procedures to ensure reporting even when employees, consultants,
subcontractors, or agents who are not required to report child abuse under Penal Code section
11166(a), gain knowledge of or reasonably suspect that a child has been a victim of abuse or neglect.
35. AUDITS AND INSPECTIONS
CONTRACTOR shall at any time during business hours, and as often as the COUNTY
may deem necessary, make available to the COUNTY for examination all of its records and data with
respect to the matters covered by this Agreement. CONTRACTOR shall, upon request by the
COUNTY, permit the COUNTY to audit and inspect all such records and data necessary to ensure
CONTRACTOR’s compliance with the terms of this Agreement.
If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00),
CONTRACTOR shall be subject to the examination and audit of the State Auditor General for a
period of three (3) years after final payment under contract (Government Code section 8546.7).
36. NOTICES
The persons having authority to give and receive notices under this Agreement
and their addresses include the following:
COUNTY CONTRACTOR
Director, Fresno County President and CEO
Department of Behavioral Health Central Star Behavioral Health, Inc.
1925 E. Dakota Avenue 1501 Hughes Way, Suite 150
Fresno, CA 93726 Long Beach, CA 90810
Any and all notices between the COUNTY and CONTRACTOR provided for or permitted
under this Agreement must be in writing and delivered either by personal service, by first-class United
States mail, by an overnight commercial courier service, or by telephonic facsimile transmission. A
notice delivered by personal service is effective upon service to the recipient. A notice delivered by
first-class United States mail is effective three (3) COUNTY business days after deposit in the United
COUNTY OF FRESNO
Fresno, CA
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States mail, postage prepaid, addressed to the recipient. A notice delivered by an overnight
commercial courier service is effective one (1) COUNTY business day after deposit with the overnight
commercial courier service, delivery fees prepaid, with delivery instructions given for next day
delivery, addressed to the recipient. A notice delivered by telephonic facsimile is effective when
transmission to the recipient is completed (but, if such transmission is completed outside of COUNTY
business hours, then such delivery shall be deemed to be effective at the next beginning of a
COUNTY business day), provided that the sender maintains a machine record of the completed
transmission. For all claims arising out of or related to this Agreement, nothing in this Section
establishes, waives, or modifies any claims presentation requirements or procedures provided by law,
including but not limited to the Government Claims Act (Division 3.6 of Title 1 of the Government
Code, beginning with Section 810).
37. GOVERNING LAW
The parties agree that for the purpose of venue, performance under this Agreement is in
Fresno County, California.
The rights and obligations of the parties and all interpretation and performance of this
Agreement shall be governed in all respects by the laws of the State of California.
38. SEVERABILITY
If any non-material term, provision, covenant, or condition of this Agreement is held by a
court of competent jurisdiction to be invalid, void or unenforceable, the remainder of the provisions shall
remain in full force and effect, and shall in no way be affected, impaired or invalidated.
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COUNTY OF FRESNO
Fresno, CA
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39. ENTIRE AGREEMENT
This Agreement, including all Exhibits, COUNTY’s RFP No. 20-015, COUNTY’s RFP No.
20-015 Addendum One (1), and CONTRACTOR’s response thereto constitutes the entire agreement
between CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all
previous agreement negotiations, proposals, commitments, writings, advertisements, publications,
and understandings of any nature whatsoever unless expressly included in this Agreement.
Exhibit A Scope of Work
Exhibit B DBH Guiding Principles of Care Delivery
Exhibit C Budget and Narrative
Exhibit D Electronic Health Records Software Charges
Exhibit E Fresno County Mental Health Plan Compliance Program and Code of
Conduct
Exhibit F Documentation and Standards
Exhibit G DHCS 1010 – Quarterly Report on Involuntary Detentions
Exhibit G-1 Quarterly Reporting Progress
Exhibit H State Mental Health Requirements
Exhibit I Medi-Cal Org Provider Standards
Exhibit J MHP Grievance and Appeals Process
Exhibit K Incident Reporting Process
Exhibit L Fixed Asset and Sensitive Item Tracking
Exhibit M National Standards for CLAS
Exhibit M-1 CLAS Cultural Competence Form
Exhibit N Disclosure of Ownership and Control Interest Statement
Exhibit O Certification Regarding Debarment, Suspension, and Other Responsibility
Matters – Primary Covered Transactions
Exhibit P Self-Dealing Transaction Disclosure Form
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and
year first hereinabove written .
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CONTRACTOR:
CENTRAL STAR BEHAY-IORAL
HEALTH, I~ ~_:
By : , e_..,/'~ ,~~.,,
Print Name: Kent Dunlap
Title: President and Chief Executive Officer
15 By :
16 Print Name: _O_liv_ia_A_r_a_nd_a _____ _
1 7 Title: Vice President and Chief Financial Officer
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Mailing Address:
Central Star Behavioral Health, Inc.
1501 Hughes Way, Suite 150
Long Beach, CA 90810
Contact: Kent Dunlap, Senior, Vice President
Phone : (310) 221-6336 ext. 125
Fund/Subclass:
AccounUProgram:
Org/Cost Center:
0001/10000
7295/0
5630/2112
2 8 FT
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COUNTY OF FRESNO
Ernest Buddy Mendes, Chairman
of the Board of Supervisors of the
County of Fresno
Date: La · ~3 · ~020
ATTEST:
Bernice E. Seidel,
Clerk of the Board of Supervisors
County of Fresno, State of California
By : ~$~ ~ sJ:\cr(?
Date: Y> -~~ -aOo2.0
COUNTY OF FRESNO
Fresno, CA
Exhibit A – Scope of Work
Page 1 of 15
ADOLESCENT YOUTH ACUTE INPATIENT PSYCHIATRIC SERVICES
Psychiatric Health Facility (PHF)
Scope of Work
ORGANIZATION: Central Star Behavioral Health, Inc.
ADDRESS: 1501 Hughes Way, Suite 150, Long Beach, CA 90810
SITE ADDRESS: 4411 E. Kings Canyon Road, Fresno, CA 93702
SERVICES: Adolescent Youth Psychiatric Health Facility
PROJECT DIRECTOR: Kent Dunlap, Senior Vice President
CONTRACT PERIOD: July 1, 2020 – June 30, 2023 with an option for two (2) additional
12-month renewals, pursuant to satisfactory performance
CONTRACT AMOUNT: See Exhibit C
SCHEDULE OF SERVICES:
CONTRACTOR shall operate the youth adolescent Psychiatric Health Facility (PHF) twenty-four
(24) hours per day, seven (7) days per week (24/7).
TARGET POPULATION:
The target population will only include youth adolescents (hereinafter referred to as
adolescents), twelve (12) years of age up to eighteen (18) years of age, in acute mental health
distress who present a threat of harm to self, and/or threat of harm to others, and/or grave
disability (severe personal disorganization and inability for self-care and/or functioning safely in
the community). CONTRACTOR will not serve adolescents younger than twelve (12) years old.
In rare circumstances, the COUNTY DBH Director, or designee, has the ability to approve
admittance of a youth younger than twelve (12) years old.
Based on data collected from FY 2018-19, the target population will present the following
symptoms upon admission will include moods and emotional regulation (92%), self-harm (82%),
anger and aggression (44%), psychotic symptoms (19%), and co-occurring substance use
disorders (about 30%).
Adolescents will include those from all payor sources: Medi-Cal beneficiaries, Medicare and
Medicare/Medi-Cal beneficiaries, indigent/uninsured clients, and those with private insurance.
Adolescents may be admitted on either a voluntary or involuntary basis, and may be Medi-Cal
beneficiaries, Medicare and Medicare/Medi-Cal beneficiaries, and/or the indigent/uninsured.
Referrals are received from DBH and other COUNTY Departments, subcontracted providers
with DBH, hospital emergency departments, Juvenile Justice Campus (Fresno County’s
detention facility for adolescents), as well as other counties and agencies. Adolescents covered
by private insurance will be accepted via our contracts with and referrals from Kaiser
Exhibit A – Scope of Work
Page 2 of 15
Permanente, and other insurers (Anthem Blue Cross, Avante Behavioral Health Plan, Cigna
Behavioral Health, Magellan, Aetna, Blue Shield, Federal Blue Shield, Beacon Health Options,
and MHN, the behavioral health subsidiary of Health Net, Inc. etc.)
Fresno County residents shall receive top priority for admission. During the prior contract term,
CONTRACTOR contracted with six (6) additional counties, and was also able to serve
adolescents from Kern, Tulare, Madera, Merced, Mariposa and Stanislaus counties.
CONTRACTOR shall continue to subcontract with these counties to provide admittance for their
respective adolescents. CONTRACTOR will continue to be responsible for contracting with
other County Mental Health Plans and healthcare coverage organizations to serve their
referrals. CONTRACTOR will work with Fresno County Mental Health Plan (FCMHP) to
understand the presumptive transfer process and how to admit adolescents who are medically
covered through another county yet residing in Fresno County at the time of need for inpatient
psychiatric services.
LOCATION OF SERVICES:
CONTRACTOR will operate the Adolescent PHF located in COUNTY Building 319 at 4411 E.
Kings Canyon Road, Fresno, CA 93702, pursuant to a separate lease agreement between
COUNTY and CONTRACTOR effective for the same contract term as this Agreement. This
lease agreement will be executed at the same time as this Agreement.
CONTRACTOR will work with COUNTY and DBH Facilities Unit to ensure the site meets and
maintains physical plant requirements for a PHF under CCR Title 22, Division 5, Chapter 9,
Article 5 and applicable Health and Safety Codes.
COUNTY is exploring possible alternative locations for its programs currently located on the
University Medical Center (UMC) Campus on Kings Canyon. CONTRACTOR will be expected
to work with COUNTY in the relocation of Adolescent PHF services in the event that a different
site is identified during the term of this Agreement. CONTRACTOR shall communicate and
coordinate with COUNTY during any such transition and perform a walk-through of any new
identified site to address facility design, service requirements, etc. and will implement any
standardized expectations for naming, branding and communications.
HOURS OF OPERATION
The Adolescent PHF shall be operated 24/7 with appropriate staffing ratios as per CCR Title
22 requirements (Division 5, Chapter 9, Article 3).
The DBH Facilities Unit shall be available to address building maintenance requests from
Monday through Friday, 8 AM through 5 PM. After-hours or emergency facility requests will
be processed by the COUNTY Internal Services Department (ISD) Facility Services.
Medical staff shall be under the supervision of CONTRACTOR’s Medical Director. A
physician shall be on-call at all times, and contract psychiatrists shall provide weekend
coverage. A Registered Nurse (RN) and/or Licensed Vocational Nurse (LVN) shall be awake
and on duty at all times. The PHF Clinical Director, a Licensed Marriage and Family Therapist
(LMFT) staff member shall supervise social workers and rehab staff.
Exhibit A – Scope of Work
Page 3 of 15
RAMP-UP AND SERVICES START DATE
CONTRACTOR shall be prepared to continue providing adolescent inpatient PHF services on
July 1, 2020. A few new services (not included in the prior contract term) will require ramp-up
as discussed herein below.
Remodel and Equipment Replacement Plan:
The following items will be acquired or finalized during the first year of this Agreement contract
term.
- Replace older office furniture and information technology equipment including
desktops and monitors.
- Begin recruitment to hire additional new positions of Discharge Coordinator and
Transitional Age Youth (TAY) Peer Support Specialist, including all required
background checks.
- Complete other new staff hiring.
- Complete onboarding, orientation and training of new staff.
- Implementation of Child Adolescent Fellowship Program rotation which is further
outlined herein below.
CONTRACTOR will work closely with DBH staff to seamlessly relocate the Adolescent PHF
services in the event that a different site is identified during the contract term.
PROJECT DESCRIPTION:
CONTRACTOR shall operate an Adolescent PHF to serve up approximately 684 (57/month)
clients for each twelve (12) month period of this Agreement. Services include intensive, acute
care, trauma-informed residential treatment to adolescents. CONTRACTOR will provide
services for up to sixteen (16) adolescents at any given time. The Adolescent PHF shall provide
acute psychiatric inpatient hospitalization, coordinated discharge planning, and effective
linkages to post-hospital outpatient mental health treatment programs and other supportive
services for adolescents and their families.
CONTRACTOR shall be responsible to comply with the requirements of the FCMHP and must
complete and submit supporting documentation for all admissions regardless of payer source to
the FCMHP. The FCMHP will perform a utilization review of all admissions to determine that
the documentation demonstrates medical necessity criteria, as defined by the State of California
Department of Health Care Services (DHCS). The 16-bed facility will be licensed by DHCS and
shall meet all regulations required for operating a psychiatric health facility W&I Code 4080
Article 3; Health and Safety Code 1250.2 and meet Medi-Cal certification by the FCMHP.
CONTRACTOR shall be responsible to enter all Client Service Information (CSI), admission
data and billing information into the COUNTY DBH electronic health record (EHR) system
(currently AVATAR) and will be responsible for any and all audit exceptions pertaining to the
delivery of services.
Exhibit A – Scope of Work
Page 4 of 15
CONTRACTOR’S RESPONSIBILITIES:
A. RESPONSIBILITIES
1. Management and alleviation of the adolescent’s acute psychiatric symptoms to
allow them to be discharged to a less restrictive level of care.
2. Clinical program shall be recovery/strengths based.
3. Adolescent PHF shall be staffed with appropriate professional staff 24/7.
4. Services shall be provided in a safe, secure and structured environment that
promotes the adolescent’s wellness and recovery, including connections to family
and community.
5. Services shall include comprehensive multi-disciplinary evaluation and a client-
centered care plan for each adolescent.
6. CONTRACTOR shall provide appropriate dietary services in accordance with Title
22, Division 5, Chapter 9, Article 3, Section 77077. A dietician shall be utilized for
menu planning and assessment for special dietary needs, consistent with Title 22
requirements.
7. CONTRACTOR shall have admission procedures in place for voluntary and
involuntary clients.
8. Treatment Planning – CONTRACTOR staff shall provide the following services
captured in written assessment and care plans:
a. Mental Status Examination
b. Medical Evaluation
c. Psycho-Social Assessment
d. Nursing Assessment
e. Multi-Disciplinary Milieu Treatment Program
f. Individualized Focused Treatment Planning
g. Aftercare Planning
9. Staffing:
a. CONTRACTOR’s staffing pattern and all staff working at the PHF shall meet
all State licensing and regulatory requirements including medical staff
standards, nursing staff standards, social work and rehabilitation staff
requirements pursuant to Title 9, Division 1, Chapter 11, Article 3, Section
1840.348 of the California Code of Regulations for Psychiatric Health
Facilities. All staff, which requires state licensure or certification, will be
required to be licensed or certified in the State of California and be in good
standing with the state licensing or certification board.
b. All CONTRACTOR’s facility staff, who provide direct patient care or perform
coding/billing functions, must meet the requirements of the FCMHP
Exhibit A – Scope of Work
Page 5 of 15
Compliance Program. This includes the screening for excluded persons
and entities by accessing or querying the applicable licensing board(s), the
National Practitioner Data Bank (NPDB), Office of Inspector General’s List
of Excluded Individuals/Entities (LEIE), Excluded Parties List System
(EPLS) and Medi-Cal Suspended and Ineligible List prior to hire and
annually thereafter. In addition, all licensed/registered/waivered staff must
complete a FCMHP Provider Application and be credentialed by the
FCMHP’s Credentialing Committee. All licensed staff shall have
Department of Justice (DOJ), Federal Bureau of Investigation (FBI), and
Sheriff fingerprinting (Live Scan) executed.
c. CONTRACTOR’s Peer and/or Family Support staff shall be available to help
educate, support, and advocate on behalf of the adolescents and their
families during the hospitalization and will assist with discharge planning
and the transition to follow-up care.
10. Medical Records and Mandated Reporting:
a. CONTRACTOR shall be responsible to enter all CSI, admission data and
billing information into COUNTY DBH’s AVATAR and will be responsible for
any and all audit exceptions pertaining to the delivery of services.
b. CONTRACTOR will be responsible for “release of information” requests for
the PHF and shall adhere to applicable federal and state regulations.
c. CONTRACTOR shall report information and admission/discharge data to
OSHPD and meet the submission deadlines of June 30 and December 31
each calendar year.
11. Organized Clinical Staff – CONTRACTOR’s clinical staff will be licensed mental
health professionals as well as rehabilitation therapists with appropriate education,
credentialing and experience to reach status as a Qualified Mental Health
Professional (QMHP).
12. Pharmaceutical and Medication Services – CONTRACTOR shall implement
medication controls required by a licensed PHF for pharmaceutical and medication
services. CONTRACTOR shall have policies, procedures and physician/nursing
protocols in place regarding medication labeling, storage/security, orders, use of
medication carts, administration, polypharmacy, and monitoring.
13. Physical Health Care – CONTRACTOR will contract with a primary care physician
and a registered dietician. CONTRACTOR will provide a full health history to each
adolescent upon admission. CONTRACTOR will have a written agreement with
one or more acute care hospitals to provide services for youth requiring additional
services.
14. Schedule of Active Therapies - CONTRACTOR shall provide a daily schedule of
therapeutic activities that will be provided as part of the clinical treatment program.
The schedule shall include wellness education with motivational support, psycho-
social, and life skill building groups on varied topics, family therapy, creative
expressive arts, recreational and fitness programs. The treatment team is
expected to schedule the adolescent’s participation activities tailored to each
Exhibit A – Scope of Work
Page 6 of 15
individual’s needs. There will also be daily meetings among the staff and
adolescents for general education and guidance about unit activities and to
collectively address milieu living issues.
15. Utilization Review, Billing and Cost Report:
a. CONTRACTOR shall notify DBH of any admission of a COUNTY client
within twenty-four (24) hours or the next business day in a manner
approved by the COUNTY. The notification method shall be mutually
acceptable by both COUNTY and CONTRACTOR.
b. CONTRACTOR shall be responsible to ensure that documentation in the
adolescent’s medical record meets medical necessity criteria for the hours
of service submitted to COUNTY for reimbursement by federal
intermediaries, third-party payers, and other responsible parties.
c. CONTRACTOR shall enter all mental health data and billing information into
the COUNTY DBH’s EHR and will be responsible for any and all audit
exceptions pertaining to the delivery of services. For Medi-Cal billing
denials by the State, CONTRACTOR will maintain an error rate no
greater than five percent (5%).
d. CONTRACTOR shall submit a complete and accurate DHCS/Short-Doyle
Medi-Cal Cost Report for each fiscal year ending June 30th affected by the
proposed agreement within ninety (90) days following the end of each fiscal
year.
e. CONTRACTOR shall ensure that cost reports are prepared in accordance
with general accounting principles and the standards set forth by the DHCS
and the COUNTY.
16. Patient’s Rights and Certification Review Hearings:
a. CONTRACTOR shall adopt and post in a conspicuous place a written policy
on patient rights in accordance with Section 70707 of Title 22 of the
California Code of Regulations and Section 5325.1 of the California Welfare
and Institutions Code and Title 42 Code of Federal Regulations Section
438.100.
b. CONTRACTOR shall allow access to COUNTY clients by the Patients’
Rights Advocate designated by the COUNTY.
c. CONTRACTOR shall conduct Mental Health Certification Review Hearings
in accordance with regulations in a location within the facility that allows for
confidentiality and is compatible with and is least disruptive to the treatment
being provided to the COUNTY patient.
17. Grievances and Incident Reports - CONTRACTOR shall log all grievances and the
disposition of all grievances received from an adolescent or their family in
accordance with the FCMHP, as indicated in Exhibit H. CONTRACTOR shall
provide a summary of the grievance log entries concerning COUNTY clients to the
DBH Director, or designee, at monthly intervals, by the fifteenth (15th) day of the
following month, in a format that is mutually agreed upon between COUNTY and
Exhibit A – Scope of Work
Page 7 of 15
CONTRACTOR. CONTRACTOR shall post signs, provided by the COUNTY,
informing the adolescents of their right to file a grievance and appeal.
CONTRACTOR shall notify COUNTY of all incidents or unusual occurrences
reportable to state licensing bodies that affect COUNTY clients within twenty-four
(24) hours. CONTRACTOR shall use the Incident Report form, as indicated in
Exhibit I, for such reporting.
Within fifteen (15) days after each grievance or incident affecting COUNTY clients,
CONTRACTOR shall provide COUNTY with the complaint and CONTRACTOR’s
disposition of, or corrective action taken to resolve the complaint or incident.
Within fifteen (15) days after CONTRACTOR submits a corrective action plan to
California State licensing and/or accrediting body concerning any sentinel event,
as the term is defined by the licensing or accrediting agency, and within fifteen
(15) days after CONTRACTOR receives a corrective action order from a California
State licensing and/or accrediting body to address a sentinel event,
CONTRACTOR shall provide a summary of such plans and orders to COUNTY.
B. OBJECTIVES
CONTRACTOR shall provide the following objectives:
1. Safe and Secure Environment – CONTRACTOR shall provide for clinical and
medical assessment, diagnostic formulation, crisis intervention, medication
management and clinical treatment for mental health clients with acute
psychiatric disorder in a safe and secure environment. All staff will be trained
and certified by a nationally recognized assault crisis training that is principally
focused on crisis prevention and de-escalation.
2. Provide the appropriate type and level of staffing to provide for a clinically
effective program design.
3. Provide an intensive treatment program which has individualized client care
plans.
4. Stabilize adolescents as soon as possible in order to assist them in their
recovery from their acute mental illness crisis.
