HomeMy WebLinkAbout325671
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COUNTY OF FRESNO
Fresno1 California
FL-128 UMCBidg319
ExodusFoundation/DBH5630
FACILITY USE AGREEMENT
Agreement No. 16-222
THIS FACILITY USE AGREEMENT (hereinafter "AGREEMENT") is made and entered
into this 24th day of _ ___.:.M.:.:.:a:::..zy ___ , 2016 , by and between the COUNTY OF FRESNO , a
political subdivision of the State of California , 2220 Tulare Street, Suite 2100, Room 2101 ,
Fresno, California, 93721-2106, (hereinafter "COUNTY"), and EXODUS FOUNDATION , INC .,
a non-profit California corporation, with offices at 9808 Venice Boulevard , Suite 700 , Culver
City, California 90232 (hereinafter "EXODUS"). COUNTY and EXODUS may, hereinafter, be
referred to collectively as "Parties" or individually as "Party".
W I T N E S S E T H :
WHEREAS, COUNTY owns the building located at 4411 E. Kings Canyon , Fresno , CA
93702 (Building 319), Fresno, CA 93702 (hereinafter "Building "); and
WHEREAS , COUNTY has reached agreement with EXODUS' affiliate , Exodus
Recovery, Inc. (Exodus Recovery), to operate a Crisis Stabilization Center Facility at the
Building ; and
WHEREAS, the Board of Supervisors of COUNTY, pursuant to Government Code
section 26227 , hereby finds that the operation of a Crisis Stabilization Center Facility providing
psychiatric health services for adults and youth is necessary to meet the social needs of the
population of the County of Fresno; and is, to wit, a necessary mental health program that will
serve the health needs of Fresno County; and
WHEREAS, pursuant to Government Code section 26227 , COUNTY finds that the
portion of the Building defined hereinbelow as the "Premises," will not be needed for COUNTY
purposes during the term of this Agreement and that the use of said Premises to provide such
psychiatric health services by EXODUS' affiliate, Exodus Recovery, under the below terms and
conditions, is in the best interest of COUNTY and the general public; and
WHEREAS, COUNTY desires to enter into this Agreement with EXODUS to allow for
and ensure the ongoing provision of psychiatric health services at the Building by EXODUS'
affiliate , Exodus Recovery ; and
WHEREAS, EXODUS represents and covenants that it is a duly organized and existing
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nonprofit corporation under the laws of the State of Nevada and that it is tax-exempt under
Internal Revenue Code section 501(c)(3).
NOW, THEREFORE, in consideration of the mutual promises, covenants and
conditions hereinafter contained, such Parties, and each of them, do agree as follows:
1. PREMISES - COUNTY shall make available to EXODUS approximately ten
thousand four hundred fifty (10,450) square feet of space at the location commonly known as
4411 E. Kings Canyon, Fresno, California 93702 (Building 319) as shown in Exhibit A, attached
hereto and by this reference incorporated herein (hereinafter “Premises”).
2. TERM AND TERMINATION - The initial term of this AGREEMENT shall be for the
three (3) year period of July 1, 2016 through June 30, 2019 (“Initial Term”). Beginning July 1,
2019, this AGREEMENT will renew automatically for two (2) consecutive one-year periods,
upon the same terms and conditions herein. Automatic renewal will occur unless either Party
provides thirty (30) days written notice of non-renewal prior to the end of the Initial Term or the
then current renewal term of this AGREEMENT. In no event shall the term of this
AGREEMENT extend beyond June 30, 2021.
Notwithstanding anything to the contrary in this AGREEMENT, COUNTY shall have the
right to terminate this AGREEMENT immediately in the event that Exodus Recovery ceases to
perform any of its obligations to provide any of the services described in Section 3 hereinbelow.
EXODUS acknowledges that Exodus Recovery is an affiliate of EXODUS and, as such,
Exodus Recovery’s failure to perform any of its obligations as described in Section 3.
hereinbelow shall be deemed EXODUS’ failure to perform any of its obligations pursuant to this
AGREEMENT. As to COUNTY, the Director of Internal Services/Chief Information Officer or
the Director of the Department of Behavioral Health, or a designee of one of them, may provide
written notice of non-renewal or termination of this AGREEMENT.
3. CONSIDERATION - There is no monetary consideration for this AGREEMENT.
COUNTY acknowledges as adequate consideration for EXODUS’ use of the Premises the
services provided by Exodus Recovery as set forth in Exodus Recovery’s Scope of Work,
attached hereto as Exhibit B, and incorporated herein by reference. Such consideration, in
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addition to the mutual promises and covenants made herein by the Parties, is deemed by the
Parties to be sufficient.
4. UTILITIES - COUNTY shall be responsible for electricity, natural gas, water, sewer,
garbage, and telephone costs.
5. USE - EXODUS shall use the Premises twenty-four (24) hours per day every day of
the year to provide the services described in Exhibit B. EXODUS agrees that the use of the
Premises shall, at all times, be consistent with providing these services. EXODUS agrees to
not commit, suffer or permit any waste or nuisance on the Premises, and not to use or permit
the use of the Premises for any illegal or immoral purposes. EXODUS further agrees to
comply with all state laws, local ordinances and other governmental regulations which may be
required by any governmental authority.
COUNTY shall make the Premises available in “as is” condition. Prior to the execution
of this AGREEMENT, EXODUS shall visit the Premises and by its independent determination
confirm that the Premises are suitable for its use. COUNTY warrants that the Premises are
safe or suitable for EXODUS’ intended use and are in compliance with all applicable laws,
ordinances and regulations for said use.
6. MAINTENANCE AND REPAIRS OF PREMISES - COUNTY shall be responsible for
the structural condition of the Premises and for all exterior and interior maintenance, including
but not limited to, the air conditioning, heating, plumbing, electrical, roof, painting, landscaping
and parking lot. COUNTY covenants that, insofar as only the aforementioned items are
concerned, the Premises shall be maintained in substantially the same condition as that
existing at the commencement of this AGREEMENT.
EXODUS or Exodus Recovery, at either’s sole expense, may contract with a private
vendor for janitorial services at the Premises. EXODUS shall ensure that any private janitorial
service providing such services shall comply with the janitorial standards established by
COUNTY for its County-owned facilities, as shown in Exhibit C, attached hereto and by this
reference incorporated herein.
EXODUS shall report (or ensure that Exodus Recovery reports) damages to the
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Premises within twenty-four (24) hours after they occur to the Director of the Department of
Behavioral Health or her designee at: dbhfacilities@co.fresno.ca.us. EXODUS shall be
responsible to pay for all damages caused by the actions of Exodus Recovery patients,
employees and invitees.
7. IMPROVEMENTS TO THE PREMISES - If EXODUS desires to make
improvements to the Premises, EXODUS shall provide drawings and plans describing the
improvements to the Director of the Department of Behavioral Health, for review and approval.
The COUNTY’S approval of EXODUS’ request to make improvements shall not be
unreasonably withheld by COUNTY.
The construction of EXODUS’ improvements to the Premises shall only be performed
by COUNTY or its approved agent.
8. ENFORCEMENT OF AGREEMENT - If EXODUS shall default on any of the
covenants or agreements contained in this AGREEMENT, COUNTY shall give written notice of
such default to EXODUS, and EXODUS shall have thirty (30) days from the date the written
notice is sent to cure such default. If EXODUS does not cure the default within thirty (30) days,
COUNTY may, at its option, at any time after such default or breach and without any demand
on or notice to EXODUS or to any other person, of any kind whatsoever, re-enter and take
possession of the Premises and remove all persons or property therefrom, and EXODUS
waives any legal remedy to defeat COUNTY'S rights and possessions hereunder. However,
nothing contained herein shall prevent COUNTY from seeking any other legal or equitable
remedies in a court of law which arise from such breach or default.
9. NOTICES - All notices to be given under this AGREEMENT by either Party to the
other Party shall be in writing, and given by any one of the following methods:
(i) Personal delivery; or
(ii) Sent by certified United States mail, first class postage prepaid,
with return receipt requested, to the applicable addresses as set forth below, in which case
such notice shall be deemed given three (3) business days if COUNTY is the recipient, or three
(3) business days if EXODUS is the recipient, after such deposit and postmark with the United
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States Postal Service; or
(iii) Sent by a reputable overnight commercial courier, in which case
such notice shall be deemed given one (1) business day if COUNTY is the recipient, or one (1)
business day if EXODUS is the recipient, after such deposit with that courier to the applicable
addresses as set forth below.
The addresses and telephone numbers of the Parties for purposes of giving receiving
notices under this AGREEMENT are as follows:
COUNTY OF FRESNO: EXODUS FOUNDATION, INC.
Robert W. Bash (FL-125) Luana Murphy, President/CEO
Director of Internal Services 9808 Venice Blvd, Suite 700
2220 Tulare Street, Suite 2100
Fresno, CA 93721-2116
(559) 600-1715
Culver City, CA 90232
(310) 945-3350
Provided however, such notices may be given to such person or at such other place
as either of the Parties may from time to time designate by giving written notice to the other
Party, and provided further however, in any event notices of changes of address or termination
of this AGREEMENT shall not be effective until actual delivery of such notice. Notices given
hereunder shall not be amendments or modifications to this AGREEMENT .
10. HOLD HARMLESS - EXODUS agrees to indemnify, save, hold harmless, and at
COUNTY'S request, defend the COUNTY, its officers, agents, and employees from any and all
costs and expenses, damages, liabilities, claims, and losses occurring or resulting to COUNTY
in connection with the performance, or failure to perform, by EXODUS, its officers, agents,
affiliates,or employees under this AGREEMENT, and from any and all costs and expenses,
damages, liabilities, claims, and loses occurring or resulting to any person, firm, or corporation
who may be injured or damaged by the performance, or failure to perform of EXODUS, its
officers, agents, affiliates or employees under this AGREEMENT.
The parties acknowledge that as between COUNTY and EXODUS each is responsible
for the negligence of its own employees and invitees.
11. INTERNAL SECURITY FOR THE PREMISES – EXODUS or its affiliate, Exodus
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Recovery, at either’s sole expense, may contract with a private security service for internal
security of the Premises. EXODUS shall ensure that in such event, the internal security
provided shall be provided twenty-four (24) hours per day every day of the calendar year.
12. INSURANCE – Without limiting the COUNTY’S right to obtain indemnification from
EXODUS or any third parties, EXODUS, at its sole expense, shall maintain in full force and
effect, the following insurance policies or a program of self-insurance, throughout the term of
this AGREEMENT:
a. Commercial General Liability - Commercial General Liability Insurance with
limits of not less than One Million Dollars ($1,000,000) per occurrence and an
annual aggregate of Two Million Dollars ($2,000,000). This policy shall be
issued on a per occurrence basis. COUNTY may require specific coverages
including completed operations, products liability, contractual liability, Explosion-
Collapse-Underground, fire legal liability, or any other liability insurance deemed
necessary because of the nature of this contract.
b. Property Insurance – Against all risk of loss to COUNTY property, at full
replacement cost with no coinsurance penalty provision, naming COUNTY as
an additional loss payee.
c. Automobile Liability - Comprehensive Automobile Liability Insurance with
limits for bodily injury of not less than Two Hundred Fifty Thousand Dollars
($250,000) per person, Five Hundred Thousand Dollars ($500,000) per accident
and for property damages of not less than Fifty Thousand Dollars ($50,000), or
such coverage with a combined single limit of Five Hundred Thousand Dollars
($500,000). Coverage should include owned and non-owned vehicles used in
connection with this AGREEMENT.
d. Worker’s Compensation - A policy of Worker’s Compensation insurance
may be required by the California Labor Code.
e. Professional Liability Insurance - If EXODUS employs professional staff
(e.g., PH.D., R.N., L.C.S.W., M.F.C.C.) in providing services, with limits of not
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less than One Million Dollars ($1,000,000) per occurrence, Three Million Dollars
($3,000,000) annual aggregate.
EXODUS shall obtain endorsements to the Commercial General Liability insurance
naming the County of Fresno (hereinafter “County”), 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 EXODUS’ policies herein. This insurance shall not be cancelled or changed without a
minimum or thirty (30) days advance written notice given to County.
Within (30) days from date EXODUS executes this AGREEMENT, EXODUS shall
provide certificates of insurance and endorsement as stated above for all of the foregoing
policies, as required herein, to the County of Fresno, Attn: ISD Lease Services (FL-128), 2220
Tulare Street, 21st Floor, Room 2101, Fresno, CA 93721-2106, stating that such insurance
coverages have been obtained and are in full force; that the County, its officers, agents and
employees will not be responsible for any premiums on the policies; that such Commercial
General Liability insurance names the County, 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 shall not be cancelled or changed
without a minimum of thirty (30) days advance, written notice given to County.
In the event EXODUS fails to keep in effect at all times insurance coverage as herein
provided, the 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 purchased from companies possessing a current A.M
Best Company rating of A FSC VII or better.
COUNTY shall maintain during the term of this AGREEMENT the following policies of
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insurance, which coverages may be provided in whole or in part through one or more programs
of self-insurance:
a. Commercial General liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence and an annual aggregate of not less
than Two Million Dollars ($2,000,000). This policy shall be issued on an
occurrence basis.
b. All-Risk property insurance.
13. INDEPENDENT CONTRACTOR - In performance of the work, duties and
obligations assumed by EXODUS under this AGREEMENT, it is mutually understood and
agreed that EXODUS, including any and all of the EXODUS' officers, agents, and employees
will at all times be acting and performing as an independent contractor, and shall act in an
independent capacity and not as an officer, agent, servant, employee, joint venturer, partner, or
associate of the COUNTY. Furthermore, COUNTY shall have no right to control or supervise
or direct the manner or method by which EXODUS shall perform its work and function.
However, COUNTY shall retain the right to administer this AGREEMENT so as to verify that
EXODUS is performing its obligations in accordance with the terms and conditions of the
AGREEMENT.
COUNTY and EXODUS shall comply with all applicable provisions of law and the
rules and regulations, if any, of governmental authorities having jurisdiction over matters the
subject thereof.
Because of its status as an independent contractor, EXODUS shall have absolutely
no right to employment rights and benefits available to COUNTY'S employees. EXODUS shall
be solely liable and responsible for providing to, or on behalf of, its employees all legally-
required employee benefits. In addition, EXODUS shall be solely responsible and save/hold
COUNTY harmless from all matters, except for COUNTY AND COUNTY’S employee’s gross
negligence and/or willful misconduct, relating to payment of EXODUS' employees, including
compliance with Social Security withholding and all other regulations governing such matters
14. SURRENDER OF POSSESSION - Upon the expiration or termination of this
FL-128 UMCBldg319 ExodusFoundation/DBH5630
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AGREEMENT, EXODUS will surrender the Premises to COUNTY in such condition as existing
at the commencement of this AGREEMENT less reasonable wear and tear, and less the
effects of any breach of COUNTY'S covenant to maintain. EXODUS will not be responsible for
any damage which EXODUS was not obligated hereunder to repair.
15. FIXTURES - EXODUS agrees that any equipment, fixtures or apparatus installed in
or on the Premises by EXODUS shall become the property of COUNTY and may not be
removed by EXODUS at any time.
16. POSSESSORY INTEREST SUBJECT TO TAXATION AND PROPERTY
INTEREST SUBJECT TO ASSESSMENT - The Parties acknowledge that California Revenue
& Taxation Code § 107.6 provides, in relevant part, the following: ‘(a) The state or any local
public entity of government, when entering into a written contract with a private party whereby a
possessory interest subject to property taxation may be created, shall include, or cause to be
included, in that contract, a statement that the property interest may be subject to property
taxation if created, and that the party in whom the possessory interest is vested may be subject
to the payment of property taxes levied on the interest.’ Accordingly, the Parties agree that
COUNTY is a ‘local public entity of government,’ and that EXODUS is a ‘private party,’
respectively, within the meaning of California Revenue & Taxation Code § 107.6(a), and that
this AGREEMENT is a ‘contract,’ which creates a possessory interest that is subject to property
taxation pursuant to California Revenue & Taxation Code § 107.6(a). In this regard, under this
AGREEMENT, EXODUS acknowledges and agrees that (1) the property interest created by
this AGREEMENT is subject to property taxation, and (2) EXODUS (i.e., the party in whom the
possessory interest is vested) shall, at its sole cost and expense, be subject to the direct
payment of property taxes levied on such interest, and shall directly pay any and all property
taxes levied on such interest, and any interest, penalties, or charges thereon for EXODUS’ late
payment of, or failure to pay such amounts when they are due and payable.
