Request For Proposals For Screening, Assessment, Referral, and Treatment Services Allan Rawland, Director Department of Behavioral Health 268 West Hospitality Lane, Suite 400 San Bernardino, CA 92415-0026 Karen Scott, Executive Director The Children and Families Commission for San Bernardino County 330 N. "D" Street, 5th Fl. San Bernardino, CA 92415 Department of Behavioral Health – Contracts Unit 268 West Hospitality Lane, Suite 400 San Bernardino, CA 92415-0026

RFP – DBH 09 – 72

Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

TABLE OF CONTENTS I.

INTRODUCTION .......................................................................................................................... 1 A. Purpose B. Period of Contract C. Minimum Proposer Requirements D. Mandatory Proposal Conference E. Questions F. Correspondence G. Admonition of Vendors H. Proposal Submission Deadline I. Local Preference Policy

II.

PROCUREMENT TIMELINE ........................................................................................................ 3

III.

PROCUREMENT CONDITIONS .................................................................................................. 3 A. Contingencies B. Acceptance of Rejection of Proposals C. Modifications D. Proposal Submission E. Incurred Costs F. Public Inspection G. Clarifications H. Negotiations I. Independent Proposer J. Pre-Award On-Site Visit K. Level of Service L. Termination of Awarded Contract M. Priority Population N. Formal Agreement O. Final Authority

IV.

DBH PROGRAM REQUIREMENTS (SCOPE OF WORK) .......................................................... 5 A. Definitions B. Background C. Program Description

V.

FIRST 5 SAN BERNARDINO PROGRAM REQUIREMENTS (SCOPE OF WORK)................. 20 A. Definitions B. Background C. Program Description

VI.

CONTRACT REQUIREMENTS .................................................................................................. 21 A. General B. Additional First 5 Contract Responsibilities C. Indemnification and Insurance Requirements D. Right to Monitor and Audit

VII.

EQUAL EMPLOYMENT OPPORTUNITY/CIVIL RIGHTS ............................................................ 36

VIII.

FORMER COUNTY OFFICIAL ................................................................................................... 37

IX.

IMPROPER CONSIDERATION .................................................................................................. 37

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Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

X.

DISCLOSURE OF CRIMINAL AND CIVIL PROCEEDINGS ....................................................... 38

XI.

CALIFORNIA PUBLIC RECORDS ACT .................................................................................... 38

XII.

DBH SUBCONTRACTOR STATUS........................................................................................... 39

XIII.

PROPOSAL SUBMISSION......................................................................................................... 39 A. General B. Proposal Presentation C. Proposal Format DBH Proposal Format First 5 San Bernardino Proposal Format

XIV.

PROPOSAL EVALUATION AND SELECTION .......................................................................... 45 A. Evaluation Process B. Evaluation Criteria C. Protests D. Final Authority

ATTACHMENTS:

A B C D E F G H I J K L M N O P

Proposal Submission Checklist Table of Contents Statements of Certification Exceptions to RFP Subcontractor Information Financial Capability Insurance Forms Local Preference Policy San Bernardino County Mental Health Plan (MHP) Grievance Procedure Budget Sample Budget Cover Page First 5 San Bernardino Application Workbook First 5 San Bernardino Program Budget Medi-Cal Certification Requirements Business Associates Agreement American Recovery and Reinvestment Act Funding (ARRA)

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Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

I.

INTRODUCTION A.

Purpose The Department of Behavioral Health (DBH), hereafter referred to as the “County”, in collaboration with The Children and Families Commission for San Bernardino County (also referenced as “Commission” and “First 5 San Bernardino”), and their partners from the Children and Family Services (CFS), Department of Public Health (DPH), Children’s Fund, Children’s Network and Preschool Services Department (PSD), are seeking proposals from interested and qualified organizations and agencies to provide Screening, Assessment, Referral, and Treatment (SART) services for children age(s) 0-5 that are determined to need assessment and treatment related to severe mental health disorders that require specialty mental health services. Specific services to be provided under this Request for Proposals (RFP) are outlined under Section IV, DBH Program Requirements and Section V, First 5 San Bernardino Program Requirements. Selected Vendors will receive separate contractual agreements with the County and First 5 San Bernardino. The SART program intends to improve the social, developmental, cognitive, emotional and behavioral functioning of children ages birth through 5 years old. DBH is seeking Vendors to provide mental health service in the West Valley, East/Central Valley, High Desert/Mountain and Morongo Basin regions of San Bernardino County. Proposers may propose to provide services for any or all of the regions.

B.

Period of Contract The contract period for DBH will be for a three (3) year period beginning on July 1, 2010 through June 30, 2013. The County may, but is not obligated to, extend awarded contract(s) for up to two (2) additional one-year periods contingent on the availability of funds and Vendor performance. Currently, the projected amount for this service is approximately four ($4) million annually countywide. DBH reserves the right, after the contract award, to amend the resulting contract as needed throughout the term of the contract to best meet the needs of all parties. The contract period for First 5 San Bernardino for this RFP will for a three (3) year period beginning on July 1, 2010 through June 30, 2013. The Commission may, but is not obligated to, extend awarded contract(s) for up to two (2) additional one-year period contingent on the availability of California Children and Families Trust funds and Vendor performance. The Commission reserves the right, after the contract award, to amend the resulting contract as needed throughout the term of the contract to best meet the needs of all parties.

C.

Minimum Proposer Requirements Proposers must: 1.

Have a representative at the mandatory proposal conference as referenced in this RFP.

2.

Attend required Technical Assistance Training. Time and place to be announced.

3.

Be a non-profit, for-profit organization or other legally constituted business entity.

4.

Have a current Medi-Cal Certification or have the ability to become Medi-Cal Certified within 90 days of the start of the contract, if applicable.

5.

Have no record of unsatisfactory performance. Proposers who are or have been seriously deficient in current or recent contract performance, in the absence of circumstances properly beyond the control of the Proposer, shall be presumed to be unable to meet this requirement.

6.

Have the ability to maintain adequate files and records and meet statistical reporting requirements.

7.

Have the administrative and fiscal capability to provide and manage the proposed services and to ensure an adequate audit trail.

8.

Meet other presentation and participation requirements listed in this RFP. Page 1 of 48

Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

D.

Mandatory Proposal Conference 1.

A mandatory proposal conference will be held at San Bernardino County Department of Behavioral Health, on: Wednesday, January 20, 2010 at 9 AM Pacific Standard Time (PST): ADDRESS: Department of Behavioral Health Training Institute 1950 S. Sunwest Lane, Suite 200 . San Bernardino, CA 92415

2. E.

Attendance at the conference is mandatory. No proposal will be accepted from any Proposer who fails to attend the proposal conference.

Questions Questions regarding the contents of this RFP must be submitted in writing on or before 12 noon PST, Thursday, January 28, 2010 and directed to the individual listed in Section I, Paragraph F. Faxes and emails are acceptable. The subject line of the e-mail must read: RFP DBH 09 – 72. All questions will be answered and both the question and answer will be posted on the County’s Purchasing Web-Site.

F.

Correspondence All correspondence, including proposals and questions, are to be submitted to:

G.

County of San Bernardino Department of Behavioral Health ATTN: Contracts Administration RE: RFP-DBH 09 – 72 268 West Hospitality Lane, Suite 400 San Bernardino, CA 92415-0026 Contact person: Johnnetta Gibson Phone: (909) 382 – 3031 Email: [email protected] Fax: (909) 382 – 3060 Admonition to Vendors Once the RFP has been issued and during the evaluation process, the individual identified above is the sole contact point for any inquiries or information relating to this RFP. Only if authorized by the County’s contact may other County Staff provide information. Any violation of this procedure may be grounds for disqualification of the Proposer. It is the responsibility of the Proposer to ensure that the RFP responses arrive in a timely manner.

H.

Proposal Submission Deadline All proposals must be received at the address listed in Paragraph F above no later than 4 PM (PST) on Tuesday, February 9, 2010. Facsimile or electronically transmitted proposals will not be accepted since they do not contain original signatures. Postmarks will not be accepted in lieu of actual receipt. Late proposals will not be considered.

I.

Local Preference Policy The County of San Bernardino has adopted a preference for Vendors whose principal place of business is located within the boundaries of the County. A five percent (5%) preference may be applied prior to approval of any purchase or acquisition of services, equipment, goods, or supplies. Page 2 of 48

Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

For purposes of the application of the local preference policy (County Policy 11 – 12), "principal place of business" is defined as the Vendor's main office (or headquarters) or a major r e g i o n a l office. A "major regional office" is defined as a business location apart from the Vendor's main office (or headquarters) which: •

Has been issued a business license, if required, and has been established and open for a minimum of six months prior to the date that the approval authority authorizes the circulation of an RFP, Request for Qualifications (RFQ), Quote(s) and Requests for Applications (RFA) for any contract, agreement, or purchase order to which it responds; and

•

Can demonstrate on–going business activity in the field of endeavor on which the Vendor is proposing, from that office during the preceding six months; and

•

Has a minimum of twenty-five percent (25%) of the Vendor's full time management employees and twenty-five percent (25%) of its full time regular employees working from the San Bernardino County location(s).

The County's Local Preference Policy means for example, if two Vendors are responding to this RFP and if quality, service and ability to meet the County's needs are equal, County staff must determine if one of the Vendors is a local Vendor. If one of the Vendors is a local vendor, and its quoted price or cost for services, equipment, goods or supplies does not exceed five percent (5%) of the other Vendor's quoted price or cost, unless it is determined that an exemption applies, staff should recommend the local Vendor for the contract award. II.

PROCUREMENT TIMELINE RFP release date Mandatory Proposal conference

January 12, 2010 Wednesday, January 20, 2010 @ 9:00 AM PST

Deadline for submission of questions

Thursday, January 28 , 2010 @ 12:00 Noon PST, **Questions may be submitted in writing prior to the Proposal Conference

Technical Assistance Training

Deadline for submission of proposals

Those attending the Mandatory Proposal Conference will be notified of any necessary Technical Assistance Training Time and Location. Tuesday, February 9, 2010 @ 4:00 PM PST

Tentative date for mailing award/denial letters

March 19, 2010

Tentative deadline for protests

March 29, 2010

Tentative date for awarding of Contract(s) Tentative start date for Contract(s)

April 30, 2010 July 1, 2010

The above dates are subject to change as deemed necessary by the County of San Bernardino.

III.

PROCUREMENT CONDITIONS A.

Contingences DBH funding for this program is contingent on funding from the appropriate office of the State of California and is subject to reimbursement under Federal and State laws. This RFP does not commit the County and the Commission to award a Contract. Cost, while not necessarily the primary Page 3 of 48

Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

factor used in the selection process, is an important factor. The County and the Commission will each award a Contract based on the proposal that best meets their needs. Those agencies that receive a First 5 San Bernardino investment as a result of this RFP, must be able to meet the contract requirements of the Commission as well as the County. B.

Acceptance or Rejection of Proposals The County and the Commission reserves the right to accept or reject any or all proposals if the County or the Commission determines it is in their best interest to do so. The County and the Commission will notify all Proposers, in writing, if the County and the Commission rejects all proposals. The County and the Commission reserve the right to terminate this procurement process at any time.

C.

Modifications The County and the Commission have the right to issue addenda or amendments to this RFP if the County and the Commission determines that additional clarifications are needed. Only those Vendors represented at the proposal conference will receive addenda or amendments issued after the mandatory proposals conference.

D.

Proposal Submission To be considered, all proposals must be submitted in the manner set forth in this RFP. It is the Proposer’s responsibility to ensure that their proposal arrives on or before the specified deadline. All proposals and materials submitted become the property of the County and the Commission.

E.

Incurred Costs This RFP does not commit the County and the Commission to pay any costs incurred in the preparation of a proposal in response to this request and Proposer agrees that all costs incurred in developing this proposal are the Proposer’s responsibility.

F.

Public Inspection Proposals will remain confidential until issuance of contracts to selected Proposer(s). At that time proposals submitted in response to this RFP become the property of the County of San Bernardino and are subject to the provisions of the California Public Records Act. This Act is designed to give reasonable public access to information in the possession of public agencies.

G.

Clarifications The County and the Commission may require the Proposer(s) selected as a potential Vendor/Contractor(s) to provide additional information or clarifications on any area contained in this RFP or which might be aid in evaluating Vendors. This may include cost, technical, or other clarifications needed to make a decision.

H.

Negotiations The County and the Commission may require the Proposer(s) selected as potential Vendor/Contractor(s) to participate in negotiations, and to submit revisions to cost, technical information, and/or other items from their proposal(s) as may result from these negotiations.

I.

Independent Proposer Any Proposer that is awarded a Contract will be considered an independent Vendor(s), wholly responsible for the manner in which it performs, and will assume exclusively the responsibility for the acts of its employees who will not be entitled to any rights and privileges of County and Commission employees nor be considered in any manner to be County or Commission employees.

J.

Pre-Award On-Site Visits

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Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

Site visits may be conducted to verify information submitted in the RFP and to determine if the proposed facilities are appropriate for the proposed services to be provided. K.

Level of Service For any Contract awarded as a result of the RFP, no minimum or maximum number of referrals or enrollments can be guaranteed by the County and the Commission.

L.

Termination of Awarded Contract The Contract between the County and/or the Commission and selected Proposer(s) will contain specific language which addresses the option of the selected Proposer(s), County or the Commission to terminate the Contract without cause, termination for the convenience of the County, and termination for cause.

M.

Priority Population Services for children age(s) 0-5 that are determined to need assessment and treatment related to severe mental health disorders that require specialty mental health.

N.

Formal Agreement Selected Vendor/Contractor(s) will be required to enter into a formal agreement with the County and the Commission. This RFP sets forth some of the general provisions which will be included in the final contracts. In submitting a response to this RFP, Proposer will be deemed to have agreed to each clause unless the proposal identifies an objection and the County or the Commission agrees to a change of language in writing. Failure to raise any objections to the contract language at the time of submittal of a response to this RFP will result in a waiver of objection to any of the contract language.

O.

Final Authority For County contracts, the final authority to award a Contract rests solely with the San Bernardino County Board of Supervisors. For Commission contracts, the final authority to award a Contract rests solely with the Children and Families Commission for San Bernardino County.

IV.

DBH PROGRAM REQUIREMENTS (SCOPE OF WORK) A.

Definitions (Program Specific) 1. 2.

3. 4.

Accessibility – Ease of obtaining services, measured by addressing geographical, travel and other barriers. Ages & Stages Questionnaire (ASQ) – Screening instruments used to assess referred children, birth through five years of age, for developmental, intellectual, speech, behavioral, and emotional problems. Ages & Stages Questionnaire Social/Emotional (ASQ-SE) – A culturally sensitive screening system for identifying young children at risk for social or emotional difficulties. Best Practice Principles – Underlying principles inherent in a "family centered model" that includes: a. The provision of community-based services and supports. b. Focusing on the family setting by partnering with families. c. A dyadic approach to treatment with the parent and child. d. Consumer-driven services that ensure access, voice, and choice for parents and children in the design, delivery, and evaluation of services. e. Drawing attention to family and child strengths in developing individualized Child and Family Service Plans. f. Providing individualized services and support to the unique needs of each child and family. Page 5 of 48

Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

g. h.

i. j.

5. 6.

7. 8.

9.

10.

11. 12.

13.

14.

Flexibility in location, time, planning, service response, and funding. Establishing community-wide collaboration in service design and system evolution, including parents, mental health, juvenile justice, education, social welfare, and cultural stakeholders in the community. Measurable accountability and outcome-driven individualized service plans. The provision of culturally relevant/competent services by tailoring responses to family culture, values, norms, strengths, and preferences. Here, the Contractor will provide DBH with fiscal year reports (Frequency and form to be provided by DBH on ”Consumer Focus Groups” to improve accessibility to specialty mental health services by identifying and removing barriers to treatment.).

Brain-based Development and Behavior – Recognition of the multiple factors in the prenatal and infancy period that affect growth, structure, and function of the brain. Children and Families Commission for San Bernardino County – The agency, commonly referred to as First 5 San Bernardino or the Commission, that works in collaboration with the community and agencies with the purpose of promoting, supporting, and improving the early development of children from the prenatal stage through five years of age. Child-centered – A value of the Model of Care that demands all decisions are made in the best interest of the child. Children and Family Services (CFS) – One of eight departments in the County of San Bernardino Human Services System, CFS provides family-centered programs and services designed to ensure safe, permanent, nurturing families for the County’s children while strengthening and attempting to preserve the family unit. Children’s Network – An organization that concerns itself with at-risk children who are defined as minors who, because of behavior, abuse, neglect, medical needs, educational assessment, and/or detrimental daily living situations, are eligible for services from one or more of the member agencies of the Children’s Network. The overall goal of the Children’s Network is to help at-risk children by improving communications, planning, coordination, cooperation, and integration among youth-serving agencies. Community-Based – The concept of children and families receiving formal services, whenever possible, in the community where they live. This will enable them to live, learn, and grow safely, competently, and productively in their families, neighborhoods, and natural environment. Cost Effectiveness – Achieving the desired goal with the minimum of expenditure. Cultural Relevance (Cultural Competency) – The acceptance and understanding of cultural mores, history, language, race, ethnicity and culture and their possible influence on the client's issues and/or behavior, i.e. using the understanding of the differences between the prevailing social culture and that of the client’s family to aid in developing individualized supports and services. Department of Behavioral Health (DBH) – DBH, under state law, provides mental health, alcohol and drug treatment and prevention services to County residents. In order to maintain a continuum of care, DBH operates, or contracts for the provision of 24-hour care, day treatment, outpatient services, case management, and crisis and referral services. Community services are provided in all major county metropolitan areas and are readily accessible to most County residents. Additionally, DBH assists individuals utilizing a Wellness, Recovery and Resilience approach to help the individual to live a healthy, satisfying, and hopeful life despite limitation and/or continuing effects caused by his/her mental illness and/or substance abuse in the least restrictive setting possible. Department of Public Health (DPH) – DPH provides a foundation for success for children by giving them the highest quality child development and family support services while offering community and preventive health services that promote and improve the health, safety, well being and quality of life in the County. Page 6 of 48

Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

15. 16.

Developmental Disabilities – Delays in motor, language, and cognitive development that impede a child’s ability to function fully. Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT) Medi-Cal – A federally-mandated Medicaid option that requires states to provide screening, diagnostic and treatment services to persons under age 21 who have unrestricted Medi-Cal and also meet necessary medical criteria by having a qualifying mental health diagnosis and functional impairment that is not responsive to treatment by a healthcare-based provider. In addition, services are generally acceptable for the purpose of correcting or ameliorating the mental disorder. For the purposes of this proposal, EPSDT Medi-Cal Rehabilitative Mental Health Services activities may include Assessment, Collateral, Crisis Intervention, Medication Support Services, Plan Development, Rehabilitation and Therapy. a. Assessment – is defined as a service activity designed to evaluate the current status of a child’s mental, emotional, or behavioral health. Assessment includes, but is not limited to, one or more of the following: mental status determination, analysis of the child’s clinical history; analysis of relevant cultural issues and history; diagnosis; and the use of testing procedures. b. Collateral – is defined as a service activity to a Significant Support Person in a child’s life for the purpose of meeting the needs of the child in terms of achieving the goals of the youth’s client plan. Collateral may include, but is not limited to, consultation and training of the significant support person(s) to assist in better utilization of mental health services by the child, consultation and training of the significant support person(s) to assist in better understanding of the youth’s serious emotional disturbance; and family counseling with significant support person(s) in achieving the goals of the youth’s client plan. The youth may or may not be present for this service activity. c. Crisis Intervention – Crisis intervention is a quick emergency response service enabling the individual and/or family, support system and/or involved others to cope with a crisis, while maintaining his/her status as a functioning community member to the greatest extent possible, and in the least restrictive care as applicable. A crisis is an unplanned event that results in the individual’s need for immediate service intervention. Crisis intervention services are limited to stabilization of the presenting emergency. This service does not include Crisis Stabilization, which is provided in a 24-hour health care facility or hospital outpatient program. Service activities include but are not limited to assessment, evaluation, collateral and therapy (all billed as crisis intervention). d. Medication Support Services – Medication support services include staff persons practicing within the scope of their professions by prescribing, administering, dispensing and/or monitoring of psychiatric medications or biologicals necessary to alleviate the symptoms of mental illness. This service includes: i. Evaluation of the need for medication. ii. Evaluation of clinical effectiveness and side effects of medication. iii. Obtaining informed consent. iv. Medication education (including discussing risks, benefits and alternatives with the individual, family or significant support persons). v. Plan development related to the delivery of this service. e. Plan Development – is defined as a service activity that consists of development of client plans, approval of client plans, and/or monitoring and recording of a child’s progress. f. Rehabilitation – is defined as a service activity that includes, but is not limited to, assistance in improving, maintaining, or restoring a child’s or group of children’s functional skills, daily living skills, social and leisure skills, and grooming and Page 7 of 48

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17.

18.

19.

20.

21.

22.

23.

personal hygiene skills; obtaining support resources; and/or obtaining medication education. i. Assistance in restoring or maintaining an individual’s functional skills, social skills, medication compliance, and support resources. ii. Age-appropriate counseling of the individual and/or family, support systems and involved others. iii. Training in leisure activities needed to achieve the individual’s goals/desired results/personal milestones. iv. Medication education for family, support systems and involved others. g. Targeted Case Management – (TCM) means services that assist a beneficiary to access needed medical, educational, social, prevocational, vocational, rehabilitative, or other community services. The service activities may include, but are not limited to, communication, coordination, and referral; monitoring service delivery to ensure beneficiary access to service and the service delivery system; monitoring of the beneficiary’s progress; placement services; and plan development. TCM may be either face-to-face or by telephone with the child/youth or significant support persons and may be provided anywhere in the community. h. Therapy - A service activity that may be delivered to an individual or group of individuals and may include family therapy (when the individual is present). Therapeutic interventions are consistent with the individual's goals, desired results, and personal milestones and focus primarily on symptom reduction as the means to improve functional impairments. Early Intervention – Providing services to the child at as young an age as possible has been shown to have positive effects on the child’s long-term outcome. For young children, early intervention services can cover a wide range of disciplines and approaches: physical therapy, occupational therapy, sensory integration, speech and language developmental therapy and dyadic therapy (often referred to as “treatment”). Family-Centered – The needs of children are addressed in the context of their families. Parents or other persons who are the primary or natural caregivers for the children participate in all aspects of the development and implementation of the plan of support and services, to the degree they are able, and to the extent permitted by any outstanding orders of the court. Family Setting/Types – Any family setting where there is a relative or caregiver interested in strength-based services and willing to work toward permanency. This may include parents, relative placements, guardianships, and/or foster homes. Formal/Professional Resources, Services, and Supports – Traditional social service options administered by professionals, (e.g., counseling, psychological evaluations, parenting classes, and anger management training.) Foster Care – Foster care is a temporary placement, which assists children in preparing for return to their birth parents or for a more permanent placement such as adoption or guardianship. Social workers visit the home on a regular basis to provide services to support the children’s needs. Foster parents receive ongoing financial and medical assistance for the child. Full-Time Equivalent (FTE) – The percentage of time a staff member works represented as a decimal. A full-time person is 1.00, a half-time person is .50 and a quarter-time person is .25. Interagency Placement Council (IPC) – A committee made up of members of DBH, Probation, CFS, IRC, Children’s Network, DPH and County Schools. Members are responsible for screening and assess initial referrals for children in RCL 14, CTF (Community Treatment Facility) and Out of State Placements. IPC ensures the assessment and recommendation will result in the special needs of the child being met.