5. Effectively partner with other programs in the crisis service system of care in
accepting COUNTY adolescents for admission for acute inpatient psychiatric
services and also to work collaboratively in discharge planning to ensure
appropriate ongoing outpatient specialty mental health treatment services will
be provided post-release.
6. Identify COUNTY adolescents with frequent admissions during the fiscal year
and develop strategies with other COUNTY and community agencies to reduce
readmissions.
7. Effectively interact with community agencies, other mental health programs and
providers, natural support systems and families to assist adolescents to be
discharged to a lower level of care, as soon as clinically appropriate.
Exhibit A – Scope of Work
Page 8 of 15
8. Work to integrate mental health and substance use disorder services through
comprehensive continuous integrated systems of care for the life span of those
served and to work as partners with a shared vision: to create a coordinated
and comprehensive system of service delivery via the County Comprehensive
Continuation Integrated System of Care (CCISC) as mentioned within this
Agreement.
C. Direct Admissions to the PHF
Regarding direct admissions to the PHF from COUNTY DBH programs or its
subcontracted providers, CONTRACTOR agrees to the following:
1. To allow direct admits from COUNTY DBH programs or its contracted
providers, when PHF beds are available.
2. Said direct admits shall not require medical clearance. However, in the event a
referred client is known to possess a contagious medical condition, said patient
shall be medically cleared by a local hospital prior to admission to the PHF
operated by CONTRACTOR.
D. Court Testimony for PHF Adolescents
Regarding the provision of court testimony related to PHF patients, CONTRACTOR
shall identify CONTRACTOR’s appropriate staff to provide court testimony relevant to PHF
clients, when required.
E. Cultural Competency
Regarding the PHF program and Cultural Competency, CONTRACTOR agrees to the
following:
CONTRACTOR refers to cultural competency as cultural attunement to remind staff of
the key values of humility, open-mindedness, avoiding assumptions, and lifelong learning about
others from diverse backgrounds versus a focus on achieving one-time competence.
F. Child-Adolescent Fellowship Program
CONTRACTOR agrees to the following:
CONTRACTOR’s Medical Director will work with the COUNTY’s DBH Medical Director
as well as the Medical Director of the University of California, San Francisco (UCSF) to plan and
coordinate for the Child-Adolescent Fellowship Program.
CONTRACTOR is prepared to accept two (2) Fellows/year (one at a time, each for a 6-
month rotation) as well as Residents (one at a time, each for a 2-month rotation). The number
of fellows and residents will be negotiated with DBH. Stipend payments would be provided by
the COUNTY under a yet to be determined and executed contract between COUNTY DBH and
Exhibit A – Scope of Work
Page 9 of 15
UCSF.
CONTRACTOR is willing to provide supervision for the Fellowship via the PHF Medical
Director, as well as from a licensed PHF Administrator and Clinical Director. The Fellowship’s
Acting Attending will consult and co-sign all medical documentation, and the PHF Administrator
will consult and co-sign all clinical notes.
CONTRACTOR will work with UCSF and/or the COUNTY’s Designated Supervisor, if
requested, to implement and carry out the Child-Adolescent Fellowship Program.
G. Staffing Training:
CONTRACTOR has developed rich and comprehensive training plans that meet the
PHF requirement of 47 hours of staff training. CONTRACTOR staff shall participate in
comprehensive and on-going training that includes, but is not limited to:
1) New Hire Orientation,
2) CONTRACTOR’s Core Practices for Clinical Excellence in Mental Health
Services Delivery, and
3) CONTRACTOR’s course catalogue offerings of elective topics available through
e-learning or classroom trainings.
PHF staff will also be intensively trained in practices critical to the delivery of PHF
services, and treatment staff will receive additional training in Evidence Based Practices (EBPs).
All staff will be required to participate in any DBH trainings and meetings.
In addition to the above, staff receive a full calendar of training topics including cultural
attunement training as it relates to various cultures and backgrounds, including recovery,
LGBTQ, youth, homeless and monolingual persons. All new staff shall participate in an
overview of cultural attunement. Employees shall also attend the annual Re-Orientation
Training and take a quiz to measure understanding. Training is conducted using the state
Health Equity and Multicultural Diversity Training (HEMCDT). At the PHF, direct service
providers will be required to attend at least eight (8) hours of cultural competency training
annually, reported to DBH as required.
Additional PHF-specific trainings include: Emergency Procedures and Non-Violent Crisis
Intervention: including training in Pro-ACT and the use of restraints, how to contact emergency
personnel, as well as training in CPR, First Aid, and Emergency Management Plans.
H. Peer Support Resources
CONTRACTOR includes Peer/Family Advocates/Parent Partners and youth mentors,
and many other staff with lived experience as part of PHF services.
CONTRACTOR values Peer Support Staff with lived experience because of their unique
ability to engage with families from a place of shared experience. They also offer fresh and
insightful perspectives about service delivery issues such as access, respect, autonomy, and
Exhibit A – Scope of Work
Page 10 of 15
quality of care. They also reinforce the innate potential for recovery, so critical during a family
crisis.
CONTRACTOR’s PHF Family Advocate helps to educate, support and advocate on
behalf of adolescents and families and assists with discharge planning and the transition to
follow-up care. They help lead Family Services, facilitating groups and working one-on-one with
the adolescents and families to articulate their voice and choice in the treatment process.
CONTRACTOR will add a Transitional Age Youth (TAY) Peer Specialist role to the PHF
services during this Agreement. This position will utilize a young adult (between the ages of 18
and 25) with lived experience in recovery. The TAY Peer Specialist will play a key role in
engaging with and articulating the voice of adolescents, from the perspective of someone who
has “been there.”
CONTRACTOR’s Peer Staff undergo the same Core Practices training as all other staff,
and also complete the CONTRACTOR’s Peer Staff Career Ladder training on family and client
voice and choice, identifying strengths, engagement strategies, communication and clarification
strategies, uncovering and understanding differences in perception, addressing stigma and
conveying hope. This curriculum is designed to enhance peer skills, increase confidence, and
help peers make a career of assisting others. They are supervised by the Clinical Director, and
supervision can consistent of one-on-one supervision, during meetings or be situationally
based. Hours of supervision may vary, typically, one (1) hour per week.
I. Discharge Coordinator
CONTRACTOR will have a Discharge Coordinator in the new Adolescent PHF. This position
will have primary responsibility for organizing discharge information and facilitating the
discharge of patients at the PHF; a process that begins at assessment and unfolds throughout
stay. Will participate in interdisciplinary meetings, collaboration and communication with
outside partners and resources, and with preparing clients for facility release.
J. Program Outcomes/Performance Outcomes Measures
CONTRACTOR’s Research and Program Practices (RPP) Department works closely
with the PHF to track and analyze COUNTY and DHCS-determined performance measures and
develops additional standardized and agency-specific assessment and outcome tools,
satisfaction surveys, and other meaningful performance measures, as needed.
CONTRACTOR is using its current EHR, 'myEvolv', by Netsmart Technologies Inc.
CONTRACTOR is open to switching to the COUNTY’s EHR known as AVATAR. If
CONTRACTOR decides to transition to the use of AVATAR, COUNTY and CONTRACTOR will
coordinate for an Amendment regarding usage and fees for access and maintenance of
COUNTY’s EHR.
Data tracked for the PHF program evaluation comes from varied sources, including:
1) PHF EHR data entered by program staff regarding client registry (demographics,
clinical profile, etc.), service utilization (incoming referrals, admit/discharge dates,
outgoing referrals and linkages); and risk behavior incident reports;
2) Exit interviews and survey methodologies to capture additional information and
Exhibit A – Scope of Work
Page 11 of 15
perspectives, including satisfaction with the service and perceptions of results, from
adolescents, families and/or agency partners;
3) System of care data set analyses to assess patterns (including repeat use) of
crisis/hospital and other high-end services relative to community services and supports
by adolescents before and after their PHF service episodes.
The following table details the indicators CONTRACTOR anticipates tracking over the
next contract period, with the understanding that final measures will be agreed upon between
COUNTY and CONTRACTOR.
See outcome tables on the following pages.
Exhibit A – Scope of Work
Page 12 of 15
Indicator (Type and Target) Who Applied Time of Measure Data Source Target Goal Expectancy
ACCESS
Time between receipt of a referral
to the PHF and contact with the
referring agency.
Time between referral and
admission to the PHF.
Intake Staff
(Nursing Dept) Admission Packet Tracker
SBHG EMR
% Referrals responded to within 1
hr. Average length of response
time.
% Referrals admitted to PHF
within 24 hrs. Average length of
referral to admission time.
ACCESS & EFFICIENCY
Denial rate of admissions when a
bed is available
Denial rate of PHF days not
meeting Medi-Cal necessity
criteria per utilization review.
Internal &
External QA/UR
Admissions &
Days in Setting
Packet Tracker
Internal &
County UR
% Denials of admissions when
bed is available will not exceed
20%
% Denials for PHF days due to
not meeting medical necessity will
not exceed 5%
EFFECTIVENESS
Reduced high-risk behaviors and
associated incidents.
PHF Psychiatrist,
Nurses & Social
Workers
BPRS at
admission, every
three days,
discharge (DC)
IRs completed at
time of incidents
Brief
Psychiatric
Rating Scale
(BPRS)
SBHG EMR
Incident Report
(IR)Tracking
Majority of clients will show
reductions in one or more
individualized target behaviors by
discharge (new tool -- we will set
baseline by Jan. 1, 2020).
IRs (esp. those related to
aggression, suicidality) will
continue at low rates per 1000
patient days as in prior years.
EFFECTIVENESS
Acquisition of coping,
communication and community
life skills.
PHF Psychiatrist,
Nurses & Social
Workers
Discharge (DC)
EMR DC Status
Form
Client/Family
DC Interviews/
Surveys
Majority of clients will have met
all/some of their treatment goals
and the majority of both clients
and caregivers will report
improved capacities by discharge
Exhibit A – Scope of Work
Page 13 of 15
Indicator (Type and Target) Who Applied Time of Measure Data Source Target Goal Expectancy
EFFICIENCY
Average length of stay.
Internal QA Admission to
Discharge
Avatar
CONTRACTOR
EHR
Average length of stay will remain
stable, similar to prior years
(average of 6 days).
% of those who discharge within
10 days does not exceed 90%.
EFFECTIVENESS &
EFFICIENCY
Collaborative approaches and
treatment strategies to reduce
hospital readmission of clients,
esp. among those with frequent
PHF readmissions.
PHF
Nursing/Clinical
& QA Leaders &
Treatment Staff
(in collaboration
w/ external
entities)
Varied QI Projects
Undertaken
Annually
Varied QI
Projects
(Recidivism
data from
County and/or
EMR; project
specific
tracking logs
are also used)
Varied per QI Project
Examples:
% clients introduced to WRAP
% clients w/ family sessions
% clients/families endorsement of
service approach on DC surveys
% readmitted within 30 days of
DC
EFFECTIVENESS &
EFFICIENCY
Effective discharge planning as
demonstrated by referral and
linkage to other DBH
programs, community providers
and other community resources.
PHF
Nursing/Clinical
& QA Leaders &
Treatment Staff
(in collaboration
w/ external
entities)
DC planning starts
at admission and
continues daily
through DC to
Aftercare linkages
CONTRACTOR
EHR Aftercare
Plan
CONTRACTOR
EHR DC Status
Form
Post DC follow-
up phone
interviews*
Majority (85%) of PHF clients
return to a home/family setting
Majority (85%) of PHF clients DC
with at least 2 referral/linkages to
community resources & supports.
COUNTY also tracks KPIs related
to timely uptakes to next-on
services (e.g., 7 days, 48 hrs.).
CUSTOMER SATISFACTION
Multiple Protocols & Survey Items
Examples:
(Client) “More confident now,
after being in the program, in my
ability to recover and cope with
mental health problems.”
(Caregiver) “Family received the
help we needed for our child.”
Family Advocate
and/or PHF
Psychiatrist
QA/Others TBD
Client/Family:
Discharge &
(possibly) Post DC
Interviews/Surveys
Youth Survey
Caregiver
Survey
Post DC follow-
up phone
interviews*
Agency Partner
Surveys
Performance benchmark is 85%
items endorsed positively.
Items or areas that fall below
benchmark are reviewed and
prioritized for QI.
Exhibit A – Scope of Work
Page 14 of 15
Indicator (Type and Target) Who Applied Time of Measure Data Source Target Goal Expectancy
(Agency Partner) “The program
provides a needed level of care in
the community.”
* Post discharge (DC) protocols are developed and available; we are assessing whether the team has capacity to sustain the data
gathering process, which is time-consuming. Pilot testing results will be available after January 1, 2020.
Exhibit A – Scope of Work
Page 15 of 15
COUNTY RESPONSIBILITIES:
COUNTY shall:
1. Perform a utilization review (through its FCMHP) of all admissions to determine that the documentation
demonstrates that medical necessity criteria as defined by DHCS was met for each period of the
admission, except for the episode of discharge.
2. Provide oversight (through COUNTY DBH) of the CONTRACTOR’s PHF program. In addition to
contract monitoring of program(s), oversight includes, but not limited to, coordination with DHCS in
regard to program administration and outcomes.
3. Assist the CONTRACTOR in making linkages with the entire behavioral health system of care. This will
be accomplished through regularly scheduled meetings as well as formal and informal consultation.
4. Participate in evaluating the progress of the overall program and the efficiency of collaboration with the
CONTRACTOR’s staff and will be available to the contractor for ongoing consultation.
5. Receive and analyze statistical outcome data from CONTRACTOR throughout the term of this
Agreement on a monthly basis, or as requested by COUNTY. DBH will notify the CONTRACTOR when
additional participation is required. The performance outcome measurement process will not be limited
to survey instruments but will also include, as appropriate, client and staff interviews, chart reviews, and
other methods of obtaining required information.
6. Recognize that cultural competence is a goal toward which professionals, agencies, and systems should
strive. Becoming culturally competent is a developmental process and incorporates at all levels the
importance of culture, the assessment of cross-cultural relations, vigilance towards the dynamics that
result from cultural differences, the expansion of cultural knowledge, and the adaptation of services to
meet culturally unique needs. Offering those services in a manner that fails to achieve its intended
result due to cultural and linguistic barriers is not cost effective. To assist the CONTRACTOR’s efforts
towards cultural and linguistic competency, DBH shall provide the following at no cost to
CONTRACTOR:
A. Technical assistance to CONTRACTOR regarding cultural competency requirements and sexual
orientation training.
B. Mandatory cultural competency training including sexual orientation and sensitivity training for
CONTRACTOR personnel, at minimum once per year. COUNTY will provide mandatory training
regarding the special needs of this diverse population and will be included in the cultural
competence training(s). Sexual orientation and sensitivity to gender differences is a basic cultural
competence principle and shall be included in the cultural competency training. Literature suggests
that the mental health needs of lesbian, gay, bisexual, transgender, and queer (or questioning)
(LGBTQ) individuals may be at increased risk for mental disorders and mental health problems due
to exposure to societal stressors such as stigmatization, prejudice and anti-gay violence. Social
support may be critical for this population. Access to care may be limited due to concerns about
providers’ sensitivity to differences in sexual orientation.
C. Technical assistance for CONTRACTOR in translating behavioral health and substance use
disorder services information into DBH’s threshold languages (English, Spanish, and Hmong).
Translation services and costs associated will be the responsibility of the CONTRACTOR.
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
1
rev 01 02 2020
DBH VISION:
Health and well being for our community.
DBH MISSION:
DBH, in partnership with our diverse community, is dedicated to providing quality, culturally
responsive, behavioral health services to promote wellness, recovery, and resiliency for
individuals and families in our community.
DBH GOALS:
Quadruple Aim
Deliver quality care
Maximize resources while focusing on efficiency
Provide an excellent care experience
Promote workforce well being
GUIDING PRINCIPLES OF CARE DELIVERY:
The DBH 11 principles of care delivery define and guide a system that strives for excellence in the
provision of behavioral health services where the values of wellness, resiliency, and recovery are
central to the development of programs, services, and workforce. The principles provide the
clinical framework that influences decision making on all aspects of care delivery including
program design and implementation, service delivery, training of the workforce, allocation of
resources, and measurement of outcomes.
1. Principle One Timely Access & Integrated Services
o Individuals and families are connected with services in a manner that is streamlined,
effective, and seamless
o Collaborative care coordination occurs across agencies, plans for care are integrated,
and whole person care considers all life domains such as health, education,
employment, housing, and spirituality
o Barriers to access and treatment are identified and addressed
o Excellent customer service ensures individuals and families are transitioned from one
point of care to another without disruption of care
Exhibit B - DBH Guiding Principles of Care Delivery
Page 1 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2
rev 01 02 2020
2. Principle Two Strengths based
o Positive change occurs within the context of genuine trusting relationships
o Individuals, families, and communities are resourceful and resilient in the way they
solve problems
o Hope and optimism is created through identification of, and focus on, the unique
abilities of individuals and families
3. Principle Three Person driven and Family driven
o Self determination and self direction are the foundations for recovery
o Individuals and families optimize their autonomy and independence by leading the
process, including the identification of strengths, needs, and preferences
o Providers contribute clinical expertise, provide options, and support individuals and
families in informed decision making, developing goals and objectives, and identifying
pathways to recovery
o Individuals and families partner with their provider in determining the services and
supports that would be most effective and helpful and they exercise choice in the
services and supports they receive
4. Principle Four Inclusive of Natural Supports
o The person served identifies and defines family and other natural supports to be
included in care
o Individuals and families speak for themselves
o Natural support systems are vital to successful recovery and the maintaining of
ongoing wellness; these supports include personal associations and relationships
typically developed in the community that enhance a quality of life
o Providers assist individuals and families in developing and utilizing natural supports.
5. Principle Five Clinical Significance and Evidence Based Practices (EBP)
o Services are effective, resulting in a noticeable change in daily life that is measurable.