The Parties acknowledge that California Constitution, Article XIIID (also known as
Proposition 218), § 2 provides as follows: ‘(b) ‘Assessment’ means any levy or charge upon
real property by an agency for a special benefit conferred upon the real property. ‘Assessment’
FL-128 UMCBldg319 ExodusFoundation/DBH5630
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includes, but is not limited to, ‘special assessment,’ ‘benefit assessment,’ ‘maintenance
assessment’ and ‘special assessment tax[;…] (e) ‘Fee’ or ‘charge’ means any levy other than
an ad valorem tax, a special tax, or an assessment, imposed by an agency upon a parcel or
upon a person as an incident of property ownership, including a user fee or charge for a
property related service[; … and] (g)’ Property ownership’ shall be deemed to include tenancies
of real property where tenants are directly liable to pay the assessment, fee, or charge in
question.’ Accordingly, the Parties agree that this AGREEMENT creates and include a
tenancy of real property, which shall be deemed to be a ‘property interest’ subject to
assessments, or fees or charges under California Constitution, Article XIIID, § 2. In this regard,
under this AGREEMENT, EXODUS acknowledges and agrees that (1) the tenancy of real
property created and included by this AGREEMENT is subject to assessments, and fees and
charges within the meaning of California Constitution, Article XIIID, § 2, and (2) EXODUS (i.e.,
the party in whom the tenancy of real property is vested) shall, at its sole cost and expense, be
subject to the direct payment of such assessments, and fees and charges levied on such
interest, and shall directly pay any and all such assessments, and fees and charges levied on
such interest, and any interest, penalties, or charges thereon for EXODUS’ late payment of, or
failure to pay such amounts when they are due and payable.
The provisions of this Section 16 shall survive the termination of this AGREEMENT.
17. RIGHT OF ENTRY - COUNTY, or its representative(s), shall have the right to enter
the Premises at any time during business hours with reasonable notice and at such other time
as EXODUS deems appropriate, to make any alterations, repairs or improvements to the
Premises. The normal business of EXODUS or its invitees shall not be unnecessarily
inconvenienced.
18. AMENDMENT - This AGREEMENT may be amended in writing by the mutual
consent of the Parties without in any way affecting the remainder.
19. NON-ASSIGNMENT - Neither Party shall assign, transfer or sub-contract this
AGREEMENT, nor their rights or duties under this AGREEMENT, without the prior written
consent of the other Party. Such consent is hereby granted for EXODUS to sub-lease the
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Premises to Exodus Recovery for the purposes described herein.
20. GOVERNING LAW - Venue for any action arising out of or relating to this
AGREEMENT shall be in Fresno County, California. This AGREEMENT shall be governed by
the laws of the State of California.
21. DISCLOSURE OF SELF DEALING TRANSACTIONS - This provision is only
applicable if the EXODUS is operating as a corporation (a for-profit or non-profit corporation) or
if during the term of this AGREEMENT, EXODUS changes its status to operate as a
corporation.
Members of EXODUS’ Board of Directors shall disclose any self-dealing transactions
that they are a party to while EXODUS is providing goods or performing services under this
AGREEMENT. A self-dealing transaction shall mean a transaction to which the EXODUS 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 D) and submitting
it to the County of Fresno prior to commencing with the self-dealing transaction or immediately
thereafter.
22. AUTHORITY - Each individual executing this AGREEMENT on behalf of EXODUS
represents and warrants that that individual is duly authorized to execute and deliver this
AGREEMENT on behalf of EXODUS and that this AGREEMENT is binding upon EXODUS in
accordance with its terms. The terms of this AGREEMENT are intended by the Parties as a
final expression of their agreement with respect to such terms as are included in this
AGREEMENT and may not be contradicted by evidence of any prior or contemporaneous
agreement, arrangement, understanding or negotiation (whether oral or written).
23. ENTIRE FACILITY USE AGREEMENT - This AGREEMENT constitutes the entire
AGREEMENT between the COUNTY and EXODUS with respect to the subject matter hereof
and supersedes all prior AGREEMENTS, negotiations, proposals, commitments, writings,
advertisements, publications, and understandings of any nature whatsoever, unless expressly
referenced in this AGREEMENT.
FL-128 UMCBidg319
ExodusFoundation/DBH5630
1 EXECUTED as of the date first herein written .
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EXODUS :
EXODUS FOUNDATION, INC.
~~ B·~~~~~~~~~~~~-
LeeAnn Skorohod , CHC , CCEP
Senior Vice President
21 Fund : 0001
Subs : 10000
22 Org No . 56302111
Acct. No. 7294
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COUNTY OF FRESNO
Fresno , California
FL-128/Exodus/DBH5630(Facility)
COUNTY:
COUNTY OF FRESNO
By 9 :¢L/) 1-~---~
Ernest Buddy Mend s, Cha1rman
Board of Supervisors
ATTEST: BERNICE E. SEIDEL, CLERK
BOARD OF SUPERVISORS
By ~v-.~ ~s.\-.w
Deputy
APPROVED AS TO LEGAL FORM:
DANIEL C . CEDERBO , COUNTY COUNSEL
0 /7
By , :..w---. _,.,.M~ • ..r
APPROVED AS TO ACCOUNTING FORM :
VICKI CROW, C .P.A.
AUDITOR-CONTROLLERffREASURER-TAX
COLLECTOR
By QJJ.v._ z: u~~Jc::=
Robert W . Bash, Direc or of Internal
Services/Chief Information Officer
RECOMMENDED FOR APPROVAL:
By ~~
12
Dawan Utecht, Director, Department of
Behavioral Health
Exodus ‐ Child/Adolescent Crisis Stabilization Center P033NBasementAccessNursing StationNorthUnitProposed CPHFCommons(Activity)AreaUncoveredPatioWaitingRoomMainEntranceExitExitExitExitExitExitExitExitExitExitExitExitExit ExitExitExitP030P019P022P004P005P017P015P011P028P029P031P034P021P020A001A005NETWORKP037A011A010A012A013A014 CONFAA08AA1190664812CHARTING5813
42343973581551855816AA10AA09C10C12C11P018ReceptionA009A048A046A047A028RN OfficeA133A130CPRSAA12123ExitExitHearing RmCourt YardC9C8C3C4C5C6C7C2C1Exodus – Adult Psychiatric Health FacilityCentral Star ‐ Child/Adolescent Psychiatric Health FacilityUrgent Care Wellness Center Exodus ‐Adult Crisis Stabilization Center Proposed CCSCExhibit AFL - 128Adult and Youth Crisis Stabilization Center
BUILDING 319UNIVERISTY MEDICAL CENTER
Exhibit B
FL-128
Page 1 of 29
ADULT CRISIS STABILIZATION CENTER
Scope of Work
ORGANIZATION: Exodus Recovery, Inc.
ADDRESS: 9808 Venice Boulevard, Suite 700, Culver City, CA 90232
SITE ADDRESS: 4411 E. Kings Canyon Road, Fresno, CA 93702 (Bldg 319)
SERVICES: Adult Crisis Stabilization Services
PROJECT DIRECTOR: Luana Murphy, MBA, President/CEO
Phone Number: (559) 453-6271
CONTRACT PERIOD: July 1, 2016 – June 30, 2019, with two (2) twelve (12) month renewal options
CONTRACT AMOUNT:
Fiscal Year Contract Maximum
FY 2016-17 $6,527,765
FY 2017-18 $6,723,623
FY 2018-19 $6,925,332
FY 2019-20 $7,133,092
FY 2020-21 $7,347,085
SCHEDULE OF SERVICES:
CONTRACTOR shall operate the Adult Crisis Stabilization Center (Adult CSC) twenty-four (24) hours per day,
seven (7) days per week. The Adult CSC shall be located at the Kings Canyon Campus at 4411 E. Kings
Canyon Road, Fresno, California 93702 (Building 319), a COUNTY-owned building, pursuant to a separate
lease agreement (and any related amendments) between COUNTY and Exodus Foundation, Inc., an affiliate
of CONTRACTOR.
TARGET POPULATION:
The target population will include clients 18 years of age and older from Fresno County, who are exhibiting
acute psychiatric symptoms and have either been placed on a Welfare and Institution Code (W&IC) 5150
designation or who request admittance to the Adult CSC on a voluntary status. CONTRACTOR will provide
crisis stabilization services to adult clients with a twenty (20) bed maximum at any given time. However,
CONTRACTOR may be in the process of assessing or evaluating additional clients, as necessary.
CONTRACTOR will accept voluntary or involuntarily admitted clients regardless of source of payment;
clients will include Medi-Cal beneficiaries, Medicare and Medicare/Medi-Cal beneficiaries, privately insured
and indigent/uninsured clients who are referred by the Department of Behavioral Health (DBH), a contract
provider with the DBH, a hospital emergency room (aka emergency department), law enforcement, or
Emergency Medical Services (EMS). Clients may also be family or self-referred.
These services shall be performed pursuant to W&IC, sections 5704.5(b), 5704.6(c), and 5614(b)(3) and
program principles and the array of treatment options required under W&IC, sections 5600.2 to 5600.9
inclusive.
PROJECT DESCRIPTION:
CONTRACTOR shall be responsible to comply with the requirements of the Fresno County Mental Health Plan
(FCMHP) and must complete and submit supporting clinical and any other such documentation as may be
Exhibit B
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required by the COUNTY for every client served in the Adult CSC. The FCMHP will perform a utilization
review of all admissions to determine that the documentation demonstrates that medical necessity criteria as
defined by the California Department of Health Care Services (DHCS) was met for each duration of the
hospitalization, except for the episode of discharge.
CONTRACTOR shall be responsible to enter all Client Service Information, admission data and billing
information into the COUNTY data system (AVATAR) and will be responsible for any and all audit exceptions
pertaining to the delivery of services.
CONTRACTOR’S RESPONSIBILITIES:
A. CONTRACTOR shall ensure that the Adult CSC provides the following services:
1. Management and alleviation of client’s acute psychiatric symptoms through effective therapeutic
interventions and supportive services to avoid the need for a higher level of psychiatric care
when clinically appropriate.
2. A recovery/strength based clinical program which has appropriate professional staffing on a
twenty-four (24) hour, seven (7) day a week basis.
3. A safe, secure environment for clients that encourages wellness and recovery.
4. A comprehensive multi-disciplinary evaluation and client-centered treatment plan.
5. Dietary services through the availability of nourishment or snacks in accordance with Title 22,
Division 5, Chapter 9, Article 3, Section 77077.
6. Admission procedures for clients, who are not on involuntary holds in accordance with Welfare
and Institutions Code 5150 and also individuals placed on W&I 5150 involuntary holds.
7. Crisis consultation services to rural service providers (e.g. emergency departments, etc.) that
may not have timely access to the centrally located crisis stabilization facilities and may require
consultation to support client care planning and/or mitigate unnecessary long transports of clients
to the Adult CSC from remote areas. Crisis consultation may occur via teleconference, tele-
behavioral health (i.e. utilization of video and computer equipment), and/or other method
presented by CONTRACTOR and deemed acceptable by the department.
8. Treatment Planning – Under the clinical direction of the mental health clinician, the multi-
disciplinary treatment team formed by the Crisis Stabilization staff shall provide the following
services:
a. Mental Status Examination
b. Medical Evaluation
c. Full Clinical Assessment
d. Nursing Assessment
e. Multi-Disciplinary Milieu Treatment Program
f. Client Centered Treatment Planning
g. Aftercare Planning and Wellness Recovery Action Plan (WRAP)
9. Staffing
a. The staffing pattern for the crisis stabilization program shall meet all current State
licensing and regulatory requirements including medical staff standards, nursing staff
Exhibit B
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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 (CCR) for
Crisis Stabilization services. All staff requiring federal/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. CONTRACTOR shall remain up-to-date with
all current regulatory changes and adhere to all new and/or modified requirements.
b. All facility staff who provide direct client care or perform coding/billing functions must meet
the requirements of the FCMHP 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 of CONTRACTOR’s staff who
have direct contact with the clients, shall have Department of Justice (DOJ), Federal
Bureau of Investigation (FBI), and Sheriff fingerprinting (Livescan) executed.
c. Peer and/or family support staff will be an active and key member of the multi-disciplinary
team to assist with treatment planning, mentoring, support and advocate with
clients/families during their time at the Adult CSC facility and will assist with discharge
planning and facilitate the client’s transition to the appropriate lower level of care.
d. The staffing requirements defined by CCR, Title 9, Section 1840.348 for the Adult CSC is
as follows:
(a) A physician shall be on call at all times for the provision of those Crisis Stabilization
Services that may only be provided by a physician.
(b) There shall be a minimum of one Registered Nurse, Psychiatric Technician, or
Licensed Vocational Nurse on site at all times beneficiaries are present.
(c) At a minimum there shall be a ratio of at least one licensed mental health or
waivered/registered professional on site for each four beneficiaries or other patients
receiving Crisis Stabilization at any given time.
(d) If the client is evaluated as needing service activities that can only be provided by a
specific type of licensed professional, such persons shall be available.
(e) Other persons may be utilized by the program, according to need.
(f) If Crisis Stabilization services are co-located with other specialty mental health
services, persons providing Crisis Stabilization must be separate and distinct from persons
providing other services.
(g) Persons included in required Crisis Stabilization ratios and minimums may not be
counted toward meeting ratios and minimums for other services.
e. CONTRACTOR shall submit daily staffing reports that identify all direct service and
support staff by first and last name, applicable licensure/certifications, full time hours
worked, and the licensed/waivered/registered mental health professionals to client ratio.
10. Medical Records
a. The CONTRACTOR shall maintain records in accordance with Exhibit D, “Documentation
Standards for Client Records.” During site visits, COUNTY shall be allowed to review
Exhibit B
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records of services provided, including the goals and objectives of the treatment plan, and
how the therapy provided is achieving the goals and objectives.
b. The CONTRACTOR will be responsible for “release of information” requests for the Adult
CSC facility and shall adhere to applicable federal and state regulations.
11. Clinical Staff - The clinical staff of CONTRACTOR shall be composed of all licensed mental
health or waivered/registered professionals as included in CCR, Title 9, Division 1, Chapter 11,
Article 3, Section 1840.348 (Crisis Stabilization Staffing Requirements).
12. Medical Staff – The medical staff shall include a physician and a registered nurse, psychiatric
technician or licensed vocational nurse and any other type of licensed professional needed to
address client needs, pursuant to CCR, Title 9, Division 1, Chapter 11, Article 3, Section
1840.348 (Crisis Stabilization Staffing Requirements).
13. Pharmaceutical Services – CONTRACTOR shall provide for medication services on an as
needed basis and the staffing must reflect this availability, pursuant to CCR, Title 9, Division 1,
Chapter 11, Article 3, Section 1840.338 (Crisis Stabilization Contact and Site Requirements) and
all other applicable federal/state regulations.
14. Assessment of Physical Health and Medical Backup Services – Pursuant to CCR, Title 9,
Division 1, Chapter 11, Article 3, Section 1840.338 (Crisis Stabilization Contact and Site
Requirements), CONTRACTOR shall provide admission history and physical examination, and
maintain a written agreement for medical services with one or more general acute care hospitals.
15. Utilization Review, Billing and Cost Report:
a. CONTRACTOR shall notify the COUNTY 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 approved by the COUNTY.
b. CONTRACTOR shall be responsible to insure that documentation in the client’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’s electronic information system and will be responsible for any and all audit
exceptions pertaining to the delivery of services.
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
120 days following the end of each fiscal year.
e. CONTRACTOR shall insure that cost reports are prepared in accordance with General
Accepted Accounting Principles (GAAP) and the standards set forth by the DHCS and the
COUNTY.
16. Patients’ 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.
Exhibit B
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17. Family Advocate - CONTRACTOR shall promote and allow client access to the Family Advocacy
Services representative (Family Advocate) who is contracted by the COUNTY to advocate and
assist clients, families and support systems who are seeking or receiving mental health services.
Exhibit B
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18. Grievances and Incident Reports
CONTRACTOR shall have all grievance forms readily available at the Adult CSC facility.
CONTRACTOR shall log all grievances and the disposition of all grievances received from a
client or a client’s family in accordance with FCMHP policies and procedures as indicated within
Exhibit G. CONTRACTOR shall provide a summary of the grievance log entries concerning
COUNTY-sponsored 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.
CONTRACTOR shall post signs, provided by the COUNTY, informing clients 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. The CONTRACTOR
shall use the Incident Report form as indicated within Exhibit H for such reporting.
Within fifteen (15) days after each grievance or incident affecting COUNTY-sponsored 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 a 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.
19. Provide a safe and secure environment to provide for clinical and medical assessment,
diagnostic formulation, crisis intervention, medication management, and clinical treatment for
mental health clients with acute psychiatric symptoms. This includes the manner in which
seclusion and restraint will be administered when necessary for the safety of the clients, other
clients in the program, and staff.
20. Provide the appropriate type and level of staffing to provide for a clinically effective program
design that adheres to State staffing requirements.
21. Provide staff training in the areas of non-violent crisis intervention, evidence-based practice, best
practice, or promising practices to insure staff are competent and proficient in the therapeutic
interventions and practices in serving adult clients accessing the Adult CSC.
22. CONTRACTOR shall utilize cost containment strategies for the provision of stock and
prescription medications to clients (i.e. by contracting with a pharmaceutical benefits
management company) and provide the COUNTY with the type of formulary utilized by the
program as well as information regarding co-pays and/or generic substitutions.
23. Provide an intensive treatment program which has individualized treatment plans.
24. Stabilize the clients’ acute psychiatric symptoms in the most expedient manner possible while
adhering to appropriate clinical care standards. This may include initiating a Treatment
Authorization Request (TAR) to the pharmacy and providing justification when psychotropic
medications are needed on an emergency basis.