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30.

Individualized Service Plan (ISP) – A flexible, creative approach to a plan of care/treatment for clients based on assessment of needs, resources, and family strengths with the ultimate goal of promoting the self-sufficiency of the family in dealing with their unique challenges. The plan reflects the best possible fit with the culture, values, and beliefs of the client and family/caregiver(s) and the referring agency’s safety concerns. Infant, Preschool, Family, Mental Health Initiative (IPFMHI) – A compendium of Screening Tools for Early Childhood Social Emotional Development booklet will be used as a guide for the selection of screening tools to be used with the infants and caregivers. Infant Mental Health – The developing capacity of the child from birth through age three to experience, regulate, and express emotions, form close and secure interpersonal relationships and explore the environment and learn all in the context of family, community, and cultural expectation for young children. Inland Regional Center (IRC) – IRC is an agency, contracted through the California Department of Developmental Services, which provides services to children and adults diagnosed with autism, mental retardation, and cerebral palsy. Long – Term Foster Care – The intentional and planned placement of a child in foster care for an extended period of time; also known as a “Planned Permanent Living Arrangement”. After the goal of adoption has been explored and not selected, and relative options are not feasible, a goal of planned long-term foster care may be seen as a viable goal. Mental Health Services – means individual or group therapies and interventions that are designed to provide reduction of mental disability and restoration, improvement or maintenance of functioning consistent with the goals of learning, development, independent living and enhanced self-sufficiency and that are not provided as a component of residential services, crisis residential treatment services, crisis intervention, crisis stabilization, day rehabilitation, or day treatment intensive. Service activities may include but are not limited to assessment, collateral, therapy, rehabilitation, and plan development. Medical Necessity – The client must meet criteria outlined in A, B, and C below to be eligible for services: A. Be diagnosed by the Mental Health Provider (MHP) with one of the following diagnoses in the most current Diagnostic and Statistical Manual, Latest Edition, published by the American Psychiatric Association: 1) Pervasive Developmental Disorders, except Autistic Disorders 2) Disruptive Behavior and Attention Deficit Disorders 3) Feeding and Eating Disorders of Infancy and Early Childhood 4) Elimination Disorders 5) Other Disorders of Infancy, Childhood, or Adolescence 6) Schizophrenia and other Psychotic Disorders 7) Mood Disorders 8) Anxiety Disorders 9) Somatoform Disorders 10) Factitious Disorders 11) Dissociative Disorders 12) Paraphilias 13) Gender Identity Disorder 14) Eating Disorders 15) Impulse Control Disorders Not Elsewhere Classified 16) Adjustment Disorders 17) Personality Disorders, excluding Antisocial Personality Disorder Page 9 of 48

Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

18)

31. 32.

33. 34.

Medication-Induced Movement Disorders related to other included diagnoses B. Must have at least one of the following impairments as a result of the mental disorder(s) listed in subdivision A above: 1) A significant impairment in an important area of life functioning. 2) A probability of significant deterioration in an important area of life functioning. 3) Except as provided in Title 9, California Code of Regulations (CCR), Section 1830.210, a probability a child will not progress developmentally as individually appropriate. For the purpose of this section, a child is a person under the age of 21 years. C. Must meet each of the intervention criteria listed below: 1) The focus of the proposed intervention is to address the condition identified in B above. 2) The expectation is that the proposed intervention will: (a) Significantly diminish the impairment, or (b) Prevent significant deterioration in an important area of life functioning, or (c) Except as provided in Title 9, CCR, Section 1830.210, allow the child to progress developmentally as individually appropriate. 3) The condition would not be responsive to physical health care based treatment. When the requirements of this section are met, clients shall receive specialty mental health services for a diagnosis included in subsection A, even if a diagnosis that is not included in subsection A is also present. Memorandum of Understanding (MOU) – An official statement outlining a mutual understanding between parties as to their working relationship. Multidisciplinary Team (MDT) – A MDT brings representatives from County agencies together to work collaboratively. a. Members of an MDT are united by the realization that child and family issues have complex causes and a serious impact on society. b. Each member has a designated role and continues to do his or her traditional job, but with the additional insight and assistance provided by others on the team. c. Formal written agreements, protocols, and/or guidelines signed by authorized representatives of all team components allow for routine sharing of information among team members. d. A Transdisciplinary Team is also a MDT team of professionals including a Pediatrician, Pediatric Clinical Psychologist, licensed and pre-licensed clinicians, occupational therapists trained in sensory integration, speech and language specialists, and family advocates, that may meet with and confer with MDT’s in the care of a child or client. (Note: These are not EPSDT Mental Health Medi-Cal services.) Needs Driven Services – Treatment is determined through the formal assessment of child and family needs. Family expression of needs is a valuable component in this process. Pre-School Services Department (PSD) – PSD provides a foundation for the success for each child by giving them the highest quality child development and family support services through the Federal Head Start program and other childcare programs in San Bernardino County.

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41.

42.

Probation Department (Probation) – Probation protects the community through assessment, treatment and control of adult and juvenile offenders by providing a range of effective services based on legal requirements and recognized professional standards. Request for Proposal (RFP) - The document used to solicit a solution or solutions from potential Vendors to a specific problem or need. Although price is important, originality and effectiveness of the proposal and the background and experience of the Proposer are evaluated in addition to the proposed price. Satisfaction Survey - Survey designed to measure the child’s, the family’s, and/or the referring Department’s overall satisfaction with the service rendered. Satisfaction Surveys address specific aspects of service provision in order to identify problems and opportunities for improvement. Seriously Emotionally Disturbed (SED) – “SED children or adolescents” refers to minors under the age of 18 years who have a mental disorder as identified in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, other than a primary substance use disorder or developmental disorder, which results in behavior inappropriate to the child's age according to expected developmental norms. Schedule of Maximum Allowances (SMA) – SMA refers to regulating maximum amounts payable by function for medical and related services pursuant to Welfare and Institutions (W& I) Code 5720 (a) and (b). Strength-based – The process of developing an Individualized Service Plan beginning with an assessment of the strengths of all the family members and other individuals involved with the family team. The Plan emphasizes the strengths of the family rather than their problems and deficits. It evaluates and utilizes family strengths in the individualized planning process. This is a departure from the professional-driven service delivery system, which traditionally focuses on family deficits and inadequately emphasizes strengths. Target Population – Children ages 0-5 who are eligible for SART Assessment/Treatment. A program-eligible child must screen positive on the ASQ/SE and/or: 1) be Medi-Cal eligible, 2) have a history of substance-exposure and/or child abuse and neglect, and 3) be referred by the CFS, DBH, or PSD. During this the term of any Contract awarded in response to this RFP, an emphasis will be placed on foster care children due to their increased risk status. Therapeutic Behavioral Service (TBS) Activity – TBS are one-to-one behavioral mental health services available to children/youth with serious emotional challenges who are under age 21 and who are eligible for a full array of Medi-Cal benefits without restrictions or limitations (full scope Medi-Cal). TBS can help children/youth and parents/caregivers, foster parents, group home staff, and school staff learn new ways of reducing and managing challenging behaviors as well as strategies and skills to increase the kinds of behavior that will allow children/youth to be successful in their current environment. TBS are designed to help children/youth and parents/caregivers (when available) manage these behaviors utilizing short-term, measurable goals based on the needs of the child/youth and family. TBS are never a stand-alone therapeutic intervention. It is used in conjunction with another mental health service. a. TBS Assessment is a clinical analysis of the history and current status of the individual’s mental, emotional, or behavioral disorder. Relevant cultural issues and history should be included where appropriate. Assessment may include diagnosis. A TBS assessment also includes identifying the child/youth’s target behaviors and/or symptoms that jeopardize continuation of the current residential placement or may interfere in transition to a lower level of care. The assessment must be comprehensive enough to identify that the minor meets medical necessity, is a fullscope Medi-Cal beneficiary under 21 years of age and is a member of the “certified class”, and that there is a need for specialty mental health services in addition to TBS. This service is not always a direct face-to-face service. Page 11 of 48

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b.

B.

TBS Collateral is contact with one or more significant support person in the life of the beneficiary, which may include consultation and training to assist in better utilization of TBS services and understanding of mental illness, the behaviors and symptoms being targeted. TBS collateral services can be used in such cases when a TBS Coach or TBS Clinician contacts the therapist providing the mental health services, or beneficiaries caregivers (parent, teacher, group home staff, neighbor, siblings, etc.), as long as it directly relates to the TBS treatment plan. As a general rule, if the Contractor is providing services that are linked to target behaviors or TBS treatment plan and the beneficiary is not present, then the Contractor would be delivering “Collateral TBS”. An example of “Collateral TBS” would be when the Contractor is working with the parent/caregiver towards the goals of the minor’s TBS treatment plan, or while conducting a TBS Treatment Team meeting. TBS collateral contacts must be with individuals identified as significant in the child/youth’s life and be directly related to the needs, goals and interventions for the child/youth identified on the TBS Treatment Plan. This service can be delivered either face-to-face or by phone. c. TBS Plan Development may include any or all of the following: i. Development and approval of treatment or service plans. ii. Verification of service necessity. iii. Monitoring of the individual’s progress. d. TBS Coach Time is a TBS service that includes one-to-one (face- to-face) therapeutic contact between a mental health provider (TBS Coach) and a beneficiary for a specified short-term period of time, which is designed to maintain the child/youth’s placement at the lowest appropriate level by resolving target behaviors and achieving short-term goals. i. TBS Coach Time may not begin until the initial assessment is completed. ii. The majority of TBS billing should fall under this category. Contractor will provide these services only upon DBH’s prior approval and in compliance with the TBS protocol as described in DMH Information Notice 03-04 and subsequent notices, and in compliance with applicable DBH policies and procedures and/or Court orders. 43. Transdisciplinary Team – A multidisciplinary team of professionals, including a Pediatrician, Pediatric Clinical Psychologist, licensed and pre-licensed clinicians, occupational therapists trained in sensory integration, speech and language specialists, and family advocates that may meet with and confer with other members of a Behavioral Health (Mental Health and Substance Abuse) MDT in the care of a child or client. (Note: These are not EPSDT Mental Health Medi-Cal services.) 44. Welfare and Institutions Code (W&I Code) – A series of statutes in California that includes programs and services designed to provide protection, support, or care of individuals. The purpose of these statutes is to provide protective services to the fullest extent deemed necessary by the juvenile court, probation department, or other public agencies designated by the Board of Supervisors to perform the duties prescribed to insure that the rights or physical, mental, or moral welfare of children are not violated or threatened by their present circumstances or environment. Background SART services shall be furnished through Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Medi-Cal and through First 5 San Bernardino funding sources to children, ages 0 – 5, who reside in San Bernardino County, primarily within the West Valley, East/Central Valley, High Desert/Mountain and Morongo Basin Regions.

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EPSDT is a federally-mandated Medicaid option requiring the provision of screening, diagnostic and treatment services to eligible Medi-Cal recipients under the age of 21. EPSDT Medi-Cal services are defined per State Department of Mental Health (DMH) Information Notice 98-03, dated March 6, 1999. The intent of the program is to expand mental health services for children and youth with Medi-Cal coverage to “ascertain physical and mental defects” and “to provide treatment to correct or ameliorate defects and chronic conditions found”. SART services are intended to improve the social, developmental, cognitive, emotional and behavioral functioning of children ages birth through 5 years old (i.e., through the child’s fifth year). Accordingly, the target population will be children up through 5 years of age who have experienced physical, sexual and emotional abuse as a result of premature birth, poor maternal nutrition, family violence, maternal depression and/or substance abuse or prenatal exposure to alcohol or other drugs. Of the 8,851 children in need of services and are unserved in San Bernardino County approximately 60% (5,314) are Latino, 18% (1,567) are African-Americans, 10% (868) are EuroAmericans, and the remaining 12% (1,102) are of other and/or multiple ethnicities. By region, 33% of the unserved children live in the East/Central Valley, 11% in the Desert/Mountain (including the Morongo Basin), and 56% in the West Valley. The following children are priorities for services under this RFP: a. b. c. d. e. f. g.

Victims of natural disaster and local emergencies Psychiatric hospital discharges Children referred by the Children and Family Services, including those who have been placed in foster care and in the Family Maintenance Program Children referred by DBH’s Perinatal Clinic Children referred by HSS-PSD/San Bernardino Preschool Services or Head Start Programs Children referred by the Children and Families Commission (First 5 San Bernardino) or any of its Community-Based Organizations meeting SART criteria. Unserved and Underserved Children in need of SART Mental Health services.

It is expected that the client population be reflective of the social, economic and ethnic characteristics of the communities served by the Contractor. Accordingly, the Contractor/Prospective Vendor shall develop admission policies and procedures regarding those children and youth in need of assessment, referral and treatment who are EPSDT Medi-Cal eligible and non-EPSDT eligible. Non-EPSDT eligible children and youth in need of assessment, referral and treatment should be screened and referred to an appropriate behavioral/mental/medical health service provider or be treated under separate funding streams such as First 5. The funding guidelines will be outlined later in this RFP. The proposal must include a specific plan or protocol to refer non-eligible individuals to DBH ACCESS for assessment, referral and treatment of siblings. DBH will not reimburse Contractor for services provided to Non-Medi-Cal beneficiaries. Furthermore, DBH or First 5 San Bernardino cannot reimburse Contractor for services provided to out-of-county Medi-Cal beneficiaries. As noted above, children screened, referred or treated by an appropriate behavioral/mental health service provider may be reimbursed under a separate funding stream. DBH’s direct or indirect involvement in the screening and/or referral of a child to a non-EPSDT behavioral/mental/medical health service provider may not be construed as obligating DBH to provide nor pay for non-EPSDT services. Additionally, certain Departmental and Community-Based Agency agreements exist between the DBH, CFS, DPH, First 5 San Bernardino, Children’s Fund, Children’s Network and PSD for the early identification and specialized Screening, Assessment, Referral and Treatment of Children 0 through 5

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Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

exposed to the physical, emotional, psychological, familial and societal ravages of substance misuse/abuse, premature birth, poor maternal nutrition, family violence, or maternal depression. C.

Program Description 1.

General Children’s SART Program Requirements a.

The first function in the model, Screening, will be a specialized function. Infants and children will be identified and referred by CFS, Head Start, and DBH. Additionally, the provider will conduct screening for CFS children utilizing the Ages and Stages Questionnaire (ASQ) and the Ages and Stages Questionnaire Social/Emotional (ASQ/SE). The provider will communicate to child’s parent or guardian and the referral source, including CFS, the results of the screening and any recommendations for assessment and treatment.

b.

The next two functions are Assessment and Referral for treatment and will be conducted by Selected Vendor(s), and shall be characterized by the following:

c.

2.

i.

Children who are seen as having primarily developmental problems only will be referred to IRC.

ii.

Multidisciplinary staffing which includes the co-location of existing assessment and treatment resources provided by public agencies and/or community organizations.

iii.

A family-based assessment approach will be utilized.

iv.

An individualized assessment and treatment plan based on the needs of the child and caretaker is required. A qualified professional public health nurse, pediatrician, psychologist, social worker, occupational therapist, speech/language clinician, or infant mental health specialist may conduct relevant assessment protocols.

v.

After a child is assessed, a report is produced which includes recommendations for treatment. The family is linked with available resources for the indicated treatments.

The last function is Treatment which ideally will be available in a child’s own community. Treatment modalities that should be considered for working with these families are: i.

Infant Mental Health

ii.

Parent- Child Interactive Therapy (PCIT)

iii.

Parent-Child Dyadic Therapy

iv.

Sensory Integration Treatment

v.

Thera-play

vi.

Other Evidence-based treatment deemed beneficial for this

vii.

Specialized population

The selected Children’s SART Vendor(s) will be responsible for the items listed below. Funding for the items listed below will be available through EPSDT Medi-Cal or through criteria to be determined by the Commission. a.

Agree to start providing assessment and treatment service no later than 90 days from the start date of the SART Contract. DBH will work with the Selected Vendor(s) to assess readiness to provide EPSDT services.

b.

Develop, coordinate, and provide formal therapeutic treatment services based on assessments and treatment recommendations. Treatment professionals should be Page 14 of 48

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primarily comprised of professionals trained in working with children ages 0-5, as well as a public health nurse. The specifics regarding the public health nurse position will be determined at a later date. A case management component will provide services to children and families which:

3.

1)

Refers child(ren) and families to appropriate services based on their treatment needs.

2)

Assures that services are explained to the child’s parent or guardian in the appropriate language and in a culturally competent manner.

3)

Assists the child’s parent or guardian with necessary arrangements for the assessment visit (i.e., transportation, childcare).

4)

Assists caregivers in obtaining medical records in preparation for the assessment visit.

5)

Assures that an assessment-results discussion takes place with the family/or guardian to assure they have a good understanding of the results of the assessment and possible treatment needs.

6)

Follows up with the family/guardian to assure that the treatment plan is initiated.

c.

Employ and train an adequate number of staff to achieve the scope of objectives. This includes ongoing staff training to develop the overall “provider capacity”.

d.

Obtain Medi-Cal certification in order to be able to bill EPSDT Medi-Cal for services to Medi-Cal eligible children.

e.

Comply with all State Department of Mental Health requirements to obtain and maintain Medi-Cal certification eligibility.

f.

Agree to utilize a multidisciplinary (also termed “transdisciplinary” in terms of other health professions) approach to assessment and treatment of children and families/guardians.

g.

Agree to provide pediatric medical evaluations and pediatric neuropsychological developmental assessments as necessary.

h.

Provide services in a culturally competent manner by recruiting, hiring, and maintaining staff members who can provide services to a diverse population.

i.

Provide services in the appropriate language and in a culturally sensitive manner.

j.

Agree to collect, analyze, and share data consistent with the countywide outcomes evaluation framework. Selected Vendor(s), in coordination with evaluators, will be responsible for tracking outcomes. 1)

The DBH Research and Evaluation (R&E) will collect/import important outcome information from targeted consumer groups and Selected Vendor(s) throughout the term of any Contract awarded in response to this RFP.

2)

R&E will notify the Selected Vendor(s) when its 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 the information needed

Program Consideration “Mental Health Services” mean individual or group therapies and interventions that are designed to provide reduction of mental disability and restoration, improvement or Page 15 of 48

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maintenance of functioning consistent with the goals of learning, development, independent living and enhanced self-sufficiency and that are not provided as a component of residential services, crisis residential treatment services, crisis intervention, crisis stabilization, day rehabilitation, or day treatment intensive. Service activities may include but are not limited to assessment, collateral, therapy, rehabilitation, and plan development. Not all of the activities need to be provided for a service to be billable. 1)

Assessment is defined as a service activity designed to evaluate the current status of a child’s mental, emotional, or behavioral health. Assessment includes, but is not limited to, one or more of the following: mental status determination, analysis of the child’s clinical history; analysis of relevant cultural issues and history; diagnosis; and the use of testing procedures.

2)

Collateral is defined as a service activity to a Significant Support Person in a child’s life for the purpose of meeting the needs of the child in terms of achieving the goals of the youth’s client plan. Collateral may include, but is not limited to, consultation and training of the significant support person(s) to assist in better utilization of mental health services by the child, consultation and training of the significant support person(s) to assist in better understanding of the youth’s serious emotional disturbance; and family counseling with significant support person(s) in achieving the goals of the youth’s client plan. The youth may or may not be present for this service activity. Services to siblings and family members who are not parents or primary caregivers may only be incidental to services provided to children prenatal through age five.

3)

Therapy is defined as a service activity that is a therapeutic intervention that focuses primarily on symptom reduction as a means to improve functional impairments. Therapy may be delivered to a child or a group of children, and may include family therapy at which the child is present.

4)

Rehabilitation defined as a service activity that includes, but is not limited to, assistance in improving, maintaining, or restoring a child’s or group of children’s functional skills, daily living skills, social and leisure skills, and grooming and personal hygiene skills; obtaining support resources; and/or obtaining medication education. (a)

Assistance in restoring or maintaining an individual’s functional skills, social skills, medication compliance, and support resources.

(b)

Age-appropriate counseling of the individual and/or family, support systems and involved others.

(c)

Training in leisure activities needed to achieve the individual’s goals/desired results/personal milestones.

(d)

Medication education for family, support systems and involved others

5)

Plan Development is defined as a service activity that consists of development of client plans, approval of client plans, and/or monitoring and recording of a child’s progress.

6)

Medication Support Services Medication support services include staff persons practicing within the scope of their professions by prescribing, administering, dispensing and/or monitoring of psychiatric medications or biologicals necessary to alleviate the symptoms of mental illness. This service includes: (a)

Evaluation of the need for medication.

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Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

(b)

Evaluation of clinical effectiveness and side effects of medication.

(c)

Obtaining informed consent.

(d)

Medication education (including discussing risks, benefits and alternatives with the individual, family or significant support persons).

(e)

Plan development related to the delivery of this service.

(f)

The Contractor shall make clients aware of their responsibility to pay for their psychiatric medications not included on the Medi-Cal formulary. However, if there is a financial hardship, and the client cannot function normally without the prescribed psychiatric medication, the Contractor shall cover the cost of those psychiatric medications not listed on the current Medi-Cal Formulary. The Contractor physician shall submit a written request to the Contractor’s/ Director for approval to waive clients' responsibility to pay for their own psychiatric medications.

7)

Crisis intervention is a quick emergency response service enabling the individual, his or her family, support system and/or involved others to cope with a crisis, while maintaining the child’s status as a functioning family and/or “immediate community” member to the greatest extent possible, and in the least restrictive care as applicable. A crisis is an unplanned event that results in the individual’s need for immediate service intervention. Crisis intervention services are limited to stabilization of the presenting emergency. This service does not include Crisis Stabilization, which is provided in a 24hour health care facility or hospital outpatient program. Service activities include but are not limited to assessment, evaluation, collateral and therapy (all billed as crisis intervention).

8)

Targeted Case Management (TCM) means services that assist a beneficiary to access needed medical, educational, social, prevocational, vocational, rehabilitative, or other community services. The service activities may include, but are not limited to, communication, coordination, and referral; monitoring service delivery to ensure beneficiary access to service and the service delivery system; monitoring of the beneficiary’s progress; placement services; and plan development. Targeted Case Management may be either face-to-face or by telephone with the child/youth or significant support persons and may be provided anywhere in the community.

9)

Peer & Family Advocate: Mental health consumers and/or their family members who serve as advocates for consumers to help them access DBH and community resources such as TAY Centers, clubhouses, social events, wellness and recovery activities, self-help groups, and mental health and drug and alcohol services. They perform the following tasks:

10)

(a)

Conduct various types of support groups, classes, wellness and recovery activities, and recreational activities throughout the department and contract agencies and promote the Mental Health Service Plan.

(b)

Access and distribute to the public various internet resources related to education; utilize the computer to maintain files, records, and basic statistics on program activities, participation, and attendance.

Transportation: Contractor will provide transportation of non-violent, medically stable persons who meet the W&I Code §5150/5855 criteria to the

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Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

closest 5150 psychiatric inpatient facility. The Contractor is encouraged to contact DBH’s Children’s/Community Crisis Response Teams as needed. 11)

The Selected Contractor(s) will conduct Consumer Focus Groups: ”Consumer Focus Groups” to improve accessibility to specialty mental health services by identifying and removing barriers to treatment. In addition, the Selected Contractor(s) will provide DBH with summary reports of focus groups (frequency and form will determined by DBH at a later date).