o Clinical practice is informed by best available research evidence, best clinical
expertise, and values and preferences of those we serve
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
Exhibit B - DBH Guiding Principles of Care Delivery
Page 2 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
3
rev 01 02 2020
6. Principle Six Culturally Responsive
o Values, traditions, and beliefs specific to an or culture(s) are
valued and referenced in the path of wellness, resilience, and recovery
o Services are culturally grounded, congruent, and personalized to reflect the unique
cultural experience of each individual and family
o Providers exhibit the highest level of cultural humility and sensitivity to the self
identified culture(s) of the person or family served in striving to achieve the greatest
competency in care delivery
7. Principle Seven Trauma informed and Trauma responsive
o The widespread impacts of all types of trauma are recognized and the various
potential paths for recovery from trauma are understood
o Signs and symptoms of trauma in individuals, families, staff, and others are recognized
and persons receive trauma informed responses
o Physical, psychological and emotional safety for individuals, families, and providers is
emphasized
8. Principle Eight Co occurring Capable
o Services are reflective of whole person care; providers understand the influence of
bio psycho social factors and the interactions between physical health, mental health,
and substance use disorders
o Treatment of substance use disorders and mental health disorders are integrated; a
provider or team may deliver treatment for mental health and substance use
disorders at the same time
9. Principle Nine Stages of Change, Motivation, and Harm Reduction
o Interventions are motivation based and adapted to the stage of change
o Progression though stages of change are supported through positive working
relationships and alliances that are motivating
o Providers support individuals and families to develop strategies aimed at reducing
negative outcomes of substance misuse though a harm reduction approach
o Each individual defines their own recovery and recovers at their own pace when
provided with sufficient time and support
Exhibit B - DBH Guiding Principles of Care Delivery
Page 3 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
4
rev 01 02 2020
10. Principle Ten Continuous Quality Improvement and Outcomes Driven
o Individual and program outcomes are collected and evaluated for quality and efficacy
o Strategies are implemented to achieve a system of continuous quality improvement
and improved performance outcomes
o Providers participate in ongoing professional development activities needed for
proficiency in practice and implementation of treatment models
11. Principle Eleven Health and Wellness Promotion, Illness and Harm Prevention, and Stigma
Reduction
o The rights of all people are respected
o Behavioral health is recognized as integral to individual and community well being
o Promotion of health and wellness is interwoven throughout all aspects of DBH services
o Specific strategies to prevent illness and harm are implemented at the individual,
family, program, and community levels
o Stigma is actively reduced by promoting awareness, accountability, and positive
change in attitudes, beliefs, practices, and policies within all systems
o The vision of health and well being for our community is continually addressed
through collaborations between providers, individuals, families, and community
members
Exhibit B - DBH Guiding Principles of Care Delivery
Page 4 of 4
Employee Salaries
Acct # Position FTE Admin Direct Total
1101 Clinical Director 1.00 105,905$105,905$
1102 Director Nursing 1.00 108,150 108,150
1103 Coordinator, Program 1.00 53,560 53,560
1104 Therapist, Recreation 1.00 56,333 56,333
1105 Therapist, Rehabilitation I III 1.00 47,069 47,069
1106 Case Manager 1.00 40,063 40,063
1107 Counselor, Youth IV 14.00 495,039 495,039
1108 Advocate Peer and Family 1.00 32,801 32,801
1109 Rehabilitation Aide I II 2.00 70,720 70,720
1110 Social Worker 4.50 321,703 321,703
1111 Coordinator, Admissions 1.00 56,347 56,347
1112 Charge & Registered Nurse 2.50 182,000 182,000
1113 Licensed Vocational Nurse 6.80 373,119 373,119
1114 Clerk, Receptionist 2.00 59,987 59,987
1115 Housekeeper 1.00 31,129 31,129
1116 Lead, Cook 1.00 28,227 28,227
1117 Cook 1.00 31,065 31,065
1118 Discharge Coordinator 1.00 43,680 43,680
1119 TAY Peer Specialist 1.00 37,440 37,440
1120 Administrator 0.75 88,566 88,566
1121 QA Coordinator 0.25 12,855 12,855
1122 QA Manager 0.25 16,802 16,802
1123 QA Assistant 0.25 7,954 7,954
1124 Training Coordinator 0.25 9,555 9,555
1125 Training Manager 0.25 18,398 18,398
1126 HR Manager 0.25 12,854 12,854
1127 HR Assistant 0.25 12,319 12,319
1128
1129
1130
1131
Personnel Salaries Subtotal 47.30 179,303$ 2,174,336$ 2,353,639$
ADOLESCENT ACUTE INPATIENT PSYCHIATRIC HEALTH FACILITY (PHF) SERVICES
Central Star Behavioral Health, Inc. | Fresno County DBH Adolescent PHF
FY 2020 2021 | 07/01/2020 6/30/2021
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 1 of 60
Employee Benefits
Acct # Admin Direct Total
1201 4,167$ 47,484$51,651$
1202 5,557 64,655 70,212
1203 22,225 258,616 280,841
1204
1205
1206
31,949$ 370,755$ 402,704$
Payroll Taxes & Expenses:
Acct # Admin Direct Total
1301 11,483$ 133,031$144,514$
1302 2,686 31,251 33,937
1303 4,352 50,647 54,999
1304
1305
1306
18,521$ 214,929$ 233,450$
229,773$ 2,760,020$ 2,989,793$
2000: CLIENT SUPPORT
Acct # Amount
2001 $
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
$
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
DIRECT CLIENT CARE TOTAL
Household Items for Clients
Medication Supports
Program Supplies Medical
Utility Vouchers
Other (Specify)
Other (Specify)
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
Line Item Description
FICA/MEDICARE
SUI
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
Child Care
Description
Employee Benefits Subtotal:
Description
OASDI
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 2 of 60
3000: OPERATING EXPENSES
Acct # Amount
3001 37,460$
3002
3003 43,616
3004
3005 9,600
3006 11,220
3007 35,100
3008 8,400
3009 53,640
3010 67,942
3011
3012
266,978$
4000: FACILITIES & EQUIPMENT
Acct # Amount
4001 22,680$
4002 11,160
4003 20,700
4004
4005 3,600
4006 56,280
4007 54,222
4008 10,000
4009
4010
178,642$
5000: SPECIAL EXPENSES
Acct # Amount
5001 $
5002
5003
5004 5,241
5005 828,120
5006 13,560
5007 94,700
5008
941,621$SPECIAL EXPENSES TOTAL:
Medication Supports
Laundry & Linen
Professional Services
Other (Specify)
FACILITIES/EQUIPMENT TOTAL:
Line Item Description
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Specify)
Translation Services
Security
Utilities
Computers & Software
Furniture & Fixtures
Other (Specify)
Other (Specify)
OPERATING EXPENSES TOTAL:
Line Item Description
Building Maintenance
Rent/Lease Building
Rent/Lease Equipment
Rent/Lease Vehicles
Food
Clothing
Program Supplies Medical
Purchased Services
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Advertising
Staff Development & Training
Staff Mileage
Line Item Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 3 of 60
6000: ADMINISTRATIVE EXPENSES
Acct # Amount
6001 320,250$
6002
6003 104,400
6004 8,400
6005 19,320
6006 8,523
6007
6008 114,375
6009 222,087
6010 133,252
6011
6012
930,607$
7000: FIXED ASSETS
Acct # Amount
7001 $
7002
7003
7004
7005
7006
7007
7008
$FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 5,307,641$
Assets over $5,000/unit (Specify)
Other (Specify)
Other (Specify)
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider Owned Equipment to be Used for Program Purposes)
Line Item Description
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Centralized Fiscal Services
Centralized Services Private Ins/Other County
Centralized Services program
Other (Specify)
Other (Specify)
Payroll Services
Liability Insurance
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 4 of 60
Acct # Service Units Rate Amount
8001 Mental Health Services 0 $
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0
8009 Phyciatric Health Facility Inpatient 5,869 895.84 5,257,739
5,869 5,257,739$
61%
3,207,221
50%1,603,610
1,603,610$
Acct # Amount
8101 Drug Medi Cal $
8102 SABG $
$
Acct # Amount
8201 Realignment 1,653,513$
1,653,513$
Acct # MHSA Component Amount
8301 CSS Community Services & Supports $
8302 PEI Prevention & Early Intervention
8303 INN Innovations
8304 WET Workforce Education & Training
8305 CFTN Capital Facilities & Technology
$
Acct # Amount
8401 Client Fees
8402 Client Insurance
8403 1,156,703
8404 788,661
8405 105,155
2,050,518$
Out of County Bed Rate=922.26/day
OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:5,307,641$
MHSA TOTAL
8400 OTHER REVENUE
Line Item Description
Private Insurance Bed Rate=1015.15/day
Uninsured
REALIGNMENT TOTAL
8300 MENTAL HEALTH SERVICE ACT (MHSA)
MHSA Program Name
Federal Financial Participation (FFP) %
MEDI CAL FFP TOTAL
8100 SUBSTANCE USE DISORDER FUNDS
Line Item Description
SUBSTANCE USE DISORDER FUNDS TOTAL
8200 REALIGNMENT
PROGRAM FUNDING SOURCES
8000 SHORT/DOYLE MEDI CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
Estimated % of Clients who are Medi Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi Cal Beneficiaries
Line Item Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 5 of 60
Budget Narrative
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 2,989,793
Employee Salaries 2,353,639
1101 Clinical Director 105,905 1.0 FTE This position has primary responsibility for overseeing the provision of mental
health services, case management services and support services to clients and their
families. Has oversight of the Program and provides supervision to clinical staff. Works
in close collaboration with Clinical Director to ensure each client receives the
appropriate care and treatment consistent with the requirements.
Responsible for the implementation and management of all regulatory requirements.
1102 Director Nursing 108,150 1.0 FTE The Director of Nursing ensures that each PHF client receives the nursing care,
treatment, medications and diet, which have been ordered by the attending physician,
ensuring the overall quality of licensed nursing care for the PHF Unit. S/he participates
in budget development for the Nursing Department and is responsible for its
implementation and management. S/he selects, hires and supervises all staff in the
Nursing Department.
1103 Coordinator, Program 53,560 1.0 FTE assists the Director of Nursing in directing the activities of assigned licensed and
non licensed personnel who provide health care services to clients of the Central Star
Youth Psychiatric Health Facility on a 24 hour 7 day a week basis.
1104 Therapist, Recreation 56,333 1.0 FTE is the treatment team member who is responsible for providing recreational
services to adolescent clients within the Rehabilitation Program. These services are
provided through individualized and/or group activities to restore, establish and
maintain optimum level of social, vocational and physical functioning which include
social activities involving group participation, indoor and outdoor recreational activities
and exercises.
1105 Therapist, Rehabilitation I III 47,069 1.0 FTE is the treatment team member who is responsible for providing direct and
indirect rehabilitation services to adolescent clients. These services are provided
through individualized and/or group activities for clients. The Rehab Therapist may also
provide work direction to Rehab Aides.
1106 Case Manager 40,063 1.0 FTE This position has primary responsibility for organizing discharge information and
facilitating the discharge of patients at the Central Star Youth PHF; a process that begins
from initial assessment and unfolds throughout the course of acute inpatient treatment.
The case manager participates in interdisciplinary meetings, collaboration and
communication with outside partners and resources, and with preparing patients for
facility release.
1107 Counselor, Youth IV 495,039 14.0 FTE is the treatment team member who is responsible for providing direct care to
meet the physical and psychosocial needs of the adolescents. This care is provided
through direct and indirect physical and verbal interactions with clients, modeling
appropriate behaviors for clients, and monitoring daily client activities. (1.0 FTE Youth
Counselor serves as a designated Safety Specialist.)
1108 Advocate Peer and Family 32,801 1.0 FTE provide outreach, advocacy, training and support for family members
throughout all stages of the treatment, transition, and aftercare.
1109 Rehabilitation Aide I II 70,720 2.0 FTE assists the Rehabilitation Therapist in providing direct and indirect rehabilitation
services to adolescent clients through individualized and/or group activities.
ADOLESCENT ACUTE INPATIENT PSYCHIATRIC HEALTH FACILITY (PHF) SERVICES
Central Star Behavioral Health, Inc. | Fresno County DBH Adolescent PHF
FY 2020 2021 | 07/01/2020 6/30/2021
PROGRAM EXPENSE
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 6 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
1110 Social Worker 321,703 4.5 FTE is the leader of each treatment team, and is responsible for preparing a
comprehensive treatment plan for each client. This position manages the
journey from intake, evaluation and assessment, the provision of case management and
other therapeutic services, through discharge planning and final placement. This
position coordinates with other agencies such as Child Protective Services, Juvenile
Probation Department, and County Department of Mental Health.
1111 Coordinator, Admissions 56,347 1.0 FTE will provide a large variety of data management and clerical tasks related to
admissions and discharges for the Psychiatric Health Facility. This position monitors
timeliness of documentation, admission/discharge tasks and other time sensitive
activities. Includes collaboration with other departments and outside agencies to
process client referrals and assist in completing the admission or discharge process.
1112 Charge & Registered Nurse 182,000 2.5 FTE is the treatment team member who is responsible for performing all nursing
duties and related nursing activities for clients. The Charge Nurse is also responsible for
the supervision of the Youth Counselor staff assigned to their respective shift.
1113 Licensed Vocational Nurse 373,119 6.8 FTE provides direct client care including medications, and supervises nursing
activities performed by professional and para professional nursing personnel on the
unit.
1114 Clerk, Receptionist 59,987 2.0 FTE provides reception, clerical and administrative support.
1115 Housekeeper 31,129 1.0 FTE This position performs a variety of tasks to ensure that the facility is in a clean,
orderly, sanitary and attractive condition
1116 Lead, Cook 28,227 1.0 FTE This position has primary responsibility for preparing food in accordance with
current applicable federal, state, and local standards, guidelines and regulations, with
our established policies and procedures and under the direction of the Administrator to
assure that quality food service is provided at all times. Lead Cook coordinates the daily
activities of the dietary department, including scheduling and monitoring work
completed
1117 Cook 31,065 1.0 FTE This position prepares food in accordance with current applicable federal, state,
and local standards, guidelines and regulations, with our established policies and
procedures and under the direction of the Administrator to assure that quality food
service is provided at all times.
1118 Discharge Coordinator 43,680 1.0 FTE provides a large variety of data management and clerical tasks related to
admissions and discharges for the Psychiatric Health Facility. This position monitors
timeliness of documentation, admission/discharge tasks and other time sensitive
activities. Includes collaboration with other departments and outside agencies to
process client referrals and assist in completing the admission or discharge process.
1119 TAY Peer Specialist 37,440 1.0 FTE is part of a team that provides services to youth. The Peer Partner is responsible
for educating, coaching, and acting as a role model and advocate for clients. The Peer
specialist collaborates with other team members and providers to ensure proper, client
centered services are provided.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 7 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
1120 Administrator 88,566 0.75 FTE manages the overall day to day operation of the adolescent Psychiatric Health
Facility (PHF) and Community Services programs. Assures compliance with Federal,
State, County and local laws and regulations. He/she oversees and assures that there is
a comprehensive quality treatment program and supervision for all PHF and Community
Services patients and reviews and approves all policies and procedures of the agency.
Manages all employee relations. The Administrator represents the CSBH agency and its
programs to governmental agencies and the community.
1121 QA Coordinator 12,855 .25 FTE, is responsible for utilization review and assisting in medical record management
by gathering and analyzing agency data and assisting in the quality control,
quality assurance, and quality improvement efforts.
1122 QA Manager 16,802 .25 FTE, manages all Quality Assurance tasks for the program, which includes records
management, documentation and service audits for compliance to Medi Cal and
internal requirements.
1123 QA Assistant 7,954 .25 FTE Performs a wide variety of administrative and clerical tasks in support of the
Quality Assurance/Total Quality Management (QA/TQM) System functions. Assists in
the quality control, quality assurance and quality improvement efforts.
1124 Training Coordinator 9,555 .25 FTE, assists in the development, coordination, delivery and administration of agency
training programs.
1125 Training Manager 18,398 .25 FTE This position has primary responsibility for development, coordination, and
supervision of training programs for Central Star PHF program. The Training Manager
regularly provides trainings. The position develops and maintains systems to track in
service attendance. The position develops opportunities to host trainings for other
professionals or participate with other organizations in providing such trainings.
1126 HR Manager 12,854 .25 FTE, manages all human resource clerical and administrative tasks for the program
staff. This position is responsible for supporting the development of a positive working
environment to enhance agency success and reduce legal risk, as well as management
team support and consultation, employee relations, interpretation and administration
of HR policies and procedures, staff recruitment and selection, compensation, and
employee benefits etc.
1127 HR Assistant 12,319 .25 FTE manages all human resource clerical and administrative tasks for the program
staff. This position is responsible for supporting the development of a positive working
environment to enhance agency success and reduce legal risk, as well as management
team support and consultation, employee relations, interpretation and administration
of HR policies and procedures, staff recruitment and selection, compensation, and
employee benefits etc.
1128 0
1129 0
1130 0
1131 0
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 8 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
Employee Benefits 402,704
1201 Retirement 51,651 Annual ESOP Pension and 401k employer match, calculated at 2.7% of annual salaries
1202 Worker's Compensation 70,212 Worker Compensation calculated at 3% of annual salaries
1203 Health Insurance 280,841 Health Insurance is calculated at 12% of annual salaries
1204 Other (Specify)
1205 Other (Specify)
1206 Other (Specify)
Payroll Taxes & Expenses: 233,450
1301 OASDI 144,514 Calculated at 6.20% of annual salaries up to the annual IRS max
1302 FICA/MEDICARE 33,937 Calculated at 1.45% of annual salaries
1303 SUI 54,999 Calculate at the Company's rate of 6% up to $7,000 of annual wages per employee
1304 Other (Specify)
1305 Other (Specify)
1306 Other (Specify)
2000: CLIENT SUPPORT
2001 Child Care
2002 Client Housing Support
2003 Client Transportation & Support
2004 Clothing, Food, & Hygiene
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies Medical
2010 Utility Vouchers
2011 Other (Specify)
2012 Other (Specify)
2013 Other (Specify)
2014 Other (Specify)
2015 Other (Specify)
2016 Other (Specify)
3000: OPERATING EXPENSES 266,978
3001 Telecommunications 37,460 $37,460, for staff cell phone reimbursement The budget is done based on a
reimbursement of $100/mo. for the director and at $60/ mo. for all other direct staff.
Included is $30,500 for landline, internet & phones which includes Wi Fi for staff tablets.
3002 Printing/Postage
3003 Office, Household & Program Supplies 43,616 $43,616, based on $21,592 for office supplies for 47.35 FTE's, County badges for 10 staff
@12.39, other non perishable supplies and $11,700 for Property Taxes, business
licenses and Joint Commission fees.
3004 Advertising
3005 Staff Development & Training 9,600 $9,600, which is comprised of the on going program required education, training and
materials for staff . Calculated at $800 per month.
3006 Staff Mileage 11,220 $11,220, this is estimated staff travel reimbursement for client visits (IRS mileage rate @
.58/miles) and for staff travel to training programs, which is based on our experience in
administering similar programs and locations.
3007 Food 35,100 $35,100 in Food to be prepared by Cook for the clients based on historical cost usually
sourced from US Foods, Inc.
3008 Clothing 8,400 Clothing: $8,4000, this cost will cover the clothing needs of the clients.
3009 Program Supplies Medical 53,640 Medical $53,640 contracted with Omnicare Pharmacy and Medline Industries.
3010 Purchased Services 67,942 Purchased service: which includes document shredding, water and coffee service,
postage meter rental, and storage facility totaling $27,942. This category also includes
$40,000 to cover laboratory and x ray services for clients.
3011 Other (Specify)
3012 Other (Specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 9 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
4000: FACILITIES & EQUIPMENT 178,642
4001 Building Maintenance 22,680 for janitorial services, repairs and maintenance, calculated at $1,900 per month for 12
months.
4002 Rent/Lease Building 11,160 administration common area shared by all programs allocated using a relative value.
4003 Rent/Lease Equipment 20,700 for copier lease, toner and maintenance for 12 months.
4004 Rent/Lease Vehicles
4005 Security 3,600 Security budgeted at $300 per month.
4006 Utilities 56,280 Electricity, Water, Gas, $4,690 per month for 12 months.
4007 Computers & Software 54,222 This line item is the budget for replacement of hardware, computers and monitors
totaling $33,455. It includes WiFi Access Point at $2,600, 23 Optiplex 3070 desktop
computers at $900/each, 2 Dell 5300 2 and 1 laptops at $1,200/each, two spare
equipment at $1,514/each and 23 monitors 22 to 23 inch at $206/each. Also included in
this line item is Microsoft licenses for the year totaling $20,767, this was calculated at
48 licenses at $433 per license.
4008 Furniture & Fixtures 10,000 This line item includes replacement of 10 office chairs, 1 industrial vacuum, new oven,
new courtyard table and mattress replacements, desk and shelving for the seclusion
room. All of these items are estimated to cost approximately $10,000.
4009 Other (Specify)
4010 Other (Specify)
5000: SPECIAL EXPENSES 941,621
5001 Consultant (Network & Data Management)
5002 HMIS (Health Management Information
System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services 5,241 Translation Services for annual translation services.
5005 Medication Supports 828,120 This line item includes Psychiatrists and Nurse Practitioner services. The psychiatrists
are budgeted at 259 hours per month at $206/hr and Nurse Practitioner $187,200 which
is equivalent to 156 hours per month at $100/hr. Psychiatrists evaluate, diagnose, and
collaborate with other team members to treat our youngsters for different mental
health disorders. Since they are physicians they have the ability to prescribe medication
and are responsible for medication management and consultation when a patient needs
a medical or neurological evaluation. Included is a Medical Director (Dr. Brar) who
provides services for the PHF program along with supporting management in the overall
coordination and quality control of psychiatrist, primary care physician, and psychiatric
nurse practitioner services, including services provided via telepsychiatry.
5006 Laundry & Linen 13,560 this line item includes towels, sheets, blankets, laundry service based on historical cost.
5007 Professional Services 94,700 This category includes $6,000 for ongoing recruitment, Includes contracted medical
doctor (Dr. Grossman) budgeted at a fixed rate of $6K per month plus $150 for each
follow up visit, and it also includes registered Dietician budgeted at $3,500 for providing
consultant services to maintain healthy dietary requirements of clients.
5008 Other (Specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 10 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
6000: ADMINISTRATIVE EXPENSES 930,607
6001 Administrative Overhead 320,250 Will not exceed 15% of total costs. This line item includes 7% of total costs which is an
allocation from Stars Behavioral Health Group. It covers operations administration,
information technology, human resources, communications, finance, and associated
fringe benefits and expenses. SBHG oversight ensures consistency with our quality
standards and policies and procedures. The cost is developed from allocating the SBHG
costs among all the programs within all the SBHG companies based on standard
accounting practices. This economy of scale results in a significant savings for all SBHG
programs. Rather than staffing each program for all necessary services above, the
services are performed by fewer employees and then shared among all SBHG programs.
$114,375 or 3% of the total expenses is budgeted as SBHG operating income. Up to 5%
of the total expenses will be net income while maintaining total
Administrative/Overhead expenses under 15% of total funding.
6002 Professional Liability Insurance
6003 Accounting/Bookkeeping 104,400 this program will be supported and greatly benefit from the experienced and
established local Starlight Community Services organization. There is a large cost
advantage to the program in being supported by Starlight CS in the areas of operations,
business office and billing functions. Without the support from an affiliated
organization, the program would need to have dedicated staff for these functions.
Additionally any costs shared with this program will result in savings to the county
though lower costs for other Central Star County Programs. The cost of this support is
budgeted at $8,700 per month which is consistent with other programs.
6004 External Audit 8,400 External Audit for annual audit fees.
6005 Liability Insurance 19,320 for general liability, property and professional liability based on $473 per FTE.
6006 Payroll Services 8,523 Payroll services: $8,523 for payroll processing fees based on $15 per month for 47.35
employees
6007 Depreciation (Provider Owned Equipment to
be Used for Program Purposes)
6008 Centralized Fiscal Services 114,375 Central Star has no ability to do fund raising to offset unallowable costs such as income
taxes as well as denials and other unreimbursed services. This line item provides a
cushion to mitigate this exposure.
6009 Centralized Services Private Ins/Other County 222,087 This Category includes centralized fiscal service allowed profit from private insurance
and other counties. Calculated at 10% of the total expenses
6010 Centralized Services program 133,252 is comprised of the SBHG corporate and regional support in the numerous areas
including support from the Senior Administrator as well as services provided for
Program Development and Evaluation (e.g., tracking and reporting outcomes, and
implementation of practices), Quality & Compliance (e.g., internal chart audits,
compliance audits, and TJC readiness preparation), and Training (e.g., TIP and Core
Practice trainings provided company wide). There is a significant cost advantage to all
the SBHG company programs in sharing these costs rather than building them into each
program. SBHG support provides oversight of all of our programs to ensure consistency
with our standards and policies and procedures. The cost of this support is shared by all
programs and is budgeted 3% of total expenses.