25. Effectively partner with other programs in the COUNTY and community system (i.e. law
enforcement, local emergency departments, etc.) in accepting COUNTY clients for admission for
crisis stabilization services.
Exhibit B
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26. Effectively partner with rural services providers (i.e. emergency departments, etc.) to provide
crisis stabilization services via teleconference, tele-behavioral health (i.e. utilization of video and
computer equipment), and/or other method deemed acceptable by COUNTY.
27. Work collaboratively with the COUNTY and community resources in discharge planning to
ensure appropriate referral and direct linkage to ongoing outpatient specialty mental health
treatment services, substance use disorder treatment services, etc. are provided. Discharge
planning would also include working collaboratively with out-of-county Mental Health Plans to
ensure clients in foster care who reside within Fresno County are linked to appropriate ongoing
specialty mental health services, substance use disorder treatment services, etc. as appropriate.
28. Identify clients with frequent admissions during the fiscal year and develop strategies with other
COUNTY and community agencies to reduce readmissions and improve clients’ overall well-
being through coordination of care.
29. Effectively interact with community agencies, other mental health programs and providers,
natural support systems, and families to assist clients to be discharged to the appropriate level of
care.
30. Work effectively with the DBH Conservatorship Team as appropriate for clients presenting to the
Adult CSC as gravely disabled who may require consideration for a temporary conservatorship.
31. Integrate mental health and substance use disorder services. The CONTRACTOR shall perform
the following:
a. Develop a formal written Continuous Quality Improvement CQI action plan to identify
measurable objectives toward the achievement of co-occurring disorders (COD) treatment
capability that will be addressed by the program during the contract period. These objectives
should be achievable and realistic for the program, based on a self-assessment and the
program priorities, but need to include attention to making progress on the following issues, at
minimum:
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 clients served have co-occurring issues;
4. Developing the goal of basic co-occurring competency for all treatment and support
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.
B. Regarding cultural and linguistic competence requirements, CONTRACTOR shall:
1. Ensure compliance with Title 6 of the Civil Rights Act of 1964 (42 U.S.C. Section 2000d, and 45
C.F.R. Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial
assistance from discriminating against persons based on race, color, national origin, sex,
disability or religion. This is interpreted to mean that a limited English proficient (LEP) individual is
entitled to equal access and participation in federally funded programs through the provision of
comprehensive and quality bilingual services.
Exhibit B
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2. Create and maintain policies and procedures for ensuring access and appropriate use of trained
interpreters and material translation services for all LEP clients, including, but not limited to,
assessing the cultural and linguistic needs of its clients, training of staff on the policies and
procedures, and monitoring its language assistance program. The CONTRACTOR’s procedures
must include ensuring compliance of any subcontracted providers with these requirements.
3. Ensure that minors shall not be used as interpreters.
4. Conduct and submit to COUNTY an annual cultural and linguistic needs assessment to promote
the provision and utilization of appropriate services for its diverse client population. The needs
assessment report shall include findings and a plan outlining the proposed services to be
improved or implemented as a result of the assessment findings, with special attention to
addressing cultural and linguistic barriers and reducing racial, ethnic, language, abilities, gender,
and age disparities.
5. Develop internal systems to meet the cultural and linguistic needs of the CONTRACTOR’s client
census including the incorporation of cultural competency in the CONTRACTOR’s mission;
establishing and maintaining a process to evaluate and determine the need for special -
administrative, clinical, welcoming, billing, etc. - initiatives related to cultural competency.
6. Develop recruitment and retention initiatives to establish contracted program staffing that is
reflective and responsive to the needs of the program and target population.
7. Establish designated staff person to coordinate and facilitate the integration of cultural
competency guidelines and attend COUNTY’s DBH Cultural Diversity Committee scheduled
meetings. The designated person will provide an array of communication tools to distribute
information to staff relating to cultural competency issues.
8. Keep abreast of evidence-based and best practices in cultural competency in mental health care
and treatment to ensure that the CONTRACTOR maintains current information and an external
perspective in its policies. The CONTRACTOR shall evaluate the effectiveness of strategies and
programs in improving the health status of cultural-defined populations.
9. Ensure that an assessment of a client’s sexual orientation is included in the bio-psychosocial
intake process. CONTRACTOR’s staff shall assume that the population served may not be in
heterosexual relationships. Sensitivity to gender and sexual orientation must be covered in
annual training.
10. Utilize existing community supports, referrals to transgender support groups, etc., when
appropriate.
11. Attend annual Cultural Competence, Compliance, Health Insurance Portability and Accountability
Act (HIPAA), Billing, and Documentation training provided by COUNTY’s DBH.
12. Report its efforts to evaluate cultural and linguistic activities as part of the CONTRACTOR’s
ongoing quality improvement efforts in the monthly activities report. Reported information may
include clients’ complaints and grievances, any resulting actions regarding complaints and
grievances, results from client satisfaction surveys, and utilization and other clinical data that may
reveal health disparities as a result of cultural and linguistic barriers.
C. Regarding Conservatees, CONTRACTOR agrees to the following:
CONTRACTOR shall work with COUNTY’s DBH Client Placement Team to find placement for
COUNTY conservatees that are discharged from the CONTRACTOR-operated Adult CSC.
Exhibit B
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D. Regarding direct admissions to the Adult CSC from COUNTY’s DBH programs or its contracted
providers, the CONTRACTOR agrees to the following:
1. To allow direct admits from COUNTY’s DBH programs or its contracted providers when the Adult
CSC has the capacity to accept clients for services.
2. Said direct admits shall not require medical clearance, if client would otherwise meet the
Emergency Medical Services 5150 Destination Policy requirements as mentioned hereinbelow in
Subsection F. 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 Adult
CSC operated by CONTRACTOR.
E. Regarding the placement of a client at another designated facility:
1. CONTRACTOR shall notify COUNTY DBH when a client will remain at the CSC for a period in
excess of 24 hours, while awaiting placement and/or transportation. The COUNTY’s Patients
Rights Advocate will be included in this notification
2. CONTRACTOR shall provide the following services to clients who remain at the CSC for a period
in excess of 24 hours and who are awaiting placement and/or transportation:
a. Three meal periods and three snack times per 24 hours
b. Daily encouragement and support with activities of daily living i.e. showering, washing of
clothes, teeth brushing, hair combing etc.
c. Daily psychiatric evaluation by both the provider and licensed nursing staff to
evaluate/determine the clients most appropriate level of care
d. Daily medication evaluation, administration and education
e. Daily group activities (e.g. 12-Step Meetings, WRAP, Goals Group, etc.)
f. Daily one-on-one peer support provided by designated Peer Advocate
g. Daily activities such as meditation, art, entertainment and outdoor activities provided in the
outside courtyard
h. Daily education in relation to mental health diagnosis, treatments, and community resources
.
F. Regarding the provision of court testimony related to Adult CSC clients, CONTRACTOR agrees to
the following:
CONTRACTOR’s staff shall provide court testimony relevant to Adult CSC clients, when required.
G. Regarding the Emergency Medical Services (EMS) 5150 Destination Policy, CONTRACTOR
agrees to the following:
CONTRACTOR agrees to follow the then-current Emergency Medical Services 5150 Destination
Policy as identified in Exhibit L, attached hereto and incorporated herein. Said policy may be
updated periodically throughout the term of this Agreement; CONTRACTOR must adhere to the
most recent policies designated by the EMS 5150 Destination Policy. References to the
Children’s Crisis Assessment Intervention Resolution (CCAIR) Unit in Exhibit L reflect services to
be performed by CONTRACTOR at the COUNTY’s Youth CSC
H. CONTRACTOR shall participate in the following meetings:
1. CONTRACTOR shall participate in periodic workgroup meetings scheduled by staff from
COUNTY’s DBH Mental Health Contracted Services Unit. The meetings shall be held monthly, or
Exhibit B
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as needed, to discuss contract requirements, data reporting, outcomes measurement, training,
policies and procedures, and overall program operations.
2. CONTRACTOR’s administrative level agency representative, who is duly authorized to act on
behalf of CONTRACTOR, shall attend regularly scheduled monthly Behavioral Health Board
meetings.
3. CONTRACTOR shall attend quarterly or periodic DBH Contractor/Provider Meetings, as
scheduled by staff from COUNTY’s Mental Health Contracted Services Unit, when deemed
necessary by the DBH Director, or designee.
4. CONTRACTOR may also be asked to make presentations in the community about the program
and services that are available.
I. Regarding the development of policies and protocols:
CONTRACTOR and COUNTY’s DBH shall collaborate on the development of specific policies
and protocols related to the daily operation of the Adult CSC. Such policies will include, but not
be limited to, the following: placement of adults in psychiatric health facilities or other inpatient
programs either locally or outside the county, facility limitations, and special client populations.
Such policies and protocols shall be mutually agreed upon between CONTRACTOR and
COUNTY’s DBH Director, or designee. Any changes to such policies and protocols shall be
mutually agreed upon between CONTRACTOR and COUNTY’s DBH Director, or designee.
PROGRAM OUTCOMES
The Department of Behavioral Health is dedicated to supporting the wellness of individuals, families and
communities in Fresno County who are affected by, or at the risk of, mental illness and/or substance use
disorders through cultivation of strengths toward promoting recovery in the least restrictive environment.
Five (5) Work Plans will be utilized to support DBH’s mission statement. The work plans were developed as
a concept of a Transformation Plan that would encompass system planning, implementation and oversight
to be reflective of a comprehensive system of care. These work plans are provided below and represent
program goals to be achieved by CONTRACTOR in addition to CONTRACTOR-developed outcomes. DBH
may adjust the outcome measurements needed under this program periodically, so as to best measure the
success of clients and program as determined by the County.
CONTRACTOR will utilize a computerized tracking system with which outcome measures and other
relevant consumer data, such as demographics, will be maintained.
1. Behavioral Health Integrated Access – timeliness between client referral to admission, admission
to treatment, and treatment to discharge; penetration rate; effectiveness of discharge planning as
demonstrated by referral and linkage to other DBH programs, community providers, and other
community resources; and services that provide screening and access to ensure clients are linked to
the services they need, including mental health substance use disorders and physical health
services.
2. Wellness, Recovery, and Resiliency Supports – collaborative approach to treatment strategies to
reduce readmission of consumers with frequent admissions to the facility; effectiveness of services
as demonstrated by the number of consumers who are able to be discharged to the community and
avoid inpatient hospitalization; measurement of recidivism rates, including measuring percentage of
recidivism within 30 days. State the Evidence Based Practices (EBP) that shall be used.
Exhibit B
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3. Cultural/Community Defined Practices – services or philosophical practices which support the
unique cultural-specific needs of individuals receiving care. Focus on behavioral health practices
which reflect the unique needs of various cultures and communities who reside within Fresno
County.
4. Behavioral Health Clinical Care – services where direct therapeutic treatment is provided. Include
the framework of “Levels of Care” where client’s needs, as identified through assessment/screening,
are matched with a complexity and intensity of services meets those needs.
5. Infrastructure Supports – includes all personnel, equipment, programs, and facilities which exist to
support the delivery of care to the clients served. Includes safety, quality improvement and
regulatory compliance functions, along with outcome assessment/program evaluation, training, and
technology.
6. Denial rate for Crisis Stabilization billing will be decreased by 5% within the first six months, based on
previous program denial rates. Rates will be determined by the utilization review performed by
FCMHP.
COUNTY RESPONSIBILITIES:
COUNTY shall:
1. Perform a utilization review, annually at a minimum, (through its FCMHP) of ten percent (10%) of all
admissions to determine that the documentation demonstrates that medical necessity criteria as defined
by the DHCS were met throughout the duration of the crisis stabilization episode. The FCMHP will
maintain discretion regarding possible subsequent utilization review beyond ten percent (10%), as
necessary.
2. Provide oversight of the CONTRACTOR’s Adult CSC program. In addition to contract monitoring of
program(s), oversight includes, but is not limited to, coordination with the DHCS in regard to program
administration and outcomes.
3. Assist the CONTRACTOR in making linkages to the appropriate level of care within the behavioral
health system of care to insure continuity 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 staff and will be available to the contractor for ongoing consultation.
5. Receive and analyze statistical outcome data from CONTRACTOR throughout the term of contract on a
monthly basis. 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:
Exhibit B
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A. 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 (LGBT) individuals may be at
increased risk for mental disorders and mental health problems due to exposure to societal
stressors such as stigmatization, prejudice and anti-gay violence. Social support may be critical for
this population. Access to care may be limited due to concerns about providers’ sensitivity to
differences in sexual orientation.
B. Assistance to CONTRACTOR in locating appropriate providers who can translate behavioral health
and substance abuse services information into COUNTY’s threshold languages (English, Spanish,
and Hmong). Translation services and costs associated will be the responsibility of the
CONTRACTOR.
Exhibit B
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YOUTH CRISIS STABILIZATION CENTER
Scope of Work
ORGANIZATION: Exodus Recovery, Inc.
ADDRESS: 9808 Venice Boulevard, Suite 700, Culver City, CA 90232
SITE ADDRESS: 4411 E. Kings Canyon Road, Fresno, CA, 93702 (Bldg 319)
SERVICES: Youth Crisis Stabilization Services
PROJECT DIRECTOR: Luana Murphy, MBA, President/CEO
Phone Number: (559) 453-6271
CONTRACT PERIOD: July 1, 2016 – June 30, 2019, with two (2) twelve (12) month renewal options
CONTRACT AMOUNT:
Fiscal Year Contract Maximum
FY 2016-17 $2,640,397
FY 2017-18 $2,719,657
FY 2018-19 $2,801,247
FY 2019-20 $2,885,284
FY 2020-21 $2,971,842
SCHEDULE OF SERVICES:
CONTRACTOR shall operate the Youth Crisis Stabilization Center (Youth CSC) twenty-four (24) hours per
day, seven (7) days per week. The Youth CSC shall be located at the Kings Canyon Campus at 4411 E. Kings
Canyon Road, Fresno, California 93702 (Building 319), a COUNTY-owned building, pursuant to a separate
lease agreement (and any related amendments) between COUNTY and Exodus Foundation, Inc., an affiliate
of CONTRACTOR.
TARGET POPULATION:
The target population will include children and youth up to 18 years of age from Fresno County, who are
exhibiting acute psychiatric symptoms and have either been placed on a Welfare and Institutions Code
(W&IC) 5150 designation or who request admittance to the Youth CSC on a voluntary status.
CONTRACTOR will provide crisis stabilization services to children and youth clients with an eight (8) bed
maximum at any given time. However, CONTRACTOR may be in the process of assessing or evaluating
additional clients, as necessary. CONTRACTOR will accept voluntary or involuntarily admitted clients
regardless of source of payment; clients may include Medi-Cal beneficiaries, Medicare and Medicare/Medi-
Cal beneficiaries, privately insured and indigent/uninsured clients who are referred by the Department of
Behavioral Health (DBH), a contract provider with the DBH, a hospital emergency department, law
enforcement, or Emergency Medical Services (EMS). Clients may also be family or self-referred. The Youth
CSC will also serve foster children and youth who reside in Fresno County and remain under the original
jurisdiction of another county.
These services shall be performed pursuant to W&IC, sections 5704.5(b), 5704.6(c), and 5614(b)(3) and
program principles and the array of treatment options required under W&IC, sections 5600.2 to 5600.9
inclusive.
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is the child health component of Medicaid.
Federal statutes and regulations state that children under age 21 who are enrolled in Medicaid are entitled to
Exhibit B
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EPSDT benefits and that States must cover a broad array of preventive and treatment services to include
crisis stabilization. The requirement is to maintain its funding for children’s services at a level equal to or
more than the proportion expended for children’s program services in FY 83-84.
PROJECT DESCRIPTION:
CONTRACTOR shall be responsible to comply with the requirements of the Fresno County Mental Health Plan
(FCMHP) and must complete and submit supporting clinical and any other such documentation as may be
required by the COUNTY for every client served in the Youth CSC. The FCMHP will perform a utilization
review of all admissions to determine that the documentation demonstrates that medical necessity criteria as
defined by the California Department of Health Care Services (DHCS) was met for each duration of the crisis
stabilization services claimed for reimbursement.
CONTRACTOR shall be responsible to enter all Client Service Information, admission data and billing
information into the COUNTY data system (AVATAR) and will be responsible for any and all audit exceptions
pertaining to the delivery of services.
CONTRACTOR’S RESPONSIBILITIES:
B. CONTRACTOR shall ensure that the Youth CSC provides the following services:
1. Management and alleviation of client’s acute psychiatric symptoms through effective therapeutic
interventions and supportive services to avoid the need for a higher level of psychiatric care
when clinically appropriate.
2. A recovery/strength based clinical program which has appropriate professional staffing on a
twenty-four (24) hour, seven (7) day a week basis.
3. A safe, secure environment for clients that encourages wellness and recovery.
4. A comprehensive multi-disciplinary evaluation and client-centered treatment plan.
5. Dietary services through the availability of nourishment or snacks in accordance with Title 22,
Division 5, Chapter 9, Article 3, Section 77077.