12)

Staffing Requirements

13)

14)

(a)

Staff hours of coverage: All staff shall be employed by the Selected Contractor(s). The staff described will work the designated number of hours per week in full time equivalents (FTE's), perform the job functions specified and shall meet the California Code of Regulations requirements. All treatment staff providing services with DBH funding shall be licensed or waivered by the State, according to DBH’s policy, and reflect the ethnic population of the community served.

(b)

Staff Counts / staff to client ratio: As may be appropriate to accomplish SART services in conformity with Title 9 and 22, and any other applicable regulations.

(c)

Licensure / Certification requirements: The Selected Contractor’s personnel will possess appropriate licenses and certificates and be qualified in accordance with applicable statutes and regulations. The Selected Contractor(s) will obtain, maintain and comply with all necessary government authorizations, permits and licenses required to conduct its operations. In addition, the Selected Contractor(s) will comply with all applicable Federal, State and local laws, rules, regulations and orders in its operations including compliance with all applicable safety and health requirements as to the Selected Contractor's employees.

Professional Development and Training requirements: Treatment professionals should be primarily comprised of professionals trained in working with children ages 0-5, as well as a public health nurse. A case management component will provide services to children and families which: (a)

Refers child(ren) and families to appropriate services based on their treatment.

(b)

Assure that services are explained to the child’s parent or guardian in the appropriate language and in a culturally competent manner.

(c)

Assist child’s parent or guardian with necessary arrangements for the assessment visit (i.e., transportation, childcare).

(d)

Assist caregivers in obtaining medical records in preparation for the assessment visit.

Staff Cultural Competency Requirements Training: The Selected Contractor(s) will provide behavioral health services in a culturally and linguistically sensitive manner. This includes providing information in the appropriate languages and providing information to persons with visual and hearing impairments. (a)

The Selected Contractor(s) will make every effort to recruit bilingual staff in order to meet community needs. Page 18 of 48

Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

15)

(b)

The Selected Contractor(s) will provide on-going training for staff on cultural issues.

(c)

Number of staff fluent in other languages (describe): As may be appropriate to accomplish SART services in conformity with Title 9 and 22, and any other applicable regulation.

Billings and Reimbursed Services Generally, the Vendor shall collect revenues for the provision of the services described in the RFP. Such revenues may include, but are not limited to, fees for services, private contributions, grants or other funds. All revenues collected shall be used to offset the cost of services and should, therefore, be considered in computing the proposed schedules to this RFP and any existing contracts arising from this RFP. Specifically, non-EPSDT reimbursable services (e.g., speech and language therapies, other nonmental health services and services that are not Medi-Cal eligible, etc.) should be provided by the prospective Vendor under separate agreements for reimbursement or by such process as to satisfy the Joint Services protocols referenced above. However, if additional funding sources become available, the Selected Vendors or programs will be notified accordingly. (a)

Billing Unit (EPSDT Medi-Cal) The billing unit for EPSDT Medi-Cal mental health services, rehabilitation support services, crisis intervention and case management/brokerage is staff time, based on minutes of time. The exact number of minutes used by staff providing a reimbursable service shall be reported and billed. In no case shall more than 60 units of time be reported or claimed for any one staff person during a one-hour period. Also, in no case shall the units of time reported or claimed for any one staff member exceed the hours worked. When a staff member provides service to or on behalf of more than one individual at the same time, the staff member’s time must be prorated to each individual. When more than one staff person provides a service, the time utilized by all involved staff members shall be added together to yield the total billable time. The total time claimed shall not exceed the actual staff time utilized for billable service. The time required for documentation and travel shall be linked to the delivery of the reimbursable service and shall not be separately billed. Plan development is reimbursable. Units of time may be billed when there is no unit of service (e.g., time spent in plan development activities may be billed regardless of whether there is a face-to-face or phone contact with the individual or significant other).

(b)

The Selected Contractor(s) shall abide by the criteria and procedures set forth in the Uniform Method of Determining Ability to Pay (UMDAP) manual consistent with State regulations for mental health programs. The Selected Contractor(s) shall not charge behavioral health/ mental health patients in excess of what UMDAP allows.

(c)

Billing Unit (Non-EPSDT) Any billing unit for mental health services, rehabilitation support services, crisis intervention and case management/brokerage provided to non-eligible EPSDT Medi-Cal children or in which nonPage 19 of 48

Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

reimbursable services are compensated under separate contracts or agreements, funding sources or matching funds will bill and report as specified in such contracts or agreements. 16)

V.

Location Requirements: (a)

The Selected Contractor(s) will maintain facilities and equipment, and operate continuously with at least the number and classification of staff required for the provision of services

(b)

The Selected Contractor(s) shall obtain the prior written consent of the Director of DBH or the designee before terminating outpatient services at the contractual approved location or providing services at another location.

(c)

Selected Contractor(s) must have a location that is accessible by public transportation and approved by DBH.

(d)

The Selected Contractor(s) shall provide adequate furnishings and clinical supplies to do outpatient therapy in a clinically effective manner.

(e)

The Selected Contractor(s) shall maintain the facility exterior and interior appearances in a safe, clean, and attractive manner.

(f)

The Selected Contractor(s) shall have adequate fire extinguishers and smoke alarms, as well as a fire safety plan.

(g)

The Selected Contractor(s) shall have an exterior sign clearly indicating the location and name of the clinic.

(h)

The Selected Contractor(s) shall have clinic pamphlets identifying the clinic and its services, in threshold languages, for distribution in the community.

(i)

Hours of operation: The main clinic office will be open 40 hours per week, and offer behavioral health services to clients during some evening and/or weekend hours as part of the 40 hours per week in which the clinic provides treatment. Selected Contractor(s) shall keep DBH informed of hours of operation.

FIRST 5 SAN BERNARDINO PROGRAM REQUIREMENTS (SCOPE OF WORK) Contracts funded through this RFP may include the additional following provisions, as applicable, subject to negotiations, revisions and Commission approval. A.

Commission Responsibilities 1.

Commission shall verify performance results of Contractor according to the Program Plan in meeting terms of the contract and the quality and effectiveness of services provided, based on criteria agreed upon, as delineated in the awarded contract.

2.

The Executive Director, on behalf of the Commission, may approve modifications to the contract that do not result in a material change to the contract or deviate from its intent. Any request must be submitted to the Commission in writing and signed by an individual authorized to commit the Contractor and may not be implemented without prior written approval.

3.

Commission shall compensate Contractor for approved expenses in accordance with Section VIII of the awarded contract.

4.

Commission shall specify all reports and deliverables required from the Contractor.

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Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

B.

5.

Commission shall provide technical assistance as deemed necessary.

6.

The Commission will designate one individual to serve as the primary contact for the contract and will notify the Contractor of this designee within 15 days of the contract approval.

Correction of Performance Deficiencies and Termination 1.

Failure by Contractor to comply with any of the provisions, covenants, requirements, or conditions of the awarded contract shall be a material breach of the awarded contract. In such event the Commission, in addition to any other remedies available at law, in equity, or otherwise specified in the awarded contract, may: a.

Afford Contractor a time period within which to cure the breach; which period shall be established at the sole discretion of the Executive Director; and

b.

Request Contractor provide and implement an action plan to correct breach within a reasonable timeframe; and/or

c.

Discontinue reimbursement to the Contractor for and during the period in which the Contractor is in breach, which reimbursement shall not be entitled to later recovery; and/or;

d.

Offset against any monies billed by the Contractor but yet unpaid by the Commission those monies disallowed pursuant to Item 2 of this paragraph; and/or

e.

Immediately terminate the awarded contract with just cause and be relieved of the payment of any consideration to the Contractor should the Contractor fail to perform the covenants herein contained at the time and in the manner herein provided. In the event of such termination, the Commission may proceed with the work in any manner deemed proper by the Commission. The cost to the Commission shall be deducted from any sum due to the Contractor under the awarded contract and the balance, if any, shall be paid by the Contractor upon demand.

2.

The Executive Director, on behalf of the Commission, shall give Contractor notice of any action pursuant to this paragraph, which notice shall be effective when given.

3.

The Executive Director is authorized to exercise Commission’s rights with respect to initiating any remedies or termination of the awarded contract in his/her sole discretion and to give notice as set forth below in the awarded contract.

4.

Commission shall have Power of Attorney to pay delinquent debts and unpaid wages from accounts payable to Contractor in the event debts and wages have not been paid on a current basis.

5.

Nothing contained in the awarded contract shall be construed as creating a joint venture, partnership or employment arrangement between the parties hereto, nor shall either party have the right, power or authority to create an obligation or duty, expressed or implied, on behalf of the party hereto.

6.

No waiver of any of the provisions of the awarded contract shall be effective, unless it is made in a writing, which refers to provisions so waived and which is executed by the parties in an amendment to the awarded contract.

7.

Any alterations, variations, modifications, or waivers of provisions of the awarded contract, unless specifically allowed in the awarded contract, shall be valid only when they have been reduced to writing, duly signed and approved by the authorized representatives of both parties as an amendment to the awarded contract. No oral understanding or contract not incorporated herein, shall be binding on any of the parties hereto. No course of dealing and no delay or failure of a party in exercising any right under any awarded contract shall affect any other or future exercise of that right or any exercise of any other right. A party shall not

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be precluded from exercising a right by its having partially exercised that right or its having previously abandoned or discontinued steps to enforce that right.

VI.

8.

If any provision of the awarded contract is held by a court of competent jurisdiction to be unenforceable or contrary to law, it shall be modified where practicable to the extent necessary so as to be enforceable, giving effect to the intention of the parties, and the remaining provisions of the awarded contract shall not be affected.

9.

The awarded contract shall be governed by and construes in all aspects in accordance with the laws of the State of California without regard to principles of conflicts of laws. The parties agree to the exclusive jurisdiction of the federal and state courts located in the County of San Bernardino, for any and all disputes arising under the awarded contract, to the exclusion of all other federal and state courts.

10.

Contractor understands and agrees that any and all legal fees or costs associated with lawsuits against Commission concerning the awarded contract shall be Contractor's sole expense and shall not be charged as a cost under the awarded contract. In the event of any contract dispute hereunder, each party to this contract shall bear its own attorneys' fees and costs regardless of who prevails in the outcome of the dispute.

CONTRACT REQUIREMENTS A.

General The Proposer(s) selected may be required to agree to the terms contained below. If the Proposer has any objections, these objections must be addressed in the RFP response to the County and the Commission or the objections will be deemed to have been waived. 1.

Representation of the County and the Commission In the performance of the awarded Contract, Proposer, its agents and employees, shall act in an independent capacity and not as officers, employees, or agents of County of San Bernardino or the Commission.

2.

Proposer Primary Contact The Proposer will designate an individual to serve as the primary point of contact for the awarded Contract. Proposer shall notify DBH and the Commission when the primary contact will be unavailable/out of the office for one (1) or more workdays. Proposer or designee must respond to County or the Commission inquiries within two (2) County business days.

3.

Change of Address Proposer shall notify the County and the Commission in writing of any change in mailing address within ten (10) calendar days of the address change.

4.

Contract Assignability Without the prior written consent of the County and the Commission, the awarded Contract is not assignable by Proposer either in whole or in part.

5.

Contract Amendments Proposer agrees any alterations, variations, modifications, or waivers of provisions of the awarded Contract shall be valid only when they have been reduced to writing, duly signed and attached to the original the Contract and approved by the required persons and organizations.

6.

Copyright County and the Commission shall have a royalty-free, non-exclusive and irrevocable license to publish, disclose, copy, translate, and otherwise use, copyright or patent, now and hereafter, all reports, studies, information, data, statistics, forms, designs, plans, procedures, systems, and any other materials or properties developed under the awarded Contract including those Page 22 of 48

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covered by copyright, and reserves the right to authorize others to use or reproduce such material. All such materials developed under the terms of the awarded Contract shall acknowledge San Bernardino County Department of Behavioral Health as the funding agency and Proposer as the creator of the publication. No such materials or properties produced in whole or in part under the awarded Contract shall be subject to private use, copyright or patent right by Proposer in the United States or in any other country without the express written consent of County or the Commission. Copies of all educational and training materials, curricula, audio/visual aids, printed material, and periodicals, assembled pursuant to the awarded Contract must be filed with County or the Commission prior to publication. Proposer shall receive written permission from County or the Commission prior to publication of said training materials. In addition, the Vendor shall properly acknowledge the Commission per the requirements stated in the Commission Attribution Standards. 7.

Attorney Costs & Fees If any legal action is instituted to enforce any party’s rights hereunder, each party shall bear its own costs and attorneys’ fees, regardless of who is the prevailing party. This paragraph shall not apply to those costs and attorney fees directly arising from a third-party legal action against a party hereto and payable under Article VI Contract Requirements, Paragraph C., 1. Indemnification.

8.

Conflict of Interest Proposer shall make all reasonable efforts to ensure that no County or Commission officer or employee, whose position in the County or with the Commission enables him/her to influence any award of this contract or any competing offer, shall have any direct or indirect financial interest resulting from the award of this contract or shall have any relationship to the Vendor or officer or employee of the Vendor. Officers, employees, and agents of cities, counties, districts, and other local agencies are subject to applicable conflict of interest codes and State law, including Section 23-602 (Code of Conduct) of Chapter 23-600 of the California Department of Social Services (CDSS) Manual of Policies and Procedures. In the event that County or the Commission determines that a conflict of interest situation exists, any increase in costs associated with the conflict of interest situation may be disallowed by County or the Commission and such conflict may constitute grounds for termination of the Agreement. This provision shall not be construed to prohibit employment of persons with whom Proposer's officers, employees, or agents have family, business, or other ties so long as the employment of such persons does not result in increased costs over those associated with the employment of any other equally qualified applicant.

9.

Grievance Procedure Proposer will ensure that staff are knowledgeable on the San Bernardino County Mental Health Plan Grievance Procedure (attached as Attachment I) and ensure that any complaints by recipients are referred to the County in accordance with the procedure.

10.

Confidentiality The Selected Contractor shall be required to protect from unauthorized use or disclosure names and other identifying information concerning persons receiving services pursuant to the awarded Contract, except for statistical information not identifying any participant. The Selected Contractor shall not use or disclose any identifying information for any other purpose other than carrying out the Contractor's obligations under the awarded Contract, except as may be otherwise required by law. This provision will remain in force even after the termination of the awarded Contract.

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11.

DBH Research Policy Research involving the client cannot be conducted without the prior written approval of the Director of the Department of Behavioral Health. Any approved research must follow the guidelines in the DBH Research Policy.

12.

DBH Contract Reimbursement a.

If applicable, Proposer is required to become Medi-Cal certified in order to provide and be reimbursed for services provided to Medi-Cal clients. Proposers may access certification procedures by referring to http://www.sbcounty.gov/dbh/Contract_Providers_Detailed_Certification_Process.pdf. Also see Attachment N for a general view of the Medi-Cal process.

b.

Contracts are typically funded annually on a July 1 – June 30 fiscal year basis.

c.

Proposer shall bill the County monthly in arrears on claim forms provided by the County.

d.

If applicable, no later than 75 days after the end of the fiscal year or expiration date or termination of a contract for services, unless otherwise notified by County, the Proposer shall provide the County with a complete and correct annual standard State of California Cost Report for Medi-Cal services.

e.

Where billing accounts have crossover Medicare and/or Insurance along with MediCal, Proposer shall first be required to bill Medicare and/or applicable insurance, then provide to the DBH Business Office copies of Proposer’s billing and the Remittance Advice (RA) that show that the bill was either paid or denied. The DBH Business Office, upon receipt of these two items, will proceed to have the remainder of the claim submitted to Medi-Cal. Without these two items, the accounts with the crossover Medicare and/or Insurance along with Medi-Cal will not be billed. Proposer shall be obligated to report all revenue received from any source, including Medicare revenue, in its monthly claim for reimbursement. Contractor shall be in compliance with the Deficit Reduction Act of 2005, Section 6032 Implementation. As a condition of payment for services, goods, supplies and merchandise provided to beneficiaries in the Medical Assistance Program (“MediCal”), providers must comply with the False Claims Act employee training and policy requirements in 1902(a) of the Social Security Act (42 USC 1396(a)(68)), set forth in that subsection and as the federal Secretary of Health and Human Services may specify.

f.

Proposer shall collect revenues for the provision of the services described in this RFP and any Contract awarded. Such revenues may include, but are not limited to, fees for services, private contributions, grants or other funds. All revenues received by the Proposer shall be reported in the annual Cost Report, and shall be used to offset gross cost.

g.

Proposer shall exercise diligence in billing and collecting fees and/or co pays from patients for services. The State of California “Uniform Method of Determining Ability to Pay” (UMDAP) shall be followed in charging clients for services under this agreement. Proposers may access these procedures at: http://www.dmh.cahwnet.gov/DMHDocs/default.asp?view=notices, Information Notice 98-13.

h.

Contractor shall input Charge Data Invoices (CDI’s) into the County's billing and transactional database system by the fifth (5th) day of the month for the previous Page 24 of 48

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month’s services. Contractor will be paid based on Medi-Cal claimed services in the County’s billing and transactional database system for the previous month. Services cannot be billed by the County to Medi-Cal until they are input into the County’s billing and transactional database system. i.

13.

Any resulting contract from this RFP, may be funded in whole or in part with funds provided by the American Recovery and Reinvestment Act of 2009 (ARRA), signed into law on February 17, 2009, Contractor shall comply with the terms and conditions as set forth and hereby incorporated by this reference as Attachment P.

First 5 San Bernardino Fiscal Provisions a.

Allowable Costs Funds provided pursuant to an awarded contract shall be expended by Contractor in accordance with the Program Budget. Such specified expenditures will be further limited to those that are considered both reasonable and necessary as determined by the Commission. Contractor agrees Commission may recover any payments for services or goods, including rental of facilities, which were not reasonable and necessary or which exceeded the fair market value. The recovery shall be limited to payments over and above reasonable or fair market amounts and any costs of recovery. The reasonable and allowable reimbursement rate for use of motor vehicles is current IRS allowable rate. Costs must be incurred only during the contract term, except when specifically approved by the Commission. Contractor shall not use current year funds to pay prior or future year obligations. Contractor will not be reimbursed for expenditures incurred after the expiration or termination of this contract. Contractor shall obtain Commission approval for all out of State travel as it relates to services provided in the awarded contract. Request must be submitted in writing 30 days in advance of travel date and travel must be approved in advanced by the First 5 Program Manager.

b.

Budget Line Item Changes A Budget Revision Request may be submitted by the Contractor to the Commission to modify a line or lines of the approved budget. The request must indicate the proposed line item changes, the budget as amended applying the requested changes and a written justification for each requested change. The request cannot result in any alteration or degradation to the program services and performance target as specified in this contract. The Executive Director, on behalf of the Commission, has the authority to approve or deny the request, provided that the modification does not deviate from the original intent of the contract or increase the total contract amount. The Contractor must submit any requests to the Commission no later than March 31st of the fiscal year. Requests must be submitted in hard copy form with original signatures. Postmarked envelopes received after March 31st will not be accepted in lieu of receipt.

c.

Budget Line Item Variances Variances in excess of 10% of a line item cannot be made by the Contractor without prior approval of the Commission. Variance shall not result in a change to the total contract amount or an increase to the administrative cost allocation of the approved budget. Contractor shall provide written justification for any budget line item variances Page 25 of 48

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of more than 10% made during a fiscal quarter in the following Quarterly Expenditure Report/Request for Funds. d.

Procurement Contractor shall procure services or goods required under this contract on a competitive basis (3 bid process when applicable), unless otherwise provided by law, and make selections based on obtaining the best value possible. When a noncompetitive procurement is used, a written justification must be maintained and be made available upon request.

e.

Fixed Assets The purchase of any equipment, materials, supplies or property of any kind, including items such as vehicles, publications, copyrights, which have a single unit cost of $1,000.00 dollars or more, including tax, and was not included in Contractor's approved budget, shall require the prior written approval of the Executive Director, on behalf of the Commission. Any such purchase shall fulfill any applicable provisions of this contract and directly relate to Contractor's services or activities under the terms of the contract. Any item with a single unit cost of $1,000.00 dollars or more, including tax, purchased with funds received under the terms of this contract and not fully consumed during the contract term shall revert to be the property of the Commission, unless otherwise specified by the Commission. The disposition of such equipment or property must be approved by the Executive Director or designee upon contract termination.

f.

Payor of Last Resort Contractor shall attain funding through other sources than the Commission to provide services or support to participants whenever possible. In cases where a participant is qualified for benefits from another source (such as Medi-cal, Healthy Families, federal or state funded programs, personal insurance, etc.), costs relating to services provided to that participant should be paid for by the primary payor first. Only the costs not covered will be allowable under this contract. Written verification shall be provided upon request

g.

Supplanting of Funds

h.

In accordance with the Commission’s Supplantation Policy, Contractor shall not supplant any Federal, State or County funds intended for the purposes of this contract with any funds made available under this contract. Contractor shall not claim reimbursement from Commission for, or apply sums received from Commission with respect to that portion of its obligations, which have been paid by another source of revenue. Contractor agrees that it will not use funds received pursuant to this contract, either directly or indirectly, as a contribution or compensation for purposes of obtaining State funds under any State program or County funds under any County programs without prior written approval of the Commission. This policy can be found on the First 5 San Bernardino website at: http://www.first5sanbernardino.org/aboutus/pdf/CFC_SB_Policy_03_02_Supplantation _Policy.pdf Payment Provisions The Commission will disburse funds in advance quarterly, based on contract budget amount for the applicable year and quarterly reports. The first quarter advance payment will be for an amount up to but not to exceeding 25% of the contract budget for the year. All subsequent quarterly advance amounts Page 26 of 48

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will be determined by actual expenditures reflected on the quarterly reports, projected costs and cash on hand collectively. The Commission reserves the right to reduce or withhold any payments from the Contractor for failure to submit reports in a timely and accurate manner, reported expenditures significantly below projections or the Contractor is not in compliance with the Contract. Final payment under this contract may be withheld until all requirements, including reports, for contract closure have been fulfilled by Contractor. i.

Fiscal Recordkeeping Fiscal records shall be kept in accordance with generally accepted accounting principles and must account for all funds, tangible assets, revenue and expenditures.

14.

Licenses and Permits Proposer will ensure that it has all necessary licenses and permits required by the laws of the United States, State of California, County, the Commission and all other appropriate governmental agencies, and agrees to maintain these licenses and permits in effect for the duration of this Contract. Proposer will notify County immediately of loss or suspension of any such licenses and permits. Failure to maintain a required license or permit may result in immediate termination of this Contract.

15.

Health and Safety Proposer shall comply with all applicable local health and safety clearances, including fire clearances, for each site where program services are provided under the terms of the Contract.

16.

Department of Justice Clearance Proposer shall obtain from the Department of Justice (DOJ) records of all convictions involving any sex crimes, drug crimes, or crimes of violence of a person who is offered employment or volunteers for all positions in which he or she would have contact with a minor, the aged, the blind, the disabled or a domestic violence client, as provided for in Penal Code Section 11105.3. This includes licensed personnel who are not able to provide documentation of prior Department of Justice clearance. A copy of a license from the State of California is sufficient proof.

17.

The Excluded Parties List System (EPLS) Neither Proposer nor its employees or subcontractors shall be named on the EPLS, which includes information regarding entities debarred, suspended, proposed for debarment, excluded or disqualified under the non-procurement common rule, or otherwise declared ineligible from receiving Federal contracts, certain subcontracts, and certain Federal assistance and benefits. The EPLS can be accessed at http://www.epls.gov/. This information may include names, addresses, DUNS numbers, Social Security Numbers (SSNs), Employer Identification Numbers or other Taxpayer Identification Numbers, if available and deemed appropriate and permissible to publish by the agency taking the action. Please be aware that although United States General Service Administration operates this system, individual agencies are responsible for the timely reporting, maintenance, and accuracy of their data.