6011 Other (Specify)
6012 Other (Specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 11 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
7000: FIXED ASSETS
7001 Computer Equipment & Software
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
7003 Furniture & Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over $500 with Lifespan of 2
Years +
7006 Assets over $5,000/unit (Specify)
7007 Other (Specify)
7008 Other (Specify)
ACCT # LINE ITEM
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Phyciatric Health Facility Inpatient
PROGRAM FUNDING SOURCES
8000 SHORT/DOYLE MEDI CAL (FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI CAL SERVICE RATES
AND/OR SERVICE UNITS, IF APPLICABLE AND/OR AS REQUIRED BY THE RFP.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 12 of 60
Employee Salaries
Acct # Position FTE Admin Direct Total
1101 Clinical Director 1.00 109,082$109,082$
1102 Director Nursing 1.00 111,394 111,394
1103 Coordinator, Program 1.00 55,167 55,167
1104 Therapist, Recreation 1.00 58,023 58,023
1105 Therapist, Rehabilitation I III 1.00 48,481 48,481
1106 Case Manager 1.00 41,265 41,265
1107 Counselor, Youth IV 14.00 509,891 509,891
1108 Advocate Peer and Family 1.00 33,785 33,785
1109 Rehabilitation Aide I II 2.00 72,842 72,842
1110 Social Worker 4.50 331,354 331,354
1111 Coordinator, Admissions 1.00 58,038 58,038
1112 Charge & Registered Nurse 2.50 187,460 187,460
1113 Licensed Vocational Nurse 6.80 384,312 384,312
1114 Clerk, Receptionist 2.00 61,787 61,787
1115 Housekeeper 1.00 32,063 32,063
1116 Lead, Cook 1.00 29,073 29,073
1117 Cook 1.00 31,997 31,997
1118 Discharge Coordinator 1.00 44,990 44,990
1119 TAY Peer Specialist 1.00 38,565 38,565
1120 Administrator 0.75 91,224 91,224
1121 QA Coordinator 0.25 13,240 13,240
1122 QA Manager 0.25 17,306 17,306
1123 QA Assistant 0.25 8,192 8,192
1124 Training Coordinator 0.25 9,842 9,842
1125 Training Manager 0.25 18,950 18,950
1126 HR Manager 0.25 13,240 13,240
1127 HR Assistant 0.25 12,688 12,688
1128
1129
1130
1131
Personnel Salaries Subtotal 47.30 184,682$ 2,239,566$ 2,424,248$
ADOLESCENT ACUTE INPATIENT PSYCHIATRIC HEALTH FACILITY (PHF) SERVICES
Central Star Behavioral Health, Inc. | Fresno County DBH Adolescent PHF
FY 2021 2022 | 07/01/2021 6/30/2022
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 13 of 60
Employee Benefits
Acct # Admin Direct Total
1201 4,293$ 49,046$53,339$
1202 5,723 66,458 72,181
1203 22,891 266,375 289,266
1204
1205
1206
32,907$ 381,879$ 414,786$
Payroll Taxes & Expenses:
Acct # Admin Direct Total
1301 11,827$ 137,024$148,851$
1302 2,767 32,187 34,954
1303 4,483 52,165 56,648
1304
1305
1306
19,077$ 221,376.00$ 240,453.27$
236,666$ 2,842,821$ 3,079,487$
2000: CLIENT SUPPORT
Acct # Amount
2001 $
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
$
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
DIRECT CLIENT CARE TOTAL
Household Items for Clients
Medication Supports
Program Supplies Medical
Utility Vouchers
Other (Specify)
Other (Specify)
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
Line Item Description
FICA/MEDICARE
SUI
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
Child Care
Description
Employee Benefits Subtotal:
Description
OASDI
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 14 of 60
3000: OPERATING EXPENSES
Acct # Amount
3001 38,584$
3002
3003 44,924
3004
3005 9,888
3006 11,557
3007 36,153
3008 8,651
3009 55,249
3010 69,980
3011
3012
274,986$
4000: FACILITIES & EQUIPMENT
Acct # Amount
4001 23,360$
4002 11,495
4003 21,321
4004
4005 3,708
4006 57,968
4007 32,500
4008
4009
4010
150,352$
5000: SPECIAL EXPENSES
Acct # Amount
5001 $
5002
5003
5004 5,398
5005 852,964
5006 13,967
5007 97,542
5008
969,870$SPECIAL EXPENSES TOTAL:
Medication Supports
Laundry & Linen
Professional Services
Other (Specify)
FACILITIES/EQUIPMENT TOTAL:
Line Item Description
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services (Specify)
Translation Services
Security
Utilities
Equipment purchase
Other (Specify)
Other (Specify)
Other (Specify)
OPERATING EXPENSES TOTAL:
Line Item Description
Building Maintenance
Rent/Lease Building
Rent/Lease Equipment
Rent/Lease Vehicles
Food
Clothing
Program Supplies Medical
Purchased Services
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Advertising
Staff Development & Training
Staff Mileage
Line Item Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 15 of 60
6000: ADMINISTRATIVE EXPENSES
Acct # Amount
6001 332,165$
6002
6003 107,532
6004 8,652
6005 19,900
6006 8,779
6007
6008 118,631
6009 230,350
6010 138,210
6011
6012
964,219$
7000: FIXED ASSETS
Acct # Amount
7001 $
7002
7003
7004
7005
7006
7007
7008
$FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 5,438,914$
Assets over $5,000/unit (Specify)
Other (Specify)
Other (Specify)
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider Owned Equipment to be Used for Program Purposes)
Line Item Description
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Centralized Fiscal Services
Centralized Services Private Ins/Other County
Centralized Services program
Other (Specify)
Other (Specify)
Payroll Services
Liability Insurance
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 16 of 60
Acct # Service Units Rate Amount
8001 Mental Health Services 0 $
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0
8009 Phyciatric Health Facility Inpatient 5,869 929.26 5,453,664
5,869 5,453,664$
61%
3,326,735
50%1,663,368
1,663,368$
Acct # Amount
8101 Drug Medi Cal $
8102 SABG $
$
Acct # Amount
8201 Realignment 1,648,617$
1,648,617$
Acct # MHSA Component Amount
8301 CSS Community Services & Supports $
8302 PEI Prevention & Early Intervention
8303 INN Innovations
8304 WET Workforce Education & Training
8305 CFTN Capital Facilities & Technology
$
Acct # Amount
8401 Client Fees $
8402 Client Insurance
8403 1,199,806
8404 818,050
8405 109,073
2,126,929$
Out of County Bed Rate=949.93
OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:5,438,914$
MHSA TOTAL
8400 OTHER REVENUE
Line Item Description
Private Insurance Bed Rate=1045.60
Uninsured
REALIGNMENT TOTAL
8300 MENTAL HEALTH SERVICE ACT (MHSA)
MHSA Program Name
Federal Financial Participation (FFP) %
MEDI CAL FFP TOTAL
8100 SUBSTANCE USE DISORDER FUNDS
Line Item Description
SUBSTANCE USE DISORDER FUNDS TOTAL
8200 REALIGNMENT
PROGRAM FUNDING SOURCES
8000 SHORT/DOYLE MEDI CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
Estimated % of Clients who are Medi Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi Cal Beneficiaries
Line Item Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 17 of 60
Budget Narrative
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 3,079,487
Employee Salaries 2,424,248
1101 Clinical Director 109,082 1.0 FTE This position has primary responsibility for overseeing the provision of mental
health services, case management services and support services to clients and their
families. Has oversight of the Program and provides supervision to clinical staff. Works
in close collaboration with Clinical Director to ensure each client receives the
appropriate care and treatment consistent with the requirements.
Responsible for the implementation and management of all regulatory requirements
1102 Director Nursing 111,394 1.0 FTE The Director of Nursing ensures that each PHF client receives the nursing care,
treatment, medications and diet, which have been ordered by the attending physician,
ensuring the overall quality of licensed nursing care for the PHF Unit. S/he participates
in budget development for the Nursing Department and is responsible for its
implementation and management. S/he selects, hires and supervises all staff in the
Nursing Department.
1103 Coordinator, Program 55,167 1.0 FTE The Coordinator assists the Director of Nursing in directing the activities of
assigned licensed and non licensed personnel who provide health care services to clients
of the Central Star Youth Psychiatric Health Facility on a 24 hour 7 day a week basis.
1104 Therapist, Recreation 58,023 1.0 FTE is the treatment team member who is responsible for providing recreational
services to adolescent clients within the Rehabilitation Program. These services are
provided through individualized and/or group activities to restore, establish and
maintain optimum level of social, vocational and physical functioning which include
social activities involving group participation, indoor and outdoor recreational activities
and exercises.
1105 Therapist, Rehabilitation I III 48,481 1.0 FTE is the treatment team member who is responsible for providing direct and
indirect rehabilitation services to adolescent clients. These services are provided
through individualized and/or group activities for clients. The Rehab Therapist may also
provide work direction to Rehab Aides.
1106 Case Manager 41,265 1.0 FTE This position has primary responsibility for organizing discharge information and
facilitating the discharge of patients at the Central Star Youth PHF; a process that begins
from initial assessment and unfolds throughout the course of acute inpatient treatment.
The case manager participates in interdisciplinary meetings, collaboration and
communication with outside partners and resources, and with preparing patients for
facility release.
1107 Counselor, Youth IV 509,891 14.0 FTE is the treatment team member who is responsible for providing direct care to
meet the physical and psychosocial needs of the adolescents. This care is provided
through direct and indirect physical and verbal interactions with clients, modeling
appropriate behaviors for clients, and monitoring daily client activities. (1.0 FTE Youth
Counselor serves as a designated Safety Specialist.)
1108 Advocate Peer and Family 33,785 1.0 FTE provide outreach, advocacy, training and support for family members
throughout all stages of the treatment, transition, and aftercare.
1109 Rehabilitation Aide I II 72,842 2.0 FTE assists the Rehabilitation Therapist in providing direct and indirect rehabilitation
services to adolescent clients through individualized and/or group activities.
ADOLESCENT ACUTE INPATIENT PSYCHIATRIC HEALTH FACILITY (PHF) SERVICES
Central Star Behavioral Health, Inc. | Fresno County DBH Adolescent PHF
FY 2021 2022 | 07/01/2021 6/30/2022
PROGRAM EXPENSE
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 18 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
1110 Social Worker 331,354 4.5 FTE is the leader of each treatment team, and is responsible for preparing a
comprehensive treatment plan for each client. This position manages the
journey from intake, evaluation and assessment, the provision of case management and
other therapeutic services, through discharge planning and final placement. This
position coordinates with other agencies such as Child Protective Services, Juvenile
Probation Department, and County Department of Mental Health.
1111 Coordinator, Admissions 58,038 1.0 FTE is responsible for interviewing all prospective admissions, conducts the initial
assessment and collects all documentation, ensuring appropriate admission at Central
Star Psychiatric Health Facility. This person maintains liaison with parents and other
legal guardians, county agencies, insurance companies and other payors, hospitals and
health care facilities, augments existing social services by providing discharge planning
services, provides direct services to clients, offers consultation and supervision to staff,
and acts as liaison to outside agencies.
1112 Charge & Registered Nurse 187,460 2.5 FTE is the treatment team member who is responsible for performing all nursing
duties and related nursing activities for clients. The Charge Nurse is also responsible for
the supervision of the Youth Counselor staff assigned to their respective shift.
1113 Licensed Vocational Nurse 384,312 6.8 FTE provides direct client care including medications, and supervises nursing
activities performed by professional and para professional nursing personnel on the
unit.
1114 Clerk, Receptionist 61,787 2.0 FTE provides reception, clerical and administrative support.
1115 Housekeeper 32,063 1.0 FTE This position performs a variety of tasks to ensure that the facility is in a clean,
orderly, sanitary and attractive condition
1116 Lead, Cook 29,073 1.0 FTE This position has primary responsibility for preparing food in accordance with
current applicable federal, state, and local standards, guidelines and regulations, with
our established policies and procedures and under the direction of the Administrator to
assure that quality food service is provided at all times. Lead Cook coordinates the daily
activities of the dietary department, including scheduling and monitoring work
completed
1117 Cook 31,997 1.0 FTE This position prepares food in accordance with current applicable federal, state,
and local standards, guidelines and regulations, with our established policies and
procedures and under the direction of the Administrator to assure that quality food
service is provided at all times.
1118 Discharge Coordinator 44,990 1.0 FTE will provide a large variety of data management and clerical tasks related to
admissions and discharges for the Psychiatric Health Facility. This position monitors
timeliness of documentation, admission/discharge tasks and other time sensitive
activities. Includes collaboration with other departments and outside agencies to
process client referrals and assist in completing the admission or discharge process.
1119 TAY Peer Specialist 38,565 1.0 FTE is part of a team that provides services to youth. The Peer Partner is responsible
for educating, coaching, and acting as a role model and advocate for clients. The Peer
specialist collaborates with other team members and providers to ensure proper, client
centered services are provided.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 19 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
1120 Administrator 91,224 0.75 FTE manages the overall day to day operation of the adolescent Psychiatric Health
Facility (PHF) and Community Services programs. Assures compliance with Federal,
State, County and local laws and regulations. He/she oversees and assures that there is
a comprehensive quality treatment program and supervision for all PHF and Community
Services patients and reviews and approves all policies and procedures of the agency.
Manages all employee relations. The Administrator represents the CSBH agency and its
programs to governmental agencies and the community.
1121 QA Coordinator 13,240 .25 FTE, is responsible for utilization review and assisting in medical record
management by gathering and analyzing agency data and assisting in the
quality control, quality assurance, and quality improvement efforts.
1122 QA Manager 17,306 .25 FTE, manages all Quality Assurance tasks for the program, which includes records
management, documentation and service audits for compliance to Medi Cal and internal
requirements.
1123 QA Assistant 8,192 .25 FTE Performs a wide variety of administrative and clerical tasks in support of the
Quality Assurance/Total Quality Management (QA/TQM) System functions. Assists in the
quality control, quality assurance and quality improvement efforts.
1124 Training Coordinator 9,842 .25 FTE, assists in the development, coordination, delivery and administration of agency
training programs.
1125 Training Manager 18,950 .25 FTE This position has primary responsibility for development, coordination, and
supervision of training programs for Central Star PHF program. The Training Manager
regularly provides trainings. The position develops and maintains systems to track in
service attendance. The position develops opportunities to host trainings for other
professionals or participate with other organizations in providing such trainings.
1126 HR Manager 13,240 .25 FTE, manages all human resource clerical and administrative tasks for the program
staff. This position is responsible for supporting the development of a positive working
environment to enhance agency success and reduce legal risk, as well as management
team support and consultation, employee relations, interpretation and administration of
HR policies and procedures, staff recruitment and selection, compensation, and
employee benefits etc.
1127 HR Assistant 12,688 .25 FTE manages all human resource clerical and administrative tasks for the program
staff. This position is responsible for supporting the development of a positive working
environment to enhance agency success and reduce legal risk, as well as management
team support and consultation, employee relations, interpretation and administration of
HR policies and procedures, staff recruitment and selection, compensation, and
employee benefits etc.
1128 0
1129 0
1130 0
1131 0
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 20 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
Employee Benefits 414,786
1201 Retirement 53,339 Annual ESOP Pension and 401k employer match, calculated at 2.7% of annual salaries
1202 Worker's Compensation 72,181 Worker Compensation calculated at 3% of annual salaries
1203 Health Insurance 289,266 Health Insurance is calculated at 12% of annual salaries
1204 Other (Specify)
1205 Other (Specify)
1206 Other (Specify)
Payroll Taxes & Expenses: 240,453
1301 OASDI 148,851 Calculated at 6.20% of annual salaries up to the annual IRS max
1302 FICA/MEDICARE 34,954 Calculated at 1.45% of annual salaries
1303 SUI 56,648 Calculate at the Company's rate of 6% up to $7,000 of annual wages per employee
1304 Other (Specify)
1305 Other (Specify)
1306 Other (Specify)
2000: CLIENT SUPPORT
2001 Child Care
2002 Client Housing Support
2003 Client Transportation & Support
2004 Clothing, Food, & Hygiene
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies Medical
2010 Utility Vouchers
2011 Other (Specify)
2012 Other (Specify)
2013 Other (Specify)
2014 Other (Specify)
2015 Other (Specify)
2016 Other (Specify)
3000: OPERATING EXPENSES 274,986
3001 Telecommunications 38,584 $38,584 for staff cell phone reimbursement The budget is done based on a
reimbursement of $100/mo. for the director and at $60/ mo. for all other direct staff.
Included is $31,415 for landline, internet & phones which includes Wi Fi for staff tablets.
3002 Printing/Postage
3003 Office, Household & Program Supplies 44,924 $44,924 based on $22,239 for office supplies for 47.35 FTE's, County badges for 10 staff
@12.39, other non perishable supplies and $12,051 for Property Taxes, business licenses
and Joint Commission fees.
3004 Advertising
3005 Staff Development & Training 9,888 $9,888, which comprise of the on going program required education, training and
materials for staff. Calculated at $824 per month.
3006 Staff Mileage 11,557 $11,557, this is estimated staff travel reimbursement for client visits (IRS mileage rate
@ .58/miles) and for staff travel to training programs, which is based on our experience
in administering similar programs and locations.
3007 Food 36,153 $36,153 to be prepared by Cook for the clients based on historical cost sourced from US
Foods, Inc.
3008 Clothing 8,651 Clothing: $8,651, this cost will cover the clothing needs of the clients.
3009 Program Supplies Medical 55,249 Medical $55,249 contracted with Omnicare Pharmacy and Medline Industries.
3010 Purchased Services 69,980 Purchased service: $69,980 which includes document shredding, water and coffee
service, postage meter rental, and storage facility. Also included is $41,200 to cover
laboratory and x ray services for clients.
3011 Other (Specify)
3012 Other (Specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 21 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
4000: FACILITIES & EQUIPMENT 150,352
4001 Building Maintenance 23,360 for janitorial services, repairs and maintenance, calculated at $1,947 per month for 12
months.
4002 Rent/Lease Building 11,495 administration common area shared by all programs allocated using a relative value.
4003 Rent/Lease Equipment 21,321 for copier lease, toner and maintenance for 12 months.
4004 Rent/Lease Vehicles
4005 Security 3,708 Security $3,708 budgeted at $309 per month.
4006 Utilities 57,968 Electricity, Water, Gas, $4,831 per month for 12 months.
4007 Equipment purchase 32,500 Equipment purchases: $32,500 for minor office equipment, furniture, IT equipment,
software and support.
4008 Other (Specify)
4009 Other (Specify)
4010 Other (Specify)
5000: SPECIAL EXPENSES 969,870
5001 Consultant (Network & Data Management)
5002 HMIS (Health Management Information
System)
5003 Contractual/Consulting Services (Specify)
5004 Translation Services 5,398 for annual translation services.
5005 Medication Supports 852,964 includes Psychiatrists and Nurse Practitioner services. The psychiatrists are budgeted at
259 hours per month at $212/hr and the Nurse Practitioner is budgeted at 156 hours per
month at $103/hr. Psychiatrists evaluate, diagnose, and collaborate with other team
members to treat our youngsters for different mental health disorders. Since they are
physicians they have the ability to prescribe medication and are responsible for
medication management and consultation when a patient needs a medical or
neurological evaluation. Included is a Medical Director (Dr. Brar) who provides services
for the PHF program along with supporting management in the overall coordination and
quality control of psychiatrist, primary care physician, and psychiatric nurse practitioner
services, including services provided via telepsychiatry.
5006 Laundry & Linen 13,967 Laundry & Linen, which comprise of towels, sheets, blankets, laundry service based on
historical cost.
5007 Professional Services 97,542 This category includes $6,180 for ongoing recruitment. Includes contracted medical
doctor (Dr. Grossman) budgeted at a fixed rate of $6K monthly plus $150 for each follow
up visit, and it also includes registered Dietician $3,605 Consultant services to
maintain healthy dietary requirements of clients.
5008 Other (Specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 22 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
6000: ADMINISTRATIVE EXPENSES 964,219
6001 Administrative Overhead 332,165 Will not exceed 15% of total costs. $332,165 or 7% of total costs is an allocation from
Stars Behavioral Health Group. It covers operations administration, information
technology, human resources, communications, finance, and associated fringe benefits
and expenses. SBHG oversight ensures consistency with our quality standards and
policies and procedures. The cost is developed from allocating the SBHG costs among all
the programs within all the SBHG companies based on standard accounting practices.
This economy of scale results in a significant savings for all SBHG programs. Rather than
staffing each program for all necessary services above, the services are performed by
fewer employees and then shared among all SBHG programs. $118,631 or 3% of the
total expenses is budgeted as SBHG operating income. Up to 5% of the total expenses
will be net income while maintaining total Administrative/Overhead expenses under
15% of total funding.
6002 Professional Liability Insurance $19,900 for general liability, property and professional liability based on $473 per FTE.
6003 Accounting/Bookkeeping 107,532 this program will be supported and greatly benefit from the experienced and
established local Starlight Community Services organization. There is a large cost
advantage to the program in being supported by Starlight CS in the areas of operations,
business office and billing functions. Without the support from an affiliated organization,
the program would need to have dedicated staff for these functions. Additionally any
costs shared with this program will result in savings to the county though lower costs for
other Central Star County Programs. The cost of this support is budgeted at $8,961 per
month which is consistent with other programs.
6004 External Audit 8,652 External Audit $8,652 for annual audit fees.
6005 Liability Insurance 19,900
6006 Payroll Services 8,779 Payroll services: $8,779 for payroll processing fees based on $15 per month for 47.35
employees.