6. Admission procedures for clients, who are not on involuntary holds in accordance with Welfare
and Institutions Code 5150 and also individuals placed on W&I 5150 involuntary holds.
7. Crisis consultation services to rural service providers (e.g. emergency departments, etc.) that
may not have timely access to the centrally located crisis stabilization facilities and may require
consultation to support client care planning and/or mitigate unnecessary long transports of clients
to the Youth CSC from remote areas. Crisis consultation may occur via teleconference, tele-
behavioral health (i.e. utilization of video and computer equipment), and/or other method
presented by CONTRACTOR and deemed acceptable by the department.
8. Treatment Planning – Under the clinical direction of the mental health clinician, the multi-
disciplinary treatment team formed by the Youth Crisis Stabilization staff shall provide the
following services:
a. Mental Status Examination
b. Medical Evaluation
c. Full Clinical Assessment
d. Nursing Assessment
e. Multi-Disciplinary Milieu Treatment Program
Exhibit B
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f. Client Centered Treatment Planning
g. Aftercare Planning and Wellness Recovery Action Plan (WRAP)
9. Staffing
a. The staffing pattern for the crisis stabilization program shall meet all current 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 (CCR) for
Crisis Stabilization services. All staff requiring federal/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. CONTRACTOR shall remain up-to-date with
all current regulatory changes and adhere to all new and/or modified requirements.
b. All facility staff who provide direct client care or perform coding/billing functions must meet
the requirements of the FCMHP 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 of CONTRACTOR’s staff who
will have direct contact with the clients, shall have Department of Justice (DOJ), Federal
Bureau of Investigation (FBI), and Sheriff fingerprinting (Livescan) executed.
c. Peer and/or family support staff will be an active and key member of the multi-disciplinary
team to assist with treatment planning, mentoring, support and advocate with
clients/families during their time at the YOUTH CSC facility and will assist with discharge
planning and facilitate the client’s transition to the appropriate lower level of care.
d. At the time of execution of this Agreement, the staffing requirements defined by the
California Code of Regulations, Title 9, Section 1840.348 for the Youth CSC are as
follows:
(a) A physician shall be on call at all times for the provision of those Crisis Stabilization
Services that may only be provided by a physician.
(b) There shall be a minimum of one Registered Nurse, Psychiatric Technician, or
Licensed Vocational Nurse on site at all times beneficiaries are present.
(c) At a minimum there shall be a ratio of at least one licensed mental health or
waivered/registered professional on site for each four beneficiaries or other patients
receiving Crisis Stabilization at any given time.
(d) If the client is evaluated as needing service activities that can only be provided by a
specific type of licensed professional, such persons shall be available.
(e) Other persons may be utilized by the program, according to need.
(f) If Crisis Stabilization services are co-located with other specialty mental health
services, persons providing Crisis Stabilization must be separate and distinct from persons
providing other services.
(g) Persons included in required Crisis Stabilization ratios and minimums may not be
counted toward meeting ratios and minimums for other services.
Exhibit B
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e. CONTRACTOR shall submit daily staffing reports that identify all direct service and
support staff by first and last name, applicable licensure/certifications, full time hours
worked, and the licensed/waivered/registered mental health professionals to client ratio.
10. Medical Records
a. The CONTRACTOR shall maintain records in accordance with Exhibit D, “Documentation
Standards for Client Records.” 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.
b. The CONTRACTOR will be responsible for “release of information” requests for the Youth
CSC facility and shall adhere to applicable federal and state regulations.
11. Clinical Staff - The clinical staff of CONTRACTOR shall be composed of all licensed mental
health or waivered/registered professionals as included in CCR, Title 9, Division 1, Chapter 11,
Article 3, Section 1840.348 (Crisis Stabilization Staffing Requirements).
12. Medical Staff – The medical staff shall include a physician and a registered nurse, psychiatric
technician or licensed vocational nurse and any other type of licensed professional needed to
address client needs pursuant to CCR, Title 9, Division 1, Chapter 11, Article 3, Section
1840.348 (Crisis Stabilization Staffing Requirements).
13. Pharmaceutical Services – CONTRACTOR shall provide for medication services on an as
needed basis and the staffing must reflect this availability pursuant to CCR, Title 9, Division 1,
Chapter 11, Article 3, Section 1840.338 (Crisis Stabilization Contact and Site Requirements) and
all other applicable federal/state regulations. The administration of a psychotropic medication(s)
to children and youth in the Foster Care System will adhere to federal/state regulations, the
requirements of pharmaceutical vendors and the coordination with the Department of Social
Services-Child Welfare as it relates to the completion of forms, provision of information, etc.
14. Assessment of Physical Health and Medical Backup Services – Pursuant to CCR, Title 9,
Division 1, Chapter 11, Article 3, Section 1840.338 (Crisis Stabilization Contact and Site
Requirements), CONTRACTOR shall provide admission history and physical examination, and
maintain a written agreement for medical services with one or more general acute care hospitals.
15. Utilization Review, Billing and Cost Report:
a. CONTRACTOR shall notify the COUNTY 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 approved by the COUNTY.
b. CONTRACTOR shall be responsible to insure that documentation in the client’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’s electronic information system and will be responsible for any and all audit
exceptions pertaining to the delivery of services.
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
120 days following the end of each fiscal year.
e. CONTRACTOR shall insure that cost reports are prepared in accordance with General
Accepted Accounting Principles (GAAP) and the standards set forth by the DHCS and the
COUNTY.
Exhibit B
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16. Patients’ 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 W&IC 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.
17. Family Advocate - CONTRACTOR shall promote and allow client access to the Family Advocacy
Services representative (Family Advocate) who is contracted by the COUNTY to advocate and
assist clients, families and support systems who are seeking or receiving mental health services.
18. Grievances and Incident Reports
CONTRACTOR shall have all grievance forms readily available at the Youth CSC facility.
CONTRACTOR shall log all grievances and the disposition of all grievances received from a
client or a client’s family in accordance with FCMHP policies and procedures as indicated within
Exhibit G. CONTRACTOR shall provide a summary of the grievance log entries concerning
COUNTY-sponsored 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.
CONTRACTOR shall post signs, provided by the COUNTY, informing clients 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. The CONTRACTOR
shall use the Incident Report form as indicated within Exhibit H for such reporting.
Within fifteen (15) days after each grievance or incident affecting COUNTY-sponsored 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 a 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.
19. Provide a safe and secure environment to provide for clinical and medical assessment,
diagnostic formulation, crisis intervention, medication management, and clinical treatment for
mental health clients with acute psychiatric symptoms. This includes the manner in which
seclusion and restraint will be administered when necessary for the safety of the clients, other
clients in the program, and staff.
20. Provide the appropriate type and level of staffing to provide for a clinically effective program
design that adheres to State staffing requirements.
21. Provide staff training in the areas of non-violent crisis intervention, evidence-based practice, best
practice, or promising practices to insure staff are competent and proficient in the therapeutic
interventions and practices in serving youth clients accessing the Youth CSC.
22. CONTRACTOR shall utilize cost containment strategies for the provision of stock and
prescription medications to clients (i.e. by contracting with a pharmaceutical benefits
Exhibit B
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management company) and provide the COUNTY with the type of formulary utilized by the
program as well as information regarding co-pays and/or generic substitutions.
23. Provide an intensive treatment program which has individualized treatment plans.
24. Stabilize the clients’ acute psychiatric symptoms in the most expedient manner possible while
adhering to appropriate clinical care standards. This may include initiating a Treatment
Authorization Request (TAR) to the pharmacy and providing justification when psychotropic
medications are needed on an emergency basis.
25. Effectively partner with other programs in the COUNTY and community system (i.e. law
enforcement, local emergency departments, etc.) in accepting COUNTY clients for admission for
crisis stabilization services.
26. Effectively partner with rural services providers (i.e. emergency departments, etc.) to provide
crisis stabilization services via teleconference, tele-behavioral health (i.e. utilization of video and
computer equipment), and/or other method deemed acceptable by COUNTY.
27. Work collaboratively with the COUNTY and community resources in discharge planning to
ensure appropriate referral and direct linkage to ongoing outpatient specialty mental health
treatment services, substance use disorder treatment services, etc. are provided. Discharge
planning would also include working collaboratively with out-of-county Mental Health Plans to
ensure clients in foster care who reside within Fresno County are linked to appropriate ongoing
specialty mental health services, substance use disorder treatment services, etc. as appropriate.
28. Identify clients with frequent admissions during the fiscal year and develop strategies with other
COUNTY and community agencies to reduce readmissions and improve clients’ overall well-
being through coordination of care.
29. Effectively interact with community agencies, other mental health programs and providers,
natural support systems, and families to assist clients to be discharged to the appropriate level of
care.
30. Integrate mental health and substance use disorder services. The CONTRACTOR shall perform
the following:
a. Develop a formal written Continuous Quality Improvement CQI action plan to identify
measurable objectives toward the achievement of co-occurring disorders (COD) treatment
capability that will be addressed by the program during the contract period. These objectives
should be achievable and realistic for the program, based on a self-assessment and the
program priorities, but need to include attention to making progress on the following issues, at
minimum:
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 clients served have co-occurring issues;
4. Developing the goal of basic co-occurring competency for all treatment and support
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.
Exhibit B
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C. Regarding cultural and linguistic competence requirements, CONTRACTOR shall:
13. Ensure compliance with Title 6 of the Civil Rights Act of 1964 (42 U.S.C. Section 2000d, and 45
C.F.R. Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial
assistance from discriminating against persons based on race, color, national origin, sex,
disability or religion. This is interpreted to mean that a limited English proficient (LEP) individual
is entitled to equal access and participation in federally funded programs through the provision of
comprehensive and quality bilingual services.
14. Create and maintain policies and procedures for ensuring access and appropriate use of trained
interpreters and material translation services for all LEP clients, including, but not limited to,
assessing the cultural and linguistic needs of its clients, training of staff on the policies and
procedures, and monitoring its language assistance program. The CONTRACTOR’s procedures
must include ensuring compliance of any subcontracted providers with these requirements.
15. Ensure that minors shall not be used as interpreters.
16. Conduct and submit to COUNTY an annual cultural and linguistic needs assessment to promote
the provision and utilization of appropriate services for its diverse client population. The needs
assessment report shall include findings and a plan outlining the proposed services to be
improved or implemented as a result of the assessment findings, with special attention to
addressing cultural and linguistic barriers and reducing racial, ethnic, language, abilities, gender,
and age disparities.
17. Develop internal systems to meet the cultural and linguistic needs of the CONTRACTOR’s client
census including the incorporation of cultural competency in the CONTRACTOR’s mission;
establishing and maintaining a process to evaluate and determine the need for special -
administrative, clinical, welcoming, billing, etc. - initiatives related to cultural competency.
18. Develop recruitment and retention initiatives to establish contracted program staffing that is
reflective and responsive to the needs of the program and target population.
19. Establish designated staff person to coordinate and facilitate the integration of cultural
competency guidelines and attend COUNTY’s DBH Cultural Diversity Committee scheduled
meetings. The designated person will provide an array of communication tools to distribute
information to staff relating to cultural competency issues.
20. Keep abreast of evidence-based and best practices in cultural competency in mental health care
and treatment to ensure that the CONTRACTOR maintains current information and an external
perspective in its policies. The CONTRACTOR shall evaluate the effectiveness of strategies and
programs in improving the health status of cultural-defined populations.
21. Ensure that an assessment of a client’s sexual orientation is included in the bio-psychosocial
intake process. CONTRACTOR’s staff shall assume that the population served may not be in
heterosexual relationships. Sensitivity to gender and sexual orientation must be covered in
annual training.
22. Utilize existing community supports, referrals to transgender support groups, etc., when
appropriate.
23. Attend annual Cultural Competence, Compliance, Health Insurance Portability and Accountability
Act (HIPAA), Billing, and Documentation training provided by COUNTY’s DBH.
24. Report its efforts to evaluation cultural and linguistic activities as part of the CONTRACTOR’s
ongoing quality improvement efforts in the monthly activities report. Reported information may
include clients’ complaints and grievances, any resulting actions regarding complaints and
Exhibit B
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grievances, results from client satisfaction surveys, and utilization and other clinical data that
may reveal health disparities as a result of cultural and linguistic barriers.
C. Regarding direct admissions to the YOUTH CSC from COUNTY’s DBH programs or its contracted providers, the CONTRACTOR agrees to the following:
1. To allow direct admits from COUNTY’s DBH programs or its contracted providers when Youth
CSC has the capacity to accept clients for services.
2. Said direct admits shall not require medical clearance, if client would otherwise meet the
Emergency Medical Services 5150 Destination Policy requirements as mentioned herein below
in Subsection F. However, in the event a referred client is known to possess a contagious
medical condition, said client shall be medically cleared by a local hospital prior to admission to
the Youth CSC operated by CONTRACTOR.
D. Regarding the provision of court testimony related to Youth CSC clients, CONTRACTOR agrees to
the following:
CONTRACTOR’s staff shall provide court testimony relevant to Youth CSC clients, when
required.
E. Regarding placements of Youth in a Psychiatric Health Facility or other inpatient level of care:
CONTRACTOR’s staff shall locate and coordinate transfer for any youth being treated at the
Youth CSC who is in need of further services and placement into a psychiatric health facility
(PHF) or other appropriate acute psychiatric inpatient facility. This includes working
collaboratively with the staffs of Central Star to coordinate the transfer of youth ages 12 to 17 to
their Youth Psychiatric Health Facility. CONTRACTOR acknowledges that transfer of youth may
occur at all hours of the day and agrees to attend promptly to the needs of the youth and will
conduct the transfer as soon as feasibly possible.
F. Regarding the placement of a Youth at another designated facility:
3. CONTRACTOR shall notify COUNTY DBH when a client will remain at the CSC for a period in
excess of 24 hours, while awaiting placement and/or transportation. The COUNTY’s Patients
Rights Advocate will be included in this notification
4. CONTRACTOR shall provide the following services to clients who remain at the CSC for a period
in excess of 24 hours and who are awaiting placement and/or transportation:
a. Three meal periods and three snack times per 24 hours
b. Daily encouragement and support with activities of daily living i.e. showering, washing of
clothes, teeth brushing, hair combing etc.
c. Daily psychiatric evaluation by both the provider and licensed nursing staff to
evaluate/determine the clients most appropriate level of care
d. Daily medication evaluation, administration and education
e. Daily group activities (e.g. 12-Step Meetings, WRAP, Goals Group, etc.)
f. Daily one-on-one peer support provided by designated Peer Advocate
g. Daily activities such as meditation, art, entertainment and outdoor activities provided in the
outside courtyard
h. Daily education in relation to mental health diagnosis, treatments, and community resources
Exhibit B
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G. Regarding the Emergency Medical Services (EMS) 5150 Destination Policy, CONTRACTOR
agrees to the following:
CONTRACTOR agrees to follow the then-current Emergency Medical Services 5150 Destination
Policy as identified in Exhibit L, attached hereto and incorporated herein. Said policy may be
updated periodically throughout the term of this Agreement; CONTRACTOR must adhere to the
most recent policies designated by the EMS 5150 Destination Policy. References to the
Children’s Crisis Assessment Intervention Resolution (CCAIR) in Exhibit L, reflect services to be
performed at COUNTY’s Youth CSC
H. CONTRACTOR shall participate in the following meetings:
1. CONTRACTOR shall participate in periodic workgroup meetings scheduled by staff from
COUNTY’s DBH Mental Health Contracted Services Unit. The meetings shall be held monthly,
or as needed, to discuss contract requirements, data reporting, outcomes measurement,
training, policies and procedures, and overall program operations.
2. CONTRACTOR’s administrative level agency representative, who is duly authorized to act on
behalf of CONTRACTOR, shall attend regularly scheduled monthly Behavioral Health Board
meetings and its Children’s Services Committee.
3. CONTRACTOR shall attend quarterly or periodic DBH Contractor/Provider Meetings, as
scheduled by staff from COUNTY’s Mental Health Contracted Services Unit, when deemed
necessary by the DBH Director, or designee.
4. CONTRACTOR may also be asked to make presentations in the community about the program
and services that are available
I. Regarding the development of policies and protocols:
CONTRACTOR and COUNTY’s DBH shall collaborate on the development of specific policies
and protocols related to the daily operation of the Youth CSC. Such policies will include, but not
be limited to, the following: placement of youth in psychiatric health facilities or other inpatient
programs either locally or outside the county, facility limitations, and special client populations.
Such policies and protocols shall be mutually agreed upon between CONTRACTOR and
COUNTY’s DBH Director, or designee. Any changes to such policies and protocols shall be
mutually agreed upon between CONTRACTOR and COUNTY’s DBH Director, or designee.
PROGRAM OUTCOMES
The Department of Behavioral Health is dedicated to supporting the wellness of individuals, families and
communities in Fresno County who are affected by, or at the risk of, mental illness and/or substance use
disorders through cultivation of strengths toward promoting recovery in the least restrictive environment.