18.

Health Insurance Portability and Accountability Act Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), regulations have been promulgated governing the privacy of individually identifiable health information. The HIPAA Privacy Regulations specify requirements with respect to contracts between an entity covered under the HIPAA Privacy Regulations and its Business Associates. Page 27 of 48

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A Business Associate is defined as a party that performs certain services on behalf of, or provides certain services for, a Covered Entity and, in conjunction therewith, gains access to individually identifiable health information. Therefore, in accordance with the HIPAA Privacy Regulations, Proposer shall comply with the terms and conditions as set forth in the attached Business Associate Agreement (Attachment O), hereby incorporated by this reference. 19.

Pro-Children Act of 1994 Proposer will comply with Public Law 103-227, Part C - Environmental Tobacco Smoke, also known as the Pro-Children Act of 1994.

20.

Environmental Regulations EPA Regulations - If the amount available to Proposer under the Contract exceeds $100,000, Proposer will agree to comply with the Clean Air Act (42 USC 7606), Section 508 of the Clean Water Act (33 USC 1368), Executive Order 11738 and Environmental Protection Agency regulations (40 CFR, Part 15). State Energy Conservation Clause - Proposer shall observe the mandatory standards and policies relating to energy efficiency in the State Energy Conservation Plan (Title 20, Division 2, Chapter 4, California Code of Regulations).

21.

Recycled Paper Products The County has adopted a recycled product purchasing standards policy (11-10), which requires contractors to use recycled paper for proposals and for any printed or photocopied material created as a result of a contract with the County or the Commission. The policy also requires Contractors to use both sides of the paper sheets for reports submitted to the County whenever practicable.

22.

Americans with Disabilities Act Proposer shall comply with all applicable provisions of the Americans with Disabilities Act (ADA). The ADA can be accessed at http://www.usdoj.gov/crt/ada/adahom1.htm.

23.

Public Accessibility Proposer shall ensure that services provided are accessible by public transportation.

24.

Notification In the event of a problem or potential problem that will impact the quality or quantity of work or the level of performance under the awarded Contract, notification will be made within one working day, in writing and by telephone to the County or the Commission.

25.

Termination for Convenience The County or the Commission for its convenience may terminate the Contract in whole or in part upon thirty (30) calendar day’s written notice. If such termination is effected, an equitable adjustment in the price provided for in the Contract shall be made. Such adjustment shall provide for payment to the Contractor(s) for services rendered and expenses reasonably incurred prior to the effective date of termination. Upon receipt of termination notice the Contractor(s) shall promptly discontinue services unless the notice directs otherwise. The Contractor(s) shall deliver promptly to County and/or the Commission, the transfer title (if necessary) all completed work, and work in progress, including drafts, documents, plans, forms, data, products, graphics, computer programs and reports.

26.

Venue The venue of any action or claim brought by any party to the Contract will be the Superior Court of California, County of San Bernardino, San Bernardino District. Each party hereby waives any law or rule of the court, which would allow them to request or demand a change Page 28 of 48

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of venue. If any action or claim concerning the Contract is brought by any third-party and filed in another venue, the parties hereto agree to use their best efforts to obtain a change of venue to the Superior Court of California, County of San Bernardino, San Bernardino District. 27.

Legality and Severability The parties’ actions under the Contract shall comply with all applicable laws, rules, regulations, court orders and governmental agency orders. If a provision of the Contract is terminated or held to be invalid, illegal or unenforceable, the validity, legality and enforceability of the remaining provisions shall remain in full effect.

28.

Inaccuracies or Misrepresentations If in the course of the RFP process or in the administration of a resulting contract, the County or the Commission determines that the Proposer has made a material misstatement or misrepresentation or that materially inaccurate information has been provided to the County or the Commission, the Proposer may be terminated from the RFP process or in the event a contract has been awarded, the contract may be immediately terminated. In the event of a termination under this provision, the County or the Commission is entitled to pursue any available legal remedies.

29.

Electronic Funds Transfer Contractor selected for Contracts shall accept all payments from County via electronic funds transfer (EFT) directly deposited into the Contractors’ designated checking account or other bank account. Contractor(s) shall promptly comply with directions and accurately complete forms provided by County required to process EFT payments.

30.

Cultural Competency The State Department of Mental Health (DMH) mandates counties to develop and implement a Cultural Competency Plan. This applies to all DBH Services. Policies and procedures and all services must be culturally and linguistically appropriate. Contract agencies will be included in the implementation process of the most recent state approved cultural competency plan for the County of San Bernardino and shall adhere to all cultural competency standards and requirements. Cultural and Linguistic Competency. Cultural competence is defined as a set of congruent practice behaviors, attitudes, and policies that come together in a system, agency, or among consumer providers and professionals that enable that system, agency, or those professional and consumer providers to work effectively in cross-cultural situations. a.

The Proposer shall be required to assess the demographic make-up and population trends of its service area to identify the cultural and linguistic needs of the eligible beneficiary population. Such studies are critical to designing and planning for providing appropriate and effective behavioral health and substance abuse services.

b.

The DBH recognizes 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. Providing medically necessary specialty behavioral health and substance abuse services in a culturally competent manner is fundamental in any effort to ensure success of high quality and cost-effective behavioral health and substance abuse services. Offering those services in a manner that fails to achieve its intended result due to cultural and linguistic barriers is not costeffective. Page 29 of 48

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c.

31.

To assist the Proposer’s efforts towards cultural and linguistic competency, the DBH shall provide the following: i.

Technical assistance to the Proposer regarding cultural competency implementation.

ii.

Demographic information to the Proposer on service area for services planning.

iii.

Cultural competency training for DBH and Proposer personnel. Proposer staff is encouraged to attend at least one cultural competency training per year.

iv.

Interpreter training for DBH and Proposer personnel.

v.

Technical assistance for the Proposer in translating behavioral health and substance abuse services information to the DBH’s threshold languages (Spanish and Vietnamese).

Taxes County is exempt from Federal excise taxes and no payment shall be made for any personal property taxes levied on Vendor or any taxes levied on employee wages. The County shall only pay for any State or local sales or use taxes on the services rendered or equipment and/or parts supplied to the County pursuant to the Contract.

32.

Release of Information No news releases, advertisements, public announcements or photographs arising out of this Contract or Vendor’s relationship with County may be made or used without prior written approval of the County.

B.

Additional First 5 Contract Responsibilities 1.

Contractor’s Service Responsibilities a.

Contractor shall provide services in a manner consistent with the Principles on Equity as adopted by the Commission. This document can be found on the First 5 San Bernardino website at: http://www.first5sanbernardino.org/aboutus/pdf/Principles_on_Equity.pdf

b.

Contractor shall coordinate with appropriate agencies whenever possible to enhance service provision and to maximize usage of First 5 San Bernardino monies available.

c.

Contractor shall deliver performance targets as specified in the contract and provide evidence of achievement as identified in the verification. The verification tools must be pre-approved by the Commission. When specified by the Commission, verification tools must be developed in collaboration with staff or agencies as designated by Commission.

d.

Contractor shall cooperate with any consultant, technical advisor, or committee as designated by the Commission to support the evaluation system development and implementation process.

e.

The Executive Director, on behalf of the Commission, may approve modifications to the contract that do not result in a material change to the contract or deviate from its intent. Any request must be submitted to the Commission in writing and signed by an individual authorized to commit the Contractor and may not be implemented without prior written approval.

f.

Contractor’s Program Plan will be placed in the Commission’s Results Based web based data system. Contractor is bound by the information contained in the Results Based system. If there is a discrepancy between the Contractor’s Program Plan and Page 30 of 48

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the Results Based web program, the Results Based information will take precedence over the Program Plan and will be used to evaluate Contractor’s performance under this contract. It is the responsibility of the Contractor to ensure that the information entered into Results Based, as it relates to the Performance Program Plan, fully captures the intent of the program/project for the term identified in Section II. 2.

Contractor’s General Responsibilities a.

Participants Contractor understands and acknowledges that the services under this contract are for the purposes of promoting, supporting and improving the early development of children prenatal through age five. As such, services provided under this contract shall offer a direct benefit to this population. Any service provided beyond this limitation, unless as agreed upon in the awarded contract, is a breach of contract and an unauthorized expenditure of First 5 San Bernardino funds. Services to siblings and family members who are not parents or primary caregivers may only be incidental to services provided to children prenatal through age five.

b.

Governing Board Upon request, Contractor shall provide the Commission with a list identifying the members of the Board of Directors or other governing party, written schedule of all Board of Directors or other governing party meetings and provide the Commission with copies of the Board of Directors’ minutes when discussions or actions taken during these meetings may impact on the awarded contract. Further, the Commission representative shall have the option of attending Board meetings during the term of the awarded contract.

c.

Responsiveness Contractor or a designee must respond to Commission inquiries within five (5) business days.

d.

Meeting Attendance Contractor will be required to attend meetings, workshops and training sessions around issues related to Contractor’s particular region or directly related to the type of services being provided by Contractor as determined by the Commission. Additionally, Contractor is required to attend Sustainability Planning workshops anticipated to occur two to five times per program year. Notifications of such meetings will be provided to Contractor within a reasonable timeframe.

e.

Maintenance and Operation Facilities shall be properly maintained and operated at all times as relevant to and necessary for the services described in this contract.

f.

Child Abuse Reporting Contractor shall ensure that all known or suspected instances of child abuse or neglect are reported to the appropriate law enforcement agency and/or to the appropriate Child Protective Services agency. This responsibility shall include: 1)

Assurance that all employees, agents, consultants or volunteers who perform services under this contract and are mandated by Penal Code Sections 11164 et seq. to report child abuse or neglect, sign a statement, upon the commencement of their employment, acknowledging their reporting requirements and their compliance with them;

2)

Development and implementation of procedures for employees, agents, consultants, or volunteers who are not subject to the mandatory reporting Page 31 of 48

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laws for child abuse to report any observed or suspected incidents of child abuse to a mandated reporting party, within the program, who will ensure that the incident is reported to the appropriate agency; Provision of or arrangement of training in child abuse reporting laws (Penal Code, Sections 11164 et seq.) for all employees, agents, consultants, and volunteers, or verification that such persons have received training in the law within thirty (30) days of employment/volunteer activity. g.

Conditions of Employment Contractor shall notify the Commission of any staff member, paid intern or volunteer, who is knowingly or negligently employed who has been convicted of any crime of violence or of any sexual crime. Contractor shall investigate all incidents where an applicant, employee, intern or volunteer has been arrested and/or convicted for any crime listed in penal Code Section 11105.3 and shall notify Commission. In its sole discretion, the Commission may require the Contractor to take action to deny or terminate employment, internship and/or volunteer services, as applicable, where the investigation shows that the underlying conduct renders the person unsuitable for employment, internship, or volunteer services. Contractor shall immediately notify the Commission concerning the arrest and/or conviction, for other than minor traffic offenses, of any paid employee, agent, consultant, intern, or volunteer staff, on this contract when such information becomes known to Contractor.

h.

Incongruous Activities Contractor agrees it will not perform or permit any political promotion or religious proselytizing activities in connection with the performance of the awarded contract. Contractor will ensure no staff will conduct activity intended to influence legislation, administrative rule making or the election of candidates for public office during the time compensated under this contract or under representation such activity is being performed under this contract.

i.

Reports Contractor, in a timely and accurate manner, shall submit reports on designated key aspects of the project as required by the Commission. Instructions, format and required information for the content will be provided by the Commission. Report requirements include, but are not limited to and subject to change, the following: 1)

Program Reports Contractor will submit Quarterly Program and Results Reports, which include quarterly and year-to-date progress on actual achievement of performance targets compared to projected achievements as detailed in Program Plan. In any quarter in which the actual target achievement varies from the projected achievement by 20% or more, Contractor shall include a brief narrative providing an explanation for the deviation and the planned program response with the Report. Program reports submitted shall also contain, as available, information in regards to participants whose account represents characteristic, distinctive or exceptional benefit from the program.

2)

Fiscal Reports

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For each calendar month, Contractor shall provide the Commission with a Budget Status and Cash Flow Projection Report within 15 calendar days from the end of the reporting period. Within 30 calendar days after the end of a fiscal quarter, Contractor shall provide the Commission with a Report of Expenditures/Request for Funds covering the fiscal quarter period. Contractor shall submit a Fiscal Year End Report by August 30th for the previous fiscal year period or part thereof during the contract term. Contractor will fulfill evaluation and other reporting requirements as mandated by the Commission and the California Children and Families Commission. Upon implementation and integration of the evaluation data base system, Contractor may be required by the Commission to complete and submit reports electronically via the system. Contractor agrees that failure to submit reports as specified will be sufficient cause for the Commission to withhold any payment due until reporting requirements have been fulfilled. Please see Attachment L – First 5 San Bernardino Application Workbook for additional requirements. C.

Indemnification and Insurance Requirements 1.

Indemnification – The Contractor agrees to indemnify, defend (with counsel reasonably approved by County) and hold harmless the County and its authorized officers, employees, agents and volunteers from any and all claims, actions, losses, damages, and/or liability arising out of this contract from any cause whatsoever, including the acts, errors or omissions of any person and for any costs or expenses incurred by the County on account of any claim except where such indemnification is prohibited by law. This indemnification provision shall apply regardless of the existence or degree of fault of indemnitees. The Contractor’s indemnification obligation applies to the County’s “active” as well as “passive” negligence but does not apply to the County’s “sole negligence” or “willful misconduct” within the meaning of Civil Code Section 2782.

2.

Insurance – The Contractor agrees to provide insurance set forth in accordance with the requirements herein. If the Contractor uses existing coverage to comply with these requirements and that coverage does not meet the specified requirements, the Contractor agrees to amend, supplement or endorse the existing coverage to do so. The type(s) of insurance required is determined by the scope of the contract services. Without in anyway affecting the indemnity herein provided and in addition thereto, the Contractor shall secure and maintain throughout the contract term the following types of insurance with limits as shown: a.

Worker’s Compensation/Employers Liability – A program of Workers’ Compensation insurance or a state-approved, self-insurance program in an amount and form to meet all applicable requirements of the Labor Code of the State of California, including Employer’s Liability with $250,000 limits covering all persons including volunteers providing services on behalf of the Contractor and all risks to such persons under this contract. If Contractor has no employees, it may certify or warrant to the County that it does not currently have any employees or individuals who are defined as “employees” under the Labor Code and the requirement for Worker’s Compensation coverage will be waived by the County’s Director of Risk Management.

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With respect to Contractors that are non-profit corporations organized under California or Federal law, volunteers for such entities are required to be covered by Worker’s Compensation insurance. b.

c.

Commercial/General Liability Insurance – The Contractor shall carry General Liability Insurance covering all operations performed by or on behalf of the Contractor providing coverage for bodily injury and property damage with a combined single limit of not less than one million dollars ($1,000,000), per occurrence. The policy coverage shall include: (1)

Premises operations and mobile equipment.

(2)

Products and completed operations.

(3)

Broad form property damage (including completed operations)

(4)

Explosion, collapse and underground hazards.

(5)

Personal Injury

(6)

Contractual liability

(7)

$2,000,000 general aggregate limit

Automobile Liability Insurance – Primary insurance coverage shall be written on ISO Business Auto coverage form for all owned, hired and non-owned automobiles or symbol 1 (any auto). The policy shall have a combined single limit of not less than one million dollars ($1,000,000) for bodily injury and property damage, per occurrence. If the Contractor is transporting one or more non-employee passengers in performance of contract services, the automobile liability policy shall have a combined single limit of two million dollars ($2,000,000) for bodily injury and property damage per occurrence. If the Contractor owns no autos, a non-owned auto endorsement to the General Liability policy described above is acceptable.

d.

Umbrella Liability Insurance – An umbrella (over primary) or excess policy may be used to comply with limits or other primary coverage requirements. When used, the umbrella policy shall apply to bodily injury/property damage, personal injury/advertising injury and shall include a “dropdown” provision providing primary coverage for any liability not covered by the primary policy. The coverage shall also apply to automobile liability.

e.

Professional Services Requirements (1)

Professional Liability – Professional Liability Insurance with limits of not less than one million ($1,000,000) per claim or occurrence and two million ($2,000,000) aggregate limits or

Errors and Omissions Liability Insurance with limits of not less than one million ($1,000,000) and two million ($2,000,000) aggregate limits or Directors and Officers Insurance coverage with limits of not less than one million ($1,000,000) shall be required for Contracts with charter labor committees or other not-for-profit organizations advising or acting on behalf of the County. (2)

If insurance coverage is provided on a “claims made” policy, the “retroactive date” shall be shown and must be before the date of the start of the contract Page 34 of 48

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work. The claims made insurance shall be maintained or “tail” coverage provided for a minimum of five (5) years after contract completion. The coverage described above is not required for contractors or consultants providing services which are not relied upon by County departments for decision making. These would include trainers or instructors, expert witnesses, statisticians, etc. 3.

Additional Insured - All policies, except for the Worker’s Compensation, Errors and Omissions and Professional Liability policies, shall contain endorsements naming the County and its officers, employees, agents and volunteers as additional insured’s with respect to liabilities arising out of the performance of services hereunder. The additional insured endorsements shall not limit the scope of coverage for the County to vicarious liability but shall allow coverage for the County to the full extent provided by the policy. Such additional insured coverage shall be at least as broad as Additional Insured (Form B) endorsement form ISO, CG 2010.11 85.

4.

Waiver of Subrogation Rights – The Contractor shall require the carriers of required coverages to waive all rights of subrogation against the County, its officers, employees, agents, volunteers, contractors and subcontractors. All general or auto liability insurance coverage provided shall not prohibit the Contractor and Contractor’s employees or agents from waiving the right of subrogation prior to a loss or claim. The Contractor hereby waives all rights to subrogation against the County.

5.

Policies Primary and Non-Contributory – All policies required herein are to be primary and non-contributory with any insurance or self-insurance programs carried or administered by the County.

6.

Severability of Interests – The Contractor agrees to ensure that coverage provided to meet these requirements is applicable separately to each insured and there will be no cross liability exclusions that preclude coverage for suits between the Contractor and the County or between the County and any other insured or additional insured under the policy.

7.

Proof of Coverage – The Contractor shall furnish Certificates of Insurance to the County Department administering the contract evidencing the insurance coverage, including endorsements, as required, prior to the commencements of performance of services hereunder, which certificates shall provide that such insurance shall not be terminated or expire without thirty (30) days written notice to the Department, and Contractor shall maintain such insurance from the time Contractor commences performance of services hereunder until the completion of such services. Within fifteen (15) days of the commencement of this contract, the Contractor shall furnish a copy of the Declaration page for all applicable policies and will provide complete certified copies of the policies and endorsements immediately upon request.

8.

Acceptability of Insurance Carrier – Unless otherwise approved by Risk Management, insurance shall be written by insurers authorized to do business in the State of California and with a minimum “Best” Insurance Guide rating of “A-VII”.

9.

Deductibles and Self-Insured Retention – Any and all deductibles or self-insured retentions in excess of $10,000 shall be declared to and approved by Risk Management.

10.

Failure to Procure Coverage – In the event that any policy of insurance required under this contract does not comply with the requirements, is not procured, or is canceled and not replaced, the County has the right but not the obligation or duty to cancel the contract or obtain insurance if it deems necessary and any premiums paid by the County will be promptly reimbursed by the Contractor or County payments to the Contractor will be reduced to pay for County purchased insurance.

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Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

11.

Insurance Review – Insurance requirements are subject to periodic review by the County. The Director of Risk Management or designee is authorized, but not required, to reduce, waive or suspend any insurance requirements whenever Risk Management determines that any of the required insurance is not available, is unreasonably priced, or is not needed to protect the interest of the County. In addition, if the Department of Risk Management determines that heretofore unreasonably priced or unavailable types of insurance coverage or coverage limits become reasonably priced or available, the Director of Risk Management or designee is authorized, but not required, to change the above insurance requirements to require additional types of insurance coverage or higher coverage limits, provided that any such change is reasonable in light of past claims again the County, inflation, or any other item reasonably related to the County’s risk. Any change requiring additional types of insurance coverage or higher coverage limits must be made by amendment to this contract. Contractor agrees to execute any such amendment within thirty (30) days of receipt. Any failure, actual or alleged, on the part of the County to monitor or enforce compliance with any of the insurance and indemnification requirements will not be deemed as a waiver of any rights on the part of the County..

D.

Right to Monitor and Audit 1.

Right to Monitor The County or any subdivision or appointee thereof, and the State of California or any subdivision or appointee thereof, including the Auditor General, shall have absolute right to review and audit all records, books, papers, documents, corporate minutes, and other pertinent items as requested, and shall have absolute right to monitor the performance of Proposer in the delivery of services provided under this Contract. Full cooperation shall be given by Proposer in any auditing or monitoring conducted. Proposer shall cooperate with County and the Commission in the implementation, monitoring and evaluation of this agreement and comply with any and all reporting requirements established by County.

2.

Availability of Records Proposer shall maintain all records and management books pertaining to local service delivery and demonstrate accountability for contract performance and maintain all fiscal, statistical, and management books and records pertaining to the program. Records, should include, but are not limited to, monthly summary sheets, sign-in sheets, and other primary source documents. Fiscal records shall be kept in accordance with Generally Accepted Accounting Principles and must account for all funds, tangible assets, revenue and expenditures. Fiscal records must also comply with the appropriate Office of Management and Budget (OMB) Circulars which state the administrative requirements, cost principles and other standards for accountancy and shall be retained for at least seven (7) years from the date of final payment or final settlement, or until audit findings are resolved, whichever is longer. All records shall be complete and current and comply with all Contract requirements. Failure to maintain acceptable records per the preceding requirements shall be considered grounds for withholding of payments for billings submitted and for termination of a Contract. The Proposer shall maintain client and community service records in compliance with all regulations set forth by the State Department of Mental Health (DMH) and provide access to clinical records by DBH staff.

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Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

Proposer(s) shall agree to maintain and retain all appropriate service and financial records for a period of at least seven (7) years, or until audit findings are resolved, which ever is later. 3.

Assistance by Proposer Proposer shall provide all reasonable facilities and assistance for the safety and convenience of County's and/or the Commission’s representatives in the performance of their duties. All inspections and evaluations shall be performed in such a manner as will not unduly delay the work of the Proposer.

4.

Single Audit Provisions Pursuant to OMB Circular A-133, Contractors expending the threshold amount, or more, in Federal funds in a year through a contract with County must have a single or programspecific audit performed which shall comply with the following requirements: a.

The audit shall be performed by a licensed Certified Public Accountant (CPA) in accordance with OMB Circular A-133 (latest revision) Audits of States, Local Governments, and Non-Profit Organizations.

b.

The audit shall be conducted in accordance with generally accepted auditing standards and Government Auditing Standards, latest revision, issued by the Comptroller General of the United States.

c.

A copy of the audit performed in accordance with OMB Circular A-133 shall be submitted to the County within thirty (30) days of completion, but no later than nine (9) months following the end of the Proposer’s fiscal year.

d.

The cost of the audit made in accordance with the provisions of OMB Circular A-133 can be charged to applicable Federal funds. Where apportionment of the audit is necessary, such apportionment shall be made in accordance with generally accepted accounting principles, but shall not exceed the proportionate amount that the Federal funds represent of the Proposer’s total revenue.

e.

The work papers and the audit reports shall be retained for a minimum of seven (7) years from the date of the audit reports, and longer if the independent auditor is notified in writing by the County to extend the retention period.

f.

Audit work papers shall be made available upon request to the County, and copies shall be made as reasonable and necessary.

The Proposer is responsible for follow-up and corrective action of any material audit findings in the single or program-specific audit report, as directed by the County in coordination with the State. VII.

EQUAL EMPLOYMENT OPPORTUNITY/CIVIL RIGHTS A.

Equal Employment Opportunity Program Proposer agrees to comply with the provisions of the Equal Employment Opportunity Program of the County of San Bernardino and rules and regulations adopted pursuant thereto: Executive Order 11246, as amended by Executive Order 11375, 11625, 12138, 12432, 12250, Title VII of the Civil Rights Act of 1964 (and Division 21 of the California Department of Social Services Manual of Policies and Procedures and California Welfare and Institutions Code, Section 10000), the California Fair Employment and Housing Act, and other applicable Federal, State, and County laws, regulations and policies relating to equal employment or social services to welfare recipients, including laws and regulations hereafter enacted. The Proposer shall not unlawfully discriminate against any employee, applicant for employment, or service recipient on the basis of race, color, national origin or ancestry, religion, sex, marital status,

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age, political affiliation or disability. obtained from DBH Contracts Unit. B.

Information on the above rules and regulations may be

Civil Rights Compliance The Proposer shall develop and maintain internal policies and procedures to assure compliance with each factor outlined by State regulation. These policies must be developed into a Civil Rights Plan, which is to be on file with DBH Contracts Unit within 30 days of awarding of the contract. The Civil Rights Plan must address prohibition of discriminatory practices, accessibility, language services, staff development and training, dissemination of information, complaints of discrimination, compliance review, and duties of the Civil Rights liaison. Upon request, DBH will supply a sample of the Civil Rights Plan format. The Proposer will be monitored by DBH for compliance with provisions of its Civil Rights Plan.

VIII.

FORMER COUNTY OFFICIALS The Proposer shall provide information on former County of San Bernardino administrative officials (as defined below) who are employed by or represent your business. The information provided must include a list of former County administrative officials who terminated County employment within the last five years and who are now officers, principals, partners, associates or members of the business. The information should also include the employment and/or representative capacity and the dates these individuals began employment with or representation of your business. For purposes of this section, “County administrative official” is defined as a member of the Board of Supervisors or such officer’s staff, County Administrative Officer or member of such officer’s staff, County department or group head, assistant department or group head, or any employee in the Exempt Group, Management Unit or Safety Management Unit. Failure to provide this information may result in the response to the request for proposal being deemed non-responsive.

IX.

IMPROPER CONSIDERATION The Proposer shall not offer (either directly or through an intermediary) any improper consideration such as, but not limited to, cash, discounts, service, the provision of travel or entertainment, or any items of value to any officer, employee or agent of the County and/or the Commission in an attempt to secure favorable treatment regarding this RFP. The County or the Commission, by written notice, may immediately reject any proposal or terminate any Contract if it determines that any improper consideration as described in the preceding paragraph was offered to any officer, employee or agent of the County and/or the Commission with respect to the proposal and award process or any solicitation for consideration was not reported. This prohibition shall apply to any amendment, extension or evaluation process once a Contract has been awarded. Proposer shall immediately report any attempt by a County and Commission officer, employee or agent to solicit (either directly or through an intermediary) improper consideration from Proposer. The report shall be made to the supervisor or manager charged with supervision of the employee or to the County Administrative Office or First 5 San Bernardino Board of Directors. In the event of a termination under this provision, the County and/or the Commission is/are entitled to pursue any available legal remedies.

X.

DISCLOSURE OF CRIMINAL AND CIVIL PROCEEDINGS The County and/or the Commission reserves the right to request the information described herein from the Proposer selected for contract award. Failure to provide the information may result in a disqualification from the selection process and no award of contract to the Proposer. The County and/or the Commission also reserve the right to obtain the requested information by way of a background check performed by an investigative firm. The selected Proposer also may be requested to provide information to clarify initial responses. Negative information provided or discovered may result in disqualification from the selection process and no award of contract. The selected Proposer may be asked to disclose whether the agency or any of its partners, principals, members, associates or key employees (as that term is defined herein), within the last ten years, has been Page 38 of 48

Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

indicted on or had charges brought against it or them (if still pending) or convicted of any crime or offense arising directly or indirectly from the conduct of the firms business, or whether the firm, or any of its partners, principals, members, associates or key employees, has within the last ten years, been indicted on or had charges brought against it or them (if still pending) or convicted of any crime or offense involving financial misconduct or fraud. If the response is affirmative, the Proposer will be asked to describe any such indictments or charges (and the status thereof), convictions and the surrounding circumstances in detail. In addition, the selected Proposer may be asked to disclose whether the firm, or any of its partners, principals, members, associates or key employees, within the last ten years, has been the subject of legal proceedings as defined herein arising directly from the provision of services by the firm or those individuals. “Legal proceedings” means any civil actions filed in a court of competent jurisdiction, or any matters filed by an administrative or regulatory body with jurisdiction over the firm or the individuals. If the response is affirmative, the Proposer will be asked to describe any such legal proceedings (and the status and disposition thereof) and the surrounding circumstances in detail. For the purposes of this provision “key employees” includes any individuals providing direct service to the County or the Commission. “Key employees” do not include clerical personnel providing service at the firm’s offices or locations. XI.

CALIFORNIA PUBLIC RECORDS ACT All information submitted in the proposal or in response to request for additional information is subject to disclosure under the provisions of the California Public Records Act, Government Code Section 6250 and following. Proposals may contain financial or other data which constitutes a trade secret. To protect such data from disclosure, Proposer should specifically identify the pages that contain confidential information by properly marking the applicable pages and inserting the following notice on the front of its response: NOTICE The data on pages_______ of this Proposal response, identified by an asterisk (*) or marked along the margin with a vertical line, contains information which are trade secrets. We request that such data be used only for the evaluation of our response, but understand that disclosure will be limited to the extent that the County of San Bernardino determines is proper under Federal, State, and local law. The proprietary or confidential data shall be readily separable from the Proposal in order to facilitate eventual public inspection of the non-confidential portion of the Proposal. The County and the Commission assumes no responsibility for disclosure or use of unmarked data for any purpose. In the event disclosure of properly marked data is requested, the Proposer will be advised of the request and may expeditiously submit to the County and the Commission a detailed statement indicating the reasons it has for believing that the information is exempt from disclosure under Federal, State and local law. This statement will be used by the County and the Commission in making its determination as to whether or not disclosure is proper under Federal, State and local law. The County and the Commission will exercise care in applying this confidentiality standard but will not be held liable for any damage or injury which may result from any disclosure that may occur.

XII.

DBH SUBCONTRACTOR STATUS A.

If the Primary Agency (defined as the agency submitting the proposal) intends to subcontract any part of the services for which it is “proposing” to a separate and independent agency or agencies, it must submit a written Memorandum of Understanding (MOU) with that agency or agencies to DBH as part of the proposal. The MOU must clearly define the following: 1.

The name of the subcontracting agency.

2.

The amount (units, minutes, etc.) and types of services to be rendered under the MOU.

3.

The amount of funding to be paid to the agency. Page 39 of 48

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XIII.

4.

The agency’s role and responsibilities.

5.

A detailed description of the methods by which the Primary Agency will insure that all subcontracting agencies meet the monitoring requirements associated with funding regulations.

6.

A budget sheet outlining how the subcontracting agency will spend the allocation.

B.

Any subcontracting agency must be approved by DBH and shall be subject to all applicable provisions of any agreement “awarded” to the Primary Agency as a result of the RFP process. The Primary Agency will be fully responsible for any performance of a subcontracting agency.

C.

DBH will not reimburse contractor or subcontractor for any expenses due to services rendered by a subcontractor NOT approved by DBH.

PROPOSAL SUBMISSION A.

B.

General 1.

All interested and qualified Proposers are invited to submit a proposal for consideration. Submission of a proposal indicates that the Proposer has read and understands this entire RFP, to include all appendices, attachments, exhibits, schedules, and addendum (as applicable) and agrees that all requirements of this RFP have been satisfied.

2.

Proposals must be submitted in the format described in this Section. Proposals are to be prepared in such a way as to provide a straightforward, concise description of capabilities to satisfy the requirements of this RFP. Expensive bindings, colored displays, promotional materials, etc., are neither necessary nor desired. Emphasis should be concentrated on conformance to the RFP instructions, responsiveness to the RFP requirements, and on completeness and clarity of content.

3.

Proposals must be complete in all respects as required in this section. A proposal may not be considered if it is conditional or incomplete.

4.

Proposals must be received no later than the date and time at the designated location as specified in Section I, Paragraph H – Proposal Submission Deadline.

5.

All proposals and materials submitted become the property of the County.

Proposal Presentation 1.

One original, with original signatures, which may be bound, and six (6) additional unbound copies of the written proposal are required. (For a total of seven (7) proposals.) The original copy must be clearly marked “Master Copy”. If one copy of the proposal is not clearly marked “Master Copy”, the proposal may be rejected. However, the County may at its sole option select, immediately after proposal opening, one copy to be used as the Master Copy. If discrepancies are found between two or more copies of the proposal, the proposal may be rejected. However, if not rejected, the Master Copy will provide the basis for resolving such discrepancies.

2.

The package containing the original and copies must be sealed and marked with the Proposer’s name and “CONFIDENTIAL – RFP DBH 09 – 72 SART SERVICES”.

3.

All proposals must be submitted on 8 1/2" by 11" recycled paper with double sided printing, unless specifically shown to be impracticable, with no less than 1/2" top, bottom, left and right margins. Proposals must be typed or prepared with word processing equipment and doublespaced. Type face must be no more than 12 characters per inch. Each page, including attachments and exhibits, must be clearly and consecutively numbered at the bottom center of the page.

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4.

C.

Proposers wishing to request a waiver of the County policy requiring that proposals be submitted on two-sided recycled paper must include such request and reasons on the cover letter of the proposal.

Proposal Format DBH Proposal Format Response to this Request for Proposal must be in the form of a proposal package. An original proposal, which may be bound, must be clearly marked “Master Copy”. In addition, DBH requires (6) unbound copies of the proposal. There should be a total of (7) copies submitted or the proposal may be rejected. The content of the proposal must be submitted in the following sequence and format:

1. Cover Page

Submit a letter, on letterhead stationary, signed by a duly authorized officer, employee, or agent of the organization/firm submitting the proposal that includes the following information: Submit three statements:

□ □ □ 2. Proposal Submission List

Check

□

3. Table of Contents

□

4. Statements of Certification

□

b. A statement indicating which individuals, by name, title, address, and phone number, are authorized to negotiate with the County on behalf of the organization or firm. c. A statement certifying that the undersigned, under penalty of perjury, is an agent authorized to submit proposals on behalf of the organization/firm. Complete and include Attachment A to ensure that all requested items have been included. Complete a table of contents for the entire proposal with respective page numbers opposite each topic. See Attachment B

Complete and include Attachment C – Statements of Certification in this section of the proposal; also attach a concise statement of the services proposed.

□ 5. Proposal/Narrative Description

a. A statement that the proposal is submitted in response to the Request for Proposal, RFP DBH 09 – 72.

a. Complete and include Attachment D – Exceptions to RFP if necessary.

Proposal should address, but is not limited to addressing, all items in Section IV, Paragraph C - Program Description and the following items:

□ □

a. A brief synopsis of the Proposer’s understanding of the County’s needs and how the Proposer plans to meet these needs. This should provide a broad understanding of the Proposer’s entire proposal. b. A narrative description of the proposed plan to achieve the program objective and requirements addressing the following elements:

□ □ □

1) Describe program services and strategies to be employed to ensure stability and continuity of care for the clients, and the Agency’s ability to be flexible in meeting changing needs. 2) Describe case management activities. 3) Outline the service approach in terms of general treatment intensity Page 41 of 48

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(if applicable), frequency, and array of service and expected length of service.

□ □ □ □ □ □ □ □ □ □ □ □ □ □

4) Describe the process of transitioning to a lower level of mental health care. 5) Describe staffing for the program, including basic level of responsibilities, duties, supervisory structure, level of authority and experience of staff members, and licensure. 6) Describe how the Agency will utilize formal and informal supports provided by professionals and non-professionals in the provision of services. 7) Discuss Agency’s methods for achieving goals cost effectively. 8) State the address of the facility and explain why it is appropriate for this contract (in targeted Geographic Service Area; near mass transit; user friendly; facility layout; etc.). 9) Describe the Agency's capacity. 10) Describe the Agency's experience. 11) Explain how the Agency will develop an advocacy and support network. 12) Describe how the Agency will respond to the training requirements. 13) Explain how the agency will meet any special program or funding. 14) Provide some examples of the outcomes expected. 15) Estimate the number of unique or unduplicated clients expected to be served and how that number will be generated and/or affected (i.e. community outreach, etc.) 16) Estimate the anticipated cost per participant.

c. Describe your Agency’s state of readiness to enroll participants, which shall include.

□ □ □ □

1) A Detailed Implementation Plan. 2) A plan to account for and differentiate as between EPSDT and nonEPSDT services, costs and revenues from all funding streams. 3) For behavioral/mental health services only, as in the assessment, referral and treatment of siblings, your specific plan or protocol for the referral of non-eligible individuals to DBH ACCESS unit (must be articulated and submitted with the RFP application). 4) Timeline for participant enrollment and hiring staffing during the first year of the program.

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□ 6. Statements of Experience

5) Explanation of any assumptions and/or constraints.

Include the following in this section of the proposal:

□ □ □ □ □ □ □

a. Business name of the Proposer and legal entity such as corporation, partnership, etc. b. Number of years the Proposer has been in business under the present business name, as well as related prior business names. c. A statement that the prospective Proposer has a demonstrated capacity to perform the required services. d. List any applicable licenses or permits presently held and indicate ability to obtain any additional licenses or permits that may be required. e. A statement that the Proposer has an organization that is adequately staffed and trained to perform the required services or demonstrate the capability for recruiting such staff. f. Experience of principal individuals of the prospective Proposer's present organization in the areas of financial and management responsibility, including names of principal individuals, current position or office and their years of service experience, including capacity, magnitude and type of work. g. With respect to contracts completed during the last five years which involve similar type projects, for each contract show:

□ □ □ □ □ □ □

1) Date of completion and duration of each contract. 2) Type of service. 3) Total dollar amount contracted for and amount received. 4) Location of area served. 5) Name and address of agency with which contracted and agency person administering the contract. 6) If none, so state.

h. If any contract was terminated prior to the original termination date during the last five years, for each contract show:

□ □ □ □ □ □

1) Date of termination and duration of each contract. 2) Type of service. 3) Total dollar amount contracted for and amount received. 4) Location of area served. 5) Name and address of agency with which contracted and agency person administering the contract. 6) Reason for termination. Page 43 of 48

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□ □

i. With respect to contracts currently in effect, for each contract show:

□ □ □ □ □ □ □ □ □ □ □ □

7. Subcontractor Information

7) If none, so state.

1) Contract start date and date due for completion. 2) Type of service. 3) Total contract amount. 4) Location of area served. 5) Name and address of agency with which the organization is currently contracting and agency person administering the contract. 6) If none, so state.

j. Controlling interest in any other firms providing equivalent or similar services. If none, so state. k. Financial interest in other lines of business. If none, so state. l. Pending litigation involving the Proposer or any officers, employees, and/or consultants thereof, in connection with contracts. If none, so state. m. Convictions or adverse court rulings involving fraud and/or related acts of all officers, consultants, and employees. If none, so state. n. A statement that the Proposer does not have any commitments or potential commitments which may impact on the Proposer’s assets, lines of credit, guarantor letters, or ability to perform the Contract. o. A statement by the Proposer certifying that neither it nor its principles is presently disbarred, suspended, proposed for disbarment, declared ineligible or voluntarily excluded from participation in transactions with federal departments or agencies.

If a Proposer plans to subcontract any portion of the service delivery described in the RFP, include a written justification for subcontracting.

□ □

a. Complete and include Attachment E b. Attach a copy of the MOU that includes:

□ □ □ □ □

1) The amount (units, minutes, etc.) and types of services to be rendered under this MOU. 2) The amount of funding to be paid to the agency. 3) A detailed description of the methods by which the Primary Agency will insure that all subcontracting agencies meet the monitoring requirements associated with funding regulations. 4) A budget sheet outlining how the subcontracting agency will spend the allocation.

c. Any subcontracting agency must be approved by DBH and shall be Page 44 of 48

Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

subject to all applicable provisions of any agreement “awarded” to the Primary Agency as a result of the RFP process. The Primary Agency will be fully responsible for any performance of a subcontracting agency. NOTE: DBH will not reimburse contractor or subcontractor for any expenses due to services rendered by a subcontractor NOT approved by DBH. 8. Audited financial statements

Such statements shall be the most recent and complete audited financial statement available and shall be for a fiscal period not more than eighteen (18) months old at time of submission. See Attachment F

□

1) In accordance with CDSS MPP Section 23-610(L), submit the three most recent and complete annual audited financial statements; the most recent must be completed within the past 18 months. If the business has been in existence for less than three years, provide the most recent statements. These statements shall be audited by an independent, certified public accountant. If you do not have audited financial statements please submit unaudited financial statements for the three most current years.

□ □ 9. Insurance

10. Local Preference Policy Form 11. Complaint and Grievance Procedures 11. Program Budget

□ □ □ □

2) In accordance with CDSS MPP Section 23-610(m), submit an unaudited financial statement to cover the period from the last audited statement to present, ending no more than 120 days prior to the date of submission of this proposal. 3) Submit an agreement to the right of the County, State and federal governments to audit the Proposer’s financial and other records.

Submit evidence of ability to obtain insurance in the amounts and coverages stated in Section V, Paragraph C - Indemnification and Insurance Requirements. See Attachment G. Complete and include Attachment H in your response to this RFP. A statement that the Proposer will ensure that any complaints made by service recipients will be referred to the County in accordance with the County procedure as defined in Attachment I. Submit complete Budget Proposal (Schedule A’s and B’s) for each program, each fiscal year and each site (if applicable) for cost analysis purposes (See Attachment J – Sample and Attachment K – Cover Page). Electronic version will be e-mailed to each agency upon verification of mandatory proposal conference attendance or upon request, as appropriate.

First 5 San Bernardino Proposal Format Response to this Request for Proposal must be in the form of a proposal package. An original proposal, which may be bound, must be clearly marked “Master Copy”. In addition, First 5 San Bernardino requires (6) unbound copies of the proposal. There should be a total of (7) copies submitted or the proposal may be Page 45 of 48

Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

rejected. The content of the proposal must be submitted in the following sequence and format: 1. Cover Page

Submit a letter, on letterhead stationary, signed by a duly authorized officer, employee, or agent of the organization/firm submitting the proposal that includes the following information: Submit three statements:

□ □ □ □ □ □

2. Letter of Authorization

XIV.

a. Agency Information. b. Contact Information. c. Agency Category. d. Program Description. e. Proposed Investment Amount. Complete each blank. (See Attachment L)

3. Performance Target Outline – Application

Complete answers the sections indicated. This should be clear, concise and not exceed ten (10) pages in its entirety. (See Attachment L)

4. Budget

Complete and include Attachment M – First 5 San Bernardino Program Budget.

□

PROPOSAL EVALUATION AND SELECTION A.

Evaluation Process All proposals will be subject to a standard review process developed by County. A primary consideration shall be the effectiveness of the agency or organization in the delivery of comparable or related services based on demonstrated performance. The evaluation process is a closed process until its completion.

B.

Evaluation Criteria 1.

Initial Review - All proposals will be initially evaluated to determine if they meet the following minimum requirements:

a.

The proposal must be complete as requested in Section XII – Proposal Submission, Sub-section - C Proposal Format include all required documents, and be in compliance with all the requirements of this RFP.

b.

Prospective Proposers must meet the requirements stated in the Minimum Proposer Requirements as outlined in Section I, Paragraph C.

Failure to meet all of these requirements may result in a rejected proposal. Incomplete proposals (those missing required documents) will be disqualified. No proposal shall be rejected, however, if it contains a minor irregularity, defect or variation if the irregularity, defect or variation is considered by the County or the Commission to be immaterial or inconsequential. In such cases the Proposer will be notified of the deficiency in the proposal and given an opportunity to correct the irregularity, defect or variation or the County or the Commission may elect to waive the deficiency and accept the proposal. 2.

DBH Evaluation - Proposals meeting the above requirements will also be evaluated on the basis of the following criteria, (not necessarily in order of priority): a.

Cost

Page 46 of 48

Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

b.

Demonstrated ability to serve target population.

c.

Proposed Program Services and Strategies.

d.

Demonstrated ability to serve the number of unduplicated clients indicated under Section IV, Sub-section C-2.

e.

Readiness to provide services.

f.

Experience

g.

Staffing levels and qualifications.

h.

Appropriateness of facility (in Geographic Service Option/area; near mass transit; facility layout; etc.)

i.

Fiscal Stability

While cost is a major consideration in the evaluation process, selection will be based on determination of which proposal will best meet the needs of the County and the requirements of this RFP. 3.

Evaluation Scoring The evaluation process for this procurement will be scored and weighted as follows:

4.

a. Evaluation of Qualifying Proposal

-

60% of Final Score

b. Cost Analysis

-

35% of Final Score

c. Local Preference Policy

-

5% of Final Score

First 5 Evaluation – Proposals meeting the above requirements will also be evaluated on the basis of the following criteria:

a.

Investment decisions will be based on: The clarity and strength of the projected results of the investment and their connection to the outcomes sought by First 5 San Bernardino -- You must make a compelling case for our decision to invest in your program. What distinguishes your program as you envision it for the next three years from the program that we are investing in now? What program improvements have you made as a result of lessons learned and course corrections to date? Are you building on past accomplishments? The likelihood that the results will be achieved; and The assessment of the return on the investment – is this the best use of the resources given other opportunities?

b.

The Decision-making Process: The review and decision-making process will include a team of reviewers from First 5 San Bernardino Commission staff and Advisory Committee members. Applications falling out of the process at any phase will be reviewed by management. The process will include the following key steps: Administrative review will be limited to responsiveness issues of the proposal (e.g. number of pages, received before deadline, etc.). Application review by a review team to provide initial assessments both individually and subsequently in a group consensus. Scoring will be based on each agency’s ability to effectively complete the Performance Target Outline including the Target

Page 47 of 48

Request for Proposals San Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

Plan (which will minimally include a target and set of milestones for service delivery as well as a target and set of milestones for sustainability.) Final review/Investment decisions: Within the constraints of the resources available, contracts will be offered to those finalists deemed quality investments based on past performance, reflections of lessons learned and program improvements during their current contract, their ability to effectively articulate desired results for the future. Contracts will be negotiated subsequent to offers being made. C.

Protests Proposers may protest the recommended award, provided the protest is in writing, contains the RFP number, is delivered to the address listed in Section I, Paragraph F of this RFP, and submitted within ten (10) calendar days of the date on the notification of intent to award. Grounds for a protest are that the County failed to follow the selection procedures and adhere to requirements specified in the RFP or any addenda or amendments; there has been a violation of conflict of interest as provided by California Government Code Section 87100 et seq.; or violation of State or Federal law. Protests will not be accepted on any other grounds. In the event of a protest, a valid and accepted protest(s) will be handled by a panel designated by the County Administrative Office or Designee. The County and Commission will consider only those specific issues addressed in the written valid and accepted protest(s). A written response will be directed to the protesting Proposer within fourteen (14) calendar days of receipt of the protest, advising of the decision with regard to the protest and the basis for the decision.