6007 Depreciation (Provider Owned Equipment to
be Used for Program Purposes)
6008 Centralized Fiscal Services 118,631 Will not exceed 15% of total costs. $332,165 or 7% of total costs is an allocation from
Stars Behavioral Health Group. It covers operations administration, information
technology, human resources, communications, finance, and associated fringe benefits
and expenses. SBHG oversight ensures consistency with our quality standards and
policies and procedures. The cost is developed from allocating the SBHG costs among all
the programs within all the SBHG companies based on standard accounting practices.
This economy of scale results in a significant savings for all SBHG programs. Rather than
staffing each program for all necessary services above, the services are performed by
fewer employees and then shared among all SBHG programs. $118,631 or 3% of the
total expenses is budgeted as SBHG operating income. Up to 5% of the total expenses
will be net income while maintaining total Administrative/Overhead expenses under
15% of total funding. This Category also includes $230,350 centralized fiscal service
allowed profit from private insurance and other counties. Calculated at 10% of the total
expenses
6009 Centralized Services Private Ins/Other County 230,350 This Category includes $230,350 centralized fiscal service allowed profit from private
insurance and other counties. Calculated at 10% of the total expenses
6010 Centralized Services program 138,210 $138,210 is comprised of the SBHG corporate and regional support in the numerous
areas including support from the Senior Administrator as well as services provided for
Program Development and Evaluation (e.g., tracking and reporting outcomes, and
implementation of practices), Quality & Compliance (e.g., internal chart audits,
compliance audits, and TJC readiness preparation), and Training (e.g., TIP and Core
Practice trainings provided company wide). There is a significant cost advantage to all
the SBHG company programs in sharing these costs rather than building them into each
program. SBHG support provides oversight of all of our programs to ensure consistency
with our standards and policies and procedures. The cost of this support is shared by all
programs and is budgeted 3% of total expenses.
6011 Other (Specify)
6012 Other (Specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 23 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
7000: FIXED ASSETS
7001 Computer Equipment & Software
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
7003 Furniture & Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over $500 with Lifespan of 2
Years +
7006 Assets over $5,000/unit (Specify)
7007 Other (Specify)
7008 Other (Specify)
ACCT # LINE ITEM
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Phyciatric Health Facility Inpatient
PROGRAM FUNDING SOURCES
8000 SHORT/DOYLE MEDI CAL (FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI CAL SERVICE RATES
AND/OR SERVICE UNITS, IF APPLICABLE AND/OR AS REQUIRED BY THE RFP.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 24 of 60
Employee Salaries
Acct # Position FTE Admin Direct Total
1101 Clinical Director 1.00 112,354$112,354$
1102 Director Nursing 1.00 114,736 114,736
1103 Coordinator, Program 1.00 56,822 56,822
1104 Therapist, Recreation 1.00 59,763 59,763
1105 Therapist, Rehabilitation I III 1.00 49,935 49,935
1106 Case Manager 1.00 42,503 42,503
1107 Counselor, Youth IV 14.00 525,188 525,188
1108 Advocate Peer and Family 1.00 34,798 34,798
1109 Rehabilitation Aide I II 2.00 75,027 75,027
1110 Social Worker 4.50 341,295 341,295
1111 Coordinator, Admissions 1.00 59,779 59,779
1112 Charge & Registered Nurse 2.50 193,084 193,084
1113 Licensed Vocational Nurse 6.80 395,842 395,842
1114 Clerk, Receptionist 2.00 63,640 63,640
1115 Housekeeper 1.00 33,025 33,025
1116 Lead, Cook 1.00 29,947 29,947
1117 Cook 1.00 32,957 32,957
1118 Discharge Coordinator 1.00 46,340 46,340
1119 TAY Peer Specialist 1.00 39,720 39,720
1120 Administrator 0.75 93,961 93,961
1121 QA Coordinator 0.25 13,637 13,637
1122 QA Manager 0.25 17,825 17,825
1123 QA Assistant 0.25 8,438 8,438
1124 Training Coordinator 0.25 10,137 10,137
1125 Training Manager 0.25 19,518 19,518
1126 HR Manager 0.25 13,637 13,637
1127 HR Assistant 0.25 13,069 13,069
1128
1129
1130
1131
Personnel Salaries Subtotal 47.30 190,222$ 2,306,754$ 2,496,976$
ADOLESCENT ACUTE INPATIENT PSYCHIATRIC HEALTH FACILITY (PHF) SERVICES
Central Star Behavioral Health, Inc. | Fresno County DBH Adolescent PHF
FY 2022 2023 | 07/01/2022 6/30/2023
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 25 of 60
Employee Benefits
Acct # Admin Direct Total
1201 4,421$ 50,376$54,797$
1202 5,895 68,592 74,487
1203 23,578 274,367 297,945
1204
1205
1206
33,894$ 393,335$ 427,229$
Payroll Taxes & Expenses:
Acct # Admin Direct Total
1301 12,182$ 141,135$153,317$
1302 2,849 33,153 36,002
1303 4,617 53,731 58,348
1304
1305
1306
19,649$ 228,019$ 247,668$
243,765$ 2,928,108$ 3,171,872$
2000: CLIENT SUPPORT
Acct # Amount
2001 $
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
$
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
DIRECT CLIENT CARE TOTAL
Household Items for Clients
Medication Supports
Program Supplies Medical
Utility Vouchers
Other (Specify)
Other (Specify)
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
Line Item Description
FICA/MEDICARE
SUI
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
Child Care
Description
Employee Benefits Subtotal:
Description
OASDI
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 26 of 60
3000: OPERATING EXPENSES
Acct # Amount
3001 39,741$
3002
3003 46,272
3004
3005 10,185
3006 11,903
3007 37,238
3008 8,912
3009 56,907
3010 72,079
3011
3012
283,237$
4000: FACILITIES & EQUIPMENT
Acct # Amount
4001 24,061$
4002 11,840
4003 21,961
4004
4005 3,819
4006 59,707
4007 33,475
4008
4009
4010
154,863$
5000: SPECIAL EXPENSES
Acct # Amount
5001 $
5002
5003
5004 5,560
5005 100,467
5006 14,385
5007 878,553
5008
998,965$SPECIAL EXPENSES TOTAL:
Professional Services
Laundry&Linen
Medication Supports
Other (Specify)
FACILITIES/EQUIPMENT TOTAL:
Line Item Description
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services
Translation Services
Security
Utilities
Equipment purchases
Other (Specify)
Other (Specify)
Other (Specify)
OPERATING EXPENSES TOTAL:
Line Item Description
Building Maintenance
Rent/Lease Building
Rent/Lease Equipment
Rent/Lease Vehicles
Food
Clothing
Program Supplies Medical
Purchased Services
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Advertising
Staff Development & Training
Staff Mileage
Line Item Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 27 of 60
6000: ADMINISTRATIVE EXPENSES
Acct # Amount
6001 342,130$
6002
6003 110,758
6004 8,912
6005 20,497
6006 9,042
6007
6008 122,189
6009 237,262
6010 142,357
6011
6012
993,146$
7000: FIXED ASSETS
Acct # Amount
7001 $
7002
7003
7004
7005
7006
7007
7008
$FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 5,602,084$
Assets over $5,000/unit (Specify)
Other (Specify)
Other (Specify)
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider Owned Equipment to be Used for Program Purposes)
Line Item Description
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Centralized Fiscal Services
Centralized Services Private Ins/Other County
Centralized Services program
Other (Specify)
Other (Specify)
Payroll Services
Liability Insurance
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 28 of 60
Acct # Service Units Rate Amount
8001 Mental Health Services 0 $
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0
8009 Phyciatric Health Facility Inpatient 5,869 957.13 5,617,276
5,869 5,617,276$
61%
3,426,539
50%1,713,269
1,713,269$
Acct # Amount
8101 Drug Medi Cal $
8102 SABG $
$
Acct # Amount
8201 Realignment 1,698,077$
1,698,077$
Acct # MHSA Component Amount
8301 CSS Community Services & Supports $
8302 PEI Prevention & Early Intervention
8303 INN Innovations
8304 WET Workforce Education & Training
8305 CFTN Capital Facilities & Technology
$
Acct # Amount
8401 Client Fees
8402 Client Insurance
8403 1,235,801
8404 842,591
8405 112,346
2,190,738$
Out of County Bed Rate=978.43
OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:5,602,084$
MHSA TOTAL
8400 OTHER REVENUE
Line Item Description
Private Insurance Bed Rate=1076.97
Uninsured
REALIGNMENT TOTAL
8300 MENTAL HEALTH SERVICE ACT (MHSA)
MHSA Program Name
Federal Financial Participation (FFP) %
MEDI CAL FFP TOTAL
8100 SUBSTANCE USE DISORDER FUNDS
Line Item Description
SUBSTANCE USE DISORDER FUNDS TOTAL
8200 REALIGNMENT
PROGRAM FUNDING SOURCES
8000 SHORT/DOYLE MEDI CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
Estimated % of Clients who are Medi Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi Cal Beneficiaries
Line Item Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 29 of 60
Budget Narrative
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 3,171,872
Employee Salaries 2,496,976
1101 Clinical Director 112,354 1.0 FTE This position has primary responsibility for overseeing the provision of mental
health services, case management services and support services to clients and their
families. Has oversight of the Program and provides supervision to clinical staff. Works
in close collaboration with Clinical Director to ensure each client receives the
appropriate care and treatment consistent with the requirements.
Responsible for the implementation and management of all regulatory requirements
1102 Director Nursing 114,736 1.0 FTE The Director of Nursing ensures that each PHF client receives the nursing care,
treatment, medications and diet, which have been ordered by the attending physician,
ensuring the overall quality of licensed nursing care for the PHF Unit. S/he participates
in budget development for the Nursing Department and is responsible for its
implementation and management. S/he selects, hires and supervises all staff in the
Nursing Department.
1103 Coordinator, Program 56,822 1.0 FTE The Coordinator assists the Director of Nursing in directing the activities of
assigned licensed and non licensed personnel who provide health care services to
clients of the Central Star Youth Psychiatric Health Facility on a 24 hour 7 day a week
basis.
1104 Therapist, Recreation 59,763 1.0 FTE is the treatment team member who is responsible for providing recreational
services to adolescent clients within the Rehabilitation Program. These services are
provided through individualized and/or group activities to restore, establish and
maintain optimum level of social, vocational and physical functioning which include
social activities involving group participation, indoor and outdoor recreational activities
and exercises.
1105 Therapist, Rehabilitation I III 49,935 1.0 FTE is the treatment team member who is responsible for providing direct and
indirect rehabilitation services to adolescent clients. These services are provided
through individualized and/or group activities for clients. The Rehab Therapist may also
provide work direction to Rehab Aides.
1106 Case Manager 42,503 1.0 FTE This position has primary responsibility for organizing discharge information
and facilitating the discharge of patients at the Central Star Youth PHF; a process that
begins from initial assessment and unfolds throughout the course of acute inpatient
treatment. The case manager participates in interdisciplinary meetings, collaboration
and communication with outside partners and resources, and with preparing patients
for facility release.
1107 Counselor, Youth IV 525,188 14.0 FTE is the treatment team member who is responsible for providing direct care to
meet the physical and psychosocial needs of the adolescents. This care is provided
through direct and indirect physical and verbal interactions with clients, modeling
appropriate behaviors for clients, and monitoring daily client activities. (1.0 FTE Youth
Counselor serves as a designated Safety Specialist.)
1108 Advocate Peer and Family 34,798 1.0 FTE provide outreach, advocacy, training and support for family members
throughout all stages of the treatment, transition, and aftercare.
1109 Rehabilitation Aide I II 75,027 2.0 FTE assists the Rehabilitation Therapist in providing direct and indirect
rehabilitation services to adolescent clients through individualized and/or group
activities.
ADOLESCENT ACUTE INPATIENT PSYCHIATRIC HEALTH FACILITY (PHF) SERVICES
Central Star Behavioral Health, Inc. | Fresno County DBH Adolescent PHF
FY 2022 2023 | 07/01/2022 6/30/2023
PROGRAM EXPENSE
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 30 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
1110 Social Worker 341,295 4.5 FTE is the leader of each treatment team, and is responsible for preparing a
comprehensive treatment plan for each client. This position manages the
journey from intake, evaluation and assessment, the provision of case management and
other therapeutic services, through discharge planning and final placement. This
position coordinates with other agencies such as Child Protective Services, Juvenile
Probation Department, and County Department of Mental Health.
1111 Coordinator, Admissions 59,779 1.0 FTE is responsible for interviewing all prospective admissions, conducts the initial
assessment and collects all documentation, ensuring appropriate admission at Central
Star Psychiatric Health Facility. This person maintains liaison with parents and other
legal guardians, county agencies, insurance companies and other payors, hospitals and
health care facilities, augments existing social services by providing discharge planning
services, provides direct services to clients, offers consultation and supervision to staff,
and acts as liaison to outside agencies.
1112 Charge & Registered Nurse 193,084 2.5 FTE is the treatment team member who is responsible for performing all nursing
duties and related nursing activities for clients. The Charge Nurse is also responsible for
the supervision of the Youth Counselor staff assigned to their respective shift.
1113 Licensed Vocational Nurse 395,842 6.8 FTE provides direct client care including medications, and supervises nursing
activities performed by professional and para professional nursing personnel on the
unit.
1114 Clerk, Receptionist 63,640 2.0 FTE provides reception, clerical and administrative support.
1115 Housekeeper 33,025 1.0 FTE This position performs a variety of tasks to ensure that the facility is in a clean,
orderly, sanitary and attractive condition
1116 Lead, Cook 29,947 1.0 FTE This position has primary responsibility for preparing food in accordance with
current applicable federal, state, and local standards, guidelines and regulations, with
our established policies and procedures and under the direction of the Administrator to
assure that quality food service is provided at all times. Lead Cook coordinates the daily
activities of the dietary department, including scheduling and monitoring work
completed
1117 Cook 32,957 1.0 FTE This position prepares food in accordance with current applicable federal, state,
and local standards, guidelines and regulations, with our established policies and
procedures and under the direction of the Administrator to assure that quality food
service is provided at all times.
1118 Discharge Coordinator 46,340 1.0 FTE will provide a large variety of data management and clerical tasks related to
admissions and discharges for the Psychiatric Health Facility. This position monitors
timeliness of documentation, admission/discharge tasks and other time sensitive
activities. Includes collaboration with other departments and outside agencies to
process client referrals and assist in completing the admission or discharge process.
1119 TAY Peer Specialist 39,720 1.0 FTE is part of a team that provides services to youth. The Peer Partner is responsible
for educating, coaching, and acting as a role model and advocate for clients. The Peer
specialist collaborates with other team members and providers to ensure proper, client
centered services are provided.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 31 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
1120 Administrator 93,961 0.75 FTE manages the overall day to day operation of the adolescent Psychiatric Health
Facility (PHF) and Community Services programs. Assures compliance with Federal,
State, County and local laws and regulations. He/she oversees and assures that there is
a comprehensive quality treatment program and supervision for all PHF and Community
Services patients and reviews and approves all policies and procedures of the agency.
Manages all employee relations. The Administrator represents the CSBH agency and its
programs to governmental agencies and the community.
1121 QA Coordinator 13,637 for .25 FTE, is responsible for utilization review and assisting in medical record
management by gathering and analyzing agency data and assisting in the
quality control, quality assurance, and quality improvement efforts.
1122 QA Manager 17,825 .25 FTE, manages all Quality Assurance tasks for the program, which includes records
management, documentation and service audits for compliance to Medi Cal and
internal requirements.
1123 QA Assistant 8,438 .25 FTE Performs a wide variety of administrative and clerical tasks in support of the
Quality Assurance/Total Quality Management (QA/TQM) System functions. Assists in
the quality control, quality assurance and quality improvement efforts.
1124 Training Coordinator 10,137 for .25 FTE, assists in the development, coordination, delivery and administration of
agency training programs.
1125 Training Manager 19,518 .25 FTE This position has primary responsibility for development, coordination, and
supervision of training programs for Central Star PHF program. The Training Manager
regularly provides trainings. The position develops and maintains systems to track in
service attendance. The position develops opportunities to host trainings for other
professionals or participate with other organizations in providing such trainings.
1126 HR Manager 13,637 .25 FTE, manages all human resource clerical and administrative tasks for the program
staff. This position is responsible for supporting the development of a positive working
environment to enhance agency success and reduce legal risk, as well as management
team support and consultation, employee relations, interpretation and administration
of HR policies and procedures, staff recruitment and selection, compensation, and
employee benefits etc.
1127 HR Assistant 13,069 .25 FTE manages all human resource clerical and administrative tasks for the program
staff. This position is responsible for supporting the development of a positive working
environment to enhance agency success and reduce legal risk, as well as management
team support and consultation, employee relations, interpretation and administration
of HR policies and procedures, staff recruitment and selection, compensation, and
employee benefits etc.
1128 0
1129 0
1130 0
1131 0
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 32 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
Employee Benefits 427,229
1201 Retirement 54,797 Annual ESOP Pension and 401k employer match, calculated at 2.7% of annual salaries
1202 Worker's Compensation 74,487 Worker Compensation calculated at 3% of annual salaries
1203 Health Insurance 297,945 Health Insurance is calculated at 12% of annual salaries
1204 Other (Specify)
1205 Other (Specify)
1206 Other (Specify)
Payroll Taxes & Expenses: 247,668
1301 OASDI 153,317 Calculated at 6.20% of annual salaries up to the annual IRS max
1302 FICA/MEDICARE 36,002 Calculated at 1.45% of annual salaries
1303 SUI 58,348 Calculate at the Company's rate of 6% up to $7,000 of annual wages per employee
1304 Other (Specify)
1305 Other (Specify)
1306 Other (Specify)
2000: CLIENT SUPPORT
2001 Child Care
2002 Client Housing Support
2003 Client Transportation & Support
2004 Clothing, Food, & Hygiene
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies Medical
2010 Utility Vouchers
2011 Other (Specify)
2012 Other (Specify)
2013 Other (Specify)
2014 Other (Specify)
2015 Other (Specify)
2016 Other (Specify)
3000: OPERATING EXPENSES 283,237
3001 Telecommunications 39,741 for staff cell phone reimbursement The budget is done based on a reimbursement of
$100/mo. for the director and at $60/ mo. for all other direct staff. Included is $32,357
for landline, internet & phones which includes Wi Fi for staff tablets.
3002 Printing/Postage
3003 Office, Household & Program Supplies 46,272 based on $22,907 for office supplies for 47.35 FTE's, County badges for 10 staff
@12.39, other non perishable supplies and $12,413 for Property Taxes, business
licenses and Joint Commission fees.
3004 Advertising
3005 Staff Development & Training 10,185 which comprise of the on going program required education, training and materials for
staff . Calculated at $849 per month.
3006 Staff Mileage 11,903 this is estimated staff travel reimbursement for client visits (IRS mileage rate @
.58/miles) and for staff travel to training programs, which is based on our experience in
administering similar programs and locations.
3007 Food 37,238 to be prepared by Cook for the clients based on historical cost sourced from US Foods,
Inc.
3008 Clothing 8,912 Clothing: $8,912, this cost will cover the clothing needs of the clients.
3009 Program Supplies Medical 56,907 contracted with Omnicare Pharmacy and Medline Industries.
3010 Purchased Services 72,079 Purchased service: $69,980 which includes document shredding, water and coffee
service, postage meter rental, and storage facility. Also included is $42,436 to cover
laboratory and x ray services for clients.
3011 Other (Specify)
3012 Other (Specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 33 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
4000: FACILITIES & EQUIPMENT 154,863
4001 Building Maintenance 24,061 for janitorial services, repairs and maintenance, calculated at $2,005 per month for 12
months.
4002 Rent/Lease Building 11,840 administration common area shared by all programs allocated using a relative value.
4003 Rent/Lease Equipment 21,961 for copier lease, toner and maintenance for 12 months.
4004 Rent/Lease Vehicles
4005 Security 3,819 Security $3,819 budgeted at $318 per month.
4006 Utilities 59,707 Electricity, Water, Gas, $4,976 per month for 12 months.
4007 Equipment purchases 33,475 for minor office equipment, furniture, IT equipment, software and support.
4008 Other (Specify)
4009 Other (Specify)
4010 Other (Specify)
5000: SPECIAL EXPENSES 998,965
5001 Consultant (Network & Data Management)
5002 HMIS (Health Management Information
System)
5003 Contractual/Consulting Services
5004 Translation Services 5,560 for annual translation services.
5005 Professional Services 100,467 This category includes $6,365 for ongoing recruitment Includes contracted medical
doctor (Dr. Grossman) budgeted at a fixed rate of $6K monthly plus $150 for each
follow up visit, and it also includes registered Dietician $3,713 providing consultant
services to maintain healthy dietary requirements of clients.
5006 Laundry&Linen 14,385 which comprise of towels, sheets, blankets, laundry service based on historical cost.
5007 Medication Supports 878,553 includes Psychiatrists and Nurse Practitioner services. The psychiatrists are budgeted at
259 hours per month at $218/hr and the Nurse Practitioner is budgeted at 156 hours
per month at $106/hr. Psychiatrists evaluate, diagnose, and collaborate with other team
members to treat our youngsters for different mental health disorders. Since they are
physicians they have the ability to prescribe medication and are responsible for
medication management and consultation when a patient needs a medical or
neurological evaluation. Included is a Medical Director (Dr. Brar) who provides services
for the PHF program along with supporting management in the overall coordination and
quality control of psychiatrist, primary care physician, and psychiatric nurse practitioner
services, including services provided via telepsychiatry.