Five (5) Work Plans will be utilized to support DBH’s mission statement. The work plans were developed as
a concept of a Transformation Plan that would encompass system planning, implementation and oversight
to be reflective of a comprehensive system of care. These work plans are provided below and represent
program goals to be achieved by CONTRACTOR in addition to CONTRACTOR-developed outcomes. DBH
may adjust the outcome measurements needed under this program periodically, so as to best measure the
success of clients and program as determined by the County.
Exhibit B
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CONTRACTOR will utilize a computerized tracking system with which outcome measures and other
relevant consumer data, such as demographics, will be maintained.
1. Behavioral Health Integrated Access – timeliness between client referral to admission, admission
to treatment, and treatment to discharge; penetration rate; effectiveness of discharge planning as
demonstrated by referral and linkage to other DBH programs, community providers, and other
community resources; and services that provide screening and access to ensure clients are linked to
the services they need, including mental health substance use disorders and physical health
services.
2. Wellness, Recovery, and Resiliency Supports – collaborative approach to treatment strategies to
reduce readmission of consumers with frequent admissions to the facility; effectiveness of services
as demonstrated by the number of consumers who are able to be discharged to the community and
avoid inpatient hospitalization; measurement of recidivism rates, including measuring percentage of
recidivism within 30 days. State the Evidence Based Practices (EBP) that shall be used.
3. Cultural/Community Defined Practices – services or philosophical practices which support the
unique cultural-specific needs of individuals receiving care. Focus on behavioral health practices
which reflect the unique needs of various cultures and communities who reside within Fresno County.
4. Behavioral Health Clinical Care – services where direct therapeutic treatment is provided. Include
the framework of “Levels of Care” where client’s needs, as identified through assessment/screening,
are matched with a complexity and intensity of services meets those needs.
5. Infrastructure Supports – includes all personnel, equipment, programs, and facilities which exist to
support the delivery of care to the clients served. Includes safety, quality improvement and
regulatory compliance functions, along with outcome assessment/program evaluation, training, and
technology.
6. Denial rate for Crisis Stabilization billing will be decreased by 5% within the first six months, based on
previous program denial rates. Rates will be determined by the utilization review performed by
FCMHP.
COUNTY RESPONSIBILITIES:
COUNTY shall:
7. Perform a utilization review, annually at a minimum, (through its FCMHP) of ten percent (10%) of all
admissions to determine that the documentation demonstrates that medical necessity criteria as defined
by the DHCS were met throughout the duration of the crisis stabilization episode. The FCMHP will
maintain discretion regarding possible subsequent utilization review beyond ten percent (10%), as
necessary.
8. Provide oversight of the CONTRACTOR’s Youth CSC program. In addition to contract monitoring of
program(s), oversight includes, but is not limited to, coordination with the DHCS in regard to program
administration and outcomes.
9. Assist the CONTRACTOR in making linkages to the appropriate level of care within the behavioral
health system of care to ensure continuity of care. This will be accomplished through regularly
scheduled meetings as well as formal and informal consultation.
10. Participate in evaluating the progress of the overall program and the efficiency of collaboration with the
CONTRACTOR staff and will be available to the CONTRACTOR for ongoing consultation.
Exhibit B
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11. Receive and analyze statistical outcome data from CONTRACTOR throughout the term of contract on a
monthly basis. 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.
12. 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. 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 (LGBT) individuals may be at
increased risk for mental disorders and mental health problems due to exposure to societal
stressors such as stigmatization, prejudice and anti-gay violence. Social support may be critical for
this population. Access to care may be limited due to concerns about providers’ sensitivity to
differences in sexual orientation.
B. Assistance to CONTRACTOR in locating appropriate providers who can translate behavioral health
and substance abuse services information into COUNTY’s threshold languages (English, Spanish,
and Hmong). Translation services and costs associated will be the responsibility of the
CONTRACTOR.
Exhibit B
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ACCESS LINE
Scope of Work
ORGANIZATION: Exodus Recovery, Inc.
ADDRESS: 9808 Venice Boulevard, Suite 700, Culver City, CA 90232
SITE ADDRESS: 4411 E. Kings Canyon Road, Fresno, CA 93702 (Bldg. 319)
SERVICES: Access Line Services
PROJECT DIRECTOR: Luana Murphy, MBA, President/CEO
Phone Number: (559)453-6271
CONTRACT PERIOD: July 1, 2016 – August 31, 2016 (Ramp Up Period)
September 1, 2016 – June 30, 2019, with two (2) twelve (12) month renewal
options
CONTRACT AMOUNT: Contract Maximum Fiscal Year
07/1/2016 through 08/31/2016 (Ramp Up Period)
09/01/2016 through 06/30/2017 (Initial Operating Period)
FY 2017-18
FY 2018-19
FY 2019-20
$23,678
$242,607
$549,407
$307,445
$318,384
$329,713 FY 2020-21
SCHEDULE OF SERVICES:
CONTRACTOR shall operate a State-mandated toll-free answering service (Access Line) twenty-four (24)
hours per day, seven (7) days per week. The Access Line shall be located at the Kings Canyon Campus at
4411 E. Kings Canyon Road, Fresno, California 93702 (Building 319), a COUNTY-owned building, pursuant to
a separate lease agreement (and any related amendments) between COUNTY and Exodus Foundation, Inc.,
an affiliate of CONTRACTOR.
PROJECT DESCRIPTION:
CONTRACTOR shall provide answering services for the Department of Behavioral Health in accordance with
State and Federal Regulations and utilize the Access Line Database to log all calls. Access line services are
not to be subcontracted out. The 1 (800) 654-3937 access line will be a separate phone line from the Adult
and Youth Crisis Stabilization (CSC) main lines. Calls received on the access line will be monitored and
recorded separately.
1.The Department of Behavioral Health (DBH) is mandated by the State of California to maintain a written
log of all requests for specialty mental health services. The log must include specific information about
each call.1
2.State regulations require that the toll-free, 24/7, Access Line established by DBH also provides
information to Medi-Cal beneficiaries about how to access specialty mental health services, including
information about the grievance and appeals processes and the State’s fair hearing system.2
1 California Code of Regulations (CCR): Title 9, Chapter 11, Section 1810.405(f) & State Department of Health Care Services Program Oversight and
Compliance - Annual Review Protocol for Consolidated Specialty Mental Health Services and Other Funded Services” Section A – Access.
Exhibit B
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3. The Access Line database (“Database”) is a web-based application, developed with intuitive, decision-
tree type functionality, and incorporates the requirements stated within the state regulations referenced
above. The Database shall be the mechanism used for collection of caller/client information received by
phone and to provide callers with information as required by the State.
4. Outcomes and expectations for the Access Line may evolve over time, based on changes to State and
Federal Regulations as well as departmental needs and goals. Any changes to Access Line will be
made at the discretion of the Department of Behavioral Health.
5. The Access line shall assess and screen the needs of the caller. The Access line shall triage the call to
meet the needs of each client. Triage shall be provided by staff appropriate to the needs of the client
(nursing staff, clinical staff, etc as needed). Direct linkage with an appropriate plan for each client shall
be provided. When available, scheduling to make client appointments would also be provided.
6. Access line screening shall be provided for mental health and substance use disorder services. The
access line services shall be flexible to meet the growing and changing needs of the Department’s
program and client needs. CONTRACTOR Access Line staffing pattern will be based on call volume.
The Department and CONTRACTOR shall work jointly on future changing needs of the Department, as
needed.
CONTRACTOR’S RESPONSIBILITIES:
CONTRACTOR will utilize the Access Line to triage all calls received and provide linkage, as appropriate.
Calls requiring Emergency Services or Crisis Stabilization Services will be transferred to the appropriate
agency for follow up. Calls not requiring Emergency Services or Crisis Stabilization services will be evaluated
for mental health and/or substance use linkage. Access Line operators will utilize resources including but not
limited to client information within COUNTY’s Avatar Electronic Health Record system, knowledge of
Department of Behavioral Health programs, and community programs to evaluate the caller’s need and form
an action plan with the caller. Callers will be provided with clear instruction regarding next steps. All calls
received, including those transferred to Emergency Services or Crisis Stabilization Services, will be
documented in the Access Line Database, identifying, at minimum, callers Name, Date of Call, and Disposition.
1. Access Line Database: The Database is located at https://www.FCMHPAccessline.com and will be
made available to designated staff. The Database is designed to assist answering service operators
handle calls of the following nature. Each call type requires specific information to be gathered as
indicated by the corresponding call screen, as shown in Exhibit M (“Fresno County Mental Health Plan
24/7 Toll-Free Access Line Intuitive Database for Logging Calls”). All calls will be logged within the
Access Log under the Emergency Calls or Non-Emergency calls listed below in subsection “a” and “b.”
a. Emergency Calls. These calls may require a warm hand-off to emergency medical services
dispatchers. When a call is received and the caller reports self or other to be in crisis or you
cannot be sure of their safety, the following five-step suicide assessment, evaluation, and triage
should be conducted:
1) Identify Risk Factors. Note those that can be modified to reduce risk. Determine if the caller
is alone.
2) Identify Protective Factors. Not those that can be enhanced. If caller is with someone, ask
caller if they are feeling unsafe (harm to self or others, risk of harm by others). If no risk of
harm by others, ask permission to speak to the person to obtain their input and information
2 California Code of Regulations (CCR): Title 9, Section 1850.205, and Code of Federal Regulations (CFR): Title 42, Part 438, Subpart F.
Exhibit B
FL-128
Page 26 of 29
about the present situation and history. Ask the caller if they have a therapist and if so, when
is their next appointment.
3) Conduct Suicide Inquiry. Suicidal thoughts, behavior, intent, plan and means, and lethality of
means. Ask about previous suicide attempts and by what means.
4) Determine Risk Level/Intervention. Determine risk. Choose appropriate intervention to
address and reduce risk.
5) Document. Document your assessment of risk, rationale, intervention, and follow up. Inform
treating provider of the call and interventions.
i. If it is determined that the caller is in danger, you may offer to call 9-1-1 for them
to do a safety check and determine if a 5150 hold should be written.
ii. If the caller is with someone who is safe and feels they can transport the caller to
the PHF, recommend that they bring the caller in for an immediate evaluation.
b. Non-Emergency Calls
1) Request No Callback: The caller is requesting only information about mental health
services and does not wish to access services at the time nor receive a call back.
2) Service Requests: The caller is requesting mental health services or calling for
information about services from the Fresno County Mental Health Plan (DBH).
3) Messages: The caller wishes to leave a message for his/her current care provider.
4) Literature Requests: The caller is requesting a Medi-Cal Mental Health Booklet or
Provider List.
5) File Complaint: The caller wishes to file or obtain information about how to file a
complaint, grievance, or appeal with the Fresno County Mental Health Plan.
6) Other Reasons: The caller is calling about something other than what is mentioned
above.
c. User Accounts: Access to the Database for designated CONTRACTOR staff shall be restricted
to inputting call data only.
1) New User Account: CONTRACTOR must submit the following for each designated staff
member requiring access to the Database to set up a user account:
i. First and last name,
ii. Hire date (mm/dd/yyyy), and
iii. Unique identification number (employee ID, clock-in ID, etc.) as assigned by
CONTRACTOR.
2) Account: CONTRACTOR shall notify DBH within 24 hours of any change to user status
or when a user is no longer employed by CONTRACTOR.
d. Password Resets:
1) During Normal Business Hours: A user can request his/her password to be reset by
personally calling DBH’s Information Systems Division Services (ISDS) during normal
business hours. User must verify his/her identity by providing ISDS their full name, hire
date and unique Identification. A new temporary password will be provided upon
satisfactory self-identification.
2) After Normal Business Hours: User will not be able to have his/her password reset after
normal business hours as ISDS will be closed. It is expected that CONTRACTOR staff
assigned to operate the Access Line will set their user accounts during DBH business
hours.
Exhibit B
FL-128
Page 27 of 29
2. Log All Calls:
a. All calls received on the Access Line phone number and by any DBH program utilizing the
phone service shall be logged into the Database, including calls patched to 911 as well as non-
mental health related requests.
b. Information about programs and services requested by callers shall be provided in accordance
to instructions in the Database decision tree.
c. If a user is unable to access the Database temporarily for any reason to log calls (including staff
without an appropriate user account), the user shall document the call by gathering the following
information about the call/caller/client. This information will then be transmitted to DBH via a
facsimile machine to a designated confidential electronic fax number provided by DBH: For
adults, FAX will be transmitted to (559) 600-7615. For children (less than 18 years of age) FAX
will be transmitted to (559) 600-7701.
1) Call Type (identify the type of call: Emergency, No Call Back, Service Request,
Message, Literature Request, File Complaint, or Other)
2) Interpreter Needed? (No/Yes)
3) Language (Specify)
4) Info is for Caller/Client (Identify)
5) First Name
6) Last Name
7) Call Back Phone #
8) Date of Birth (of person seeking services)
9) Estimated Age (Ask for this information only after DOB has been requested and cannot
be provided)
10) Comments (Specify the reason for call: caller wants to file an appeal, hearing voices
and wants to talk to a therapist, connected to 911, etc.)
If the frequency of such occurrences (inability to access the database) reaches a level, as
determined by DBH and regardless of cause that warrants more detailed information to be
logged, CONTRACTOR may be requested to provide up to the level of detail as is collected by
the Database. It is the responsibility of CONTRACTOR to notify DBH, ISDS staff, or designated
staff if the Database Access Log is not accessible.
3. Language Interpreter Services: CONTRACTOR shall utilize the account set up through Fresno
County’s contract with Language Line Services to provide interpreter services to callers when
necessary or appropriate. A Language Line Quick Reference Guide (Exhibit N) is embedded in the
Database as part of the decision tree to assist operators with accessing this service.
a. Instances considered necessary or appropriate include, but are not limited to, when such
services is being requested or is accepted by the caller; the operator does not speak the caller’s
language; or the operator feels such services are necessary for effective communication with
the caller.
b. All costs related to the use of Language Line services through this account will be paid for by
Fresno County directly to Language Line Services and shall not be a part of this Agreement.
c. DBH is not responsible for costs related to interpreter services provided to callers by any other
party or agency.
Exhibit B
FL-128
Page 28 of 29
4. TDD/Relay Service: CONTRACTOR shall utilize either a Telecommunication Device for the Deaf
(TDD) service or Telecommunication Relay Services (TRS) when handling calls from clients who are
Deaf, Hard of Hearing, Speech-Disabled or Deaf and Blind. CONTRACTOR may utilize the TRS if
unable to secure TDD equipment, to communicate with a caller whom the operator determines may be
deaf, hearing-impaired or speech-disabled.
5. Evaluation of Protocols: CONTRACTOR and DBH will collaborate in the ongoing evaluation of
protocols for the design and flow of Access Line services. Changes to the Access Line will be mutually
agreed upon by CONTRACTOR and DBH and be in accordance with mandates by the State of
California.
PERFORMANCE MEASUREMENTS AND MONITORING
As mandated by the State, CONTRACTOR shall meet all performance goals on a monthly basis as detailed
below in Table A. The Database is designed to enable telephone operators to appropriately handle calls
received on the Access Line and to collect the required information within the Access Log.
1. Performance Measures:
Table A: Performance Measures
# Performance Measure Goal
1. Call was logged in Access Line Database 100%
2. Operator asked if the caller’s/client’s situation is an emergency 100%
3. Operator asked for caller’s/client’s name 100%
4. Operator logged caller’s/client’s name accurately in Database. Calls where
caller does not provide a name will be recorded as such, “No Name Provided.”
100%
5. Operator asked for caller’s/client’s call back phone number 100%
6. Operator logged caller’s/client’s call back phone number accurately in Database 100%
7. Operator asked for the reason for call 100%
8. Operator logged the reason for call accurately in Database 100%
9. Operator utilized AT&T Language Line Service when applicable
a. Caller requests/accepts interpreter services
b. Operator does not speak the caller’s language
c. Operator feels interpreter services are necessary
100%
10. Operator provided appropriate linkages to mental health services
a. To the adult services program(s) as indicated in the Access Line
Database
b. To the children’s services program(s) as indicated in the Access Line
Database
100%
11. Operator provided information on the grievances/appeals/State fair hearing
process
100%
2. Performance Monitoring: DBH will conduct test calls of the Access Line on a monthly basis to monitor
the performance measures described in Table A.
a. Test calls may be made in English and/or non-English languages as deemed appropriated by
DBH.
Exhibit B
FL-128
Page 29 of 29
b. The number of test calls performed by DBH to the Access Line each month shall match the
number of test calls conducted by the State during their review of the Access Line as stated in
the most recent version of the State Medi-Cal Protocol. For Fiscal Year 2016-17, the number of
test calls will be, at minimum, seven (7) per month.
c. Test Call Outcomes Feedback: DBH will provide feedback on test call outcomes to
CONTRACTOR designated staff overseeing the Access Line as follows:
1) The results of individual test calls shall be provided to CONTRACTOR designated staff
within 24 hours or as soon as possible after the call is performed and the “Access Line
Test Call Feedback Form” (Exhibit O) is completed.
2) A monthly Test Call Outcomes Summary Report of all test calls performed during the
preceding month shall be provided to CONTRACTOR within 14 days after month end.