D.

Final Authority The final authority to award a Contract(s) rests solely with the County of San Bernardino Board of Supervisors and the Commission. The following statements are incorporated as part of the proposal in response to the County of San Bernardino:

Page 48 of 48

Request for ProposalsSan Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

ATTACHMENT A

PROPOSAL SUBMISSION CHECKLIST Use this checklist to ensure that all items have been included. This form is to be completed and included in the proposal. Items Completed 1.

Cover Page

2.

Attachment A – Proposal Submission Checklist

3.

Attachment B – Table of Contents

4.

Attachment C – Statements of Certification

5.

Attachment D – Exceptions to RFP, if necessary

6.

Proposal/Narrative Description

7.

Statements of Experience

8.

Attachment E – Subcontractor Information; with attached copy of MOU

9.

Attachment F – Financial Capability (Audited Financial Statements)

10.

Attachment G - Insurance Forms

11. 12.

Attachment H – Local Preference Policy Attachments J and K – Budget Cover Page with appropriate budget submissions

13.

Attachment L – First 5 San Bernardino Application Workbook

14

Attachment M – First 5 San Bernardino Program Budget

Number of Pages

Page 1 of 1

Request for Proposals San Bernardino County Department of Behavioral Health ATTACHMENT B Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

TABLE OF CONTENTS

Item

Page Number

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15 16. 17. 18. 19 20.

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Request for ProposalsSan Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

ATTACHMENT C

STATEMENTS OF CERTIFICATION RFP DBH 09 – 72 Screening, Assessment, Referral and Treatment Services

Statement 1.

2. 3.

4.

5.

6.

7. 8.

Agree (Initial)

Disagree with requirement (initial and explain in Attachment D- Exceptions)

Services will be provided as described in the Request for Proposals, beginning July 1, 2010 and continuing through June 30, 2013. The offer made in the proposal is firm and binding for 120 days from the date the proposal is opened and recorded. All declarations in the proposal and any attachments are true and shall constitute a warranty, the falsity of which shall entitle the County to pursue any remedy by law. All aspects of the proposal, including cost, have been determined independently, without consultation with any other prospective Proposer or competitor for the purpose of restricting competition. The proposer agrees that all aspects of the RFP and the proposal submitted shall be binding if the proposal is selected and a Contract is awarded. Proposer will provide the County with any other information that the County determines is necessary for an accurate determination of the Proposer’s ability to perform services as proposed. If selected, the Proposer agrees to comply with all applicable rules, laws, and regulations. If applicable and selected, the Proposer agrees to be Medi-Cal certified in accordance with the State Department of Mental Health Site Certification Protocol, Title 9 CCR and the San Bernardino County Department of Behavioral Health requirements. (Attachment N)

________________________________________________ Signature (Authorized Signer) ________________________________________________ Print Name

___________________________ Date

________________________________________________ Company/Agency _______________________________________________

________________________________________________ Address

Page 1 of 1

Request for ProposalsSan Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

ATTACHMENT D

EXCEPTIONS TO RFP DBH 09 – 72 Proposer has reviewed the RFP and General Contract Terms in their entirety and has the following exceptions: (Please list your exceptions by indicating the section or paragraph number, and page number, as applicable. Be specific about your objections to content, language, or omissions. Add as many pages as required.)

Name of Authorized Representative: Signature of Authorized Representative: Title:

Date:

Page 1 of 1

Request for ProposalsSan Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

ATTACHMENT E

SUBCONTRACTOR NAME (name of firm, entity or organization): Name And Title Of Proposer’s Contact Person: Mailing Address:

Telephone Number: Fax Number: Email Address: Federal Employer Identification Number: Number of years under current name: Justification for Subcontracting: (Work)

Capacity to Perform the Required Services Statement:

Subcontractor’s Authorized Signature: The undersigned hereby certifies that the information above is correct and agrees to serve as a subcontractor on and perform all work as indicated above and will comply with all items as indicated in Section IV of _________________________________________________________, RFP DBH 09 – 72. I have attached an MOU to this sheet for DBH review. Signature: Print Name:

Date: Title:

Page 1 of 1

Request for ProposalsSan Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

ATTACHMENT F

PROPOSER’S FINANCIAL CAPABILITY Use this page as a cover sheet for financial documents. Per Section XII, Sub Section C, Item #8 of this RFP: Proposer must provide the Company’s three most recent and complete annual audited financial statements; the most recent must be completed within the past 18 months. If business has been in existence less than three years, and audited financial statements are not available, you must provide most recent financial statements that have been audited by an independent, certified public accountant. If you do not have audited financial statements please submit unaudited financial statements for the three most current years You must also provide an unaudited financial statement to cover the period from the last audited statement to present, ending no more than 120 days prior to the date of submission of this proposal. Submit a signed statement/agreement on a separate sheet, to the right of the County, State and federal governments to audit the proposer’s financial and other records.

Page 1 of 1

Request for ProposalsSan Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

ATTACHMENT G

INSURANCE Use this page as a cover sheet when submitting insurance documents. Submit evidence of ability to insure as stated in Section V, Sub section B - Indemnification and Insurance Requirements.

Page 1 of 1

Request for ProposalsSan Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

ATTACHMENT H

County of San Bernardino Department of Behavioral Health Local Preference Policy Form ____________________________________________________

Please check all that apply:

1.

Main or regional Office located within County boundaries.

2.

Issued a business license, if required, and has been established and open for six months prior to release of solicitation.

3.

Has a minimum of 25% full-time management employed and 25% of its full-time regular employed working from County locations.

4.

The statements above do not apply to our agency.

_______________________________ Signature (Authorized Signer)

________________ Date

______________________________________________ Print Name ______________________________________________ Company/Agency ______________________________________________ Address ______________________________________________

Page 1 of 1

Request for ProposalsSan Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

ATTACHMENT I

San Bernardino County Mental Health Plan (MHP) Grievance Procedure BENEFICIARY COMPLAINTS, APPEALS AND/OR GRIEVANCES 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: ¾ ¾ ¾

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. Provided below is additional information about the grievance process. GRIEVANCES BY CLIENTS (Verbal and/or Written) A grievance is an expression of dissatisfaction about any matter other than an action. Clients are encouraged to discuss issues and concerns regarding their mental health services directly with their provider(s). Beneficiary grievances (including those by families, legal guardians, or conservators of Clients) may be directed to the provider, to the Access Unit, and/or to the Department’s Patients’ Rights Office. A grievance can be a verbal or a written statement of the Client’s concerns or problems. The Client has the right to use the grievance process at any time. Grievance forms, as well as envelopes already addressed to the Access Unit, must be available at all providers’ offices in locations where the Client may obtain them without making a verbal request. If they have questions regarding the grievance process, clients may contact their providers, the Access Unit, or the Office of Patients’ Rights. The Access Unit records the grievance in a log within one working day of the date of the receipt of the grievance. The Access Unit sends an acknowledgement letter and resolution letter to the Client as hereafter described. The Access Unit or MHP designee has 60 calendar days to resolve a grievance. Fourteen-day extensions are allowed if the Consumer requests or the MHP determines it is in the best interest of the Consumer. Grievances are tracked by the Access Unit and sent to the Continuous Quality Improvement Committee after resolution. Appeal Procedures when the Consumer is dissatisfied after receipt of a Notice of Action, which: 1. 2. 3. 4. 5.

Denies or limits authorization of a requested service, including the type or level of service; Reduces, suspends, or terminates a previously authorized service; Denies, in whole or in part, payment for a service; Fails to provide services in a timely manner, as determined by the MHP or; Fails to act within the timeframes for disposition of standard grievances, the resolution of standard appeals, or the resolution of expedited appeals, as hereafter described. a. A Consumer may complete an Action Appeal form, which is to be forwarded to the Access Unit, or orally appeal to the Access Unit. If oral, it must be followed up in writing. The Access Unit sends an acknowledgement letter when an appeal is received.

Page 1 of 3

Request for ProposalsSan Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

ATTACHMENT I

San Bernardino County Mental Health Plan (MHP) Grievance Procedure BENEFICIARY COMPLAINTS, APPEALS AND/OR GRIEVANCES b. c.

d.

The Access Unit records the appeal in a log within one working day of the date the appeal is received. The Access Unit maintains and tracks the appeals. A written decision is to be made by the Access Unit in 45 calendar days from the date of receipt of the form, and mailed to the Consumer. Fourteen days extensions are allowed if the Consumer requests or the MHP determines it is in the best interest of the Consumer. The Access Unit sends a resolution letter to the Consumer. Expedited Appeals can be requested if the time for the standard resolution could seriously jeopardize the Consumer’s life, health or ability to function. The parties will be notified of the MHP decision no later than 3 working days after the MHP has received the appeal.

REQUEST FOR A STATE FAIR HEARING Medi-Cal beneficiaries may request a State Fair Hearing at any time before, during, or within 90 days of the completion of, the MHP’s beneficiary problem resolution process. The client also has the right to request a State Fair Hearing whether or not the client uses the problem resolution process, and whether or not the client has received a Notice of Action. If the client is currently receiving mental health services and has received a Notice of Action letter which denies, reduces or terminates those services, and if the client requests a State Fair Hearing within 10 days of receipt of the Notice of Action, it may be possible to maintain the same level of services pending the outcome of the State Fair Hearing. To request a State Fair Hearing, the client should call or write to: Public Inquiry and Response 744 “P” Street, M.S. 16-23 Sacramento, CA 95814 Telephone: (800) 952-5253 TDD: (800) 952-8349 ADDITIONAL POINTS 1. At any time during the complaint, grievance, second opinion, or State Fair Hearing process, the client may authorize a person to act on his or her behalf, to use the complaint/grievance resolution process on his or her behalf, or to assist him or her with the process. 2. Filing a complaint or a grievance will not restrict or compromise the client’s access to mental health services. 3. At any time during the complaint/grievance process, the client may contact the Access Unit at (888) 743-1478 or the Patient’s Rights’ Office at (800) 440-2391 for assistance. COMPLAINTS/GRIEVANCES REGARDING PROVIDERS AND SERVICES Complaints or grievances by clients about providers or mental health services may be made to the Access Unit or to the Patients’ Rights Office. Complaints and grievances will be reviewed and investigated by the appropriate office within the Department of Behavioral Health, and the issues contained therein will be reviewed by the Quality Improvement Committee. Providers cited by the beneficiary or otherwise involved in the grievance process will be notified of the final disposition of that grievance. Concerns of the Department of Behavioral Health regarding a provider's possible unprofessional, unethical, incompetent, or breach-of-contract behavior will be investigated by the Patients’ Rights Office or other

Page 2 of 3

Request for ProposalsSan Bernardino County Department of Behavioral Health Screening, Assessment, Referral, and Treatment Services (SART) RFP – DBH 09 – 72

ATTACHMENT I

San Bernardino County Mental Health Plan (MHP) Grievance Procedure BENEFICIARY COMPLAINTS, APPEALS AND/OR GRIEVANCES department, by appropriate state licensing authorities, or by the Quality Improvement Committee. In extreme cases, in which client safety is at risk, the Director may suspend the provider’s credentialed status while an investigation proceeds. Providers will prominently display and make available printed materials which announce and explain the complaint, grievance, Second Opinion and State Fair Hearing processes without the beneficiary’s having to make a verbal or written request for these materials. The Department of Behavioral Health has the Consumer Guide and poster in the two threshold languages. Any complaint or grievance which a provider receives from a beneficiary should be forwarded to the Access Unit immediately. PROVIDER PROBLEM RESOLUTION AND APPEAL PROCESS COMPLAINTS (verbal) Provider complaints regarding the system-of-care structure and procedures may be directed verbally or in writing to the Access Unit Supervisor, who may be able to resolve or explain the issue. When a provider complaint concerns a denied or modified request for payment authorization, or the processing or payment of a provider's claim, the provider has a right to access the Provider Appeal Process at any time before, during, or after the Provider Problem Resolution Process has begun. APPEALS/GRIEVANCES (written) In response to a denied or modified request for payment authorization, or a dispute concerning the processing or payment of a claim, a provider may make use of the written Provider Appeal Process. The written appeal must be sent to the Access Unit Supervisor within 90 calendar days of the date of receipt of the non-approval of payment or within 90 calendar days of the MHP’s failure to act on a request. The Program Manager or designee will communicate a response to the provider within 60 calendar days of receipt of the appeal, 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 applicable, the provider shall submit a revised request for MHP payment authorization within 30 calendar days from receipt of the MHP’s decision to approve the payment authorization request. If the Program Manager does not respond to the appeal within 60 calendar days of receiving it, the appeal shall be considered denied.

Page 3 of 3

ATTACHMENT J DBH Budget Proposal - Sample SCHEDULE A - Planning Estimates

SAN BERNARDINO COUNTY DEPARTMENT OF BEHAVIORAL HEALTH

Prepared by: Title:

Provider No. Address:

July 1, ___ thru June 30, __

Date Completed:

Distribution % MODE OF SERVICE

LINE

TOTAL

SERVICE FUNCTION

# 1 2 3 4 5 6 7 8 9 10 Mix %

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Contractor Name:

FY 20__ - 20__ 0

Actual Cost Contract (cost reimbursement)

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

26 27 28

EXPENSES SALARIES BENEFITS (1+2 must equal total staffing costs) OPERATING EXPENSES TOTAL EXPENSES (1+2+3) AGENCY REVENUES PATIENT FEES PATIENT INSURANCE MEDI-CARE GRANTS/OTHER TOTAL AGENCY REVENUES (5+6+7+8) CONTRACT AMOUNT (4-9) Share % FUNDING 50.00% MEDI-CAL (FFP) 90.00% EPSDT (State share applied to line 11) 65.00% HEALTHY FAMILIES MEDI-CAL MHSA MIOCR GRANT SAMHSA GRANT PATH GRANT CALWORKS REALIGNMENT REALIGNMENT-MATCH FUNDING TOTAL NET COUNTY FUNDS (Local Cost) MUST = ZERO STATE FUNDING (Including Realignment) FEDERAL FUNDING TOTAL FUNDING UNITS OF TIME COST PER UNIT OF TIME UNITS OF SERVICE--Hours

0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0

0 0

0 0

0 0

0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0

0

0

0

0

0

0

0

0

0

0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

APPROVED:

PROVIDER AUTHORIZED SIGNATURE

DATE

FISCAL SERVICES

DATE

DBH PROGRAM MANAGER

DATE

Page 1 of 6

ATTACHMENT J DBH Budget Proposal - Sample Schedule A Page 2 of 2

SAN BERNARDINO COUNTY DEPARTMENT OF BEHAVIORAL HEALTH SCHEDULE "A" STAFFING DETAIL FY 20__ - 20__ July 1, ___ thru June 30, __

(12 months)

Staffing Detail - Personnel (Includes Personal Services Contracts for Professional Services) CONTRACTOR NAME: Name

Degree/ License

Position Title

Full Time Annual Salary*

Full Time Fringe Benefits*

Total Full Time Salaries & Benefits*

% Time Total Salaries Budgeted Spent on and Benefits Units of Total Salaries Total Benefits Contract Charged to Contract Charged to Charged to Services Contract Services Services Contract Services Contract Services

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Total Program

TOTAL 0.00 COST:

-

0

Detail of Fringe Benefits: Employer FICA/Medicare, Workers Co Unemployment, Vacation Pay, Sick Pay, Pension and Health Ben * = Sub-Contracted Person listed on Schedule "A" Planning as operating expenses, not salaries & benefits.

APPROVED:

PROVIDER AUTHORIZED SIGNATURE

DATE

DBH FISCAL SERVICES

DATE

DBH PROGRAM MANAGER

DATE

Page 2 of 6

ATTACHMENT J DBH Budget Proposal - Sample SAN B ER N AR D IN O C O U N T Y D EPAR T M EN T O F B EH AVIO R AL H EALT H SC H ED U LE B Contra ctor Na m e : P rovider No. A ddres s :

FY 20__ - 20__

July 1, ___ thru June 30, __ P repared by : Title:

Date Com pleted:

O pe rating Expe nse s - Ple ase list all ope rating costs charge d to this program, including administrativ e support costs and manage me nt fe e s along with a de tail e xplanation of the cate gorie s be low. IT EM

TOTAL COS T TO % CHARGED TO ORGANIZATION OTHER CONTRACTS

T O T AL C O ST S T O O T H ER C O N T R AC T S

% C H AR G ED T O T H IS C O N T R AC T

T O T AL C O ST T O T H IS C O N T R AC T

1

0%

$0

2

0%

$0

$0

3

0%

$0

$0

4

0%

$0

$0

5

0%

$0

$0

6

0%

$0

$0

7

0%

$0

$0

8

0%

$0

$0

9

0%

$0

$0

10

0%

$0

$0

11

0%

$0

$0

12

0%

$0

$0

0%

$0

$0

SU B T O T AL B : G R O SS C O ST S T O T AL A + B :

PR OVID ER AU TH OR IZED SIGN ATU R E

$0

D ATE

FISC AL SER VIC ES

D ATE

25%

D BH PR OGR AM MAN AGER

$0

D ATE

Page 3 of 6

ATTACHMENT J DBH Budget Proposal - Sample DEPARTMENT OF BEHAVIORAL HEALTH SCHEDULE B BUDGET NARRATIVE FY 20__ - 20__

July 1, ___ thru June 30, __

Contractor Name: Provider No. Address:

Prepared by: Title:

Date Completed:

Budget Narrative for Operating Expenses. Explain each expense by line item. Provide an explanation for determination of all figures ( rate, duration, quantity, Benefits, FTE's, etc.) for example explain how overhead or indirect cost were calculated.

ITEM

Justification of Cost

1 2 3 4 5 6 7 8 9 10 11 12

APPROVED:

PROVIDER AUTHORIZED SIGNATURE

DATE

FISCAL SERVICES

DATE

DBH PROGRAM MANAGER

DATE

Page 4 of 6

ATTACHMENT J DBH Budget Proposal - Sample S AN B E R N AR D IN O C O U N T Y D E P AR T M E N T O F B E H AVIO R AL H E AL T H SC H ED U LE B F Y 20__ - 20__ C o n tracto r N ame : P rovider N o. A ddres s : P repared by :____________ Date C om pleted:

Title: __________________

Inc om e to s upport the P rogram from July 1, ___ thru June 3

L ist ca sh inco m e a nd in-k ind d o na tio ns to the o rg a niza tio n whic h a re a llo c a te d in who le o r p a rt to sup p o rt the p ro p o se d p ro g ra m . A d d itio na lly, p le a se list a ll o the r re ve nue a nd so urce s o f the re ve nue .

SOURCE OF IN C O ME / IN -K IN D

TO TAL IN C O ME % C H AR G E D TO TO O R G AN IZATIO N TH IS P R O G R AM

1

$

-

2

$

-

3

$

-

4

$

-

5

$

-

6

$

-

T O T AL O T HE R INC O ME /INK IND :

E R AU TH O R IZE D S IG N ATU R E

$

-

D ATE

0%

FIS C AL S E R VIC E S

D ATE

D B H P R O G R AM MAN AG E R

Page 5 of 6

ATTACHMENT J DBH Budget Proposal - Sample SAN BERNARDINO COUNTY DEPARTMENT OF BEHAVIORAL HEALTH SCHEDULE B FY 20__ - 20__

Contractor Name: Address: Prepared by: Date Completed:

Client Service Projections July 1, ___ thru June 30, __ Jul-08

Aug-08

Sep-08

Oct-08

Nov-08

Dec-08

Jan-09

Feb-09

Mar-09

Apr-09

May-09

Jun-09

TOTAL

Units of service (Hours or Minutes)

Case Management Mental Health Services Medication Support Crisis Intervention Number of Unduplicated Clients Served

0 #DIV/0! #DIV/0! #DIV/0! #DIV/0!

#DIV/0! #DIV/0! #DIV/0! #DIV/0!

#DIV/0! #DIV/0! #DIV/0! #DIV/0!

#DIV/0! #DIV/0! #DIV/0! #DIV/0!

Projected Cost per Unit #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

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ATTACHMENT K BUDGETS Use this page as a cover sheet when submitting budgets. Submit complete Budgets (Schedule A’s and B’s) for each program, for each fiscal year and for each site (if applicable) for cost analysis purposes (See Attachment J - Sample). Electronic version will be e-mailed to each agency upon verification of mandatory proposal conference attendance or upon request, as appropriate. Failure to submit the Budget sheets as requested WILL result in the elimination of the entire submitted proposal; it will not move forward in the evaluation process.

Page 1 of 1

ATTACHMENT L First 5 San Bernardino Application Workbook I.

INTRODUCTION Welcome to First 5 San Bernardino’s Outcome Framework! This workbook will give you the context and the tools you need to develop this section of your proposal. The workbook is designed to help you develop a response to First 5 San Bernardino’s portion of the Request for Proposal (RFP DBH 09 – 72), a response which will help you both justify an investment in your project and manage that project for results. As your investor, we seek answers to these key questions: A.

What “human gain” will result from our investment, or in some cases, what will be different when your project is complete?

B.

What are the chances that this “gain” or difference will be fully achieved?

C.

Is this the best use of our funds – given all the opportunities before us?

A Performance Target Outline, developed using this workbook, will answer these three questions and is your application to us. This will take more thought than many proposals, where key questions can be postponed until you get the contract. The good news is that once you have thought things through, the actual writing is shorter. We only ask for the information that will answer our questions! And if you secure a contract, you are ready to roll with the project. You do not need one document to get the money and another to spend it well. This workbook contains explanations and examples of responses for each section. The examples are only that – aid to help you understand the nature of the information we need from you to answer our questions. They are purposefully drawn from a project whose results are not a match to a typical First 5 San Bernardino Request for Proposal. Your responses should be limited to ten (10) pages and should be attached to a completed cover sheet, a guide for which is also attached. A simplified budget form is also attached and must be completed and submitted as part of your proposal. This section of the proposal should be clearly identified with an additional cover sheet marked Part II – First 5 San Bernardino SART Services. This section of your proposal should adhere to the requirements and proposal formatting guidelines given outlined in Article XIV. Proposal Submission Guidelines. If your project is selected for a First 5 investment, more information may be requested as part of the contracting process.

Page 1 of 25

ATTACHMENT L First 5 San Bernardino Application Workbook II.

APPLICATION INSTRUCTIONS A.

Cover Page 1.

Please complete the cover page in its entirety.

2.

For AGENCY INFORMATION

3.

For CONTACT INFORMATION please indicate the appropriate individuals as follows: ⇒ ⇒ ⇒

B.

Program Contact: the person in charge of program delivery Fiscal Contact: the person responsible for fiscal activity related to the application Contract Representative: the person with the authority to sign the application

4.

Under AGENCY CATEGORY if you check other, please indicate a category that best describes your agency.

5.

The PROGRAM DESCRIPTION should be a concise description of the proposed project and its benefits in no more than two (2) paragraphs.

6.

Include the PROPOSED INVESTMENT AMOUNT for each year for up to three (3) years with a total cumulative amount at the bottom. Amounts requested shall not exceed 5% of the current 2010-2011 contract amount and written documentation demonstrating an annual decrease of funds requested from First 5 San Bernardino will be required.

Letter of Authorization Please fill in each blank to ensure application submission is authorized by appropriate parties and documented as such.