5008 Other (Specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 34 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
6000: ADMINISTRATIVE EXPENSES 993,146
6001 Administrative Overhead 342,130 Will not exceed 15% of total costs. $342,130 or 7% of total costs is an allocation from
Stars Behavioral Health Group. It covers operations administration, information
technology, human resources, communications, finance, and associated fringe benefits
and expenses. SBHG oversight ensures consistency with our quality standards and
policies and procedures. The cost is developed from allocating the SBHG costs among
all the programs within all the SBHG companies based on standard accounting practices.
This economy of scale results in a significant savings for all SBHG programs. Rather than
staffing each program for all necessary services above, the services are performed by
fewer employees and then shared among all SBHG programs. $122,189 or 3% of the
total expenses is budgeted as SBHG operating income. Up to 5% of the total expenses
will be net income while maintaining total Administrative/Overhead expenses under
15% of total funding. This Category also includes $237,261 centralized fiscal service
allowed profit from private insurance and other counties. Calculated at 10% of the total
expenses
6002 Professional Liability Insurance for general liability, property and professional liability based on $473 per FTE.
6003 Accounting/Bookkeeping 110,758 this program will be supported and greatly benefit from the experienced and
established local Starlight Community Services organization. There is a large cost
advantage to the program in being supported by Starlight CS in the areas of operations,
business office and billing functions. Without the support from an affiliated
organization, the program would need to have dedicated staff for these functions.
Additionally any costs shared with this program will result in savings to the county
though lower costs for other Central Star County Programs. The cost of this support is
budgeted at $9,230 per month which is consistent with other programs.
6004 External Audit 8,912 for annual audit fees.
6005 Liability Insurance 20,497
6006 Payroll Services 9,042 payroll processing fees based on $15 per month for 47.35 employees.
6007 Depreciation (Provider Owned Equipment to
be Used for Program Purposes)
6008 Centralized Fiscal Services 122,189 Will not exceed 15% of total costs. $342,130 or 7% of total costs is an allocation from
Stars Behavioral Health Group. It covers operations administration, information
technology, human resources, communications, finance, and associated fringe benefits
and expenses. SBHG oversight ensures consistency with our quality standards and
policies and procedures. The cost is developed from allocating the SBHG costs among
all the programs within all the SBHG companies based on standard accounting practices.
This economy of scale results in a significant savings for all SBHG programs. Rather than
staffing each program for all necessary services above, the services are performed by
fewer employees and then shared among all SBHG programs. $122,189 or 3% of the
total expenses is budgeted as SBHG operating income. Up to 5% of the total expenses
will be net income while maintaining total Administrative/Overhead expenses under
15% of total funding. This Category also includes $237,261 centralized fiscal service
allowed profit from private insurance and other counties. Calculated at 10% of the total
expenses
6009 Centralized Services Private Ins/Other County 237,262 This Category includes $237,262 centralized fiscal service allowed profit from private
insurance and other counties. Calculated at 10% of the total expenses
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 35 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
6010 Centralized Services program 142,357 is comprised of the SBHG corporate and regional support in the numerous areas
including support from the Senior Administrator as well as services provided for
Program Development and Evaluation (e.g., tracking and reporting outcomes, and
implementation of practices), Quality & Compliance (e.g., internal chart audits,
compliance audits, and TJC readiness preparation), and Training (e.g., TIP and Core
Practice trainings provided company wide). There is a significant cost advantage to all
the SBHG company programs in sharing these costs rather than building them into each
program. SBHG support provides oversight of all of our programs to ensure consistency
with our standards and policies and procedures. The cost of this support is shared by all
programs and is budgeted 3% of total expenses.
6011 Other (Specify)
6012 Other (Specify)
7000: FIXED ASSETS
7001 Computer Equipment & Software
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
7003 Furniture & Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over $500 with Lifespan of 2
Years +
7006 Assets over $5,000/unit (Specify)
7007 Other (Specify)
7008 Other (Specify)
ACCT # LINE ITEM
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Phyciatric Health Facility Inpatient
PROGRAM FUNDING SOURCES
8000 SHORT/DOYLE MEDI CAL (FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI CAL SERVICE RATES
AND/OR SERVICE UNITS, IF APPLICABLE AND/OR AS REQUIRED BY THE RFP.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 36 of 60
Employee Salaries
Acct # Position FTE Admin Direct Total
1101 Clinical Director 1.00 115,725$115,725$
1102 Director Nursing 1.00 118,178 118,178
1103 Coordinator, Program 1.00 58,526 58,526
1104 Therapist, Recreation 1.00 61,556 61,556
1105 Therapist, Rehabilitation I III 1.00 51,433 51,433
1106 Case Manager 1.00 43,779 43,779
1107 Counselor, Youth IV 14.00 540,944 540,944
1108 Advocate Peer and Family 1.00 35,842 35,842
1109 Rehabilitation Aide I II 2.00 77,278 77,278
1110 Social Worker 4.50 351,534 351,534
1111 Coordinator, Admissions 1.00 61,572 61,572
1112 Charge & Registered Nurse 2.50 198,876 198,876
1113 Licensed Vocational Nurse 6.80 407,717 407,717
1114 Clerk, Receptionist 2.00 65,550 65,550
1115 Housekeeper 1.00 34,016 34,016
1116 Lead, Cook 1.00 30,844 30,844
1117 Cook 1.00 33,945 33,945
1118 Discharge Coordinator 1.00 47,730 47,730
1119 TAY Peer Specialist 1.00 40,912 40,912
1120 Administrator 0.75 96,779 96,779
1121 QA Coordinator 0.25 14,046 14,046
1122 QA Manager 0.25 18,360 18,360
1123 QA Assistant 0.25 8,691 8,691
1124 Training Coordinator 0.25 10,441 10,441
1125 Training Manager 0.25 20,104 20,104
1126 HR Manager 0.25 14,046 14,046
1127 HR Assistant 0.25 13,461 13,461
1128
1129
1130
1131
Personnel Salaries Subtotal 47.30 195,928$ 2,375,957$ 2,571,885$
ADOLESCENT ACUTE INPATIENT PSYCHIATRIC HEALTH FACILITY (PHF) SERVICE S
Central Star Behavioral Health, Inc. | Fresno County DBH Adolescent PHF
FY 2023 2024 | 07/01/2023 6/30/2024
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 37 of 60
Employee Benefits
Acct # Admin Direct Total
1201 4,554$ 52,987$57,540$
1202 6,072 69,551 75,623
1203 24,286 282,597 306,882
1204
1205
1206
34,911$ 405,135$ 440,046$
Payroll Taxes & Expenses:
Acct # Admin Direct Total
1301 12,548$ 145,369$157,917$
1302 2,935 34,147 37,082
1303 4,756 55,342 60,098
1304
1305
1306
20,239$ 234,858$ 255,097$
251,078$ 3,015,950$ 3,267,028$
2000: CLIENT SUPPORT
Acct # Amount
2001 $
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
$
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
DIRECT CLIENT CARE TOTAL
Household Items for Clients
Medication Supports
Program Supplies Medical
Utility Vouchers
Other (Specify)
Other (Specify)
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
Line Item Description
FICA/MEDICARE
SUI
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
Child Care
Description
Employee Benefits Subtotal:
Description
OASDI
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 38 of 60
3000: OPERATING EXPENSES
Acct # Amount
3001 40,934$
3002
3003 47,660
3004
3005 10,490
3006 12,260
3007 38,355
3008 9,179
3009 58,614
3010 74,242
3011
3012
291,734$
4000: FACILITIES & EQUIPMENT
Acct # Amount
4001 24,783$
4002 12,195
4003 22,619
4004
4005 3,934
4006 61,499
4007 34,479
4008
4009
4010
159,509$
5000: SPECIAL EXPENSES
Acct # Amount
5001 $
5002
5003
5004 5,727
5005 14,817
5006 103,481
5007 904,909
5008
1,028,934$SPECIAL EXPENSES TOTAL:
Laundry & Linen
Professional Services
Medication Supports
Other (Specify)
FACILITIES/EQUIPMENT TOTAL:
Line Item Description
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services
Translation Services
Security
Utilities
Equipment purchases
Other (Specify)
Other (Specify)
Other (Specify)
OPERATING EXPENSES TOTAL:
Line Item Description
Building Maintenance
Rent/Lease Building
Rent/Lease Equipment
Rent/Lease Vehicles
Food
Clothing
Program Supplies Medical
Purchased Services
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Advertising
Staff Development & Training
Staff Mileage
Line Item Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 39 of 60
6000: ADMINISTRATIVE EXPENSES
Acct # Amount
6001 352,394$
6002
6003 114,081
6004 9,179
6005 21,111
6006 9,313
6007
6008 125,855
6009 244,379
6010 146,627
6011
6012
1,022,939$
7000: FIXED ASSETS
Acct # Amount
7001 $
7002
7003
7004
7005
7006
7007
7008
$FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 5,770,144$
Assets over $5,000/unit (Specify)
Other (Specify)
Other (Specify)
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider Owned Equipment to be Used for Program Purposes)
Line Item Description
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Centralized Fiscal Services
Centralized Services Private Ins/Other County
Centralized Services program
Other (Specify)
Other (Specify)
Payroll Services
Liability Insurance
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 40 of 60
Acct # Service Units Rate Amount
8001 Mental Health Services 0 $
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0
8009 Phyciatric Health Facility Inpatient 5,869 985.85 5,785,792
5,869 5,785,792$
61%
3,529,333
50%1,764,667
1,764,667$
Acct # Amount
8101 Drug Medi Cal $
8102 SABG $
$
Acct # Amount
8201 Realignment 1,749,019$
1,749,019$
Acct # MHSA Component Amount
8301 CSS Community Services & Supports $
8302 PEI Prevention & Early Intervention
8303 INN Innovations
8304 WET Workforce Education & Training
8305 CFTN Capital Facilities & Technology
$
Acct # Amount
8401 Client Fees
8402 Client Insurance
8403 1,272,874
8404 867,869
8405 115,716
2,256,459$
Out of County Bed Rate=1007.78
OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:5,770,144$
MHSA TOTAL
8400 OTHER REVENUE
Line Item Description
Private Insurance Bed Rate=1109.28
Uninsured
REALIGNMENT TOTAL
8300 MENTAL HEALTH SERVICE ACT (MHSA)
MHSA Program Name
Federal Financial Participation (FFP) %
MEDI CAL FFP TOTAL
8100 SUBSTANCE USE DISORDER FUNDS
Line Item Description
SUBSTANCE USE DISORDER FUNDS TOTAL
8200 REALIGNMENT
PROGRAM FUNDING SOURCES
8000 SHORT/DOYLE MEDI CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
Estimated % of Clients who are Medi Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi Cal Beneficiaries
Line Item Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 41 of 60
Budget Narrative
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 3,267,028
Employee Salaries 2,571,885
1101 Clinical Director 115,725 1.0 FTE This position has primary responsibility for overseeing the provision of mental
health services, case management services and support services to clients and their
families. Has oversight of the Program and provides supervision to clinical staff. Works
in close collaboration with Clinical Director to ensure each client receives the
appropriate care and treatment consistent with the requirements.
Responsible for the implementation and management of all regulatory requirements
1102 Director Nursing 118,178 1.0 FTE The Director of Nursing ensures that each PHF client receives the nursing care,
treatment, medications and diet, which have been ordered by the attending physician,
ensuring the overall quality of licensed nursing care for the PHF Unit. S/he participates
in budget development for the Nursing Department and is responsible for its
implementation and management. S/he selects, hires and supervises all staff in the
Nursing Department.
1103 Coordinator, Program 58,526 1.0 FTE The Coordinator assists the Director of Nursing in directing the activities of
assigned licensed and non licensed personnel who provide health care services to
clients of the Central Star Youth Psychiatric Health Facility on a 24 hour 7 day a week
basis.
1104 Therapist, Recreation 61,556 1.0 FTE is the treatment team member who is responsible for providing recreational
services to adolescent clients within the Rehabilitation Program. These services are
provided through individualized and/or group activities to restore, establish and
maintain optimum level of social, vocational and physical functioning which include
social activities involving group participation, indoor and outdoor recreational activities
and exercises.
1105 Therapist, Rehabilitation I III 51,433 1.0 FTE is the treatment team member who is responsible for providing direct and
indirect rehabilitation services to adolescent clients. These services are provided
through individualized and/or group activities for clients. The Rehab Therapist may
also provide work direction to Rehab Aides.
1106 Case Manager 43,779 1.0 FTE This position has primary responsibility for organizing discharge information
and facilitating the discharge of patients at the Central Star Youth PHF; a process that
begins from initial assessment and unfolds throughout the course of acute inpatient
treatment. The case manager participates in interdisciplinary meetings, collaboration
and communication with outside partners and resources, and with preparing patients
for facility release.
1107 Counselor, Youth IV 540,944 14.0 FTE is the treatment team member who is responsible for providing direct care to
meet the physical and psychosocial needs of the adolescents. This care is provided
through direct and indirect physical and verbal interactions with clients, modeling
appropriate behaviors for clients, and monitoring daily client activities. (1.0 FTE Youth
Counselor serves as a designated Safety Specialist.)
1108 Advocate Peer and Family 35,842 1.0 FTE provide outreach, advocacy, training and support for family members
throughout all stages of the treatment, transition, and aftercare.
1109 Rehabilitation Aide I II 77,278 2.0 FTE assists the Rehabilitation Therapist in providing direct and indirect
rehabilitation services to adolescent clients through individualized and/or group
activities.
ADOLESCENT ACUTE INPATIENT PSYCHIATRIC HEALTH FACILITY (PHF) SERVICES
Central Star Behavioral Health, Inc. | Fresno County DBH Adolescent PHF
FY 2023 2024 | 07/01/2023 6/30/2024
PROGRAM EXPENSE
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 42 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
1110 Social Worker 351,534 4.5 FTE is the leader of each treatment team, and is responsible for preparing a
comprehensive treatment plan for each client. This position manages the
journey from intake, evaluation and assessment, the provision of case management
and other therapeutic services, through discharge planning and final placement. This
position coordinates with other agencies such as Child Protective Services, Juvenile
Probation Department, and County Department of Mental Health.
1111 Coordinator, Admissions 61,572 1.0 FTE is responsible for interviewing all prospective admissions, conducts the initial
assessment and collects all documentation, ensuring appropriate admission at Central
Star Psychiatric Health Facility. This person maintains liaison with parents and other
legal guardians, county agencies, insurance companies and other payors, hospitals and
health care facilities, augments existing social services by providing discharge planning
services, provides direct services to clients, offers consultation and supervision to staff,
and acts as liaison to outside agencies.
1112 Charge & Registered Nurse 198,876 2.5 FTE is the treatment team member who is responsible for performing all nursing
duties and related nursing activities for clients. The Charge Nurse is also responsible
for the supervision of the Youth Counselor staff assigned to their respective shift.
1113 Licensed Vocational Nurse 407,717 6.8 FTE provides direct client care including medications, and supervises nursing
activities performed by professional and para professional nursing personnel on the
unit.
1114 Clerk, Receptionist 65,550 2.0 FTE provides reception, clerical and administrative support.
1115 Housekeeper 34,016 1.0 FTE This position performs a variety of tasks to ensure that the facility is in a clean,
orderly, sanitary and attractive condition
1116 Lead, Cook 30,844 1.0 FTE This position has primary responsibility for preparing food in accordance with
current applicable federal, state, and local standards, guidelines and regulations, with
our established policies and procedures and under the direction of the Administrator
to assure that quality food service is provided at all times. Lead Cook coordinates the
daily activities of the dietary department, including scheduling and monitoring work
completed
1117 Cook 33,945 1.0 FTE This position prepares food in accordance with current applicable federal,
state, and local standards, guidelines and regulations, with our established policies and
procedures and under the direction of the Administrator to assure that quality food
service is provided at all times.
1118 Discharge Coordinator 47,730 1.0 FTE will provide a large variety of data management and clerical tasks related to
admissions and discharges for the Psychiatric Health Facility. This position monitors
timeliness of documentation, admission/discharge tasks and other time sensitive
activities. Includes collaboration with other departments and outside agencies to
process client referrals and assist in completing the admission or discharge process.
1119 TAY Peer Specialist 40,912 1.0 FTE is part of a team that provides services to youth. The Peer Partner is
responsible for educating, coaching, and acting as a role model and advocate for
clients. The Peer specialist collaborates with other team members and providers to
ensure proper, client centered services are provided.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 43 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
1120 Administrator 96,779 0.75 FTE manages the overall day to day operation of the adolescent Psychiatric
Health Facility (PHF) and Community Services programs. Assures compliance with
Federal, State, County and local laws and regulations. He/she oversees and assures
that there is a comprehensive quality treatment program and supervision for all PHF
and Community Services patients and reviews and approves all policies and procedures
of the agency. Manages all employee relations. The Administrator represents the
CSBH agency and its programs to governmental agencies and the community.
1121 QA Coordinator 14,046 .25 FTE, is responsible for utilization review and assisting in medical record
management by gathering and analyzing agency data and assisting in the
quality control, quality assurance, and quality improvement efforts.
1122 QA Manager 18,360 .25 FTE, manages all Quality Assurance tasks for the program, which includes records
management, documentation and service audits for compliance to Medi Cal and
internal requirements.
1123 QA Assistant 8,691 .25 FTE Performs a wide variety of administrative and clerical tasks in support of the
Quality Assurance/Total Quality Management (QA/TQM) System functions. Assists in
the quality control, quality assurance and quality improvement efforts.
1124 Training Coordinator 10,441 .25 FTE, assists in the development, coordination, delivery and administration of
agency training programs.
1125 Training Manager 20,104 .25 FTE This position has primary responsibility for development, coordination, and
supervision of training programs for Central Star PHF program. The Training Manager
regularly provides trainings. The position develops and maintains systems to track in
service attendance. The position develops opportunities to host trainings for other
professionals or participate with other organizations in providing such trainings.
1126 HR Manager 14,046 .25 FTE, manages all human resource clerical and administrative tasks for the program
staff. This position is responsible for supporting the development of a positive working
environment to enhance agency success and reduce legal risk, as well as management
team support and consultation, employee relations, interpretation and administration
of HR policies and procedures, staff recruitment and selection, compensation, and
employee benefits etc.
1127 HR Assistant 13,461 .25 FTE manages all human resource clerical and administrative tasks for the program
staff. This position is responsible for supporting the development of a positive working
environment to enhance agency success and reduce legal risk, as well as management
team support and consultation, employee relations, interpretation and administration
of HR policies and procedures, staff recruitment and selection, compensation, and
employee benefits etc.
1128 0
1129 0
1130 0
1131 0
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 44 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
Employee Benefits 440,046
1201 Retirement 57,540 Annual ESOP Pension and 401k employer match, calculated at 2.7% of annual salaries
1202 Worker's Compensation 75,623 Worker Compensation calculated at 3% of annual salaries
1203 Health Insurance 306,882 Health Insurance is calculated at 12% of annual salaries
1204 Other (Specify)
1205 Other (Specify)
1206 Other (Specify)
Payroll Taxes & Expenses: 255,097
1301 OASDI 157,917 Calculated at 6.20% of annual salaries up to the annual IRS max
1302 FICA/MEDICARE 37,082 Calculated at 1.45% of annual salaries
1303 SUI 60,098 Calculate at the Company's rate of 6% up to $7,000 of annual wages per employee
1304 Other (Specify)
1305 Other (Specify)
1306 Other (Specify)
2000: CLIENT SUPPORT
2001 Child Care
2002 Client Housing Support
2003 Client Transportation & Support
2004 Clothing, Food, & Hygiene
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies Medical
2010 Utility Vouchers
2011 Other (Specify)
2012 Other (Specify)
2013 Other (Specify)
2014 Other (Specify)
2015 Other (Specify)
2016 Other (Specify)
3000: OPERATING EXPENSES 291,734
3001 Telecommunications 40,934 staff cell phone reimbursement The budget is done based on a reimbursement of
$100/mo. for the director and at $60/ mo. for all other direct staff. Included is $33,328
for landline, internet & phones which includes Wi Fi for staff tablets.
3002 Printing/Postage
3003 Office, Household & Program Supplies 47,660 based on $23,594 for office supplies for 47.35 FTE's, County badges for 10 staff
@12.39, other non perishable supplies and $12,785 for Property Taxes, business
licenses and Joint Commission fees.
3004 Advertising
3005 Staff Development & Training 10,490 which comprise of the on going program required education, training and materials
for staff . Calculated at $874 per month.
3006 Staff Mileage 12,260 this is estimated staff travel reimbursement for client visits (IRS mileage rate @
.58/miles) and for staff travel to training programs, which is based on our experience in
administering similar programs and locations.
3007 Food 38,355 to be prepared by Cook for the clients based on historical cost sourced from US Foods,
Inc.
3008 Clothing 9,179 this cost will cover the clothing needs of the clients.
3009 Program Supplies Medical 58,614 contracted with Omnicare Pharmacy and Medline Industries.
3010 Purchased Services 74,242 Purchased service: $74,242 which includes document shredding, water and coffee
service, postage meter rental, and storage facility. Also included is $43,709 to cover
laboratory and x ray services for clients.
3011 Other (Specify)
3012 Other (Specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 45 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
4000: FACILITIES & EQUIPMENT 159,509
4001 Building Maintenance 24,783 for janitorial services, repairs and maintenance, calculated at $2,005 per month for 12
months.
4002 Rent/Lease Building 12,195 administration common area shared by all programs allocated using a relative value.
4003 Rent/Lease Equipment 22,619 for copier lease, toner and maintenance for 12 months.
4004 Rent/Lease Vehicles
4005 Security 3,934 budgeted at $328 per month.
4006 Utilities 61,499 Electricity, Water, Gas, $5,125 per month for 12 months.
4007 Equipment purchases 34,479 for minor office equipment, furniture, IT equipment, software and support.
4008 Other (Specify)
4009 Other (Specify)
4010 Other (Specify)
5000: SPECIAL EXPENSES 1,028,934
5001 Consultant (Network & Data Management)
5002 HMIS (Health Management Information
System)
5003 Contractual/Consulting Services
5004 Translation Services 5,727 for annual translation services.
5005 Laundry & Linen 14,817 which comprise of towels, sheets, blankets, laundry service based on historical cost.
5006 Professional Services 103,481 This category includes $6,556 for ongoing recruitment. Includes contracted medical
doctor (Dr. Grossman) budgeted at a fixed rate of $6K monthly plus $150 for each
follow up visit, and it also includes registered Dietician $3,825 providing consultant
services to maintain healthy dietary requirements of clients.
5007 Medication Supports 904,909 includes Psychiatrists and Nurse Practitioner services. The psychiatrists are budgeted
at 259 hours per month at $225/hour and the Nurse Practitioner is budgeted at 156
hours per month at $109/hr. Psychiatrists evaluate, diagnose, and collaborate with
other team members to treat our youngsters for different mental health disorders.
Since they are physicians they have the ability to prescribe medication and are
responsible for medication management and consultation when a patient needs a
medical or neurological evaluation. Included is a Medical Director (Dr. Brar) who
provides services for the PHF program along with supporting management in the
overall coordination and quality control of psychiatrist, primary care physician, and
psychiatric nurse practitioner services, including services provided via telepsychiatry.
5008 Other (Specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 46 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
6000: ADMINISTRATIVE EXPENSES 1,022,939
6001 Administrative Overhead 352,394 Will not exceed 15% of total costs. $352,394 or 7% of total costs is an allocation from
Stars Behavioral Health Group. It covers operations administration, information
technology, human resources, communications, finance, and associated fringe benefits
and expenses. SBHG oversight ensures consistency with our quality standards and
policies and procedures. The cost is developed from allocating the SBHG costs among
all the programs within all the SBHG companies based on standard accounting
practices. This economy of scale results in a significant savings for all SBHG programs.
Rather than staffing each program for all necessary services above, the services are
performed by fewer employees and then shared among all SBHG programs. $125,855
or 3% of the total expenses is budgeted as SBHG operating income. Up to 5% of the
total expenses will be net income while maintaining total Administrative/Overhead
expenses under 15% of total funding. This Category also includes $244,379 centralized
fiscal service allowed profit from private insurance and other counties. Calculated at
10% of the total expenses
6002 Professional Liability Insurance for general liability, property and professional liability based on $473 per FTE.
6003 Accounting/Bookkeeping 114,081 this program will be supported and greatly benefit from the experienced and
established local Starlight Community Services organization. There is a large cost
advantage to the program in being supported by Starlight CS in the areas of operations,
business office and billing functions. Without the support from an affiliated
organization, the program would need to have dedicated staff for these functions.
Additionally any costs shared with this program will result in savings to the county
though lower costs for other Central Star County Programs. The cost of this support is
budgeted at $9,507 per month which is consistent with other programs.
6004 External Audit 9,179 for annual audit fees.
6005 Liability Insurance 21,111
6006 Payroll Services 9,313 for payroll processing fees based on $15 per month for 47.35 employees.
6007 Depreciation (Provider Owned Equipment to
be Used for Program Purposes)
6008 Centralized Fiscal Services 125,855 Will not exceed 15% of total costs. $352,394 or 7% of total costs is an allocation from
Stars Behavioral Health Group. It covers operations administration, information
technology, human resources, communications, finance, and associated fringe benefits
and expenses. SBHG oversight ensures consistency with our quality standards and
policies and procedures. The cost is developed from allocating the SBHG costs among
all the programs within all the SBHG companies based on standard accounting
practices. This economy of scale results in a significant savings for all SBHG programs.
Rather than staffing each program for all necessary services above, the services are
performed by fewer employees and then shared among all SBHG programs. $125,855
or 3% of the total expenses is budgeted as SBHG operating income. Up to 5% of the
total expenses will be net income while maintaining total Administrative/Overhead
expenses under 15% of total funding. This Category also includes $244,379 centralized
fiscal service allowed profit from private insurance and other counties. Calculated at
10% of the total expenses
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 47 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
6009 Centralized Services Private Ins/Other County 244,379 This Category includes $244,379 centralized fiscal service allowed profit from private
insurance and other counties. Calculated at 10% of the total expenses
6010 Centralized Services program 146,627 Centralized Program Services: $146,627 is comprised of the SBHG corporate and
regional support in the numerous areas including support from the Senior
Administrator as well as services provided for Program Development and Evaluation
(e.g., tracking and reporting outcomes, and implementation of practices), Quality &
Compliance (e.g., internal chart audits, compliance audits, and TJC readiness
preparation), and Training (e.g., TIP and Core Practice trainings provided company
wide). There is a significant cost advantage to all the SBHG company programs in
sharing these costs rather than building them into each program. SBHG support
provides oversight of all of our programs to ensure consistency with our standards and
policies and procedures. The cost of this support is shared by all programs and is
budgeted 3% of total expenses.
6011 Other (Specify)
6012 Other (Specify)
7000: FIXED ASSETS
7001 Computer Equipment & Software
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
7003 Furniture & Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over $500 with Lifespan of 2
Years +
7006 Assets over $5,000/unit (Specify)
7007 Other (Specify)
7008 Other (Specify)
ACCT # LINE ITEM
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Phyciatric Health Facility Inpatient
PROGRAM FUNDING SOURCES
8000 SHORT/DOYLE MEDI CAL (FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI CAL SERVICE
RATES AND/OR SERVICE UNITS, IF APPLICABLE AND/OR AS REQUIRED BY THE RFP.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 48 of 60
Employee Salaries
Acct # Position FTE Admin Direct Total
1101 Clinical Director 1.00 119,197$119,197$
1102 Director Nursing 1.00 121,724 121,724
1103 Coordinator, Program 1.00 60,282 60,282
1104 Therapist, Recreation 1.00 63,403 63,403
1105 Therapist, Rehabilitation I III 1.00 52,976 52,976
1106 Case Manager 1.00 45,091 45,091
1107 Counselor, Youth IV 14.00 557,171 557,171
1108 Advocate Peer and Family 1.00 36,917 36,917
1109 Rehabilitation Aide I II 2.00 79,596 79,596
1110 Social Worker 4.50 362,080 362,080
1111 Coordinator, Admissions 1.00 63,419 63,419
1112 Charge & Registered Nurse 2.50 204,843 204,843
1113 Licensed Vocational Nurse 6.80 419,949 419,949
1114 Clerk, Receptionist 2.00 67,517 67,517
1115 Housekeeper 1.00 35,036 35,036
1116 Lead, Cook 1.00 31,769 31,769
1117 Cook 1.00 34,964 34,964
1118 Discharge Coordinator 1.00 49,162 49,162
1119 TAY Peer Specialist 1.00 42,138 42,138
1120 Administrator 0.75 99,682 99,682
1121 QA Coordinator 0.25 14,468 14,468
1122 QA Manager 0.25 18,911 18,911
1123 QA Assistant 0.25 8,952 8,952
1124 Training Coordinator 0.25 10,754 10,754
1125 Training Manager 0.25 20,707 20,707
1126 HR Manager 0.25 14,468 14,468
1127 HR Assistant 0.25 13,865 13,865
1128
1129
1130
1131
Personnel Salaries Subtotal 47.30 201,807$ 2,447,234$ 2,649,041$
ADOLESCENT ACUTE INPATIENT PSYCHIATRIC HEALTH FACILITY (PHF) SERVICE S
Central Star Behavioral Health, Inc. | Fresno County DBH Adolescent PHF
FY 2024 2025 | 07/01/2024 6/30/2025
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 49 of 60
Employee Benefits
Acct # Admin Direct Total
1201 4,690$ 53,446$58,136$
1202 6,254 72,768 79,022
1203 25,014 291,075 316,089
1204
1205
1206
35,958$ 417,289$ 453,247$
Payroll Taxes & Expenses:
Acct # Admin Direct Total
1301 12,924$ 149,730$162,654$
1302 3,023 35,172 38,195
1303 4,899 57,002 61,901
1304
1305
1306
20,846$ 241,904$ 262,750$
258,611$ 3,106,427$ 3,365,038$
2000: CLIENT SUPPORT
Acct # Amount
2001 $
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
$
Other (Specify)
Other (Specify)
Other (Specify)
Other (Specify)
DIRECT CLIENT CARE TOTAL
Household Items for Clients
Medication Supports
Program Supplies Medical
Utility Vouchers
Other (Specify)
Other (Specify)
Client Housing Support
Client Transportation & Support
Clothing, Food, & Hygiene
Education Support
Employment Support
Other (Specify)
Other (Specify)
Other (Specify)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
Line Item Description
FICA/MEDICARE
SUI
Retirement
Worker's Compensation
Health Insurance
Other (Specify)
Other (Specify)
Other (Specify)
Child Care
Description
Employee Benefits Subtotal:
Description
OASDI
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 50 of 60
3000: OPERATING EXPENSES
Acct # Amount
3001 42,162$
3002
3003 49,090
3004
3005 10,805
3006 12,628
3007 39,505
3008 9,454
3009 60,372
3010 76,469
3011
3012
300,485$
4000: FACILITIES & EQUIPMENT
Acct # Amount
4001 25,527$
4002 12,561
4003 23,298
4004
4005 4,052
4006 63,344
4007 35,514
4008
4009
4010
164,295$
5000: SPECIAL EXPENSES
Acct # Amount
5001 $
5002
5003
5004 5,899
5005 15,262
5006 106,586
5007 932,056
5008
1,059,803$SPECIAL EXPENSES TOTAL:
Laundry & Linen
Professional Services
Medication Supports
Other (Specify)
FACILITIES/EQUIPMENT TOTAL:
Line Item Description
Consultant (Network & Data Management)
HMIS (Health Management Information System)
Contractual/Consulting Services
Translation Services
Security
Utilities
Equipment Purchase
Other (Specify)
Other (Specify)
Other (Specify)
OPERATING EXPENSES TOTAL:
Line Item Description
Building Maintenance
Rent/Lease Building
Rent/Lease Equipment
Rent/Lease Vehicles
Food
Clothing
Program Supplies Medical
Purchased Services
Other (Specify)
Other (Specify)
Telecommunications
Printing/Postage
Office, Household & Program Supplies
Advertising
Staff Development & Training
Staff Mileage
Line Item Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 51 of 60
6000: ADMINISTRATIVE EXPENSES
Acct # Amount
6001 362,966$
6002
6003 117,503
6004 9,454
6005 21,745
6006 9,593
6007
6008 129,631
6009 251,710
6010 151,026
6011
6012
1,053,628$
7000: FIXED ASSETS
Acct # Amount
7001 $
7002
7003
7004
7005
7006
7007
7008
$FIXED ASSETS EXPENSES TOTAL
TOTAL PROGRAM EXPENSES 5,943,249$
Assets over $5,000/unit (Specify)
Other (Specify)
Other (Specify)
Administrative Overhead
Professional Liability Insurance
Accounting/Bookkeeping
External Audit
Depreciation (Provider Owned Equipment to be Used for Program Purposes)
Line Item Description
Line Item Description
Computer Equipment & Software
Copiers, Cell Phones, Tablets, Devices to Contain HIPAA Data
Furniture & Fixtures
Leasehold/Tenant/Building Improvements
Other Assets over $500 with Lifespan of 2 Years +
ADMINISTRATIVE EXPENSES TOTAL
Centralized Fiscal Services
Centralized Services Private Ins/Other County
Centralized Services program
Other (Specify)
Other (Specify)
Payroll Services
Liability Insurance
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 52 of 60
Acct # Service Units Rate Amount
8001 Mental Health Services 0 $
8002 Case Management 0
8003 Crisis Services 0
8004 Medication Support 0
8005 Collateral 0
8006 Plan Development 0
8007 Assessment 0
8008 Rehabilitation 0
8009 Phyciatric Health Facility Inpatient 5,869 1,015.42 5,959,367
5,869 5,959,367$
61%
3,635,214
50%1,817,607
1,817,607$
Acct # Amount
8101 Drug Medi Cal $
8102 SABG $
$
Acct # Amount
8201 Realignment 1,801,489$
1,801,489$
Acct # MHSA Component Amount
8301 CSS Community Services & Supports $
8302 PEI Prevention & Early Intervention
8303 INN Innovations
8304 WET Workforce Education & Training
8305 CFTN Capital Facilities & Technology
$
Acct # Amount
8401 Client Fees $
8402 Client Insurance
8403 1,311,061
8404 893,905
8405 119,187
2,324,153$
Out of County Bed Rate=1038.01
OTHER REVENUE TOTAL
TOTAL PROGRAM FUNDING SOURCES:5,943,249$
MHSA TOTAL
8400 OTHER REVENUE
Line Item Description
Private Insurance Bed Rate=1142.56
Uninsured
REALIGNMENT TOTAL
8300 MENTAL HEALTH SERVICE ACT (MHSA)
MHSA Program Name
Federal Financial Participation (FFP) %
MEDI CAL FFP TOTAL
8100 SUBSTANCE USE DISORDER FUNDS
Line Item Description
SUBSTANCE USE DISORDER FUNDS TOTAL
8200 REALIGNMENT
PROGRAM FUNDING SOURCES
8000 SHORT/DOYLE MEDI CAL (FEDERAL FINANCIAL PARTICIPATION)
Line Item Description
Estimated Specialty Mental Health Services Billing Totals:
Estimated % of Clients who are Medi Cal Beneficiaries
Estimated Total Cost of Specialty Mental Health Services Provided to Medi Cal Beneficiaries
Line Item Description
Fresno County Department of Behavioral Health Contract Budget Template Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 53 of 60
Budget Narrative
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 3,365,038
Employee Salaries 2,649,041
1101 Clinical Director 119,197 1.0 FTE This position has primary responsibility for overseeing the provision of mental
health services, case management services and support services to clients and their
families. Has oversight of the Program and provides supervision to clinical staff. Works
in close collaboration with Clinical Director to ensure each client receives the
appropriate care and treatment consistent with the requirements.
Responsible for the implementation and management of all regulatory requirements
1102 Director Nursing 121,724 1.0 FTE The Director of Nursing ensures that each PHF client receives the nursing care,
treatment, medications and diet, which have been ordered by the attending physician,
ensuring the overall quality of licensed nursing care for the PHF Unit. S/he participates
in budget development for the Nursing Department and is responsible for its
implementation and management. S/he selects, hires and supervises all staff in the
Nursing Department.
1103 Coordinator, Program 60,282 1.0 FTE The Coordinator assists the Director of Nursing in directing the activities of
assigned licensed and non licensed personnel who provide health care services to clients
of the Central Star Youth Psychiatric Health Facility on a 24 hour 7 day a week basis.
1104 Therapist, Recreation 63,403 1.0 FTE is the treatment team member who is responsible for providing recreational
services to adolescent clients within the Rehabilitation Program. These services are
provided through individualized and/or group activities to restore, establish and
maintain optimum level of social, vocational and physical functioning which include
social activities involving group participation, indoor and outdoor recreational activities
and exercises.
1105 Therapist, Rehabilitation I III 52,976 1.0 FTE is the treatment team member who is responsible for providing direct and
indirect rehabilitation services to adolescent clients. These services are provided
through individualized and/or group activities for clients. The Rehab Therapist may also
provide work direction to Rehab Aides.
1106 Case Manager 45,091 1.0 FTE This position has primary responsibility for organizing discharge information and
facilitating the discharge of patients at the Central Star Youth PHF; a process that begins
from initial assessment and unfolds throughout the course of acute inpatient treatment.
The case manager participates in interdisciplinary meetings, collaboration and
communication with outside partners and resources, and with preparing patients for
facility release.
1107 Counselor, Youth IV 557,171 14.0 FTE is the treatment team member who is responsible for providing direct care to
meet the physical and psychosocial needs of the adolescents. This care is provided
through direct and indirect physical and verbal interactions with clients, modeling
appropriate behaviors for clients, and monitoring daily client activities. (1.0 FTE Youth
Counselor serves as a designated Safety Specialist.)
1108 Advocate Peer and Family 36,917 1.0 FTE provide outreach, advocacy, training and support for family members
throughout all stages of the treatment, transition, and aftercare.
1109 Rehabilitation Aide I II 79,596 2.0 FTE assists the Rehabilitation Therapist in providing direct and indirect
rehabilitation services to adolescent clients through individualized and/or group
activities.
ADOLESCENT ACUTE INPATIENT PSYCHIATRIC HEALTH FACILITY (PHF) SERVICES
Central Star Behavioral Health, Inc. | Fresno County DBH Adolescent PHF
FY 2024 2025 | 07/01/2024 6/30/2025
PROGRAM EXPENSE
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 54 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
1110 Social Worker 362,080 4.5 FTE is the leader of each treatment team, and is responsible for preparing a
comprehensive treatment plan for each client. This position manages the
journey from intake, evaluation and assessment, the provision of case management and
other therapeutic services, through discharge planning and final placement. This
position coordinates with other agencies such as Child Protective Services, Juvenile
Probation Department, and County Department of Mental Health.
1111 Coordinator, Admissions 63,419 1.0 FTE is responsible for interviewing all prospective admissions, conducts the initial
assessment and collects all documentation, ensuring appropriate admission at Central
Star Psychiatric Health Facility. This person maintains liaison with parents and other
legal guardians, county agencies, insurance companies and other payors, hospitals and
health care facilities, augments existing social services by providing discharge planning
services, provides direct services to clients, offers consultation and supervision to staff,
and acts as liaison to outside agencies.
1112 Charge & Registered Nurse 204,843 2.5 FTE is the treatment team member who is responsible for performing all nursing
duties and related nursing activities for clients. The Charge Nurse is also responsible for
the supervision of the Youth Counselor staff assigned to their respective shift.
1113 Licensed Vocational Nurse 419,949 6.8 FTE provides direct client care including medications, and supervises nursing
activities performed by professional and para professional nursing personnel on the
unit.
1114 Clerk, Receptionist 67,517 2.0 FTE provides reception, clerical and administrative support.
1115 Housekeeper 35,036 1.0 FTE This position performs a variety of tasks to ensure that the facility is in a clean,
orderly, sanitary and attractive condition
1116 Lead, Cook 31,769 1.0 FTE This position has primary responsibility for preparing food in accordance with
current applicable federal, state, and local standards, guidelines and regulations, with
our established policies and procedures and under the direction of the Administrator to
assure that quality food service is provided at all times. Lead Cook coordinates the daily
activities of the dietary department, including scheduling and monitoring work
completed
1117 Cook 34,964 1.0 FTE This position prepares food in accordance with current applicable federal, state,
and local standards, guidelines and regulations, with our established policies and
procedures and under the direction of the Administrator to assure that quality food
service is provided at all times.
1118 Discharge Coordinator 49,162 1.0 FTE will provide a large variety of data management and clerical tasks related to
admissions and discharges for the Psychiatric Health Facility. This position monitors
timeliness of documentation, admission/discharge tasks and other time sensitive
activities. Includes collaboration with other departments and outside agencies to
process client referrals and assist in completing the admission or discharge process.
1119 TAY Peer Specialist 42,138 1.0 FTE is part of a team that provides services to youth. The Peer Partner is responsible
for educating, coaching, and acting as a role model and advocate for clients. The Peer
specialist collaborates with other team members and providers to ensure proper, client
centered services are provided.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 55 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
1120 Administrator 99,682 0.75 FTE manages the overall day to day operation of the adolescent Psychiatric Health
Facility (PHF) and Community Services programs. Assures compliance with Federal,
State, County and local laws and regulations. He/she oversees and assures that there is
a comprehensive quality treatment program and supervision for all PHF and Community
Services patients and reviews and approves all policies and procedures of the agency.
Manages all employee relations. The Administrator represents the CSBH agency and its
programs to governmental agencies and the community.
1121 QA Coordinator 14,468 .25 FTE, is responsible for utilization review and assisting in medical record
management by gathering and analyzing agency data and assisting in the
quality control, quality assurance, and quality improvement efforts.
1122 QA Manager 18,911 .25 FTE, manages all Quality Assurance tasks for the program, which includes records
management, documentation and service audits for compliance to Medi Cal and internal
requirements.
1123 QA Assistant 8,952 .25 FTE Performs a wide variety of administrative and clerical tasks in support of the
Quality Assurance/Total Quality Management (QA/TQM) System functions. Assists in the
quality control, quality assurance and quality improvement efforts.
1124 Training Coordinator 10,754 .25 FTE, assists in the development, coordination, delivery and administration of agency
training programs.
1125 Training Manager 20,707 .25 FTE This position has primary responsibility for development, coordination, and
supervision of training programs for Central Star PHF program. The Training Manager
regularly provides trainings. The position develops and maintains systems to track in
service attendance. The position develops opportunities to host trainings for other
professionals or participate with other organizations in providing such trainings.
1126 HR Manager 14,468 .25 FTE, manages all human resource clerical and administrative tasks for the program
staff. This position is responsible for supporting the development of a positive working
environment to enhance agency success and reduce legal risk, as well as management
team support and consultation, employee relations, interpretation and administration of
HR policies and procedures, staff recruitment and selection, compensation, and
employee benefits etc.
1127 HR Assistant 13,865 .25 FTE manages all human resource clerical and administrative tasks for the program
staff. This position is responsible for supporting the development of a positive working
environment to enhance agency success and reduce legal risk, as well as management
team support and consultation, employee relations, interpretation and administration of
HR policies and procedures, staff recruitment and selection, compensation, and
employee benefits etc.
1128 0
1129 0
1130 0
1131 0
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 56 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
Employee Benefits 453,247
1201 Retirement 58,136 Annual ESOP Pension and 401k employer match, calculated at 2.7% of annual salaries
1202 Worker's Compensation 79,022 Worker Compensation calculated at 3% of annual salaries
1203 Health Insurance 316,089 Health Insurance is calculated at 12% of annual salaries
1204 Other (Specify)
1205 Other (Specify)
1206 Other (Specify)
Payroll Taxes & Expenses: 262,750
1301 OASDI 162,654 Calculated at 6.20% of annual salaries up to the annual IRS max
1302 FICA/MEDICARE 38,195 Calculated at 1.45% of annual salaries
1303 SUI 61,901 Calculate at the Company's rate of 6% up to $7,000 of annual wages per employee
1304 Other (Specify)
1305 Other (Specify)
1306 Other (Specify)
Client Support
2001 Child Care
2002 Client Housing Support
2003 Client Transportation & Support
2004 Clothing, Food, & Hygiene
2005 Education Support
2006 Employment Support
2007 Household Items for Clients
2008 Medication Supports
2009 Program Supplies Medical
2010 Utility Vouchers
2011 Other (Specify)
2012 Other (Specify)
2013 Other (Specify)
2014 Other (Specify)
2015 Other (Specify)
2016 Other (Specify)
Operating Expenses 300,485
3001 Telecommunications 42,162 for staff cell phone reimbursement The budget is done based on a reimbursement of
$100/mo. for the director and at $60/ mo. for all other direct staff. Included is $34,328
for landline, internet & phones which includes Wi Fi for staff tablets.
3002 Printing/Postage
3003 Office, Household & Program Supplies 49,090 based on $24,302 for office supplies for 47.35 FTE's, County badges for 10 staff @12.39,
other non perishable supplies and $13,168 for Property Taxes, business licenses and
Joint Commission fees.
3004 Advertising
3005 Staff Development & Training 10,805 which comprise of the on going program required education, training and materials for
staff . Calculated at $874 per month.
3006 Staff Mileage 12,628 this is estimated staff travel reimbursement for client visits (IRS mileage rate @
.58/miles) and for staff travel to training programs, which is based on our experience in
administering similar programs and locations.
3007 Food 39,505 to be prepared by Cook for the clients based on historical cost sourced from US Foods,
Inc.
3008 Clothing 9,454 this cost will cover the clothing needs of the clients.
3009 Program Supplies Medical 60,372 contracted with Omnicare Pharmacy and Medline Industries.
3010 Purchased Services 76,469 Purchased service: $76,469 which includes document shredding, water and coffee
service, postage meter rental, and storage facility. Also included is $45,020 to cover
laboratory and x rayservices for clients.
3011 Other (Specify)
3012 Other (Specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 57 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
Facilities & Equipment 164,295
4001 Building Maintenance 25,527 for janitorial services, repairs and maintenance, calculated at $2,127 per month for 12
months.
4002 Rent/Lease Building 12,561 administration common area shared by all programs allocated using a relative value.
4003 Rent/Lease Equipment 23,298 for copier lease, toner and maintenance for 12 months.
4004 Rent/Lease Vehicles
4005 Security 4,052 budgeted at $338 per month.
4006 Utilities 63,344 Electricity, Water, Gas, $5,125 per month for 12 months.
4007 Equipment Purchase 35,514 for minor office equipment, furniture, IT equipment, software and support.
4008 Other (Specify)
4009 Other (Specify)
4010 Other (Specify)
Special Expenses 1,059,803
5001 Consultant (Network & Data Management)
5002 HMIS (Health Management Information
System)
5003 Contractual/Consulting Services
5004 Translation Services 5,899 for annual translation services.
5005 Laundry & Linen 15,262 which comprise of towels, sheets, blankets, laundry service based on historical cost.
5006 Professional Services 106,586 This category includes $6,753 for ongoing recruitment. Includes contracted medical
doctor (Dr. Grossman) budgeted at a fixed rate of $6K monthly plus $150 for each follow
up visit, a
5007 Medication Supports 932,056 includes Psychiatrists and Nurse Practitioner services. The psychiatrists are budgeted at
259 hours per month at $232/hr and the Nurse Practitioner is budgeted at 156 hours per
month at $112/hr. Psychiatrists evaluate, diagnose, and collaborate with other team
members to treat our youngsters for different mental health disorders. Since they are
physicians they have the ability to prescribe medication and are responsible for
medication management and consultation when a patient needs a medical or
neurological evaluation. Included is a Medical Director (Dr. Brar) who provides services
for the PHF program along with supporting management in the overall coordination and
quality control of psychiatrist, primary care physician, and psychiatric nurse practitioner
services, including services provided via telepsychiatry.
5008 Other (Specify)
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 58 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
Administrative Expenses 1,053,628
6001 Administrative Overhead 362,966 Will not exceed 15% of total costs. $362,966 or 7% of total costs is an allocation from
Stars Behavioral Health Group. It covers operations administration, information
technology, human resources, communications, finance, and associated fringe benefits
and expenses. SBHG oversight ensures consistency with our quality standards and
policies and procedures. The cost is developed from allocating the SBHG costs among all
the programs within all the SBHG companies based on standard accounting practices.
This economy of scale results in a significant savings for all SBHG programs. Rather than
staffing each program for all necessary services above, the services are performed by
fewer employees and then shared among all SBHG programs. $129,630 or 3% of the
total expenses is budgeted as SBHG operating income. Up to 5% of the total expenses
will be net income while maintaining total Administrative/Overhead expenses under
15% of total funding. This Category also includes $251,710 centralized fiscal service
allowed profit from private insurance and other counties. Calculated at 10% of the total
expenses
6002 Professional Liability Insurance for general liability, property and professional liability based on $473 per FTE
6003 Accounting/Bookkeeping 117,503 $117,503, this program will be supported and greatly benefit from the experienced and
established local Starlight Community Services organization. There is a large cost
advantage to the program in being supported by Starlight CS in the areas of operations,
business office and billing functions. Without the support from an affiliated organization,
the program would need to have dedicated staff for these functions. Additionally any
costs shared with this program will result in savings to the county though lower costs for
other Central Star County Programs. The cost of this support is budgeted at $9,792 per
month which is consistent with other programs.
6004 External Audit 9,454 for annual audit fees.
6005 Liability Insurance 21,745
6006 Payroll Services 9,593 for payroll processing fees based on $15 per month for 47.35 employees.
6007 Depreciation (Provider Owned Equipment to
be Used for Program Purposes)
6008 Centralized Fiscal Services 129,631 Will not exceed 15% of total costs. $362,966 or 7% of total costs is an allocation from
Stars Behavioral Health Group. It covers operations administration, information
technology, human resources, communications, finance, and associated fringe benefits
and expenses. SBHG oversight ensures consistency with our quality standards and
policies and procedures. The cost is developed from allocating the SBHG costs among all
the programs within all the SBHG companies based on standard accounting practices.
This economy of scale results in a significant savings for all SBHG programs. Rather than
staffing each program for all necessary services above, the services are performed by
fewer employees and then shared among all SBHG programs. $129,630 or 3% of the
total expenses is budgeted as SBHG operating income. Up to 5% of the total expenses
will be net income while maintaining total Administrative/Overhead expenses under
15% of total funding. This Category also includes $251,710 centralized fiscal service
allowed profit from private insurance and other counties. Calculated at 10% of the total
expenses
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 59 of 60
ACCT # LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
PROGRAM EXPENSE
6009 Centralized Services Private Ins/Other County 251,710 This Category includes $251,710 centralized fiscal service allowed profit from private
insurance and other counties. Calculated at 10% of the total expenses
6010 Centralized Services program 151,026 Other: Centralized Program Services: $151,026 is comprised of the SBHG corporate and
regional support in the numerous areas including support from the Senior Administrator
as well as services provided for Program Development and Evaluation (e.g., tracking and
reporting outcomes, and implementation of practices), Quality & Compliance (e.g.,
internal chart audits, compliance audits, and TJC readiness preparation), and Training
(e.g., TIP and Core Practice trainings provided company wide). There is a significant cost
advantage to all the SBHG company programs in sharing these costs rather than building
them into each program. SBHG support provides oversight of all of our programs to
ensure consistency with our standards and policies and procedures. The cost of this
support is shared by all programs and is budgeted 3% of total expenses.
6011 Other (Specify)
6012 Other (Specify)
Fixed Assets
7001 Computer Equipment & Software
7002 Copiers, Cell Phones, Tablets, Devices to
Contain HIPAA Data
7003 Furniture & Fixtures
7004 Leasehold/Tenant/Building Improvements
7005 Other Assets over $500 with Lifespan of 2
Years +
7006 Assets over $5,000/unit (Specify)
7007 Other (Specify)
7008 Other (Specify)
ACCT # LINE ITEM
8001 Mental Health Services
8002 Case Management
8003 Crisis Services
8004 Medication Support
8005 Collateral
8006 Plan Development
8007 Assessment
8008 Rehabilitation
8009 Phyciatric Health Facility Inpatient
PROGRAM FUNDING SOURCES
8000 SHORT/DOYLE MEDI CAL (FEDERAL FINANCIAL PARTICIPATION)
PROVIDE DETAILS OF METHODOLOGY(IES)USED IN DETERMINING MEDI CAL SERVICE RATES
AND/OR SERVICE UNITS, IF APPLICABLE AND/OR AS REQUIRED BY THE RFP.
Fresno County Department of Behavioral Health Contract Budget Narrative Revised 2/7/2020
Exhibit C | PHF Budget & Narrative
Page 60 of 60
Page 1 of 3 Exhibit E - Fresno County MH Compliance Plan and Code of Conduct
Page 2 of 3 Exhibit E - Fresno County MH Compliance Plan and Code of Conduct
Page 3 of 3 Exhibit E - Fresno County MH Compliance Plan and Code of Conduct
(excluding State Hospitals)
Please see the next page or reverse side for Reporting Instructions
State of California - Health and Human Services Agency
Exhibit G - DHCS 1010 Form
Page 1 of 2
Department of Health Care Services
DHCS 1010 (8/12)
State of California - Health and Human Services Agency
Exhibit G - DHCS 1010 Form
Page 2 of 2
Department of Health Care Services
DHCS 1010 (8/12)
PROGRAM OUTCOMES
Quarterly Progress Report
The following items listed below represent program goals to be achieved by contractor
on the number of goals it can achieve, resulting from performance outcomes. The
selected contractor will utilize a computerized tracking system with which outcome
measures and other relevant client data, such as demographics, will be maintained.
1. The time between client referral and admission to the PHF.
2. Effectiveness of discharge planning as demonstrated by the referral and linkage to
other Department of Behavioral Health programs, community providers and other
community resources.
3. Collaborative approach and treatment strategies to reduce readmission of clients
with frequent readmissions to the facility.
4. Denial rate for PHF that do not meet Medi-Cal medical necessity criteria as
determined by the utilization review performed by the Fresno County Mental Health
Plan.
Reporting Documents:
Annual, Quarterly, and monthly reports requested by the County, and utilized by
the Contractor to measure program goals/success are to be developed by the
Contractor and approved by the Department of Behavioral Health (DBH) Director
and/or designee.
Additional program outcomes developed by Contractor will be established and
approved by DBH prior to commencement of program operation. Some
additional outcomes Contractor may develop and seek approval are:
Reduce incidence of involuntary hospitalization and incarcerations (Post
Discharge)
Reduce frequency and severity of crisis in the community (Post Discharge)
Increased acquisition of community living, coping and communication skills
Reduction in high risk behavior (e.g. substance abuse, high risk sexual
activity)
Increased linkage to and utilization of community resources and natural
supports to foster ongoing wellness and re
Discharge to a stable living situation
Return to or linkage to outpatient mental health services
Establishing a permanent relationship with one or more caring support person
Exhibit G-1 Quarterly Progress Reporting
Page 1 of 1
Exhibit I - Medi-Cal Org Provider Standards
Exhibit I - Medi-Cal Org Provider Standards
Exhibit K - Protocol for Completion of Incident Report Page 1 of 7
Exhibit K - Protocol for Completion of Incident Report Page 2 of 7
Exhibit K - Protocol for Completion of Incident Report Page 3 of 7
Exhibit K - Protocol for Completion of Incident Report Page 4 of 7
Exhibit K - Protocol for Completion of Incident Report Page 5 of 7
Exhibit K - Protocol for Completion of Incident Report Page 6 of 7
Exhibit K - Protocol for Completion of Incident Report Page 7 of 7
Exhibit L - Fixed Asset and Sensitive Item Tracking
Field Number Field
Description Instruction or Comments Required or
Conditional
Header Vendor
Indicate the legal name of the agency contracted to
provide services.Required
Header Program
Indicate the title of the project as described in the
contract with the County.Required
Header Contract #
Indicate the assigned County contract number. If not
known, County staff can provide.Required
Header Contact Person
Indicate the first and last name of the primary agency
contact for the contract.Required
Header Contact #
Indicate the most appropriate telephone number of the
primary agency contact for the contract.Required
Header Date Prepared
Indicate the most current date that the tracking form
was completed by the vendor.Required
a Item
Identify the item by providing a commonly recognized
description of the item.Required
b Make/Brand Identify the company that manufactured the item.Required
c Model Identify the model number for the item, if applicable. Conditional
d Serial # Identify the serial number for the item, if applicable. Conditional
e Fixed Asset
Mark the box with an "X" if the cost of the item is
$5,000 or more to indicate that the item is a fixed
asset.
Conditional
f Sensitive Item
Mark the box with an "X" if the item meets the criteria
of a sensitive item as defined by the County.Conditional
g Date Requested
Indicate the date that the agency submitted a request
to the County to purchase the item.Required
h Date Approved
Indicate the date that the County approved the request
to purchase the item.Required
i Purchase Date Indicate the date the agency purchased the item.Required
j Location Indicate the physical location of the item Required
k Condition
Indicate the general condition of the item (New, Good,
Worn, Bad).Required
l
Fresno County
Inventory
Number
Indicate the FR # provided by the County for the item. Conditional
m Cost
Indicate the total purchase price of the item including
sales tax and other costs, such as shipping.Required
FIXED ASSET AND SENSITIVE ITEM TRACKING
Exhibit L - Fixed Asset and Sensitive Item Tracking
National Standards for Culturally and Linguistically
Appropriate Services (CLAS) in Health and Health Care
Principal Standard:
1. Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse
cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.
Governance, Leadership, and Workforce:
2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy,
practices, and allocated resources.
3. Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are
responsive to the population in the service area.
4. Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and
practices on an ongoing basis.
Communication and Language Assistance:
5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at
no cost to them, to facilitate timely access to all health care and services.
6. Inform all individuals of the availability of language assistance services clearly and in their preferred language,
verbally and in writing.
7. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals
and/or minors as interpreters should be avoided.
8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the
populations in the service area.
Engagement, Continuous Improvement, and Accountability:
9. Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them
throughout the organization’s planning and operations.
10. Conduct ongoing assessments of the organization’s CLAS-related activities and integrate CLAS-related measures into
measurement and continuous quality improvement activities.
11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health
equity and outcomes and to inform service delivery.
12. Conduct regular assessments of community health assets and needs and use the results to plan and implement
services that respond to the cultural and linguistic diversity of populations in the service area.
13. Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural
and linguistic appropriateness.
14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent,
and resolve conflicts or complaints.
15. Communicate the organization’s progress in implementing and sustaining CLAS to all stakeholders, constituents, and
the general public.
Exhibit M - National Standards for CLAS
The Case for the Enhanced National CLAS Standards
Health equity is the attainment of the highest level of health for all people (U.S. Department of Health and Human
Services [HHS] Office of Minority Health, 2011). Currently, individuals across the United States from various cultural
backgrounds are unable to attain their highest level of health for several reasons, including the social determinants of
health, or those conditions in which individuals are born, grow, live, work, and age (World Health Organization, 2012),
such as socioeconomic status, education level, and the availability of health services (HHS Office of Disease Prevention
and Health Promotion, 2010). Though health inequities are directly related to the existence of historical and current
discrimination and social injustice, one of the most modifiable factors is the lack of culturally and linguistically appropriate
services, broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of
all individuals.
Health inequities result in disparities that directly affect the quality of life for all individuals. Health disparities adversely
affect neighborhoods, communities, and the broader society, thus making the issue not only an individual concern but
also a public health concern. In the United States, it has been estimated that the combined cost of health disparities and
subsequent deaths due to inadequate and/or inequitable care is $1.24 trillion (LaVeist, Gaskin, & Richard, 2009).
Culturally and linguistically appropriate services are increasingly recognized as effective in improving the quality of care
and services (Beach et al., 2004; Goode, Dunne, & Bronheim, 2006). By providing a structure to implement culturally and
linguistically appropriate services, the enhanced National CLAS Standards will improve an organization’s ability to address
health care disparities.
The enhanced National CLAS Standards align with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities
(HHS, 2011) and the National Stakeholder Strategy for Achieving Health Equity (HHS National Partnership for Action to
End Health Disparities, 2011), which aim to promote health equity through providing clear plans and strategies to guide
collaborative efforts that address racial and ethnic health disparities across the country. Similar to these initiatives, the
enhanced National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care
disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and
linguistically appropriate services. Adoption of these Standards will help advance better health and health care in the
United States.
Bibliography:
Beach, M. C., Cooper, L. A., Robinson, K. A., Price, E. G., Gary, T. L., Jenckes, M. W., Powe, N.R. (2004). Strategies for improving minority healthcare quality. (AHRQ
Publication No. 04-E008-02). Retrieved from the Agency of Healthcare Research and Quality website:
http://www.ahrq.gov/downloads/pub/evidence/pdf/minqual/minqual.pdf
Goode, T. D., Dunne, M. C., & Bronheim, S. M. (2006). The evidence base for cultural and linguistic competency in health care. (Commonwealth Fund Publication No. 962).
Retrieved from The Commonwealth Fund website: http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultlinguisticcomp_962.pdf
LaVeist, T. A., Gaskin, D. J., & Richard, P. (2009). The economic burden of health inequalities in the United States. Retrieved from the Joint Center for Political and Economic
Studies website: http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%2
0Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf
National Partnership for Action to End Health Disparities. (2011). National stakeholder strategy for achieving health equity. Retrieved from U.S. Department of Health and
Human Services, Office of Minority Health website: http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286
U.S. Department of Health and Human Services. (2011). HHS action plan to reduce racial and ethnic health disparities: A nation free of disparities in health and health care.
Retrieved from http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Healthy people 2020: Social determinants of health. Retrieved
from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=39
U.S. Department of Health and Human Services, Office of Minority Health (2011). National Partnership for Action to End Health Disparities. Retrieved from
http://minorityhealth.hhs.gov/npa
World Health Organization. (2012). Social determinants of health. Retrieved from http://www.who.int/social_determinants/en/
Exhibit M - National Standards for CLAS
Exhibit N - Disclosure of Ownership & Control Interest Statement
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Exhibit N - Disclosure of Ownership & Control Interest Statement
Exhibit O - Certification Regarding Debarment, Suspension,
and Other Responsibility Matters
Exhibit O - Certification Regarding Debarment, Suspension,
and Other Responsibility Matters
Exhibit P - Self-Dealing Transaction Disclosure Form
Exhibit P - Self-Dealing Transaction Disclosure Form
Exhibit Notice of Child Abuse Reporting Form
NOTICE OF CHILD ABUSE REPORTING LAW
The undersigned hereby acknowledges that Penal Code section 11166 and the
contractual obligations between County of Fresno (COUNTY) and CONTRACTOR
related to the provision of Adult Full-Service Partnership Program Services , require
that the undersigned report all known or suspected child abuse or neglect to one or more
of the agencies set forth in Penal Code (PC) section (§) 11165.9.
a child by another person, sexual abuse as defined in PC §11165.1, neglect as defined
in PC §11165.2, willful cruelty or unjustifiable punishment as defined in PC §11165.3,
and unlawful corporal punishment or injury as defined in PC §11165.4.
A child abuse report shall be made whenever the undersigned, in his or her
professional capacity or within the scope of his or her employment, has knowledge of or
observes a child whom the undersigned knows or reasonably suspects has been the
victim of child abuse or neglect. (PC §11166.) The child abuse report shall be made to
security department), or to any county welfare department, including Fresno County
objectively reasonable for a person to entertain a suspicion, based upon facts that could
cause a reasonable person in a like position, drawing, when appropriate, on his or her
training and experience, to suspect child abuse or neglect. The pregnancy of a child
does not, in and of itself, constitute a basis for reasonable suspicion of sexual abuse.
(PC §11166(a)(1).)
Substantial penalties may be imposed for failure to comply with these child abuse
reporting requirements.
Further information and a copy of the law may be obtained from the department
head or designee.
I have read and understand the above statement and agree to comply with the
child abuse reporting requirements.
SIGNATURE _____________________________ DATE ______________________