3. Corrective Action Plan: An “Access Line Statement of Deficiencies and Plan of Correction” (Exhibit P)
shall accompany the monthly Test Call Outcomes Summary Report if any goal was unmet (outcome
falls below 100%) or issues related to test calls were not resolved satisfactorily.
a. The “Category” and “Summary Statement of Deficiencies” will be completed by DBH based
upon findings from the monthly report.
b. CONTRACTOR shall complete the “Provider’s Plan of Correction” and “Completion Date”
sections, sign and date the form and return it to the department within 14 calendar days from
the date of receipt.
c. The completed form shall be returned to the designated DBH staff, in compliance with HIPAA
regulations regarding safeguarding client information when applicable.
E-MAILING PROTECTED HEALTH INFORMATION (PHI)
Any e-mail communication with/to DBH staff containing client Protected Health Information (PHI) shall be done
so in compliance with HIPAA regulations on PHI as follows:
1. Include the Confidentiality Statement below at the beginning of all e-mails containing PHI and at the
beginning of each e-mail in a string of emails that contain PHI.
2. Confidentiality Statement:
Confidentiality Statement: This e-mail message, including any attachments, is for the
sole use of the intended recipient(s) and may contain confidential and privileged
information. Any unauthorized review, use, disclosure or distribution is prohibited. If you
are not the intended recipient, please contact the sender without using reply e-mail and
destroy all copies of the original message.
3. Examples of PHI: Client Name, Address, Phone Number, Date of Birth, Social Security Number
4. Do not include the client’s name in the “Subject” line of the e-mail.
5. All phone calls and messages emailed to DBH staff containing PHI shall be sent as an encrypted
attachment. A standard password will be provided by DBH. Do not list the password within the body of
the e-mail.
Note: when appropriate, DBH ISDS staff is available to provide technical support.
Exhibit D
To Scope of Work Exhibit B
Page 1 of 3
0374 d dbh
Documentation Standards For Client Records
The documentation standards are described below under key topics related to client care. All
standards must be addressed in the client record; however, there is no requirement that the record
have a specific document or section addressing these topics.
A. Assessments
1. The following areas will be included as appropriate as a part of a comprehensive client record.
• Relevant physical health conditions reported by the client will be prominently identified and
updated as appropriate.
• Presenting problems and relevant conditions affecting the client’s physical health and mental
health status will be documented, for example: living situation, daily activities, and social
support.
• Documentation will describe client’s strengths in achieving client plan goals.
• Special status situations that present a risk to clients or others will be prominently documented
and updated as appropriate.
• Documentations will include medications that have been described by mental health plan
physicians, dosage of each medication, dates of initial prescriptions and refills, and
documentations of informed consent for medications.
• Client self report of allergies and adverse reactions to medications, or lack of known
allergies/sensitivities will be clearly documented.
• A mental health history will be documented, including: previous treatment dates, providers,
therapeutic interventions and responses, sources of clinical data, relevant family information and
relevant results of relevant lab tests and consultations reports.
• For children and adolescents, pre-natal and perinatal events and complete developmental
history will be documented.
• Documentations will include past and present use of tobacco, alcohol, and caffeine, as well as
illicit, prescribed and over-the-counter drugs.
• A relevant mental status examination will be documented.
• A five axis diagnosis from the most current DSM, or a diagnosis from the most current ICD,
will be documented, consistent with the presenting problems, history mental status evaluation
and/or other assessment data.
2. Timeliness/Frequency Standard for Assessment
• An assessment will be completed at intake and updated as needed to document changes in the
client’s condition.
• Client conditions will be assessed at least annually and, in most cases, at more frequent
intervals.
B. Client Plans
1. Client plans will:
Exhibit D
To Scope of Work Exhibit B
Page 2 of 3
0374 d dbh
• have specific observable and/or specific quantifiable goals
• identify the proposed type(s) of intervention
• have a proposed duration of intervention(s)
• be signed (or electronic equivalent) by:
* the person providing the service(s), or
* a person representing a team or program providing services, or
* a person representing the MHP providing services
* when the client plan is used to establish that the services are provided under the direction of an
approved category of staff, and if the below staff are not the approved category,
* a physician
* a licensed/ “waivered” psychologist
* a licensed/ “associate” social worker
* a licensed/ registered/marriage and family therapist or
* a registered nurse
• In addition,
* client plans will be consistent with the diagnosis, and the focus of intervention will be
consistent with the client plan goals, and there will be documentation of the client’s participation
in and agreement with the plan. Examples of the documentation include, but are not limited to,
reference to the client’s participation and agreement in the body of the plan, client signature on
the plan, or a description of the client’s participation and agreement in progress notes.
* client signature on the plan will be used as the means by which the CONTRACTOR(S)
documents the participation of the client
* when the client’s signature is required on the client plan and the client refuses or is unavailable
for signature, the client plan will include a written explanation of the refusal or unavailability.
• The CONTRACTOR(S) will give a copy of the client plan to the client on request.
2. Timeliness/Frequency of Client Plan:
• Will be updated at least annually
• The CONTRACTOR(S) will establish standards for timeliness and frequency for the individual
elements of the client plan described in item 1.
C. Progress Notes
1. Items that must be contained in the client record related to the client’s progress in treatment
include:
• The client record will provide timely documentation of relevant aspects of client care
• Mental health staff/practitioners will use client records to document client encounters,
including relevant clinical decisions and interventions
• All entries in the client record will include the signature of the person providing the service (or
electronic equivalent); the person’s professional degree, licensure or job title; and the relevant
identification number, if applicable
• All entries will include the date services were provided
• The record will be legible
Exhibit D
To Scope of Work Exhibit B
Page 3 of 3
0374 d dbh
• The client record will document follow-up care, or as appropriate, a discharge summary
2. Timeliness/Frequency of Progress Notes:
Progress notes shall be documented at the frequency by type of service indicated below:
A. Every Service Contact
Mental Health Services
Medication Support Services
Crisis Intervention
Exhibit G
To Scope of Work Exhibit B
Page 1 of 2
Fresno County Mental Health Plan
Grievances
Fresno County Mental Health Plan (MHP) provides beneficiaries with a grievance
and appeal process and an expedited appeal process to resolve grievances and
disputes at the earliest and the lowest possible level.
Title 9 of the California Code of Regulations requires that the MHP and its fee-
for-service providers give verbal and written information to Medi-Cal beneficiaries
regarding the following:
• How to access specialty mental health services
• How to file a grievance about services
• How to file for a State Fair Hearing
The MHP has developed a Consumer Guide, a beneficiary rights poster, a
grievance form, an appeal form, and Request for Change of Provider Form. All
of these beneficiary materials must be posted in prominent locations where Medi-
Cal beneficiaries receive outpatient specialty mental health services, including
the waiting rooms of providers’ offices of service.
Please note that all fee-for-service providers and contract agencies are required
to give their clients copies of all current beneficiary information annually at the
time their treatment plans are updated and at intake.
Beneficiaries have the right to use the grievance and/or appeal process without
any penalty, change in mental health services, or any form of retaliation. All
Medi-Cal beneficiaries can file an appeal or state hearing.
Grievances and appeals forms and self addressed envelopes must be available
for beneficiaries to pick up at all provider sites without having to make a verbal or
written request. Forms can be sent to the following address:
Fresno County Mental Health Plan
P.O. Box 45003
Fresno, CA 93718-9886
(800) 654-3937 (for more information)
(559) 488-3055 (TTY)
Provider Problem Resolution and Appeals Process
The MHP uses a simple, informal procedure in identifying and resolving provider
concerns and problems regarding payment authorization issues, other
complaints and concerns.
Exhibit G
To Scope of Work Exhibit B
Page 2 of 2
Informal provider problem resolution process – the provider may first speak to a
Provider Relations Specialist (PRS) regarding his or her complaint or concern.
The PRS will attempt to settle the complaint or concern with the provider. If the
attempt is unsuccessful and the provider chooses to forego the informal
grievance process, the provider will be advised to file a written complaint to the
MHP address (listed above).
Formal provider appeal process – the provider has the right to access the
provider appeal process at any time before, during, or after the provider problem
resolution process has begun, when the complaint concerns a denied or modified
request for MHP payment authorization, or the process or payment of a
provider’s claim to the MHP.
Payment authorization issues – the provider may appeal a denied or modified
request for payment authorization or a dispute with the MHP regarding the
processing or payment of a provider’s claim to the MHP. The written appeal
must be submitted to the MHP within 90 calendar days of the date of the receipt
of the non-approval of payment.
The MHP shall have 60 calendar days from its receipt of the appeal to inform the
provider in writing of the decision, including a statement of the reasons for the
decision that addresses each issue raised by the provider, and any action
required by the provider to implement the decision.
If the appeal concerns a denial or modification of payment authorization request,
the MHP utilizes a Managed Care staff who was not involved in the initial denial
or modification decision to determine the appeal decision.
If the Managed Care staff reverses the appealed decision, the provider will be
asked to submit a revised request for payment within 30 calendar days of receipt
of the decision
Other complaints – if there are other issues or complaints, which are not related
to payment authorization issues, providers are encouraged to send a letter of
complaint to the MHP. The provider will receive a written response from the
MHP within 60 calendar days of receipt of the complaint. The decision rendered
buy the MHP is final.
Exhibit H
To Scope of Work Exhibit B
Page 1 of 2 FFRREESSNNOO CCOOUUNNTTYY MMEENNTTAALL HHEEAALLTTHH PPLLAANN
GGRRIIEEVVAANNCCEESS AANNDD IINNCCIIDDEENNTT RREEPPOORRTTIINNGG
PPRROOTTOOCCOOLL FFOORR CCOOMMPPLLEETTIIOONN OOFF IINNCCIIDDEENNTT RREEPPOORRTT
• The Incident Report must be completed for all incidents involving clients. The staff person
who becomes aware of the incident completes this form, and the supervisor co-signs it.
• When more than one client is involved in an incident, a separate form must be completed
for each client.
Where the forms should be sent - within 24 hours from the time of the incident
• Incident Report should be sent to:
DBH Program Supervisor
Exhibit H
To Scope of Work Exhibit B
Page 2 of 2
INCIDENT REPORT WORKSHEET
When did this happen? (date/time) Where did this happen?
Name/DMH #
1. Background information of the incident:
2. Method of investigation: (chart review, face-to-face interview, etc.)
Who was affected? (If other than consumer)
List key people involved. (witnesses, visitors, physicians, employees)
3. Preliminary findings: How did it happen? Sequence of events. Be specific. If attachments are needed write
comments on an 8 1/2 sheet of paper and attach to worksheet.
Outcome severity: Nonexistent inconsequential consequential death not applicable unknown
4. Response: a) corrective action, b) Plan of Action, c) other
Completed by (print name)
Completed by (signature) Date completed
Reviewed by Supervisor (print name)
Supervisor Signature Date
CENTRAL CALIFORNIA
EMERGENCY MEDICAL SERVICES
A Division of the Fresno County Department of Public Health
Manual
Emergency Medical Services
Administrative Policies and Procedures
Policy
Number 547
Page 1 of 10
Subject Patient Destination
References Title 13, Section 1106 of the California Code of Regulations
Title 22, Division 9, Chapter 7 of the California Code of Regulations
Effective:
04/18/83
I. POLICY
Patients of the Prehospital EMS System shall be transported to an appropriately staffed and equipped hospital.
II.MEDICAL PATIENT DESTINATION
A. Medical Patients shall be transported to the appropriate destination in accordance with the following chart:
Fresno County Kings County Madera County Tulare County
Medical – Adult
Non-emergent Patient’s Choice Patient’s Choice Patient’s Choice Patient’s Choice
Life-threatening Closest Appropriate Closest Appropriate Closest Appropriate Closest Appropriate
Acute current of injury
(acute MI)
Regional Medical
Center or St. Agnes
Medical Center
(Quickest travel time)
Kaweah Delta Medical
Center or Regional
Medical Center
(Quickest travel time)
Regional Medical
Center or St. Agnes
Medical Center
(Quickest travel time)
Kaweah Delta Medical
Center or Regional
Medical Center
(Quickest travel time)
Medical – Pediatric (14 years or younger)
Stable Patient/Family Choice Patient/Family Choice Patient/Family Choice Patient/Family Choice
Unstable RMC or Children’s ***
(Quickest travel time)
RMC or Children’s ***
(Quickest travel time)
RMC or Children’s ***
(Quickest travel time)
Kaweah Delta Medical
Center or
Sierra View District
Hospital ***
(Quickest travel time)
5150 patients
5150 - Adult CSC or Patient’s Choice
within Fresno County
Patient’s Choice within
Kings County
Patient’s Choice within
Madera County
Patient’s Choice within
Tulare County
5150 – Children (<18 yrs)
CCAIR or
Patient/Family Choice
(See criteria below)
Patient/Family Choice
within Kings County
Patient/Family Choice
within Madera County
Patient/Family Choice
within Tulare County
Kaiser (within Kaiser
Facility)
Kaiser designated
facility N/A N/A N/A
Veteran’s
Administration
Veteran’s
Administration N/A N/A N/A
*** If transport time is greater than 60 minutes, base hospital contact shall be made to determine appropriate destination.
Approved By
Signatures on File at EMS Agency
EMS Division Manager
Revision
01/01/2015
Signatures on File at EMS Agency
EMS Medical Director
Exhibit L
To Scope of Work Exhibit B
Page 2 of 10
Subject:
Patient Destination
Policy
Number: 547
B.Medical Patient Destination – Considerations
1.In a non-emergent situation (as determined by the EMT or Paramedic at the scene and/or the Base Hospital
Physician/MICN giving medical direction), the patient will be taken to the receiving hospital of his/her
choice. If the patient is unable to determine this, the hospital designated by the private physician and/or
patient's family member will be utilized.
Paramedics and EMTs should determine where the patient normally receives their medical care and
encourage the patient to return to that hospital for medical care as long as the patient’s medical condition
allows for such transport.
2.The Paramedic/EMT/MICN/BHP should only provide the patient with alternatives for destination of
patient choice. It is inappropriate for the Paramedic/EMT/MICN/BHP to endorse specific facilities or
provide personal opinion on the quality of local facilities.
3.Health Plans - If the patient is a member of a health plan with a preferred hospital, an attempt should be
made to transport the patient to a participating facility.
4.Closest Appropriate Hospital
a.The closest appropriate hospital is defined as the closest emergency department "equipped, staffed,
and prepared to administer care appropriate to the needs of the patient" (California Code of
Regulations, Title 13, Section 1106 (b) 2).
b.Closest is defined as the shortest travel time not necessarily the closest by distance.
c.The Base Hospital Physician will have the ultimate authority concerning patient destination.
d.The closest appropriate hospital does not mean that critically ill patients always go to the closest
“receiving” hospital. They go to the closest "appropriate” hospital. The following guidelines will
help to define "appropriate":
1)Due to short transport times, the appropriate receiving facility for a life-threatening
medical situation would be a hospital with a basic emergency service (holds a special
services permit from the California State Department of Health Services). Hospitals with
basic emergency services are:
a)Adventist Medical Center Hanford (AMC-H)
b)Children’s Hospital Central California (Children’s Hospital)
c)Clovis Community Medical Center (CCMC)
d)Kaiser Permanente Hospital (KPH)
e)Kaweah Delta Medical Center (KDMC)
f)Madera Community Hospital (MCH)
g)Saint Agnes Medical Center (SAMC)
h)Sierra View District Hospital (SVDH)
i)Tulare Regional Medical Center (TRMC)
j)Regional Medical Center (RMC)
2)Rural Areas - Due to prolonged travel times to the urban area, the appropriate receiving
hospital for a life-threatening medical situation would be a hospital with a standby
emergency service (holds a special services permit from the California State Department
of Health Services). Hospitals with stand-by emergency services that are approved to
receive ambulances are:
a)Adventist Medical Center Reedley (AMC-R)
b)Adventist Medical Center Selma (AMC-S)
Exhibit L
To Scope of Work Exhibit B
Page 3 of 10
Subject:
Patient Destination
Policy
Number: 547
c)Coalinga Regional Medical Center (CRMC)
5.Acute Cardiac Emergency
In the event of an acute current of injury transport should be to a facility with interventional heart
catheterization capabilities. The following is a list of readings from various cardiac monitors:
•*** ACUTE MI *** (Zoll Monitor E Series)
•***STEMI*** (Zoll Monitor X Series))
•***ACUTE MI SUSPECTED*** (Physio-Control Monitor LifePak 12)
•***MEETS ST ELEVATION MI CRITERIA*** (Physio-Control Monitor LifePak 15)
Transport should be either to:
•Regional Medical Center
•Kaweah Delta Medical Center
•Saint Agnes Medical Center;
whichever has the quickest transport time, if transport time is less than 60 minutes. If transport time is
greater than 60 minutes then transport to the closest appropriate facility or consider helicopter rendezvous.
Destination is determined by:
a.Interpretation of 12-lead ECG; or
b.Base Hospital consultation if required.
6.Patients who go directly to the closest appropriate receiving hospital:
a.Any unstable or unmanageable airway (this is defined as unable to maintain a BLS airway).