C.

Performance Target Outline - Application Please answer the sections indicated in the Performance Target Outline - Application. This is intended to be concise and should not exceed ten (10) typed pages in its entirety. This includes the Program Work Plan.

D.

Budget (This is a separate Excel spreadsheet file) Please complete the budget template and narrative for the first year of services to align with your proposed program.

E.

Budget Narrative Please complete the budget template and narrative for the first year of services to align with your proposed program.

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ATTACHMENT L First 5 San Bernardino Application Workbook

COVER PAGE AGENCY INFORMATION Legal Name Agency: Address:

of

Number

Street

Suite

City

State

Zip

Phone:

Fax:

Tax Identification #:

Website:

PROGRAM CONTACT Name:

Phone #:

Title:

Fax #:

Email: FISCAL CONTACT Name:

Phone #:

Title:

Fax #:

Email: CONTRACT REPRESENTATIVE Name:

Phone #:

Title:

Fax #:

Email: School Districts __K-8 __K-12 Community Based Organization (CBO) County Government Agency Private Entity/Institution __For Profit __Non-Profit Proposed Investment Amount: Year 1 $

Type of Agency:

County/State Educational Institutions Faith Based Organization Other Government Agency Other: please describe:

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ATTACHMENT L First 5 San Bernardino Application Workbook Year 2 Year 3 Total

$ $ $

Please indicate the percent of your total program budget that is attributed to each target. Target #1 ____________________________________________________________ Percentage of total budget for 2010-2011 _____________________ Target #2 _____________________________________________________________ Percentage of total budget for 2010-2011 _____________________ Target #3 _____________________________________________________________ Percentage of total budget for 2010-2011 _____________________ Target #4 _____________________________________________________________ Percentage of total budget for 2010-2011 _____________________

Program Description:

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ATTACHMENT L First 5 San Bernardino Application Workbook

LETTER OF AUTHORIZATION First 5 San Bernardino 330 North D St. Suite 500 San Bernardino, CA 92415 Subject: RFP DBH 09 – 72 Screening, Assessment, Referral and Treatment (SART) As an authorized officer or agent of ___________________________, who is authorized to sign for and submit applications on behalf of this organization, I hereby certify and affirm under penalty of perjury, the following statements: 1.

The information in the application is true and accurate.

2.

___________________________ will provide any requested information and/or documentation regarding administrative, financial, or legal status as deemed necessary.

3.

___________________________ will permit official representatives of First 5 San Bernardino access to its facilities, staff, and records in conducting a pre-award survey in connection with this application.

4.

___________________________ hereby authorizes First 5 San Bernardino to contact any references and/or sources named, herein, in order to verify funding, accreditation, performance, and other information deemed necessary for review of this application.

5.

___________________________ will provide services as described, herein, at the price stipulated, herein, from July 1, 2010 to June 30, 2013. The price(s) contained herein is/are the same charged to all other individuals or organizations contracted for and/or receiving the same services. All material facts presented in this application shall be binding and included as part of the contract, if the application is selected and the contract is awarded.

6.

All aspects of this application, including costs, have been determined independently, without consultation with any other potential competitor.

7.

If selected and awarded a contract, organization will comply with all applicable rules, laws, and regulations, along with the terms of the contract.

I declare under penalty of perjury that I am an agent authorized to submit applications on behalf of the applying organization.

_________________________________________ Print Name

_________________________________________ Official Title

_________________________________________ Signature

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ATTACHMENT L First 5 San Bernardino Application Workbook III.

PERFORMANCE TARGET OUTLINE - WHAT’S INSIDE A.

YOUR ORGANIZATION Mission and Core Expertise Recent Accomplishments

B.

PARTICIPANTS YOU WILL SERVE Population Participants Profile Participant Description

C.

YOUR PROJECT Description Key Details

D.

PERFORMANCE TARGETS AND GENERAL OUTCOMES Targets “No Program” Baseline Verification

E.

KEY PEOPLE Project Director “Delivery” Staff

F.

INTERMEDIARIES/PARTNERS Intermediaries/Partners Evidence of Commitment

Section 1: Your Organization 1.

Mission and Core Expertise – In no more than three paragraphs describe your organization, its mission, and any statements of vision or values that are critical to you. Please attach to your proposal whatever material you have available to describe your history, growth, and current programs. Then, take a few more paragraphs to tell us what you see as your core expertise – exactly what it is that your organization does best in the program area for which you seek investment. Example: The mission of the Carver Homes Community Organization is to enable the families living within the Carver Homes complex to improve the quality of their lives through education, job training and employment development programs. Our core expertise in mentoring students, the program for which we apply, is in knowing: a) the characteristics that predict success in a mentor; b) motivating individuals with those characteristics to sign up; and c) supporting mentors such that they enjoy and find great meaning through the success of the kids with whom they work.

2.

Recent Accomplishments – Describe the accomplishments (not the activities) within the past two years that you consider most relevant to this proposal. Be as specific as you can about the gains you have achieved for those you serve. If you have any verification or evaluations to support these accomplishments, please include them as an attachment. Example: In the past two years, we have mentored 75 high school seniors considered at risk for dropping out of school. Of these, 72 have graduated from high school and 70 obtained a job or started further education within 3 months. Carver Homes was the winner of the 2001 Nonprofit of the Year Award for Organizational Excellence.

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ATTACHMENT L First 5 San Bernardino Application Workbook Section 2:

Participants You Will Serve

The first step in devising a performance target involves defining your participants. These are the people who have the need or problem you address (whether in employment, health, or any other area) or are behaving in a way that you want to change to create a gain (e.g., people doing something to add pollution to San Diego Bay). In most cases, they have a choice; to stop smoking, for example, or attend school, get a job. This is why we see your participants as your customers. Most effective programs believe their approach is better suited to some potential participants than others. Factors of “fit” might be characteristics of the individual, of their environment, and degree of barriers to achieving success. 1.

Population – This is the approximate number of individuals within your geographic focus that share the specific condition or circumstance your organization is addressing. This gives us a sense of the nature and degree of the challenge you face… it defines your “market”. Example: There are approximately 300 low-income youth between the ages of 15 and 18 years old living in Carver Homes, a public housing complex in North East Washington, DC. In 1999, 122 students in this housing development did not complete high school.

2.

Participants Description – Please describe your participants – those whom you plan on serving – and tell us if they are distinct in any way from the full population you defined above. We generally view it as a sign of strength that a program has defined the people who can benefit most from its particular approach. Example: Youth on the Move Mentoring Program serves 200 high-school sophomores, juniors and seniors, about 2/3 of the population defined above, who responded to a youth conducted survey focused on their future aspirations. Our target focuses on the 60 seniors in the program. Our students expressed a desire to improve their lives, and some interest in attending college or getting further technical training after graduation. Eighty-five percent of the youth live in single parent families and over half receive some form of public assistance. Seventy percent of the parents in this housing complex failed to complete high school. Substance abuse is a chronic problem among a significant number of families and 10% of our students are wards of the court.

3.

Participant Examples – Describe two specific participants, (please do not use real names), to give us a feel for their specific circumstances and the reasons they will use your program. Your examples should also reflect the most important variations you see among your participants. Example 1: Rosa is an 18 year-old young woman whose family emigrated from Guatemala 5 years ago. She has worked hard to learn English, but her English language capability is not sufficient for her to reach her goals. In addition, she comes from a country where women marry young and almost never pursue higher education. Her family does not understand or support her desire to become a dental hygienist. Example 2: Tariq is a 17 year-old African American young man who has been reared in the Carver Homes complex by his 55 year-old Grandmother. His mother died from a severe asthma attack and the whereabouts of his father are unknown. An older brother, now 25, has been in and out of jail since he was 16. Tariq is torn between an interest and proficiency in science and math and a desire to fit in with his friends who place little value on academic achievement.

Section 3: Your Project Projects are often defined in lengthy descriptions of what you will do. Your investor looks to get to the factors that will make a difference. 1.

Description – Briefly define your project – what you will actually do. We are interested here in your approach and strategy, not the details of your work plan. Page 7 of 25

ATTACHMENT L First 5 San Bernardino Application Workbook Example: Youth on the Move Mentoring Program began in 1998 and offers tutoring and mentoring to 200 sophomores, juniors and seniors who live in Caver Homes. Sixty of our students are in their senior year of high school. Following their freshman year, students are enrolled in a six-week summer program that is designed to strengthen study skills and introduce them to the many options for education and training after high school. At the beginning of their junior year, each student is matched with a mentor who makes a two-year commitment to the student and the program. Through an orientation program and ongoing mentor workshops, mentors gain an understanding of the challenges faced by their students; the specific duties and responsibilities of mentors and the various resources mentors can call upon to support them in their efforts. Early in the relationship, mentors help their students formulate their plans for the future, identify personal and academic issues that must be addressed and agree on ways the mentor can support the student in achieving their objectives. Once a match has been made, the mentor has contact with the student at least once a week and participates in monthly seminars with other mentors and students. Students also participate in a tutoring program two evenings a week to address academic deficiencies. Americorp volunteers attending local colleges staff the program. Americorp students are great role models because of similarities in age and in some cases background. During the evenings and on Saturdays, students can use the computer lab where they access tutorial programs and receive training on the latest software. 2.

Key Details a.

Intensity and Duration – Be clear on how often, how long and at what depth participants need to interact with their program to get to the target. Describe what will be required to achieve the desired results. This step can also help to justify the cost of your program. Example: Our mentoring program is very intense. It requires sustained weekly contact with the student with virtually no weeks missed. We’ve learned that less intensive mentoring has very little impact on graduation rates or success after high school. Additionally, the majority of our students need significant support in dealing with family problems that threaten to impede the academic improvement needed to obtain their educational goals.

b.

Comparative Advantages – Many organizations believe that their program has one or more features or approaches that make it stand out from others in the general category. This is your opportunity to demonstrate unique features of your work or program. Example: Nutritious meals, designed to appeal to the taste of young people, are served before each tutoring session. This distinctive element dramatically increases the students’ energy and attention level. Also, to recognize their effort, progress, and achievements, students receive monthly incentives that range from passes to local attractions to gifts from corporate sponsors. We have found that these incentives at far higher than a token level, also improve results.

Section 4:

Performance Targets

Performance targets are those specific and verifiable human gains that you seek for your participants or the changes in conditions you seek to make it happen. Targets are not activities (such as participation in workshops) or outputs (such as a completed plan or even a building). They speak to what higher achievement is made possible by activities and outputs. Use these steps help to generate targets for the participants you have identified: 1.

Identify the changes or conditions you seek,

2.

Specify the degree of change you consider a success, Page 8 of 25

ATTACHMENT L First 5 San Bernardino Application Workbook 3.

Estimate how many participants will change…or how much of the changed condition you can impact. a.

Targets – Indicate the gain you are creating and the number of participants that will achieve it. In the case of environmental or other projects that seek a change not in persons but in condition indicate that change as your target. Your targets should reflect what you think you can achieve even if everything does not go perfectly. Example: At least 50 youth will attend a college/university, participate in a careertraining program or be hired into a position with strong advancement possibilities.

b.

The “No Program” Baseline – Your investor wants to know of the value your program adds and thus asks this question: what would have happened without your program? You are not asked for rigorous research here – just the best available insight from those most in a position to know. Example: Guidance Counselors in the school our 60 seniors attend tell us that about 20 in a typical year will go onto college or get a job within a year of graduation. Our target of 50 suggests a net gain of about 30 students achieving this success.

c.

Verification – How will you verify that your targets have been achieved? Please tell us the information or other evidence you will use to define success for your participants for each of your stated targets. At this point, you may wish to revisit your targets to make sure that they are framed in such terms that success can be verified and linked to Commission level outcomes. In some cases you will be using indicators known to improve conditions. (Example: a reduction in chemicals washed into body of water from a farm or golf course is an indicator that water quality will improve.) Example: College attendance verified through college transcripts (with participant permission), as well as emails and phone calls between program participants and mentors/program staff. Job training, attendance and performance verified by training group with participant permission. Employment verified by employer with participant permission.

Section 5: Key People Clear program successes are one way the investor knows you are likely to succeed. A second factor is just who are the people who will make this happen. Not organizational leaders but the person who owns the target as project director…and those who directly interact with participants. They make all the difference. 1.

Project Director – We believe that the right person is as critical as the right organization or the right plan. Provide a profile of the individual who assumes direct responsibility for hitting your targets. While we are interested in education and past experience, we are most interested in those qualities or traits that make this person the best choice for success. Example: Samuel Turner is the project director for Youth on the Move Mentoring Program and takes personal responsibility for hitting our targets. He was an educator for 11 years. For his ability to bring out the best in each of his students, he was twice voted Teacher of the Year by his students and peers. Samuel believes that all students can achieve academically and the high expectations he holds for every young person permeates the program. He is tenacious and very energetic, accomplishing what he sets out to achieve and settling for nothing less. Samuel was the former chair of his neighborhood development corporation where he singlehandedly recruited over 40 business and professional volunteers to help in the organization’s activities. He is also able to diminish any apprehension that volunteers may have about working with the young people living in the Carver Homes complex.

Page 9 of 25

ATTACHMENT L First 5 San Bernardino Application Workbook 2.

“Delivery” Staff – We also believe that those who directly deliver the program to participants are equally important. Please tell us about the key individuals who will play these roles and, as with the director, the factors that most predict their success. Example: Joyce Johnson is the resident manager of Carver Homes. She has lived in the housing project for over 20 years and has gained the trust of all its residents, especially its young people. Formerly on welfare, Joyce has become a community leader by virtue of her energy, creativity and great compassion. She is also a meticulous planner and organizer who can be trusted to pay careful attention to the important details of the program’s operations.

Section 6: Intermediaries/Partners This is the group of organizations and individuals on whom you rely for success and whose decisions and behavior you do not control. You may have many or none. Think this through carefully. For example, some drug prevention programs relied on support from principals for in-school prevention programs – only to find out far too late that it was individual teachers who made the decision. 1.

Intermediaries/Partners – If you have such a group or person, please list them here, along with the role they must play. For example, your project may involve hiring an outside Contractor to provide certain services to program participants. Example: Young Professionals Association of Washington, DC has agreed to make our program their service project for the next three years. They have committed 50 mentors to Youth on the Move.

2.

Evidence of Commitment – Include here the confirmation letters from intermediaries and/or partners that are committed to playing the role specified above. While we do not wish to burden you with general support letters or endorsements, we are very interested in the specific commitments that groups are making which are crucial for your success. Please attach letters describing commitments that have been made by your partners. Example: Date: Dear Mr. Turner: We are delighted to confirm that the Young Professionals Association of Washington, DC has selected Youth on the Move Mentoring Program as its signature project for the years 2002 through 2009. We confirm that we will provide a minimum of 50 mentors for your program from among our membership in 2002 and in the subsequent years of the agreement. At its most recent meeting, our board of directors unanimously approved participation in your project and has authorized our full support. Sincerely, Andrea J. Cunningham

Page 10 of 25

ATTACHMENT L First 5 San Bernardino Application Workbook

Performance Target Outline - Application Important: Please refer to the Application Workbook in Part III. The workbook is designed to help you develop a response to this application and includes explanations and examples of responses for each section. Your responses should be limited to ten pages and should be attached to a completed cover sheet and budget. Your Organization 1.

Describe your organization’s experience in providing Screening, Assessment, Referral and Treatment Services. Please share the success you have had during the past two years. Have the customer results achieved met your expectations? Describe at least one course correction made based on any lessons learned during the past two years.

Participants You Will Serve 2.

Describe the participants currently served. Did your initial assumptions about your participants change/evolve throughout the past two years? Have there been any changes in your participant population that would require a change in your program design?

Your Project 3.

Briefly describe the evidence-based model or promising practice you will implement (or continue to offer) in an effort to achieve sustained behavior change in your participants. What are the key elements of your program? How do you engage your participants and how do you keep them involved?

Performance Targets 4. In the attached Program Work Plan, please reflect the intended outcomes (performance targets) of your program. What specific human gain will you seek for the participants in your program? What are the key achievements or methods that show participant progress in getting from a present condition or circumstance to the gain/outcome you have targeted for your project?

Key People 5.

Who are the internal “spark plugs” that directly deliver the program? Provide a profile of the individual who assumes direct responsibility for reaching your targets. Please also tell us about the key individuals who directly delivers the program to participants and describe the factors that most predict their success.

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ATTACHMENT L First 5 San Bernardino Application Workbook Intermediaries and Partners 6.

Tell us about the external collaborative partners on whom you rely for success. Describe their contributions in terms of work or resources they add to the effectiveness of your program.

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ATTACHMENT L First 5 San Bernardino Application Workbook

Agency Name: Program Work Plan Performance Target: By June 30, 20___of the __________ number of participants that participate in the __________________ program, _______ will achieve ____________ as verified by ______________________________ . F5SB Desired Results Area (Direct link to the Strategic Plan and Commission Level Outcomes)

Work Plan Area (Tasks, Objectives and Services)

General Outcome(s) (Key achievements/ benchmark that will best show participant progress in getting from a present condition to the targeted gain or condition change

Method(s) (Establishing that something represented to happen does in fact take place and tools used to assess that it happened)

Page 13 of 25

Child & Family Assessment   SERVICE / ACTIVITY    Developmental Screening 

DEFINITION  A procedure designed to identify children who should receive  more intensive assessment or diagnosis for potential  developmental delays. 1   Utilizes a standard screening instrument  such as the ASQ.    This assessment is a structured evaluation of a child's  Developmental Assessment  development (physical, language, intellectual, social, and/or  emotional) by a developmental assessment specialist, or a team  of professionals that can include a pediatrician, language  specialist, audiologist, occupational therapist, child psychologist,  and child psychiatrist, among others.  Also utilizes standardized  assessment instruments as determined by the staff providing the  assessment. 2  Services provided to child and/or parent to provide intervention  Developmental Treatment Session  and treatment to address child’s developmental needs.    Providing parents with connections or access to developmental  Outgoing Referral for Developmental Services  services deemed necessary to meet the child’s need.     A procedure designed to identify children who should receive    more intensive assessment or diagnosis for potential behavioral  Behavior Screening  problems or challenges.  Utilizes a standard screening instrument  such as the ASQ:SE.   This assessment is a structured evaluation of a child's  development (social and/or emotional) by an assessment  specialist, or a team of professionals that can include a    pediatrician, mental health professional (such as social workers),  Behavioral Assessment  child psychologist, and child psychiatrist, among others.  May  also utilizes standardized assessment instruments as determined  by the staff providing the assessment.    Services provided to child and/or parent to provide intervention  Behavior Treatment Session  and treatment to address child’s behavioral needs.    Providing parents with connections or access to behavioral  Outgoing Referral for Behavioral Services  intervention services deemed necessary to meet the child’s need.    Case management sessions are provided to ongoing clients,  clients identified as core recipients of service.  This could include    assistance with basic family needs (food, clothes, housing)  Case Management Session  provided on‐site as well as additional support to help a family  move towards self‐sufficiency. 

Page 14 of 3

1 2

Definition taken from the Centers for Disease Control (CDC). Definition taken from babycenter.com.

Page 14 of 25

Parent Support Session/Workshop/Class 

    Referral/Linkage Session    Substance Abuse Screening or Assessment    Substance Abuse Treatment Session    Outgoing Referral for Substance Abuse  Services    Tobacco Cessation Session 

  Provider Trainings/Meetings 

Provided in a group setting, parent support increases parental  feelings of connectedness and support.  May be led by agency  staff but may also be facilitated or co‐facilitated by parent  partners.  Providing parents and families with connections or access to  critical services and programs not represented physically at the  center.  May include basic needs such as food, clothes, and  housing assistance.      Screening and diagnostic services for substance abuse  Treatment, counseling, and/or therapy for adult/parent identified  as having a substance abuse problem  Providing parents with connections or access to substance abuse  treatment services not represented physically at the agency.  Education on tobacco‐related issues and abstinence support for  participants using tobacco products. Includes providing  information on reducing young children’s exposure to tobacco  smoke.  Learning opportunities provided to staff providers in order to  improve the capacity of these providers to improve the delivery of  services to families with young children.   

 

Page 15 of 25

BUDGET JUSTIFICATION Tips/Reminders For Completing A Budget Justification 1.

Read the budget line item definitions when categorizing expenses to ensure appropriate use of line items.

2.

Use line item numbers and categories as they are listed on the Program Budget template. The justification explains the figures shown on the Program Budget, therefore it needs to be set up consistent with the budget and easily used in conjunction with the budget.

3.

For each budgeted line item, the following three amounts should be reflected on the justification consistent with the Program Budget:

4.

a.

Total Project Costs (column A): The total costs projected as necessary to carry out the project successfully. This column should include all costs related to the project without considering the source of funding for those costs.

b.

Other Funding Sources (column B): Reflects only those costs from Total Project Costs (column A) that will be paid for by another funding source other than First 5 San Bernardino.

c.

First 5 Funded Project Costs (column C): Those costs reflected in column A that are to be paid for by First 5 San Bernardino. Column C is the difference of column A less column B.

In addition to the above mentioned cost categories to be reflected in the justification, the following information must be included for each budgeted position in the Salaries & Benefits (section A): a.

A brief description of the major responsibilities of the position

b.

The calculation that was used to determine the project cost for the position (# of project hours x hourly rate of pay = total project cost)

c.

Any other relevant information that would be helpful to clarify the role of the position within the project.

5.

The Benefits line item reflects all benefits that pertain to the budgeted positions. description of the benefits that are provided.

6.

The line item categories under Services & Supplies (section B) should clearly reflect the specific items being budgeted in each of the line items. More general descriptions will be allowed for line items that are self-explanatory which are: Postage, Office Supplies & Bldg/Equipment Maintenance.

7.

The Professional Services/Consultants (line item B17) costs must be broken down listing the agency/individual that will be providing the service and a description of the services they will be providing.

8.

Indirect Costs (line item B18) should reflect the indirect rate being used and the justification for the rate. It is appropriate here to refer to an approved document that supports the indirect cost rate such

Give a brief

Page 16 of 25

as an approved cost allocation plan or an assignment of an indirect cost rate as determined by the governing body for your agency. A copy of the supporting document will be required.

9.

Subcontracts (section C) must list each agency that you have subcontracted with to provide direct services to participants under this contract and describe the direct service to be provided.

10.

Please do not use the word, “etc.” and the phrase, “including, but not limited to…” or any other word usage that eludes to non-specific costs being budgeted, and/or an unlimited allowance of other items that may be charged against a particular line item. Usage of these types of phrases will not be allowed in the budget justifications.

11.

Reflect the grand total of the Budgeted costs at the bottom of your justification. This should match the grand totals reflected on the Program Budget.

Page 17 of 25

Budget Line items defined A.

SALARIES/BENEFITS ƒ

The only budget items that should be listed here are the salaries and benefits for actual employees of the agency. Independent Contractors are NOT listed in this section of the budget.

ƒ

FTE stands for “Full Time Equivalent”. An FTE is a measurement equal to one staff person working a full-time work schedule (2,080 hours) in a year. Expressing budgeted positions numerically by FTE’s provides a common unit of measurement for positions budgeted. The number of FTE’s is a numerical value expressing a percentage of time and/or a percentage of funds related to a particular classification using a full time equivalent measurement (40 hours/week, 2,080 hours/year) as a baseline. •

FTE value is calculated by dividing the total hours being budgeted for each position by the standard number of hours for full-time employees (2,080 hrs). The result is the number of FTEs for that position.

•

Example: An agency has 8 case workers scheduled to work the following hours: 3 case workers will work 40 hrs/wk or 2,080 hrs/yr = 6,240 hrs 2 case workers will work 30 hrs/wk or 1,560 hrs/yr = 3,120 hrs 1 case worker will work 20 hrs/wk or 1,040 hrs/yr = 1,040 hrs 2 case workers will work 5 hrs/wk or 260 hrs/yr = 520 hrs Total hours = 10,920 divided by 2,080 = 5.25 FTE

Although the agency had 8 individuals working as case workers, the full time equivalent of those was 5.25.

B.

ƒ

Benefits will be reflected as one line item for all positions

ƒ

Ensure that there are no employees working in two or more positions and being paid for more than one FTE total hours.

SERVICES/SUPPLIES 1.

Program Materials/Supplies: Items directly related to service delivery such as course curriculum, children’s books, journals used by participants, child development toys, etc. This line item is categorized as a program cost.

2.

Participant Support/Incentives: Items purchased to give to participants to provide support or incentive to follow through with the program (food should not be charged to this line item). This line item is categorized as a program cost.

3.

Participant Transportation: Costs involved with transporting participants to needed services and/or appointments and back home. May be in the form of bus passes, gasoline for a van used for the purpose of transporting participants, cab services or other transportation services. This line item is categorized as a program cost.

4.

Food for Classes/Meetings: All food or catering costs for meetings or conferences, classes or workshops. This line item is categorized as a program or administrative cost.

5.

Staff Development/Training: Registration fees or other costs associated with attending staff training courses, conferences, seminars, and other staff development activities. (travel & mileage expenses should be reflected under line item 6). This line item can be categorized as a program or administrative cost.

Page 18 of 25

C.

6.

Employee Mileage/Travel: Employee mileage and other travel-related costs such as hotel & airline costs, meals, parking, car rental, etc. related to the program. This line item can be categorized as a program or administrative cost.

7.

Advertisements: Newspaper ads, radio, and other advertising costs. This line item should normally be administrative, however some exceptions could apply.

8.

Printing: Printing of brochures and flyers, business cards & letterhead, etc. This line item should normally be administrative, however some exceptions could apply.

9.

Postage: Postage expenses. This line item should normally be administrative; however, some exceptions could apply.

10.

Subscriptions: Costs to subscribe to a particular magazine, newsletter or other type of publication for the benefit of the program. This line item is categorized as a program or administrative cost.

11.

Office Supplies: General supplies needed in the overall operations/administration of the program. This line item can be categorized as a program or administrative cost.

12.

Office Equipment: Costs for equipment such as computers, printers, small furniture items, fax machines, or the lease costs associated with office equipment. This line item can be categorized as a program or administrative cost.

13.

Rent/Lease Building: Facility rental costs (please provide the rental/lease agreement). This line item can be categorized as a program or administrative cost.

14.

Maintenance: Costs for maintenance and upkeep of buildings and/or equipment. This line item is categorized as an administrative cost.

15.

Utilities: Phone, DSL, cell phones, electricity, and other monthly utility costs. This line item is categorized as an administrative cost.

16.

Insurance: Insurance costs. This line item is categorized as an administrative cost.

17.

Professional Services/Consultants: Independent Contractors hired to perform services not related to providing direct services and do not directly impact performance targets or have responsibility for them. Examples: Janitorial services, bookkeeping services, one-time speakers, etc. This line item can be categorized as a program or administrative cost.

18.

Indirect Costs: Must be accompanied by an approved cost allocation plan.

SUBCONTRACTS ƒ

D.

These are contracts with other agencies to provide direct services for which they will be responsible for achieving the performance targets for the portion of services they are providing. These agencies would be responsible for reporting to the primary agency, which is then responsible to report to First 5. The primary agency is responsible for the performance of its subcontractors therefore site visits must be conducted on that level.

ADMINISTRATIVE COSTS The following items are considered administrative costs. These items are almost always administrative in nature and the contract agency must have a compelling reason for us to consider categorizing it as a program-related cost. The total budgeted allocation for administrative costs cannot exceed 10% of the total contract dollar amount per year. ƒ

Salary and benefits costs associated with the following duties: •

Payroll duties/employee evaluations/scheduling/personnel issues

•

Accounting/bookkeeping duties Page 19 of 25

•

General oversight of the agency (i.e., Executive Director)

•

Computer maintenance/technical duties

•

Monitoring for compliance

ƒ

Employee mileage/travel associated with administrative duties (above)

ƒ

Staff training associated with administrative staff or functions

ƒ

Office supplies (direct program-related supplies should be charged to program materials)

ƒ

Office equipment used for administration

ƒ

Rent/Utilities utilized for program support and administration

ƒ

Maintenance costs

ƒ

Insurance costs

ƒ

Postage

ƒ

Printing

ƒ

Indirect costs

Page 20 of 25

RFP - DBH 09 – 72 SART SERVICES Program Budget (This is the attached Excel spreadsheet file marked Attachment M) Please complete the budget template (Attachment M) and narrative for the first year of services to align with your proposed program.

Budget Narrative Program Budget Justification Fiscal Year 2010-2011

Salaries & Benefits Position Title Description of duties/responsibilities: Project Hours: x Hourly Rate: = Total Project Costs: Thru Other Sources: First 5 Budget Total: Position Title Description of duties/responsibilities: Project Hours: x Hourly Rate: = Total Project Costs: Thru Other Sources: First 5 Budget Total: Position Title Description of duties/responsibilities: Project Hours: x Hourly Rate: = Total Project Costs: Thru Other Sources: First 5 Budget Total: Position Title Description of duties/responsibilities: Project Hours: x Hourly Rate: = Total Project Costs: Thru Other Sources: First 5 Budget Total: Position Title Description of duties/responsibilities: Project Hours: x Hourly Rate: = Total Project Costs: Thru Other Sources: First 5 Budget Total: Position Title Description of duties/responsibilities: Project Hours: x Hourly Rate: = Total Project Costs: Thru Other Sources: First 5 Budget Total: Position Title Description of duties/responsibilities: Page 21 of 25

Project Hours: x Hourly Rate: = Total Project Costs: Thru Other Sources: First 5 Budget Total: Position Title Description of duties/responsibilities: Project Hours: x Hourly Rate: = Total Project Costs: Thru Other Sources: First 5 Budget Total: Position Title Description of duties/responsibilities: Project Hours: x Hourly Rate: = Total Project Costs: Thru Other Sources: First 5 Budget Total: Position Title Description of duties/responsibilities: Project Hours: x Hourly Rate: = Total Project Costs: Thru Other Sources: First 5 Budget Total: Position Title Description of duties/responsibilities: Project Hours: x Hourly Rate: = Total Project Costs: Thru Other Sources: First 5 Budget Total: Benefits Description of benefits Thru other sources = $

Calculation of benefits = $ First 5 Budget Total = $ Total Salaries & Benefits:

Total Project Costs: Thru Other Sources: Thru Other Sources:

$ $ $

Services & Supplies 1.

Program Materials/Supplies

Total Project = $ First 5 Budget Total = $ 2.

Participant Support/Incentives Total Project = $ First 5 Budget Total = $

3.

Explanation/Justification here Thru other sources = $

Explanation/Justification here Thru other sources = $

Participant Transportation Page 22 of 25

Total Project = $ First 5 Budget Total = $ 4.

Food Expense for Classes/Meetings Total Project = $ First 5 Budget Total = $

5.

Explanation/Justification here Thru other sources = $

Office Equipment Total Project = $ First 5 Budget Total = $

13.

Explanation/Justification here Thru other sources = $

Office Supplies Total Project = $ First 5 Budget Total = $

12.

Explanation/Justification here Thru other sources = $

Subscriptions Total Project = $ First 5 Budget Total = $

11.

Explanation/Justification here Thru other sources = $

Postage Total Project = $ First 5 Budget Total = $

10.

Explanation/Justification here Thru other sources = $

Printing Total Project = $ First 5 Budget Total = $

9.

Explanation/Justification here Thru other sources = $

Advertisements Total Project = $ First 5 Budget Total = $

8.

Explanation/Justification here Thru other sources = $

Employee Mileage/Travel Total Project = $ First 5 Budget Total = $

7.

Explanation/Justification here Thru other sources = $

Staff Development/Training

Total Project = $ First 5 Budget Total = $ 6.

Explanation/Justification here Thru other sources = $

Explanation/Justification here Thru other sources = $

Rent/Lease Building Total Project = $ First 5 Budget Total = $

Explanation/Justification here Thru other sources = $ Page 23 of 25

14.

Building/Equipment Maintenance Total Project = $ First 5 Budget Total = $

15.

Utilities Total Project = $ First 5 Budget Total = $

16.

Explanation/Justification here Thru other sources = $

Professional Services/Consultants Total Project = $ First 5 Budget Total = $

18.

Explanation/Justification here Thru other sources = $

Insurance/Taxes/Licenses Total Project = $ First 5 Budget Total = $

17.

Explanation/Justification here Thru other sources = $

Explanation/Justification here Thru other sources = $

Indirect Costs Total Project = $ First 5 Budget Total = $

Total Services & Supplies:

Explanation/Justification here Thru other sources = $

Total Project Costs:

$

Thru Other Sources:

$

First 5 Total Budget:

$

Subcontracts Contractor Description of contractor: Total Project = $ First 5 Budget Total = $

Thru other sources = $

Contractor Description of contractor: Total Project = $ First 5 Budget Total = $

Thru other sources = $

Page 24 of 25

Contractor Description of contractor: Total Project = $ First 5 Budget Total = $

Thru other sources = $

Contractor Description of contractor: Total Project = $ First 5 Budget Total = $

Thru other sources = $

Contractor Description of contractor: Total Project = $ First 5 Budget Total = $

Thru other sources = $

Contractor Description of contractor: Total Project = $ First 5 Budget Total = $

Total Subcontracts: Total Subcontracts:

Total Project Budget:

Thru other sources = $

Total Project Costs: $ Thru Other Sources: $ First 5 Budget Total = $

Total Project Costs: $ Thru Other Sources: $ First 5 Budget Total = $

Page 25 of 25

ATTACHMENT M First 5 San Bernardino Program Budget – Sample

PROGRAM BUDGET FISCAL YEAR 2009-2010 CONTRACTED AGENCY NAME: DESCRIPTION

TOTAL PROGRAM COSTS

OTHER FUNDING SOURCES

DONATED RESOURCES

FIRST 5 FUNDED PROJECT COSTS

FIRST 5 %

A

B

C

D

E

A. SALARIES & BENEFITS FTE

POSITION TITLE

1

1.00

$

0

#DIV/0!

2

1.00

$

0

#DIV/0!

3

1.00

$

0

#DIV/0!

4

1.00

$

0

#DIV/0!

5

1.00

$

0

#DIV/0!

6

1.00

$

0

#DIV/0!

7

1.00

$

0

#DIV/0!

8

1.00

$

0

#DIV/0!

9

1.00

$

0

#DIV/0!

10

1.00

$

0

#DIV/0!

$

0

#DIV/0!

$

0

#DIV/0!

$

0

#DIV/0!

TOTAL SALARIES

$

$

$

TOTAL BENEFITS TOTAL SALARIES & BENEFITS

$

$

$

Page 1 of 3

ATTACHMENT M First 5 San Bernardino Program Budget – Sample

B. SERVICES & SUPPLIES

A

B

C

D

D

E

1

PROGRAM MATERIALS/SUPPLIES

$

0

#DIV/0!

2

PARTICIPANT SUPPORT/INCENTIVES

$

0

#DIV/0!

3

PARTICIPANT TRANSPORTATION

$

0

#DIV/0!

4

FOOD EXPENSE FOR CLASSES/MEETINGS

$

0

#DIV/0!

5

STAFF DEVELOPMENT/TRAINING

$

0

#DIV/0!

6

EMPLOYEE MILEAGE/TRAVEL

$

0

#DIV/0!

7

ADVERTISEMENTS

$

0

#DIV/0!

8

PRINTING

$

0

#DIV/0!

9

POSTAGE

$

0

#DIV/0!

10

SUBSCRIPTIONS

$

0

#DIV/0!

11

OFFICE SUPPLIES

$

0

#DIV/0!

12

OFFICE EQUIPMENT

$

0

#DIV/0!

13

RENT/LEASE BUILDING

$

0

#DIV/0!

14

BUILDING/EQUIPMENT MAINTENANCE

$

0

#DIV/0!

15

UTILITIES

$

0

#DIV/0!

16

INSURANCE/TAXES/LICENSES

$

0

#DIV/0!

PROFESSIONAL SERVICES/CONSULTANTS

#DIV/0!

17.1

$

0

#DIV/0!

17.2

$

0

#DIV/0!

17.3

$

0

#DIV/0!

17.4

$

0

#DIV/0!

17.5

$

0

#DIV/0!

$

0

#DIV/0!

$

0

#DIV/0!

19

$

0

#DIV/0!

20

$

0

#DIV/0!

21

$

0

#DIV/0!

$

0

#DIV/0!

17

PROFESSIONAL SERVICES - SUBTOTAL

18

INDIRECT COSTS (AS APPROVED)

TOTAL SERVICES/SUPPLIES

$

$

$

$

Page 2 of 3

ATTACHMENT M First 5 San Bernardino Program Budget – Sample

C. SUBCONTRACTS

A

B

C

D

E

SUBCONTRACTS - AGENCY NAME

#DIV/0!

1

$

0

#DIV/0!

2

$

0

#DIV/0!

3

$

0

#DIV/0!

4

$

0

#DIV/0!

5

$

0

#DIV/0!

TOTAL SUBCONTRACTS

TOTAL PROJECT BUDGET

$ $

$ 0.00%

0.00%

$

$

#DIV/0!

$

$

#DIV/0!

0.00%

0.00%

Page 3 of 3

ATTACHMENT N

DBH Contract Provider Medi-Cal Certification Process

Page 1 of 1

ATTACHMENT O BUSINESS ASSOCIATE AGREEMENT

Except as otherwise provided in this Agreement, CONTRACTOR, hereinafter referred to as BUSINESS ASSOCIATE, may use or disclose Protected Health Information to perform functions, activities or services for or on behalf of the COUNTY OF SAN BERNARDINO, hereinafter referred to as the COVERED ENTITY, as specified in this Agreement and in the attached Contract, provided such use or disclosure does not violate the Health Insurance Portability and Accountability Act (HIPAA), 42 U.S.C. 1320d et seq., and its implementing regulations, including but not limited to, 45 Code of Regulations Parts 160, 162, and 164, hereinafter referred to as the Privacy and Security Rules. I.

Obligations and Activities of Business Associate. A.

Business Associate shall not use or further disclose Protected Health Information other than as permitted or required by this Agreement or as Required By Law. Business Associate shall disclose to its employees, subcontractors, agents, or other third parties, and request from Covered Entity, only the minimum Protected Health Information necessary to perform or fulfill a specific function required or permitted hereunder.

B.

Business Associate shall implement administrative, physical, and technical safeguards to: 1.

Prevent use or disclosure of the Protected Health Information other than as provided for by this Agreement.

2.

Reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic Protected Health Information that it creates, receives, maintains, or transmits on behalf of the Covered Entity.

C.

Business Associate shall mitigate, to the extent practicable, any harmful effect that is known to Business Associate of a use or disclosure of Protected Health Information by Business Associate in violation of the requirements of this Agreement.

D.

Business Associate shall report to Covered Entity any use or disclosure of the Protected Health Information not provided for by this Agreement and/or any security incident with respect to electronic Protected Health Information of which it becomes aware.

E.

Business Associate shall ensure that any agent, including a subcontractor, to whom it provides Protected Health Information received from, or created or received by Business Associate on behalf of Covered Entity, shall comply with the same restrictions and conditions that apply through this Agreement to Business Associate with respect to such information.

F.

Business Associate shall provide access to Protected Health Information in a Designated Record Set to Covered Entity or to an Individual, at the request or direction of Covered Entity and in the time and manner designated by the Covered Entity, in order to meet the requirements of 45 CFR 164.524.

G.

Business Associate shall make any amendment(s) to Protected Health Information in a Designated Record Set that the Covered Entity directs or agrees to pursuant to 45 CFR 164.526, in the time and manner designated by the Covered Entity.

H.

Business Associate shall make internal practices, books, and records, including policies and procedures and Protected Health Information, relating to the use and disclosure of Protected Health Information received from, or created or received by Business Associate on behalf of, Covered Entity available to the Covered Entity, and/or to the Secretary for the U.S. Department of Health and Human Services, in a time and manner designated by the Covered Entity or the Secretary, for purposes of the Secretary determining Covered Entity’s compliance with the Privacy and Security Rules.

Page 1 of 3

ATTACHMENT O

II.

III.

I.

Business Associate shall document such disclosures of Protected Health Information and information related to such disclosures as would be required for Covered Entity to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

J.

Business Associate shall provide to Covered Entity or an Individual, in the time and manner designated by the Covered Entity, information collected in accordance with provision (i), above, to permit Covered Entity to respond to a request by the Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

K.

Upon termination of this Agreement, Business Associate shall return all Protected Health Information required to be retained and return or destroy all other Protected Health Information received from the Covered Entity, or created or received by the Business Associate or its subcontractors, employees or agents on behalf of the Covered Entity. In the event the Business Associate determines that returning the Protected Health Information is not feasible, the Business Associate shall provide the Covered Entity with written notification of the conditions that make return not feasible. Business Associate further agrees to extend any and all protections, limitations, and restrictions contained in this Agreement, to any Protected Health Information retained by Business Associate or its subcontractors, employees or agents after the termination of this Agreement, and to limit any further uses and/or disclosures to the purposes that make the return or destruction of the Protected Health Information infeasible.

Specific Use and Disclosure Provisions. A.

Except as otherwise limited in this Agreement, Business Associate may use Protected Health Information for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the Business Associate.

B.

Except as otherwise limited in this Agreement, Business Associate may disclose Protected Health Information for the proper management and administration of the Business Associate, provided that disclosures are Required By Law, or Business Associate obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as Required By Law or for the purpose for which it was disclosed to the person, and the person notifies the Business Associate of any instances of which it is aware in which the confidentiality of the information has been breached.

C.

Except as otherwise limited in this Agreement, Business Associate may use Protected Health Information to provide Data Aggregation service to Covered Entity as permitted by 42 CFR 164.504(e)(2)(i)(B).

D.

Business Associate may use Protected Health Information to report violations of law to appropriate Federal and State authorities, consistent with 42 CFR 164.502(j)(1).

Obligations of Covered Entity. A.

Covered Entity shall notify Business Associate of any limitation(s) in its notice of privacy practices of Covered Entity in accordance with 45 CFR 164.520, to the extent that such limitation may affect Business Associate’s use or disclosure of Protected Health Information.

B.

Covered Entity shall notify Business Associate of any changes in, or revocation of, permission by Individual to use or disclose Protected Health Information, to the extent that such changes may affect Business Associate’s use or disclosure of Protected Health Information.

Page 2 of 3

ATTACHMENT O C.

IV.

Covered Entity shall notify Business Associate of any restriction to the use or disclosure of Protected Health Information that Covered Entity has agreed to in accordance with 45 CFR 164.522, to the extent that such restriction may affect Business Associate’s use or disclosure of Protected Health Information.

General Provisions. A.

Remedies. Business Associate agrees that Covered Entity shall be entitled to seek immediate injunctive relief as well as to exercise all other rights and remedies which Covered Entity may have at law or in equity in the event of an unauthorized use or disclosure of Protected Health Information by Business Associate or any agent or subcontractor of Business Associate that received Protected Health Information from Business Associate.

B.

Ownership. The Protected Health Information shall be and remain the property of the Covered Entity. Business Associate agrees that it acquires no title or rights to the Protected Health Information.

C.

Regulatory References. A reference in this Agreement to a section in the Privacy or Security Rule means the section as in effect or as amended.

D.

Amendment. The Parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for Covered Entity to comply with the requirements of the Privacy and Security Rules and the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191.

E.

Interpretation. Any ambiguity in this Agreement shall be resolved to permit Covered Entity to comply with the Privacy and Security Rules.

Page 3 of 3

ATTACHMENT P AMERICAN RECOVERY AND REINVESTMENT ACT FUNDING (ARRA) Use of ARRA Funds and Requirements This Contract may be funded in whole or in part with funds provided by the American Recovery and Reinvestment Act of 2009 (“ARRA”), signed into law on February 17, 2009. Section 1605 of ARRA prohibits the use of recovery funds for a project for the construction, alteration, maintenance or repair of a public building or public work (both as defined in 2 CFR 176.140) unless all of the iron, steel and manufactured goods (as defined in 2 CFR 176.140) used in the project are produced in the United States. A waiver is available under three limited circumstances: (i) Iron, steel or relevant manufactured goods are not produced in the United States in sufficient and reasonable quantities and of a satisfactory quality; (ii) Inclusion of iron, steel or manufactured goods produced in the United States will increase the cost of the overall project by more than 25 percent; or (iii) Applying the domestic preference would be inconsistent with the public interest. This is referred to as the “Buy American” requirement. Request for a waiver must be made to the County for an appropriate determination. Section 1606 of ARRA requires that laborers and mechanics employed by contractors and subcontractors on projects funded directly by or assisted in whole or in part by and through the Federal Government pursuant to ARRA shall be paid wages at rates not less than those prevailing on projects of a character similar in the locality as determined by the Secretary of Labor in accordance with the Davis-Bacon Act (40 U.S.C. 31). This is referred to as the “wage rate” requirement. The above described provisions constitute notice under ARRA of the Buy American and wage rate requirements. Contractor must contact the County contact if it has any questions regarding the applicability or implementation of the ARRA Buy American and wage rate requirements. Contractor will also be required to provide detailed information regarding compliance with the Buy American requirements, expenditure of funds and wages paid to employees so that the County may fulfill any reporting requirements it has under ARRA. The information may be required as frequently as monthly or quarterly. Contractor agrees to fully cooperate in providing information or documents as requested by the County pursuant to this provision. Failure to do so will be deemed a default and may result in the withholding of payments and termination of this Contract. Contractor may also be required to register in the Central Contractor Registration (CCR) database at http://www.ccr.gov and may be required to have its subcontractors also register in the same database. Contractor must contact the County with any questions regarding registration requirements. Schedule of Expenditure of Federal Awards In addition to the requirements described in “Use of ARRA Funds and Requirements,” proper accounting and reporting of ARRA expenditures in single audits is required. Contractor agrees to separately identify the expenditures for each grant award funded under ARRA on the Schedule of Expenditures of Federal Awards (SEFA) and the Data Collection Form (SF-SAC) required by the Office of Management and Budget Circular A-133, “Audits of States, Local Governments, and Nonprofit Organizations.” This identification on the SEFA and SF-SAC shall include the Federal award number, the Catalog of Federal Domestic Assistance (CFDA) number, and amount such that separate accountability and disclosure is provided for ARRA funds by Federal award number consistent with the recipient reports required by ARRA Section 1512 (c). In addition, Contractor agrees to separately identify to each subcontractor and document at the time of subcontract and at the time of disbursement of funds, the Federal award number, any special CFDA number assigned for ARRA purposes, and amount of ARRA funds. Contractor may be required to provide detailed information regarding expenditures so that the County may fulfill any reporting requirements under ARRA described in this section. The information may be required as frequently as monthly or quarterly. Contractor agrees to fully cooperate in providing information or documents as requested by the County pursuant to this provision. Failure to do so will be deemed a default and may result in the withholding of payments and termination of this Contract. ARRA – 8/12/09

Page 1 of 1