Example: If the patient can be bagged via a BVM without an ET Tube or OPA, this is not an
unstable airway.
b. Any patient with CPR in progress.
c.Any critically ill or unstable patient when Base Hospital contact is not possible (i.e., Paramedic or
EMT must make the ultimate destination decision).
7. Patients who go to a non-receiving hospitals:
Patients may be transported to a non-receiving hospital only when the Base Hospital has contacted the
receiving doctor and received assurance of immediate acceptance of the patient. Such assurance should
then be documented on the Base Hospital run form.
8. Patients who go to a receiving hospital, which is not closest:
Unstable patients who request this hospital and, in the opinion of the Base Hospital Physician, the extra
travel time is not dangerous to the patient
Exhibit L
To Scope of Work Exhibit B
Page 4 of 10
Subject:
Patient Destination
Policy
Number: 547
C.Fresno County 5150 Holds – Considerations
1.Fresno County 5150 patient criteria for transport Crisis Stabilization Center (CSC) and Children’s Crisis
Assessment Intervention Resolution (CCAIR):
a.If the patient meets the following criteria, he/she shall be transported directly to Crisis Stabilization
Center (CSC) if age 18 or greater; or the Children’s Crisis Assessment Intervention Resolution
(CCAIR) if under 18 years of age:
•No urgent medical complaint or evidence of acute medical/surgical/trauma problem requiring
urgent treatment prior to psychotic admission.
•No alteration in mental status due to dementia or delirium.
•Glasgow Coma Score 14 or 15.
•Complete vital signs within limits (HR, RR, BP, and GCS).
•Not febrile to palpation/measurement.
•Under the influence of alcohol or drugs, patient can walk without assistance and is able to
follow verbal commands (does not apply to CCAIR).
1)Adults:
a)Pulse: 50-120.
b)Systolic Blood Pressure: 100-180.
c)Diastolic Blood Pressure: less than 120.
d)Respiratory Rate: 12-30.
2)Pediatrics:
a)Vital signs appropriate for children (policy 530.32).
NOTE: Refer to the Criteria for Transporting a Fresno County 5150 Patient Directly to Crisis
Stabilization Center (CSC) or CCAIR Screening Form attached to this policy.
Patients that Crisis Stabilization Center (CSC) cannot accept:
•Patients with dementia or delirium
•Patients with ongoing medical care (i.e., patients who require continuous oxygen use,
catheters, wired devices, etc.)
•Patients in wheelchairs that cannot move independently
•Patients with any open wound, laceration, skin ulcer, or decubitus that requires anything
more that once daily dry gauze and tape dressing
b.All other patients on a 5150 hold in Fresno County not meeting the above criteria will be
transported to Patient/Family Choice within Fresno County.
c.Patients placed on a 5150 hold are to be transported to facilities within the county where the 5150
hold was initiated.
d.The 5150 destination policy does not apply to psychiatric patients who are voluntarily requesting
evaluation (not on a 5150 hold). If the patient is not on a 5150 hold, then transport will be to a
receiving facility of their choice, which includes CSC (Fresno County only) if patient meets
criteria within this policy.
e.Veteran’s Administration
Exhibit L
To Scope of Work Exhibit B
Page 5 of 10
Subject:
Patient Destination
Policy
Number: 547
2.The Veteran’s Administration emergency department will accept all patients with a Veterans
Administration (VA) Identification Card or active duty Department of Defense (DOD) Card (Patient Name
Only, no dependant(s). Name of patient on card must be the patient requesting transport). No prior
approval or Base Hospital contact is necessary. If the patient requests transport to Veterans Administration
emergency department and does not have the identification noted above, contact the VA Emergency
Department directly for prior approval before the patient is transported. The complete name and the full
social security number will be required. Contact the Veteran’s Administration on Med 6 or 241-3600.
3.Patients that cannot be transported directly to the Veteran’s Administration are:
•Cardiac arrest due to trauma
•Pediatric cardiac arrest
•Trauma Center Triage Criteria
•OB patient in active labor
•Gynecological complaints and known obvious pregnancy with vaginal bleeding
•ST-segment elevation myocardial infarction (STEMI)
NOTE: INTERFACILITY TRANSPORTS ARE NOT MANAGED THROUGH THIS PROCEDURE.
III. TRAUMA PATIENT DESTINATION
A. Trauma patients shall be transported to the appropriate destination in accordance with the following chart:
TRAUMA DESTINATION CHART
n
o
p
y Glasgow Coma Score < 13 (or, in patients whose
normal GCS is less than 15, or a decrease of two
or more of the patients GCS score)
y Penetrating injury to the head
y Paraplegia
y Quadriplegia
RMC
(Consider air transport)
Assess Local Criteria
y Systolic Blood Pressure:
o Adults: < 90 mm Hg
o Pediatrics: < 80 mm Hg with signs and
symptoms of shock (Refer to EMS Policy
530.32 for estimated weight formulas or
use Broselow Tape)
y Respiratory Rate:
o Adults: < 10 or > 30
o Children: < 20 if under age 1
Assess Physiological Criteria
RMC or KDMC
(Consider air transport)
Assess Anatomy of Injury
y Penetrating injuries to neck or torso
y Flail chest
y Two or more proximal long‐bone fractures
y Amputation proximal to wrist or ankle
RMC or KDMC
(Consider air transport)
Exhibit L
To Scope of Work Exhibit B
Page 6 of 10
Subject:
Patient Destination
Policy
Number: 547
q
r
s
t
Assess Burns
RMC
(Consider air transport)
STABLE TRAUMA PATIENTS WITH:
y Partial/Full thickness burns > 10% TBSA
y Partial/Full thickness circumferential burns
y Partial/Full thickness burns to face, hands, feet,
major joints, perineum, or genitals
y Electrical burns with voltage > 120 volts
y Chemical burns > 10% TBSA
Assess Special Considerations
Consider transport to
RMC or KDMC
WITH A SIGNIFICANT COMPLAINT:
y Age greater than 55 years
y Anticoagulation or bleeding disorders
y Pregnancy greater than 20 weeks
y Auto vs. Pedestrian > 20 mph
y Motorcycle crash > 20 mph
Assess Mechanism of Injury
y Falls
o Adults: > 20 ft. (one story = 10 ft.)
o Children: > 10 ft. or 3 times height of the
child
RMC or KDMC
(Consider air transport)
Paramedic/Flight Nurse Judgment
WITH A SIGNIFICANT COMPLAINT
Consider RMC or KDMC
Base Hospital Consultation
Transport According to Policy
SIGNIFICANT COMPLAINT
Perseveration
Deteriorating mental status
Severe chest pain
Severe shortness of breath
Severe abdominal pain
Sustained, overwhelming “Feeling of Doom”
Exhibit L
To Scope of Work Exhibit B
Page 7 of 10
Subject:
Patient Destination
Policy
Number: 547
NOTE: If transport time is greater than 60 minutes for patients meeting trauma triage criteria, base hospital contact
shall be made to determine appropriate destination.
NOTE: If transport time is greater than 2 hours for patients meeting burn triage criteria, base hospital contact shall
be made to determine appropriate destination.
B. Triage Criteria
Triage criteria will determine if the patient will be transported to a trauma center or closest receiving hospital.
C. Trauma Patient Destination – Considerations
1.If the patient is in cardiac arrest from penetrating trauma in the greater Fresno or Visalia metropolitan area,
the patient should be transported to Regional Medical Center or Kaweah Delta Medical Center, bypassing a
closer receiving facility. However, if the transport time to Regional Medical Center or Kaweah Delta
Medical Center is greater than ten (10) minutes, then transport should be to the closest receiving facility
within ten minutes transport time (Refer to EMS Policy #550).
2.Trauma patients, meeting trauma center criteria, who have a transport time greater than 60 minutes to the
trauma center, will require base hospital contact for destination decision.
3.The following types of incidents should be consideration for transport to the designated Trauma Center,
based upon paramedic judgment:
a.Motorcycle Crash - Non-ambulatory with potential of significant injuries
b.Auto versus Pedestrian - Non-ambulatory with potential of significant injuries
NOTE: Paramedic judgment is based upon the paramedic’s own knowledge and experience to determine if the
patient’s condition would require transport to a designated Trauma Center due the mechanism of injury and
potential underlying injuries. The Paramedic may contact a Base Hospital for advice on destination.
4.Transport of Trauma Patients by Helicopter
A trauma patient should not be transported by helicopter unless they meet trauma triage criteria to be
transported to the Regional Trauma Center or the patient is inaccessible by ambulance (i.e., wilderness
transports). EXCEPTION: When the paramedic feels helicopter transport of the patient would be
beneficial to the outcome of the patient.
5.Burn Patients
a.The following patients should be transported directly to the Regional Burn Center (Regional
Medical Center) bypassing other hospitals if ETA to Regional Medical Center is within two hours.
1)Patients with 2o (partial thickness) or 3o (full thickness) burns that are more than 10% total
body surface area
2)Patients with 2o (partial thickness) or 3o (full thickness) circumferential burns of any body part
3)Patients with 2o (partial thickness) or 3o (full thickness) burns to face, hands, feet, major joints,
perineum, or genitals
4)Electrical burns with voltage greater than 120 volts
5)Patients with chemical burns greater than 10% total body surface area.
6. Carbon Monoxide Poisoning - Early call-ins to Regional Medical Center should be made for patients that
appear to have significant exposure to carbon monoxide poisoning (altered mental status, vomiting, and
headaches).
Exhibit L
To Scope of Work Exhibit B
Page 8 of 10
Subject:
Patient Destination
Policy
Number: 547
7.Trauma patients who go directly to the closest appropriate receiving hospital:
a. Any unstable or unmanageable airway (this is defined as unable to maintain a BLS airway).
Example: If the patient can be bagged via a BVM without an ET Tube or OPA, this is not an
unstable airway.
b.Any patient with CPR in progress (refer to EMS Policy #550).
c.Any critically injured or unstable patient when Base Hospital contact is not possible (i.e.,
Paramedic or EMT must make the ultimate destination decision).
IV.PATIENTS WHO REFUSE TRANSPORT TO THE APPROPRIATE HOSPITAL
A Base Hospital shall be contacted for the purpose of physician consultation on patients who meet one or more of the triage
criteria and refuse transport to the appropriate hospital. This will usually not be a problem with the acutely ill patient.
However, some patients with normal mental status may wish to be transported to a different hospital than the one selected via
the triage criteria. These situations should be treated as “Refusal of Medical Care and/or Transportation" situation (refer to
EMS Policy #546). The Base Hospital Physician, after radio contact, may allow the patient to go to the destination of their
choice, have a “Refusal of Medical Care and/or Transportation " signed or insist on transport to the designated hospital.
V. PATIENTS WHO CAN GO DIRECTLY TO AN EMERGENCY DEPARTMENT WAITING ROOM
Prehospital personnel shall utilize the emergency department patient entrance at all receiving hospitals for non-emergent
patients. Delivery of patients to the appropriate area of the emergency department is based on severity of illness.
Patients who meet the following criteria can be taken directly to the emergency department walk-in waiting room, bypassing
the ambulance entrance used for serious or critically ill patients.
•Patients 18 years old or older or minors accompanied by a responsible adult.
•Patient has normal, age appropriate vital signs (± 5%).
•Patient can sit unassisted and has reasonable mobility.
•Patient does not meet criteria for ETA call-in.
•Patient does not have IV access started by EMS.
•Patient is not on a 5150 hold or in custody.
EMS personnel must give report to a hospital employee authorized to triage, or take possession of the patient, and obtain a
signature for transfer of patient care. If there is a difference of opinion as to the appropriate waiting area, or location of the
patient, the hospital representative will make the final decision as to the disposition of the patient and provide the turnover
signature.
Exhibit L
To Scope of Work Exhibit B
Page 9 of 10
Subject:
Patient Destination
Policy
Number: 547
VI. SPECIAL CONSIDERATION FOR OBSTETRICS OR PREGNANT PATIENTS REQUESTING ADVENTIST MEDICAL
CENTER – HANFORD
While Central Valley General Hospital will not have an emergency department, the hospital will still be open as an in-patient
/ out-patient facility for OB/GYN services. Ambulance patients may be taken directly to Central Valley General Hospital
under the following circumstances:
•Transfers from a physician’s office when the physician requests that the patient be taken directly to Central Valley
General Hospital
•An interfacility transfer from another hospital (i.e., direct admit)
•Obstetrics or pregnancy related calls when directed by the Base Hospital (Adventist Medical Center–Hanford) to
transport directly to Central Valley General Hospital. A full standard call-in must be made to the Base Hospital on
all OB/GYN patients.
VII. SPECIAL CONSIDERATION FOR HEART HOSPTAL DESTINATION
While the Heart Hospital is a hospital within Central California EMS Region, it does not have an emergency
department and is not an approved facility for patient transports within EMS Policy and Procedures. Patients who are
requesting transport to the Heart Hospital from the prehospital setting will require Base Hospital contact to confirm
acceptance. Since the Heart Hospital is under the Community Medical Center organization, EMS personnel should contact
Regional Medical Center when requesting transport to the Heart Hospital. If attempts to contact Regional Medical Center
are unsuccessful, EMS personnel should contact another Base Hospital. Interfacility transfers involving the Heart Hospital
shall be in accordance with EMS Policy #553, “ALS Interfacility Transports”.
Exhibit L
To Scope of Work Exhibit B
Central California EMS Agency
Criteria for Transporting a Fresno County 5150/Psychiatric Patient
Directly to CSC or CCAIR Screening Form
Patient’s Name: ________________________________________ EMS #: __________________
Patient has urgent medical complaint or evidence of acute medical/surgical problem.
[ ] True – transport Patient/Family Choice [ ] False
Patient has alteration in mental status due to dementia or delirium.
[ ] True – transport Patient/Family Choice [ ] False
Patient has a Glasgow Coma Score 13 or less.
[ ] True – transport Patient/Family Choice [ ] False
There are lacerations with a gap of greater than 2 mm or fat/muscle visible in the wound (excludes any type of stab
wound).
[ ] True – transport Patient/Family Choice [ ] False
There are lacerations or wounds inflicted by others.
[ ] True – transport Patient/Family Choice [ ] False
Complete vital signs are within limits:
Adults:
Pulse outside range of 50-120. [ ] True – transport Patient/Family Choice [ ] False
Systolic Blood Pressure outside range of 100-180. [ ] True – transport Patient/Family Choice [ ] False
Diastolic Blood Pressure greater than 120. [ ] True – transport Patient/Family Choice [ ] False
Respiratory Rate outside range of 12-30. [ ] True – transport Patient/Family Choice [ ] False
Pediatrics:
Vital signs inappropriate for children
(Policy 530.32) [ ] True – transport Patient/Family Choice [ ] False
Patient is febrile to palpation/measurement.
[ ] True – transport Patient/Family Choice [ ] False
Is patient under the influence of alcohol or drugs.
[ ] Yes [ ] No
If yes, to under the influence of alcohol or drugs, does patient require assistance to walk.
[ ] True – transport Patient/Family Choice [ ] False
If all of the above answers are False, patient may be transported to CSC/CCAIR. Otherwise transport is
Patient/Family Choice.
Patients that Crisis Stabilization Center (CSC) cannot accept:
•Patients with dementia or delirium
•Patients with ongoing medical care (i.e., patients who require continuous oxygen use, catheters,
wired devices, etc.)
•Patients in wheelchairs that cannot move independently
•Patients with any open wound, laceration, skin ulcer, or decubitus that requires anything more that
once daily dry gauze and tape dressing
Exhibit L
To Scope of Work Exhibit B
Page 10 of 10
Fresno County Mental Health Plan
24/7 Toll-Free Access Line
Intuitive Database for Logging Calls
The Access Line database is a web-based application, developed with intuitive, decision-tree functionality that
will be used by the answering service provider for the collection of caller/client information received on the
24/7 Toll-Free Access Line and all other department programs utilizing the answering service, and to provide
callers with information on how to access SMHS in accordance with the State requirements. The database
contains features incorporates the State-mandated requirements related to logging initial requests for
specialty mental health services.
DATABASE SCREENSHOTS
GREETING SCREEN: User’s name will appear in the greeting based upon the user’s login information.
INTERPRETER SCREEN: After either option from the greeting menu above is selected, the interpreter
screen opens up. It contains a drop-down listing of languages and step-by-step instructions on how to
reach Language Line Services
Exhibit M
To Scope of Work Exhibit B
Page 1 of 10
EMERGENCY SCREEN: Questions on the “Client” tab change according to the response in regards to
whom the call is made for.
Exhibit M
To Scope of Work Exhibit B
Page 2 of 10
NON-EMERGENCY CALLS – ROUTING SCREEN
Exhibit M
To Scope of Work Exhibit B
Page 3 of 10
Exhibit M
To Scope of Work Exhibit B
Page 4 of 10
REQUEST NO CALL BACK SCREEN: For callers requesting only information regarding MH services or
access to MH services.
SERVICE REQUEST SCREEN:
Exhibit M
To Scope of Work Exhibit B
Page 5 of 10
LEAVE A MESSAGE SCREEN:
Exhibit M
To Scope of Work Exhibit B
Page 6 of 10
REQUEST LITERATURE/INFORMATION SCREEN:
Exhibit M
To Scope of Work Exhibit B
Page 7 of 10
FILE COMPLAINT SCREEN (Part 1 of 2):
Exhibit M
To Scope of Work Exhibit B
Page 8 of 10
FILE COMPLAINT SCREEN SCREEN (Part 2 of 2): Provides descriptions of the various types of
complaints that can be filed and offers alternative formats for the various forms.
Exhibit M
To Scope of Work Exhibit B
Page 9 of 10
OTHER REASON SCREEN: For calls that fall outside of the list of call types (routing screen).
BACK-END USER DASHBOARD: Logged calls are categorized by call type. Allows department staff to
retrieve and triage calls for appropriate follow-up. Features include the ability to view and edit the
logged call, provide comments on what was done with the call, and close the call out once the
appropriate follow-up/action(s) has been completed.
Exhibit M
To Scope of Work Exhibit B
Page 10 of 10
Exhibit N
To Scope of Work Exhibit B
Page 1 of 1
Exhibit O
To Scope of Work Exhibit B
Page 1 of 1
Fresno County Mental Health Plan
1-800-654-3937 Access Line Test Call Feedback Form
The toll-free Access Line is available 24 hours a day, seven days a week, to provide information on how
to access specialty mental health services, including services needed to treat a beneficiary’s urgent
condition. The toll-free line also provides information on how to use the beneficiary problem resolution
and fair hearing processes. This line also has language capabilities in all languages spoken by the
beneficiaries of Fresno County
TEST CALLER INFORMATION
Name of Staff Testing Line: Date of Call: / /
Fictitious Name of Caller: Time of Call: : AM PM
Fictitious Name of Client (if different): Client is a(n): Minor (under 18 years)
Adult (18 years and over)
Language of Caller/Client: English Spanish Hmong Other (Specify):
Caller’s/Client’s Phone # Provided to Operator: ( ) - None Given N/A
Reason for the call:
RESULTS OF TEST CALL
1. Did the person who took your call tell you his/her
name? Yes No If Yes, what was it:
2. Did the person who took your call ask if your situation is a crisis / emergency? Yes No
3. Did the person who took your call ask for your name? Yes No
4. Did the person who took your call ask for your phone number? Yes No
5. Foreign language test callers only: Did the person who took your call speak
your language or provide help with free language assistance services?
N/A Yes No
6. Did the person give appropriate information on how to access services? N/A Yes No
7. Did the person give appropriate phone #’s (i.e. UCWC/Exodus) to contact DBH? N/A Yes No
8. Did the person give appropriate information on how to receive literature upon
your request?
N/A Yes No
9. Did the person give appropriate information on how to file a complaint upon
your request?
N/A Yes No
ADDITIONAL COMMENTS
Exhibit P
To Scope of Work Exhibit B
Page 1 of 1
Fresno County Mental Health Plan
1 (800) 654-3937 Access Line - Statement of Deficiencies and Plan of Correction
Provider Name
Address
City Zip Code
Phone ( ) - Ext.
Category Summary Statement of
Deficiencies
Provider’s Plan of
Correction Completion Date
/ /
/ /
/ /
/ /
/ /
Provider’s Signature Title Date
EXHIBIT “C”
FL-128
1
COUNTY OF FRESNO
CLEANING STANDARDS AND REQUIREMENTS
General – Applies to Most County Facilities
It is the intent of the County that County facilities be maintained at a high standard of
cleanliness. These specifications are intended to establish an acceptable level of
service. Cleaning frequencies are established as minimums. All items not specifically
included but found to be necessary to properly clean the buildings, shall be included as
though written into this Statement of Work.
The term “clean” includes, but is not limited to, the complete removal of trash, dirt,
dust, lint, webs, marks, stains, spots, spillages, graffiti, odors, film, gum, grease, tar,
paint, etc. or cleaning product residue.
Hours of Service
Cleaning of County facilities is to be done with as little hindrance of the County staff
and clients as possible. The cleaning schedule must be flexible to work around the
scheduling needs of building occupants.
Normal cleaning is to be done between the hours of 7:00 a.m. and 4:30 p.m. Periodic
tasks such as floor care may be scheduled for the swing shift which begins at 4:00
p.m.
Cleaning Requirements
This section defines the general cleaning components, standards and requirements
that apply to all buildings. In addition, there are some unique cleaning requirements
which may exceed and supplement these general standards due to the nature of a
building, the clients they serve and the services provided. Those site-specific cleaning
requirements are defined for each building.
Frequency (examples)
D-Daily
W-Weekly
M-Monthly
Q-Quarterly
SA-Semi-Annually
A-Annually
#D - # Days Per Week (e.g. 3D = 3 days per week)
MON, TUE, WED, THU, FRI - one day per week on a specific day
AN - As Needed (as determined by the County)
AR - As Requested
EXHIBIT “C”
FL-128
2
Routine and Periodic
The minimum required frequency for each task is defined in the specific task sheets for
each facility.
Routine - Cleaning tasks are ones that occur in the range of multiple times per day to
weekly.
Periodic - Cleaning tasks occur less frequently and are done at intervals such as
monthly, quarterly, semi-annually or annually.
Periodic tasks required advanced scheduling. This assures that building tenants will
have ample time to prepare for the service. It also gives building tenants the
opportunity to identify any particular problem areas that should be addressed.
Elevators
Routine - Clean and vacuum elevator tracks on all floors to remove debris. Vacuum
carpeted floor; sweep and damp mop hard surface floors. Clean elevator doors (on all
floors) and walls with the appropriate cleaner for the surface material (e.g. stainless
steel cleaner for stainless steel, wood cleaner for wood surfaces, general purpose
cleaner for other surfaces.) Dry with a clean dry cloth. Remove any graffiti with graffiti
remover and a damp cloth. Rinse with water and dry. Post wet floor sign, when
needed.
Periodic -
Exterior
Routine - Sweep the exterior entrance area to within 15' from entrance. Remove trash.
Remove all graffiti that can be removed with janitorial cleaners and processes. Report
other graffiti to DBH who will refer the work to County Facility Services.
Patios and courtyards that are within the perimeter of the building should be swept and
cleaned regularly
Periodic - Hose down cob webs and dirt from eves, awnings, and corners of facility
with a high pressure hose, where needed. Post wet floor signs. Mop up any puddled
water.
Floors
Hard Surface Floors
Maintain all floors in such a manner as to promote longevity and safety upon
completion of work; all floors shall be left in a clean, high luster shine, orderly and safe
condition at all times.
Remove and replace furniture as required to perform the work, exercising necessary
safety practices to prevent damage to County property and return to its proper place.
Post sufficient safety signs indicating slip hazards and/or wet floor when buffing, damp
mopping, stripping and waxing.
EXHIBIT “C”
FL-128
3
Routine - Resilient and Hard Tile:
Sweep to remove loose dirt and other material on all service days.
Spot clean all hard surface floors for (Spillages, stains, gum, candy, etc.) on all service
days.
Dust mop floors with a wide, treated dust mop, keeping the dust mop head on the floor
at all times. Pick up soil fro floor with a dustpan. Periodically shake out mop head into
a plastic bag. When mop head gets soiled, put n a container marked dirty mop heads
and replace with a clean mop head.
Damp mop all surface hard tile (concrete, ceramic, resilient, wood, quarry, terrazzo,
linoleum, etc) on all service days.
Upon completion of these tasks, floors shall be left in a clean, orderly, safe condition
and free of all scuff marks, dirt, dust, soil, spots, stains, deposits, oil, grease, gum,
finish residue buildup, etc.
Periodic - Clean all baseboards and floor drains. Cleaning requires the removal of
grime, dirt, wax build up, cleaning compound and finish residue, which builds up on the
baseboards, corners, edges and grout.
Spray-buff floor, using a floor machine equipped with a buffing pad, to a high luster.
Apply a new coat of finish as needed.
Machine scrub restroom floors with a disinfecting detergent cleaner.
Strip and refinish all resilient tile with 2 coats of skid-proof wax according to the
periodic cleaning. Finish shall be applied only to appropriate areas free of residual dirt
and build-up (i.e. swept, spot cleaned, and damp mopped) Floors are not to be left
unfinished after stripping/scrubbing.
Finish Requirements:
1. Removability
2. Slip Resistance
3. Durability
4. Gloss
5. Clear and no discoloration
6. Dry within 30 minutes.
7. Non- foaming wax
8. Non - powdering
9. Stability
10. Recoatability
11. Buffable
Carpeting
Routine -
Completely vacuum all high traffic areas.
EXHIBIT “C”
FL-128
4
Completely vacuum non-high traffic areas such as offices. This includes underneath
desks, chairs, between walls and filing cabinets, behind doors and in comers and
edges of carpet and wall. Move furniture as needed.
Spot clean to remove stains such those caused by spilled beverages, candy, gum, etc.
Use stain and gum remover for carpets.
Periodic - Deep clean all hard carpeted floors within the first 60 days of the
Agreement and then according to the frequencies for each building as
articulated in Exhibit A.
Deep clean all carpets with spin bonnet or hot water extraction equipment. At a
minimum of every fourth cleaning, hot water extraction cleaning is required in order to
deep clean.
Proper carpet cleaning shall result in a carpet free from all types of airborne soil, dry
dirt, spots, spills, stains, smudges and water/petroleum soluble soils. A cleaned carpet
shall be uniform in appearance when dry and vacuumed.
Carpet extraction is to be done according to the periodic schedule
Furniture
Furniture includes, but is not limited to desks, tables, reading tables, conference room
tables, interview room tables, chairs, windows, and reception area partitions.
Routine – Dust and spot clean furniture. Clean employee desktops only if they have
been cleared of papers.
Set-up conference rooms when requested by building occupants.
Periodic - Vacuum/spot clean all fabric stationary and movable chairs, benches,
couches, partitions, etc. Clean counters and cabinets, moldings, door frames, furniture
legs, arms rest. Note: personnel desks are not to be disturbed and or touched unless
cleared by the occupant with a note left instructing that it be cleaned. Restore all
furniture, wastepaper baskets, etc., to their original position.
Maintenance
The Janitorial staff will be vigilant and notice and report any maintenance issues
immediately so that they may be addressed and corrected. Contractor shall report all
maintenance-related problems to Facility Services. Examples include, but are not
limited to:
1. Burned-out lighting
2. Dripping or running faucets.
3. Leaking fixtures (such as toilets and urinals).
4. Continuously or long-running flush-o-meters.
5. Inadequate or non-flushing flush-o-meters.
EXHIBIT “C”
FL-128
5
6. Carpet tears that pose a trip hazard.
7. Loosened floor tiles.
8. Cracked or broken windows.
9. Door locking problems.
10. Pests (e.g. spiders, ants, roaches, mice)
Miscellaneous
Routine/As Needed – The Janitors are responsible for a variety of miscellaneous
tasks that don’t fit into other categories. They include, but are not limited to:
• Changing batteries in automated air sanitizers, automated paper towel
dispensers and other similar items, as needed
Restrooms
Clean and disinfect all restrooms in the buildings at the frequencies identified in the
building-specific schedule. For purposes of restroom requirements, “clean” shall be
defined as disinfecting, polishing, and removing all water spots. Disinfectant must be a
“hospital” grade disinfectant that kills fungus, virus, and bacteria and has organic soil
tolerance.
Routine - Clean all toilets, toilet seats, urinals. This includes removing any
encrustation, stains, scale, deposits, and build-up.
Clean and polish all exposed fixtures and piping, lavatories, counters, changing tables,
dispensers, mirrors, partitions, doors, walls, moldings, ceiling and wall vents, shelves,
furniture, trim, baseboards, etc., in restrooms and adjacent lounge areas using a
germicidal detergent.
Deodorant urinal screens shall be used in urinals only. Highly scented disinfectants,
objectionable or odoriferous cleaners shall not be used
In many buildings, restrooms must be checked and touched up or re-cleaned multiple
times throughout a normal workday. Since the Contractor only works after normal
working hours, this will be the responsibility of the County.
Restroom Floors - Clean restroom floors according to the flooring standards, schedule,
and protocol described in the flooring section.
Stairways/Stairwells
Routine - Sweep stairwells and remove all trash. Damp mop stairs and remove any
stains, gum, etc.
Scrub and sanitize hand rails.
EXHIBIT “C”
FL-128
6
Periodic -
Supplies
Contractor is responsible for procurement, storage, distribution and supply of plastic
wastebasket liners, toilet tissue, paper towels, liquid hand soap, disposable liners for
sanitary napkin cans, blood and bodily fluid cleanup kits, and all cleaning products
necessary to perform the services required herein.
Stocking Dispensers
1. Dispensers are to be refilled and cleaned daily
2. No refill/extra supplies shall be stocked in the area of dispensers
3. All dispensers found to be less than half filled will be considered insufficient.
4. Contractor will maintain ten (10) day’s stock of restroom supplies in the Janitorial
closets at all facilities for the term of the contract. (Note: Some facilities may not
have a closet or room that can accommodate a 10 day supply. In those cases the
items shall be stored in the nearest County facility that can accommodate the
supplies).
Material Safety Data Sheets (MSDS) - Prior to the use of any product/chemical in the
building, Facility Services will have on hand a Material Safety Data Sheet for each
such product/chemical. These are maintained in a file in each janitorial closet where
materials area stored.
Surfaces
General Surfaces - Dust and clean all surfaces including, but not limited to the
following, to remove dust, finger marks, smudges, graffiti, gum, dirt buildup, and/or
accumulation:
• baseboards • light switches (and surrounding wall area)
• ceiling and wall vents • metal trim
• ceiling or shelf fans • moldings
• counters • partitions
• door frames • picture frames
• door jams • push plates
• doors • vending machines
• elevators • walls
• fire extinguishers • window blinds
• kick plates
General Surface cleaning requirements include:
• Ash Trays - Empty and Clean outside ashtrays, if applicable
EXHIBIT “C”
FL-128
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• Brass and Chrome – Polish (brass, chrome, etc.) doorknobs, handrails, kick
plates and push plates on doors or other pieces of door trim. Use a cloth and
polish, wipe film dry.
• Chalkboards and Whiteboards - Chalkboards and white boards should only
be cleaned upon request and with appropriate cleaner provided by the user
department. Trays should be cleaned with a suitable cleaner.
• Drinking Fountains - Clean drinking fountains with germicidal detergent to
sanitize. Remove calcium deposits with an environmental stain remover. Wipe
off with a dry cloth, then polish and wipe dry. If drinking fountain drain is slow,
report it to maintenance.
• Glass - Clean both sides of entrance door glass, clean door glass frames and
accompanying glass panels including transoms (inside and outside), removing
all fingerprints and dirt. Spot clean all interior glass. Contractor shall clean all
interior glass partitions, inside exterior glass, display cases, mirrors,
Periodic
• Ceilings and Corners – Remove cobwebs from all ceilings, doors, and corners
within the building
• Light fixtures -. Clean light fixtures, as needed, to remove insects, dirt, etc., in
and on the fixtures.
• Vents, Grills and Diffusers - Clean/vacuum all supply and return air diffusers
and any other vents on walls or ceilings.
Trash and Recycling
Trash Pick-Up and Removal
Routine - Empty all waste receptacles, including wastebaskets, trash cans, and boxes
(if labeled "trash", etc.) Deposit the trash into appropriate waste disposal containers.
Empty boxes, papers, magazines, etc; outside of trash receptacles not labeled trash
are not to be removed.
Ensure all waste receptacles are maintained in a clean and odor-free condition. Wash
wastebaskets and replace plastic liners, as needed.
Remove all trash and waste to a designated on-site dumpster or compactor) for
disposal. CA.
Remove all trash and sweep sidewalks for ten feet (10’) from all entrances/exits to the
building.
Recycling
Routine - Transport all recyclables such as mixed paper, plastic/glass and aluminum
containers from bins inside County offices to designated location containers. Note that
some buildings have extensive quantities of materials that must be recycled.
EXHIBIT “C”
FL-128
8
Empty large shredders and transport shredded paper to recycle locations. Empty
small, “personal” shredders only upon request from building occupants.
All cardboard is to be broken down before empting into the appropriate on-site
container (i.e. compactor, recycle bin).
Walk-Off Mats – Provide clean walk-off mats at all times in locations where they
currently exist.
Windows and Window Coverings
Routine - See “Surfaces” section regarding general glass cleaning.
Periodic – Periodic window glass cleaning is done by a window cleaning contractor.
Clean/dust all window coverings.
Exhibit D
Page 1 of 2
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as “County”),
members of a contractor’s board of directors (hereinafter referred to as “County Contractor”), must
disclose any self-dealing transactions that they are a party to while providing goods, performing
services, or both for the County. A self-dealing transaction is defined below:
“A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest”
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member’s name, job title (if applicable), and date this disclosure is being made.
(2) Enter the board member’s company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction; and
b. The nature of the material financial interest in the Corporation’s transaction that the
board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Exhibit D
Page 2 of 2
(1) Company Board Member Information:
Name: Date:
Job Title:
(2) Company/Agency Name and Address:
(3) Disclosure (Please describe the nature of the self-dealing transaction you are a party to)
(4) Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a)
(5) Authorized Signature
Signature: Date: