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FY2013 11/20/2012
AGREEMENT This Agreement is made and entered into this 20th day of November, 2012, between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as "Board" or "County," and Guidance /Care Center, hereinafter referred to as "PROVIDER." WHEREAS, the County participates in funding substance abuse and mental health (SAMH) services within the County pursuant to Section 394.76(9)(a), Florida Statutes; and WHEREAS, the PROVIDER is a not - for - profit corporation that provides SAMH services within Monroe County; and WHEREAS, it is a legitimate public purpose to provide substance abuse and mental health services for individuals, now, therefore, IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as follows: FUNDING 1. GRANT OFFER TO THE PROVIDER. The County hereby agrees to provide local match funding for State funding pursuant to Section 394.76(9)(a), Florida Statutes, and the contract between the PROVIDER and South Florida Behavioral Health Network (ME225 -3 -27) attached here in (Attachment D) to provide substance abuse and mental health services; such funds shall be expended for alcohol, drug abuse, or mental health service programs. 2. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially and satisfactorily performing and carrying out the duties and obligations of the Board, shall reimburse the Provider for a local match portion of the Provider's expenditures for Substance Abuse and Mental Health services, as billed by the Provider, for clients qualifying for such services under applicable state and federal regulations and eligibility determination procedures, for substance abuse treatment. This cost shall not exceed a total reimbursement of SIX HUNDRED FIFTY SEVEN THOUSAND AND SIXTY SIX AND NO /100 DOLLARS ($657,066.00) in fiscal year 2012 -2013. 3. TERM. This Agreement shall commence on October 1, 2012, and terminate September 30, 2013, unless earlier terminated pursuant to other provisions herein. 4. PAYMENT. Payment will be paid monthly as hereinafter set forth. Baker Act and SAMH Billing Summary Forms, certified monthly financial and service load reports will be made available to the Board to validate the delivery of services under this contract. The monthly financial report is due in the office of the Clerk of the Board no later than the 15th day of the following month. After the Clerk of the Board pre- audits the certified report, the Board shall reimburse the Provider for its monthly expenses. However, the total of said monthly payments in the aggregate sum shall not exceed the total amount shown in Article 2, above, during the term of this agreement. To preserve client confidentiality required by law, copies of individual client bills and records shall not be available to the Board for reimbursement purposes but shall be made available only under controlled conditions to qualified auditors for audit purposes. The organization's final invoice must be received within sixty days after the termination date of this contract shown in Article 3 above. Payment will be made periodically, but no more frequently than monthly, as hereinafter set forth. Reimbursement requests will be submitted to the Board via the Clerk's Finance Office. The County shall only reimburse, subject to the funded amounts below, those reimbursable expenses which are reviewed and approved as complying with Monroe County Code of Ordinances, State laws and regulations and Attachment A - Expense Reimbursement Requirements. Any funds Guidance Care Center -SAMH Contract; FY13; page 1 expended in violation of this Agreement or in violation of appropriate Federal, State, and County requirements shall be refunded in full to the County. Evidence of payment by the PROVIDER shall be in the form of a letter, summarizing the expenses, with supporting documentation attached. The letter should contain a notarized certification statement. An example of a reimbursement request cover letter is included as Attachment B. The organization's final invoice must be received within thirty days after the termination date of this contract shown in Article 3 above. After the Clerk of the Board examines and approves the request for reimbursement, the Board shall reimburse the PROVIDER. However, the total of said reimbursement expense payments in the aggregate sum shall not exceed the total amount shown in Article 2, above, during the term of this agreement. 5. AVAILABILITY OF FUNDS. The County reserves the right to withhold /reduce the funds to the Provider in the event that the Department of Children and Families eliminates /reduces the State contract funding. If funds cannot be obtained or cannot be continued at a level sufficient to allow for continued reimbursement of expenditures for services specified herein, this agreement may be terminated immediately at the option of the Board by written notice of termination delivered to the PROVIDER. The Board shall not be obligated to pay for any services or goods provided by the PROVIDER after the PROVIDER has received written notice of termination, unless otherwise required by law. 6. CLAIMS FOR FEDERAL OR STATE AID. PROVIDER and County agree that each shall be, and is, empowered to apply for, seek, and obtain federal and state funds to further the purpose of this Agreement; provided that all applications, requests, grant proposals, and funding solicitations shall be approved by each party prior to submission. 7. PURCHASE OF PROPERTY. All property, whether real or personal, purchased with funds provided under this agreement, shall become the property of Monroe County and shall be accounted for pursuant to statutory requirements. RECORDKEEPING 8. RECORDS. PROVIDER shall maintain all books, records, and documents directly pertinent to performance under this Agreement in accordance with generally accepted accounting principles consistently applied. Each party to this Agreement or their authorized representatives shall have reasonable and timely access to such records of each other party to this Agreement for public records purposes during the term of the Agreement and for four years following the termination of this Agreement. If an auditor employed by the County or Clerk determines that monies paid to PROVIDER pursuant to this Agreement were spent for purposes not authorized by this Agreement, the PROVIDER shall repay the monies together with interest calculated pursuant to Sec. 55.03, FS, running from the date the monies were paid to PROVIDER. 9. PUBLIC ACCESS. The County and PROVIDER shall allow and permit reasonable access to, and inspection of, all documents, papers, letters or other materials in its possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the County and PROVIDER in conjunction with this Agreement; and the County shall have the right to unilaterally cancel this Agreement upon violation of this provision by PROVIDER. 10. COMPLIANCE WITH COUNTY GUIDELINES. The PROVIDER must furnish to the County the following (items A -M must be provided prior to the payment of any invoices): (a) IRS Letter of Determination and GUIDESTAR printout indicating current 501(c)(3) status; (b) List of the Organization's Board of Directors of which there must be at least 5 and for each board member please indicate when elected to serve and the length of term of service; (c) Evidence of annual election of Officers and Directors; Guidance Care Center -SAMH Contract; FY13; page 2 (d) Unqualified audited financial statement from the most recent fiscal year for all organizations that expend $150,000 a year or more; if qualified, include a statement of deficiencies with corrective actions recommended /taken; (e) Copy of a filed IRS Form 990 from most recent fiscal year with all attached schedules; (f) Organization's Corporate Bylaws, which must include the organization's mission, board and membership composition, and process for election of officers; (g) Organization's Policies and Procedures Manual which must include hiring policies for all staff, drug and alcohol free workplace provisions, and equal employment opportunity provisions; (h) Specific description or list of services to be provided under this contract with this grant (see Attachment C, per contract ME225- 3 -27); (i) All legally required licenses; (j) Any updates /amendments throughout the fiscal year to the South Florida Behavioral Network contract with the Department of Children and Families (KH -225) and with Guidance /Care Center (ME225- 3 -27); (k) Annual Performance Report describing services rendered during the most recently completed grant period (to be furnished within 30 days after the contract end date.) The performance report shall include statistical information regarding the types and frequencies of services provided, a profile of clients (including residency) and numbers served, and outcomes achieved; (I) Cooperation with County monitoring visits that the County may request during the contract year; and (m) Other reasonable reports and information related to compliance with applicable laws, contract provisions and the scope of services that the County may request during the contract year. 11. AUDIT. The Provider shall provide the County with an annual audit pursuant to Section 394.76(9)(a), Florida Statutes, which separately reflects the funds received from the County and related expenditures of said funds during the 2012 -2013 fiscal year. Provider audits shall be performed at no cost to the County and shall be provided to the County no later than January 1, 2014. RESPONSIBILITIES 12. SCOPE OF SERVICES. The PROVIDER, for the consideration named, covenants and agrees with the Board to substantially and satisfactorily perform and provide the services outlined in Attachment C to residents of Monroe County, Florida. 13. ATTORNEY'S FEES AND COSTS. The County and PROVIDER agree that in the event any cause of action or administrative proceeding is initiated or defended by any party relative to the enforcement or interpretation of this Agreement, the prevailing party shall be entitled to reasonable attorney's fees, court costs, investigative, and out -of- pocket expenses, as an award against the non - prevailing party, and shall include attorney's fees, courts costs, investigative, and out -of- pocket expenses in appellate proceedings. Mediation proceedings initiated and conducted pursuant to this Agreement shall be in accordance with the Florida Rules of Civil Procedure and usual and customary procedures required by the circuit court of Monroe County. 14. BINDING EFFECT. The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the benefit of the County and PROVIDER and their respective legal representatives, successors, and assigns. 15. CODE OF ETHICS. County agrees that officers and employees of the County recognize and will be required to comply with the standards of conduct for public officers and employees as delineated in Section 112.313, Florida Statutes, regarding, but not limited to, solicitation or acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public position, conflicting employment or contractual relationship; and disclosure or use of certain information. Guidance Care Center -SAMH Contract; FY13; page 3 16. NO SOLICITATION /PAYMENT. The County and PROVIDER warrant that, in respect to itself, it has neither employed nor retained any company or person, other than a bona fide employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bona fide employee working solely for it, any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of the provision, the PROVIDER agrees that the County shall have the right to terminate this Agreement without liability and, at its discretion, to offset from monies owed, or otherwise recover, the full amount of such fee, commission, percentage, gift, or consideration. 17. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the PROVIDER is an independent contractor and not an employee of the Board. No statement contained in this agreement shall be construed so as to find the PROVIDER or any of its employees, contractors, servants or agents to be employees of the Board. COMPLIANCE ISSUES 18. COMPLIANCE WITH LAW. In providing all services pursuant to this agreement, the PROVIDER shall abide by all statutes, ordinances, rules and regulations pertaining to or regulating the provision of such services, including those now in effect and hereinafter adopted. Any violation of said statutes, ordinances, rules and regulations shall constitute a material breach of this agreement and shall entitle the Board to terminate this contract immediately upon delivery of written notice of termination to the PROVIDER. 19. PROFESSIONAL RESPONSIBILITY AND LICENSING. The PROVIDER shall assure that all professionals have current and appropriate professional licenses and professional liability insurance coverage. Funding by the Board is contingent upon retention of appropriate local, state and /or federal certification and /or licensure of the PROVIDER'S program and staff. 20. NON - DISCRIMINATION. County and PROVIDER agree that there will be no discrimination against any person, and it is expressly understood that upon a determination by a court of competent jurisdiction that discrimination has occurred, this Agreement automatically terminates without any further action on the part of any party, effective the date of the court order. County or PROVIDER agree to comply with all Federal and Florida statutes, and all local ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1) Title VI of the Civil Rights Act of 1964 (PL 88 -352) which prohibits discrimination on the basis of race, color or national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC ss. 1681 -1683, and 1685 - 1686), which prohibits discrimination on the basis of sex; 3) Section 504 of the Rehabilitation Act of 1973, as amended (20 USC s. 794), which prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended (42 USC ss. 6101 -6107) which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL 92 -255), as amended, relating to nondiscrimination on the basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91 -616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, ss. 523 and 527 (42 USC ss. 690dd -3 and 290ee -3), as amended, relating to confidentiality of alcohol and drug abuse patient records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC s. et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC s. 1201 Note), as maybe amended from time to time, relating to nondiscrimination on the basis of disability; 10) Any other nondiscrimination provisions in any Federal or state statutes which may apply to the parties to, or the subject matter of, this Agreement. AMENDMENTS, CHANGES, AND DISPUTES Guidance Care Center -SAMH Contract; FY13; page 4 21. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the services and /or reimbursement of services shall be accomplished by an amendment, which must be approved in writing by the County. 22. ADJUDICATION OF DISPUTES OR DISAGREEMENTS. County and PROVIDER agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of the parties. If no resolution can be agreed upon within 30 days after the first meet and confer session, the issue or issues shall be discussed at a public meeting of the Board of County Commissioners. If the issue or issues are still not resolved to the satisfaction of the parties, then any party shall have the right to seek such relief or remedy as may be provided by this Agreement or by Florida law. 23. COOPERATION. In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breach of this Agreement, County and PROVIDER agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement. County and PROVIDER specifically agree that no party to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. ASSURANCES 24. COVENANT OF NO INTEREST. County and PROVIDER covenant that neither presently has any interest, and shall not acquire any interest, which would conflict in any manner or degree with its performance under this Agreement, and that only interest of each is to perform and receive benefits as recited in this Agreement. 25. NO ASSIGNMENT. The PROVIDER shall not assign this agreement except in writing and with the prior written approval of the Board, which approval shall be subject to such conditions and provisions as the Board may deem necessary. This agreement shall be incorporated by reference into any assignment and any assignee shall comply with all of the provisions herein. Unless expressly provided for therein, such approval shall in no manner or event be deemed to impose any obligation upon the Board in addition to the total agreed upon reimbursement amount for the services of the PROVIDER. 26. NON - WAIVER OF IMMUNITY. Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the County and the PROVIDER in this Agreement and the acquisition of any commercial liability insurance coverage, self- insurance coverage, or local government liability insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall any contract entered into by the County be required to contain any provision for waiver. 27. ATTESTATIONS. PROVIDER agrees to execute such documents as the County may reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug - Free Workplace Statement. 28. AUTHORITY. Each party represents and warrants to the other that the execution, delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. INDEMNITY ISSUES 29. INDEMNIFICATION AND HOLD HARMLESS. The PROVIDER covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners from any and all claims for bodily injury (including death), personal injury, and property damage (including property owned by Monroe County) and any other losses, damages, and expenses (including attorney's fees) which arise out of, in connection with, or by reason of services provided by the Guidance Care Center -SAMH Contract; FY13; page 5 PROVIDER occasioned by the negligence, errors, or other wrongful act or omission of the PROVIDER'S employees, agents, or volunteers. 30. PRIVILEGES AND IMMUNITIES. All of the privileges and immunities from liability, exemptions from laws, ordinances, and rules and pensions and relief, disability, workers' compensation, and other benefits which apply to the activity of officers, agents, or employees of any public agents or employees of the County, when performing their respective functions under this Agreement within the territorial limits of the County shall apply to the same degree and extent to the performance of such functions and duties of such officers, agents, volunteers, or employees outside the territorial limits of the County. 31. NO PERSONAL LIABILITY. No covenant or agreement contained herein shall be deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe County in his or her individual capacity, and no member, officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to any personal liability or accountability by reason of the execution of this Agreement. 32. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non - Delegation of Constitutional or Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any participating entity from any obligation or responsibility imposed upon the entity by law except to the extent of actual and timely performance thereof by any participating entity, in which case the performance may be offered in satisfaction of the obligation or responsibility. Further, this Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the constitutional or statutory duties of the County, except to the extent permitted by the Florida constitution, state statute, and case law. 33. NON - RELIANCE BY NON - PARTIES. No person or entity shall be entitled to rely upon the terms of this Agreement to enforce or attempt to enforce any third -party claim or entitlement to or benefit of any service or program contemplated hereunder, and the County and the PROVIDER agree that neither the County nor the PROVIDER or any agent, officer, or employee of either shall have the authority to inform, counsel, or otherwise indicate that any particular individual or group of individuals, entity or entities, have entitlements or benefits under this Agreement separate and apart, inferior to, or superior to the community in general or for the purposes contemplated in this Agreement. GENERAL 34. Execution in Counterparts. This Agreement may be executed in any number of counterparts, each of which shall be regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement by signing any such counterpart. 35. NOTICE. Any notice required or permitted under this agreement shall be in writing and hand - delivered or mailed, postage pre -paid, by certified mail, return receipt requested, to the other party as follows: For Board: Grants Administrator and Monroe County Attorney 1100 Simonton Street PO Box 1026 Key West, FL 33040 Key West, FL 33041 For PROVIDER Frank Rabbito, Senior Vice President Guidance /Care Center 1205 Fourth Street Key West, FL 33040 Guidance Care Center -SAMH Contract; FY13; page 6 36. GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES. This Agreement shall be governed by and construed in accordance with the laws of the State of Florida applicable to contracts made and to be performed entirely in the State. In the event that any cause of action or administrative proceeding is instituted for the enforcement or interpretation of this Agreement, the County and PROVIDER agree that venue will lie in the appropriate court or before the appropriate administrative body in Monroe County, Florida. The County and PROVIDER agree that, in the event of conflicting interpretations of the terms or a term of this Agreement by or between any of them the issue shall be submitted to mediation prior to the institution of any other administrative or legal proceeding. 37. NON - WAIVER. Any waiver of any breach of covenants herein contained to be kept and performed by the PROVIDER shall not be deemed or considered as a continuing waiver and shall not operate to bar or prevent the Board from declaring a forfeiture for any succeeding breach, either of the same conditions or covenants or otherwise. 38. SEVERABILITY. If any term, covenant, condition or provision of this Agreement (or the application thereof to any circumstance or person) shall be declared invalid or unenforceable to any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant, condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent permitted by law unless the enforcement of the remaining terms, covenants, conditions and provisions of this Agreement would prevent the accomplishment of the original intent of this Agreement. The County and PROVIDER agree to reform the Agreement to replace any stricken provision with a valid provision that comes as close as possible to the intent of the stricken provision. 39. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the parties hereto with respect to the subject matter hereof and supersedes any and all prior agreements with respect to such subject matter between the PROVIDER and the Board. [THIS SPACE INTENTIONALLY LEFT BLANK WITH SIGNATORY PAGE TO FOLLOW] Guidance Care Center -SAMH Contract; FY13; page 7 IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as of the day and year first written above. (SEAL) Anny NGctvi I , BOARD OF COUNTY COMMISSIONERS ' ATTEST: KO H"r CLERK 4c1 lr 4- e ert ^^ OF MONROE COUNTY, FLORIDA By/ Deputy Clerk Mayor /Chairman Guidance/Care Center • , (Federal ID No. ` l ) ft3&t2 > Witness Intl!' to I d ,P u044, t/ t � �' B�. fitness C I - 1)Dc� `ou) r .. - �' ` Guidance/Care Center 21a- tae‘r site, 13 lyzeet MONROE COUNTY ATTORNEY APPROVED AS TO FORM: tea ( r f1;, Qj tlt - Pri n n Co H ISTINE M. LIMBERT- BARROWS ASSISTANT COUNTY ATTORNEY Date 11/(n/la N ;. v rn 7 r - rn c-� © o = ri C) a Guidance Care Center -SAMH Contract; FY13; page 8 PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list." Guidance Care Center -SAMH Contract; FY13; page 14 SWORN STATEMENT UNDER ORDINANCE NO. 10 -1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE r�i^� A �,,,'� j� i CD.A 112 :0A3harrants that he /it has not employed, retained or o erwise had act on his /its behalf any former County officer or employee in violation of Section 2 4 of Ordinance No. 10 -1990 or any County officer or employee in violation of Section 3 of Ordinance No. 10 -1990. For breach or violation of this provision the County may, in its discretion, terminate this contract without liability and may also, in its discretion, deduct from the contract or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, gift, or consideration paid to the former County officer or employe - / 9 I (si nature) Date: 1 i r\,1 IA - p STATE OF A CS COUNTY OF 41,6J, A Al 1 PERSONALLY APARED BEFORE ME, the undersigned authority, al. t` 1 L. �1 Oilln- who, after first being sworn by me, affixed his /her signature (name of individual signing) in the space provided above on this a J day of 1.5*.s.+ °1' , 20 L Z . VA■L NOTARY PUBL My commission expires: OMB - MCP FORM #4 VAL UMW MY COMMISSION #1ff169756 EXPIRES: APR 16,2016 - Mod 1st Staff Manna Guidance Care Center -SAMH Contract; FY13; page 15 DRUG -FREE WORKPLACE FORM The undersigned vendo in accordance with Florida Statute 287.087 hereby certifies that: e of Business) 1. Publishes a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Informs employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug -free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Gives each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notifies the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 (Florida Statutes) or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. Imposes a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, or any employee who is so convicted. 6. Makes a good faith effort to continue to maintain a drug -free workplace through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. 0 STATE OF e t A A ,N (Sig /' ure of Respondent) COUNTY OF L _ _ Date PERS(i Alpri RED BEFORE ME, the undersigned authority, ■ .I 1,.-4j0 who, after first being sworn by me, (name of indi idual 1e ning) affixed his/ er signature in the space provided above on this 54 day of No , 201 Z. V0• My commission expires: PUBLIC 4tig VAL CA MY COMMON m88768 DARE& APR tR 2018 80WIRV lit MM1 NMrf1A01 Guidance Care Center -SAMH Contract; FY13; page 16 ATTACHMENT A EXPENSE REIMBURSEMENT REQUIREMENTS This document is intended to provide basic guidelines to Human Service and Community -Based Organizations, county travelers, and contractual parties who have reimbursable expenses associated with Monroe County business. These guidelines, as they relate to travel, are from the Monroe County Code of Ordinances and State laws and regulations. A cover letter (see Attachment B) summarizing the major line items on the reimbursable expense request needs to also contain the following notarized certified statement: "I certify that the above checks have been submitted to the vendors as noted and that the attached expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this organization's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source." Invoices should be billed to the contracting agency. Third party payments will not be considered for reimbursement. Remember, the expense should be paid prior to requesting a reimbursement. Only current charges will be considered, no previous balances. Reimbursement requests will be monitored in accordance with the level of detail in the contract. This document should not be considered all- inclusive. The Clerk's Finance Department reserves the right to review reimbursement requests on an individual basis. Any questions regarding these guidelines should be directed to 305 - 292 -3534. Data Processing, PC Time, etc. The vendor invoice is required for reimbursement. Inter - company allocations are not considered reimbursable expenditures unless appropriate payroll journals for the charging department are attached and certified. Payroll A certified statement verifying the accuracy and authenticity of the payroll expense is needed. If a Payroll Journal is provided, it should include: dates, employee name, salary or hourly rate, total hours worked, withholding information and paid payroll taxes, check number and check amount. If a Payroll Journal is not provided, the following information must be provided: pay period, check amount, check number, date, payee, and support for applicable paid payroll taxes. Postage, Overnight Deliveries, Courier, etc. A log of all postage expenses as they relate to the County contract is required for reimbursement. For overnight or express deliveries, the vendor invoice must be included. Rents, Leases, etc. A copy of the rental or lease agreement is required. Deposits and advance payments are not allowable expenses. Reproductions, Copies, etc. A log of copy expenses as they relate to the County contract is required for reimbursement. The log must define the date, number of copies made, source document, purpose, and recipient. A reasonable fee for copy expenses will be allowable. For vendor services, the vendor invoice and a sample of the finished product are required. Supplies, Services, etc. For supplies or services ordered, a vendor invoice is required. Guidance Care Center -SAMH Contract; FY13; page 9 Telefax, Fax, etc. A fax log is required. The log must define the sender, the intended recipient, the date, the number called, and the reason for sending the fax. Telephone Expenses A user log of pertinent information must be remitted including: the party called, the caller, the telephone number, the date, and the purpose of the call. Travel and Meal Expenses Travel expenses must be submitted on a State of Florida Voucher for Reimbursement of Travel Expenses. Travel reimbursement requests must be submitted and will be paid in accordance with Monroe County Code of Ordinances and State laws and regulations. Credit card statements are not acceptable documentation for reimbursement. If attending a conference or meeting, a copy of the agenda is needed. Airfare reimbursement requires the original passenger receipt portion of the airline ticket. A travel itinerary is appreciated to facilitate the audit trail. Auto rental reimbursement requires the vendor invoice. Fuel purchases should be documented with paid receipts. Taxis are not reimbursed if taken to arrive at a departure point: for example, taking a taxi from one's residence to the airport for a business trip is not reimbursable. Parking is considered a reimbursable travel expense at the destination. Airport parking during a business trip is not. A detailed list of charges is required on the lodging invoice. Balance due must be zero. Room must be registered and paid for by traveler. The County will only reimburse the actual room and related bed tax. Room service, movies, and personal telephone calls are not allowable expenses. Mileage reimbursement shall be at the rate established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. An odometer reading must be included on the state travel voucher for vicinity travel. Mileage is not allowed from a residence or office to a point of departure. For example, driving from one's home to the airport for a business trip is not a reimbursable expense. Meal reimbursement shall be at the rates established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. Meal guidelines state that travel must begin prior to 6 a.m. for breakfast reimbursement, before noon and end after 2 p.m. for lunch reimbursement, and before 6 p.m. and end after 8 p.m. for dinner reimbursement. Non - allowable Expenses The following expenses are not allowable for reimbursement: capital outlay expenditures (unless specifically included in the contract), contributions, depreciation expenses (unless specifically included in the contract), entertainment expenses, fundraising, non - sufficient check charges, penalties and fines. Guidance Care Center -SAMH Contract; FY13; page 10 ATTACHMENT B ORGANIZATION LETTERHEAD Monroe County Board of County Commissioners Finance Department 500 Whitehead Street Key West, FL 33040 Date The following is a summary of the expenses for (Organization name) for the time period of to Check # Payee Reason Amount 101 Company A Rent $ X,XXX.XX 102 Company B Utilities XXX.XX 104 Employee A P/R ending 05/14/01 XXX.XX 105 Employee B P/R ending 05/28/01 XXX.XX (A) Total $ X,XXX.XX (B) Total prior payments $ X,XXX.XX (C) Total requested and paid (A + B) $ X,XXX.XX (D) Total contract amount $ X,XXX.XX Balance of contract (D -C) $ X,XXX.XX I certify that the above checks have been submitted to the vendors as noted and that the expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this organization's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source. Chief Executive Officer Attachments (supporting documentation) Sworn to and subscribed before me this day of 20_ by who is personally known to me. Notary Public Notary Stamp Guidance Care Center -SAMH Contract; FY13; page 11 ATTACHMENT C Services to be provided: (Insert a description of your organization including a list of the services that will be provided by your organization under this contract.) Local match portion of State - Funded Substance Abuse Mental Health Services, inclusive of Baker Act services, per Florida Statutes, and contract between Guidance Care Center and the South Florida Behavioral Health Network (ME225- 3 -27). Guidance Care Center -SAMH Contract; FY13; page 12 ATTACHMENT D GCC's Contract with South Florida Behavioral Health Network Contract (ME225 -3 -27) Guidance Care Center -SAMH Contract; FY13; page 13 � � 3 ►" South Florida Behavioral Health Network, Inca www.sfbhn.org ti August 3, 2012 Marianne Benvenuti, Regional Controller Guidance/Care Center 3000 41 Street Ocean Marathon, Florida 33050 Dear Marianne: Enclosed please find the executed signature pages for the contracts between South Florida Behavioral Health Network, Inc. and Guidance/Care Center, Inc. contract number ME225 -3 -27 (main contract) and for the Emergency Contract. I have also enclosed an original copy of the Lobbying form (Attachment III) for both contracts and the SOAR Agreement for the main contract. I look forward to working with your agency during FY2012 — 2013, and feel free to contact me to facilitate ac ' i es pe . ining to your contract. • in erely/ , Eve Kelly Contract Manag= (786) 507 -7461 ekell sfbhn.or, Enc. (5) South Florida Behavioral .d= Health Network, Inc. STANDARD CONTRACT THIS CONTRACT is entered into between the South Florida Behavioral Health Network, Inc., (SFBHN) hereinafter referred to as the "Managing Entity" (ME) and Guidance Care Center, Inc., hereinafter referred to as the "Network Provider." 1. Contract Document The Network provider shall provide services in accordance with the terms and conditions specified in this contract including all attachments and exhibits, and documents incorporated by reference which constitute the contract document. 2. Requirements of Section 287.058, Florida Statutes (F.S.) The Network Provider shall provide units of deliverables, including reports, findings, and drafts, as specified in this contract. These deliverables must be received and accepted by the contract manager and /or designee, in writing prior to payment. The Network Provider shall submit bills for fees or other compensation for services or expenses in sufficient detail for proper pre -audit and post- audit; where itemized payment for travel expenses are permitted in this contract, submit bills for any travel expenses in accordance with section 112.061, F.S., or at such lower rates as may be provided in this contract. To allow public access to all documents, papers, letters, or other public records as defined in subsection 119.011(12), F.S. and as prescribed by subsection 119.07(1) F.S., made or received by the Network Provider in conjunction with this contract except that public records which are made confidential by law must be protected from disclosure. It is expressly understood that the Network Provider's failure to comply with this provision shall constitute an immediate breach of contract for which the ME may unilaterally terminate the contract. 3. Provisions of the Prime Contract All provisions, terms and conditions, or amendments, addendum, changes or revisions applicable to the Network Provider made subsequent to the initial execution of the Prime Contract, i.e., the Contract entered into between the DCF and SFBHN (ME), not in conflict with this Contract, shall be binding upon the Network Provider and the Network Provider agrees to comply with same. The Prime Contract is incorporated by reference in this Contract. In case of conflict with the provisions, terms and conditions of The Prime Contract and this Contract, the provisions, terms and conditions of this Contract will prevail. 4. Effective and Ending Dates This contract shall begin on July 1, 2012. It shall end at midnight, local time in Miami -Dade County, Florida on June 30, 2013. 5. State of Florida Law This contract is executed and entered into in the State of Florida, and shall be construed, performed and enforced in all respects in accordance with Florida law, without regard to Florida provisions for conflict of laws. Courts of competent jurisdiction in Florida shall have exclusive jurisdiction in any action regarding this contract and venue shall be the appropriate state court in Miami -Dade County, Florida. 6. Federal Law a. If this contract contains federal funds, the Network Provider shall comply with the provisions of federal law and regulations including but not limited to, 45 Code of Federal Regulations (CFR), Part 74, 45 CFR, Part 92, and other applicable regulations. b. If this contract contains over $100,000 of federal funds, the Network Provider shall comply with all applicable standards, orders, or regulations issued under section 306 of the Clean Air Act, as amended (42 United States Code (U.S.C.) 7401 et seq.), section 508 of the Federal Water Pollution Control Act, as amended (33 U.S.C. 1251 et seq.), Executive Order 11738, as amended and where applicable, and Environmental Protection Agency regulations (40 CFR, Part 30). The Network Provider shall report any violations of the above to the ME. c. No federal funds received in connection with this contract may be used by the Network Provider, or agent acting for the Network Provider, or subcontractor to influence legislation or appropriations pending before the Congress or any State legislature. If this contract contains federal funding in excess of $100,000, the Network Provider must, prior to contract execution, complete Guidance Care Center, Inc. 1 Contract No. ME225 -3 -27 • the Certification Regarding Lobbying form, Attachment jjj. If a Disclosure of Lobbying Activities form, Standard Form LLL, is required, it may obtained from the contract manager. All disclosure forms as required by the Certification Regarding Lobbying form must be completed and returned to the contract manager, prior to payment under this contract. d. Unauthorized aliens shall not be employed. The ME shall consider the employment of unauthorized aliens a violation of section 274A(e) of the Immigration and Nationality Act (8 U.S.C. 1324 a) and section 101 of the Immigration Reform and Control Act of 1986. Such violation shall be cause for unilateral cancellation of this contract by the ME. Pursuant to Executive Orderl1 -2 signed on January 4, 2011, the Network Provider, and if applicable all subcontractors for work contemplated under this contract, shall use the E- Verify system established by the U.S. Department of Homeland Security to verify the employment eligibility of its employees and the subcontractors' employees performing under this contract. e. If this contract contains $10,000 or more of federal funds, the Network Provider shall comply with Executive Order 11246, Equal Employment Opportunity, as amended by Executive Order 11375 and others, and as supplemented in Department of Labor regulation 41 CFR, Part 60 and 45 CFR, Part 92, if applicable. f. If this contract contains federal funds and provides services to children up to age 18, the Network Provider shall comply with the Pro- Children Act of 1994 (20 U.S.C. 6081). Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000 for each violation or the imposition of an administrative compliance order on the responsible entity, or both. 7. Audits, Inspections, Investigations, Records and Retention a. The Network Provider shall establish and maintain books, records and documents (including electronic storage media) sufficient to reflect all income and expenditures of funds provided by the ME under this contract. b. Retention of all client records, financial records, supporting documents, statistical records, and any other documents (including electronic storage media) pertinent to this contract shall be maintained by the Network Provider for a period of six (6) years after completion of the contract or longer when required by law. In the event an audit is required by this contract, records shall be retained for a minimum period of six (6) years after the audit report is issued or until resolution of any audit findings or litigation based on the terms of this contract, at no additional cost to the ME. c. Upon demand, at no additional cost to the ME, the Network Provider will facilitate the duplication and transfer of any records or documents during the required retention period in Section 7.b. d. These records shall be made available at all reasonable times for inspection, review, copying, or audit by Federal, State, or other personnel duly authorized by the ME. e. At all reasonable times for as long as records are maintained, persons duly authorized by the ME, State, and Federal auditors, pursuant to 45 CFR, section 92.36(i)(10), shall be allowed full access to and the right to examine any of the Network Provider's contracts and related records and documents, regardless of the form in which kept. f. A financial and compliance audit shall be provided to the ME as specified in this contract and in Attachment It g. The Network Provider shall comply and cooperate immediately with any inspections, reviews, investigations, or audits deemed necessary by The Office of the Inspector General (section 20.055, F.S.). h. The Network Provider shall include the aforementioned audit, inspections, investigations and record keeping requirements in all subcontracts and assignments. 8. Monitoring by the ME The Network Provider shall permit all persons who are duly authorized by the ME to inspect and copy any records, papers, documents, facilities, goods and services of the Network Provider which are relevant to this contract, and to interview any clients, employees and subcontractor employees of the Network Provider to assure the ME of the satisfactory performance of the terms and conditions of this contract. Following such review, the ME will deliver to the Network Provider a written report of its findings, and may direct the development, by the Network Provider, of a corrective action plan where appropriate. The Network Provider hereby agrees to timely correct all deficiencies identified in the corrective action plan. This provision will not limit the ME's termination rights under Section 40. Failure to implement corrective action plans to the satisfaction of the ME, after receiving due notice, shall be grounds for contract termination. 9. Indemnification a. The Network Provider shall be fully liable for the actions of its agents, employees, partners, or subcontractors and shall fully indemnify, defend, and hold harmless the ME, State and the Florida Department of Children and Families (DCF), and its officers, agents, and employees, from suits, actions, damages, and costs of every name and description, including attorneys' fees, arising Guidance Care Center, Inc. 2 Contract No. ME225 -3 -27 from or relating to any alleged act or omission by the Network Provider, its agents, employees, partners, or subcontractors, provided, however, that the Network Provider shall not indemnify for that portion of any loss or damages proximately caused by the negligent act or omission of the ME. b. The Network Provider shall fully indemnify, defend and hold harmless the ME, the State and the DCF, from any suits, actions, damages, and costs of every name and description , including attorneys' fees, arising from or relating to violation of infringement of a trademark, copyright, patent, trade secret or intellectual property right, provided, however, that the foregoing obligation shall not apply to the ME's misuse or modification of Network Provider's products or a ME's operation or use of Network Provider's products in a manner not contemplated by the contract or the purchase order. If any product is the subject of an infringement suit or in the Network Provider's opinion is likely to become the subject of such a suit, the Network Provider may at its sole expense procure for the ME the right to continue using the product or modify it to become non - infringing. If the Network Provider is not reasonably able to modify or otherwise secure the ME the use, the ME shall not be liable for any royalties. The Network Provider's indemnification for violation or infringement of a trademark, copyright, patent, trade secret or intellectual property right shall encompass all such items used or accessed by the Network Provider, its officers, agents or subcontractors in the performance of this contract or delivered to the ME for the use of the ME, its employees, agents or contractors. c. The Network Provider shall protect, defend, and indemnify, including attorney's fees and cost, the ME for any and all claims and litigation (including litigation initiated by the ME) arising from or relating to Network Provider's claim that a document contains proprietary or trade secret information that is exempt from disclosure or the scope of the Network Provider's redaction, as provided for under Section 34. d. The Network Provider shall not be liable for any cost, expense, or compromise incurred or made by the ME in any legal action without the Network Provider's prior written consent, which shall not be unreasonably withheld. The Network Provider's inability to evacuate liability or its evaluation of liability shall not excuse its duty to defend and indemnify after receipt of notice. Only an adjudication or judgment after the highest appeal is exhausted finding the ME negligent shall excuse the Network Provider of performance under this provision, in which case the ME shall have no obligation to reimburse the Network Provider for costs of its defense. If the Network Provider is an agency or subdivision of the State, its obligation to indemnify, defend and hold harmless the ME shall be to the extent permitted by section 768.28, F.S. or other applicable law, and without waiving the limits of sovereign immunity. 10. Insurance Continuous adequate liability insurance coverage shall be maintained by the Network Provider during the existence of this contract and any renewal(s) and extension(s) of it. By execution of this contract, unless it is a state agency or subdivision as defined by subsection 768.28(2), F.S., the Network Provider accepts full responsibility for identifying and determining the type(s) and extent of liability insurance necessary to provide reasonable financial protections for the Network Provider and the clients to be served under this contract. The limits of coverage under each policy maintained by the Network Provider do not limit the Network Provider's liability and obligations under this contract. Upon the execution of this contract, the Network Provider shall furnish the ME written verification supporting both the determination and existence of such insurance coverage. Such coverage may be provided by a self- insurance program established and operating under the laws of the State of Florida. The ME reserves the right to require additional insurance as specified in this contract. 11. Confidentiality of Client Information The Network Provider shall not use or disclose any information concerning a recipient of services under this contract for any purpose prohibited by state or federal law or regulations except with the written consent of a person legally authorized to give that consent or when authorized by law. 12. Assignments and Subcontracts a. The Network Provider shall not assign the responsibility for this contract to another party without prior written approval of the ME, upon the ME's sole determination that such assignment will not adversely affect the public interest; however, in no event may the Network Provider assign or enter into any transaction having the effect of assigning or transferring any right to receive payment under this contract which right is not conditioned on full and faithful performance of Network Provider's duties hereunder. Any sublicense, assignment, or transfer otherwise occurring without prior approval of the ME shall be null and void. The Network Provider shall not subcontract for any of the work contemplated under this contract without prior written approval of the ME, which shall not be unreasonably withheld. b. The Network Provider shall ensure that all subcontract agreements for work contemplated under this contract, adhere to all of the requirements of the ME's Prime Contract with the department, KH225 and all the requirements of this contract. A copy of the contract KH225 can be found at the ME's website, www.sfbhn.org. c. To the extent permitted by Florida Law, and in compliance with Section 9. of this Standard Contract, the Network Provider is responsible for all work performed and for all commodities produced pursuant to this contract whether actually furnished by the Network Provider or its subcontractors. Any subcontracts shall be evidenced by a written document. The Network Provider further agrees that the ME shall not be liable to the subcontractor in any way or for any reason. The Network Provider, at its expense, will defend the ME against such claims. Guidance Care Center, Inc. 3 Contract No. ME225 -3 -27 d. The Network Provider shall make payments to any subcontractor within seven (7) working days after receipt of full or partial payments from the ME in accordance with section 287.0585, F.S., unless otherwise stated in the contract between the Network Provider and subcontractor. Failure to pay within seven (7) working days will result in a penalty that shall be charged against the Network Provider and paid by the Network Provider to the subcontractor in the amount of one -half of one percent (.005) of the amount due per day from the expiration of the period allowed for payment. Such penalty shall be in addition to actual payments owed and shall not exceed fifteen (15 %) percent of the outstanding balance due. e. The State of Florida shall at all times be entitled to assign or transfer, in whole or part, its rights, duties, or obligations under its contract with the ME to another governmental agency in the State of Florida, upon giving prior written notice to the ME. In the event the State of Florida approves transfer of the ME's obligations, the Network Provider remains responsible for all work performed and all expenses incurred in connection with the contract. This contract shall remain binding upon the successors in interest of either the Network Provider or the ME. f. The Network Provider shall include, or cause to be included, in all subcontracts (at any tier) the substance of all clauses contained in this Standard Contract that mention or describe subcontract compliance. 13. Return of Funds a. The Network Provider shall return to the ME any overpayments due to unearned funds or funds disallowed that were disbursed to the Network Provider by the ME and any interest attributable to such funds pursuant to the terms and conditions of this contract. In the event that the Network Provider or its independent auditor discovers that an overpayment has been made, the Network Provider shall repay said overpayment immediately without prior notification from the ME. In the event that the ME first discovers that an overpayment has been made, the contract manager or designee, on behalf of the ME, will notify the Network Provider by letter of such findings. Should repayment not be made forthwith, the Network Provider will be charged interest on the outstanding balance after the ME notification or Network Provider discovery. Payments made for such services subsequently determined by the ME to be in full compliance with the contract requirements shall be deemed overpayments. b. The funds paid to the Network Provider are continually subject to Review, Revision and Adjustment after evaluation of Utilization and Performance measures monitored by ME. 14. Client Risk Prevention and Incident Reporting If services to clients are to be provided under this contract, the Network Provider and any subcontractors shall, in accordance with the client risk prevention system, report those reportable situations listed in CFOP 215 -6 in the manner prescribed in CFOP 215 -6 or circuit or region operating procedures. The Network Provider shall immediately report any knowledge or reasonable suspicion of abuse, neglect, or exploitation of a child, aged person, or disabled adult to the Florida Abuse Hotline on the statewide toll -free telephone number (1- 800- 96ABUSE). As required by Chapters 39 and 415, F.S., this provision is binding upon both the Network Provider and its employees. 15. Civil Rights Requirements In accordance with Title VII of the Civil Rights Act of 1964, the Americans with Disabilities Act of 1990, or the Florida Civil Rights Act of 1992, as applicable the Network Provider shall not discriminate against any employee (or applicant for employment) in the performance of this contract because of race, color, religion, sex, national origin, disability, age, or marital status. Further, the Network Provider agrees not to discriminate against any applicant, client, or employee in service delivery or benefits in connection with any of its programs and activities in accordance with 45 CFR 80, 83, 84, 90, and 91, Title VI of the Civil Rights Act of 1964, or the Florida Civil Rights Act of 1992, as applicable and CFOP 60 -16. These requirements shall apply to all contractors, subcontractors, subgrantees or others with whom it arranges to provide services or benefits to clients or employees in connection with its programs and activities. The Network Provider shall complete the Civil Rights Compliance Checklist, CF Form 946 in accordance with CFOP 60 -16 and 45 CFR 80. This is required of all Network Providers that have fifteen (15) or more employees. 16. Independent Capacity of the Contractor a. In performing its obligations under this contract, the Network Provider shall at all times be acting in the capacity of an independent contractor and not as an officer, employee, or agent of the ME or the State of Florida, except where the Network Provider is a state agency. Neither the Network Provider nor its agents, employees, subcontractors or assignees shall represent to others that it has the authority to bind the ME unless specifically authorized in writing to do so. This contract does not create any right to state retirement, leave benefits or any other benefits of state employees as a result of performing the duties or obligations of this contract. b. The Network Provider shall take such actions as may be necessary to ensure that each subcontractor of the Network Provider will be deemed to be an independent contractor and will not be considered or permitted to be an agent, servant, joint venturer, or partner of the ME or the State of Florida. The ME will not furnish services of support (e.g., office space, office supplies, telephone service, secretarial or clerical support) to the Network Provider, or its subcontractor or assignee, unless specifically agreed to by Guidance Care Center, Inc. 4 Contract No. ME225 -3 -27 the ME in this contract. c. All deductions for social security, withholding taxes, income taxes, contributions to unemployment compensation funds and all necessary insurance for the Network Provider, the Network Provider's officers, employees, agents, subcontractors, or assignees shall be the sole responsibility of the Network Provider. 17. Sponsorship As required by section 286.25, F.S., if the Network Provider is a non - governmental organization which sponsors a program financed wholly or in part by state funds, including any funds obtained through this contract, it shall, in publicizing, advertising, or describing the sponsorship of the program state: "Sponsored by (Network Provider's Name) , Inc., South Florida Behavioral Health Network, and the State of Florida, Department of Children and Families ". If the sponsorship reference is in written material, the words "South Florida Behavioral Health Network " and "State of Florida, Department of Children and Families" shall appear in at least the same size letters or type as the name of the organization. 18. Publicity Without limitation, the Network Provider and its employees, agents, and representatives will not, without the ME's prior written consent in each instance, use in advertising, publicity or any other promotional endeavor any ME or State mark, the name of the ME's or State mark, the name of the ME , the State, or any ME or State affiliate or any officer or employee of the ME or the State , or represent, directly or indirectly, that any product or service provided by the Network Provider has been approved or endorsed by the ME, or refer to the existence of this contract in press releases, advertising or materials distributed to the Network Provider's prospective customers. 19. Final Invoice The final invoice for payment shall be submitted to the ME no more than fifteen (15) days after the contract ends or is terminated. If the Network Provider fails to do so, all rights to payment are forfeited and the ME will not honor any requests submitted after the aforesaid time period. Any payment due under the terms of this contract may be withheld until all reports due from the Network Provider and necessary adjustments thereto, have been approved by the ME. 20. Use of Funds for Lobbying Prohibited The Network Provider shall comply with the provisions of sections 11.062 and 216.347, F.S., which prohibit the expenditure of contract funds for the purpose of lobbying the Legislature, judicial branch, or a state agency. 21. Public Entity Crime Pursuant to section 287.133, F.S., the following restrictions are placed on the ability of persons on the convicted vendor list or the discriminatory vendor list. When a person or affiliate has been placed on the convicted vendor list following a conviction for a public entity crime, or an entity or affiliate has been placed on the discriminatory vendor list, such person, entity or affiliate may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or the repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in section 287.017, F.S., for CATEGORY TWO for a period of thirty -six (36) months from the date of being placed on the convicted vendor list. This provision applies to the Network Provider and all their subcontractors. 22. Gratuities The Network Provider agrees that it will not offer to give or give any gift to any ME employee. As part of the consideration for this contract, the parties intend that this provision will survive the contract for a period of two years. In addition to any other remedies available to the ME, any violation of this provision will result in referral of the Network Provider's name and description of the violation of this term to the Department of Management Services for the potential inclusion of the Network Provider's name on the suspended vendors list for an appropriate period. The Network Provider will ensure that its subcontractors, if any, comply with these provisions. 23. Intellectual Property a. It is agreed that all intellectual property, inventions, written or electronically created materials, including manuals, presentations, films, or other copyrightable materials, arising in relation to Network Provider's performance under this contract, and the performance of all of its officers, agents and subcontractors in relation to this contract, are works for hire for the benefit of the ME, fully compensated for by the contract amount, and that neither the Network Provider nor any of its officers, agents nor subcontractors may claim any interest in any intellectual property rights accruing under or in connection with the performance of this contract. It is specifically agreed that the ME shall have exclusive rights to all data processing software falling within the terms of section 119.084, F.S., which arises or is developed in the course of or as a result of work or services performed under this Guidance Care Center, Inc. 5 Contract No. ME225 -3 -27 contract, or in any way connected herewith. Notwithstanding the foregoing provision, if the Network Provider is a university and a member of the State University System of Florida, then section 1004.23, F.S., shall apply. b. If the Network Provider uses or delivers to the ME for its use or the use of its employees, agents or contractors, any design, device, or materials covered by letters, patent, or copyright, it is mutually agreed and understood without exception that the compensation paid pursuant to this contract includes all royalties or costs arising from the use of such design, device, or materials in any way involved in the work contemplated by this contract. c. All applicable subcontracts shall include a provision that the Federal awarding agency reserves all patent rights with respect to any discovery or invention that arises or is developed in the course of or under the subcontract. Notwithstanding the foregoing provision, if the Network Provider or one of its subcontractors is a university and a member of the State University of Florida, then section 1004.23, F.S., shall apply, but the ME shall retain a perpetual, fully -paid, non - exclusive license for its use and the use of its contractors of any resulting patented, copyrighted or trademarked work products. 24. Real Property Any state funds provided for the purchase of or improvements to real property are contingent upon the Network Provider granting to the state a security interest in the property at least to the amount of the state funds provided for at least five (5) years from the date of purchase or the completion of the improvements or as further required by law. As a condition of receipt of state funding for this purpose, the Network Provider agrees that, if it disposes of the property before the ME's interest is vacated, the Network Provider will refund the proportionate share of the state's initial investment, as adjusted by depreciation. 25. Information Security Obligations a. An appropriately skilled individual shall be identified by the Network Provider to function as its Data Security Officer. The Data Security Officer shall act as the liaison to the ME's security staff and will maintain an appropriate level of data security for the information the Network Provider is collecting or using in the performance of this contract. An appropriate level of security includes approving and tracking all Network Provider employees that request or have access to any ME or DCF data system or information. b. The Data Security Officer will ensure that user access to the data system or information has been removed from all terminated Network Provider employees immediately upon termination of employment. c. The Network Provider shall provide the latest DCF security awareness training to its staff and subcontractors who have access to ME or DCF information. d. All Network Provider employees who have access to ME or DCF information shall comply with, and be provided a copy of CFOP 50 -2, and shall sign the DCF Security Agreement form CF 0114 annually to the Managing Entity's contract manager and the Managing Entity's Director of Information Technology. A copy of CF 0114 may be obtained from the contract manager. e. The Network Provider shall make every effort to protect and avoid unauthorized release of any personal or confidential information by ensuring both data and storage devices are encrypted as prescribed in CFOP 50 -2. If encryption of these devices is not possible, then the Network Provider shall assure that unencrypted personal and confidential ME or DCF data will not be stored on unencrypted storage devices. The Network Provider shall require the same of all subcontractors. f. The Network Provider agrees to notify the contract manager as soon as possible, but no later than five (5) business days following the determination of any breach or potential breach of personal and confidential ME or DCF data. The Network Provider shall require the same notification requirements of all subcontractors. g. The Network Provider shall provide notice to affected parties no later than forty -five (45) days following the determination of any potential breach of personal or confidential ME or DCF data provided in section 817.5681, F.S. The Network Provider shall require the same notification requirements of all subcontractors. 26. Accreditation The ME is committed to ensuring provision of the highest quality services to the persons we serve. Accordingly, the ME has expectations that where accreditation is generally accepted nationwide as a clear indicator of quality service, the majority of the ME's Network Providers will either be accredited, have a plan to meet national accreditation standards, or will initiate a plan within a reasonable period of time. 27. Network Provider Employment Opportunities a. Agency for Workforce Innovation and Workforce Florida: The Network Provider understands that the DCF, the Agency for Workforce Innovation, and Workforce Florida, Inc., have jointly implemented an initiative to empower recipients in the Temporary Assistance to Needy Families Program to enter and remain in gainful employment. The ME encourages Network Provider participation with the Agency for Workforce Innovation and Workforce Florida. Guidance Care Center, Inc. 6 Contract No. ME225 -3 -27 b. Transitioning Young Adults: The Network Provider understands DCF's Operation Full Employment initiative to assist young adults aging out of the dependency system. The ME encourages Network Provider participation with the local Community -Based Care Lead Agency Independent Living Program to offer gainful employment to youth in foster care and young adults transitioning from the foster care system. 28. Health Insurance Portability and Accountability Act The Network Provider shall, where applicable, comply with the Health Insurance Portability and Accountability Act (42 U. S. C. 1320d.) as well as all regulations promulgated thereunder (45 CFR Parts 160, 162, and 164). 29. Emergency Preparedness a. If the tasks to be performed pursuant to this contract include the physical care or supervision of clients, the Network Provider shall, within thirty (30) days of the execution of this contract, submit to the contract manager an emergency preparedness plan which shall include provisions for records protection, alternative accommodations for clients in substitute care, alternate facilities for the 24 hour facilities in case those facilities are incapacitated by the disaster and the expectation for returning exceeds emergency sheltering capabilities and time allowances supplies, and a recovery plan that will allow the Network Provider to continue functioning in compliance with the executed contract in the event of an actual emergency. For the purpose of disaster planning, the term supervision includes the responsibility of the ME, or its contracted agents to ensure the safety, permanency and well -being of a child who is under the jurisdiction of a dependency court. Children may remain in their homes, be placed in a non - licensed relative /non - relative home, or be placed in a licensed foster care setting. b. The ME agrees to respond in writing within thirty (30) days of receipt of the plan accepting, rejecting, or requesting modifications. In the event of an emergency, the ME may exercise oversight authority over such Network Provider in order to assure implementation of agreed emergency relief provisions. c. An updated emergency preparedness plan shall be submitted by the Network Provider no later than 12 months following the acceptance of an original plan or acceptance of an updated plan. The ME agrees to respond in writing within 30 days of receipt of the updated plan, accepting, rejecting, or requesting modification to the plan. 30. Notification of Legal Action The Network Provider shall notify the ME of legal actions taken against them or potential actions such as lawsuits, related to services provided through this contract or that may impact the Network Provider's ability to deliver the contractual services, or adversely impact the ME. The ME's contract manager will be notified within ten (10) days of Network Provider becoming aware of such actions or from the day of the legal filing, whichever comes first. 31. Whistleblower's Act Requirements In accordance with subsection 112.3187(2), F.S., the Network Provider and its subcontractors shall not retaliate against an employee for reporting violations of law, rule, or regulation that creates substantial and specific danger to the public's health, safety, or welfare to an appropriate agency. Furthermore, agencies or independent contractors shall not retaliate against any person who discloses information to an appropriate agency alleging improper use of governmental office, gross waste of funds, or any other abuse or gross neglect of duty on the part of an agency, public officer, or employee. The Network Provider and any subcontractor shall inform its employees that they and other persons may file a complaint with the Office of Chief Inspector General, Agency Inspector General, the Florida Commission on Human Relations or the Whistle- blower's Hotline number at 1- 800- 543 -5353. 32. Proprietary or Trade Secret Information a. Unless exempted by law, all public records are subject to public inspection and copying under Florida's Public Records Law, Chapter 119, F.S. Any claim by Network Provider of proprietary or trade secret confidentiality for any information contained in Network Provider's documents (reports, deliverables or work papers, etc., in paper or electronic form) submitted in connection with this contract will be waived, unless the claimed confidential information is submitted in accordance with Section 32. b. below. b. The Network Provider must clearly label any portion of the documents, data or records submitted that it considers exempt from public inspection or disclosure pursuant to Florida's Public Records Law as proprietary or trade secret. The labeling will include a justification citing specific statutes and facts that authorize exemption of the information from public disclosure. If different exemptions are claimed to be applicable to different portions of the protected information, the Network Provider shall include information correlating the nature of the claims to the particular protected information. c. The ME, when required to comply with a public records request including documents submitted by the Network Provider, may require the Network Provider to expeditiously submit redacted copies of documents marked as confidential or trade secret in accordance with Section 32. b. above. Accompanying the submission shall be an updated version of the justification under Section 32. b., correlated specifically to redacted information, either confirming that the statutory and factual basis originally asserted remain unchanged or indicating any changes affecting the basis from the asserted exemption from public inspection or Guidance Care Center, Inc. 7 Contract No. ME225 -3 -27 disclosure. The redacted copy must exclude or obliterate only those exact portions that are claimed to be proprietary or trade secret. If the Network Provider fails to promptly submit a redacted copy, the ME is authorized to produce the records sought without any redaction of proprietary or trade secret information. d. The Network Provider shall be responsible for defending its claim that each and every portion of the redactions of proprietary or trade secret information are exempt from inspection and copying under Florida's Public Records Law. 33. Support to the Deaf or Hard -of- Hearing a. The Network Provider and its subcontractors, where direct services are provided, shall comply with section 504 of the Rehabilitation Act of 1973, 29 U.S.C. 794, as implemented by 45 C.F.R. Part 84 (hereinafter referred to as Section 504), the Americans with Disabilities Act of 1990, 42 U.S.C. 12131, as implemented by 28 C.F.R. Part 35 (hereinafter referred to as ADA), and the Children and Families Operating Instruction (CFOP) 60 -10, Chapter 4, entitled "Auxiliary Aids and Services for the Deaf or Hard -of- Hearing." b. If the Network Provider or any of its subcontractors employs fifteen (15) or more employees, the Network Provider shall designate a Single- Point -of- Contact (one per firm) to ensure effective communication with deaf or hard -of- hearing customers or companions in accordance with Section 504, the ADA, and CFOP 60 -10, Chapter 4. The name and contact information for the Network Provider's Single- Point -of- Contact shall be furnished to the ME's Grant or Contract Manager within fourteen (14) calendar days of the effective date of this requirement. c. The Network Provider shall, within 30 days of the effective date of this requirement, contractually require that its subcontractors comply with section 504, the ADA, and CFOP 60 -10, Chapter 4. A Single- Point -of- Contact shall be required for each subcontractor that employs fifteen (15) or more employees. This Single- Point -of- Contact will ensure effective communication with deaf or hard -of- hearing customers or companions in accordance with Section 504 and the ADA and coordinate activities and reports with the Network Provider's Single- Point -of- Contact. d. The Single- Point -of- Contact shall ensure that employees are aware of the requirements, roles & responsibilities, and contact points associated with compliance with Section 504, the ADA, and CFOP 60 -10, Chapter 4. Further, employees of Network Providers and its subcontractors with 15 or more employees shall attest in writing that they are familiar with the requirements of Section 504, the ADA, and CFOP 60 -10, Chapter 4. This attestation shall be maintained in the employee's personnel file. e. The Network Provider's Single- Point -of- Contact will ensure that conspicuous Notices which provide information about the availability of appropriate auxiliary aids and services at no -cost to the deaf or hard -of- hearing customers or companions are posted near where people enter or are admitted within the agent locations. Such Notices must be posted immediately by Network Providers and subcontractors. The approved Notice can be downloaded through the Internet at: http://www.dcf.state.fl.us/admin/civilrights/ f. The Network Provider and its subcontractors shall document the customer's or companion's preferred method of communication and any requested auxiliary aids /services provided in the customer's record. Documentation, with supporting justification, must also be made if any request was not honored. The Network Provider shall submit compliance reports monthly, by the 4th business day following the reporting month, to the ME's Grant or Contract Manager. The Network Provider shall distribute Customer Feedback forms to customers or companions, and provide assistance in completing the forms as requested by the customer or companion. g. If customers or companions are referred to other agencies, the Network Provider must ensure that the receiving agency is notified of the customer's or companion's preferred method of communication and any auxiliary aids /service needs. h. The network provider's and its subcontractors' direct service employees shall complete the Effective Communication Online (as requested of all Managing Entity employees) and sign the Attestation of Understanding. Direct service employees will also print their certificate of completion, attach it to their Attestation of Understanding, and maintain them in their personnel file. 34. Contract Amount The ME shall pay for contracted services according to the terms and conditions of this Contract in an amount not to exceed $4,706,252.00 subject to the availability of funds and satisfactory performance of all terms by the Network Provider. Of the total Contract amount, the ME will be required to pay $3,921,877.00, subject to the delivery and billing for services. The remaining amount of $784,375.00, represents "Uncompensated Units Reimbursement Funds ", which the ME, at its sole discretion and subject to the availability of funds, may pay to the Network Provider, in whole or in part, or not at all, for Exemplary Performance by the Network Provider. Exemplary Performance will be determined by the Network Provider delivering and billing for services in excess of those units of service the ME will be required to pay. The ME's obligation to pay under this Contract is contingent upon an annual appropriation by the Legislature and the Contract between the ME and the DCF. Any costs or services eligible to be paid for under any other contract or from any other source are not eligible for payment under this Contract. 35. Contract Payment The ME has ten (10) working days, subject to the availability of funds, to inspect and approve goods and services, unless the bid Guidance Care Center, Inc. 8 Contract No. ME225 -3 -27 specifications, purchase order, or this contract specify otherwise. With the exception of payments to health care providers for hospital, medical, or other health care services, if payment is not available within forty (40) days, measured from the latter of the date a properly completed invoice is received by the ME or the goods or services are received, inspected, and approved, a separate interest penalty set by the Chief Financial Officer pursuant to section 55.03, F.S., will be due and payable in addition to the invoice amount. Payments to health care providers for hospital, medical, or other health care services, shall be made not more than thirty -five (35) days from the date eligibility for payment is determined. Financial penalties will be calculated at the daily interest rate of .03333 %. Invoices returned to a Network Provider due to preparation errors will result in a non - interest bearing payment delay. Interest penalties less than one (1) dollar will not be paid unless the Network Provider requests payment. Payment shall be made only upon written acceptance by the ME and shall remain subject to the subsequent audit or review to confirm contract compliance. 36. Financial Consequences for Network Provider's Failure to Perform If the Network Provider fails to meet the minimum level of service or performance identified in this agreement, or that is customary for the industry, than the ME will apply financial consequences commensurate with the deficiency. Financial consequences may include but are not limited to refusing payment, withholding payments until deficiency is cured, tendering only partial payments, imposition of penalties per Section 39., and termination of contract and requisition of services form an alternate source. Any payment made in reliance on the Network Provider's evidence of performance which evidence is subsequently determined to be erroneous, will be immediately due as an overpayment in accordance with Section 13. above, entitled "Return of Funds" to the extent of such error. 37. Vendor Ombudsman A Vendor Ombudsman has been established within the Department of Financial Services. The duties of this office are found in section 215.422, F.S., which include disseminating information relative to prompt payment and assisting vendors in receiving their payments in a timely manner from a state agency. The Vendor Ombudsman may be contacted at (850) 413 -5516. 38. Notice Any notice that is required under this contract shall be in writing, and sent by U.S. Postal Service or any expedited delivery service that provides verification of delivery or by hand delivery. Said notice shall be sent to the representative of the Network Provider responsible for administration of the program, to the designated address contained in this contract. 39. Financial Penalties for Failure to Comply with Requirement for Corrective Action a. In accordance with the provisions of section 402.73(1), F.S., and Rule 65- 29.001, F.A.C., corrective action plans may be required for noncompliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed for failures to implement or to make acceptable progress on such corrective action plans. b. The increments of penalty imposition that shall apply, unless the ME determines that extenuating circumstances exist, shall be based upon the severity of the noncompliance, nonperformance, or unacceptable performance that generated the need for corrective action plan. The penalty, if imposed, shall not exceed ten percent (10 %) of the total contract payments during the period in which the corrective action plan has not been implemented or in which acceptable progress toward implementation has not been made. Noncompliance that is determined to have a direct effect on client health and safety shall result in the imposition of a ten percent (10 %) penalty of the total contract payments during the period in which the corrective action plan has not been implemented or in which acceptable progress toward implementation has not been made. c. Noncompliance involving the provision of service not having a direct effect on client health and safety shall result in the imposition of a five percent (5 %) penalty. Noncompliance as a result of unacceptable performance of administrative tasks shall result in the imposition of a two percent (2 %) penalty. d. The deadline for payment shall be as stated in the Order imposing the financial penalties. In the event of nonpayment the ME may deduct the amount of the penalty from invoices submitted by the Network Provider. 40. Termination a. This contract may be terminated by either party without cause upon no less than sixty (60) calendar days' notice in writing to the other party unless a sooner time is mutually agreed upon in writing. Said notice shall be delivered by U.S. Postal Service or any expedited delivery service that provides verification of delivery or by hand delivery to the contract manager or the representative of the Network Provider responsible for administration of the program. This provision shall not limit the ME's ability to terminate this contract for cause according to other provisions herein. b. In the event funds for payment pursuant to this contract become unavailable, the ME may terminate this contract upon no less than twenty -four (24) hour notice in writing to the Network Provider. Said notice shall be sent by U.S. Postal Service or any expedited delivery service that provides verification of delivery. The ME shall be the final authority as to the availability and adequacy of funds. In the event of termination of this contract, the Network Provider will be compensated for any work Guidance Care Center, Inc. 9 Contract No. ME225 -3 -27 satisfactorily completed. c. In the event the Network Provider fails to fully comply with the terms and conditions of this contract, the ME may terminate upon no less than twenty -four (24) hours (excluding Saturday, Sunday, and Holidays) notice in writing to the Network Provider after Network Provider's failure to fully cure such noncompliance within the time specified in a written notice of noncompliance issued by the ME specifying the nature of the noncompliance and the actions required to terminate the contract. The ME's failure to demand performance of any provision of this contract shall not be deemed a waiver of performance. The ME's waiver of any one breach of any provision of this contract shall not be deemed to be a waiver of any other breach and neither event shall be construed to be a modification of the terms and conditions of this contract. The provisions herein do not limit the ME's right to remedies at law or in equity. d. Failure to have performed any contractual obligations with the ME in a manner satisfactory to the ME will be a sufficient cause for termination. To be terminated as a Network Provider under this provision, the Network Provider must have: (1) previously failed to satisfactorily perform in a contract with the ME, been notified by the ME of the unsatisfactory performance, and failed to correct the unsatisfactory performance to the satisfaction of the ME; or (2) had a contract terminated by the ME for cause. Termination shall be upon no less than twenty -four (24) hour notice in writing. 41. Renegotiations or Modifications Modifications of provisions of this contract shall be valid only when they have been reduced to writing and duly signed by both parties. The rate of payment and the total dollar amount may be adjusted retroactively to reflect price level increases and changes in the rate of payment when these have been established through the appropriations process and subsequently included in the ME's prime contract with the DCF. 42. Dispute Resolution It is the sole responsibility of the managing entity to resolve differences with the Network Provider pertaining to this contract. The Network Provider and the managing entity agree to cooperate in resolving any differences in interpreting the contract. Within five (5) working days of the execution of this contract, each party shall designate one person to act as its representative for dispute resolution purposes, and shall notify the other party of the person's name and business address and telephone number. Within five (5) working days from delivery to the designated representative of the other party of a written request for dispute resolution, the representatives will conduct a face to face meeting to resolve the disagreement amicably. If the representatives are unable to reach a mutually satisfactory resolution, either representative may request referral of the issue to the Executive Director of the respective parties. Upon referral to this second step, the Executive Directors of the parties shall confer in an attempt to amicably resolve the issue. If the Executive Directors of the parties cannot resolve the issue, then in that event, the decision of the managing entity shall prevail subject to any legal rights that the Network Provider may have and /or wish to exercise. Venue for any court action will be in Miami -Dade County, Florida. This provision shall not limit the parties' rights of termination under Section 40. 43. Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List (For Contracts Valued at $1,000,000.00 (total contract value), or more, awarded, extended, or renewed on or after July 1, 2011). The Network Provider agrees to refrain from any of the prohibited business activities with the Governments of Sudan and Iran as described in s.219.473, F.S. Pursuant to section s.287.135(5), F.S., the ME may immediately terminate this contract for cause if the Network Provider is found to have submitted a false certification or if the Network Provider is placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List during the term of the contract. Guidance Care Center, Inc. 10 Contract No. ME225 -3 -27 44. Official Payee and Representatives (Names, Addresses, Telephone Numbers and E -Mail Addresses): a. The Provider name, as shown on page 1 of this Contract, and c. The name, address, and telephone of the Contract Manager for mailing address of the official payee to whom the payment shall the ME for this contract is: be made is: Guidance Care Center, Inc. Evelyn Kelly 3000 41 Street Ocean South Florida Behavioral Health Network, Inc. Marathon, Florida 33050 7205 Corporate Center Drive, Suite #200 Miami, Florida 33126 Tel: 786 -507 -7461 E -Mail: ekellvelsfbhn.orq b. The name of the contact person and street address where the d. The name, address, and telephone number of the representative Provider's financial and administrative records representative of the Provider responslle for the administration are maintained is: of the program under this contract is: Marianne Benvenuti 3000 41 Street Ocean Frank Rabitto, Sr. Vice President Marathon, Florida 33050 3050 Biscayne Boulevard, Suite 900 Tel: 305-434-9043 Miami, Etorida 33137 E -mail: Marianne.benvenuti @westcare.com E -mail: trabbito@westcare.com Upon change of representatives (names, addresses, telephone numbers and e-mail addresses) by either party, notice shall be provided in writing to the other party and the notification attached to the originals of this contract. 45. All Terms and Conditions Included This contract and it attachments, LB. N. IV. V and any exhibits • referenced in said attachments, together with any documents incorporated by reference, including the ME prime contract KH225 (which can be found at http://www.stbhn.org), contain all the terms and conditions agreed upon by the parties. There are no provisions, terms, conditions, or obligations other than those contained herein, and this contract shall supersede all previous communications, representations, or agreements, either verbal or written between the parties. If any term or provision of this contract is legally determined unlawful or unenforceable, the remainder of the contract shall remain in full force and effect and such term or provision shall be stricken. In the event of a conflict between the provisions of the documents, the documents shall be interpreted in the following order of precedence: a. Attachment 1, exhibits, and other attachments, if any; b. Any documents incorporated into any attachment by reference; c. The Standard Contract; d. Any documents incorporated herein by reference BY SIGNING THIS CONTRACT, THE PARTIES AGREE THAT THEY HAVE READ AND AGREE TO THE ENTIRE CONTRACT, AS DESCRIBED IN SECTION 45 . ABOVE. IN WITNESS THEREOF, the parties have caused this contract, attachments, exhibits, and any documents referenced herein, to be executed by their undersigned officials as duly authorized. PROVIDER: G Care Center Inc. SOUTH FLORIDA BEHAVIORAL HEALTH NETWORK, INC. SIGNED SIGNED BY: 1 BY: 9 / / G•C • O`er/ NAME: Frank Rabbito N • ' E: + ohn W. Dow TITLE: Senior Vice Pre ' ent 4 : President & CEO DATE: - 1 I ac_. DATE: 7 1 Federal Tax ID# (or SSN) 59- 1458324 Provider Fiscal Year Ending Date 06/30 Guidance Care Center, Inc. 11 Contract No. ME225 -3-27 { 07/01/2012 ATTACHMENT I A. SERVICES TO BE PROVIDED 1. Definition of Terms a. Contract Terms Contract terms used in this document can be found in the Florida Department of Children and Families Glossary of Contract Terms, which is incorporated herein by reference, and can be obtained from the designated managing entity contract manager. b. Program /Service Specific Terms (1) "Accessible" — Children, families and community members should be helped to become knowledgeable about how to ask for and receive services that are timely, comprehensive and family - friendly without facing unreasonable barriers. (2) "Activity" is an educational process or procedure intended to stimulate learning. (3) "Adolescent" is a client who is receiving substance abuse treatment services who is between the ages of 12 and 17. (4) "Annual Action Plan" is an annual plan developed by the managing entity and approved by the department that contains the deliverables for the ten baseline functions and other requirements for the behavioral health services needs for the Southern Region. (5) "Approaches" are the methods used in dealing with or accomplishing a task or goal. (6) "Approved Regional Plan" is a plan established by the department in accordance with section 394.674, F.S. and section 394.675, F.S. and updated annually or as required. (7) "ASAM PPC -2R Florida Supplement" is the American Society of Addiction Medicine, Patient Placement Criteria for the Treatment of Substance Related Disorders, second edition - revised, July 1, 2001, or the latest revised edition thereof. (8) "Assessment Instrument" is a tool used for collection of detailed information concerning an individual's substance abuse, emotional and physical health, social roles, and other areas that may reflect the severity of the individual's abuse of alcohol or drugs, as a basis for identifying an appropriate treatment regimen. (9) "Attrition" is the loss of program participants during the course of the services due to voluntary dropout or other reasons. Higher rates of attrition can potentially threaten the validity of services and programming strategies. Attrition is one of the six criteria of Quality of Research in the National Registry of Evidence -based Program (NREPP) used to Evidence -based Programs and Practices. (10) "Available Appropriations" are State and other governmental funds allocated for mental health and substance abuse services including prevention and the associated local matching funds. (11) "Baseline" is the initial time point in service interventions just before the intervention or Guidance Care Center, Inc. 12 Contract No. ME225 -3 -27 07/01/2012 treatment begins. The information gathered at baseline is used to measure change in targeted outcomes over the course of the services. (12) "Behavioral Health Services" are mental health services and substance abuse prevention and treatment services as defined in chapters 394, 397 and 916, F.S. which are provided using state and federal funds. (13) "Casual Factors /Risk Factors" are research -based constructs that have been identified as being strongly related to, and influencing the occurrence and magnitude of, substance use and related risk behaviors and their subsequent consequences. These variables are the proximal focus of prevention strategies, changes in which are then expected to affect consumption and consequences. (14)"Client" (synonymous with recipients of services /individual(s) served) is any individual who is receiving services in any substance abuse or mental health program whose cost of care is paid, in part or in whole, by the Department, Medicaid, Medicaid capitated managed care entities, or local match. Individuals who take part in substance abuse prevention programs or services are referred to as participants. (15) "Client Fees" is compensation to the managing entity's contracted network providers for services rendered to the client, who has been authorized to receive services pursuant to this contract, from any source of funds, including city, county, state, federal, private sources and client paid. (16) "Clinical Assessment" is the collection of detailed information concerning an individual's behavioral health, emotional and physical health, social roles, and other areas that may reflect the individual's overall health as a basis for identifying an appropriate treatment regimen. (17) "Clinical Pathways" is a method that charts relationships among project tasks illustrating the sequence and interdependence of tasks over time. A "map" of preferred treatment/ intervention activities which outlines the types of information needed to make decisions, the timelines for applying that information, and what action needs to be taken by whom. They provide a way to monitor care "in real time," and are also designed to support resource management, clinical audits and financial management. (18) "Clinician" is a substance abuse or mental health professional that provides one or more of the following services: assessment; individual, group, or family counseling services, or case management. (19) "Coalition" is a formal arrangement for cooperation and collaboration among groups or sectors of a community in which each group retains its identity, but all agree to work together toward a common goal of building a safe, healthy, and drug free community. (20) "CODECATTM (Co- occurring Disorders Educational Competency Assessment Tool)" is a tool used to evaluate clinicians' training needs based on a competency assessment to determine knowledge, skills, attitudes, and values relative to persons with co- occurring disorders. (Contract manager may delete if this is a prevention only contract) (21) "Community' is a specific geographic or demographic population. Geographic includes counties and municipalities. Demographic includes race, ethnicity, age, gender or any combination thereof. Guidance Care Center, Inc. 13 Contract No. ME225 -3 -27 • 07/01/2012 (22) "Community -Based Services" are mental health and /or substance abuse services provided outside of a state mental facility or inpatient settings, such as psychiatric residential treatment facilities for children. (23) "Community -Based Medicaid Administrative Claiming (CBMAC)" is the mechanism whereby states are eligible to claim federal Medicaid funds /reimbursement for qualifying Medicaid administrative activities. (24) "Community Conditions" is circumstances that underlie underage drinking or other substance abuse and /or alcohol - related problems identified by recognized community substance abuse coalitions in the needs assessment process during the development of Comprehensive Community Action Plans. (25) "Community Events" are generally, one -time activities that are conducted in response to a request for the network provider to participate in a community event and are NOT a part of a program manual's Schedule of Activities and are NOT associated with a particular group of program participants within the data system. These events tend to be large (rallies), busy (community health fairs), or have no direct contact (billboards broadcast media). Therefore, the count of many individual activities is an estimate and may include some under age 18. The total reported here is a duplicated count (26) "Community- Focused" is the process of planning, management and decision- making to ensure resources are designed to build on the unique strengths and meet the specific needs of the local community. (27) "Community Prevention" are strategies and activities aimed at changing community conditions related to substance abuse. It is aimed at larger universal populations and selected sub - populations, does not track specific individuals and includes environmental strategies designed to change one or more community conditions. (28) "Community Substance Abuse Coalition" is community organizations recognized by the Department of Children and Families and SFBHN as organizations that convene representatives of community sectors and stakeholders that reflect the demographics and diversity of the community. The purpose of these organizations is to assess problems related to substance use or abuse in their community, develop and facilitate a coordinated response to those problems, track and report on progress toward community goals and objectives, and build community capacity to implement evidence -based practices in planning and implementation. (29) "Community Prevention" means strategies and activities aimed at changing community conditions related to substance abuse. It is aimed at larger universal populations and selected sub - populations, does not track specific individuals and includes environmental strategies designed to change one or more community conditions. (30) "Comprehensive Community Action Plan" means a plan developed by a local, department recognized, community substance abuse coalition which is based on an assessment of substance abuse related epidemiology data and the resources needed to address identified needs. The plan includes goals to reduce the community's prioritized substance use problems and the approaches to take to achieve them. A community's data - driven strategic response to change conditions and factors that underlie alcohol and other drug problems and related consequences. The plan includes two goals: Guidance Care Center, Inc. 14 Contract No. ME225 -3 -27 07/01/2012 1) to achieve a long -term change in a substance abuse behavior pattern, and 2) to build community and organization capacity to effectively achieve the identified outcome. The plan defines short term and intermediate objectives for tracking progress toward goal achievement. (31) "COMPASSTM (Comorbidity Program Audit and Self- Survey for Behavioral Health Services)" is a tool that can be used by behavioral health care systems to assess program competencies in multiple areas that reflect the basic expectations of program performance for mental health services, substance abuse disorder services and integrated systems of care. (32) "Comprehensive Community Action Plan" is a plan developed by a local, department recognized, community substance abuse coalition which is based on an assessment of substance abuse related epidemiology data and the resources needed to address identified needs. The plan includes goals to reduce the community's prioritized substance use problems and the approaches to take to achieve them. (33) "Comprehensive Continuous Integrated System of Care (CCISC) model" is a system design and implementation model for organizing services for individuals and families with co- occurring disorders that is designed to improve services capability on a statewide or regional basis to achieve: system level change; efficient use of resources; use of evidence -based and consensus based practices; and integrated mental health and substance abuse services throughout the system, by organizing a process in which every program improves their provision of co- occurring disorder services, and every clinical staff person improves their level of co- occurring disorder service competency based on their job and level of training. (34) "Consequences" are the social, economic and health problems associated with the use of alcohol and illicit drugs. Any social, economic or health problem can be defined as a substance use problem if the use of alcohol, tobacco, or drugs increases the likelihood of the problem occurring. (35) "Consolidated Program Description" is the combination of all of the managing entity network providers' program descriptions and the managing entity program description. (36) "Consumer Price Index" is a measure of the average change in prices over time of goods and services purchased. (37) "Continuous Quality Improvement" is the systematic on -going process of improving performance, both in process and end of process indicators, in order to meet the individual service recipient's valid requirements. (38) "Continuum of Services" are recovery- oriented systems of care will offer a full array of services, including pretreatment, treatment, continuing care and support throughout recovery. Individuals will have a full range of stage- appropriate services from which to choose at any point in the recovery process. (39) "Contract Manager" is the managing entity employee who is responsible for enforcing the compliance with administrative and programmatic terms and conditions of a contract. The contract manager is the primary point of contact through which all contracting information flows between the managing entity and the network provider. All actions related to the contract shall be initiated by or coordinated with the contract manager. Guidance Care Center, Inc. 15 Contract No. ME225 -3 -27 07/01/2012 (40) "Contributing Factors" are more specific dimensions or aspects of constructs which collectively can be used to measure the theory to which they are linked. (41) "Co- occurring Disorder" is any combination of mental health and substance abuse in any individual, whether or not they have been already diagnosed. (42) "Co- occurring disordered family' is a family where one member has one kind of problem, like a child with an emotional disturbance, and another member has another kind of problem, like a family member or caregiver with a substance abuse issue. (43) "Co- occurring Disorder Service Capability' is the ability of any program to organize every aspect of its program infrastructure (policies, procedures, practices, documentation, and staff competencies), within its existing resources, to be able to provide and /or coordinate appropriately matched, integrated services to the individuals and families with co- occurring disorders that are routinely presenting for care in that program. (44) "Core components" is the most essential and indispensable components of a service intervention (core intervention components) or the most essential and indispensable components of an implementation program (core implementation components). (45) "Cost Analysis" is the review of the proposed cost elements to determine if they are necessary, allowable, appropriate and reasonable. (46) "Cost Center" is a grouping of services that are similar in time, intensity and function where the average cost for service is generally the same, and are specified in the State Funding by Program and Activity which is incorporated herein by reference. See Rule 65E- 14.021, Florida Administrative Code (F.A.C.), and the Substance Abuse Recovery Support Services (Individual and Group),Clinical Supervision for Evidence -Based Practices, and the Children's System of Care Comprehensive Community Service Team are incorporated herein by reference and may be obtained from the contract manager. The description for the Adult System of Care Comprehensive Community Service Team, is specified in Section D, Special Provisions. (47) "Culturally Competent Services" means acknowledging and incorporating variances in normative acceptable behaviors, beliefs and values in determining and individual's mental wellness /illness and incorporating those variances into assessment and treatment that promotes recovery. (48) "Data Management' are activities that use data elements to track cost, utilization, quality of care and access to services within the network of providers. (49) "DCF PAM 155 -2" is the Department of Children & Families, Pamphlet 155 -2 - Mental Health and Substance Abuse Measurement and Data, effective July 2010 (10th edition, version 1),or the latest revised edition thereof, means a document promulgated by the department that contains required data - reporting elements for substance abuse and mental health services, and which can be found at: http: / /www.dcf. state.fl.us/ programs /samh /pubs_reports.shtml, and is incorporated herein by reference. (50) "Department" means the State of Florida Department of Children and Families. (51) "Direct Contact" for prevention services are activities conducted by a prevention services Guidance Care Center, Inc. 16 Contract No. ME225 -3 -27 07/01/2012 specialist while in direct contact with a child or adult. These services may be provided in a one -to -one context, where the specialist is working with only one participant at a time or in a group context where the specialist is working directly with more than one participant (NOTE: This may include family members or other collateral contacts as indicated in the program manual). (52) "Direct Prevention" Level 1 Prevention Programs include persons participating in Universal and Selective programs in cost center 16. Level 1 Prevention Programs address subgroups of the general population that are at a higher risk of substance abuse than the general population. The mission is to provide individuals with the information and skills necessary to prevent the abuse of substances. This is an unduplicated count of participants. Level 2 Prevention Programs include persons participating in Indicated programs in cost center 16 and all programs in cost center 17. Level 2 Prevention Programs are designed to prevent the onset of substance abuse in individuals who do not meet the DSM -IV criteria for addiction but who are showing early danger signs in the form of multiple risk factors. The mission of Level 2 Prevention Programs is to identify individuals who are exhibiting early signs of substance abuse and other problem behaviors associated with substance abuse and to target them with special programs. This is an un- duplicated count of participants. (53) "Dissemination" is the targeted distribution of program information and materials to a specific audience. The intent is to spread knowledge about the program and encourage its use. (54) "Environmental Strategy" is a public health approach that strengthens policies and practices related to alcohol and other drug access, availability, promotion, enforcement and /or community norms. Grounded in the field of public health, which emphasizes the broader physical, social, cultural and institutional forces that contribute to the problems that coalitions address, environmental strategies offer well- accepted prevention approaches that coalitions use to change the context (environment) in which substance use and abuse occur. Environmental strategies incorporate prevention efforts aimed at changing or influencing community. (55) "Epidemiology data" are data relating to factors affecting the health and illness of populations that serve as the foundation and logic of interventions made in the interest of public health. (56) "Evaluation Plan" is a written document which will identify the outcomes that will be measured, data collection methods and instruments, and a plan for their collection. (57) "Evidence -Based Assessment Instruments" are assessment instruments that include, but are not limited to, one of the following for use in the completion of the Psychosocial Assessment with adolescents: the Global Appraisal of Individual Needs (GAIN); Adolescent Diagnostic Interview (ADI); the Mini - International Neuropsychiatric Interview (Mini -Kid) or other instruments designated by the Managing Entity. (58) "Evidence- Based" are those practices that are based on accepted practices in the profession and are supported by research, field recognition, or published practice Guidance Care Center, Inc. 17 Contract No. ME225 -3 -27 1 07/01/2012 guidelines. (59) "Family" is a target population of an evidence -based practice. Through this contract, any person or group that supports the individual receiving services. A fundamental social group in society typically consisting of one or two parents and their children or two or more people who share goals and values, have long -term commitments to one another, and reside usually in the same dwelling place. (60) "Family Intervention Specialists /Adult Intervention Specialists (FIS)" are individuals employed to provide adult behavioral health outreach, screening, intervention, and case management to families involved in the child welfare system and /or the Abuse Hotline. (61) "Family Intervention Specialist Services" are services designed to reduce the incidence of child abuse and neglect resulting from parents' or caregivers' behavioral health and to improve outcomes for families in the child welfare system and /or community based care. (62) "Fidelity" is the degree to which the evidence -based practice implemented adheres to the practice's implementation design. (63) "Fidelity of Implementation" is ideality of implementation occurs when implementers of a research -based program or intervention (e.g., teachers, clinicians, counselors) closely follow or adhere to the protocols and techniques that are defined as part of the intervention. For example, for a school -based prevention curriculum, fidelity could involve using the program for the proper grade levels and age groups, following the developer's recommendations for the number of sessions per week, sequencing multiple program components correctly, and conducting assessments and evaluations using the recommended or provided tools. (64) "Florida Department of Children and Families Strategic Intent" is the Secretary's Strategic Intent gives guidance and summarizes the department's major initiatives. This document provides the Secretary's intent on what the department and its partners must accomplish during a specific period of time. The Secretary's guidance drives the development of the department's Strategic Plan, which depicts how the department will achieve these initiatives, when they will be accomplished and the metrics used to measure progress. (65) "Florida System of Care (FSC)" is the Department's initiative to integrate substance abuse and mental health service structures to promote co- occurring disorder service capability throughout the system of care from the initial point of client contact at assessment through conclusion of services. (66) "Forensic Mental Health Services" are services provided to individuals with mental illness pursuant to Chapter 916, Florida Statutes. (67) "Global Assessment of Individual Needs (GAIN)" is one of the department approved evidenced -based assessment instrument. Information regarding this instrument can be obtained from the following website: http: / /www.chestnut.org /LI /gain/ (68) "Governing Board" is the Commission, Board of Directors, Board of Trustees, Governing Body, etc. (69) "HIPAA" is the acronym for Health Insurance Portability and Accountability Act (42 U.S.C. 1320d, and 45 CFR Parts 160, 162, and 164). (70) "Implementation" is the use of a prevention or service interventions in a specific community - Guidance Care Center, Inc. 18 Contract No. ME225 -3 -27 { 07/01/2012 based or other setting with a particular target audience. (71) "Incompetent to Proceed (ITP)" as defined in chapter 916 F.S., means unable to proceed at any material stage of a criminal proceeding, which shall include trial of the case, pretrial hearings involving questions of fact on which the defendant might be expected to testify, entry of a plea, proceedings for violation of probation or violation of community control, sentencing, and hearings on issues regarding a defendant's failure to comply with court orders or conditions or other matters in which the mental competence of the defendant is necessary for a just resolution of the issues being considered. (72) "Indicated" is one of the three categories (Universal, Selective, Indicated) developed by the Institute of Medicine to classify preventive interventions. Indicated prevention strategies focus on preventing the onset or development of problems in individuals who may be showing early signs but are not yet meeting identified levels of a particular disorder. (73) "Indicated Prevention" is education and other evidence -based practices conducted with groups of individuals to reduce personal risk factors or substance abuse or strengthen protective factors. (74) "Indigent Drug Program (IDP)" is the program that allows the Department of Children and Families to purchase medications for individuals who are indigent. (75) "Indirect Prevention" are strategies and activities aimed at changing community conditions related to substance abuse. It includes environmental strategies designed to change one or more community conditions. Indirect Prevention is aimed at larger universal populations and selected sub - populations and does not track specific individuals. Indirect Prevention seeks to impact community conditions through media, policies, policy enforcement, or other similar methods. Strategies utilized in Indirect Prevention may include education, information dissemination, alternatives, and environmental activities. Environmental strategies may also be known as "Environmental Prevention ", "Environmental Programs ", or "Environmental Practices." (76) "Intervention" is a strategy or approach intended to prevent an undesirable outcome (preventive intervention), promote a desirable outcome (promotion intervention) or alter the course of an existing condition (treatment intervention). (77) "KIT Solutions" is the entity that maintains the database called Performance Based Prevention System (PBPS). (78) "Knight Information Software Database (KIS)" is the managing entity's online data system which network providers are required to use to collect and report data and performance outcomes on clients served whose services are paid for, in part or in whole, by the managing entity's Substance Abuse and Mental Health (SAMH) contract, Medicaid, or local match. (79) "Local Match" are funds received from governing bodies of local government, including city commissions, county commissions, district school boards, special tax districts, private hospital funds, private gifts both individual and corporate, bequests and funds received from community drives or any other sources. See section 394.67(14), F.S. and 65E- 14.005, F.A.C. (80) "Managing Entity (ME)" means pursuant to section 394.9082(2)(d), F.S., a corporation that is organized in the State of Florida, is designated or filed as a non - profit Guidance Care Center, Inc. 19 Contract No. ME225 -3 -27 07/01/2012 organization under section 501(c)(3) of the Internal Revenue Code, and is under contract to the Department to manage the day -to -day operational delivery of behavioral health services through an organized system of care. (81) "Mental health promotion" is an attempt to (a) encourage and increase protective factors and healthy behaviors that can help prevent the onset of a diagnosable mental disorder and (b) reduce risk factors that can lead to the development of a mental disorder. In this contract, mental health promotion is associated with substance abuse prevention strategies to promote wellness and reinforce protective factors that enhance wellbeing. (82) "Monitoring Subcontracts" is the process whereby the managing entity conducts a systematic organized review of a network provider's performance in order to give reasonable assurance that the network provider is complying with subcontract requirements, rules, regulations and laws applicable to contract performance. (83) "Network Provider" is an entity that Contracts with the Managing Entity and receives funding to provide services to clients; in this contract the network provider is synonymous with provider or subcontractor. (84) "Outcome" is a change in behavior, physiology, attitudes, or knowledge that can be quantified using standardized scales or assessment tools. In the context of NREPP, outcomes refer to measurable changes in the health of an individual or group of people that are attributable to the intervention. (85) "Outcome evaluation" is an evaluation to determine the extent to which an intervention affects its participants and the surrounding environments. Several important design issues must be considered, including how to best determine the results and how to best contrast what happens as a result of the intervention with what happens without the program. (86) "Overpayment" is for the purposes of this contract, the amount of money the department has paid the managing entity and /or the managing entity has paid the network provider for administrative expenses and /or program expense over and above what was properly earned for these expenses by the managing entity according to the approved line item budget. (87) "Participant" is any individual who takes part in targeted substance abuse prevention programs, activities or services which are paid, in part or in whole, by the Department through the ME. (88) "Payor class" means Medicare, Medicare HMO, Medicaid, Medicaid HMO, private- pay health insurance, private -pay health maintenance organization, private preferred provider organization, the Department of Children and Family Services, other government programs, self -pay patients, and charity care. (89) "PBPS" is the Performance Based Prevention System that collects data related to community assessments and plans and substance abuse prevention programs and activities. The system can be accessed by contacting technical support at 1- 888 - 600 -4777 or https : / /kitprevention.kithost.net /. (90) "Performance Measures" are quantitative indicators, outcomes and outputs that are used by the Department to objectively measure performance and are used by the managing entity and network providers to improve services. Guidance Care Center, Inc. 20 Contract No. ME225 -3 -27 07/01/2012 (91) "Prevalence" is the count of all individuals affected by a disease /condition within a particular period of time, compared with the entire population of concern. (92) "Prevention" is a process involving strategies aimed at the individual or the environment which preclude, forestall, or impede the development of substance abuse problems and promote healthy development of individuals, families and communities. (93) "Programs" are a structured Schedule of Activities (by instructors and participants) designed so that participants will attain, so far as possible, certain educational and behavioral objectives. (94) "Program Planning Tool (PPT)" is the data collection module contained in the PBPS that collects a variety of program information. It is designed to assure substance abuse prevention contracts reflect best practices and level of effort, inform the Department's coalition and network provider support system, and set the stage for evaluating effectiveness in achieving community and program outcomes. (95) "Prevention Program Description (PPD)" is the report generated as a result of completing the PPT. The PPD contains the information required for a program description pursuant to Rule 65E- 14.021, Florida Administrative Code (F.A.C.). (96) "Prevention Program" is a structured Schedule of Activities designed so that participants will attain so far as possible, certain educational, attitudinal, social and behavioral objectives. This is an unduplicated count of participants. (97) "Prevention Service" is a structured schedule of activities designed so that participants will attain certain educational, attitudinal, social, and behavioral objectives. Prevention services are focused on enhancing protective factors and resilience (strengths and assets) and reversing or reducing known risk factors (challenges). (98) "Prime Contract" is the contract between the Department of Children and Families and the Managing Entity. (99) "Program Description" is the document the network provider prepares and submits to the ME for approval prior to the start of the contract period, which provides a detailed description of the services to be provided under the contract pursuant to Rule 65E- 14.021, F.A.C. It includes but is not limited to the network provider's organizational profile, a detailed description of each program and cost center funded in the contract, the geographic service area, service capacity, staffing information, and client and target population to be served. (100) "Projects for Assistance in Transition from Homelessness (PATH)" is a Federal grant to support homeless individuals with behavioral health needs. (101) "Promising Practices" is the use of practices that incorporate the best objective information available regarding effectiveness and acceptability. (102) "Prorated Share" is the total number of unpaid units or funds divided by the number of months remaining between the time the prorated share is calculated and the end date of the contract. (103) "Protected Health Information" (PHI) relates to any information whether oral or recorded in any form or medium that is created or received by a health care provider, Guidance Care Center, Inc. 21 Contract No. ME225 -3 -27 07/01/2012 health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual. (104) "Provider Network" (subcontractor or network provider) refers to the direct service agencies that are under contract with a managing entity and that together constitute a comprehensive array of emergency, acute care, residential, outpatient, recovery support, and consumer support services or other services as designated by this contract. See section 394.9082, F.S. (105) "Psychosocial Assessment" is a series of evaluative measures designed to identify the behavioral and social factors involved in substance abuse and its symptoms, and in the determination of placement and the development of the treatment plan, as defined in Rule 65D- 30.002, Florida Administrative Code (F.A.C.). (106) "Quality Assurance" is a process that measures performance in achieving pre- determined standards, validates internal practice and uses sound principles of evaluation to ensure that data are collected accurately, analyzed appropriately, reported correctly and acted upon in a timely manner. The process may employ peer review, outcomes assessment, and utilization management techniques to assess quality of care. (107) "Quality Improvement/Continuous Quality Improvement" is a management technique to assess and improve internal operations and network services. It focuses on organizational systems rather than individual performance and seeks to continuously improve quality. The process involves setting goals implementing systematic changes, measuring outcomes, and making subsequent appropriate improvements. Quality improvement activities will assess compliance with contract requirements, state and Federal law and associated administrative rules, regulations, and operating procedures and validate quality improvement systems and findings. (108) "Recovery' is an on -going process which enables a person with behavioral health issues to live a meaningful life in a community of his or her choice while striving to achieve his or her potential. This allows individuals to improve their health, wellness, and quality of life. (109) "Recovery Based" is process built upon overcoming the negative impact of substance abuse addiction or mental illness. A system of care provides treatment and supports that promote recovery and functioning in the community. (110) "Representative Payee" refers to an entity /individual who is legally authorized to receive Supplemental Security Income, Social Security Income, Veterans Administration benefits, or other federal benefits on behalf of an individual served. (111) "Resource Assessment" is a written inventory of current resources available to apply toward achieving a community long -term outcome and the identification of gaps in skills, materials, facilities, community readiness and other capacities necessary to successfully achieve a community long -term outcome. (112) "SAMH" stands for the Substance Abuse and Mental Health Programs within the Department. (113) "SAVE/VIS Program" is the U.S. Department of Homeland Security (DHS) administers Guidance Care Center, Inc. 22 Contract No. ME225 -3 -27 07/01/2012 the Systematic Alien Verification for Entitlements (SAVE) program. This program verifies immigration status and eligibility of alien applicants for federal benefits. The alien status verification system under SAVE is entitled the Alien Status Verification Index (ASVI), as described at 60 Federal Register 52694, 52697 (1995) administered by the Computer Sciences Corporation (CSC) as the Verification Information System (VIS). The SAVENIS Program can and may provide assistance in verifying eligibility in cases where a client does not possess sufficient documentation. (114) "Schedule of Activities" is the written instructional content, materials, resources, and processes in order to attain educational objectives. (115) "Selective prevention" refers to strategies that are targeted to subpopulations identified as being at elevated risk for a disorder. (116) "Service Units" means those units of measure specified in Rule 65E- 14.021, F.A.C. and in the Substance Abuse Recovery Support Services, Adult Comprehensive Community Service Teams, Children's Comprehensive Community Service Teams and Clinical Supervision for Evidence Based Practices exhibits. (117) "SOAR" stands for Supplemental Security Income /Social Security Disability Insurance (SSI /SSDI) Outreach, Access and Recovery and is a technical assistance initiative. This strategy helps States and communities increase access to SSI and SSDI for people through training, technical assistance and strategic planning. (118) "Stakeholder" are individuals /groups with an interest in the provision of behavioral health services. (119) "State Designated Prevention Evaluation Contractor" is a comprehensive drug research center Contracted by the Department to evaluate prevention outcomes. (120) "Statewide Inpatient Psychiatric Programs (SIPP)" are residential inpatient facilities under contract with the Agency for Health Care Administration under the Medicaid IMD waiver for children under age 18 to provide diagnostic and active treatment services in a secure setting. (121) "Strategic Prevention Framework (SPF)" is the SPF is a community -based data driven approach to community mobilization that employs ongoing assessment and evaluation to move communities toward their goals of reducing substance abuse and its consequences. The Strategic Prevention Framework: 1) assess the conditions that underlie the onset and progression of substance abuse, including childhood and underage drinking; 2) select evidence -based practices to change those conditions and reduce substance- abuse related problems in the communities; and 3) build prevention capacity and infrastructure to sustain achievements. (122) "Strategies" is a plan of action or policy designed to achieve a major goal. (123) "Substance abuse" is s a pattern of chronic or harmful use of alcohol, illicit or prescribed drugs that result in adverse physical, psychological, or social consequences. (124) "Substance Abuse and Mental Health Information System (SAMHIS)" is the Department's online data system which network providers are required to use to collect and report data and performance outcomes on individuals served whose services are paid for, in part or in whole, by the Department's Substance Abuse and Mental Health (SAMH) Guidance Care Center, Inc. 23 Contract No. ME225 -3 -27 07/01/2012 contract, Medicaid, or local match. Instructions on how to access the system can be found in DCF PAM 155 -2. (125) "Supplemental Program Activities" are Schedule of Activities that are made available to program participants in order to reinforce the participant's involvement in the program and the knowledge presented in the Schedule of Activities. (Direct Prevention only) NOTE: the nature and number of Supplemental Program Activities should not threaten the fidelity of program implementation. (126) "Sustainability' is the long -term survival and continued effectiveness of an intervention. (127) "System of Care" are behavioral health services that are coordinated and developed into an integrated network of services accessible and responsive to the needs of individuals served, their families, and community stakeholders. (128) "TANF Participant" is a person or family member of that person defined in 45 CFR Part 260.30 and section 414.1585 and subsection 414.0252(9), F.S. (129) 'Targeted Prevention" are education and other evidenced -based practices conducted with groups of individuals to reduce personal risk factors or substance abuse or strengthen protective factors. (130) 'Temporary Assistance to Needy Families (TANF)" are cash assistance for families, including any family receiving cash assistance payments or TANF diversion services from the state program pursuant to the provisions of section 414.045, F.S., and Part A of Title IV of the Social Security Act. (131) 'Transformation" is a process that strives to change the form and function of the behavioral health services delivery system to better meet the needs of the individuals and families it is designed to serve. (132) "Unit Measurement" is used in billing the managing entity for services. The definition of each unit of measure can be found in Rule 65E- 14.021, F.A.C. (133) "Universal prevention" are strategies that can be offered to the full population, based on the evidence that it is likely to provide some benefit to all (reduce the probability of disorder), which clearly outweighs the costs and risks of negative consequences. (134) "Utilization Management" is a system to ensure maximum, cost - effective, and clinically appropriate utilization of behavioral health services. The goal of the program is to eliminate waitlists and maximize utilization as well as diverting individuals served to more clinically appropriate services when applicable. (135) "Verifiable Service" is a service provision that is documented in compliance with the requirements contained in Rule 65E- 14.021, F.A.C. 2. General Description a. General Statement The services provided under this contract are community -based SAMH services for a consumer - centered and family- focused coordinated system of care. The contract requires a qualified, direct service, community -based network provider who will provide services for adults Guidance Care Center, Inc. 24 Contract No. ME225 -3 -27 07/01/2012 and /or children with behavioral health issues as authorized in section 394.9082, F.S., and in the ME's contract with the Department, which is incorporated herein by reference, and which are consistent with the Approved Regional Plan. The network provider shall work in partnership with the Managing Entity to better meet the needs of individuals with co- occurring substance abuse and mental health disorders. The partnership process will be open, transparent, dynamic, fluid, and visible. The process shall also serve as an opportunity for collaboration to continuously improve the quality of services provided to the residents of Florida. During the course of the contract period, the Managing Entity will require that the network provider participate in the process of improving co- occurring disorder service capability system wide. The network provider shall work in collaboration and shall assist, upon request of the managing entity, in fulfilling its contractual obligations pursuant to the Prime Contract with the Department of Children and Families including but not limited to the following functions: (1) System of Care Development and Management; (2) Utilization Management; (3) Quality Improvement; (4) Data Collection, Reporting, and Analysis; (5) Financial Management; (6) Disaster Planning and Responsiveness b. Approved Annual Action Plan The ME will develop and operationalize an annual action plan, in partnership with the Department and network providers upon request by the managing entity. This action plan which is incorporated herein by reference, will be approved by the Department on an annual basis and may be modified by mutual agreement and approved /dated by the Managing Entity Executive Director and the approved Department Representative i.e., the SAMH Regional Director. A copy of any revisions to the approved annual action plan shall be provided to the Department's contract manager. c. Authority Section 394.9082, F.S., and the Prime Contract provides the Managing Entity with the authority to contract for these services. d. Scope Of Service The following scope of service applies to the contract period and any renewal or extension: (1) The network provider is responsible for the administration and provision of services to the target population(s) indicated in Exhibit A, Clients and Participants to be Served, and in accordance with the tasks outlined in Section B.1.a., of this contract. Services shall also be delivered at the locations specified in, and in accordance with the Program Description, as required by Rule 65E- 14.021, F.A.C. which is herein incorporated by reference, and maintained in the ME's contract manager's file. (2) Services are to be delivered in the following county(ies): Miami -Dade County X Monroe County Guidance Care Center, Inc. 25 Contract No. ME225 -3 -27 07/01/2012 e. Major Program Goals (1) The intent of the Substance Abuse and Mental Health Programs are to reduce or prevent substance abuse and promote and improve the mental health of the residents of the state by making behavioral health services available through a community -based system of care. (2) It is the goal of the Managing Entity and network provider to improve accountability, ensure quality of care through best practice models and seek to ensure delivery of behavioral health services across the provider network and across systems resulting in systematic access to a full continuum of care for all children, adolescents and adults who enter the publicly- funded behavioral health services systems. (3) It is the goal to improve co- occurring capability and expertise in all programs. (4) The intent of substance abuse prevention is to promote and improve the behavioral health of Florida's Southern Region communities by assisting the Managing Entity in strategically applying substance abuse prevention programs, and environmental strategies that are relevant to community needs as defined in a Department approved Comprehensive Community Action Plan. Once approved the plan can be obtained at: https : / /kitservices2.kithost.net/. f. Minimum Programmatic Requirements The network provider shall maintain the following minimum programmatic requirements: (1) System Of Care The consumer - centered and family- focused system of care will: (a) Be driven by the needs and choices of the customers; (b) Promote family and personal self- determination and choice; (c) Be ethically, socially, and culturally responsible; and (d) Be dedicated to excellence and quality results. There is a commitment to expand clinical treatment to include the behavioral health Transformation Initiative, evidence -based practices and recovery support services in accordance with priorities established by the Managing Entity and the Department for substance abuse, mental health treatment and /or co- occurring disorders, substance abuse and mental health treatment capacity, children and families, criminal and juvenile justice, HIV and hepatitis. (2) Guiding Principles Guiding principles specify that services are as follows: (a) Inclusive - involve and engage families and consumers as full partners to participate in the planning and delivery of services; (b) Comprehensive - incorporating a broad array of service and supports (e.g. physical, emotional, clinical, social, educational and spiritual); Guidance Care Center, Inc. 26 Contract No. ME225 -3 -27 07/01 /2012 (c) Individualized - meeting the individual's exceptional needs and strengths; (d) Community -based - provided in the least restrictive, clinically appropriate setting; (e) Coordinated -both at the system and service delivery levels to ensure that multiple services are provided and change as seamlessly as possible when warranted, and (f) Cultural and linguistic competence. 3. Clients to be Served See Exhibit A, Clients and Participants to be Served . B. MANNER OF SERVICE PROVISION 1. Service Tasks The following tasks must be completed for each fiscal year covered in the contract period. a. Task List (1) Based on client needs, the network provider agrees to provide appropriate services from the list of approved programs /activities described in Exhibit G, State Funding by Program and Activity and the description of such services specified in the Program Description as required by Rule 65E- 14.021, F.A.C. (2) The network provider shall serve the number of persons indicated in Exhibit D, Substance Abuse and Mental Health Required Outcomes/Outputs within the activities specified in Exhibit G, State Funding by Program and Activity. (3) The network provider shall comply with the provisions of Exhibit I, Substance Abuse Family Intervention Services and the revised Family Intervention Guidelines, incorporated herein by reference. All Family Intervention Specialist positions will be identified by the network provider upon request by the managing entity. (4) The network provider shall adhere to group size limitations not to exceed fifteen (15) individuals per group for any clinical therapy service provided. In addition to other programmatic documentation requirements, service documentation to evidence group activates shall include the following: (a) Data Elements: I. Service Documentation -Group Sign in Sheet i. Recipient name and identification number; ii. Staff name and identification number iii. Service date; iv. Start time v. Duration; vi. Cost Center; vii. Brief description of type of group; viii. Program (AMH, ASA, CMH, CSA) Guidance Care Center, Inc. 27 Contract No. ME225 -3 -27 07/01/2012 11. Audit Documentation - Recipient Service or Non - Recipient Chart: 1. Recipient name and identification number or if non - recipient, participant's name, address, and relation to recipient; ii. Staff name and identification number iii. Service date iv. Duration; and v. Group progress note (5) The network provider shall develop and implement policies so that all applicable providers' employees abide by the terms and conditions of Section 25., Information Security Obligations, of the Standard Contract. The network provider shall submit to the Managing Entities Contract manager, by 08/01/2012, verification that all network provider employees and subcontractors who have access to managing entity and Department information systems have completed the Security Agreement form as identified in Section 25. Information Security Obligations, of the Standard Contract. (6) For licensable services, the network provider shall have and maintain correct and current Department of Children and Families and Agency for Health Care Administration (AHCA) licenses and only bill for services under those licenses. In the event any of the network provider's license(s) are suspended, revoked, expired or terminated, the managing entity may cease payment for services delivered by the network provider under such license(s) until said license(s) are reinstated by the Department of Children and Families. (7) By 08/01/2012 the network provider shall submit to the ME's contract manager and implement a Quality Assurance Plan that details how the network provider will ensure and document that quality services are being provided to the clients served, which is herein incorporated by reference. The network provider shall submit: updates as amended of the Quality Assurance Plan within 30 days of adoption. (8) By 08/01/12 establish a Quality Improvement Plan, which is herein incorporated by reference, of quality improvement activities for fiscal year 2012 -2013 to improve performance. The network provider shall submit amendments to the Quality Improvement Plan, and quarterly reports on the implementation of plan to the managing entity's contract manager. (9) By 08/01/2012, the network provider shall submit to the ME's contract manager grievance procedures, which include an appeal process with the managing entity, should the grievance not be resolved at the network provider level, which applicants for, and recipients of, services being provided under this contract, may use to present grievances to the network provider, or to the managing entity about contracted services. (10)The network provider shall use the GAIN, the approved utilization management assessment tool for substance abuse, if substance abuse services are purchased through this contract. The Managing Entity in conjunction with the Department may specify an alternate assessment tool that may replace the current tool. Consumer placement criteria specific to mental health services will be developed by the managing entity and approved by the Southern Region SAMH Program Office. Standardized tools and assessments approved by the Department through the ME must be used to determine placement and level of care. (11) If the network provider provides medication management services, the network provider shall Guidance Care Center, Inc. 28 Contract No. ME225 -3 -27 07/01/2012 ensure that clients discharged from state mental health treatment facilities will be maintained on the medication that was prescribed for them by the facility at discharge pursuant to s. 394.676, F.S. Maintenance includes performing required lab tests, providing the medication, and providing appropriate physician oversight. (12)By 08/01/2012 the network provider shall submit to the ME's contract manager a disaster plan consistent with Section 29., Emergency Preparedness, of the Standard Contract. (13)On an annual basis, within thirty (30) days of the beginning of hurricane season, the network provider's emergency /disaster plan will be updated and activated upon notification of a disaster from the ME. The managing entity will conduct post disaster assessments of damage incurred by network providers. (14) By 08/01/2012, the network provider shall submit to the ME's contract manager a completed Civil Rights Compliance Questionnaire. (15) Comprehensive Continuous Integrated System of Care (CCISC): The network provider will participate in the Comprehensive Continuous Integrated System of Care (CCISC) Initiative. CCISC participation will be considered in the allocation of lapse and /or new funding, subject the availability of funds. Lapse funds and new funds will be allocated in accordance with network providers' participation in the CCISC initiative. (16) The network provider shall coordinate services for persons with co- occurring disorders. (a) During the course of the contract period, the network provider shall design services based on the recognition of the needs of individuals and families with co- occurring disorders in the population served, and participate with the ME in a quality improvement process to improve co- occurring disorder service capability in all programs. (b)The network provider shall develop and operate a system of care to ensure the provision of appropriate services in the least restrictive setting for adults and children with substance abuse, mental health and /or co- occurring disorders. Those services are needed in order to provide a seamless Comprehensive Continuous Integrated System of Care (CCISC) for this population that will increase access to services and improve outcomes in the most cost effective manner. (c)The network provider shall implement a "no wrong door" model by developing a process for assessing, referring and /or treating clients with co- occurring disorders to increase access of persons identified as co- occurring to provide services for both disorders regardless of the initial point of contact. As used in conjunction with the CCISC model, "no wrong door" (See http: / /www.kenminkoff.com /ccisc.html ) requires that systems develop policies and procedures that mandate a welcoming approach to individuals with co- occurring psychiatric and substance disorders in all system programs, eliminate arbitrary barriers to initial evaluation and engagement, and specify mechanisms for helping each client (regardless of presentation and motivation) to get connected to a suitable program as quickly as possible. Guidance Care Center, Inc. 29 Contract No. ME225 -3 -27 07/01/2012 (17) By 08/01/2012, the network provider shall submit to the ME's contract manager copies of its "no wrong door" policies and procedures as required by the CCISC Initiative. The policies and procedures must address the referral and linkage process of clients to local community providers for services not offered by the network provider. The network provider is responsible for tracking and ensuring that the proper linkages are made. (18) The network provider shall submit to the managing entity a 6 -month follow -up report on their implementation of the co- occurring action plans. (19) The network provider shall perform the following tasks related to the co- occurring disorder service capability initiative: (a) Develop and submit to the managing entity for approval an action plan for assessing and referring clients with co- occurring disorders by June 30` of each year of the contract term that details: i. An overview of the network provider's co- occurring disorder service capabilities with regard to service structure (assessment, stabilization, treatment, support, and other services); ii. Networking capacities with local network providers in the community for persons with co- occurring disorders; iii. Strategies and activities to develop or improve co- occurring disorder service capability; iv. Scope of services and programs to be included in the process; and v. Timeframes for reviewing co- occurring disorder service capability within each network provider program. (b) Complete network provider co- occurring disorder service capability as directed by the managing entity using theCOMPASS (c) Following evaluation of each program using the COMPASS, evaluate clinicians' co- occurring disorder service capabilities as directed by the managing entity using the CODECAT. (d) Develop and submit to the managing entity a summary report by June 30`h of each year that details: i. The types of network provider involvement in state and local co- occurring planning processes; ii. The number of times the COMPASS was used and the composition of the focus group(s) for each use; iii. Brief narrative detailing the findings from the COMPASS, the action steps developed, and progress made for each action step; Guidance Care Center, Inc. 30 Contract No. ME225 -3 -27 07/01/2012 iv. The number of clinicians evaluated using the CODECAT; v. Brief narrative detailing the findings from the CODECAT and action steps developed to enhance clinicians' co- occurring attitudes, knowledge, values and skills; and vi. Overall progress toward co- occurring disorder service capability development in accordance with timeframes specified in the action plan. (20) Any network provider that attains or that already has attained co- occurring disorder service capability must demonstrate prior use of the COMPASS and CODECAT assessment tools as part of their overall process to improve co- occurring disorder service capabilities, and must: (a) Submit to the managing entity for approval a compliance report by June 30 of each year in lieu of repeating the administration of the COMPASS and CODECAT assessment tools. The compliance report must provide detail on when and how the assessment tools were used and the program (s) and staff participating in the evaluations. The COMPASS and CODECAT assessment tools can be found at: www.ZiaPartners.com. (b) The network provider must provide copies of training guidelines or curricula and co- occurring policies to demonstrate attainment of co- occurring disorder service capability. This compliance report and related documents shall be accepted, upon approval from the managing entity, in lieu of the annual requirement for an action plan; and (c) Submit a summary report by June 30 each year that describes through brief narrative, any changes to the co- occurring disorder service structure including new programs, training, or changes in policy and procedures. (21)The network provider shall evaluate co- occurring disorder service capabilities within their agency and their clinical staff. Prevalence data shall be collected using the KIS. The network provider shall include the number of co- occurring individuals from the previous fiscal year in their annual action plans. Specifically, prevalence data will be collected via the Substance Abuse Outcomes Admission, Mental Health Outcomes Admission, and Detoxification Outcome forms which may be obtained from the ME's contract manager upon request. (22)The network provider should be engaged in performance improvement activities to improve its ability to recognize accurate prevalence of co- occurring disorders in its data system. (23)Trauma Informed Care (TIC) Many individuals with behavioral health issues have experienced trauma that affects their development and adjustment. The ME and the Southern Region are committed to developing a system of care that incorporates comprehensive assessment tools that identify those affected by trauma and a system of care that meets their needs. Network providers will be implementing the Trauma Informed Care initiative through the following: a continuous quality improvement plan or component in the existing agency wide continuous quality improvement plan that delineates participation in the TIC initiative. As part of the plan or component of the plan must include the following: Guidance Care Center, Inc. 31 Contract No. ME225 -3 -27 07/01/2012 (a) Identification of at least two TIC Champions at the beginning of each contract term. If any changes occur to the existing champions notice must go to the Contract Manager, Director of CQI and Compliance and Director of Behavioral Health Services; (b) Participation in the regional Trauma Informed Care meetings to develop the process for identifying and responding to those affected by trauma. (c) Attendance at the regional trainings regarding Trauma Informed Care as applicable. Applicable trainings will be documented in agency action plan. (d) Completion and submission of an agency -wide self- assessment using the Trauma assessment tool as identified by the Department and SFBHN by December 30 of each year. (e) Development and submission of a TIC Evidence of Commitment plan that includes the below along with incorporated results of the self- assessment tool by January 15th of each year: i. An overview of the network provider's TIC capabilities with regard to service structure (assessment, stabilization, treatment, support, and other services); ii. Networking capacities with local providers in the community for persons with trauma; iii. Strategies and activities to develop or improve TIC service capability; iv. Scope of services and programs to be included in the process; and v. Timeframes for reviewing TIC capability within each network provider program. (f) Participation in all TIC related activities to ensure staff and agency become competent in all areas of trauma informed care. (g) Implementation Trauma Informed Care throughout the agency will be documented in quarterly QA/QI Reports. (24)The network provider will participate in the SOAR initiative to include the submission of SOAR web -based data as outlined in the Working Agreement for SSI /SSDI Outreach, Access, and Recovery (SOAR) Initiative Community Provider Agency found on Attachment IV, of this contract. (25)The network provider shall comply with Children and Families Operating Procedure 215 -8, OVERSIGHT OF HUMAN SUBJECT RESEARCH AND INSTITUTIONAL REVIEW BOARD DESIGNATION. The policy and guidance can be found at httc: / /www.dcf.state.fi.us /news /h umanresearchcolicy.shtm I. Approval from the Department through the ME is mandatory for all research conducted by any employee, contracted organization or individual, or any public or private vendor, even if the aforementioned has their own Institutional Review Board which has granted approval. (26)The network provider shall participate in the State's Peer Review process, when implemented, to assess the quality, appropriateness, and efficacy of services provided to individuals pursuant Guidance Care Center, Inc. 32 Contract No. ME225 -3 -27 F 07/01/2012 to 45 CFR 96.136. (27)The network provider shall execute a Memorandum of Understanding (MOU) with the appropriate Federally Qualified Health Center within ninety (90) days of the effective date of this contract. The MOU shall be submitted to the ME's Contract Manager on or before September 1 of each fiscal year. The MOU provides for integration of primary care services to the medically underserved. A network provider designated as a Federally Qualified Health Center is exempt from this requirement. (28) The network provider will demonstrate efforts to initiate and support local county implementation of the Medicaid Substance Abuse Local Match Program in order to expand community service capacity through draw down of Federal funding. (29)The network provider shall maintain in one place for easy accessibility and review by the ME's staff all policies, procedures, tools, and plans adopted by the network provider. The network provider's policies, procedures, and plans, must conform to state and federal laws, the Florida Administrative Code, state and federal regulations, state and federal rules, and minimally meet expectations/ requirements contained in applicable Department of Children and Families and managing entity operating procedures. (30) The network provider shall maintain a mechanism for monitoring, updating, and disseminating policies and procedures regarding compliance with current government laws, rules, practices, regulations, and the ME's policies and procedures. (31) The network provider shall meet with the ME's staff at regularly scheduled or specially called meetings when notified by the ME. (32) The network provider shall assist the managing entity in the reporting and managing of the Substance Abuse and Mental Health Waiting List for all levels of care. (33)The network provider shall implement and maintain fiscal operational procedures. These shall contain but, not be limited to procedures relating to overpayments, charge -backs that directly apply to subcontractors and documentation of cost sharing (match) that comply with state and federal rules, regulations and /or Managing Entity policies and procedures. (34) The network provider shall meet the standards for timely access to care along the lines of those required by ME, accrediting bodies and the Medicaid prepaid plans as identified below: i. Immediate /Crisis: seen immediately for life behavioral health life threatening emergencies ii. Within 24 hours of initial contact for non -life threatening emergencies; iii. Within 48 hours for urgent care; iv. The offer of an appointment for routine care within 7 business days. Non - compliance with timely access to care for services terms will result in a corrective action. Guidance Care Center, Inc. 33 Contract No. ME225 -3 -27 07/01/2012 (35)The network provider will promote personal self- determination and choice by: i. Ensuring that the needs and preferences of consumers and their families drive treatment planning and service delivery, and that consumers and their families (with consent) are involved in all aspects of treatment (pre, during and post); ii. Engaging service recipients, family members, and advocates in the design, development, and evaluation of services; iii. Giving consumers a choice of provider and services, whenever possible; iv. Assessing and improving consumer satisfaction. (36)The network provider shall develop and assure the delivery of services based on Evidence -Based Practices /Promising Practices Guidelines in accordance with the approved Program Description. (37) The network provider shall ensure access to services that meet linguistic and cultural needs of recipients. (38) The network provider agrees to provide sign language, translation, and interpretive services required to meet the communication needs of service recipients, including English, Spanish and Creole. Services will meet the cultural needs and preferences of the covered populations. (39) The network provider assures to engage in recruitment to maintain as much as possible staff with the ethnic and racial composition of the clients served. (40) If not already accredited, the network provider shall take appropriate steps to obtain /maintain national accreditation during state fiscal year 2012 -2013 in order to promote best practices and the highest quality of care. The network provider shall provide the ME with their full accreditation and licensing reports upon request. Providers whose contract or annual service reimbursement amount exceeds $35,000 but is less than $350,000 and serve more than three unrelated persons, must comply with the CARF Standards for Unaccredited Providers. (41)The network provider shall ensure provision of services to clients with special needs The network provider shall ensure the coordination of specialty services including employability skills training and linkage, victimization and trauma services, infant mental health services, the elderly, and services to families in recovery. The network provider shall also ensure the availability of appropriate services to consumers with special needs such as those who are blind, deaf or hard of hearing, developmentally disabled, physically handicap, criminally involved, or forensic clients. The managing entity reserves the right to modify this list as the needs of the consumers change. I. The network provider shall provide early diagnosis and treatment intervention to enhance recovery and prevent hospitalization. ii. The network provider agrees to comply with provisions of Exhibit J, Assisted Living Facilities With a Limited Mental Health License, if services to such Guidance Care Center, Inc. 34 Contract No. ME225 -3 -27 07/01/2012 residents are offered. iii. The network provider shall work with the ME, the state, and other stakeholders to reduce the admissions and the length of stay for dependent children and adults with mental illness in residential treatment services. (42) Develop and Disseminate Consumer Manual The network providers shall assist the ME in developing and maintaining a manual for service recipients which includes information about access procedures, recipient rights and responsibilities (including grievance and appeal procedures). This information will be available for use by the consumers within each subcontractor location. (43) Work and Social Opportunities The network provider will employ Peer Services Coordinators to develop work and social opportunities for clients and make recommendations to the ME and subcontractors for a consumer- driven system. (44) Assist Stakeholder Involvement in Planning, Evaluation, and Service Delivery Participate in Planning: At the ME's request, the network provider will assist the managing entity in engaging local stakeholders, per section 394.9082 F.S., in its support activities for the Department's local plans and in the development of its Annual Action Plan. (45) Develop, Maintain and Improve Reporting The network provider shall submit reports included in Exhibit C, Required Reports. In all cases, the delivery of reports, ad hoc or scheduled, shall not be construed to mean acceptance of those reports. Acceptance, in writing, of required reports shall constitute a separate act and shall be approved by the managing entitys contract manager. The managing entity reserves the right to reject reports as incomplete, inadequate or unacceptable. (46) The network provider shall provide prevention services as outlined in 65D- 30.013, F.A.C., and in accordance with this contract, the program description and Attachment V, Prevention Services. (47)The prevention services network provider shall ensure that a PPT is contained in the Performance Based Prevention System. The "final" PPT shall be printed from PBPS and sent to the managing entity's contract manager for approval within 30 days of contract execution. The managing entity shall review and approve the Prevention Program Tool (PPT). (48)The network provider shall ensure that Prevention Program Coordinators and any other personnel responsible for entering data into the Prevention data system, including subcontractors who upload data from their own system, must register and complete training on use of the PPT at least annually. (49)The network provider contracted for HIV Early Intervention Services will designate a representative to participate in the local Department of Health HIV /AIDS planning body's meetings. The network provider shall ensure participation in a minimum of 50% of the Guidance Care Center, Inc. 35 Contract No. ME225 -3 -27 07/01/2012 meetings involving community service partners. (50)Network providers shall collaborate with the local community substance abuse coalitions (where available) to help develop and support capacity to address community substance abuse needs. Activities shall be specified in the Prevention Activities Exhibit, which is incorporated herein by reference, and as specified in the approved annual action plan. (51) Based on the most recent local community anti -drug coalitions' action plan or the most recent county Substance Abuse epidemiology data, the network provider agrees to administer and deliver appropriate evidence -based strategies and approaches as specified in the Program Description required by Rule 65E- 14.021, F.A.C., and is on file in the ME contract manager's file and incorporated herein by reference. (52) Client Satisfaction Survey The network providers shall conduct client satisfaction surveys as per DCF PAM 155 -2. Failing to provide the required number of satisfaction surveys will result in a corrective action. (53) Forensic Service Program The network provider will be responsible for ensuring the provision of mental health, substance abuse and ancillary services to individuals charged with felony offenses and have been committed or may be at risk of commitment to the Department of Children and Families, pursuant to chapter 916, F. S. The network provider will participate in a comprehensive forensic program that meets all requirements of chapter 916, F.S., Forensic Client Services Act, the Forensic Mental Health Services Exhibit and established forensic performance measures. (a) All individuals referred for admission to short -term residential treatment facility (SRT) by the ME's SAMH Forensic Coordinator and /or Forensic Specialists shall be granted an on -site face -to -face interview with 72 hours of referral. Written findings and recommendations must be completed and submitted to the referral source and the regional forensic coordinator. (b) All individuals referred for admission to a residential treatment facility by the ME's SAMH Forensic Coordinator and /or Forensic Specialists will be granted an on -site face - to -face interview within a minimum of 72 hours of referral, if individuals reside within Miami -Dade, Monroe and Broward County. For individuals who are referred for admission and who live outside of the above referenced counties, the network provider shall coordinate the interview date for the client with the Forensic Specialist and /or ME's SAMH Forensic Coordinator. The network provider must submit written findings and recommendations to the referral source and the ME's SAMH Forensic Coordinator within 48 hours of client interview. (c) The community case manager will coordinate services and provide the court with routine progress reports as required by the conditional release order Rule 65E- 15.051(14), F.A.C. The Forensic Specialist may accompany the case manager to all court hearings regarding individuals on conditional release. (d) The community case manager will consult with the Forensic Specialist regarding any apparent conditional release violation. Network Provider staff will be responsible for Guidance Care Center, Inc. 36 Contract No. ME225 -3 -27 07/01/2012 notifying the court and the Forensic Specialist of any conditional release violations via affidavit or sworn statement per s. 916.17(2), F.S. (e) The network provider will not return individuals on conditional release to court prior to consultation with the ME's Forensic Coordinator and /or assigned Forensic Specialist, except in cases of physical aggression by the individual in question. (f) Programs must provide services in English, Spanish and Creole. (g) Conditional Release Monitoring —The network provider will ensure that individuals on conditional release order in Dade and Monroe Counties, including individuals transferred into the counties from other circuits are monitored. i. The network provider will ensure that individuals on conditional release order are monitored in accordance with the requirements of Rule 65E -15. F.A.C., Continuity of Care Case Management and the court order to ensure compliance with the order and department rules. ii. The network provider will ensure the committing court is immediately notified by phone and in writing of any deviations from the conditional release order. The network provider will ensure the ME SAMH Forensic Coordinator is copied on written correspondence to the court. iii. The network provider will ensure the review of required monthly monitoring reports in order to intervene in problematic situations, to provide alternative treatment modalities when necessary, and to identify trends and issues that illustrate opportunities for improvement in service delivery. The network provider will bring the aforementioned situations, trends and issues to the immediate attention of the ME SAMH Forensic Coordinator. iv. The network provider will ensure the distribution of copies of conditional release orders and modifications to the agency providing mental health and substance abuse services to the individual and to the SAMH Regional and Headquarters Office in Tallahassee. (h) Utilization Management The network provider shall facilitate the Forensic Specialists' requirement to manage the residential treatment beds funded by community forensic dollars in Circuit 11 and the statewide community forensic beds located in Circuits 11 & 17. This includes a short - term residential treatment facility and residential level 2 beds. The network provider will be responsible for managing the appropriate utilization of community forensic residential treatment beds. (54) Projects for Assistance in Transition from Homelessness (PATH) (a) The network provider shall submit an annual PATH application to the Mental Health Program Office as requested. (b) The network provider shall provide support services for individuals who have a serious mental illness and /or substance abuse and are homeless or at imminent risk of becoming homeless. (c) The network provider shall implement services and provide deliverables as set forth and described in each approved and signed Local Intended Use Application which is Guidance Care Center, Inc. 37 Contract No. ME225 -3 -27 07/01/2012 a requirement of the PATH grant application. (d) Eligible PATH local matching funds must be expended in the provision of PATH eligible services to PATH eligible persons. The expenditures must match the types of services outlined in the Local Intended Use Plan. The formula to be followed is cited in Section 524 of the Public Health Services Act, as amended by Public Law 101 -645. (e) The network provider will complete PATH activities as follows: (I) Submit Annual Data Report to SAMHSA (ii) Submit the Annual reapplication for the PATH Grant (55)Children's Mental Health Services, including services for Severely Emotionally Disturbed Children, Emotionally Disturbed Children and their Families (i) The key strategic objectives and strategies that support the department's mission and direct the provision of services to Florida's residents are detailed in the Substance Abuse and Mental Health Services Plan 2010 -2013, which is incorporated herein by reference. They represent the primary focus of the Substance Abuse and Mental Health programs, and it is expected that the network provider will ensure adherence to them, including but not limited to the following: (a) Ensure that families and youth are full partners in the development and implementation of individual recovery plans and have a prominent voice in designing supports and services. (b) Prioritize services and supports for children who are involved with the child welfare and juvenile justice systems. Within these priority groups, children birth to five years of age, youth transitioning to adulthood and children at risk of residential treatment are the focus of specific activities and initiatives. System transformation is the driving force for current and future activities, with an emphasis on evidence based practices that are culturally competent, focused on prevention, early identification and intervention, and fam ily- centered. (c) Ensure that services and supports for children, youth, and families are sensitive to the impact of trauma, and are designed to address treatment issues and minimize system elements that might produce further trauma. (d) Address the critical need for better information, planning, and assistance for eligible children transitioning into the adult mental health system. (e) Develop coordinated systems of care for children that provide services and supports that promote recovery and resiliency by being: (i) Community -based (ii) Culturally competent (iii) Strength -based (iv) Evidenced -based practices for children and adolescents - including Multi- systemic Therapy for children and youth with or at risk of juvenile justice involvement, Therapeutic Foster Care, Family Support and Education, Cognitive Behavioral Therapy for Guidance Care Center, Inc. 38 Contract No. ME225 -3 -27 07/01/2012 traumatic stress, Dyadic Therapy for infants and toddlers, and the Wraparound Approach. (v) Individualized, child focused, and family directed. (vi) Inclusive of early intervention with the child and family. (vii) Coordinated across agencies and time lines (f) The managing entity will agree to ensure that its subcontractors provide a full continuum of services to address the needs of Severely Emotionally Disturbed Children, Emotionally Disturbed Children and their Families. These services must include but not be limited to: (f) Dyadic Therapy for children under 5, (ii) Behavior Analysis services for children with behavior problems, (iii) Life skills and Wellness Recovery Action Plan services to children transitioning to the adult system. b. Task Limits The network provider shall perform services in accordance with applicable, rules, statutes, licensing standards and policies and procedures. Services shall only be provided in the Southern Region (Miami -Dade and Monroe Counties), with the exception of clients residing in state hospitals, or Short -Term Residential Treatment programs that are Southern Region clients, or by exception with approval by the department through the ME. The network provider agrees to abide by the approved Program Description, and is not authorized by the ME to perform any tasks related to the project other than those described in the approved Program Description and in this contract, without the express written consent of the ME. If applicable, the network provider, with managing entity written approval, may unbundle Medical Services from the Substance Abuse Residential Levels II, Ill, and IV cost centers for clients with co- occurring disorders, unbundle Psychological Evaluations from the Children's Mental Health Residential Levels I and II, and unbundle Psychological Evaluations from the Children's Substance Abuse Residential Levels II, III, and IV cost centers. The network provider shall ensure that services are performed in accordance with applicable rules, statutes, and licensing standards. 2. Staffing Requirements a. Staffing Levels (1) The network provider shall maintain staffing levels in compliance with applicable rules, statutes, licensing standards and policies and procedures. See Exhibit F, Minimum Service Requirements. (2) The network provider shall engage in recruitment to maintain as much as possible staff with the ethnic and racial composition of the clients served. b. Professional Qualifications (1) The network provider shall comply with applicable rules, statutes, requirements, and standards Guidance Care Center, Inc. 39 Contract No. ME225 -3 -27 07/01/2012 with regard to professional qualifications. See Exhibit F, Minimum Service Requirements. (2) The network provider shall provide employment screening for all mental health personnel and all owners, directors, and chief financial officers of service network providers using the standards for Level II screening set forth in Chapter 435, and s. 408.809 F.S., except as otherwise specified in s. 394.4572(1)(b) -(c), F.S. For the purposes of this contract, "Mental health personnel" includes all program directors, professional clinicians, staff members, and volunteers working in public or private mental health programs and facilities who have direct contact with individuals held for examination or admitted for mental health treatment. Additionally, the network provider shall provide employment screening for substance abuse personnel using the standards set forth in Chapter 397, F.S. This includes all owners, directors, and chief financial officers of service network providers and all service network provider personnel who have direct contact with children receiving services or with adults who are developmentally disabled receiving services. c. Staffing Changes The network provider shall notify the ME's contract manager, in writing within (10) calendar days of staffing changes regarding the positions of Chief Executive Officer, Chief Financial Officer, Medical Director, and Clinical Director. Additionally, the network provider will notify the ME's contract manager in writing, of changes in the Executive Director or any senior management position. d. Subcontractors (1) This contract allows the network provider to subcontract for the provision of all services, subject to the provisions of, but not limited to, Section 12. of the Standard Contract. Written requests by the network provider to subcontract for the provision of services under this contract will be routed through the ME's contract manager for approval. The ME is not obligated nor will it pay for any services delivered prior to its written approval of the act of subcontracting. The act of subcontracting shall not in any way relieve the provider of any responsibility for the contractual obligations of this contract. (2) The network provider shall implement and maintain procedures for subcontract procurement, development, performance, and management that comply with state and federal rules, regulation, and /or Managing Entity policies and procedures, in addition to identifying the managing entity's pre- approval process for approving the network providers act of subcontracting. (3) The network provider shall maintain individual subcontractor files for each subcontractor and provide a copy of all subcontracts prior to the execution of those subcontracts and any amendments to the managing entity's contract manager. (4) The network provider shall not subcontract for substance abuse /mental health services with any person or entity which: (a) is barred, suspended, or otherwise prohibited from doing business with any government entity, or has been barred, suspended, or otherwise prohibited from doing business with any government entity within the last 5 years; (b) is under investigation or indictment for criminal conduct, or has been convicted of any crime which would adversely reflect on their ability to provide services, or which adversely reflects their ability to properly handle public funds; (c) is currently involved, or has been involved within the last 5 years, with any litigation, Guidance Care Center, Inc. 40 Contract No. ME225 -3 -27 07/01/2012 regardless of whether as a plaintiff or defendant, which might pose a conflict of interest to the department, the state or its subdivisions, or a federal entity providing funds to the department; (d) had a contract terminated by the department or ME for failure to satisfactorily perform or for cause; or, (e) failed to implement a corrective action plan approved to the satisfaction of the managing entity, the department, and other governmental entities, after having received due notice. (5) All subcontract agreements shall adopt the applicable terms and conditions of the network provider's contract with the ME, which is incorporated herein by reference. Subcontract agreements shall include a detailed scope of work; clear and specific deliverables; and performance standards. The subcontractors will be required to follow the network provider's and the ME's Policies and Procedures, and Contract, which is incorporated herein by reference and may be found on the ME's website www.sfbhn.org. (6) Unless the Department agrees to an alternative payment method as authorized in section 394.9082, F.S., and prior to entering into any subcontract, or an amendment which modifies the previously negotiated unit cost rate or adds additional cost centers, the network provider shall conduct a cost analysis for said subcontract, in accordance with Rule 65E- 14.021, F.A.C.. A cost analysis is the review of the proposed cost elements to determine if they are necessary, allowable, appropriate and reasonable. Subcontractors will be required to comply with Rule 65E- 14.021, F.A.C., Unit Cost Method of Payment, including but not limited to, cost centers, unit measurements, descriptions, program areas, data elements, maximum unit cost rates, required fiscal reports, program description, setting unit cost rates, payment for services including allowable and unallowable units and requests for payments. (7) The United States Public Health Service Act, Sections 1931(a)(1)(E), and 1916 (a)(5), and Title 45 of the Code of Federal Regulations, Part 96.135(a)(5) prohibit States from expending Substance Abuse Prevention and Treatment Block Grant (SAPTBG) and Community Mental Health Services funds `To provide financial assistance to any entity other than a public or non - profit private entity". Ordinarily, the term "financial assistance" is used to describe a grant relationship as distinguished from a procurement relationship, typically funded by contract. While the above - referenced statute and regulations preclude States from providing grants to for - profit entities, procurement contracts may be entered into with for - profit entities. This is the latest interpretation from the United States Department of Health and Human Services Substance Abuse and Mental Health Services Administration (4/5/2009). [PHS Act, ss. 1931(a)(1)(E), and 1916 (a)(5), and 45 CFR, Part 96.135(a)(5)] Additional guidance for contracting SAPTBG funds can be obtained in the SAMH Funding Restrictions Guide at the following website: http: / /www.dcf.state.fL ustmentalhealth /publications /samhfund.doc (8) The network provider shall monitor the performance of all subcontractors and perform follow up actions as necessary. The network provider shall notify the managing entity within 48 hours of conditions related to subcontractor performance that could impair continued service delivery. 3. Service Location and Equipment a. Service Delivery Location The location of services will be as specified in the approved Program Description required by Rule 65E- 14.021(8)(d)1.d.(III), F.A.C. b. Service Times (1) A continuum of services shall be provided on the days and times as specified in the approved Program Description. Guidance Care Center, Inc. 41 Contract No. ME225 -3 -27 07/01/2012 (2) The network provider shall notify the ME's contract manager, in writing, at least ten (10) calendar days prior to any changes in days and times where services are being provided pursuant to Rule 65E- 14.021(8)(d)5., F.A.C. c. Changes In Location The network provider shall notify the ME's contract manager, in writing, at least ten (10) calendar days prior to any changes in location where services are being provided pursuant to Rule 65E- 14.021(8)(d)d(III), F.A.C. d. Equipment The network provider shall furnish all appropriate equipment necessary for the effective delivery of the services purchased. In the event that the network provider is allowed to purchase any non - expendable property with funds under this contract, the network provider will ensure compliance with the Tangible Property Requirements, Department operating Policies and Procedures as outlined in CFOP 40 -5, CFOP 80 -2, Rule 65E -14, F.A.C., which are incorporated herein by reference and may be obtained from the ME's contract manager. The provider shall submit an inventory report, as specified in Exhibit K, Network Provider Inventory List and by the date(s) listed in Exhibit C, Required Reports. 4. Deliverables a. Services The network provider shall deliver the services specified in and described in the Program Description submitted by the network provider and as set forth in Exhibit G, State Funding by Program and Activity. b. Records And Documentation The network provider shall protect confidential records from disclosure and protect client confidentiality in accordance with ss. 397.501(7), 394.455(3), 394.4615, and 414.295, F.S., and also the Health Insurance Portability and Accountability Act (HIPAA), and any other applicable State, and Federal laws, rules, and regulations. c. Reports Where this contract requires the delivery of reports to the managing entity, mere receipt by the managing entity shall not be construed to mean or imply acceptance of those reports. It is specifically intended by the parties that acceptance of required reports shall require a separate act in writing. The managing entity reserves the right to reject reports as incomplete, inadequate, or unacceptable according to the parameters set forth in the resulting contract. The managing entity, at its option, may allow additional time within which the network provider may remedy the objections noted by the managing entity or the managing entity may, after having given the network provider a reasonable opportunity to comply with the report requirements, declare this agreement to be in default. (1) The network provider shall submit to the M E financial and programmatic reports specified in Exhibit C, Required Reports, by the dates specified. (2) The network provider shall ensure that its audit report will include the standard schedules that are outlined in Rule 65E- 14.003, F.A.C. Guidance Care Center, Inc. 42 Contract No. ME225 -3 -27 07/01/2012 (3) All children's mental health network providers shall complete a typed quarterly progress report, as specified in Exhibit M, Child Welfare Quarterly Clinical Report, that is filed in the medical record. The network provider is required to provide Children and Families or Community Based Care workers, immediately upon request, with the most recent quarterly written report detailing the progress, current status and therapeutic needs of the named child. (4) The network provider shall submit treatment data, as set out in subsection 394.74(3) (e), F.S. and Rule 65E- 14.022, F.A.C., and DCF PAM 155 -2. (5) In addition to the modifiers to procedure codes that are currently required to be utilized as per DCF PAM 155 -2, Appendix 2, the network provider is directed to utilize the following modifiers required for services funded by the following sources, where applicable: Panel Approved Code Short Description 10 27CHV - Children IV 11 27HIV -IV Drug Usage 12 27WOM- Services to Women 15 CFBAS-Comm unity Forensic Beds 18 GX018 -PATH (6) Service Provision Requirements for Substance Abuse Prevention and Treatment Block Grants (a) The network provider agrees to comply with the data submission requirements outlined in DCF PAM 155 -2 and with the funding restrictions outlined in "SAMH OCA's And Funding Restrictions" which can be found at: http: / /www.dcf.state.fl.us/ programs /samh /contractingMore.shtml and which are incorporated herein by reference. For services (b) In addition to the modifiers to procedure codes that are currently required to be utilized as per DCF PAM 155 -2, Appendix 2, the network provider is directed to utilize the following modifiers required for Block Grant funds, where applicable: Panel Approved Code Short Description 10 27CHV - Children IV 11 27HIV -IV Drug Usage 12 27WOM- Services to Women (c) The network provider agrees to comply with applicable data submission requirements outlined in Exhibit C, Required Reports. This exhibit lists required annual reports for SAPTBG set -aside funded pregnant women and women with dependent children services, SAPTBG set -aside funded HIV Early Intervention Programs, and the SAPTBG for Evidenced -based Outreach Services to Injection Drug Users. (d) The network provider shall make available, either directly or by arrangement with others, tuberculosis services to include counseling, testing, and referral for evaluation and treatment. (e) The network provider shall use SAPTBG funds provided under this contract to support both substance abuse treatment services and appropriate co- occurring disorder treatment services for individuals with a co- occurring mental disorder only if the funds allocated are used to support substance abuse prevention and treatment services and are tracked to the specific substance abuse activity as listed in Exhibit G, State Funding by Program and Activity. Guidance Care Center, Inc. 43 Contract No. ME225 -3 -27 07/01/2012 (f) The network provider is required to participate in the peer -based fidelity assessment process to assess the quality, appropriateness, and efficacy of treatment services provided to individuals under this contract pursuant to 45 CFR 96.136. (7) Data for services shall be submitted electronically to the ME by the 8th of each month into the Knight Information Software database (KIS). In addition, the network provider will submit data on prevention activities in the Performance Based Prevention System (PBPS) by the 8th of each month following the month of service. The network provider shall also: (a) Ensure that the data submitted clearly documents all client admissions and discharges which occurred under this contract; (b) Ensure that all data submitted to the KIS is consistent with the data maintained in the network provider's clients' files; (c) Review the managing entity's File Upload History screen in SAMHIS to determine the number of records accepted, updated and rejected. Based on this review, the network provider shall download any associated error files to determine which client records were rejected and to make sure that the rejected records are corrected and resubmitted in the KIS; (d) Resubmit corrected records no later than the next monthly submission deadline. The failure to submit any data set or the network provider's total monthly submission per data set, which results in a rejection rate of 10% or higher of the number of monthly records submitted will require the network provider to submit a corrective action plan describing how and when the missing data will be submitted or how and when the rejected records will be corrected and resubmitted; and (e) In accordance with the provisions of section 402.73(1), F. S., and Rule 65- 29.001, F.A.C., corrective action plans may be required for non - compliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed for failures to implement or to make acceptable progress on such corrective action plans. Failure to implement corrective action plans to the satisfaction of the Managing Entity and after receiving due notice, shall be grounds for contract termination. (8) In addition to utilizing the modifiers to procedure codes for block grant funds identified in paragraph 4.(6) (b) above, the network provider, upon request by the Managing Entity or the Department, shall submit information regarding the amount and number of services paid for by the Community Mental Health Services Block Grant and /or the Substance Abuse Prevention and Treatment Block Grant. (9) A facility designated as a public receiving or treatment facility under this contract shall report the following Payor Class data to the ME, unless such data are currently being submitted into KIS. Public receiving or treatment facilities that do not submit data into KIS, shall report these data annually as specified in Exhibit C, Required Reports, even if such data are currently being submitted to the Agency for Health Care Administration: (a) Number of licensed beds available by payor class; (b) Number of contract days by payor class; (c) Number of persons served (unduplicated) in program by payor class and diagnoses; (d) Number of utilized bed days by payor class; Guidance Care Center, Inc. 44 Contract No. ME225 -3 -27 07/01/2012 (e) Average length of stay by payor class; and (f) Total revenues by payor class. (10)The network provider shall obtain the format and directions for submitting Payor Class data from the managing entity. (11)The network provider shall submit Payor Class data to the managing entity no later than 90 days following the end of the facility's fiscal year. 5. Performance Specifications a. Performance Measures (1) The network provider shall meet the performance standards and required outcomes as specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes/Outputs. (2) The network provider agrees that the Knight Information Software (KIS) Data System and SAMHIS will be the source for all data used to determine compliance with performance standards and outcomes in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes/Outputs or other data system as specified by the Managing Entity. Any conflicts will be clarified by the Managing Entity and the network provider shall adhere to the Managing Entity's resolution. The network provider shall submit all service related data for clients funded in whole or in part by SAMH funds, local match, or Medicaid. (3) The network provider agrees that the Performance Based Prevention System (PBPS) will be the source for all data used to determine compliance with substance abuse prevention related performance standards and outcomes in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes/Outputs or other data system specified by the Managing Entity. The network provider shall submit all service related data for clients funded, in whole or in part, by SAMH funds. (4) The network provider shall ensure that the Prevention Program Coordinator and any other personnel responsible for directly entering data into the Prevention data system register for data entry training on PBPS and complete online or face -to -face training within thirty (30) days of hire, and annually thereafter. The network providers shall maintain the certificate of attendance for all participants for all trainings. This does not apply to network providers who have their own data system and upload data to PBPS. (5) In addition to the performance standards and required outcomes specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs, the network provider shall meet requirements set forth in Section D. 10. Special Provisions, Performance Measures for Continuous Quality Improvement Programs, and Attachment V, Prevention Services. b. Performance Measurement Terms DCF PAM 155 -2 provides the definitions of the data elements used for various performance measures which are quantitative indicators, outcomes, and outputs used by the managing entity to objectively measure a network provider's performance, and contains policies and procedures for submitting the required data. KIT Solutions maintains the procedures for submitting the required prevention data into PBPS. c. Performance Evaluation Methodology Guidance Care Center, Inc. 45 Contract No. ME225 -3 -27 07/01/2012 (1) The network provider shall collect information and submit performance data and individual client outcomes, to the managing entity data system in compliance with DCF PAM 155 -2 requirements. The specific methodologies for each performance measure may be found at the following website: http : / /dashboard.dcf.state.fl.us (2) The network provider is expected to have the capability to engage in organized performance improvement activities, and to be able to participate in partnership with the department and ME in performance improvement projects that are related to system wide transformation and improvement of services for individuals and families. (3) By execution of this contract the network provider hereby acknowledges and agrees that its performance under the contract must meet the standards set forth above and will be bound by the conditions set forth in this contract. If the network provider fails to meet these standards, the ME, at its exclusive option, may allow a reasonable period, not to exceed six (6) months, for the network provider to correct performance deficiencies. If performance deficiencies are not resolved to the satisfaction of the ME within the prescribed time, and if no extenuating circumstances can be documented by the network provider to the ME's satisfaction, the ME must terminate the contract. The ME has the sole authority to determine whether there are extenuating or mitigating circumstances. (4) The ME will monitor the standards and outcomes specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes/Outputs, in Section D. 10. Performance Measures for Continuous Quality Improvement Programs, and in Attachment V, Prevention Services, during the contract period, to determine if the network provider is achieving the levels that are specified. (5) Performance data information may be found on the department's web -based performance Dashboard at: http:/ /dcfdashboard.dcf.state.fl.us /. Additional prevention data information may be found on the Exhibit D Report which is transmitted to the ME Director of Prevention Services monthly. 6. Network Provider Responsibilities a. Network Provider Unique Activities (1) The network provider is responsible for the satisfactory performance of the tasks referenced inf this contract. By executing this contract, the network provider recognizes its responsibility for the tasks, activities, and deliverables described herein and warrants that it has fully informed itself of all relevant factors affecting the accomplishment of the tasks, activities and deliverables and agrees to be fully accountable for the performance thereof whether performed by the network provider or its subcontractors. (2) The network provider agrees that services other than those set out in this contract will be provided only upon receipt of a written authorization from the managing entity's contract manager or an authorized managing entity staff member. The department through the managing entity, has final authority to make any and all determinations that affect the health safety and well- being of the residents of the State of Florida. (3) The network provider shall ensure that the invoices submitted to the ME reconcile with the amount of funding and services specified in this contract, as well as the network provider's agency audit report and client information system. (4) The network provider shall comply with all other applicable federal laws, state statutes and associated administrative rules as may be promulgated or amended. See Exhibit F, Minimum Service Requirements. Guidance Care Center, Inc. 46 Contract No. ME225 -3 -27 07/01/2012 (5) Pursuant to s. 394.74(3)(e), F.S., the network provider shall maintain data on the performance standards specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs, for the types of services provided under this contract and maintain data specified in Attachment V, Prevention Services, for the types of prevention strategies under this contract. The network provider shall submit such data to the ME upon request. (6) A network provider that receives federal block grant funds from the Substance Abuse Prevention and Treatment or Community Mental Health Block Grants agrees to comply with Subparts I and II of Part B of Title XIX of the Public Health Service Act, s. 42 U.S.C. 300x -21 et seq. (as approved September 22, 2000) and the Health and Human Services (HHS) Block Grant regulations (45 CFR Part 96). (7) A network provider that receives funding from the SAPTBG certifies compliance with all of the requirements of the Substance Abuse and Mental Health Services Administration (SAMHSA) Charitable Choice provisions and the implementing regulations of 42 CFR54a. (8) The network provider shall be engaged in performance improvement activities to improve its ability to recognize accurate prevalence of co- occurring disorders in its data system. (9) If required by 45 CFR Parts 160, 162, or 164; the following provisions shall apply [45 CFR 164.504(e)(2)(ii)]: (a) The network provider hereby agrees not to use or disclose protected health information (PHI) except as permitted or required by this contract, state or federal law. (b) The network provider agrees to use appropriate safeguards, secure methods, and security measures to prevent use or disclosure of PHI other than as provided for by this contract or applicable law. This applies to all manual and electronic data. (c) The network provider agrees to report to the Department any use or disclosure of the information not provided for by this contract or applicable law. (d) The network provider hereby assures the Department and the Managing Entity that if any PHI received from the Department or the Managing Entity, or received by the network provider on the Department's or the Managing Entity's behalf, is furnished to network provider's subcontractors or agents in the performance of tasks required by this contract, that those subcontractors or agents must first have agreed to the same restrictions and conditions that apply to the network provider with respect to such information. (e) The network provider agrees to make PHI available in accordance with 45 C.F.R. 164.524. (f) The network provider agrees to make PHI available for amendment and to incorporate any amendments to PHI in accordance with 45 C.F.R. 164.526. (g) The network provider agrees to make available the information required to provide an accounting of disclosures in accordance with 45 C.F.R. 164.528. (h) The network provider agrees to make its internal practices, books and records relating to the use and disclosure of PHI received from the Department or the Managing Entity or created or received by the network provider on behalf of the Department or the Managing Entity available for purposes of determining the network provider's compliance with these assurances. (i) The network provider agrees that at the termination of this contract, if feasible and where not inconsistent with other provisions of this contract concerning record retention, it will return or Guidance Care Center, Inc. 47 Contract No. ME225 -3 -27 07/01/2012 destroy all PHI received from the Department or Managing Entity or received by the network provider on behalf of the department that the network provider still maintains regardless of form. If not feasible, the protections of this contract are hereby extended to that PHI which may then be used only for such purposes as make the return or destruction infeasible. (j) A violation or breach of any of these assurances shall constitute a material breach of this contract. (10) The network provider shall provide performance information or reports other than those required by this agreement at the request of the ME, the Southern Region's SAMH Regional Director, or their designee. For requests that are complex and difficult to address, all parties will develop and implement a mutually viable work plan. (11) The network provider shall cooperate with the ME and the Department when investigations are conducted regarding a regulatory complaint of the network provider. (12) The network provider shall make available and communicate all plans, policies, procedures, and manuals to the ME staff, network provider staff, and to clients /stakeholders if applicable. (13) The network provider shall be responsible for the fiscal integrity of all funds under this contract, and for demonstrating that a comprehensive audit and tracking system exists to account for funding by client, , and have the ability to provide an audit trail. Maximize all potential sources of revenue to increase services, and institute efficiencies that will consolidate infrastructure and management functions in order to maximize funding, (14) The network provider will have a data system in place that adequately supports the collection, tracking, and analysis of data necessary to perform utilization management activities, reviews of clinical /administrative performance related to levels of care, clinical outcomes, and adherence to clinical /administrative standards. (15) The network provider shall make available to the ME all evaluations, assessments, surveys, monitoring or other reports and any corrective action plans, pertaining to outside licensure, accreditation, or other reviews conducted by funding entities or others and received from such other entities within ten (10) days of receipt by network provider. (16) The network provider shall maintain human resource policies and procedures that provide safeguards to ensure compliance with laws, rules and regulations. Integrate current and /or new state /federal requirements and policy initiatives into its operations upon provision by the Department and ME of the same. (17) The network provider shall assist the ME and the Department in developing legislative budget requests based upon identified needs of the community. (18) The network provider shall make available source documentation of units billed by network provider upon request from the ME staff. (19) Client Trust Funds (CTF) (a) The network provider shall submit a letter to the contract manager certifying that they either are or are not the representative payee for Supplemental Security Income, Social Security Administration, Veterans Administration, or other federal benefits on behalf of a client within thirty (30) days of contract/amendment execution or by July 15th of each fiscal year. (b) If the network provider is the representative payee for Supplemental Security Income, Social Security Administration, Veterans Administration, or other federal benefits on behalf of the client, the network provider shall comply with the applicable federal laws including the Guidance Care Center, Inc. 48 Contract No. ME225 -3 -27 07/01/2012 establishment and management of individual client trust accounts (20 CFR 416 and 31 CFR 240). (Circuits may delete paragraphs (b) —(d) if not applicable.) (c) Any network provider assuming responsibility for administration of the personal property and /or funds of clients shall follow the Department's Accounting Procedures Manual 7 APM, 6, Volume 7, incorporated herein by reference. Department or the ME personnel or their designees upon request may review all records relating to this section. Any shortages of client funds that are attributable to the network provider shall be repaid, plus applicable interest, within one (1) week of the determination. (d) All reports specified in the Department's Accounting Procedures Manual 7 APM, 6, Volume 7 shall be maintained onsite and available for review by Department or ME staff, and shall be submitted to the ME upon request. (e) The network provider shall also maintain and submit documentation of all payment/fees received on behalf of SAMH clients receiving Supplemental Security Income, Social Security Administration, Veterans Administration, or other federal benefits upon request from the ME. (20) The network provider agrees to comply with Exhibit N, Missing Children, if the network provider is providing services to children where the care of the child is assigned to the Department or network provider. (21) Upon request, the ME will assist with the development and implementation of client admission, continued stay, discharge criteria specific to each level of care, diagnosis, presenting problems, and the establishment of review dates. b. Coordination with other Providers/Entities • (1) The network provider shall develop, maintain, and improve care coordination and integrated care systems as follows: i. Develop Initial Service Agreements (a) The network provider shall fulfill their designated role in implementing and /or maintaining a system of care in support of the cooperative agreements with the judicial system and the criminal justice system which define strategies and alternatives for diverting persons from the criminal justice system and address the provision of appropriate services to persons with substance abuse, mental health and /or co- occurring disorders who are involved with the criminal justice system, as specified in the approved annual action plan. These agreements address the provision of appropriate services to persons who have behavioral health problems and leave the criminal justice system. (b) The network provider agrees to fulfill their designated role in implementing and /or maintaining a system of care in support of the Southern Region's SAMH Program Office's - approved working agreement with the Department's contracted Community Based Care (CBC) providers. The intent of the working agreement is to establish a formal linkage of partnerships with a shared vision for improving outcomes for families involved in the child welfare system by providing integrated community support and services. (c) The network provider may be required to develop and implement cooperative agreements with other external stakeholders as described in the approved Annual Guidance Care Center, Inc. 49 Contract No. ME225 -3 -27 07/01/2012 Action Plan. (d) The network provider shall execute a memorandum of understanding with the local community substance abuse coalitions to help develop and support capacity to address community substance abuse needs. (2) Plan for Care Coordination (a) The network provider agrees to coordinate services with other providers and state entities rendering services to children, adults, and families as the need is identified by either the ME, the Department or as defined in the approved annual action plan. (b) When indicated by the ME, the network provider will ensure that substance abuse and /or mental health services are available to clients served by the Protective Investigators to support the principle of keeping children in the home whenever possible. (c) The network provider will make efforts to initiate and support local county implementation of the Medicaid Substance Abuse Local Match Program in order to expand community service capacity through draw down of Federal funding. (3) The failure of other providers or entities does not relieve the network provider of any accountability for tasks or services that the network provider is obligated to perform pursuant to this contract. c. Minimum Service Requirements See Exhibit F, Minimum Service Requirements. 7. Managing Entity Responsibilities a. Managing Entity Obligations (1) The managing entity will provide administrative and programmatic oversight to ensure that network providers comply with all consumer - related services and other requirements of this contract. (2) The network provider agrees that the managing entity is solely responsible for the oversight of the network provider and enforcement of all terms and conditions of this contract. Any and all enquiries and /or issues arising under this contract are to be brought solely and directly to the managing entity for consideration and resolution between the network provider and the managing entity. In any event, the managing entity's decision on all issues is final and solely subject to the managing entity's appeal process and legal rights of the network provider. (3) The managing entity is responsible for the administration, management, and oversight, and through subcontracts, the provision of behavioral health services in Miami -Dade and Monroe counties as stipulated in the Prime Contract, and in this contract. Prevention services designed to preclude the development and /or exacerbation of substance abuse problems and mental health disorders by addressing risk factors with adults, children and families and in the community at large are a part of the behavioral health services. Guidance Care Center, Inc. SO Contract No. ME225 -3 -27 07/01/2012 (4) The managing entity shall monitor and take action when necessary so that services which meet the standards defined herein will be provided throughout the contract period. (5) The ME will ensure that subcontractors use the GAIN, when appropriate, as the behavioral health assessment and placement tool for ages 12 and up in the Southern Region, or as otherwise specified in the approved annual action plan. b. Monitoring Requirements (1) The ME will monitor the network provider in accordance with this contract and the managing entitys Contract Monitoring Operating Procedures which can be obtained from the designated ME contract manager, and is incorporated herein by reference. The network provider shall comply with any coordination or documentation required by the managing entitys evaluator(s) to successfully evaluate the programs, and shall provide complete access to all budget and financial information related to services provided under this contract, regardless of the source of funds. (2) The ME will monitor the network provider on its performance of all tasks and special provisions of the contract. (3) The ME will provide a written report to the network provider within thirty (30) calendar days of the monitoring. If the report indicates corrective action is necessary, the network provider shall have ten (10) calendar days from receipt of the monitoring report to respond in writing to the request. In the sole discretion of the managing entity, if there is a threat to health, life, safety or well -being of clients, the ME may require immediate corrective action or take such other action as the ME deems appropriate. Failure to implement corrective action plans to the satisfaction of the Managing Entity and after receiving due notice, shall be grounds for contract termination. c. Training and Technical Assistance (1) The ME's contact manager, or designee, will provide training and technical assistance concerning the terms and conditions of this contract. (2)The ME will provide technical assistance and support to the network provider to ensure the continued integration of services and support for clients, to include but not limited to, quality improvement activities to implement evidenced -based practice treatment protocols, the application of process improvement methods to improve the coordination of access and services that are culturally and linguistically appropriate. (3) The managing entity will provide technical assistance and support to the network provider for the maintenance and reporting of data on the performance standards that are specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes /Outputs and in Attachment V, Substance Abuse Prevention Services. In addition, the ME may convene cross - organizational training and assistance to help non - accredited network providers become accredited. (4)The managing entity implements a training program for its staff and the network provider staff. The trainings assure that staff receives externally mandated and internal training. The managing entity may coordinate training or directly provide training to network provider staff. d. Review Compliance with Utilization Management Criteria (1) As part of the quality improvement program, the ME will provide or coordinate reviews of Guidance Care Center, Inc. 51 Contract No. ME225 -3 -27 07/01/2012 service compliance with criteria and practice guidelines, such as retrospective reviews to ensure the level of placement of clients is appropriate. The managing entity will take corrective action to resolve situations in which the subcontracted network provider is not following the guidelines or working to help the system meet its utilization goals. (2) Authorize Services (a)The ME shall conduct authorization and reauthorizations for applicable levels of care as described in the approved Annual Action Plan in order to ensure timely access to behavioral health services and eliminate the wait lists. The authorization processes includes: (1) Timeliness standards for authorization review must adhere to timelines standards referenced in Section B.1.a.(35) for the services provided and departmental, statutory, and judicial regulations or requirements. (ii) Processes for making the criteria on which decisions are made available to practitioners, including any standardized tools and assessments for use in determining placement and /or level of care. (iii) Provisions for providing timely appeals, or second opinions, when a request for authorization for a particular service is denied. (An appeal differs from a grievance in that grievances are used when a recipient or member of the covered population believes that he or she has been treated improperly, whereas an appeal is a request to review a judgment.) The second opinion shall be obtained according to the timeliness standards for the service in question. (3) The ME will participate in the collaborative development and implementation of the working agreement with the Community Based Care and substance abuse and mental health network providers to ensure the integration of services and support within the community. The ME will support the development and implementation of the working agreement by providing an example of a policy working agreement, system of care information, data reporting requirements and technical assistance. (4) The ME has the right to review the network provider's policies, procedures, and plans. Once reviewed by the managing entity, the policies and procedures may be amended provided that they conform to state and federal laws, the state Administrative Code, and federal regulations. Substantive amendments to submitted policies, procedures and plans shall be provided to the ME. (5) The managing entity may request supporting documentation and review source documentation of units billed to the managing entity. e. Managing Entity Determinations Through the Department, the ME has exclusive authority to make the following determination(s) and to set the procedures that the network provider shall follow in obtaining the required determination(s): Whether the network provider is meeting the terms and conditions of this contract, to include the Standard Contract, Attachment I, any documents incorporated into any attachment by reference, Program Description, and any documents incorporated by herein by reference. C. Method of Payment Exhibit B, Method of Payment Guidance Care Center, Inc. 52 Contract No. ME225 -3 -27 07/01/2012 Exhibit E -1 Substance Abuse and Mental Health Services Monthly Request for Non -TANF Payment /Advance Exhibit G, State Funding by Program and Activity Exhibit H, Funding Detail and Local Match D. Special Provisions 1. The network provider is expected to reduce its administration cost to 13% or less for Fiscal Year 2012 -2013 for SAMH services purchased under this contract. The cost savings shall be reallocated to support the increase of direct services. The network provider's Projected Cost Center Operating and Capital Budget shall evidence the reduction and redistribution of the cost savings. 2. The network provider shall adhere to the deliverables as set forth in Attachment V, Substance Abuse Prevention Services. 3. Renewals For prevention services awarded through the SFBHN Solicitation #003, Prevention Invitation to Negotiate, Prevention of Substance Abuse and Related Consequences, this contract may be renewed annually for period not to exceed three (3) years with a projected end date of June 30, 2015, subject to the availability of funds. Renewals for two (2) years and three (3) shall be made by mutual agreement and shall be contingent upon satisfactory performance, monitoring and evaluations as determined by SFBHN, subject to the availability of funds. Any renewal shall be in writing. 4. Utilization Management Program The network provider agrees to: (a) Utilize a transmittal system, which may be a computerized management information system, for submitting /receiving and recording information and documentation required as part of the Substance Abuse Utilization Management Program. (b) Request and receive an authorization number from the managing entity for all clients requiring admission into a substance abuse service prior to the client being admitted to the program for treatment. (c) Complete all required assessment components outlined in the SAUM Manual for all children /adolescent clients requiring substance abuse treatment services. The information will be submitted to the managing entity prior to the authorization request. (d) Participate and cooperate in the centralized waiting list in accordance with the waiting list policies and procedures outlined in the SAUM Manual. (e) Provide to the managing entity Treatment Plans within 30 days of admission, Treatment Plan reviews within 14 days, and a discharge summary within 5 days of discharge for all High - Risk /High Users as defined in the SAUM Manual. Treatment Plans and Discharge Summaries will comply with the requirements set forth in Rule 65D -30, F.A.C. 5. Waiting List and Interim Services In the event that waiting lists develop, the network provider will collaborate with the Managing Entity and community partners, to develop and implement procedures for managing the substance abuse and mental health waiting list for all applicable levels of care including provision of interim services. The authorization of services are specified in Section B. 7. Managing Entity Responsibilities. Guidance Care Center, Inc. 53 Contract No. ME225 -3 -27 07/01/2012 6. Prior - authorized client's Roster -Adult & Children's Substance Abuse Residential Level I & Level II. The network provider shall submit a request for reimbursement on the approved ME invoices found on Exhibit E -1 of this contract.. A listing of all prior- authorized clients served including, client name, client I.D. number, authorization number, and service period must be provided to support the invoice. This information must be submitted on Fxhibit P. Pre - Authorization Residential Utilization Management Roster, of this contract and attached to the approved Managing Entity's invoice, Exhibit E -1 as a prerequisite for payment. The network provider shall maintain back -up documentation for step -down services for a period of six (6) years from the expiration date of the contract per Section 7. of the Standard Contract. 7. Utilization Management Program (Adult & Children SAMH UM) (a) The Managing Entity will comply with and implement the policies and procedures of the District 11 Utilization Management Program, detailed in the 'Substance Abuse Utilization Management (SAUM) Policies and Procedures Manual, January 2004 - updated Edition' (or latest revised edition thereof). The network provider will comply with the policies and procedures of the District II Utilization Management Program, detailed in the `Substance Abuse Utilization Management (SAUM) Policies and Procedures Manual, January 2004 - updated Edition' (or latest revised edition thereof). The network provider will offer clients a multi- level continuum of care services for treatment of substance abuse. Each level of care has the following duration or length of stay: Cost Center Maximum Service Period Residential Level I & II Children (No more than 6 months) Residential Level I & II Adults (No more than 61 days or No more than 90 days for clients Identified as "high risk" by the Managing Entity) Residential Level 11 Families in Transition Program: Families & Pregnant Woman (No more than 5 months) Residential Level IV Adults and Children (No more than 3 months) Day /Night Adults and Children (No more than 3 months) Outpatient Adults and Children (No more than 6 months) (b) The network provider shall obtain written authorization from the ME prior to providing Residential Level I & II services. A written authorization will also be required, prior to the expiration of the initial length of stay, in order to extend Residential Level I & II services. The request for an extension must be justified in accordance with GAIN criteria and in accordance with the SAUM Policies and Procedures Manual. (c) Case management services may be provided to clients receiving residential services as a separate service pursuant to other terms and conditions in this contract. Post - residential clients may continue to receive case management services only if they are receiving outpatient or day -night services. (d) When a client has been provided residential services as a non - Managing Entity funded client (e.g. paid by insurance), that stay is subtracted from the prescribed length of stay should the client become eligible to receive network provider- funded services. (e) The managing entity will be responsible for managing the utilization of residential treatment beds funded by community forensic dollars in Circuit 11 and the statewide community forensic beds located in the Southern Region. This includes a short -term residential treatment facility Guidance Care Center, Inc. 54 Contract No. ME225 -3 -27 07/01/2012 and residential level 2 beds. The managing entity will be responsible for managing the appropriate utilization of community forensic residential treatment beds. 8. Adult System of Care Comprehensive Community Service Teams Case Management (CCST) (1) Adult System of Care Comprehensive Community Service Team (CCST) services must continue to provide Adult Mental Health Case Management Services as defined by the Continuity of Care Guidelines for Geo Care, Inc. /South Florida State Hospital (on file at the Southern Region SAMH Program Office). Additionally, CCST must provide appropriate Adult Mental Health services to CCST clients with the availability to increase or decrease intensity and frequency of similar services, as needed. Programs must provide services in English, Spanish, and Creole as required by the population served. (2) Description Comprehensive Community Service Team (CCST) services take place in either an outpatient or community -based setting and provide consumers with mental illness and /or substance use disorders assistance in identifying goals and making choices to promote resiliency and facilitate recovery. For consumers with mental health and /or substance abuse problems, recovery is the personal process of overcoming the negative impact of a psychiatric and /or substance abuse /use despite its continued presence. CCST services are intended to restore the individual's function and participation in the community. The services are designed to assist and guide consumers in reconnecting with society and rebuilding skills in identified roles in their environment. The focus is on the individual's strengths and resources as well as their readiness and phase of recovery. A team approach for delivery of services will be used to guide and support the consumer's served with development of a recovery plan focusing on the areas of individual and family living, learning, working and socialization. The expectation is that therapeutic services and supports will be determined based on the clinical needs of the consumer. Therefore, not every consumer will require involvement of all members of the team. The type(s) and intensity of clinical services and supports will be determined by the consumer and is based upon a full clinical assessment. (3) CCST should prioritize the following populations: (a) Persons who are being admitted to, or discharged from, a state treatment facility or are awaiting admission to or discharge from a state treatment facility; (b) Persons who are in a state treatment facility regardless of admission date; (c) Persons who are at -risk of institutionalization or incarceration for mental health reasons; (d) Persons who have had one or more admissions to a crisis stabilization unit (CSU), short - term residential facility (SRT), or inpatient psychiatric unit; (e) Persons who reside or have been discharged from a mental health residential treatment facility; (f) Persons who are at -risk or have been adjudicated as incompetent to proceed or not guilty by reason of insanity due to their mental illness and are being released to the community under a conditional release plan; (g) Persons who are experiencing long -term or serious acute episodes of mental impairment that may put them at -risk of requiring more intensive services (4) CCST Team Composition The treatment approach must be delivered by staff working in a Multi- Disciplinary Team. At a minimum the Multi- Disciplinary Team must consist of: (a) A CCST Supervisor —1 FTE (b) Two Part-time Peer Specialists — 0.5 FTE each (c) A Care Coordinator/Targeted Case Manager —1 FTE (d) A Therapist/Clinician —1 FTE Guidance Care Center, Inc. 55 Contract No. ME225 -3 -27 07/01/2012 (e) Vocational /Employment/Housing Manager —1 FTE Members of the team can be added to include a Psychiatrist etc. based on the needs of the consumer. All members of the team must meet at least monthly and staff must be trained and competent in utilizing evidence -based practices, recovery concepts and language. The consumer's voice and choice should be seen throughout, starting with a recovery -based self- assessment tool and continuing with statements of needs, goal- setting and decision - making. The Peer Specialist(s) must be working towards a certification by the Florida Certification Board and must be a true peer; which means that the peer specialist is also (or has been) a consumer of public or private mental health or substance abuse services. A Peer Specialist provides peer mentoring to consumers. They also assist consumers by teaching them how to navigate the mental health and substance abuse service system to achieve resiliency and recovery. In order to provide the full complement and quality of services and supports offered through the CCST, each team must maintain a full staffing pattern as specified in the approved program description, incorporated herein by reference, which aligns with the allocation of contracted dollars. However, failure to maintain a full complement of staff may result in the reallocation of contracted dollars. While SFBHN understands that staff turnover is common in the social service industry, it is the responsibility of the provider to ensure that all positions are filled within six weeks of the position becoming available. In addition, a full complement of staff allows the provider to receive maximum reimbursement for services provided. Additionally, given that CCST is reimbursed based on staff availability, any position(s) that remains vacant for extended periods of time will negatively impact the provider's ability to draw down allocated funds. It is expected that temporary staff trained in the services delivery model and implemented evidence -based practices will be re- assigned to vacant position(s) to ensure that the full array of services and supports are provided to all consumers. (5) System of Care Values The system of care values including those listed below must be embedded within all aspects of the CCST: (a) Consumer - Centered (b) Family Driven Care (c) Cultural and Linguistic Competence (d) Individualized (e) Evidence -Based practices (f) Streamlining and expediting access to services (g) Continuous Quality Assurance (h) Collaborative (i) Community -Based (j) Integrated Services (k) Trauma - Informed Care (1) Trauma - Specific Care (6) Documentation There must be evidence that staff are aware of consumer's needs and documentation in the service record that identified needs are addressed by the CCST and the person receiving services. Staff must assist consumers with obtaining benefits (insurance, Social Security and income). Documentation in the service record must reflect efforts, progress and barriers to individualized goals and treatment objectives, including school performance. Documentation is necessary to identify changes in services, supports and continuity of those services and supports (i.e., treatment plan updates indicating new /revised /achieved goals). A crisis plan must be developed with the consumer and contained within the case record. Guidance Care Center, Inc. 56 Contract No. ME225 -3 -27 07/01/2012 There must be evidence that supports were offered to the consumer receiving services. Supports are necessary in self- managing wellness via activities such as, but not limited to, education, supportive counseling, or skills training. The consumer needs to be aware and involved in appropriate self -help or support groups. Evidence is required that the people receiving services actively takes part in achieving his /her service goal(s) and chooses the people who are involved in their recovery (as in Wellness Recovery Action Plan "WRAP Plans" Crisis Management tools). These persons could be family members, friends or significant others, CCST staff, or other Peer support. There should be evidence that the CCST staff partners with the consumer, assisting and building confidence in their decision - making ability. Furthermore, documentation must reflect the use of natural supports and the Peer Specialist must document all contact with the consumer. (7) Data Requirements Data submission to SFBHN is required for all services provided under the CCST cost center. These services must be submitted as directed by SFBHN. All service data must be entered every month in keeping with contractual requirements. (8) Services Array Services and supports provided includes but is not limited to Assessment, Case Management, Intensive Case Management, Outpatient, In- home /On -Site, Intervention, Information and Referral, Prevention, Prevention /Intervention, Outreach and other transition, and Therapeutic Recreational Activities (non - traditional support services) as identified on the treatment plan and outlined in the policy governing the use of flexible funding. The above listed services are reimbursed in a bundled staff hour rate and may not be contracted for separately. Incidental Expenses may be utilized as specified in Rule 65E- 14.021(2)j, F.A.C., for persons served through CCST to purchase medications and other enhancement and support services not included in this bundled rate that are in concert with the individual's treatment plan. (9) Minimum Training Requirements (a) Motivational Interviewing. - All clinicians /therapist assigned to the CCST team are encourage to complete the Motivational Interviewing training within one year of employment with the CCST team. (b) Wellness Recovery Action Planning (WRAP) - All CCST team members are required to complete the initial three day WRAP training and utilize the strategies with all consumers enrolled in CCST. This training must be completed within six months of joining the CCST team. The WRAP facilitator five day training is available to all CCST team members but is not a required training. (c) SSI /SSDI, Outreach, Access and Recovery (SOAR) training - Targeted Case Managers /Care Coordinators, and Peer Specialists are required to attend this training. This training must be completed within six months of joining the CCST team. (d) Peer Specialist Training— All Peer Specialists are required to complete the Peer Specialist training as outlined by the Florida Certification Board within six months of employment with the CCST team and attempt certification within one year of employment with the CCST team. (e) Person to Person Training — All case managers seeking to become Care Coordinators must complete and acquire the Person to Person certification within 90 days. (f) Other Best Practices as approved by SFBHN — The CCST team can utilize other evidence -based practices approved by SFBHN. However, all evidence -based practices Guidance Care Center, Inc. 57 Contract No. ME225 -3 -27 07/01/2012 utilized by the provider must be implemented with fidelity checks to ensure that the model is being correctly utilized. (10) Programs: Adult Mental Health & Substance Abuse (a) Unit of Measure: Staff Hour (b) Maximum unit cost rate: $ 37.86 (c) Data Elements: Service Documentation — CCST Duty Roster (Exhibit L) (i) Staff name and identification number (ii) Service Date (iii) Hours scheduled to work — Beginning & Ending Time (iv) Cost Center (v) Program (vi) Signature of Supervisor (d) Audit Documentation — Time Sheet (i) Staff name and identification number (ii) Date (iii) Hours Worked — Beginning & Ending Time (iv) Program (v) Cost Center (vi) Signature of Supervisor (e) Some of the additional elements SFBHN will be reviewing include the following: (i) Number of consumers linked to Medicaid and tracking the length of time for approval of benefits (SOAR Data submission) (ii) Type of therapeutic services provided (iii) The frequency of each therapeutic service (iv) Number of consumers receiving Evidence -Based Practices (EBP) and which EBPs are used (v) Staff productivity, which is the amount of direct care hours provided monthly (vi) Fidelity to the treatment model utilized (11) Adult CCST Caseload CCST provides therapeutic services and supports to consumers with varying and complex needs. Therefore, it is anticipated that caseloads will vary widely in intensity and types of services and support provided to consumers. While some cases may involve one therapeutic session per week others may warrant significantly more clinical services in order to address the changing and complex needs of the consumer. For that reason, at least an average of 60.19 % of each member of the CCST team's time must be spent providing direct care services. For purposes of determining staff productivity, provision of a group only counts for one hour of staff productivity per hour of group. For example, staff productivity is not measured by counting a separate hour of productivity for each consumer in the group. It is expected that only one staff member will be providing each group. For purposes of determining staff productivity, provision of a group only counts for one hour of staff productivity per hour of group. For example, staff productivity is not measured by counting a separate hour of productivity for each consumer in the group. It is expected that only one staff member will be providing each group. In order to track that group size limitations and staff productivity levels are being met, the documentation requirements listed in Section B. 1.a.(3) are Guidance Care Center, Inc. 58 Contract No. ME225 -3 -27 07/01/2012 required for CCST group in addition to the duty roster and time sheet service and audit documentation requirements for CCST Individual. (12) Invoicing Requirements The network provider shall ensure that the monthly billing and the data submitted into KIS support the 60.19% direct care services requirement as stated above. Failure to adhere to this requirement may cause the ME to withhold payment until such requirement is met. 9. Continuous Quality Improvement Programs (1) Each service network provider must maintain a continuous quality improvement program to objectively and systematically monitor and evaluate the appropriateness and quality of care, to ensure that services are rendered consistent with prevailing professional standards, and to identify and resolve problems. Additionally, the program must support activities to ensure that fraud, waste and abuse do not occur. (2) For each service network provider, a written plan must be developed with a copy made available upon request to the managing entity which addresses the minimum guidelines for the network provider's continuous quality improvement program, including, but not limited to: (a) Individual care and services standards to include transfers and referrals, co- occurring supportive services, and trauma informed services. (b) Individual records maintenance and compliance. (c) Staff development standards. (d) Service- environment safety and infection control standards. (e) Peer review and utilization management review procedures. (f) Incident reporting policies and procedures that include verification of corrective action and a provision that specifies that a person who files an incident report may not be subjected to any civil action by virtue of that incident report. (g) Fraud, waste, abuse and other potential wrongdoing auditing, monitoring, and remediation procedures. (3) The continuous quality improvement program is the responsibility of the director and is subject to review and approval by the governing board of the service network provider. (4) Each director shall designate a person who is an employee of or under contract with the service network provider as the network provider's continuous quality improvement manager. (5) The quality improvement program must also: (a) Composition of quality assurance review committees and subcommittees, purpose, scope, and objectives of the continuous quality assurance committee and each subcommittee, frequency of meetings, minutes of meetings, and documentation of meetings. (b) Provide a framework for evaluating outcomes, including: (i) Output measures, such as capacities, technologies, and infrastructure that make up the system of care. Guidance Care Center, Inc. 59 Contract No. ME225 -3 -27 07/01/2012 (ii) Process measures, such as administrative and clinical components of treatment. (iii) Outcome measures pertaining to the outcomes of services; (c) Provide for a system of analyzing those factors which have an effect on performance; (d) Provide for a system of reporting the results of continuous quality improvement reviews; and, (e) Incorporate best practice models for use in improving performance in those areas which are deficient. (f) For agencies utilizing seclusion and restraint procedures and as required by law (65E- 5.180), establishment and utilization of a Seclusion and Restraint Oversight Committee responsible for the timely review of each use of seclusion and restraint to include: (i) Circumstances that lead to the event. (ii) Nature of the de- escalation efforts and alternatives to seclusion and restraint are attempted. (iii) Staff response to the incident. (iv) Ways to effectively support the person's constructive coping in the future and avoid the need for future seclusion and restraint. (6) The ME may access all service network provider records and policies necessary to determine compliance with this section. Records relating solely to actions taken in carrying out this section and records obtained by the managing entity to determine a network provider's compliance with this section are confidential and exempt from s. 119.07(1) and s. 24(a), Art. I of the State Constitution. Such records are not admissible in any civil or administrative action except in disciplinary proceedings by the Department of Health or the appropriate regulatory board, and are not part of the record of investigation and prosecution in disciplinary proceedings made available to the public by the Department of Health or the appropriate regulatory board. Meetings or portions of meetings of continuous quality improvement program committees that relate solely to actions taken pursuant to this section are exempt from s. 286.011. 10. Performance Measures for Continuous Quality Improvement Programs The network provider shall track by program, as applicable, the following performance measures and report it quarterly within the QA/QI plan reports by the dates specified in Exhibit C, Required Reports: (1) Mental Health Services (Admission type): Cost Centers 01- Assessment 19- Residential Level 2 03- Crisis Stabilization Unit 20- Residential Level 3 06 Day /Night 21 Residential Level 4 08- In Home/ On -Site 34- FACT 09- Inpatient 35- Outpatient Group 12- Medical Services (psychiatric) 39 -Short-term Residential Treatment 14- Outpatient Individual 44- CCST Individual 18- Residential Level 1 45- CCST Group Guidance Care Center, Inc. 60 Contract No. ME225 -3 -27 07/01/2012 (a) Average number of calendar days between a request for service and the date of the initially scheduled face -to -face appointment, tracked by assessment, counseling /psychotherapy and psychiatric appointments. (b) Percent of clients who do not appear for their initial appointment tracked by assessments, counseling /psychotherapy and psychiatric appointments. (c) Percent of appointments cancelled by the client tracked for all initial appointments for assessments, counseling /psychotherapy and psychiatric services. (d) Percent of appointments cancelled by the staff for all initial appointments for assessments, counseling /psychotherapy and psychiatric services. (e) Medication error percentage, as documented during the reporting period including: wrong medication, wrong dose or wrong time of administration as reported in inpatient/CSU and residential settings. (2) Substance Abuse Services (Admission type): Cost Centers 01- Assessment 21- Residential Level 4 06 Day /Night 24- Detoxification 08- In Home /On -Site 35- Outpatient Group 12- Medical Services (psychiatric) 44- CCST Individual 14- Outpatient Individual 45- CCST Group 18- Residential Level 1 19- Residential Level 2 20- Residential Level 3 (a) Average number of calendar days between a request for services and the date of the initially scheduled face -to -face appointment, tracked by assessment and counseling services. (b) Percent of persons who do not appear for their initial appointments tracked by assessments and counseling services. (c) Percent of appointments cancelled by the client for initial appointment for assessments and counseling. (d) Percent of appointments cancelled by the staff, tracked by initial appointment, counseling /psychotherapy and psychiatric appointments. (e) Medication error percentage, as documented during the reporting period including: wrong medication, wrong dose or wrong time of administration as reported in JARF /Detox and residential settings. 11. Incident Reports (a) The network provider shall submit incident reports into the Incident Reporting and Analysis System (IRAS) on all reportable incidents per CFOP 215 -6, within 24 hours of receiving notification of a reportable incident. Guidance Care Center, Inc. 61 Contract No. ME225 -3 -27 07/01/2012 In the event an incident has an immediate impact on the health or safety of a consumer, has potential media impact, or involves employee - related incidents of criminal activity, the network provider must notify the ME Risk and Compliance Coordinator as soon as possible, but not to exceed 24 hours. Certain incidents may warrant additional follow -up by the ME. Follow -up may include on -site investigations or requests for additional information. When additional information is requested, each network provider will submit the information requested by the ME within 24 hours unless other specified of receiving the requests. It is the responsibility of the network provider to maintain a monthly log listing all incidents occurring at the agency, including those submitted to the Office of the Inspector General and those not reportable in IRAS, with the following information: Consumer's initials, incident report tracking number from IRAS (if applicable), incident report category, date and time of incident, and follow -up action taken. (b) All network providers (inpatient and outpatient) will report seclusion and restraint events in SAMHIS and in accordance with Rule 65E- 5.180(7)(g), F.A.C. 12. Mandatory Reporting Requirements (a) The network provider and any subcontractor must comply with and inform its employees of the following mandatory reporting requirements. Each employee of the network provider, and of any subcontractor, providing services in connection with this contract who has any knowledge of a reportable incident shall report such incident as follows: (1) Reportable incidents that may involve an immediate or impending impact on the health or safety of a client shall be immediately reported to the contract manager; and (2) Other reportable incidents shall be reported to the ME and Department's Office of Inspector General by completing a Notification /Investigation Request (form CF 1934) and emailing the request to the Office of Inspector General at ig_complaints @dcf.state.fl.us. The network provider and subcontractor may also mail the completed form to the Office of Inspector General, 1317 Winewood Boulevard, Building 5, 2nd Floor, Tallahassee, Florida, 32399 -0700; or via fax at (850) 488 -1428. (b) A reportable incident is defined in Children and Families Operating Procedures CFOP 180 -4 (CFOP 180 -4) Mandatory Reporting Requirements to The Office of The Inspector General, which can be obtained from the contract manager. 13. Option for Increased Services The network provider acknowledges and agrees that the contract may be amended to include additional, negotiated, services as deemed necessary by the managing entity. Additional services can only be increased if the network provider demonstrates competence in the provision of contractual services and meets whatever criteria is established by the managing entity from time to time. The managing entity in its sole discretion shall determine at what time and to which network provider and what amounts are to be given to network providers for additional services. 14. Sliding Fee Scale The ME requires the network provider to comply with the provisions of Rule 65E- 14.018, F.A.C. A copy of the network provider's sliding fee scale that reflects the uniform schedule of discounts referenced in Guidance Care Center, Inc. 62 Contract No. ME225 -3 -27 07/01/2012 Rule 65E- 14.018(4), F.A.C. shall be furnished to the managing entity within thirty (30) days of contract execution. 15. Transportation Disadvantaged The network provider agrees to comply with the provisions of chapter 427, F.S., Part I, Transportation Services, and Chapter 41 -2, F.A.C., Commission for the Transportation Disadvantaged, if public funds provided under this contract will be used to transport clients. The network provider agrees to comply with the provisions of Children and Families Operating Procedures 40 -50 (CFOP 40 -5) Acquisition of Vehicles For Transporting Disadvantaged Clients if public funds provided under this contract will be used to purchase vehicles which will be used to transport consumers. (Contract managers delete if not applicable) 16. Agreements with Health Maintenance Organizations/Managed Care Organizations (a) The network provider shall notify the managing entity's contract manager, in writing, prior to entering into a contract for the provision of substance abuse and mental health services with a health maintenance organization or other managed care organization that is capitated by Medicaid to provide substance abuse and /or mental health services or an agent of any such health maintenance organization or other managed care organization. (b) Copies of the contract shall be furnished to the managing entity's contract manager within thirty (30) days of execution. 17. Medicaid Enrollment (a) Those network providers with SAMH contracts in excess of $500,000 annually and rendering substance abuse services shall enroll as a Medicaid provider. This process shall be initiated within ninety (90) days of contract execution. A waiver of the ninety (90) day requirement may be granted, in writing, by the Department's Director of Substance Abuse, through the ME. (b) All network providers whose contracts are $500,000 or more annually, and enrolled as a Medicaid provider shall participate and ensure its subcontracted Medicaid providers whose contracts are $500,000 or more annually participate in Department sponsored training, conduct required sampling, and conduct quality assurance and administrative activities necessary to recover federal matching funds on behalf of the Department, as part of the Community Based Medicaid Administrative Claiming (CBMAC) program. The CBMAC program allows participating network providers to claim reimbursement for administrative activities performed while providing eligible Federal Medicaid Title XIX services. (c) Participation in the CBMAC program by Substance Abuse and Mental Health providers who are enrolled as Medicaid providers with contract amounts less than $500,000 annually, and who have the technological capability to participate electronically is optional. 18. National Provider Identifier (NPI) (a) All network providers shall obtain and use an NPI, a HIPAA standard unique health identifier for health care providers. (b) An application for an NPI may be submitted online at https: // nppes. cros .hhs.gov /NPPES /StaticForward.do ?forward= static.npistart. (c) Additional information can be obtained from one of the following websites: Guidance Care Center, Inc. 63 Contract No. ME225 -3 -27 07/01/2012 (1) The Florida Medicaid HIPAA located at: http: / /www.fdhc .state.fl.us /hipaa/index.shtml (2) The National Plan and Provider Enumeration System (NPPES) located at: https: / /nppes .cros.hhs.gov /NPPES/Welcome.do (3) The CMS NPI located at: http: / /www.cros. hhs.gov /NationalProvldentStand/ 19. Indigent Drug Program (a) The network provider shall ensure that all funds allocated for use of purchasing psychotropic medications, or medications used to treat addictions, or medications accessed through line of credit from the Indigent Drug Program (IDP) are used for individuals who meet any of the following criteria: (1) Have an annual income that is at or below 150% of the Federal Poverty Income Guidelines, as published annually in the Federal Register. (2) Have no liable third -party insurance or other source of psychotropic medications available, nor is the individual a participant in a program where psychotropic medications are paid for by any other funding source. (3) If the individual has third party insurance for psychotropic medications but has temporarily been denied benefits for these medications, they may receive IDP medications until such time as eligibility has been reestablished. (b) The network provider shall actively participate in manufacturer's patient assistance programs for medications needed by a significant portion of clients served by the network provider. (c) The network provider shall participate in any regional training events made available by the Department. The network provider shall also participate in any training events made available by the Florida Louis DeLa Parte Florida Mental Health Institute of the University of South Florida's Medicaid Drug Therapy Management System Program for Behavioral Health which is posted on the following website: http : / /flmedicaidbh.fmhi.usf.edu /. (d) The network provider shall for purposes of auditing and /or monitoring, retain and make available upon request a copy of the license and the permit issued in accordance with the requirements specified in s. 499.012(1)(d), F.S. 20. Ethical Conduct The network provider understands that performance under this contract involves the expenditure of public funds from both the state and federal governments, and that the acceptance of such funds obligates the network provider to perform its services in accordance with the very highest standards of ethical conduct. No employee, director, officer, agent of the network provider shall engage in any business, financial or legal relationships that undermine the public trust, whether the conduct is unethical, or lends itself to the appearance of ethical impropriety. Network providers' directors, officers or employees shall not participate in any matter that would inure to their special gain, and shall recuse themselves accordingly. Public funds may not be used for purposes of lobbying, or for political contributions, or for any expense related to such activities, pursuant to Section 20. of the Standard Contract of this contract. The network provider understands that the managing entity contracts with the department, and as a subcontractor, recognizes that the department is a public agency which is mandated to conduct business in the sunshine, pursuant to section 286.011, F.S., and chapter 119, Florida Law, and that all issues relating to the business of the department, the managing entity and the Guidance Care Center, Inc. 64 Contract No. ME225 -3 -27 07/01/2012 network provider are public record and subject to full disclosure. The network provider understands that attempting to exercise undue influence on the managing entity, the department and its employees to allow deviation or variance from the terms of this contract other than a negotiated, publicly disclosed amendment, is prohibited by the State of Florida, pursuant to section 286.011, F.S. The network provider's conduct is subject to all state and federal laws governing the conduct of entities engaged in the business of providing services to government. 21. Liability Insurance Coverage The network provider shall notify the managing entity's Contract Manager within thirty (30) calendar days if there is a modification to the terms of insurance, to include but not limited to, cancellation or modification to policy limits. 22. Information Technology Resources If applicable, the network providers must receive written approval from the managing entity prior to purchasing any Information Technology Resource (ITR) contract funds. The Contract Manager is responsible for serving as the liaison between the network provider and the managing entity during the completion of the process as instructed by the Contract Manager. The network provider will not be reimbursed for any ITR purchases made prior to obtaining the managing entity's written approval. 23. Programmatic, Fiscal & Contractual Contract File References All of the documentation submitted by the network provider which may include, but not be limited to the network provider's original proposal, Program Description, Program /Cost Center Actual Expenses and Revenues Schedule, Projected Cost Center Operating and Capital Budget, Agency Capacity Report and Personnel Detail Record, are herein incorporated by reference for programmatic, contractual and fiscal assurances of service provision These referenced contractual documents will be part of the contract manager's file. Documents incorporated by reference in this contract are available in the managing entity contract manager's file. 24. Employee Loans Funds provided by the ME to the network provider under this contract shall not be used by the network provider to make loans to their employees, officers, directors and /or subcontractors. Violation of this provision shall be considered a breach of contract and the termination of this contract shall be in accordance with the Section 40. of the Standard Contract. A loan is defined as any advancement of money for which the repayment period extends beyond the next scheduled pay period. 25. Travel The network provider's internal procedures will assure that: travel voucher Form DFS- AA -15, State of Florida Voucher for Reimbursement of Traveling Expenses, incorporated herein by reference, be utilized completed and maintained on file by the network provider. Original receipts for expenses incurred during officially authorized travel, items such as car rental and air transportation, parking and lodging, tolls and fares, must be maintained on file by the Network provider. Section 287.058 (1) (b) F.S., requires that bills for any travel expense shall be maintained in accordance with Section 112.061, F.S. governing payments for traveling expenses. CFOP 40 -1 (Official Travel of State Employees and Non - Employees) provides further explanation, clarification, and instruction regarding the reimbursement of traveling expenses necessarily incurred during the performance of business. The network provider must retain on file documentation of all travel expenses to include the following data elements: name of the traveler, dates of travel, travel destination, purpose of travel, hours of Guidance Care Center, Inc. 65 Contract No. ME225 -3 -27 07/01/2012 departure and return, per diem or meals allowance, map mileage, incidental expenses, signature of payee and payee's supervisor. 26. Incidental Funds for Adult Mental Health (a) The network provider agrees to use incidental funds allocated under this contract for housing, medication and other emergency expenses for indigent clients. (b) The network provider agrees to keep in the clients' file a record of all client expenses charged against the funds. (c) The network provider shall keep a record to log all incidental funds expenditures as specified in Exhibit 0, Incidental Expense Fund Invoice and Expenditure Log for Adult Mental Health. (d) The network provider shall submit as back to the monthly invoice an expenditure report as specified in Exhibit 0, Incidental Expense Fund Invoice and Expenditure Log for Adult Mental Health. (e) The ME reserves the right to reduce the contract amount by the incidental funds projected surplus. 27. Evidence Based Prevention All network providers rendering substance abuse prevention services are required to use an evidence based prevention program. Network provider agencies involved in the validation process for prevention programs must notify the circuit SAMH Program Office of progress annually. 28. Property and Title to Vehicles a. Property (1) Nonexpendable property is defined as tangible personal property of a nonconsumable nature that has an acquisition value or cost of $1,000 or more per unit and an expected useful life of at least one year, and hardback covered bound books that are not circulated to students or the general public, the value or cost of which is $250 or more. Hardback books with a value or cost of $100 or more should be classified as nonexpendable property only if they are circulated to students or to the general public. All computers, including all desktop and laptop computers, regardless of the acquisition cost or value are classified as nonexpendable property. Motor vehicles include any automobile, truck, airplane, boat or other mobile equipment used for transporting persons or cargo. (2) When state property will be assigned to a provider for use in performance of a contract, the title for that property or vehicle shall be immediately transferred to the provider where it shall remain until this contract is terminated or until other disposition instructions are furnished by the ME's contract manager. When property is transferred to the provider, the department shall pay for the title transfer. The provider's responsibility starts when the fully accounted for property or vehicle is assigned to and accepted by the provider. Business arrangements made between the provider and its subcontractors shall not permit the transfer of title of state property to subcontractors. While such business arrangements may provide for subcontractor participation in the use and maintenance of the property under their control, the ME shall hold the provider solely responsible for the use and condition of said property. Provider inventories shall be conducted in accordance with CFOP 80 -2. (3) If any property is purchased by the provider with funds provided by this contract, the provider shall inventory all nonexpendable property including all computers. A copy of which shall Guidance Care Center, Inc. 66 Contract No. ME225 -3 -27 07/01/2012 be submitted to the along with the expenditure report for the period in which it was purchased. At least annually, the provider shall submit a complete inventory of all such property to the ME whether new purchases have been made or not. (4) The inventory (see Exhibit K, Network Provider Inventory List) shall include, at a minimum, the identification number; year and /or model, a description of the property, its use and condition, current location, the name of the property custodian, class code (use state standard codes for capital assets), if a group, record the number and description of the components making up the group, name, make, or manufacturer, serial number(s), if any, and if an automobile, the VIN and certificate number; acquisition date, original acquisition cost, funding source, information needed to calculate the federal and /or state share of its cost. (5) The ME's contract manager must provide disposition instructions to the provider prior to the end of the contract period. The provider cannot dispose of any property that reverts to the ME or department without the contract manager's approval. The provider shall furnish a Closeout Inventory Form no later than 30 days before the completion or termination of this contract. The Closeout Inventory Form shall include all nonexpendable property including all computers purchased by the provider. The Closeout Inventory Form shall contain, at a minimum, the same information required by the annual inventory. (6) The provider hereby agrees that all inventories required by this contract shall be current and accurate and reflect the date of the inventory. If the original acquisition cost of a property item is not available at the time of inventory, an estimated value shall be agreed upon by both the provider and the ME and shall be used in place of the original acquisition cost. (7) Title (ownership) to and possession of all property purchased by the provider pursuant to this contract shall be vested in the ME upon completion or termination of this contract. During the term of this contract, the provider is responsible for insuring all property purchased by or transferred to the provider is in good working order. The provider hereby agrees to pay the cost of transferring title to and possession of any property for which ownership is evidenced by a certificate of title. The provider shall be responsible for repaying to the ME the replacement cost of any property inventoried and not transferred to the ME upon completion or termination of this contract. When property transfers from the provider to the ME, the provider shall be responsible for paying for the title transfer. (8) If the provider replaces or disposes of property purchased by the provider pursuant to this contract, the provider is required to provide accurate and complete information pertaining to replacement or disposition of the property as required on the provider's annual inventory. (9) The provider hereby agrees to indemnify the ME and the department against any claim or loss arising out of the operations of any motor vehicle purchased by or transferred to the provider pursuant to this contract. (10) A formal contract amendment is required prior to the purchase of any property item not specifically listed in the approved contract budget. b. Title to Vehicles (1) Title (ownership) to, and possession of, all vehicles acquired with funds from this contract shall be vested in the ME upon completion or termination of the contract. The provider will retain custody and control during the contract period, including extensions and renewals. (2) During the term of this contract, title to vehicles furnished by the state or acquired at the direction of the state (using state or federal funds) shall not be vested in the provider. Subcontractors shall not be assigned or transferred title to these vehicles. The provider hereby agrees to indemnify the ME or the department against any claim or loss arising out of the Guidance Care Center, Inc. 67 Contract No. ME225 -3 -27 07/01/2012 operations of any motor vehicle purchased by or transferred to the provider pursuant to this contract 29. Verification of Employment Status (E- Verify) 1. Employment Eligibility Verification (a) Definitions. As used in this clause - "Employee assigned to the contract" means all persons employed during the contract term by the provider /grantee to perform work pursuant to this contract within the United States and its territories, and all persons (including subcontractors) assigned by the provider /grantee to perform work pursuant to the contract/grant with the department. "Subcontract" means any contract entered into by a subcontractor to furnish supplies or services for performance of a prime contract or a subcontract. It includes but is not limited to purchase orders, and changes and modifications to purchase orders. "Subcontractor" means any supplier, distributor, vendor, or firm that furnishes supplies or services to or for a prime provider or another subcontractor. (b) Enrollment and verification requirements. (1) The provider /grantee shall - (i) Enroll. Enroll as a provider /grantee in the E- Verify program within 30 calendar days of contract award; (ii) Verify all new employees. Within 90 calendar days of enrollment in the E- Verify program, begin to use E- Verify to initiate verification of employment eligibility. All new employees assigned by the provider /grantee /subcontractor to perform work pursuant to the contract with the DCF shall be verified as employment eligible within 3 business days after the date of hire; and (2) The provider /grantee shall comply, for the period of performance of this contract, with the requirement of the E- Verify program enrollment. (i) The Department of Homeland Security (DHS) or the Social Security Administration (SSA) may terminate the provider's /grantee's enrollment and deny access to the E- Verify system in accordance with the terms of the enrollment. In such case, the provider /grantee will be referred to a DHS or SSA suspension or debarment official. (ii) During the period between termination of the enrollment and a decision by the suspension or debarment official whether to suspend or debar, the provider /grantee is excused from its obligations under paragraph (b) of this clause. If the suspension or debarment official determines not to suspend or debar the provider /grantee, then the provider /grantee must reenroll in E- Verify. (c) Web site. Information on registration for and use of the E- Verify program can be obtained via the Internet at the Department of Homeland Security Web site: http: / /www.dhs.gov /E- Verify . (d) Individuals previously verified. The provider /grantee is not required by this clause to perform additional employment verification using E- Verify for any employee whose employment eligibility was previously verified by the provider /grantee through the E- Verify program. (e) Individuals performing work prior to the E- verify requirement. Employees assigned to and performing work pursuant to this contract prior to February 04, 2011 do not require employment Guidance Care Center, Inc. 68 Contract No. ME225 -3 -27 07/01/2012 eligibility verification through E- verify. (f) Evidence of the use of the E- Verify system will be maintained in the employee's personnel file. (g) Subcontracts. The provider /grantee shall include the requirements of this clause, including this paragraph (g) (appropriately modified for identification of the parties), in each subcontract." E. List of Exhibits The following exhibits, or the latest revisions thereof, are incorporated in and made a part of the contract. 1. Exhibit A, Clients and Participants to be Served 2. Exhibit B, Method of Payment 3. Exhibit C, Required Reports 4. Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs 5. Exhibit E -1, Substance Abuse and Mental Health Monthly Request for Non -TANF Payment/Advance 6. Exhibit F, Minimum Service Requirements 7. Exhibit G, State Funding by Program and Activity 8. Exhibit H, Funding Detail & Local Match Plan 9. Exhibit I, Substance Abuse Family Intervention Specialist Services 10. Exhibit J, Assisted Living Facilities With a Limited Mental Health License 11. Exhibit K, Network Provider Inventory List 12. Exhibit L, CCST Duty Roster 13. Exhibit M, Child Welfare Quarterly Clinical Report 14. Exhibit N, Missing Children 15. Exhibit 0, Incidental Fund Invoice and Expenditure Log for Adult Mental Health 16. Exhibit P, Pre- Authorization Residential Utilization Management Roster Guidance Care Center, Inc. 69 Contract No. ME225 -3 -27 07/01/2012 EXHIBIT A CLIENTS AND PARTICIPANTS Client Non- specific TO BE SERVED Performance Contract SAMH Services Program A. General Description The network provider shall furnish services funded by this contract to the target population(s) checked below: Non- Prevention Prevention ® Adult Mental Health- Forensic Involvement ❑ Adult at Substance Abuse ® Adult Mental Health- Severe & Persistent Mental Illness ❑ Children's at Substance Abuse ® Adult Mental Health- Serious & Acute Episodes of Mental Illness ❑ Community Prevention -Adult at SA Z Adult Mental Health - Mental Health Problems ® Community Prevention- Children at SA ® Children's Mental Health- Emotional Disturbances ❑ Children's Mental Health -At Risk of Emotional Disturbances ® Children's Mental Health- Serious Emotional Disturbances ® Adult Substance Abuse ® Children's Substance Abuse B. Client and Participant Eligibility (1) The network provider agrees that all persons meeting the target population descriptions in the table above are eligible for services based on the availability of resources. A detailed description of each target population is contained in s. 394.674, Florida Statutes. (2) Crisis stabilization, substance abuse detoxification, and addiction receiving facility services shall be provided to all persons meeting the criteria for admission subject to the availability of beds and /or funds. C. Client and Participant Determination (1) Determination of client eligibility is exclusively the responsibility of the network provider. (2) Participant eligibility (Direct Prevention) and target population eligibility (Community Prevention) shall also be based upon the community action plan or on the relevant epidemiology data. D. Contract Limits (1) The network provider is not authorized to bill the department for more units than are specified in Exhibit G, State Funding by Program and Activity, or for more units than can be purchased with the amount of funds Guidance Care Center, Inc. 70 Contract No. ME225 -3 -27 07/01/2012 specified in Exhibit G, State Funding by Program and Activity. (2) The network provider agrees that funds provided in this contract will not be used to serve persons outside the target population(s) specified in the paragraph above. NOTE: Prevention funds allocated to underage drinking programs and activities targeting eighteen (18) to twenty (20) year old individuals may be taken from Adult Substance Abuse Prevention funds. (3) Services provided under this contract are limited by the availability of funds. The network provider may not authorize or incur indebtedness on behalf of the Managing Entity or the Department. Guidance Care Center, Inc. 71 Contract No. ME225 -3 -27 07/01/2012 Exhibit B Method of Payment 1. Payment Clauses a. This is a fixed price (unit cost) contract. The unit prices are listed on Exhibit G, State Funding by Program and Activity. The ME shall pay the network provider for the delivery of service units provided in accordance with the terms and conditions of this contract for a total dollar amount not to exceed $4,706,252.00, subject to the availability of funds and satisfactory performance of all terms by the network provider. Of the total Contract amount, the ME will be required to pay $3,921,877.00, subject to the delivery and billing for services. The remaining amount of $784,375.00 represents "Uncompensated Units Reimbursement Funds", which the ME, at its sole discretion and subject to the availability of funds, may pay to the network provider, in whole or in part, or not at all, for Exemplary Performance by the network provider. Exemplary Performance will be determined by the network provider delivering and billing for services in excess of those units of service the ME will be required to pay. The ME's obligation to pay under this Contract is contingent upon an annual appropriation by the Legislature and the Contract between the ME and the DCF. Any costs or services eligible to be paid for under any other contract or from any other source are not eligible for payment under this Contract. b. Aftercare, Intervention, Outpatient, and Recovery Support Services (Substance Abuse) are eligible for special group rates. Group services shall be billed on the basis of a contact hour, at 25% of the contract's established rate for the individual services for the same cost center. Excluding Outpatient, total hourly reimbursement for group services shall not exceed the charges for fifteen individuals per group. Group size limitations outlined in the current Medicaid Handbook apply to Outpatient group services funded under this contract. c. Pursuant to s. 394.76(3), Florida Statutes (F.S.), the provider agrees to provide local matching funds in the amount of $933,952.00 as indicated in Exhibit H, Funding Detail and Local Match. Should the network provider receive any funding from the "Uncompensated Units Reimbursement Funds'; then the amount of Local Match as it appears on Exhibit H, Funding Detail, will automatically change, utilizing the following formula: The additional match required on the uncompensated units = Uncompensated Substance Abuse Services X 16.67% + Uncompensated Mental Health Services that is not exempt from local match requirements X 33.33% * *The following MH services are exempt from local match requirement i. Deinstitutionalization Projects Case Management Intensive Case Management Residential Services I -IV • Supported Housing /Living Supported Employment Short Term Residential Treatment (not exempt if funded by Baker Act funds or operated by a public receiving facility) FACT Teams ii. CMH Programs (100435 Category & 102780 (PRTS) Category) that are not grant funded. Guidance Care Center, Inc. 72 Contract No. ME225 -3 -27 07/01 /2012 d. In accordance with the provisions of s. 402.73(1), F.S., and Rule 65- 29.001, Florida Administrative Code (F.A. C.), corrective action plans may be required for noncompliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed for failures to implement or to make acceptable progress on such corrective action plans. e. The managing entity shall reduce or withhold funds pursuant to Rule 65- 29.001, F.A.C., if the network provider fails to comply with the terms of the contract and /or fails to submit client reports and /or data as required in DCF PAM 155 -2, Rule 65E -14, F.A.C. and by the due dates listed on Exhibit C, Required Reports. f. The managing entity's decision to reduce or withhold funds will be submitted to the provider in writing. The written notice will specify the manner in which the provider has failed to comply with the terms of the contract. When, and if, compliance is achieved, the withheld funds will be disbursed to the provider. g. If the Provider closes or suspends the provision of services funded by this contract, the provider agrees to notify the managing entity in writing thirty (30) calendar days prior to their intent to close, suspend or end service(s). If the provider fails to notify the managing entity, the provider hereby agrees not to request payment for services provided in prior months if the actual number of services in the month for which payment is being requested is less than twenty -five percent (25 %) of the prorated amount of services by cost center as given on Exhibit G, State Funding by Program and Activity or twenty -five percent (25 %) of the prorated share of the amount of funding as specified on Exhibit G, State Funding by Program and Activity. h. The managing entity in its sole discretion and subject to funding availability, may purchase from any provider prior to the end of the contract period any service units provided at any time during the term of the contract. 2. MyFloridaMarketPlace Transaction Fee This contract is exempt from the MyFloridaMarketPlace Transaction Fee in accordance with Rule 60A- 1.032(1)(d), F.A.C. 3. Additional Release of Funds At its sole discretion, the ME may approve the release of more than the monthly prorated amount when the network provider submits a written request justifying the release of additional funds, if funds are available and services have been provided. 4. Medicaid Billing a. The Department is always the payor of last resort. The ME and the network provider specifically agree that the Department, through the ME is never a liable third party for Medicaid eligible services provided to individuals that meet the eligibility criteria for Medicaid. Authorized network provider services shall be reimbursed in the following order of precedence: 1 Any liable first, second, and /or third party payors, then ii. Medicaid, pursuant to s. 409.910, F.S., if the individual meets the eligibility criteria for Medicaid, and the service is Medicaid eligible, then iii. The Department through the ME (only if none of the above are available or eligible for payment). Guidance Care Center, Inc. 73 Contract No. ME225 -3 -27 07/01/2012 iv. The network provider shall identify and report Medicaid earnings separate from all other fees; v. Medicaid earnings cannot be used as local match; vi. The network provider shall ensure that Medicaid payments are accounted for in compliance with federal regulations; vii. In no event shall both Medicaid and the ME be billed for the same service; b. The network provider operating a residential treatment facility licensed as a crisis stabilization unit, detoxification facility, short -term residential treatment facility, residential treatment facility Levels 1 or 2, or therapeutic group home that is greater than 16 beds is not permitted to bill or knowingly access Medicaid Fee For - Service programs for any services for individuals eligible for Medicaid while in these facilities; and c. The network provider operating a children's residential treatment center of greater than 16 beds is not permitted to bill or knowingly access Medicaid Fee -For Service programs for any services for individuals meeting the eligibility criteria for Medicaid in these facilities except as permitted under the Medicaid State Inpatient Psychiatric Program Waiver. d. The network provider shall assist individuals receiving services who need assistance and who meet the eligibility criteria for Medicaid to make application including assistance with medical documentation required in the disability determination process; and e. The network provider agrees to assist individuals eligible for Medicaid covered by a Medicaid capitated entity who need and request assistance to obtain covered mental health services that the treating provider considers to be medically necessary. This assistance shall include assisting clients in appealing a denial of services. 5. Payments from Medicaid Health Maintenance Organizations, Prepaid Mental Health Plans, or Provider Services Networks. Unless waived in Section D (Special Provisions) of this contract, the provider agrees that payments from a health maintenance organization, prepaid mental health plan, or provider services network will be considered to be "third party payer" contractual fees as defined in Rule 65E- 14.001(2)(z), F.A.C. Services which are covered by the subcapitated contracts and provided to persons covered by these contracts must not be billed to the department. 6. Invoice Requirements a. The rates negotiated with any network provider may not exceed the model rate as specified in Rule 65E -14, F.A.C. b. Network providers are required to comply with Rule 65E- 14.021, Unit Cost Method of Payment, including but not limited to, cost centers, unit measurements, descriptions, program areas, data elements, maximum unit cost rates, required fiscal reports, program description, setting unit cost rates, payment for services including allowable and unallowable units and requests for payments. If agreed upon with the ME and the Department, other payment methods may be permitted. c. The network provider shall request payment monthly through submission of a properly completed invoice, Exhibit E -1, Substance Abuse and Mental Health Monthly Request for Non -TANF Payment within twelve (12) days following the end of the month for which payment is being requested for the delivery of service d. The network provider shall submit a monthly Incidental Expense Fund Invoice and Expenditure Log for Adult Mental Health, Exhibit 0, to the ME's Contract Manager Guidance Care Center, Inc. 74 Contract No. ME225 -3 -27 07/01/2012 and by the dates specified in Exhibit C, Required Reports. The report shall identify by client, the category of the expense (pursuant to Rule 65E- 14.021(7), F.A.C.), the program, month of service and amount billed per category. e. If no services are due to be invoiced from the preceding month, the network provider shall submit a written document to the ME indicating this information within twelve (12) days following the end of the month. f. The network provider's final invoice must reconcile actual service units provided during the contract period with the amount paid by the ME. The provider shall submit their fiscal year final invoice to the ME within fifteen (15) days after the end of each state fiscal year in the contract period. g. Pursuant to 65E- 14.021(10)(b)6.b., F.A.C. , the year -to -date number of units of service reported on a request for payment or any associated worksheet shall not exceed the total number of units reported and accepted in the ME's data system pursuant to Rule 65E- 14.022, F.A.C. h. Pursuant to 65E- 14.021(10)(a)2., F.A.C., any costs or service units paid for under any other contract or from any other source are not eligible for payment. The network provider must subtract all units which are billable to Medicaid, and all units for SAMH client services paid from other sources, including Social Security, Medicare payments, and funds eligible for local matching which include patient fees from first, second, and third -party payers, from each monthly request for payment. For services provided based on bed -day availability, the provider must report any payments received from all other sources on the "Schedule of Bed -Day Availability" at the end of the fiscal year and refund any overpayment. i. Invoices shall be submitted in detail sufficient for a proper pre -audit and post- audit. 7. Supporting Documentation a. The network provider agrees to maintain and submit to the ME, if applicable, service documentation for each service billed to the ME pursuant to this contract. Proper service documentation for each SAMH cost center is outlined in Rule 65E - 14.021(7), F.A.C., in Section D., Special Provisions for Adult System of Care Comprehensive Communly Service Teams services, Exhibit 0, Incidental Expense Fund Invoice and Expenditure Log for Adult Mental Health. b. The provider shall maintain documentation to support all units billed to the ME and units subtracted for SAMH client services on each monthly request for payment. c. The network provider shall ensure that all services provided are entered into the KIS data system designated by the managing entity. d. The ME, Department and the State's Chief Financial Officer reserve the right to request supporting documentation at any time after actual units have been delivered. 8. Funding Sweeps The network provider agrees that at the sole discretion of the ME and at such time and upon terms, conditions or criteria set by the managing entity, a review of the funding utilization rate or pattern of the provider may be conducted by the ME. Based upon such review, if it is determined that the rate of utilization may result in a lapse of funds, then in that event the ME may amend the network Guidance Care Center, Inc. 75 Contract No. ME225 -3 -27 07/01/2012 provider's total amount of funding by reducing same in order to prevent the potential lapse. The ME will notify the network provider in writing of the reduction prior to amending the total amount of funding. The ME's Lapse Policy is incorporated herein by reference. Guidance Care Center, Inc. 76 Contract No. ME225 -3 -27 07/01/2012 Exhibit C Required Reports Required Reports Due Date # of Copies Send to: Response to Monitoring Reports and Corrective Action Within 10 days from the day the report is 1 SFBHN Contract Plans received. Manager Sliding Fee Scale [reflecting the uniform schedule of Within 30 days after the beginning of each 1 SFBHN Contract discounts referenced in 65E- 14.018(4)] fiscal year. Manager Final FY 2012 -2013 (1) Network Providers Agency Service Capacity Report, (2) Projected Cost Center Operating and Capital Within 30 days after Contract execution or SFBHN Contract Budget (If applicable), Y 1 (3) Cost Center Personnel Detail upon request of the Contract Manager Manager Report (If applicable), & (4) Program Description. Monthly Data Required by DCF PAM 155 -2 Electronic SFBHN MIS Office Within 8 days after end of month Submission Incident Report Within 24 hours of occurrence 1 IRAS Audit Schedules for Network Providers (for c lient non - spec unit cost performance contracts) Due 180 days after the end of the fiscal year SFBHN Contract Schedule of State Eamings or 45 days upon completion of audit, 1 Manager whichever comes first. Due 180 days after the end of the fiscal year SFBHN Contract Schedule of Related Party Transaction Adjustments or 45 days upon completion of audit, 1 Manager whichever comes first. Program /Cost Center Actual Expenses & Revenues Due 180 days after the end of the fiscal year SFBHN Contract Schedule or 45 days upon completion of audit, 1 Manager whichever comes first. Due 180 days after the end of the fiscal year Schedule of Bed -Day Availability Payments or 45 days upon completion of audit, 1 SFBHN Contract Manager whichever comes first. 180 days after the end of the managing Financial & Compliance Audit per Attachment II entity's fiscal year or 45 days after its SFBHN Contract 1 completion, whichever comes first. Manager (See Attachment II) Reports Required for Substance Abuse Providers SFBHN Contract Annual Report for HIV Early Intervention Services, Manager & SAPT Block Grant Set Aside Funded Services Only Upon Request 1 Substance Abuse Program Office Annual Report for Evidenced -based Injection Drug User SFBHN Contract Outreach Services, SAPT Block Grant Mandate, 1 Manager & Designated Providers Only Upon Request Substance Abuse Program Office Annual Report for Pregnant Women and Women With SFBHN Contract Dependent Children SAPT Block Grant Set Aside Upon Request 1 Manager & Funded Services Only Substance Abuse Program Office Guidance Care Center, Inc. 77 Contract No. ME225 -3 -27 07/01/2012 Required Reports I Due Date I # of JS end to: Copies Other Reports 1 SFBHN Contract Monthly Service Invoice Monthly, by the 12 after the month of service Manager SFBHN Contract Invoice Review Supporting Documentation As requested by the contract manager 1 Manager Prevention Services Report printed from PEPS Submitted with the monthly invoice 1 SFBHN Contract Manager October 12, 2012 January 12, 2013 SFBHN Contract Coalition Activities Report 1 April 12, 2013 Manager June 15, 2013 By July 15 of each fiscal year and/or 15 days 1 SFBHN Contract Final Invoice after contract end date Manager Wait List SFBHN Contract (until departments automated system is operational) Monthly by the 15"' after the month of service 1 Manager Within 30 days of contract execution. Submit Provider's Grievance Procedures updates as amended within 30 days of 1 SFBHN Contract execution of the amendment Manager Provider Informed Consent Forms 1 SFBHN Contract Within 30 days of contract execution Manager Provider's Emergency Preparedness Plan 1 SFBHN Contract Within 30 days of contract execution Manager Provider's Civil Rights Compliance Questionnaire 1 SFBHN Contract Within 30 days of contract execution Manager Provider's Security Agreements, per Standard Contract 1 SFBHN Contract Within 30 days of contract execution Manager Annually, prior to contract SFBHN Contract Affidavit Regarding Debarment execution, or as requested by the contract 1 manager. Manager Report SFBHN Contract Inventory P Within 30 days of contract execution 1 Manager "No Wrong Door" Policy and Procedure August 1, 2012 1 SFBHN Contract Manager Quality Improvement Plan SFBHN Contract August 1, 2012 1 Manager October 15, 2012 1 Quarterly Report on Implementation of Quality January 15, 2013 SFBHN Contract Improvement Plan April 15, 2013 Manager July 15, 2013 Quality Assurance Plan August 1, 2012 1 SFBHN Contract Manager October 15, 2012 1 Quarterly Report on the Implementation of Quality January 15, 2013 SFBHN Contract Assurance Plan April 15, 2013 Manager July 15, 2013 Guidance Care Center, Inc. 78 Contract No. ME225 -3 -27 07/01/2012 Co- occurring Action Plans 06/30/2013 1 SFBHN Contract Manager CODECAT 06/30/2013 1 SFBHN Contract Manager COMPASS Follow -up Self - Assessment for all Network 06/30/2013 SFBHN Contract Providers 1 Manager Cooperative Agreements Within 30 days of execution of the 1 SFBHN Contract agreements Manager TANF SAMH Program Logs and Service Data As per the contract and/or as requested by 1 SFBHN TANF the contract manager Supervisor ADA Client Communication Assessment Auxiliary Aid by the 4th business day following the 1 SFBHN Contract Service Record Monthly Summary Report reporting month Manager External Quality Assurance Reviews, Monitoring As per the contract and/or as requested by 1 SFBHN Contract Reports, Surveys & Corrective Action Plans the contract manager Manager Client Trust Fund Letter August 1, 2012 1 SFBHN Contract Manager Children's Mental Health Children's Mental Health Quarterly clinical reports on all dependent children Per the contract and Exhibit S. 1 Copy in chart Children's Mental Health Quarterly clinical reports on all As per the contract and/or as requested by 1 Copy in chart community children the contract manager Adult Mental Health Monthly by the 12 of each month following the SFBHN Contract Incidental Expense Fund Invoice and Expenditure Log for 1 Manager and ME month of service Adult Mental Health (Exhibit 0) System of Care Per PATH Grant PATH Annual Data Report to SAMHSA Per PATH Grant Application Instructions 1 Application Instructions Drafts to be submitted to managing entity for Contract Manager, PATH Annual Reports Southern Region SAMH Program Office, and ME System of DCF Central Office in Tallahassee in April or 1 Care Staff May of each fiscal year as requested Forensic Services Forensic Monthly Report for Individuals on Conditional Release By 15 of each month 1 TeamCoordinat .or /MH Guidance Care Center, Inc. 79 Contract No. ME225 -3 -27 07/01/2012 Exhibit D MENTAL HEALTH & SUBSTANCE ABUSE REQUIRED OUTCOMES /OUTPUTS (Part I) Provider Name: Guidance Care Center, Inc. Contract #: ME225 -3 -27 Date: 07/01/2012 Revision #: NA I. Mental Health Contracted Services A. Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH, Medicaid and Local Match) Numbers to Be Served 1. Adult Mental Health a. Adults with Severe and Persistent Mental Illness (SPMI) (M0016) /(MH0I6) 1 200 b. Adults with Serious and Acute Episodes of Mental Illness (M05301)/(MH5301) 40 c. Adults with Mental Health Problems (M05302)/(MH5302) 250 d. Adults with Forensic Involvement (M0018) /(MH018) 4 2. Children's Mental Health a. Children with Serious Emotional Disturbances (SED) (M0031) /(MH031) 150 b. Children with Emotional Disturbances (ED) (M0032)/(MH032) 225 c. Children at -risk of Emotional Disturbances (M0033)/(MH033) 0 Minimum Contract B. Required Performance Outcome Standards for Each Target Population Standard 1. Adult Mental Health - Adults with Severe and Persistent Mental Illness a. Percent of adults with severe and persistent mental illnesses who live in stable housing environment will be at least (M0742)/MH742) 93% b. Average annual number of days (post admission assessments) worked for pay for adults with severe and persistent mental illness will be at least (M0003)/(MH003) 30 2. Adult Mental Health - Adults in Mental Health Crisis, including Adults with Serious and Acute Episodes of Mental Illness and Adults with Mental Health Problems a. Percent of adults in mental health crisis who live in stable housing environment will be at least (M0744)/MH744) 90% 3. Adult Mental Health - Adults with Serious Mental Illness (SPMI, MH Crisis, Forensic) a. Percent of adults with serious mental illness who are competitively employed will be at least (M0703)1MH703) 15% 4. Adult Mental Health - Forensic Involvement a. Percent of adults in forensic involvement who live in stable housing environment will be at least (M0743)/MH743) 70% 5. Children Mental Health - Seriously Emotionally Disturbed a. Percent of children who live in stable housing environment will be at least (M0779)/(MH779) 95% Guidance Care Center, Inc. 80 Contract No. ME225 -3 -27 07/01/2012 b. Percent of children who improve their level of functioning will be at least (M0378)/MH378) 65% c. Percent of school days seriously emotionally disturbed children attended will be at least (M0012) /(MH404) 86% 6. Children Mental Health - Emotionally Disturbed a. Percent of children who live in stable housing environment will be at least (M0778)/(MH778) 95% b. Percent of children who improve their level of functioning will be at least (M0377)/(MH377) 64% 7. Children Mental Health - At -Risk of Emotional Disturbance a. Percent of children who live in stable housing environment will be at least (M0780)/(MH780) 90% C. Required Internal Measures 1. Data Submission Outcomes for Mental Health a. Percent of persons receiving state - contracted mental health service event records which have matching mental health initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) 95% (M0759) Guidance Care Center, Inc. 81 Contract No. ME225 -3 -27 07/01/2012 Exhibit D MENTAL HEALTH & SUBSTANCE ABUSE REQUIRED OUTCOMES /OUTPUTS (Part 1I) II. Substance Abuse Contracted Services A. Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH, Medicaid and Local Match) Numbers to Be Served 1. Adults with Substance Abuse Problems a. Number of Adults Served (M0063)/(SA063) 415 2. Children with Substance Abuse Problems a. Number of Children Served (M0052)/(SA052) 176 3. Adult At -Risk of Substance Abuse Problems - (NonGAA) a. Number of adults participating in Prevention Services 25,309 (M0785)/(SA785) b. Number of adults participating in Level 1 Prevention Programs NA (M0767)/(SA767) c. Number of adults participating in Level 2 Prevention Programs NA (M0768)/(SA768) d. Number of adults participating in Level 1 Prevention Programs who NA complete 75 percent of the program's schedule of activities (M0769)/(SA769) e. Number of adults participating in Level 2 Prevention Programs who NA complete 75 percent of the program's schedule of activities (M0770)/(SA770) 4. Children At -Risk of Substance Abuse Problems - (Baseline - NonGAA) a. Number of children participating in Prevention Services 5,000 (M0762)/(SA762) b. Number of children participating in Level 1 Prevention Programs 1,123 (M0761)/(SA761) c. Number of children participating in Level 2 Prevention 50 Programs (M0695)/(SA695 ) d. Number of children participating in Level 1 Prevention Programs who 954 complete 85 percent of the program's schedule of activities (M0763)/(SA763) e. Number of children participating in Level 2 Prevention Programs who 42 complete 85 percent of the program's schedule of activities (M0764)(SA764) Minimum Contract B. Required Performance Outcome Standards for Each Target Population Standard 1. Adults with Substance Abuse Problems a. Percent of adults who successfully complete substance abuse treatment 50% services will be at least (M0755)/SA755) b. Percent change in clients who are employed from admission to 20% discharge will be at least (M0753)/SA405) c. Percent of adults who live in a stable housing environment at the time 80% of discharge will be at least (M0756)/SA756) d. Percent change in the number of adults arrested 30 days prior to 35% admission versus 30 days prior to discharge (M0754/SA754) 2. Adult At -Risk of Substance Abuse Problems - (Baseline -Non GAA) a. Percent of adults participating in Level 1 Prevention Programs who complete 85 percent of the program's schedule of activities will be at least 50% (M0771)/(SA771) Guidance Care Center, Inc. 82 Contract No. ME225 -3 -27 07/01 /2012 b. Percent of adults participating in Level 2 Prevention Programs who complete 85 percent of the program's schedule of activities will be at least 50% (M0772)/(SA772) 3. Children with Substance Abuse Problems a. Percent of children who successfully complete substance abuse 55% treatment services will be at least (SA725)/(SA755) b. Percent of children who live in a stable housing environment will be at 85% least (M0752)/SA752) c. Percent change in the number of children arrested 30 days prior to 20% admission versus 30 days prior to discharge will be at least (M0751/SA751) 4. Children At -Risk of Substance Abuse Problems - (Baseline -Non GAA) a. Percent of children participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least 50% (M0765)/(SA765) b. Percent of children participating in Level 2 Prevention Programs who complete 85 percent of the program's schedule of activities will be at least 50% (M0766)/(SA766) 5. Data Submission for Prevention Program Tool (baseline - Non GAA) a. Percent of approved Prevention Descriptions completed within 30 days 50% of contract execution. C. Required Internal Measures 1. Data Submission Outcomes for Substance Abuse a. Percent of persons receiving state - contracted substance abuse service event records which have matching substance abuse initial (purpose 1) 95% admission records in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0758) Guidance Care Center, Inc. 83 Contract No. ME225 -3 -27 07/01/2012 a- AGErCY NAM* Exhibit ,T ME b. CONTRACT N0.: NTALHeALTH 4. MONitWYEAR OP: Non -TANF el.'- mpn(ne remanIntr. 12 MONTHLY PAYMENTtADVANCE REQUEST FEDERAL IC) M: 4ENDO13 ID 01 different Man Fed D/: 9 ADDRESS (4&Wnoer, City, State. 0P); Specme4 Non- TAHS Funding YTD Total YTO SAMH Nan• DIRerenos (YTD sof Non -TANF Levee tor the Eligible Non TANF PAW 10r Unpal0 Mount Due Cost Center UnRS P.M for DART 1 • EARNINGS Adtvity Only TANF *Earned Earnings Eamings) PrOrateO Snare (Owed) Unit Rate this Month adl uat the C OS!' Centers from COLS a0 butt the For Activlty only '. total for each (( 4) D Budget E nifty 60510502 months 1 esa *t of C04 5 (004.0 of ACT ry1TY COa4 Center* ffr0m E xh G) oot.4 Of Vatke4tt 1004. 300141 rentlnl401 or Cote. , to0t.7r col All 4 1 2 3 4 5 4 T E 5 Entstgency Stabilization - 502004 00ssl Slao0ailon XXXXXXX 50 00 50.00 XXXXXXX 50.00 D.00000 Cods StelppnrEmergemgr XXXXXXX. SO 00 30,00 XXXXXXX 50.00 0.00000 inpatient XXXXXXX 5000 50.00 X XXXXXX SO. DO 0. 00000 Em►rgen0y Sta0MaatW4 Total * 50.00 50.00 40.00 €0.00 40.00 . Recovery & Re*nency Services • 502015 Reedensal Level XXXXXXX 50,00 50.00 XXXXXXX - 50.00 0.00000 pesidendaltratiVErlhancoulleanie . XXXXXXX 50.00 50.00 XXXXXXX. 50.00 0.00000 Resdera *Leveil XXXXXXX 50.00 50.00 XXXXXXX 50,00 0.00000 ' R esd vets Leretll XXXXXXX 50.00 40.00 XXXXXX 50,00 0,00000 Resdeala Level XXXXXXX 50.00 50.00 XXXXXXX 50.00 0.00000 R 40mta. BOar4wrSupernsion Lin i XXXXXXX 50.00 50.00 XXXXXXX 50.00 0. 00000 Room 6 BOatdw/Stpevfs4anlevll XXXXXXX 50.00 50.00 XXXXXXX 50.00 0.00000 R tom & Board AlSUper4at0 Lev it X XX xXX 50.00 50.00 XXXXXXX 50 OD 0.00000 Stan -term Resd44taa Treatment XXXXXXX 50.00 50.00 XXXXXXX 50.00 0.00000 Case 4.tanagemM XxX.XxxX S0 00 00 %XXXXXX 5000 0. 00000 4MariWe Cass Management XXXXXXX 50.00 50.00 XXXXXXX 50.00 0. DOOOD Assessment xXX%XXx 50.00 SO 00 XXXXXXX 50.00 0.00000 Day Care XXXXXXX 50.00 €0.00 XXXXXXX 50.00 0. 00000 Days all XXXXXXX 50.00 S0.00 XXXXXXX 50.00 0.00000 intervention- IndivelJa XXXXXXX 50.00 50,00 XXXXXXX 50,00 0.00000 Intervention- Group XXXXXXX 5000 50,00 XXXXXXX. . 50.00 0.00000 Mexicali Services XXXXXXX 50.00 50.00 XXXXXXX 50.00 000000 Outpaent- vJtild%al XXXXXXX 90.00 SO 00 XXXXXXX 50,00 0.00000 Outpatient- Gran; XXXXXXX 50.00 50.00 XXXXXXX - 50.00 D.000o 5neteed Employment XXXXXXX 50.00 50.00 XXXXXXX 50.00 0. 00000 OrOp -a%SM -Hap Center XXXXXXX 50.00 50.00 XXXXXXX 50.00 0.00000 in-Nome and On 545 XXXXXXX 50.00 50.00 XXXXXXX 50.00 0.00000 Outreach XXXXXXX 50.00 50.00 XXXXXXX 50.00 0,00000 Prevention XXXXx4X 50.00 5000 XXXXXXX $0 00 000000 RNpn Services XXXXXXX 50.00 50.00 XXXXXXX 50.00 0.00000 Suppate0 Employment XXXXXXX 50.00 ' 50.00 Xx4XXXX AD 00 0.00000 S000ortiveHOUSnatJrew XXXXXXX 50.00 : 50.00 XXXXXXX 50.00 0.00000 Speoine0 Nan• TANF Funding _ YTD Total YTD SAMN Non Difference (YTD 4 o Non -TANF Level for the Eligible Non- TANF P *0 for Unpaid Amount Due Coat Center Unite Palo for PMT 1 • EARNING3 AdIVitY Only - TMF $ Earned Earn4n0s Ea ml most Prorated Snare f0Ye41 Unit Ride this Month 0Just the Coat Centers from Col Sao Ma the For AGM/Ity only **Lai tOr•aeh [4004. 2 - oat 4) r ACM mA is the Budget Entity 00510502 months user 010015 tool C df - AC T MD/ 1 CO0 Centers (from It xn 0) (01.1 Ot 4t%anIL (004.3.01.4) ' rsmal0Mg)- or C01 6 trtkant) 404 7 • cot in 1 2 3 4 5 S 7 S 3 474447455. 44G. XXXXXXX 50,00 50.00 XXXXXXX 50.00 0.00000 A.necare - Group XXXXXXX 54700 SO 00 XXXXXXX ' 50,00 0,00000 fnferrna00n& Retfrra4 XXXXXXX - 5000 50,00 XXXXXXX 00,00 0, 00000 Meta 1 9e*V4cfm XXXXXXX 50.00 50.00 XXXXXXX 50.00 0.00000 *covert & Resiliency Srve Total a 40.00 50,00 €0.00 50.00 50.00 R&R - FACT Teams 502015 I Fact Teat, XXXXXXX ' SO00 50. ' XXXXXXX 50.00 0. 00000 MIR Fact Total * 50.00 50.00 *0.00 *0.00 *0.00 R 4L R COnstrehen*y• COmtta4nny Service Team. 502018 CCST•OlOUk4a XXXXXXX SO. SO 00 XXXXXXX 50.00 0.00000 0027•0nsup XXXXXXX 50.00 50.00 XXXXXXX 50.00 0.00000 Ran • CO57 TOM O* 50.00 €0,00 10.00 40.00 €0.00 Rang - incidental Expense* i !Madan* Expenses XXXXXXX 50.00 50.00 XXXXXXX 50.00 0.00000 RSR incidental Ea5lanai*704* s - *0,00 50.00 50.00 €0.00 50.00 n GRAND TOTAL* 50.00 40.00 50.00 50.00 50.00 50.00 ' Unless ire Contactor requests and Me ME approves payment In exae6a of tM profale4 share. fl, Lelia Re0oupm*44440t Internet a *0.00 1. Lea* Reooupmentot Advance* 50.00 1. TOTAL AMOUNT OF ME PAYMENTtAOVANCE * *0.00 • YTD Interest YTD Internet - YTD Fantle YTD Advance ferried RIK0Uped Advanced B*an0a PMT 2- FUNDING 015TR/9UTION ...For ME use) , iFot ME %641 r tfor Prov. use/ ,JPOr P004. ttel ./For ME use) 5400 r 5000 r 50,00 4 50. n • Current A.04a0Ce • flan.30a+*Tirnt "n)r1R' Fn 44* l ti.: n5440 *iaan0A1 TR -flT P4 101* 7AT* ttfel7 an Ann442171ar* RW+4eo P*r000a4len This traeeun 50.00 50 00 50.00 40 00 40 00 50.00 - 50 00 50.00 50.00 50,00 5000 50.00 50.00 It TOTAL AMOUNT OF STATE ADVANCE * 40.00 ' 1, TOTAL AMOUNT OF STATE PAYMENT 4 . 50.00 PART 3 •CERTIFICATION a APPROVAL m. tonally the a00ve 4* oe ap 04Xate and in agreement W4M this agency re0onis an0 with Me terms Of tn4s agency's contract within* ME. Ao0tt4Onaty, I certify Mat 3101 ent denlOgrapnis and seM4* even data has 5eln suOrniaed to o4* MEt 10 accordance with the contract. • 5lanal%r• Title Date n. F or ME Contract Manager useonty: ME USE 01 ALT Date MYdlee et e0*Med: Date D000atserv/0** ROOe4vet Date inspected and Approved: Approved Byr Date: Guidance Care Center, Inc. 84 Contract No. ME225 -3 -27 07/01/2012 Exhibit E a. AGENCY NAPE: CLIENT NON- SPECIFIC PERFORMANCE CONTRACT WORKSHEET FOR REQUEST FOR PAYMENT c.FONTRACT Adult Mental Health FOrCOSt a on the bes c. FROM TO: d PROGRAM utilization, Columns D & J MUST NOT e FEDERAL 0 # BE > than, and Column !: MUST NOT be g. VEND 0 (ti different than Fed ID): 'C than, the # of units reported to the h.ADDRESS (Number, City, State, Zp): ; MHSA Data Warehouse Non -TANF- Units & Earrings TANF -Units & Eamings YTD Total Units YTD Local to Enrolled YTD Billable Match Units to YTD Total Non - YTD Total Non - YTD Total TANF YTD Total Clients & Non- Medicaid Units Enrolled Clients YTD Total Units TANF Units TANF 8 Amount Units Eligible to IMF $ Mount Contracted ClientSpecdic to Enrolled & Non - Client- Eligible to be Eligible to be for Eligible be Billed to for Eligible ACTIVITY Rate Units Clients Specific Units Bided to SAMH Billed to SAMH Units SAMH Units Al Cost Center B C 1 D 1 E 1 F 1 D {G F) H 1 (cam) 1 J 1 (CxJ) ) Emergency Stabilization - 502004 Crisis Stabilization (No TMF) $0.00 0.00000 0.00000 0.00000 0.00000 0.00000' $000 ; 314 ,_ Crisis Support/Emergency $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00000 $0.00 Inpatient (No TINF) $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 Recovery & Resiliency Services - 502018 Residential Level I $0.00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00000 $0.00 Residential Level I - Enhanced Rates $0.00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00000 $0.00 Residential Level II 50.00 0.00000 0.00000 0.00000 0.00000 0.00000' 50.00 0.00000 $50.00 Residential Level Ii 50.00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00000 $0.00 Residential Level N 50.00 0.00000 0.00000 0.00000 0.00000' 0.00000' $0.00 0.00000 $0.00 Room & Board w /Supervision Lev I $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00000 $0.00 Room & Board w /Supervision Lev II $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00000 $0.00 Room & Board w /Supervision Lev III $0.00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00000 $0.00 Short - tens Residential Treatment 50.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00000 $0.00 Case Management $0.00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00000 $0.00 Intensive Case Management $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00000 $0.00 Assessment 50.00' 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00000 $0.00 Day Care 50.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00000 $0.00 Day /Night $0.00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00000 $0.00 Intervention - Individual $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00000 $0.00 Intervention - Group $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00000 $0.00 Medical Services (No TANF) $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000 ' $0 00 , o Outpatient - ixividral $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00000 n \ $0.00 Outpatient - Group $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00000 $0.00 Sheltered Employment (No TANF) 50.00 0.00000 0.00000 0.00000 0.00000 0.00000' $000 Drop - In/Self- -Help Centers (No TANF) $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 °3 In - Home and On Site $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00000 $0.00 Outreach $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0. 00000 50.00 Prevention 50.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' 50.00 0.00000 $0.00 Respite Services $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' 50.00 0.00000 $0.00 Supported Employment $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00000 $0.00 Supportive Housing/Living $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00000 $0.00 Aftercare - irdvidual 50.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00000 50.00 Aftercare - Group 50.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00000 $0.00 Information & Referral (No IMF) $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 Mental Health Clubhouse Services $0.00! 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00000 $0.00 Recovery & Resiliency - FACT Teams - 502018 (Fact Team (No TANF) $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 Recovery & Resiliency CCST - 502018 CCST - ixiividual 50.00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00000 $0.00 CCST - Group $0.00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00000 $0.00 Recovery & Resiliency - Incidental Expenses $0.00 'Incidental Expenses $0.00 0.00000', 0.00000 0.00000 0.00000 0.00000' $0.00 0.00000 $0.00 Guidance Care Center, Inc. 85 Contract No. ME225 -3 -27 07/01/2012 • Exhibit E St, AGENCY NAME: EXH1811 E.1 p., CONTRACT NO.: CHILDREN•S MENTAL HEALTH c, MONTWYEAR or: hion•TANF e_ "-monde rernetning^: 12 • MONTH LY PAYIVIENTADVANCE REQUEST Pa II EDERAI_ 10 et . S., VENOOR 10 Or Caterer* Man ream). , ia. ADDRESS dtUrnOIN. CRY, Stale. Do): Specingigt Nen- T ANT f u naafi; YTO TOtal YTO &QOM Non (YTO 0 of Non•TANO Lewin ror Me 01151040 NO, TANI P5113 ll np410 Arrount Due Coot Center units Paid Tor PART I - EARNINGS Activity Only TAN? $ Earner, Earnings Earnt nolo) Prorate.] Share (Owed) Unit Rate tarn Month Enter and athirst the Coat Canters from C0i.5ao Met the . r or *privity *my total for earn ((Tog 2 - cot 4) f Aottv It y le Me ttutrget entrty*01110303 Truman* tesaer or Cot5 (cor C of tiCrhntv r Cost Centime Mom 051* 0) _ICON of wagging i.col S AI remaining* or Col.* smtrants (raw** col 1 2 3 :5s , .,- , . 4 5 0 7 a 9 0 nergenoy Statraltgeon - 303001 C.,Iiigg Smog aces I ,cariere XXXXXXX 50 00 5000 50 00 XXXXXXX XXX)CXXX 20.00 5000 20.00 XX.2000LX 20.00 0 00000 XXXXXXX S000 5000 5000 XXXXXXX SO 00 0 90000 Onus SupporttErnergency 50 00 0 00009 • ErnergenCe StetettatIon Total sr S0,00 20.00 S000 50.00 50.00 $0.00 gingoovery & Rogitaisncy Services .• 503013 ReNgenliat Lev N I XXXXXXX 50.00 50.00 50.00 XXXXXXX 50 00 0.00000 Ft se/deneal Levin I - Enhanced Patel XXXXXXX 50.0* 50.00 SO 00 X% XXXXX 50 00 000000 R ergdentlal LerN I XXXXXXX 20 00 50.00 50.00 XXXXXXX 50,00 0.00000 Ft a sIgennal Lerni el XXXXXXX i 30 00 50 00 50.00 XXXXXXX SO 00 0 00000 Ste Manilla LINN IV XXXXXXX 50.00 50,00 30.00 XXXXXXX $0.00 0,00000 Hoorn A eloarOwnSupervision Levi XXXXXXX 50 00 50.00 50.00 XXXXXXX 50.00 0 00000 • Room 11. CoarownSuperaston Levu XXXXXXX 30 00 50.00 50,00 XXXXXXX 30.00 0.00000 Hoorn A Board VerSupengsvon UNIX XXXXXXX 50 00 50 00 5000 XXXXXXX 50.00 000000 Cass Managrrnent XXXXXXX 50.00 30.00 5000 XXXXXXX 50.00 0,00000 IrneneVe C Hie Management XXXXXXX 50.00 30.00 3000 XXXXXXX 50 00 0 00000 Asaesenatel XXXXXXX 50,00 50,00 50.00 XXXXXXX $0,00 0 00000 Ray Care XXXXXXX 50.00 3000 5000 XXXXXXX 50 00 0 00000 Craymagrit XXXXXXX 30.00 39,00 50 00 XXXXXXX 50,00 0 00000 ' ireervintlas - indMOUS1 XXXXXXX 50.00 3000 3000 XXXXXXX 50 00 0 00000 intervention • GrOUP XXXXXXX 50 .00 5000 50.00 XXXXXXX 30.00 0 00000 MINIoal 5.110vICee XXXXXXX 20,00 30,00 20.00 XXXXXXX $0,00 *00000 OtAplatent - eldiveNsall XXXXXXX 50.00 30.00 50,00 XXXXXXX 30.00 0 00000 Out Ninent - GrOup XXXXXXX 50.00 3000 50.00 XXXXXXX 50.00 0 00000 10410rne WO On 31t* XXXXXXX 30.00 50,90 50.00 XXXXXXX 30,00 000000 Outreach XXXXXXX 50.00 3000 . 50,00 XXXXXXX 50.00 *00000 Prevention XXXXXXX 50 00 30,99 50.00 XXXXXXX 50.00 0 00990 PrreventronMtemerNO XXXXXXX 30.00 50,00 30.00 XXXXXXX 50.00 0 00000 Reeptte Serric se XXXXXXX 30 00 30,00 50.00 XXXXXXX 30 00 0 00000 supported emproyrnent XXXXXXX 20 00 30.00 50.00 XXXXXXX 50,00 0 00000 ISUppertNIIHOustresUelog XXXXXXX 30 00 50,00 50,00 XXXXXXX 30 00 0 00000 Speediest Hon- YTD Total YID SAMH TANF Funding E ligible *ion- tior.TAfIF Difference *of tion-TANF Level for the TANIF $ Paid for (YTO Unpaid Prorated Amount DY. C ost Center Units Paid for PART 1 - EARNINGS GOntIntred ..' Activtry Only Earned Earnings Earnings) Share (Owed) Unit Rate the Month Enter and argue th• Cost G. enter* from cous so that the r Or Acttvityonry total fo• each ((cot 2 .. co, 4) , Activity fa OW roonthe km** r Of C01.9 (COCC OT *0 / ACTIVITY I COSA Center* , (from Eat, G) joo*.t Or 1` t) . (Col 3-Co■ .4) rernalnIngr or Cot C. reVrNant) 001.7 I COI JO 1 2 3 A ' S a 7 a - a .11:1•- XXXXXXX . xxxx so 0:: ao ao 50 ock . XXXXXXX I Arnim ars -Group XXXXXXX 50,00 50.00 50.00 XXXXXXX 50 00 0,00000 XXXXXXX 30.00 5000 50,00 XXXXXXX 50.00 0 00900 e...moon 4, atererns X S0,00 0 00000 .. 20 00 0.00000 Recovery A Reetteney ser a Total • 50.00 $0.00 50,00 20.00 50.00 $0.00 ft A R Contrinshenenn• Community service Team- 303013 I CO5T-inosnege XXXXXXX 50.00 50.00 50.00 XXXXXXX $0,00 CCST-Group XXXXXXX 20 00 %000 5000 XXXXXXX 30.00 0.00000 ft&ft - CC 57 Torre . 20.00 50 .00 $0,00 20.00 $0.00 20.00 Sart ,, Incidental Expense. l i n ncissintal Expenses XXXXXXX 30 00 5000 50.00 XXXXXXX 50,00 0.00000 Ast indidonte * spongier% Total u 20.00 50 00 50.00 50.00 $0.00 50.00 GRAND TOTAL.. 20.00 20 .00 $0.00 20.00 20.00 50.00 • Untess the contractor requests and tre ME approves payment in excess 01 5*. prorated share, h, Less Recougment of Interest u $0,00 i. Les s Recoupment of Advancer. $0.00 3, TOTAL AMOUNT OF STATE PAYMENT/ADVANCE vr 20.00 i ! . 1T0 interest 170 Internet YTO I. end* - YTO Advance a arne0 RI/COON] AI:Iva Ealanor P ART 2- FUNDING OISTRIDUTION _pros' me use) _fro? me ualt) Jr or Pros/ Wen „fret MP/. Urfe) .. .ff or me use) 3000 , 30.00 50 00 50.00 Current AdvanO* Op .A1 aZATIOP,, CO De rpor me vet mace 1 1)n.0 TR PIJNO 5 C.I.T P OC.x. or 00 a AMON* DOS ReGRet les OUetowedt 50,00 50 00 50 00 , 50 00 50,00 , f , SO 00 . . . 30,00 _ SO 00 _ 50 00 30 00 4 , • k, TOTAL AMOUNT OF ME ADVANCE *** 20.00 I. TOTAL AMOUNT OF ME PAYMENT ss 5000 PART 3 -CERTIFICATION & APPROVAL m. I cersfy the above to be accurate and in agreement with this agency's records and with the terms of this agency's contract with the ME, Additionally, t c edify that all ctent d ernographic and service event data ha been subverted *0 Ine departmental accordance with the oo raract, Sa]natUnt Tale Date n For ME Contract Manarter use only: IvE USE ONLY Date Invoice Received: . Date Goods/Services Receive:red; Oahe Ins plaited and Approved: Approved 13v/ Date; . _ _ . Guidance Care Center, Inc. 86 Contract No. ME225-3-27 07/01/2012 Exhibit E la. AGENCY NAME: CLIENT NON-SPECIFIC PERFORMANCE CONTRACT b. CONTRACT No.: WORKSHEET FOR REQUEST FOR PAYME For cost centers paid for: on the basis of c. FROM TO: Children's Mental Health ut zation, Cobunns D dr . MUST NOT BE> f d PROGRAM than , ' , and Column E MUST NOT be <than e FEDERAL ID tr: the # of units reported to the PIMA Data !g VENDOR ID (If different than Fed ID): Warehouse 1h. ADDRESS (Number, City, State, Zp): Non -TANF- Units & Eamingsi TANF -Units & Eamings YTD Total YTD Local Units to Match Units Enrolled YTD Billable to Enrolled YTD Total YTD Total YTD Total YTD Total Clients & Medicaid Clients & Units Non -TANF YTD Total TANF Units TANF $ Non-Client- Units to Non - Client- Eligible to Units Eligible Non -TANF $ Eligible to Amount for Contracted Specific Enrolled Specific be Billed to to be Billed to Amount for be Billed to Eligible ACTIVITY Rate Units Clients Units SAMH SAMH Eligible Units SAMH Units Al Cost Center B / C l D E 1 F 1 D-(E+F) H 1 (C ) 1 J 1 K) , Emergency Stabilization - 503001 Crisis Stabilization (No TANF) $0.00 0.00000 0.00000 0.00000 0.00000' 0.00000' $0 00 ' Crisis Support/Emergency $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00 $0.00 Inpatient (No TANF) $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0 00 s , y Recovery & Resiliency Srvs - 503013 Residential Level I $0.00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00' $0.00 Residential Level I- Enhanced Rates $0.00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00' $0.00 Residential Level II $0.00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00' $0.00 Residential Level III $0.00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00' $0.00 Residential Level IV $0.00 0.00000 0.00000 0.00000' 0.00000 ' 0.00000' $0.00 0.00' $0.00 Room & Board w /Supervision Lev I $0.00 0.00000 0.00000 0.00000 0.00000' 0.00000' $0.00 0.00 $0.00 Room & Board w/Super ision Lev II $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00' $0.00 Room & Board w /Supervision Lev 01 $0.00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00' $0.00 Case Management $0.00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00' $0.00 Intensive Case Management $0.00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00' $0.00 Assessment $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00 $0.00 Day Care $0.00 0.00000 0.00000 0.00000 0.00000' 0.00000' $0.00 0.00' $0.00 Day/Night $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00' $0.00 Intervention - Individual $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00' $0.00 Intervention -Group $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00' $0.00 Medical Services (No TANF) $0.00 0.00000 0.00000 0.00000' 0.00000 v 0.00000' $0.00 Outpatient - Individual $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00 ' $0.00 Outpatient -Group $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00' $0.00 It -Home and On Site $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00' $0.00 Outreach $0.00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00' $0.00 Prevention $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 0.00' $0.00 PreventioMntervention Day $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00' $0.00 Respite Services $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 0.00' $0.00 Supported Employment $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00' $0.00 Supportive Housing/Living $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00' $0.00 Aftercare - Individual $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00' $0.00 Aftercare - Group $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00' $0.00 Information & Referral (No TANF) $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 ,`.$O,00 Mental Health Clubhouse Services $0.00 0.00000 0.00000 0.00000' 0.00000' 0.00000' $0.00 0.00' $0.00 • Recovery & Resiliency Comprehensive - Community Service Team - 503013 CCST - Individual $0.00 0.00000 0.00000 0.00000' 0.00000 ' 0.00000' $0.00 0.00' $0.00 CCST -Group $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00' $0.00 Recovery & Resiliency - Incidental Expenses Incidental Expenses $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000 $0.00 0.00' $0.00 Guidance Care Center, Inc. 87 Contract No. ME225 -3 -27 07/01/2012 Exhibit E ... AGE NC Y NagE EXHIBIT E2 .CONTRACT No ADULT SUBSTANCE ABUSE . VONTmorf AR OF TANF • .. vets rent none' 12 MONTHLY PAYMENTIADVANCE REQUEST ..FEDERALIOS. ,. At40OR 10 firdttrent than Fed DI ....ADDRESS Number Ct State. 29 (') Si:4 TAN F Funding Levet YID Total YID SAM H Deference * 01 TANF Units for the Activity E tigiOle TANF $ TANF Paid for tTTO Unpaid Amount Due Cost Center Paid tor thle PART 1 .EARNINGS Only Earned Earnings Eamon's) P (Meted Share (Owed) U mt Rate Month E nter and adtust the Cog Centers from Co1.5 so that . For An Nutty only the total for ((cot 2 col 41( each Activity ts Budget E nifty 60910603 Itol.K of months the lesser of Icolk of ACTIVITY (Cog Centers (from E sh GI Vtrktht) • q tticiii remould C o4.5 or CNA.. Viricsht) (coil ( cOM0 , 1 2 3 4 5 6 1' 8 9 . reattran*& Aftercare • 60200? , -X'sseavxect XXXXXXX 50 00 SO 00 XXXXXXX 50 00 0 00000 Catttlettlit*Mtlit XXXXXXX SO 00 00 00 XXXXXXX SO 00 0 00000 0,44 Soctortit intfilienty X XXXXXX SO 00 50 00 xXXXXXX 00 00 0 00000 Day Care XXXXXXX 00 00 0000 XXXXXXX 50 00 0 00000 0 r.4( gm x...t. (.... X XX SO 00 00 03 )■ XXX X XX 53 00 0 '0'0000 in & On See XXXXXXX 0000 50 00 XXXXXXX 50.00 0.00000 ■ C sat Maple-crams X X XXx xx SO 00 50 00 XX XX XX X 50 00 0 00000 inuttven non . bandual XXXXXXX 50 .00 $0.00 XXXXXXX S000 0.00000 merx alma ■.Oraxo XXXXXXX 55100 5003 XXXXXXX 00 00 0 00000 0 tstaatext - !nitro:loaf XXXXXXX 5000 00 00 XXXXXXX 50 00 0 00000 .0 ■..,toate m - Grouts X X X X X X X 50 03 00 00 X k. X X X X ;X 00 00 000000 Outreach XXXXXXX 50.00 00 00 XXXXXXX 00.00 0.00000 0 es tSexttm L a, ei ■ XX s, A XXX 56 00 50 30 XX XX X XX 50 00 0 00000 R esdental Level nhenced R stet XXXXXXX 00 00 50 00 XXXXXXX 50. 0 00000 ;,..s4extalLe,ts X Xx X X XXX SO 00 S0.0 :x X AX X XX SO 00 v30000 A escStert•11.004i1 XXXXXXX 50.00 5000 XXXXXXX 50 00 000000 Rittiteltial L. tv ei iV XXXXXXX 00 00 SO 00 .XX Xx, X XX SO 00 0 30000 Respite Serowe XXXXXXX 50.00 00.00 XXXXXXX 50 00 000000 5 Er ccsvrext /.k\\ X( SO 00 00 33 x X x X XXX 00 00 030000 Su000rtxm modulo/1.1,4m XXXXXXX 00.00 50.00 XXXXXXX 50.00 0.00000 XXxX XXX 56 00 50 00 xXxxx XX 50 00 0 00000 , Aftercare - Otsloxttusa X XXXXX 50 00 5000 XXXXXXX 00 00 0 00000 .4.■.tertast ., Gset)s) X X XXX XX 50 00 00 00 X X XXX X X 50 00 0 00000 Room Si Sosistl ArSuperstscm Lev I XXXXXXX 50.00 0000 XXXXXXX 50,00 0 00000 Room & Soax.: Le, i l X X XXXXX 00 03 00 .00 x xXX X ),.X 00 00 006000 Room 3 Board weStiperviSiitin Lev it X X XXX XX 50 00 50.00 XXXXXXX $0 00 0.00000 .. 0 ect,t 7. 01,10iitii X X i. X XXX SO 00 SO 00 ii XXX X K. 53 00 0 30000 R noway Group XXXXXXX 50.00 00.00 XXXXXXX SO 00 0.00000 Treatment & Aftercare Total e 50.00 10.00 50.00 50.00 00.00 . revention 402406 nterview', XXXXXXX ig gg x 0040 ii.g Vx Itixx 0 00000 S000 Prevention Total. 00.00 • ncklental Expenses I mpotent* Expenses XXXXXXX 0000 00.00 XXXXXXX 00. 00 0.00000 Incidental E sponse* Total s $1000 50.00 $0.00 $000 50.00 TOTAL: 10.00 10,00 50.00 50.00 50.00 50.00 U ccetracut ritstits 2* told tiii.145 amssexsas Pax min r 4 ..." 34 " W .2 " 14 . h• Less Recoupment of Intents* e 00.00 I. Less Recoopment of Advance - S0.00 I. TOTAL AMOUNT OF ME PAYME NTIADVANCE * 50.00 - , YT 0 *merest YTO Interest YID Fund* ' YTO Advance -, Earned Recouped ArNianced Balance PART 2 - FUNDING DISTR*BUTION 4 iFq04E kite) „ Stir Mt XiSel ,itotPitit us* „IF as Prov use). .sf or ME ssaa) 50 00 5000 0000 50,00 , C lostxt Advance olitsc,,,,■-ssz:-To Is c 00 0 $P1, of Q se t vo It 'io '00' F6N0 t CAT it 0 '0 .n a ..• ,. , ft - 50.00 00 00 00 . 00 00 00 00,00 00 .00 06 00 00. 00 50 00 00.00 50 .00 00 00 50 00 It TOTAL AMOUNT OF VIE ADVANCE * 50.00 ' 1. TOTAL AMOUNT OF ME PAYMENT- 00.00 PART 3 ., CERT* CATION & APPROVAL m. I certify the above to be accurate and in acreeinent with this ageitCYS records and eath the terms ot this agency's contract with the ME it dditionaly, 1 cenitiV that at dent demograptec and service event data has he en Subrrated to the El E in accordance ',seethe contract Sicnatist Tait Otte n For ME Contract Manager u se only: ME USE ONLY Date Invoice Received: Date Goods/Services Re..eited; 0 ate Inspected and Approved: Avortived 8 vl Date; Guidance Care Center, Inc. 88 Contract No. ME225-3-27 07/01/2012 Exhibit E a. AGENCY NAME: CLIENT NONSPECIFIC PERFORMANCE CONTRACT 1 ' WORKSHEET FOR REQUESTFOR PAYMENT For cost centers paid for on the b. CONTRACT No.: A dult Substance Abuse basis of ubhzzalion, Columns D g, c FROM: TO: J MUST NOT BE > than, and- d PROGRAM: Column E &UST NOT be<than, e FEDERAL ID is the # of un s reported to the g. VENDOR D (If afferent than Fed ID): MHSA Data Warehouse h. ADDRESS (Number, City, State, Zip): • Non-TANF- Units & Earnings TANF - Units & Earrings YTD Total YTD Local Units to Match Units YTD Total Enrolled YTD Billable to Enrolled YTD Total Non -TANF YTD Total YTD Total Clients & Medicaid Clients & Units Units YTD Total Non- TANF Units TANF $ Non- Client - Units to Non- Client Eligible to Eligible to TANF$ Eligible to Amount for Contracted Specific Enrolled Specific be Billed to be Biled to ! Amount for be Billed to Eligible ACTIVITY Rate Units Clients Units SAMH SAM6i Eligible Units SAM'li Units A �CastCer�er B � C � 0 � E � F 1 ° � +F) � H 1 (c�) J 1 ( K Treatment & Aftercare -603007 Assessment $0.00 0.00000 0.00000 0.00000 0.00000 ' 0.00000 50.00 0,0000 50.00 Case Management 50.00 0 -00000 0.00000 0.00000 0,00000' 0.00000 50.00 0.00000 50.00 • Crisis Support/Emergency 50.00 0.00000 0,00000' 0,00000' 0.00000 r 0.00000 50.00 0.00000 50.00 Day Care 50.00 0.00000 0,00000' 0.00000' 0.00000' 0.00000' 50,00 0,00000 50.00 Dayavgnt 50.00 0.00000 0,00000 0.00000 0.00000' 0,000001 $0.00 0.00000 50.00 h -Home & On Site 50.00 0.00000 0.00000 0.00000 0.00000' 0.00000 $0.00 0,00000' 50,00 htensive Case Management $000 0.00000 0.00000 0.00000 0.00000 0.00000 50.00 0.00000 50.00 htervention - Indiaidual 50.00 0.00000 0.00000 0.00000 0.00000' 0.00000 50.00 0.00000 50.00 Intaventron -Group 50.00 0.00000 0,00000. 0.00000 0.00000' 0.00000 50.00 0.00000 50.00 fJedccd Services (No TANF) 50.00 0.00000 0.00000 0.00000 0.00000' 0.00000 50.00 , f Methadone Maintenance (No TANF) 50.00 0.00000 0.00000 0.00000 0.00000' 0.00000' $0.00 - . Outpatient - hdvndual 50,00' 0.00000 0.00000 0.00000 0,00000' 0.00000 50.00 0.00000 50.00 OutPa - pup 50.00', 0.00000', 0.00000', 0.00000 0.00000' 0.00000 $0.00 0.00000 50.00 Outreach 50.00 0.00000 0,000001 0.00000 0.00000' 0.00000' 50.00 0,00000 50.00 Residenlial Level! 50.00 0.00000 0.00000 0.00000 0.00000' 0.00000 50.00 0.00000 50.00 Resdentat Level I - Enhanced Rates 50.00 0.00000 0.00000 0.00000 0,00000' 0.00000 50.00 0.00000 50.00 Residential Level!! 50.00 0.00000 0.00000 0.00000 0.00000' 0.00000 $0.00 0.00000 $0.00 ResdentaI Level 01 50.00 0.00000 0,00000 0.00000 0.00000' 0.00000 50,00 0,00000 50,00 Residential level IV 50.00 0.00000 0.00000 0.00000 0.00000' 0.00000 50.00 0.00000 50.00 Respite Services 50.00 0.00000 0.00000 0.00000 0.00000' 0,00000 50.00 0.00000 50.00 Supported Employment 50.00 0.00000' 0.00000 0.00000 0.00000' 0.00000 $0.00 0.00000 50.00 Supportive Houshg Livhg 50.00 0,00000 0.00000' 0.00000 0,00000' 0.00000 50.00 0.00000 50.00 TASC 50.00 0.00000 0.00000 0.00000 0.00000' 0.00000 50.00 0.00000 50.00 r'+ferc re - Ind ictjal 50.00 000000` 0.00000 0,00000 0.00000' 0.00000 50.00 0.00000 50.00 Aftercare - Group 50.00' 0.00000 0.00000 0.00000 0.00000' 0.00000 50.00 0.00000 50.00 Room & Board vv±Super ision Lev I 50.00 0.00000 0 00000'' 000000 0.00000' 0.00000 50.00 0,00000' 50.00 Room & Board rs /Supe€vision Lev II 50.00 0.00000 0.00000 0.00000 0.00000' 0.00000 50.00 0.00000 50.00 Room & Board sv/ /Supervision Lev it ' 50.00 0.00000 0.00000 0.00000 0.00000 0.00000 50.00 0.00000 50.00 RecoveryStwort - Indvdual 50.00 0.00000 0.00000 0.00000 0.00000 0.00000' 50.00 0.00000 50.00 Rec ovary Suport - Group 50.00 0.00000 0,00000 0.00000 0.00000 000000 50.00 0,00000 5000 Information & Referral (No TANF) 50.00' 0.00000 000000 0.00000 0.00000 0.00000 $0.00 Detoxification - 603006 Substance Abuse Detox (No TANF) ' 50.00 0.00000 0.00000 0.00000 0.00000 0.00000 50.00 Outpatient Detoxification (No TANF) 50.00 0.00000 0.00000 0.00000 0.00000 0.00000 Prevention - 603006 Prevention 50.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 50.00 Information & Referral No TANF) 50.00 0.00000 0.00000 0.00000 0.00000 0.00000', 50.00 FACT Teams - xxxxxx (Fact Tarn (No TANF) 50.00 0.00000 0.00000 0.00000 0.00000 0.00000 50.00 Incidental Expenses (Incidental Exposes 50.00 0.00000 0.00000 0.00000 0.00000_ 0.00000 50.00 0.00000 $0.00 Guidance Care Center, Inc. 89 Contract No. ME225 -3 -27 07/01/2012 Exhibit E a. rG[ NCY NAME: EXHIBIT E. p.. c 0NTRACT NO.: CHILDREN SUBSTANCE ABUSE C. MONTNf tAR or Non -TANF d. - -month* rem Siena"; 12 MONTHLY PAYMENT/ADVANCE REQUEST e. FE OE ISM-C 5' T. vs NO0ft 10 (it011erent t0an F ea C): 0. ADORE 35 (Went/at City, State ap): PART 1 - EARNING a Spe0ln.0 Non- YTD Total YID SARAN N On. DlttennC• Ptareted Snare Amount Due Coat Center s or Non -TAN F TANF Funding EllgibiaN on- TANF Patd 00r (YTD U npaid (Owed) UNt Rate U nit* Paid for Laval Pot the TANF S [amid 9 arnln00 Earrangs) Iles Monir Actlnity Only E nter an0 ad)USt One Coot For A0tivity only Centers from 8utl at Ent 6(001. 2- col 4)i Col so tnat 0 My COST 0665 : montna the total for {0Ol.0 oT ACTIVITY: Cost Center* (tro9E*PI G) JnoI.I ofwr*ere) (004.3. 001.41 remaining)- sac* activity Is WrNne) e (col .7: col T restrfont ♦ Aftercare - 603607 ? 3 4 5 ¢ 7 ; 5 Aauesmant XXXXXXX 20.00 5000 ,XXXXXXX S0.00 0.00000 C aee Manabemant XXXXXXX 50.00 30 00 XXXXXXX 50.00 000000 Cn85 Support'Emergency XXXXXXX 50.00 50.00 XXXXXXX D ay Care XXXXXXX 9000 5000 XXXXXXX 50. 00 000000 nt 2000 0.00000 0 tiy01 tr XXXXXXX 50.00 SO C XX XXXX 20.00 000000 n•NOma a On sate XXXXXXX S0 00 90.00 XXXXXXX SO 00 0 00000 . Intonerte Cate Manag4m ant XXXXXXX 50.00 50.00 XXXXXXX - 5000 000000 inteeventem- in*M*ual XXXXXXX S0.00 SO 00 XXXXXXX 50.00 0.00000 intomonlbn - Group XXXXXXX 2000 SO 00 XXXXXXX $0.00 000000 Memos Sett ea XXXXXXX 50.00 30.00 XXXXXXX 50.00 0.00000 rt etnadono- taanlanenaa XXXXXXXX 50.00 SO00 XXXXXXX 50.00 0.00000 0utpa1MM- nevdntai XXXXXXX SO 00 3000 XXXXXXX 30.00 0.09000 Outpanant -Group XXXXXXX 50.00 50.00 XXXXXXX 50.00 0.00000 O utreaan XXXXXXX 50.00 SO 00 XXXXXXX 50.00 0.00000 0 etel mtal Loon I XX XX.XXX S0.00 5000 XXXXXXX SO 00 0.00000 R aswanoal Leval I .noa*Rat* XXXXXXX 30 50.00 XXXXXXX SO 00 0.00000 R eatt*rttiai Laoet 2 XXXXXXX 5000 5000 XXXXXXX 50.00 0.00000 R esldenOal Level M XXXXXXX 5000 50.00 XXXXXXX 30.00 0.00000 eaa•nnal Lanai nE XXXXXXX 50.00 SO 00 XXXXXXX 50.00 0.00000 RaspaeSestcaa XXXXXXX 50.00 30.00 XXXXXXX 5 1100o11290m COM ant ;XXXXXXX S0 -00 5000 XXXXXXX 50.00 0.00000 3 upportNie Nowlin04,min* XXXXXXX 50.00 30.00 XXXXXXX 30.00 0 0000 Trx XX XXXXX 3000 5000 XXXXXXX 30.00 0.00000 Atomare-navtduai XXXXXXX 3000 50.00 XXXXXXX 50.00 0.00000 xotraare - Group XXXXXXX 50.00 5000 :XXXXXXX S0.00 0.00000 Room & Soar* orSUparvlson Levi XXXXXXX 50.00 30.00 XXX %XXX 30.00 0.00000 Room a xBupen +aron cave x.X XXXXX SO 00 50 - 00 XXXXXXX 50.00 9 0900 • Room & Soar* w5upervtaan Lev a XXXXXXX 90.00 SO 00 XXXXXXX 30.00 0.00000 R*cover*3upport - moi:aaual XXXXXXX 20.00 5000 XXXXXXX 50.00 0.00000 el ecO.ery Support -Group X XX(X XXX 50.00 50.00 XXXXXXX 50.00 000000 n tarn ab0n 6 Rewrrat XXXXXXX 500 SO OD XXXXXXX 30.00 0.00000 • Treatment & Aftercare Tots/ • 50,00 30,00 90.00 3000 90.00 0 a Mt toocatton - 000003 I Substance **Ouss O etox XXXXXXX 50.00 SO 00 XXXXXXX 50.00 0.00000 Outpatient 0*91090inon XXXXXXX 5n nn SO 1*) XXXXXXX O at *sliest /*r1 Tool • 50.00 S0.00 30,00 90.00 90,00 30.00 0,00000 Spectra * Non- YT Total YTD SARAN NOM. Oltteranoa Prorate* Soar* Amount Ou* - Cost Cents/ aor N on-TAN F PART( -E ARNING5 COn3nUSd: 1AM P Funding Eligible NOM TAM Pa)4 tar (YTD 0npai0 ' (Geed) Urat Rat* Onto Pald for Level for bra TAN. 9 [armed E *MI ngs E*Mingo) DO* MOntn M.vi� Only E *tar end 4d)ute ma Cost PO!' AOttvlty o n l y Centers Rom )1001. 2 -col 4), C o l .5 sonnet 5 Udget E nttty COS( 0203 (CO1.tt of ln1nth• tie total for 9001,5 of AC T1VITY. C oat Cortaro Imam! 0110) Wgnt) (001,3 - 901.4( 70 0)7)inat• eel O Aptfvny la, Woken) „ 1001,7 +00).31 1 2 3 4 5 - a n 7 $ a PreYanUOn - 103006 IP revert ,1 XXXXXXX SO00 S0.00 XXXXXXX $0.00 0.00000 intern ab2na Reline XXXXXXX 50.00 3000 XXXXXXX 50.00 0.00000 Prev*nnon TOW a. 50.00 $0,00 30.00 $0.00 $0.00 FACT Teems - J0011004 'Fact - ream XXXXXXX 30.00 30.00 XXXXXXX 30.00 0.00000 TACT Total • $0 -00 50,00 50,00 $000 30,00 Incidental Exam*** ;(� g p pl In ClOenta xnerta(t zpeneea TOtet • X 5 0 .00 X 38 -00 $0-00 5 0 . 00 XX .00 90 .E 50.00 0 00000 TOTAL: 9000 90.00 90.00 $0.00 $0,00 30.00 SAnla SS the Contractor requests And the ME approves payment in 018.055 of the prorated Share n. Less Rearmament of Interest = 9. Lass Rearmament arAdvance= L TOTAL AMOUNT OF ME PAYMENT/ADVANCE = 5000 YTD tnteraet YTD interest YTD Funds YTD entrance Earns* R0OOU0W Acres'*** 0etande , 0AR T2- FUMOMMOO *STRip0TIOM (For ME Use) , (F or ME use) , (rot Ptoy. use) (00r Prow. eae) (re, ME yes) , 50.00 50.00 50.00 SO 00 Current *015110* Q0Q4)1ZXTlON 0 De iF0rrlE USeL Ni00*e NUM ter - 1.1 -.0T FUND* 0AT0 00++00 10a - *11100m00a __Ls., assi 1.01009m Due Owed) an nn 5n nn SO 00 50.00 3000 S0 00 *0 00 50 00 30.00 30 00 SOHO 00 nn an n0 k. TOTAL AMOUNT OF ME ADVANCE = 50.00 1 M TOTAL OF ME PAYMENT • 50910 ' PART 3 - CER lie' IC,A tIOH & APPROVAL m. 10*1MY0e above to be accurate and in apreemels with this a0e1YM3 records aver/tat the terms of this aoencv+s OanD*ct yen Ole NE. Additionally. I attneyeet at 04ert democ raptac and stoma. avert. data has boom submitted to the ME. in accordance 03rd, the contract. Sidoahre Title OaM n. For ME Contract Manama use or/y: ME USE ONLY Dame NnmoiOe R ecaived: Data Oood9FSo.vices Recanted: Data Inspected and Approved= Approved By/ Date: Guidance Care Center, Inc. 90 Contract No. ME225 -3 -27 07/01/2012 Exhibit E a. AGENCY NAME: CLIENT NON - SPECIFIC PERFORMANCE CONTRACT WORKSHEET FOR REQUEST FOR PAYMENT For costcettters paid for on the b. CONTRACT No.: Children's Substance Abuse basis of utilization, Coluinris0& c. FROM TO: NOT BE ? than, and Column d PROGRAM E MUST NOT be < than, the # of e FEDERAL ID #: g. ' VENDOR ID (If different than Fed ID): units reported to the MHSA Data h. ADDRESS (Number, City, State, Zp): Warehouse Non -TANF- Units & Earnings TANF -Units & Earnings YTD Total YTD Local Units to Match Units YTD Total Enrolled YTD Billable to Enrolled YTD Total Non -TANF ! YTD Total YTD Total Clients & Medicaid Clients & Units Units YTD Total Non. TANF Units TANF $ Non - Client - Units to Non - Client- Eligible to Eligible to TANF $ Eligible to Amount for Contracted Specific Enrolled Specific be Billed to be Billed to Amount for be Billed to Eligible ACTMTY Rate Units Clients Units SAMH SAMH Eligible Units SAMH Units Cost Center D -(E +F) (CxH) (CxJ) A B C 1 D 1 E 1 F 1 G H 1 I ' J 1 K Assessment $0.00 0.00000', 0.00000 0.00000 0.00000 0.00000! $0.00 0.00000 $0.00 Case Management $0.00', 0.00000', 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 Crisis Support/Emergency $0.00 0.00000', 0.00000 0.00000 0.00000 0.00000! $0.00 0.00000 $0.00 Day Care $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 Day /Night $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 In -Home & On Site $0.00, 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 Intensive Case Management $0.00, 0.00000 0.00000 0.00000 0.00000 0.00000', $0.00 0.00000 $0.00 Intervention - Individual $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 Intervention - Group $0.00! 0.00000 0.00000 0.00000 0.00000 0.00000! $0.00 0.00000 $0.00 Medical Services (No TANF) $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 Methadone Maintenance (No TANF) $0.00 0.00000', 0.00000 0.00000 0.00000 ' 0.00000 Outpatient - hdividual $0.00 0.00000 0.00000 0.00000 0.00000 0.00000, $0.00 0.00000 $0.00 Outpatient - Group $0.00', 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 Outreach $0.00 0.00000 0.00000 0.00000 0.00000 0.00000! $0.00 0.00000 $0.00 Residential Level I $0.00 0.00000 0.00000 0.00000 0.00000 ' 0.00000 $0.00 0.00000 $0.00 Residential Level I - Enhanced Rates $0.00! 0.00000 0.00000 0.00000 0.00000' 0.00000 $0.00 0.00000 $0.00 Residential Level II $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 Residential Level 11 $0.00 0.00000', 0.00000 0.00000 0.00000 0.00000, $0.00 0.00000 $0.00 Residential Level IV $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 Respite Services $0.00 j 0.00000', 0.00000 0.00000 0.00000 ' 0.00000 $0.00 0.00000 $0.00 Supported Employment $0.00 0.00000! 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 Supportive Housing/Living $0.00 0.00000! 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 TASC $0.00 0.00000 0.00000 0.00000 0.00000 0.00000! $0.00 0.00000 $0.00 Aftercare - ndivdual $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 Aftercare- Group $0.00! 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 Room & Board w /Supervision Lev I $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 Room & Board w /Supervision Lev II $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 Room & Board w /Supervsion Lev Al $0.00'', 0.00000 0.00000 0.00000 0.00000 0.00000', $0.00 0.00000 $0.00 Recovery Support - Individual $0.00 0.00000! 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 Recovery Support - Group $0.00 0.00000 0.00000 0.00000 0.00000 0.00000! $0.00 0.00000 $0.00 Information & Referral (No TANF) $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 Detoxification - 602001 Substance Abuse Detox (No TANF) $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 Outpatient Detoxification (No TANF) $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 Prevention - 602002 Prevention $0.00 0.00000 0.00000 0.00000 0.00000 0.00000! $0.00 0.00000 $0.00 Preventionllntervention - Day $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 Information & Referral (No TANF) $0.00 0.00000 0.00000 0.00000 0.00000 0.00000! $0.00 Incidental Expenses (Incidental Expenses $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 Guidance Care Center, Inc. 91 Contract No. ME225 -3 -27 07/01/2012 Exhibit F Minimum Service Requirements The provider and its subcontractors shall be knowledgeable of and fully comply with all applicable state and federal laws, rules and regulations, as amended from time to time, that affect the subject areas of the contract. Authorities include but are not limited to the following: I. PROGRAMMATIC AUTHORITY (FEDERAL) A. Mental Health 42 U.S.C. 300x to 300x -9 (Block Grant for community Mental Health Services) http://www4.1aw.cornell.edu/uscode/42/ch6AschXVIIpB.html B. Substance Abuse Prevention and Treatment Block Grant (SAPTBG) 42 U.S.C. 290kk, et seq.(Limitation on use of funds for certain purposes) http: / /www4.law.cornell.edu /uscode /html /uscode42 /usc sec 42 0000029 0 -- kk000 -.html 42 U.S.C. 300x -21 to 300x -35 and 300x -51 to 300x -66(SA Treatment & Prevention Block Grants) http: / /www4.law.cornell.edu /uscode /html /uscode42 /usc sup 01 42 10 6 A 20 XVII 30 B 40 ii.html 42 CFR, Part 54 (Charitable choice) http: / /www.access.gpo.aov /nara /cfr /waisidx 03/42cfr54 03.html 45 CFR 96.120 — 137 (SA Treatment & Prevention Block Grants) http : / /www.access.apo.gov /nara/cfr /waisidx 03/45cfr96 03.html Restrictions on expenditures of SAPTBG 45 CFR 96.135 http: / /www.access.gpo.gov /nara/cfr /waisidx 01/45cfr96 01.html C. Substance Abuse - Confidentiality 42 CFR, Part 2 http: / /www.access.gpo.gov /nara/cfr /waisidx 03/42cfr2 03.html D. Health Insurance Portability and Accountability Act (HIPAA) 45 CFR 164 http : / /www.access.gpo.gov /nara/cfr /waisidx 03/45cfr164 03.html Guidance Care Center, Inc. 92 Contract No. ME225 -3 -27 07/01/2012 E. Social Security Income for the Aged, Blind and Disabled 20CFR416 http : / /www.access.gpo.gov /nara/cfr /waisidx 03/20cfr416 03.html F. Endorsement and Payment of Checks Drawn on the United States Treasury 31 CFR 240 relating to SSA http: / /www.access.apo.gov /nara/cfr /waisidx 03/31 cfr240 03.html G. Temporary Assistance to Needy Families (TANF) Part A, Title IV of the Social Security Act 45 CFR, Part 260 http://www.access.gpo.gov/nara/cfr/waisidx 03/45cfr260 03.html Section 414.1585, F.S. http://www.leg.state.fl.us/statutes/index.cfm?App mode = Display Statute &Search String=&URL=0400-0499/0414/Sections/0414.1585.html H. Positive Alternatives to Homelessness (PATH) Public Health Services Act, Title V, Part C, Section 521, as amended 42 U.S.C. 290cc -21 et. seq. http:/ /www. law. cornell .edu /uscode /html /uscode42 /usc sup 01 42 10 6A 20 111 -A 30 C.html Stewart B. McKinney Homeless Assistance Amendments Act of 1990, Public Law 101 -645 http: / /www4.law.cornell.edu /usc -cgi /get external.cgi ?type =pubL &target= 101 -645 42 CFR, Part 54 http: / /www.access.gpo.gov /nara /cfr /waisidx 03/42cfr54 03.htm1 I. Americans with Disabilities Act of 1990 42 U.S.C. 12101 et seq. http: / /www.law.cornell .edu /uscode /html /uscode42 /usc sec 42 00012101----000 - .html II. FLORIDA STATUTES All State of Florida Statutes can be found at the following website: http: / /www.leq.state.f1. us/ statutes /index.cfm ?Mode= ViewStatutes &Subme nu= 1 Guidance Care Center, Inc. 93 Contract No. ME225 -3 -27 07/01/2012 A. Child Welfare and Community Based Care Chapter 39, F.S. Proceedings Relating to Children Chapter 119, F.S. Public Records Chapter 402, F.S. Health and Human Services; Miscellaneous Provisions Chapter 435, F.S. Employment Screening Chapter 490, F.S. Psychological Services Chapter 491, F.S. Clinical, Counseling and Psychotherapy services Chapter 1002, F.S. Student and Parental Rights and Educational Choices Section 402.3057, F.S. Persons not required to be refingerprinted or rescreened Section 414.295, F.S. Temporary Cash Assistance; Public Records Exemptions B. Substance Abuse and Mental Health Services Chapter 381, F.S. Public Health General Provisions Chapter 386, F.S. Particular Conditions Affecting Public Health Chapter 395, F.S. Hospital Licensing and Regulation Chapter 394, F.S. Mental Health Chapter 397, F.S. Substance Abuse Services Chapter 400, F.S. Nursing Home and Related Health Care Facilities Chapter 435, F.S. Employment Screening Chapter 458, F.S. Medical Practice Chapter 459, F.S. Osteopathic Medicine Chapter 464, F.S. Nursing Chapter 465, F.S. Pharmacy Chapter 490, F.S. Psychological Services Chapter 491, F.S. Clinical, Counseling and Psychotherapy Services Chapter 499, F.S. Drug, Cosmetic and Household Products Chapter 553, F.S. Building Construction Standards Chapter 893, F.S. Drug Abuse Prevention and Control Section 409.906(8), F.S. Optional Medicaid — Community Mental Health Services C. Developmental Disabilities Chapter 393, F.S. Developmental Disabilities D. Adult Protective Services Chapter 415, F.S. Adult Protective Services E. Forensics Chapter, F.S.916, F.S. Mentally Deficient and Mentally III Defendants. Chapter 985, F.S. Juvenile Justice; Interstate Compact on Juveniles Section 985.19, F.S. Incompetency in Juvenile Delinquency Cases Guidance Care Center, Inc. 94 Contract No. ME225 -3 -27 07/01/2012 Section 985.24, F.S. Interstate Compact on Juveniles; Use of detention; prohibitions; F. Florida Assertive Community Treatment (FACT) General Appropriations Act http://www.flsenate.aov/Welcome/index.cfm?CFID=105701865&CFTOKE N= 34016817 G. State Administrative Procedures and Services Chapter 120, F.S. Administrative Procedures Act Chapter 287, F.S. Procurement of Personal Property and Services Chapter 815, F.S. Computer - Related Crimes Section 112.061, F.S. Per diem and Travel Expenses* Section 112.3185, F.S. Additional Standards for State Agency Employees Section 215.422, F.S. Payments, Warrants & Invoices; Processing Times Section 216.181(16)(b), F.S. Advanced funds invested in interest bearing accounts *Travel Expenses are specified in the DFS Reference Guide for State Expenditures http: / /www.mvfloridacfo.com /aadir /reference %SFauide /reference auide.htm III. FLORIDA ADMINISTRATIVE CODE (RULES) A. Child Welfare and Community Based Care All references to F.A.C. may be found at the following website: https : / /www.flrules.ora /default.asp Rule 65C -12, F.A.C. Emergency Shelter Care Rule 65C -13, F.A.C. Substitute Care of Children Rule 65C -14, F.A.C. Group Care Rule 65C -15, F.A.C. Child Placing Agencies B. Substance Abuse and Mental Health Services Rule 65C -12, F.A.C. Emergency Shelter Care Rule 65D -30, F.A.C. Substance Abuse Services Office Rule 65E -4, F.A.C. Community Mental Health Regulation Rule 65E -5, F.A.C. Mental Health Act Regulation Rule 65E -10, F.A.C. Psychotic and Emotionally Disturbed Children Purchase of Residential Services Rules Rule 65E -12, F.A.C. Public Mental Health, Crisis Stabilization Units, Short Term Residential Treatment Programs Rule 65E -14, F.A.C. Community Substance Abuse and Mental Health Services - Financial Rules Rule 65E -15, F.A.C. Continuity of Care Case Management Rule 65E -20, F.A.C. Forensic Client Services Act Regulation Guidance Care Center, Inc. 95 Contract No. ME225 -3 -27 07/01/2012 C. Financial Penalties Rule 65 -29, F.A.C. Penalties on Service Providers Reduction /withholding of funds Rule 65- 29.001, F.A.C. Financial Penalties for a Provider's Failure to Comply With a Requirement for Corrective Action IV. MISCELLANEOUS A. Department of Children and Families Operating Procedures CFOP 155 -10, Services for Children with Mental Health & Any Co- occurring Substance Abuse Treatment Needs In Out of Home Care Placements http: / /www.dcf.state.fl.us /admin/ publications /policies /155- 10.pdf CFOP 215 -6, Incident Reporting and Client Risk Prevention http: / /www.dcf.state.fl.us /publications /policies /215 -6.pdf B. Federal Cost Principles OMB Circular A -21, Cost Principles for Educational Institutions http: / /www.whitehouse.gov /omb /circulars a021 2004 OMB Circular A -87, Cost Principles for State, Local and Indian Tribal Governments http: / /www.whitehouse.aov /omb /circulars a087 2004 OMB Circular A102, Grants and Cooperative Agreements with State and Local Governments http: / /www.whitehouse.gov /omb /circulars a102 OMB Circular A -122, Cost Principles for Non - profit Organizations http: / /www.whitehouse.gov /omb /circulars a122 2004 C. Audits OMB Circular A -133, Audits of States, Local Governments and Non - Profit Organizations http: / /www.whitehouse.gov/ sites /default/files /omb /assets /a133/a133 revised 200 7. pdf Section 215.97, F.S., Florida Single Audit Act http: / /www.lea.state.fl.us /statutes /index.cfm ?App mode = Display Statute &Search String=&URL=0200-0299/0215/Sections/0215.97.html Guidance Care Center, Inc. 96 Contract No. ME225 -3 -27 07/01/2012 Comptrollers Memorandum #03 (1999- 2000): Florida Single Audit Act Implementation http://www.myfloridacfo.com/aadir/cm0/cm990003.htm D. Administrative Requirements 45 CFR, Part 74 - Uniform Administration Requirements for Awards and Subawards to Institutions of Higher Education, Hospitals, other Non - Profit Organizations and Other Commercial Organizations http : / /www.access.gpo.gov /nara/cfr /waisidx 06/45cfr74 06.html 45 CFR, Part 92 - Uniform Administration Requirements (State and Local Governments)\ http://www.access.gpo.gov/nara/cfr/waisidx 06/45cfr92 06.html OMB Circular A110, Uniform Administrative Requirements for Grants and Other Agreements http: / /www.whitehouse.gov /omb /circulars /a110 /a110.html E. Data Collection and Reporting Requirements Rule 65E- 14.022, F.A.C. https://www.flrules.org/gateway/ruleNo.asp?ID=65E-14.022 Section 397.321(3)(c), F.S., Data collection & dissemination system http: / /www.leg.state.fl.us /Statutes /index.cfm ?App mode = Display Statute &Searc h String = &URL= 0300 -0399 /0397 /Sections /0397.321.html Section 394.74(3)(e), F.S., Data Submission http: / /www.leg.state.fl.us /Statutes /index.cfm ?App mode = Display Statute &Searc h Strinq = &URL= 0300 - 0399 /0394 /Sections /0394.74.html Section 394.77, F.S., Uniform management information, accounting, and reporting systems for providers. http: / /www.leg.state.fl.us /Statutes /index.cfm ?App mode = Display Statute &Searc h String= &URL= 0300 - 0399 /0394 /Sections /0394.77.html CFP 155 -2, Mental Health and Substance Abuse Data Measurement Handbook http: / /www.dcf.state.fl.us /programs /samh /pubs reports.shtm1 Guidance Care Center, Inc. 97 Contract No. ME225 -3 -27 07/01/2012 Exhibit G Exhibit G: STATE FUNDING BY PROGRAM & ACTIVITY Fiscal Year 2012 -13 Provider Nave: Guidance Care Center, Inc. (GCC) Contract #:p ME225 -3 -27 1 Revision #: 33 Adult Mental Health Children Mental Health Activity /Cost Center TANF$ Unit TANF$ Unit X = Yes Rate X = Yes Rate 1 2 3 4 5 6 7 Emergency Stabilization 0 : ,u f 5t, j 03. Crisis Stabilization (No TANF) Unit: bed-day `" 1 $323.771 [ 1 ........ ... 04. Crisis Support/Emrgency Unit: staff hour r "�" $43.17 .] <. _... _._.__... �� 1 543.17 09. Inpatient (No TANF) €€ Unit24-hrday "� i ..__��.__.I }+ t :` - ",' I 7 Non -TANF= $1,112,903 Non -TANF= $15.677 Total Emergency Stabilization = $1,112,903 Total Emergency Stabilization = $15,677 Uncompensated Units = $222,581 Uncompensated Units = $3,135 Recovery& Resiliency 5B20 ix 13 01. Assessment Unit: contact hour • . $79 .47 02. Case Management _ __ _ .................. Unit: direct staff hour , - (. -- � �c` ( � $60A5 05. Day Care Unit: 4hrday (l6. Day /Night i Unit: 4-hr day - ......._.....t ......._......._... 07. Drop-In/Self Help Centers (No-TANF) Unit: facility day . , ����' 08. In -Home and On Site 7 Umt:diectstaffhour ( 1 ' s ad € $70.11 10. Intensive Case Management € Unit• durect staff hour ... ,,, - _ "-- I 11. Intervention - Indvidual Unit drect staff hour f"'"' � ;e" ', h ■ 61.95 12. Medical Services (No TANF) Unit: contact hour`` - 0 . � - - � I 390.47 mm � �a?� r �� ( $390A7 14. Outpatient - Indvidual Unit: contact hour' .._......__.........� 5 , ^�,.. - ,.. � _ $91.09 15. Outreach Unit: nondirect staffhour , __ i -- 1 € 16. Prevention Unit: nondirect staff hour ?.. _ 3 L. 1 L 17. Prevention/lntervention - Day Unit: 4 -hrday ����%�µ,.,w �..9'�� �'`���� ' ' '"'.< �� ,' [1.-- 18. Residential Level 1 Unit: 24-hr day ? 1 [ $265.11 ;�3 19. Residential Level II Unit: 24-hr day 20. Residential Level 111 ...._. .. .... _ ............. Unit: 24 s hr day .... .....� � , .... .... ........ 21. Residential Level IV Unit:24-hrday 22. Respite Services Unit: contact hour L ..... j _ 23. Sheltered Employment (No TANF) Unit: 4-hr day 25. Supported Enployrrent Unit direct staff hour i .- ) 26. Supportive Housing/Living 1 29. Aftercare - Individual Unitduectstaffhour � m_____. i�,, ,e L $63.21 1 30. Information and Referral (No TAN}) Unit staff hour � '. 35. Outpatient - Group Unit: contact hour - (� C $22.7 36. Room and Boardw /SupervisionLevell " Unit: 24 -hrday e _ ...... .... ..... ..... ............_ r 1 37. Room and Board w /Supervision Level 11 Unit:24 -hrday j r - -- _..._, 38. Room and Board va'Supervision Level III Unit: 24-hr day � Y $88.25 39. Short -term ResidentialTreatnent - Unit Bed -Day I Guidance Care Center, Inc. 98 Contract No. ME225 -3 -27 07/01/2012 Exhibit G Adult Mental Health Children's Mental Health Activity /Cost Center TANF$ Unit TANF$ Unit X = Yes Rate X = Yes Rate 1 2 4 6 7 9 11 40. Mental Health Clubhouse Services Unit: Clubhouse staff hour [ $37.71 1 a -- 2 42. Intervention - Group Unit: contact hour 43. Aftercare - Group Unit: contact hour Non -TANF= :556,M9 Non -TANF= $440,000 TANF =( — — __ $01 TANF Total Recovery & Resiliency = $556,889 Total Recovery & Resiliency = $440,000 Uncompensated Units = $111,378 Uncompensated Units = $88,000 Recovery & Resiliency - FACT Team - sons' ;. 34. FACT Teams (No TANF) Unit: staff hour ........ ..... „,,1 .W V. FACT = Total FACT= $0.00 Uncompensated Units = Recovery & Resiliency - CCST I SO2O1 * 1 1 503013:; ° 1 44. COST- Individual Unit: Staff Hour j } I j( [ : I L�....� L $41.65 t .�_ f '.: 3..,...b�� W... 4,.. �. -....1 �� i Non -TANF= 5714331 Non -TANF= TANF=[ $01 TANF = -- Total CCST Services = $714 ,331 Total CCST Services = $0 Uncompensated Units = $142,866 Uncompensated Units = Recovery & resiliency • CCST • EA.C.ES. 5030 44. COST- Individual Unit: Staff Hour y „ ,,; r ii I§ Non -TANF= TANF �s, Total F.A.C.ES. Services = $0 Uncompensated Units = Recovery & Resiliency - Community Forensic 1 502018 1 1 50301/' ' 1 19. Residential Level II _ gg ## Unit: 24-hr day __. _. _. _.. -..._] I _.... .. ___ L.. __.........___._...._..._._ > -' E .. .. i t_ 1 39. Short -term Residential Treatment Unit:Bed - Da 77y .4: Non -TANF= Non -TANF= TANF =I I TANF= ° Total Forensic Services = $0 Total Forensic Services = $0 Uncompensated Units = Uncompensated Units = Recovery & Resiliency - Incidental Expenses ( 50201 =e . J 50 28. Incidental Expenses: General Unit: each $50 spent r $50.00 -' r � $13.900 � " 28. Incidental Expenses: COST - F.A.C.ES. _ Unit: each $50 spent j_ (_ _ L 28. Incidental 6:pens es: Forensic Unit each $SO spent L $5000 f $10000 Non-TANF= $23,900 Non -TANF= $0 TANF =t $0 TANF ..., Total Incidental Expenses = $23,900 Total Incidental Expenses = $0 Uncompensated Units = $4,780 Uncompensated Units = $0 Total Non -TANF= $2,408,023 Total Non - TANF = 5455,677 Total TANF =[ $! Total TANF= Total Mental Health Funds = $2,408,023 Total Mental Health Funds = $455,677 Guidance Care Center, Inc. 99 Contract No. ME225 -3 -27 07/01/2012 Exhibit G Adult Substance Abuse Children's Substance Abuse Activity /Cost Center TANF$ Unit TANF$ Unit X = Yes Rate X = Yes Rate 1 2 3 4 5 6 7 Detoxification 6G v : .;, 11: 24. Substance Abuse Detoxification (No TANF) f Unit: bed -day �.. ': x$204.94_ t' EL. M 32. Outpatient Detoxification (No TANF) Unit: 4-hr day Total Non -TANF = 186,643 Total Non -TANF = Total Detoxification = $186,643 Total Detoxification = $0 Uncompensated Chits = $37329 Uncompensated Units Prevention ,' €, a i. - 1 60200E ". 1 16. Prevention Unit: non -direct staffhour s .,, .. I . _ .. _._ -_._ 1 1 17. Prevention/Intervention - Day Unit: 4 -hrday 1 __1 r - __. -._� 30. Information and Referral (No TANF) Unit: staff hour " 1 '' Total Non -TANF= Total Non -TANF= $172,262 Total Prevention = $0 Total Prevention = $172,262 Uncompensated Units = Uncompensated Units = $34,452 Treatment and Aftercare 1 6030n.' ;;, ' 1 1 ; :`t 01. Assessment Unit: contact hour i 1 $79.47 ( L $79.47 i 02. Case Management Unit: direct staff hour �.. __ . __ _ ] 1 . _ $60,45 _... - 1,,,,„, ____ _1 . w . � .$60.45 04. Crisis Support/Emergency _ Unit: staff hour $43.17 05. Day Care Unit: 4-hr day ' 1 i 1. __... .. 1 1 ..__. .. _._ 1 1 .. . 1 . 06. Day /Night . Unit: 4-hr day 1 1 1 1 1 08. In- Home & On Site Unit: direct staff hour L 1 r $70.11 -J L 1 L $70.11 10. Intensive Case Management Unit direct staffhour 11. Intervention - Imividual Unit: direct staffhour 1 1 1 $61.95 1 1 1 1 $61.95 12. Medcal Services (No TANF) Unit: contact hour 1 $390.47 1 ': „ , / < ' [ $390.47 13. Methadone Maintenance (No TANF) Unit dosage 1-_.--- .. --__ ---- r 14. Outpatient - Individual Unit: contact hour 1 1 [ $91.09 1 ) 1 1 $91.09 1 15. Outreach Unit: non-direct staff hour ( 1 ( $43.20 ....... 1 _ _ � 1 1_ $43.20 1 18. Residential Level 1 Unit: 24-hr day 1 _.___ L__..___._ i i.____.] 1,,,,...______I 19. Residential Level II Unit:24-hrday t 71 20. Residential Level 111 Unit: 24-hr day _ 1 1- -_ ._,J 21. Residential Level IV Unit: 24-hr day ��� ; _ L _- 1 1 22. Respite Services Unit: contact hour - 71 ( ------1 t 1 . _ _ L._ _.. . , „,...„..........i L__ . _I 25. Supported Ettploynent Unit: direct staffhour -1 x 26. Supportive Housing /Living Unit: direct staff hour 1 1 i - . 1 --__ 27. TASC ...._.._ . ...... Unit direct staff hour [ 1.... 1 ._�.. .. � . 1 $59.22 .._.1 I i $59.22 29. Aftercare Unit: direct staff hour 1 ( I _.. $63.21 � _1 Guidance Care Center, Inc. 100 Contract No. ME225 -3 -27 07/01/2012 Exhibit G Adult Substance Abuse Children's Substance Abuse Activity / Cost Center TANF $ [brit TANF $ Unit X = Yes Rate X = Yes Rate 1 2 3 4 5 6 7 35. Outpatient Group Unit: Contact Hour , $22.77 1 i $22.77 36. Room and Board w /Supervision Level I Unit: 24-hr day I 1 37. Room and Board w /Supervision Level II Unit: 24-hr day [1___:1 38. Room and Board w /Supery is ion Level B1 Unit: 24-hr day 42. Intervention - Group Unit: Contact hour i _ __�_� $15.49 _.____._._.. $15.49 43. Aftercare - Group 6 Unit: contact hour I $15.80 j i _ _ . 46. Recovery Support - Individual Unit: direct staff hour ....._....W_.. _ __ 47. Recovery Support - Group Unit: contact hour i 48. Clinical Supervision for Evidence -Based Practices Unit: contact hour Total Non -TANF = $345,979 Total Non -TANF = $309,139 Total TANF =_ $0 Total TANF= _ $0,1 Total Treatment & Aftercare = $345,979 Total Treatment & Aftercare = $309,139 Uncompensated Liits = $69,196 Uncompensated Units = $61,828 Treatment & After - CCST 1 h :. 603007 j 1 6: 44. CCST- hndividual Unit: Staff Hour [1_. ! ! I Non -TANF= Non -TANF= TANF= $0 TANF = I Total CCST Services = $0 Total CCST Services = $0 Uncompensated Units = $0 ih compensatedUnits = Incidental Expenses I 603007 j I 602003. j 28. Incidental Expenses Unit: each $50 spent i L $5 0.00 i [ � ����� 1 Total Non -TANF = $44,154 Total Non -TANF = $0 Total TANF =r $0 Total TANF= -- $10 Total Incidental FSipenses = $44,154 Total Incidental Expenses — $0 Total Non-TANF = $576,776 Total Nat -TANF = $481,401 Total TANF =I $0 Total TANF =1 _ $0 Total Substance Abuse Funds = $576,776 Total Substance Abuse Funds = $481,401 Guidance Care Center, Inc. 101 Contract No. ME225 -3 -27 07/01/2012 Exhibit H FY 2012 -2013 10(HIBrr it FUNDING uF :rwIL .. _._ Provider Name: r 3u idance Care Center, Mc. ((ICC) i Contract #: M!_'J25 -3 Revision #:1 — MEN'I'AL HEALTH Nudger F}rtity 60910506 - Adult's Mental Health OCA AMOUNT Budget Entity 60910506 - G'hil(lren'S Mental Health OCA AMOUNT 502004 - EMERGENCY STAB ILIZATR)N 503001- EMERGENCY STAB BJZA'FION (/A -ADULT r COMM. MENrAL HEALTH (100610) G /A- CHILDREN'S MENTAL HEALTH (100435) ADAMH Trust Fund TF (027(05)* AI SSI ADA Trust Fu nd TF (027005)* (1 ;S1 General Revenue (000326)* 4 F551 $ 108.264 General Revenue ((X)0126)* c t-S41 _ $ v � 15.677 TSTF (122023)* A FSSI FGTF Title XXI (261015) 89Q01 General Revenue 0X/0326)* SMHA 1 _ General Revenue ((XX)326)* SMHCI (JA -BAKER ACT SERVICES (100611) _ CIA- CHBA)RHV'S BAKER ACT (104257) 11— General Revenue ((XX).126)* LSS" I $ I IX74 63 General Revenue (0(X)326)* (. L•tiS i r � TSTF (122023)* AFS51 - F)nergency Stabilization Total = $ 1,112,903 Emergency Stabilization Total = $ 15,677 Uncompensated Units $ 222.581 Uncompensated Units $ 3,135 5020 - RECOVERY RFSILB•NCY 503013- RFX2OVERY & RESIL1FNCY (WA-ADULT COMM MENTAL HEALTH (100610) (:/A- CIBLDRF7V'S MENTAL HEALTH (100435) ADAMH Trust Fund TF (027(X)5) 1RR 1 ADAMH Trust Fund TF (027005)* (J-R E$ 153752 OS MTF (027(X)5) ARKS 1 General Revenue 0XX)326)* ( RRS 1 $ 286.248 General Revenue (0(X)326) ARRS1 $ 1038348 General Revenue Children At Risk of ED (000326) CARED) QLA GA PE Fam Ministry (0(X)326)* .'IFMIAID FGTF MIAMI DADS Wrap Around Pat YR -1 (261015) (iNIDW 1 Q2 /Catnap Forensic Beds -Adair Svc (IXX)326) CI =BAS r_$ 160,(XX) Federal Grant Trust Fund (261015) CRRS1 _ _ • ADAMH Tlus t Fund - FACT Adm. (027(/05) FT"A. 1 J General Revenue (000326) SP5N1.', General Revenue - FACT Admire (0(X)326) FT'A 19 cR JV Res for In . rap To Pro((X)0326)* ;.>. FGTF- FMGPMA - Medicaid Adndn (261015) Fr A 19 FGTF - Title XXI (261015) 89(7)13 General Revenue -FACT sues (000326) FCSIY FGTF- FGX3JD Jail Divers Pro (261015) GI DTI G/A- PURCHAS ED RFS IIIIFN'r1AL • FGTF- FGGCST Trans From Homelessness (261015) ONO18 r$ 90,827 TREATMENT SERVICES (102780) O&MTF (027(X)5) NIHSIh ( M & GR/CAID Non-MCA ID MOE (000326)* 9F RNAi General Revenue ((X)0326) ShlliA GR. /Busch Res Treatment-Medicaid Svcs 0XX/326) iF K'I'S W TTF TA NF (401(X)1) 39A 18 ................... ............................... General Revenue (((5)326) LJ'PME Tobacco Settlement Trust Fund (122023) .A RRS1 Federal Grant Trust Fund (261015) A RRS 1 ....._......_._._. - -- - (WA- INDK ;1NT PSYCH MFRS PROGRAM (101350) General Revenue ((XX)326)* ARRSI rs ...... .5945 1 • • Total Non -TANF $ 1.295.120 Total Non-TA NF $ 440355) Recovery d& Resiliency Total = $ 1,295,120 Recovery & Resiliency Taal = $ 440,000 Uncompensated Units $ 259,024 Uncompensated Units $ 88.(X/) TOTAL ADULTS MENTAL HEAL: CI-I = $ 2, 408,023 TOTAL CI- IB.DRFN'S MENTAL HEALTH = $ 455,677 SUBSTANCE ABUSE Budget Entity 60910604 - Adult's Substance Abuse OCA AMOUNT Budget Entity 60910604 - Children's Substance Abuse OCA AMOUNT . 603005 - 1)ETOXIFICATION 602001 - DETOX IFICATION /ARF (JA -COMM SUBSTANCE AB(SES VCS (100618) ( ✓A- CH1LD /ADOL SUBSTANCE ABIitiES VCS (100420) A DA MH Trust Fund TF (027(X)5) * ** 1) FXAS $ 84.3591 A DAMH Trust Fund TF (027(X)5) * ** IJIXCS .v General Revenue ((XX)326) ** D'I'XAS $ ....... 102,284 General Revenue ((X))326) ** DIX(S TSTF (122023)** DTX( S Detoxification Total = $ 186,643 Detoxification Total = $ - Uncompensated Units $ 37.329 Uncompensated Units $ . - 603006 - PREVENTION SERVICES 602002- PREVENTION SERVICES (JA -COMM SUBSTANCE AB US' ESVCS (100618) (:/A- CHILIWADOL SUBSTANCE ABUSESVCS (100420) General Revenue ((XX)326) ** PRVA 1 1 A DAH Trust Fund TF (027(X5) * ** !RV(S $ 172.262 X) ADA Trust Fund TF (027(5) * * ** PRVAS 1 M T 1 General Revenue ((X/)326) ** General Revenue ((XX)326) ** I ICS Prevention Services Total = $ - Prevention Services Total = $ 172,262 Uncotr>pens uteri Units $ - Uncompensated Units $ 34,452 • 603007 - TREATMENT & AFTFRCARE 602003 - TRFATMFNT t& AFTERCARE: (:/A- COMMSUBSTANCE AB U S F. SVCS (100618) (WA- CHBd) /A1)OL SUBSTANCE AB CRESVCS (100420) A DA MH Trust Fund TF(0270X)5) * ** IK1'AS $ 321,938 1 A DAMH Trust Fund TF(027(X)5) * ** 'lR1(., L Gener Revenue 0X/)326) ** 1 RTAS $ 64,595 General Revenue 00X)326) ** '11(.1 CS $ 309,139 O&M TF (516015) T 1(TA S TSTF (122023)** ADAMH Trust Fund TF (027(X/5)*** 271 -(IS $ 36(0 OBeMTF (516015) * 'T RTCS ADAMH This t Fund TF (027(05) * ** 27W OM A DA MH Trust Fund TF (027(X)5) * ** 7(.HV _- - General Revenue (( /X)326) 391 - WTTF TA NF (401())1) rI(.1 �- WTTFTANF(401(X)I) 39 1'(1) General Revenue (( 0X)326) ** SPIT'S CR- Indigent Drug Pro MOE (((X)326) ** DI'CX)8 ADA MH Trust Fund TF ((727(X)5) * ** SPICS FGTF FL Acess to Rev (261015) FA T'86 SSBGTF (639(X72) - i K r CS r • FGTF- Medicaid A dm (261015) ATACO4 ____ • FGTF - Screen Interven Treat Pat (261015) S13( X/4 General Revenue ((X/)326) ** SPJAS ( _ _ „_ € • ADAMH Trust Fund TF (027005). Pi A.' • Total Non-TA NF $ 390.133 Total Non-TA NF $ 309.139 Treatment .@ Aftercare Taal = $ 390,133 Treatment & Aftercare 'Coal = $ 309,139 • Uncompensated Units $ 78.027 Uncompensated Units $ 61.828 'DITAL ADULT'S SUBSTANCEABUSE= $ 576,776 'TOTAL CHR,DRFN'S SUBSTANCE ABUSE= $ 481,401 'IX)TAI. ALL PROGRAMS = $ 3,921,877 TOTAL ALL UNCOMPENSATFI) UNITS = $ 784,375 FUNDS NOT REQUIRING MATCH: (:RAND TOTAL ()F PROGRAMS & UNCOMPFNS ATI']) UNITS = $ 4,706,252 ;Drug Alt S )ecru _ ._ ._.... 4 10 (XX) € LOCAL REQUIRING ATCHREQUIRED = $ 2,801,857 $ 53405() TOTAL FUNDS D. ttt t 1 t Project $ 933,952 ICMH Program $ 375 970 ADDITIONAL LO MATCH =f „ MH Block Grant • TOTAL FUNDS NOT REQUIRING MATCH = $ 1,120,020 GRAND TOTAL LOCAL MATCH = $ 933,952 *Commtuttity Mental Health 01oek (runt ** Expenditure must Ise Sul Abuse Prevention anal "t'rcutmcnt Block (kunt eligible ”' Slilxt ape, Altus Prevent ia,n and "Treatment Black (hunt - ',ruling Agreement - R1.11'RIC rI(JNS API'I.V Guidance Care Center, Inc. 102 Contract No. ME225 -3 -27 07/01/2012 Exhibit H L(X7AL MA1('H PLAN , .., . ,u,itiiko AMH Total $ 654,509.00 Agency Name: 'Guidance Care Center, Inc. (GCC) CMH Total NA Contract Number ME225-3-27 ASA Total $ 187,800.00 Date: 7/1/2012 CSA Total $ 91,643.00 Grand Total $ 933,952A2) "; AlitirT14118.4AL litt$8:$6 , ' . 7'N‘, ', ' flounces .nliNTALtimiiii : - - . - Aa‘tstestmetAtitta....... , zf k.- . - - .. cuowiews. ostotevAtimAntsV - I. Assessment I. Assessment , I. Assessment 1. a. Total Match -0. Total Match V ------ - a. Total Match . b. Rate $ - b. Rate 0 $ - b. Rate - h. Rate !.. $ - c. Units Nrchased r n/a c. Units Purchased n/a c. Unit, Purchased n/a c. Units Purchased F n/a 2. Case Nhmagement 2. Case Management 2. Case Management 2. Case Management a. Total Match rs . a. Total Match r $ - a. Total Match 1 9 15.300.00 a. Total Match 9 , - h. Rate $ - b. Role .•0 - b. Rate '`'' C:?;40 b. Rate 9 . c. Units Purehased n/a a. Units Purchased : n/a c. Units Purchased 253.10 e. Units Purchased F n/a I Crisis Stabilization 3. Crisis Stabilization I Crisis Stalilization 3. Crisis Shdilization a. Total Mao, s 247.865.00 u. Total March rs Total Match rs - .. "r..I MI. h b. Run " b. IL.. rs _ b. Rate is - b. Rate Units - c. Purchased 765.56 c. Unas Purchased r n/a c. Units Purchased n/a c. Units Purchased . n/a 4. Crisis S upport/Dnergency 4. Crisis Supsort/Dnergency 4. Crisis Support/Emergency 4. Crisis Support/Dnergency a. Total Match ! s 15,688.00 a. Total Match r $ . a. Total Match rs . a. Total Match rs - b. Rate :411f0WWT.: :1 n. Rate r $ - b. Rate ; $ - b. Rate . . c. Units Purchased r 363.40 c. Unit, Purchased r n/a c. Units Purchased tt/a c. Units Purchased n/a 5. I/En/Care 5. Day Care 5. Day Care 5. Day Care a a. Total Match - A. TOIAI Match - a. Total Match rs Total Match - b. RAW ;$ .. b. Rate $ - b. Rate e $ • - h. Rate ; $ c. Units Purchased n/a c. Units Purchased 0/a 0. Units Purchased n/, c. Units Purchased ' n/a 6. Day-Night 6. Day-Night 6. Day-Night 6. Day-Night a. Total Match c: - a. Total Match r $ . a. Total Match 6$ - a. Total Match b. Rate - h. Rate $ - 0 Rate . b. Rate ' 0 c. Units Purchased n/a c. Units Purchased n/a o. Units Purchased 7 n/a c. Units Purchased 7. Dropis/Self-Help Centers 7. Drop-In/Self-Relpeenten 7 Drop-In/Self-HelpCenters 7. Dronlet/Scli-Help Centers . a. Tot al Match $ - a. Total Match $ - a. Total Match 7 $ - a. Total Match r $ F. Rate ? $ - b. Rate $ - b. Rate 7 $ - b. Rate 7$ c. Units Purchased r n/a c. Units Purchased n/a c. Units Purchased • n/a c. Units Purchased n/a 0. Irol-losne and On-S ite Senices 8. In-Home and On-Site Services 8. In-Hosne and tin-Site Services 8. In-Home and i/o-S in Sersices , , a. ToIJI Match "6 _ a. Total Match ; $ - a. Total Match , r S - a. Total Match r$ - b. Rate r $ - b. Rate , $ - b. Rata r, - F. Rate '9 . ,. Units Purchased ? n/a c. Unas Purchased n/a C. UnAS Purchased 11 1 ota e. Unas Purchased Na 9. linadient 9 Inpatient 9. Inpatient 9. Inpatient a. Total Match , S - a. Total Match r _ a. Total Match Fs - a. Total Match r s . . ,,, r b. Rate 5 - b. Rate P $ i. - b. Rate I $ - b. Rate s . 7 c. Una Putchased n/a c. Units Purchased , a/a c. Unns Purchased 0/00. Units Purchased Na to. Intensiw Case Management IR Intensise Case Management 10. Intensise Case Management 10. Intensise Case Management a. Total Match YS _ a. Total Match r $ _ a. Total Match r $ - a. Total Match rs - b. Ratc rs _ b. Rate ;5 . 0, R,,,, $ - b. Rate $ - ' c. Units Purchased r n/a c. Units Purchased n/a c. Units Purchased r 0/0 c. Units Purchased • n/a II. Intenention II. Intervention 1 I. Intersention I I. Intersendon a. Total Match ' - a. Total Match rs _ a. Total Match " 9 IL8,00 . b. C $ - F. Rate r $ - b. Rate $ - h. Rate $ c. Units Purchased n/a c. Units Pu it rchased n/a c. Units Purchas r ed n/a c. Units Purchased r n/a 12. Medical Services O. Medical Services 12. Medical Services 12. Medical Services a. Total Match ; $ 120.000.03 a. Total Match 1 $ , - - a. Total Match i $ - a. Total Match % $ > - , - II Rate '',' , gfrariNAN3:,.. b. Rata 1 5 - h. Rate 1 6 - b. Rate 1 $ - c. Units Pu rchased i 307.32 c. Timis Purchased n/a c. Units Purchased n/a e. Unas Purchased ■ n/a 13. Methadone Maintenance 13. Methadone Maintenance 13. Nkthadone Maintenance II Methadone Maintenance a. Total Match I 5 - a. Total Match '. $ - a. Total Match 1 $ - a. Total Match : $ . b. Lae i $ - h. Rate ; $ - b. Rate - b. Rate . $ c. Units Purchased n/a c. Units Purchased E n/a c. Units Purchased n/a c. Unita Purchased n/a 14. Outpatient - Individual 14. Outpatient - Individual 14. tintnstient - individual 14. Outpatient - Indvidual , a. Total Match i $ '0. Total Match - $ - a. Total Match i $ 3000000 a. Total Match . $ h. Rate - b. Rate , $ - b. Rate :,)':', 1,',,,tekg6:21:01t:F b. Rate i $ c. Units Purchased i n/a c. Units Purchased n/a c. Units Purchased 329.34 e. Units Purchased n/a 15. Ont. /5. Outreach 15. t/uireach 15. (hdreach a. Total Match : $ - a. Total Match $ - a. Total Match $ - a. Total Match , S 73.500.00 b. Rate 1 $ - h. Rate : $ - b. Rate $ - b. Rate ';:let$SWAt-FT- o Units Purchased i n/a c. Units Purchased n/a c. Unas Purchased n/a 0. Units Purchased 1,547.04 16. Prevention I6. Presention 16. Prewntion 16. Presendon a. Total Match , $ 'O. Total Match ', $ - a. Total Match $ - a. Total Match i $ 18.143.00 b. Rate ; S - b. RAI. .: $ - b. Rate $ - b. Rate 70:-',..-TalS1411W c. Units Ruchased i n/a c. Units Purchased n/a c. Unas Purchased 1 n/a c. Unit, Purchased 419.98 17. Presention/Intersention - Day 17. Presention/Intersention - Day 17. Presention/Intersention - Day 17. Prevention/Intenention - Da,, a. Total Match i $ - a. Total Match '. $ - a. Total Match i $ l - a. Total Match b. Rate , 0 - b. Rate ' $ - b. Rate $ - b. Rate ' $ - a. Units Purchased . n/a c. Units Purchased • n/a c. Units Purchased ■ , n/a c. Units Purchased n/a M. Residential Easel I 18. Residential land I 18. Residential law! I 18. Residential lase! I a. Total Match a. Total Match $ - a. Total Match a. Total Match i $ - b. Rate b. Rate $ - b. Rate h. Rate : $ - c. Units Purchased n/a c. Units Purchased 0/0 c. Units Purchased i n/a c. Units Purchased n/a 19. Residential Usti 11 19 Residential lawl II 19 Residential lasel II 19. Residential Lewl II a. Total Match $ - a. Total Match . $ - a. Total Match , 0. Total Match ' $ b. Rate $ - b. Rate $ - b. Rate ! b. Rate ' 6 c. Units Purchased n/a c. Units Purchased i st/a c. Units Purchased 5 0/0 c. Units Purchased 0/0 20 . Residential Lewl III 20 Residential Lesel III 20. Residential lawl III 20. Residential 'awl III • ■ J. Total Match S - a. Total Match : $ - a. Total Match 0, - a. Total Match , $ • b. Rate S - 0 Rate : S - b. Rate i 1 1 $ - h. Rate . $ ti. Units Purchased n/a c. Units Purchased n/a c. Units Purchased J n/a c. Unas Purchased n/a Guidance Care Center, Inc. 103 Contract No. ME225-3-27 07/01/2012 Exhibit H 21. ResldentlW Level N ......., ..._ 2 1 . Residential Lem' N ......... 21. Residential Level IV 21. Residential Lem' N a. Total Match S - a. Total Match rs - n Total Match rA a. Total Match !$ b. Rate !S - h Rate 5 $ - h Rate $ - h. Rate $ Units Purchased n/a c. Units P rchased E n/a Units Purchased n/a c. Unns Purchased h. 22. Respite Services . ,_,..,,..,,,_ 22. Respite * tier 22. Respite Services .......__ 22. Respite Services .... . . ...... a Total M ich r, . � Total Match r$��������� - Total M tch r$ a. Total Match ` Y ` $ - h Rate y $ - b. Rat s b. Rate y S b. Rate 7 c Units Purchased a n/a c. Units Purchased n/a c. Units Purchased Y' t/a c. Units Purchased 1 n/a • 73 Sheltered anploymeo1 1 S heltered IMptoyment 23 Sheltered Elnphryment 3. S heltered Duploymen1 ..,..... ......... a .............. ............ Total Match y.5 ........ - Total Match $ _ Total M t •h $ � .Total Match ;$ - a. h Rue . $ - b. Rat $ - h Res r $ b. Rte $ - e Units Purchased f n/a c. Units Purchased n/a c Units Purchased r n/a c. Units Purchased n/a 24. Substance Abse Iletosifl avian 24. Substance Apure Ihhdflcation 24. S h:tance Abuse Detmdflcatioo 24. Sulatance Abuse Detosdflcadon e . __._... - ,,,,_,.._ Total Match 3 - Total Match $ - Twirl M t h $ 11 500 W a. Total Match A a. h Rate :S - b Rat $ - h Rat it M1, Rate c $ - Units Purchased n/a c. Units Purchased n/a c. Units Purchased 548.94 c. Units Purchased r n/a c. 25. Supported employment - 25 Supported Employment 25. Supported Suated Flnpioymeru 25. Supported Employment a. Total Match r- 5 - - �,_. _ a. Total Match $ ran a. Total Match • S a Total Match A b. Rate $ - h. Rate S.$ - h. Rate 5 - b. Rate . $ - c Units Purchased n/a c. Units Purchased n/a c Units Purchased n/a c. Units Purchased n/a 26 SupportedxonsIng/thing 26 Supported Hlnaing/uving 26 Supported Housing/using 26. Supported Homing/living a. Total Match 5 - Tool Match r S - a. Total Match 5 .Total Match s` - h Rate a $ - h Rat ;$ b. Rate r S b. Rate $ c Units Rtrchavcd • n/a c. Units Purchased n/a c Units Purchased n/a c. Units Purchased n/a 27. TASC 27. TASC 27. TASC 27. TA-SC a Total Match rS - a. Total Match $ - a Total Match , 5 a. Total Match r $ n Rate E S - b Rate $ - h. Rate r S h. Rate t 8 c. Units Purchased n/a c Units Purchased n /a c. Units Purchased Y n/a c. Units Purchased r n/a • 28. Incidental Expenses 28. Incidental Expenses 28. Incidental Expenses 28. Incidental Expenses a. Total Match 1 5 a Total Match 8 - . Total Match r $ - a. Total Match $ b. Rate 1 5 - h. Rate $ _ h. Rate 5 - h. Rate $ - • c. Units Purchased . n/a c. Units Purchased n/a c. Units Purchased 1 n/a c. Units Purchased n/a • • 29. Aftercare 29. Aftercare 29. Aftercare 29. Aftercare ,_.._.._. _ _....._..__ �. ....._..�______ ....�__ i a. Total Match 5 - a. Total Match A - a. Total Match : 5 a. Total Match - b. Rate : S - b. Rate - 5 - h. Rate 5 - b. Rate 5 - c. Units Purchased n/a c. Units Purchased n/a c Units Purchased i n/a c. Units Purchased n/a 30. Information and Referral 30. Information and Referral 30. Information and Referral 30. Informetlm and Referral a. Total Match S - a. Total Match i 5 - a Totai Match 5 - a. Total Match $ n. Rate 5 n. Rate 5 n. Rate $ n. Rate $ c. Units Purchased n/a c. Units Purchased ? n/a c. Units Purchased n/a c. Units Purchased n/a �' 31. Reserved 31. Reserved 31. Reserved 31. Reserv 32. Outpatient Detoxification __.__... 32. Outpatient Hato/dilation T .^_ 32 0utpatient Detoxification 32.Outpatient Detmdfleation . ` . 5 _. ... - - ,,, - a. Total Mach i S - a. Total Match 15 - a Total Match - a. Total Match $ - b. Rate : $ - h. Rate i $ - b Rate $ - b. Rat $ - c. Units Purchased . Ma c. Units Purchased n/a c. Units Purchased n/a c. Units Purchased n/a 31 Reserved 33. Reversed 33. Reserved 31 Reserved 34. FACT Team 34. FACT Team 34. FACT Team 34. FACT Team a. Total Match 5 - a Total Match $ - a Total Match 5 a. Total Match L$ - b. Rate 5 - h. Bute $ - h Rate i 5 - h. Rate `$ c. Units Purchased I n/a c. Units Purchased [ n/a c Units Purchased n/a c. Units Purchased ( n/a 35 Outpatient• Clamp i S - _.. ......._. 35 (hrpadent ('soup 35. Outpatient • Gaup 35. Outpatient -( Mi a. Total tch a. Total Match A - a. Total M.nch : S 30,(00.00 a. Total Match 1 $ b. Rate ' S - b. Rate $ - n. Rate 6 0 h. Rae $ . c. Units Purchased • n/a c. Units Purchased n/a c. Units Purchased 1,317.38 c. Units Purchased Nit 36. Ram & Board with Supervision Level 1 36 Rom & Board with Supervision level l 36 Roan & Board with Supervision Level I 36. Rom & Board with Supervision Level I a. T al Match 5 - a. Total M ich S a Total M t h S .Total Match 1$ - b State Rate S - M1 State Rat $ b. State Rate $ b. State Rates $ c. Hours or Units Purchased n/a c. Hours or Units Purchased /_c Hours or Units Purchased i n/a c. Hours or Units Purchased n/a 37. Roan & Board with Supervision Level 11 ... 37. Room& Baird with Supervision Level B 37. Room & Band with Supervi a Ion Level R ...,, 37. Room & Board with Supervision 1 1 B • a Total Match S - a Total Match I S - a Total Match $ - a. Total Match i $ . h State Rat 5 - h State Rate i 5 - b State Rat ' S - b. State Rate $ c Hours or Units Purchased n/a c. Hours or Units Purchased n/a c Hours or Units Purchased n/a c. Hours or Units Purchased I Ma 38. Raven &Board with S pent i I.erel IR 38. Room & Board with Supervision Level Id . 38. Room &Board with Superdi ion Level 111 ,._..__. 38. Room & Board with Supervision Level m a Total MOCK $ - a. Total Match $ - a. Total Match 5 - a. Total Match 8 - b State Rate 5 - b State Rate - b St t Rte s 5 - h. State Rate ! 5 c. Hours or Units Purchased n/a Hours or Units Purchased i n/a c. Hours or Units Purchased n/a c. Hours or Units Purchased 1 n/a 39. Short •term Residenti8 T anent .......... 39. Short-term Residential 'freahnent 39. Shut -term Residential Treatment 39. Short4erm Residential Treatment a. Total Match S 65,778.W a. Total Match S - a. Total Match i 5 - a. Total Match $ b. Rate b Rate { $ - b Rate - 5 - h. Rate j $ c. Units Purchased 291.41 c Units Purchased l Ma c Units Purchased - n/a c. Units Purchased n/a 40. Mental Health Clubhouse Services 40. Mental Health Clubhouse Services 40. Mental Health Clubhouse Services 40. Mental Health Clubhouse Services a. Total Match S 12,17800 a. Total Match 1 $ a. Total Minch i S .. -.... -... a. Total Match is - _........ b. Rate s 4=`-'R h. Rate 1 5 - b- Rate = 5 - h. Rate $ - c. Units Purchased 322.94 c. Units Purchased n/a c. Units Purchased n/a c. Units Purchased r n/a 44. COST 41. Canprehemlde Community Service Team.CC')T) 41. Comyreheaive Community Senice 'ream(CCST) 41. Comprehensise Community Service Tam(CCST) a. Taal Match S 193,IX0.00 a Total Minch i 0 - a Total Match 5 - a. Total Match t $ . - h. Rate b • Rate 1 S - b Rate : S - b. Rate $ Units Purchased 4,633.85 c. Units Purchased j n/a c. Units Purchases' _ n/a Units Purchased f n/a .55911 Total 5 654,509.00 CARL Total $ - .tSA Total 5 187,800310 C'SA'I'obd $ 91,643.()0 • Guidance Care Center, Inc. 104 Contract No. ME225 -3 -27 07/01/2012 EXHIBIT I SUBSTANCE ABUSE FAMILY INTERVENTION SPECIALIST SERVICES 1. PURPOSE Family Intervention Specialists (FIS) are intended to reduce the incidence of child abuse and neglect resulting from parent(s)' or caregiver(s)' substance abuse and to improve outcomes for substance involved families in the child welfare system. 2. AUTHORITY The FIS positions are specifically appropriated by the legislature as a line -item budget. FIS services are performed in compliance with Rule 65D -30, Florida Administrative Code (F.A.C.). 3. PROGRAM SPECIFIC TERMS a. AFTERCARE - Structured services provided to individuals who have completed an episode of treatment and who are in need of continued observation and support to maintain recovery. b. CASE MANAGEMENT - A process which is used by a network provider to ensure that clients receive services appropriate to their needs and includes linking clients to services and monitoring the delivery and effectiveness of those services. c. CHILD WELFARE - Services provided directly or under contract with the Florida Department of Children and Families' Family Safety Program Office. d. DEPARTMENT - The Department of Children and Family Services, created pursuant to Section 20.19, Florida Statues (F.S.). e. INTERVENTION - Includes activities and strategies that are used to prevent or impede the development or progression of substance abuse problems. f. INTERVENTION PLAN - A written plan of goals and objectives to be achieved by a client who is involved in intervention services. g. QUALIFIED PROFESSIONAL - A physician licensed under Chapter 458 or 459, F.S., a practitioner licensed under Chapter 490 or 491, F.S., or a person who is certified through a department- recognized certification process as provided for in ss. 397.311(24), and 397.416, F.S. Individuals who are certified are permitted to serve in the capacity of a qualified professional, but only within the scope of their certification. Guidance Care Center, Inc. 105 Contract No. ME225 -3 -27 07/01/2012 h. SCREENING - A process involving a brief review to determine the person's appropriateness and eligibility for substance abuse services and the possible level of service. i. SUMMARY - A written statement summarizing the results of the screening relative to the perceived condition of the client and a further statement of possible needs based on the client's condition. 4. GEOGRAPHIC AREA & LOCATION a. Services will be provided to the residents of Monroe County and will be performed at the locations of Key West, Marathon, and Key Largo or in the field (i.e. client's home, community service center, etc.). b. FIS services should be located in a place where they will be easily available and accessible to child welfare personnel. FIS locations must be licensed for Intervention: General Intervention and Intervention: Case Management as required by Rule 65D -30, F.A.C. 5. SERVICES & TIMES FIS provide adult substance abuse outreach, screening, intervention, and case management. FIS do not provide direct treatment services. Services will be provided, at a minimum, Monday through Friday, with flexible hours to meet the needs of clients. 6. PROFESSIONAL QUALIFICATIONS a. This contract provides for two (2) Family Intervention Specialist(s). b. These must be specific staff positions identified as a FIS or FIS supervisor. c. Staff shall preferably hold the appropriate clinical license or certification. The minimum qualifications are a bachelor's degree in a social behavior science or related field and one (1) year of applicable experience. Preference should be given to certified addictions professionals or to individuals who have both substance abuse and child abuse /neglect knowledge and experience. All FIS services are to be provided under the supervision of a qualified professional, as required by Rule 65D -30, F.A.C. 7. CLIENT ELIGIBILITY Services may be provided to parent(s) /caregiver(s) referred by child welfare or a dependency court in which substance abuse is suspected during the initial child abuse /neglect investigation, or at any point during child protective supervision or out - Guidance Care Center, Inc. 106 Contract No. ME225 -3 -27 07/01/2012 of -home care. Priority will be given to cases where a child is at risk for immediate removal or has been removed from the family, with a goal of reunification in the family safety plan. Services may also be provided for the enrolled parent(s)' /caregiver(s)' family members, household residents, or significant others in need of substance abuse prevention or treatment services, as well as children in relative placements. 8. REFERRALS TO FIS a. A referral shall be made when the dependency court or a child welfare worker suspects that parent(s)' /caregiver(s)' alcohol and /or drug abuse may be contributing factors in a situation where a child's safety or well -being is at risk. Priority referrals are those children at risk for immediate removal or when children have been removed. b. The FIS shall attempt contact with the client within three (3) working days from receipt of the complete referral package. A phone contact or face -to -face visit is acceptable for the initial contact. During this contact, the FIS will conduct a screening or set an appointment to conduct a screening. c. The network provider is responsible for determining what constitutes a complete referral package and conveying the requirements for a complete referral package to the referral agents. 9. CASELOAD Each FIS shall maintain a caseload with a maximum of thirty -five (35) families. A family includes all members of the family who are in need of substance abuse services. Caseload size shall be based on the severity, case management needs, and resources available to support the FIS. Once the FIS case load has reached capacity, the referrals shall continue to be screened and referred to an appropriate treatment provider. 10. SCREENING a. The FIS shall conduct a comprehensive screening, using the department's "FIS Screen for Mental Health, Substance Abuse, and Co- Occurring Instrument ", or a screening instrument approved by the department. Additional circuit screening tools may be used. If appropriate, a toxicology chemical dependency screening may be completed to identify the nature and extent of the substance use and to determine the most appropriate substance abuse referral source. b. The screening shall be completed within ten (10) working days from the date of the receipt of the referral package. Guidance Care Center, Inc. 107 Contract No. ME225 -3 -27 07/01/2012 11. FIS REFERRAL OF CLIENT TO SERVICES a. If the client or a client's family member is in need of services, the FIS shall refer and schedule an appointment within 48 hours for the client to be seen within seven (7) working days after completion of the screening with the most appropriate local provider for an assessment and subsequent services. b. Upon completion of the client referral, the FIS shall provide a summary to the referral agent/child welfare worker. FIS can provide the summary to the referral agent/child welfare worker through electronic transmissions. The FIS must use appropriate safeguards to prevent use or disclosure of protected health information. c. The primary referrals may be to substance abuse treatment providers for more in -depth evaluation and substance abuse treatment, if needed. Other referrals may include referrals for mental health screenings, assessments or treatment, referrals for medical or physical problems, other social or assistance services, legal, educational, housing, vocational, or employment services. d. Referrals shall be based upon the client's needs, available community resources, and financial considerations. e. Each FIS shall maintain a directory of treatment resources, eligibility criteria, and referral procedures for available prevention and treatment resources in each community. The network provider agrees to mutually define, with child welfare, the role of the FIS positions within the system of care. The FIS will establish and maintain a working relationship with Our Kids, DCF, SFBHN, and all DCF licensed providers within the community(ies). 12. CASE PLANNING a. The FIS are responsible for developing the substance abuse intervention plan as required by Rule 65D -30, F.A.C. The FIS are required to provide a copy of the intervention plan to the child welfare worker for incorporation into the child welfare case plan. b. The FIS are responsible for reviewing and updating the substance abuse intervention plan as required by Rule 65D -30, F.A.C. An updated intervention plan is also required when there is a major change of status regarding the client's participation in substance abuse treatment. The FIS are required to provide a copy of the updated intervention plan to the child welfare worker for incorporation into the child welfare case plan. 13.CASE MANAGEMENT The FIS shall perform continued case management related to the substance Guidance Care Center, Inc. 108 Contract No. ME225 -3 -27 07/01/2012 abuse portion of the plan. This will continue throughout the duration of the client's participation in substance abuse services. FIS should make contact, preferably face -to -face, at least monthly with the client. This may include participation in formal staffing or informal contact. Case management activities shall include: I. Monitoring client's condition and progress in treatment; II. Linking clients to services as dictated by their needs; and III. Facilitating client's participation in treatment by removing barriers. 14. PROGRESS REPORT & STAFFING a. The FIS shall provide a monthly written status report throughout the duration of the open substance abuse case to the child welfare worker, indicating treatment progress and alerting the child welfare worker to any barriers or other concerns. A written report is also required when there is a major change of status regarding the client's participation, and at the close of the case. b. The FIS shall participate in staffing of the family's progress as requested by the child welfare worker or the substance abuse provider. The FIS will facilitate a staffing of the family's progress when there is a major change of status regarding the client's participation in substance abuse treatment. Although face -to -face staffing is preferred, interested parties may participate through telephone conferencing. c. The FIS are required to remain informed regarding the status of the child welfare case plan. 15. DEPENDENCY COURT LIAISON a. The FIS shall provide liaison services to the dependency court and inter- agency communication regarding the status and progress of clients in the FIS caseload who are in substance abuse treatment. In accordance with 42CFR 2.61, FIS, in consultation with the substance abuse treatment provider, shall assist child welfare staff in making recommendations to the court regarding family reunification. b. The FIS shall appear in court under any of the following circumstances: I. Clinical case staffing of the client indicates the need for the FIS; II. The court issues a subpoena to the FIS; III. The department or a child welfare agency provides a request to the FIS in writing, requesting client court representation; or IV. Upon request of an attorney representing the department. c. If the court requests a written status report in lieu of court appearance, the Guidance Care Center, Inc. 109 Contract No. ME225 -3 -27 07/01/2012 FIS shall provide said report to the department's Legal Counsel for filing with the court. Client/family requests for an FIS to appear on their behalf will be taken into consideration. 16. LENGTH OF SERVICE & DISCHARGE a. FIS services shall be provided to an eligible client receiving substance abuse treatment or substance abuse aftercare treatment to ensure linkage with and support for the child welfare case plan. The network provider may continue to provide FIS services to clients in active substance abuse treatment, or in substance abuse aftercare after the child welfare case is closed. b. The client may be discharged from FIS services upon any of the following: I. Substance abuse treatment is completed; II. The case is closed by the child welfare agency; III. The client refuses to participate in the program; or IV. The client is incarcerated, or moves to another geographic area. c. Decisions about when to close a case or keep it open should be made by the FIS in consultation with the substance abuse provider, child welfare worker, and /or the court. 17.CASE RECORDS Case records must be consistent with requirements of Chapter 65D -30, F.A.C. Refer to the FIS revised guidelines for a specific description of required records. The revised FIS guidelines can be obtained from the department's contract manager. 18. DATA REPORTING REQUIREMENTS Data shall be maintained by the network provider and submitted to the state Substance Abuse Program Office as required by CFP 155 -2. FIS shall enter data using an FIS Staff ID as defined in CFP 155 -2. Data will also be submitted to the circuit office as per Exhibit C. 19.TRAINING The network provider agrees to allocate training dollars per FIS position to participate in the FIS statewide meetings when they occur, any training provided by the DCF Substance Abuse Program Office specifically for FIS, or to attend a work related conference. Guidance Care Center, Inc. 110 Contract No. ME225 -3 -27 07/01/2012 20. INCIDENTALS FUNDS a. These funds may be used to remove barriers to treatment that are identified as problems in the client's intervention plan and to provide resources that are necessary to keep the family member in treatment. This funding may be used when no other resources are available. b. Uses of these funds include, but are not limited to, transportation, childcare, housing assistance, clothing, and educational /vocational assistance. Incidental funds may also be used for toxicology screens when they are identified as necessary in the client's screening or case management monitoring process, and in those instances when it is necessary to verify use or abstinence for a client in treatment. c. Although use of these funds for toxicology screens is allowable, this should only occur in situations where other resources are unavailable. Incidental funds should primarily be used to fund clients' needs to remove barriers to treatment. d. Criteria for use of the incidental funds, procedures for accessing them, and the accounting for expenditures will be developed cooperatively between the provider, the FIS, and the contract manager. The department's contract manager will have final approval of the criteria, procedures, and accounting for these funds. e. Each month, the network provider shall submit a report to the department's contract manager, which details year -to -date expenditures and the balance of the FIS incidental funds, along with the corresponding incidental fund request form(s). The expenditure of FIS incidental funds will be reflected in the incidental expenses cost center on the monthly invoice. This information must be monitored by the network provider agency to ensure that the funds allocated at the beginning of each fiscal year are not exceeded. f. The total amount of FIS funding for this contract is $100,000.00. This includes $0.00 that the network provider agrees to make available for Incidentals funds. 21.INCIDENTAL FUND REQUEST FORM a. The incidental fund request must contain, at a minimum, the information below: I. Name of the FIS accessing funds; II. Funds spent on behalf of (client name); III. Referral type (protective investigation /supervision); IV. Date of request; V. Description of Goods /Services requested; VI. How the purchase is related directly to the FIS intervention plan; VII. Goal /Reason for purchase amount requested; and VIII. FIS and approving authority signature with date. Guidance Care Center, Inc. 111 Contract No. ME225 -3 -27 07/01/2012 Exhibit J Assisted Living Facilities with Limited Mental Health License Authority: s. 394.4574, F.S. Network providers that enter into a cooperative agreement with an Assisted Living Facility- Limited Mental Health (ALF -LMH) that are also responsible for providing case management services to mental health residents in the ALF -LMH shall: 1) Ensure that all mental health residents as defined in s. 394.4574 (1) F.S. are assessed by a psychiatrist, clinical psychologist, clinical social worker or psychiatric nurse or individual who is supervised by one of these professionals, to establish that all residents are appropriate to reside in the ALF. A copy of that documentation shall be provided to the ALF administrator no later than 30 days following admission. 2) Ensure that case managers are assigned to all ALF -LMH residents who meet criteria as a mental health resident. If the resident declines case management, case managers must attempt to engage the person for a period not less than 30 days and document efforts in the ALF records. If the mental health resident continues to decline services, they must be encouraged to do so in writing, unless that is also refused. Documentation of a resident's declination of case management services and stated reason for declination must be maintained in case records at the ALF -LMH. 3) Ensure that individuals living in ALF -LMH and meeting the definition of a mental health resident served by the network provider are offered mental health services needed, including but not limited to case management, psychiatric medication treatment, access to drop -in centers, clubhouses and other services where available. 4) Ensure that a cooperative agreement to provide mental health services, including case management as required in s. 429.075 F.S, is developed between the network provider and administrator of the ALF -LMH. 5) Ensure that the cooperative agreement identifies, at a minimum: mental health services available; contact information for both the ALF Administrator and mental health provider, including after -hours emergency access; transportation provision; and services and activities available at the ALF -LMH. The ALF -LMH administrators must also be given contact information for the Department's Circuit Substance Abuse Mental Health Program Office and the managing entity, as appropriate. The cooperative agreement must contain a provision requiring the provider to maintain a file for each ALF - LMH client with copies of all required documentation. All ALF -LMH client records must be available for production by the network provider for monitoring purposes. 6) Ensure that the Cooperative Agreement is annually updated between the provider and the ALF -LMH Administrator. 7) Ensure that an annual community living support plan, as defined in s. 429.02 F.S., is prepared by the assigned case manager and the resident served, in consultation with the ALF -LMH administrator of the facility in face -to -face meetings. At a minimum, meetings will be held for initial plan development and annual updates to the plan. More frequent meetings shall be held as necessary to resolve concerns expressed by the resident, case manager, or ALF -LMH Administrator. The plan should be individualized and should include information about support services and special needs. 8) Report all concerns related to health and safety violations to appropriate officials at the Agency for Health Care Administration and the Department's Abuse Hotline. Guidance Care Center, Inc. 112 Contract No. ME225 -3 -27 07/01/2012 Exhibit K, Network Provider Inventory List o w ( / 0. y ^ 6 11 2 '1 r , tx jw or a o ,, • CC u, e 4, ix ri a, V c. es 8 w 1- . 11 8 .. ,D .. Q om : Q i3 - ` CO GP 4. CP O m v o � .' , 'a r ii" C R7 r o 41 cl E 5' .ice/ * f ' ! J 8 474'' i , 1 ,: .o v aft > _ r.. N r I F L hi t C L i - .. -J . . . .4 " . ` . :,4 :1 r ., r .. .. Guidance Care Center, Inc. 113 Contract No. ME225 - - 27 07/01/2012 EXIHIBIT L CCST DUTY ROSTER CCST DUTY ROSTER FOR THE WEEK OF: *PROGRAM: AMH /CMH /ASA /CSA (circle one) COST CENTER: 44. CCST — Individual / 45. COST -Group *Funding Source: Non -TANF /TANF (circle one) ❖ Remember to exclude Holidays (unless staff is scheduled to work) Part Time Does this staff Hours / Scheduled to Work CCST STAFF NAME /ID # or work in any other MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY Full Time cost center or Beginning & Beginning & Beginning & Beginning & Beginning & Beginning & Beginning & program? Ending Time Ending lime Ending lime Ending lime Ending Time Ending Time Ending Time 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. SIGNATURE OF SUPERVISOR: Date: Note: * Fill out a separate Duty Roster for each program and funding sources combination. Guidance Care Center, Inc. 114 Contract No. ME225 -3 -27 07/01/2012 EXHIBIT M CHILD WELFARE QUARTERLY CLINICAL REPORT Date of Report: Name of Person Completing Report: Title: Child's Name: DOB: DOA: School: Grade: School Placement: School Performance: Full Case Management Agency: Full Case Manager's Name: Phone #: Cell #: Relevant Incidents: Type of Service(s): Frequency: Location: Presenting Problem(s): Treatment Plan Goals/ Progress: * *Attach copy of most current Treatment Plan or Treatment Plan Review DSM IV Diagnosis (Current): Axis I: Axis II: Axis III: Axis IV: CGAS: Psychotropic Medications: Y/N If yes: Name of Psychiatrist: Was Medication treatment Plan completed? Y/N If yes, date of court approval: Current medication and dosage: Previous medication, if applicable: Rational for current medication: Date that child started taking the medication: Child's Treatment Summary /Therapeutic Recommendations: Therapist Signature Supervisor Signature Guidance Care Center, Inc. 115 Contract No. ME225 -3 -27 07/01/2012 EXHIBIT N MISSING CHILDREN The network provider agrees when services are for children who are adjudicated dependent where the care of the child is assigned to the department or network provider, to follow the procedures outlined in Rule 65C- 30.019, F.A.C. and Rule 65C- 29.013, F.A.C. and in Children and Families Operating Procedure (CFOP) 175 -85, entitled "Prevention, Reporting, and Services to Missing Children ". The network provider will perform the departmental functions as described in Rule 65C- 30.019, F.A.C. and CFOP 175 -85 which correspond to the functional role of this contract. The network provider also agrees when services for children are community based and the child involved is not adjudicated dependent, to comply with all licensing and contracting requirements. 1. Definitions a. Designee - a person, contractual network provider or other agency or entity named by the department. b. Exigent Circumstances - situations that require immediate actions, such as the child is under the age of thirteen, believed to be out of the zone of safety for their age and development, mentally incapacitated, in a life threatening situation, in the company of others who could endanger their welfare or is absent under circumstance inconsistent with established behaviors. c. FDLE -MCIC - Florida Department of Law Enforcement - Missing Children's Information Center. d. Family Services Counselor - a professional position responsible for case management for children placements. The term includes Department of Children and Families staff and staff working for an agency named as a designee. e. Missing Child - a person who is under the age of 18 years; whose location has not been determined; is currently placed in an out -of -home care setting; court order in -home placement; or is the subject of an active abuse investigation in which the child has been sheltered, would have been sheltered if their location had become known, or who was in the physical custody of the department or a network provider when they went missing; and who has been or will be reported as missing to a law enforcement agency. 2. Reporting Missing Children a. The network provider agrees to immediately notify the family services counselor(s), their supervisor, and /or the CBC Lead agency, and the legal guardian to ensure that they are fully aware of the circumstances involving a missing child. b. The network provider shall ensure and document that the family services counselor(s), their supervisor, and /or the CBC Lead agency have assumed responsibility for taking all required steps to recover the missing child and are fully engaged. Guidance Care Center, Inc. 116 Contract No. ME225 -3 -27 07/01/2012 c. The network provider agrees to instruct caregivers, including relative and non - relative caregivers, and all other staff that might be required to report a child as missing to local law enforcement to immediately undertake the following activities, as applicable, and document all actions and activities related to any efforts made to report and /or locate any child who is determined to be missing from their care or supervision: d. If exigent circumstances exist, the caregiver, family services counselor, or until the family services counselor is engaged, the network provider employee, who has identified that a child is missing from their care or supervision shall immediately call local law enforcement as soon as a determination has been made that a child is missing and they shall request that the responding office: (1) Take a report of the missing child. (2) Assign a case number to the missing child report and provide the case number back to the caregiver or person who is reporting the child missing. (3) Provide local law enforcement with a recent high quality photo of the child, or provide local law enforcement with a recent high quality photo when one becomes available. (4) Request that a copy of the police report be provided to the family services counselor once a police report becomes available. (5) If the responding law enforcement officer refuses to take a missing child report, for any reason, the individual attempting to report the child as missing will document the officer's name and specific local law enforcement agency name and request to speak to the law enforcement agency Watch /Shift Commander. If the law enforcement agency Watch Commander refuses to take a missing child report and it is a caregiver that is attempting to report the child as missing, the caregiver will immediately contact the family services counselor or on- call staff and provide them with all information related to local law enforcement not issuing a missing child report. Once the family services counselor or on -call staff have learned that a local law enforcement agency will not issue a missing child report they will immediately seek assistance from the local area Community Based Care (CBC) Child Location Specialist or the Department of Children and Families Regional Criminal Justice Services Coordinator on resolving any issue related to reporting the child as missing to local law enforcement. (6) If it is a caregiver who has reported the child as missing to local law enforcement or attempted to report a child as missing to local law enforcement, they shall immediately notify the child's family services counselor or emergency on -call staff and provide them with the following information: (a) The law enforcement agency name that the child was reported as missing to or attempted to be reported as missing to; Guidance Care Center, Inc. 117 Contract No. ME225 -3 -27 07/01/2012 (b) The law enforcement missing child case number if one was issued by local law enforcement; (c) A copy of the law enforcement report when one is made available; (d) Detailed information on the child's overall state of mind and behavior prior to the child going missing; (e) Detailed description of what the child was last seen wearing; (f) Detailed information on possible locations that the child might be going to; and (g) Detailed information on any individuals that the child might be traveling with. e. If exigent circumstances do not exist, the caregiver , family services counselor, or other network provider staff will within the first four (4) hours of learning that a child might be missing check to see what, if any, of the child's personal belongings are missing or if the child left a note; and, the caregiver , family services counselor, or other staff (if the family services counselor is not yet engaged), will: (1) Contact the following persons as appropriate to ascertain if the child has been seen, or has given any indications that may explain the child's missing status: (a) School /child's teachers and school resource officer; (b) The child's relatives /parents, both local and non - local, if appropriate, and the caregiver has the means for such contact; (c) Any friends or places that the child generally frequents, the local runaway shelter, if there is one in the community; and, (d) The child's employer, if applicable. (2) Write down any information gathered that might help locate the child. (3) Provide telephone /beeper numbers and ask for the individuals above to call back and share information if they have further information or see the child. a. If at any time during the initial four (4) hour search for the child, if the caregiver, family services counselor, or any other network provider employee (if the family services counselor is not yet engaged), becomes concerned about the immediate safety and well -being of the child, or the child's location remains unknown after four (4) hours from the time that the caregiver, family services counselor, or network provider employee learned that the location of the child was unknown, they shall immediately call local law enforcement and they shall follow the steps outlined in Section 2.a., above. Guidance Care Center, Inc. 118 Contract No. ME225 -3 -27 07/01/2012 b. If at any time, the child is located or returns to the caregivers home after law enforcement has been notified of the missing child case, all law enforcement agencies and other agencies that were notified of the missing child episode must be contacted immediately by the caregiver, family services counselor, or other network provider employee who made the report. If at any time new information is obtained on a possible location of the missing child, the caregiver, family services counselor, or any other employee of the network provider shall immediately contact all law enforcement agencies and other agencies that were notified of the missing child episode as to the possible location of the child. If the Family Services Counselor has been engaged, the network provider shall also inform them and the legal guardian of the new information once law enforcement has been notified. c. All of the department's documentation related to the missing child episode shall be completed and entered into the department's approved missing child reporting system within one working day of the family services counselor, on -call staff, or Community Based Care (CBC) Child Location Specialist learning of a missing child episode regardless of whether local law enforcement has issued a missing child report number. This includes the uploading of a recent high quality photograph of the child into the department's approved missing child reporting system. If local law enforcement has refused to issue a missing child report a dummy local law enforcement case number of 00000 and the name of the local law agency that refused to issue the missing child report shall be used to complete and enter the missing child episode into the department's approved missing child reporting system. Guidance Care Center, Inc. 119 Contract No. ME225 -3 -27 07/01/2012 EXHIBIT 0 INCIDENTAL EXPENSE FUND INVOICE AND EXPENDITURE LOG FOR ADULT MENTAL HEALTH Incidental Expense Fund Invoice and Expenditure Log for Adult Mental Health Reporting Month: Network Provider: Contract No. Cost Center: Amount Allocated: Amount Remaining: Recipient Program Civil or Description Requisition Status (Date request Amount Check # & Name & ID # Forensic of Date approved/pending /denied) Disbursement Date Expenses Staff name & Title Total Amount for Housing $ $ - Total Amount for Medication $ Total Amount for Emergency Expenses $ Guidance Care Center, Inc. 120 Contract No. ME225 -3 -27 07/01/2012 EXHIBIT P SAMH PRE - AUTHORIZATION RESIDENTIAL UTILIZATION MANAGEMENT ROSTER (1) Provider Name and Address: (2) Contract No: (3) SAMH Program: (4) Invoice Period: (5) Page _ of (6) Client (7) Authorization (8) Client Name (9) Social (10) Placement (11) (12) (13) (14) (15) Total Count Number (Last, First) Security Authorization No. of Units of Service Number No Service Period Cost Center Unit Rate Services Cost Rendered (Col. 13 x 14) I. 2. 3. 4. 5 . 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Totals $ Provider's Authorized Representative I CERTIFY THAT THE ABOVE IS ACCURATE AND CORRECT Provider's Signature Date Name (Print or Type) Tittle Guidance Care Center, Inc. 121 Contract No. ME225 -3 -27 07/01 /2012 ATTACHMENT I1 The administration of resources awarded by the Managing Entity to the network provider may be subject to audits as described in this attachment. MONITORING In addition to reviews of audits conducted in accordance with OMB Circular A -133 and Section 215.97, F.S., as revised, the Managing Entity may monitor or conduct oversight reviews to evaluate compliance with contract, management and programmatic requirements. Such monitoring or other oversight procedures may include, but not be limited to, on -site visits by Managing Entity staff, limited scope audits as defined by OMB Circular A -133, as revised, or other procedures. By entering into this agreement, the recipient agrees to comply and cooperate with any monitoring procedures deemed appropriate by the managing entity. In the event the Managing Entity determines that a limited scope audit of the recipient is appropriate, the recipient agrees to comply with any additional instructions provided by the Managing Entity regarding such audit. The recipient further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the department's inspector general, the state's Chief Financial Officer or the Auditor General. AUDITS PART I: FEDERAL REQUIREMENTS This part is applicable if the recipient is a State or local government or a non - profit organization as defined in OMB Circular A -133, as revised. In the event the recipient expends $500,000 or more in Federal awards during its fiscal year, the recipient must have a single or program- specific audit conducted in accordance with the provisions of OMB Circular A -133, as revised. In determining the Federal awards expended during its fiscal year, the recipient shall consider all sources of Federal awards, including Federal resources received from the Managing Entity. The determination of amounts of Federal awards expended should be in accordance with guidelines established by OMB Circular A -133, as revised. An audit of the recipient conducted by the Auditor General in accordance with the provisions of OMB Circular A -133, as revised, will meet the requirements of this part. In connection with the above audit requirements, the recipient shall fulfill the requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A -133, as revised. The schedule of expenditures should disclose the expenditures by contract number for each contract with the Managing Entity in effect during the audit period. The financial statements should disclose whether or not the matching requirement was met for each applicable contract. All questioned costs and liabilities due the Managing Entity shall be fully disclosed in the audit report package with reference to the specific contract number. Single Audit Information for Recipients of Recovery Act Funds: (a) To maximize the transparency and accountability of funds authorized under the American Recovery and Reinvestment Act of 2009 (Pub. L. 111 -5) (Recovery Act) as required by Congress and in accordance with 2 CFR 215.21 "Uniform Administrative Requirements for Grants and Agreements" and OMB Circular A -102 Common Rules provisions, recipients agree to maintain records that identify adequately the source and application of Recovery Act funds. OMB Circular A -102 is available at http: / /www.whitehouse.gov /om b /circulars /a102 /a102.htm I. (b) For recipients covered by the Single Audit Act Amendments of 1996 and OMB Circular A -133, "Audits of States, Local Governments, and Non - Profit Organizations," recipients agree to separately identify the expenditures for Federal awards under the Recovery Act on the Schedule of Expenditures of Federal Guidance Care Center, Inc. 122 Contract No. ME225 -3 -27 07/01/2012 Awards (SEFA) and the Data Collection Form (SF —SAC) required by OMB Circular A -133. OMB Circular A -133 is available at http: / /www.whitehouse.gov /omb /circulars /a133/a133.html. This shall be accomplished by identifying expenditures for Federal awards made under the Recovery Act separately on the SEFA, and as separate rows under Item 9 of Part III on the SF —SAC by CFDA number, and inclusion of the prefix "ARRA -" in identifying the name of the Federal program on the SEFA and as the first characters in Item 9d of Part III on the SF —SAC. (c) Recipients agree to separately identify to each subrecipient, and document at the time of subaward and at the time of disbursement of funds, the Federal award number, CFDA number, and amount of Recovery Act funds. When a recipient awards Recovery Act funds for an existing program, the information furnished to subrecipients shall distinguish the subawards of incremental Recovery Act funds from regular subawards under the existing program. (d) Recipients agree to require their subrecipients to include on their SEFA information to specifically identify Recovery Act funding similar to the requirements for the recipient SEFA described above. This information is needed to allow the recipient to properly monitor subrecipient expenditure of ARRA funds as well as oversight by the Federal awarding agencies, Offices of Inspector General and the Government Accountability Office. PART II: STATE REQUIREMENTS This part is applicable if the recipient is a nonstate entity as defined by Section 215.97(2), Florida Statutes. In the event the recipient expends $500,000 or more in state financial assistance during its fiscal year, the recipient must have a State single or project- specific audit conducted in accordance with Section 215.97, Florida Statutes; applicable rules of the Department of Financial Services; and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for - profit organizations), Rules of the Auditor General. In determining the state financial assistance expended during its fiscal year, the recipient shall consider all sources of state financial assistance, including state financial assistance received from the Managing Entity, other state agencies, and other nonstate entities. State financial assistance does not include Federal direct or pass- through awards and resources received by a nonstate entity for Federal program matching requirements. In connection with the audit requirements addressed in the preceding paragraph, the recipient shall ensure that the audit complies with the requirements of Section 215.97(8), Florida Statutes. This includes submission of a financial reporting package as defined by Section 215.97(2), Florida Statutes, and Chapters 10.550 or 10.650, Rules of the Auditor General. The schedule of expenditures should disclose the expenditures by contract number for each contract with the Managing Entity in effect during the audit period. The financial statements should disclose whether or not the matching requirement was met for each applicable contract. All questioned costs and liabilities due the Managing Entity shall be fully disclosed in the audit report package with reference to the specific contract number. PART III: REPORT SUBMISSION Any reports, management letters, or other information required to be submitted to the Managing Entity pursuant to this agreement shall be submitted within 180 days after the end of the network provider's fiscal year or within 30 days of the recipient's receipt of the audit report, whichever occurs first, directly to each of the following unless otherwise required by Florida Statutes: A. Managing Entity Contract Manager for this contract (1 electronic copy and management letter, if issued ) Guidance Care Center, Inc. 123 Contract No. ME225 -3 -27 07/01/2012 B. Reporting packages for audits conducted in accordance with OMB Circular A -133, as revised, and required by Part I of this agreement shall be submitted, when required by Section .320(d), OMB Circular A -133, as revised, by or on behalf of the recipient directly to the Federal Audit Clearinghouse using the Federal Audit Clearinghouse's Internet Data Entry System at: http: // harvester. census .qov /fac /collect/ddeindex.html and other Federal agencies and pass- through entities in accordance with Sections .320(e) and (f), OMB Circular A -133, as revised. C. Copies of reporting packages required by Part II of this agreement shall be submitted by or on behalf of the recipient directly to the following address: Auditor General Local Government Audits /342 Claude Pepper Building, Room 401 111 West Madison Street Tallahassee, Florida 32399 -1450 Email address: flaudgen _localgovt@aud.state.fl.us Network providers, when submitting audit report packages to the Managing Entity for audits done in accordance with OMB Circular A -133 or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit or for - profit organizations), Rules of the Auditor General, should include, when available, correspondence from the auditor indicating the date the audit report package was delivered to them. When such correspondence is not available, the date that the audit report package was delivered by the auditor to the network provider must be indicated in correspondence submitted to the Managing Entity in accordance with Chapter 10.558(3) or Chapter 10.657(2), Rules of the Auditor General. PART IV: RECORD RETENTION The recipient shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six years from the date the audit report is issued and shall allow the Managing Entity or its designee, Chief Financial Officer or Auditor General access to such records upon request. The recipient shall ensure that audit working papers are made available to the Managing Entity or its designee, Chief Financial Officer or Auditor General upon request for a period of three years from the date the audit report is issued, unless extended in writing by the managing entity. Guidance Care Center, Inc. 124 Contract No. ME225 -3 -27 07/01/2012 Attachment 111 CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS The undersigned certifies, to the best of his or her knowledge and belief, that (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or an employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $101 ! 11 fore such failure. 1 " ` 7/9/12 ignatur: Date FRANK RABBITO ME225 - 3 - 27 Name of Authorized Individual Application or Contract Number GUIDANCE CARE CENTER, INC. Name of Organization Address of Organization Guidance Care Center, Inc. 125 Contract No. ME225 -3-27 07/01/2012 Attachment III CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or an employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Signature Date FRANK RABBITO ME225 -3 -27 Name of Authorized Individual Application or Contract Number GUIDANCE CARE CENTER, INC. Name of Organization Address of Organization Guidance Care Center, Inc. 125 Contract No. ME225 -3 -27 07/01/2012 Attachment P1 Working Agreement for SSI /SSDI Outreach, Access, and Recovery (SOAR) Initiative Community Provider Agency The CommunityProviderA8ency shah' have designated SOAR train'eid staffwho agree to do folloiviriF 1. Contact the Identified Social Security Administration (SSA) liaison according to the Community Provider Agency's zip code and create an individualized application submission procedure that will be utiilzed for all initial SOAR applications. The procedure should indude the agreed upon preferred method of communication with the SSA liaison and how the protective fling date will be established for each datm. 2. Submit claims for SOAR applicants as soon as possible but within two weeks of the notification, at the latest. 3. Complete and submit a SSA 1696 Appointment of Representative form that will list the name of the hrdividual and the agency that will serve as the SOAR claimant's representative. This form will be submitted with the application. 4, Follow up on any additional needed non- medical information for SSA within two working days of notification of the need for information. This folow -up will either provide the documentation needed or notify SSA of the steps being taken to obtain the notification. 5. Receive notification from the SSA claims representative once the claim has cleared the non - medical process and has been sent to the Division of D'rsabifity Determinations (DD/D). This notification will take place within 24 hours of sending the daim to the DDD. 6. Obtain all existing medical information and submit it to the DDD, once the application for SSI/SSDI is completed. 7. Contact the DDD office within one week of notification of the daim having gone to the DDD to determine who the disability adjudicator is and make contact by phone with that adjudicator, notifying hinlher of working with a SOAR claimant, confirming the authorized representative status, and informing the examiner of the records being collected. 8. Maintain contact with the DDD adjudicator as appropriate, to chedc on the status of the claim and to continue to submit information. 9. Submit all existing medical information and additional evaluation information to the DDD within 30 calendar days of the submission of the application to the DDD by SSA. 10. Submit the medical summary report to the DDD within 30 calendar days as well. 11. Collect data regarding SOAR applications and submit it on an ongoing basis, via the Policy Research Associates' (PRA) web -based data entry program. Frank C. Rabbito, Sr. VP Guidance /Care Center, Inc. • I - , • (Print Name) Community Provider Agency 1 f L. 719!12 Signature Date Guidance Care Center, Inc. 126 Contract No. ME225 -347 07/01/2012 Attachment V Prevention Services DESCRIPTION OF SERVICES (Include overall intention of program, outline of program activities, target population to be served, implementation of EBP, and partners if applicable): The Guidance /Care Center's (G /CC) program consists of three evidenced -based practices and an environmental strategy to address the specific Tong -term outcome identified in the CCAP for Monroe County: Goal 1: Reduce the Monroe County prevalence rate of past 30 -day alcohol use among youth. Goal 2: Increase youths' attitudes and beliefs about the risk of harm of underage drinking The long term goal is to reduce DUI crashes countywide amongst 18 -20 year olds by 10% in 2015 by reducing parent acceptance and approval of behavior and increasing the perception of harm and risk in youth. TARGET POPULATION OR PARTICIPANTS (Include numbers in tables and a narrative description of participant characteristics below): Level 1 and Level 2 Number of Participants Youth living in Monroe County 1,123 Teens living in Monroe County SO Environmental Strategy: "Parents Who Host, Lose the Most" 60,619 Description of participants to be served (describe criteria for program enrollment eligibility, geographic areas /neighborhoods or schools to be served, risk factors, as well as any other significant demographics information; if serving children with disabilities, include type of disabilities): Male and female youth ages 10 -17 years and their parents who reside in Monroe County. Services will be provided at all three high schools, the alternative high school, three middle schools and two elementary schools. The TGFDV Program will be available to all 10 graders attending any one of the three Monroe County High Schools, as well as youth attending the alternative school or living at Florida Keys Children's Shelter in Tavernier. The TGFD Program will be available to 6` and 7th graders attending Big Pine Academy, 7th and 8 graders attending Key Largo Middle School, and Plantation Key Middle School, and 5"' graders attending Stanley Switlik School and 6"' graders at Marathon Middle School. * # Site Name Street Address City Zip Code Children/ Parents Other Youth Key West High School 2100 Flagler Ave Key West 33040 292 0 0 Coral Shores High School 89901 Old Highway Tavernier 33070 182 0 0 Key Largo Middle School 104801 Overseas Highway Key Largo 33037 196 0 0 Plantation Key Middle School 100 Lake Rd. Tavernier 33050 120 0 0 Stanley Switlik School 3400 Overseas Highway Marathon 33050 75 0 0 Marathon Middle High School 350 Sombrero Rd. Marathon 33050 190 0 0 Florida Keys Children's Shelter 73 High Point Rd. Tavernier 33070 40 0 0 Big Pine Academy 30220 Overseas Highway Big Pine 33043 28 0 0 "t >rfir; -tr fir Guidance Care Center, Inc. 127 Contract No. ME225 -3 -27 07/01/2012 PERFORMANCE MEASURES Quantity Activities /Service Name & Description (include # Children/ # # *Required % To Meet Activity frequency, intensity, & duration of sessions as well as the Youth Parents Others Sessions Required Level (1 number of cycles expected to be offered and tentative or 2) schedule), Too Good For Drugs Too Good For Violence 1,123 0 0 10 sessions 85% 1 Total = 1,123 served from July 1, 2012 through June 30, for 2013 Teen Intervene 50 0 0 1 85% 1 50 served from July 1, 2012 through June, 30, 2013 assessment 3 sessions for 1.5 hours each Environmental Strategy — Parents Who Host, Lose 5,000 20,109 5,000 822 50% NA The Most Environ Public education, Social Marketing, Media Advocacy mental 400 Public Service Announcements on radio and cinema Strategy 10 press releases 1 kickoff event 1 media campaign 10 presentations in the community 20 campaign posters in windows of local businesses 20 stickers posted in businesses that sell and serve alcohol that you must be 21 to purchase or use throughout the county Posters and other information regarding serving to those without ID will be available to vendors at the over 650 festivals in Monroe County each year serving alcohol Quantity Performance Measures Activity/ Service Name and *of participants to Required # of sessions for % of participants Description receive service participants to achieve results to meet required Goal 1: Reduce the Monroe County prevalence rate of past 30 -day alcohol use among youth. Goal 2: Increase youths' attitudes and beliefs about the risk of harm of underage drinking Too Good For Drugs Too Good For 1,123 12 sessions 85% = 955 Violence Participants Teen Intervene 50 1 assessment and 85% = 43 3 sessions for 1.5hours each participants Goal 1: Reduce the Monroe County prevalence rate of past 30 -day alcohol use among youth. Goal 2: Increase youths' attitudes and beliefs about the risk of harm of underage drinking Environmental Strategy 1 60,619 1 822 1 50%= 30,309 don-. e:,1:ef f r•✓en' o, a< < o? s Guidance Care Center, Inc. 128 Contract No. ME225 -3 -27 07/01/2012 Parents Who Host, Lose the Most I 1 1 participants Quality Description of the required program Quality measures. Quality Measure Measurement and Reporting Toot Timing Average number of sessions attended 85% of 1,123 participants or 955 will • At the end of each cohort of (Participant Retention) complete Too Good For Violence Too group sessions Good For Drugs post test and a minimum of 12 sessions • Ten (10) by September 30, 85% of 50 or 43 participants complete 2012, an additional 10 by the Teen Intervene sessions — a January 15, 2013, for a total minimum of 3 sessions of 20; an additional 10 by Measure: (Survey and Logs) March 2013 for a total of 30; and additional 20 by May 31, 2013 for a total of 50 youth. # and % of youth satisfied with services 90% • At the end of each TGFD V provided Satisfaction survey sessions for youth in TG FDV • At the end of each Teen Intervene session — or by June 15, 2013 for youth in Teen Intervene Observation of service delivery/ Fidelity Curriculum fidelity checklist One time for each cohort (school) checklist in September and March Documentation of structured supervision Supervisory Tool /Checklist and Notes During regular supervisory sessions for each staff and not less than one time per month # and % of staff with necessary 100% At the time of contract training/certification monitoring Participant Outcomes Outcome Data Source /Measurement Timing Associated Activity 1,123 youth will receive the 1. Data entered into the At admission into Staff trained; Program TGFDV/TGFD curricula annually PBPS system & The GCC program timelines developed; database Database set -up; 2. Client enrollment forms At end of sessions TGFCV/TGFD 3. Pre /post surveys sessions facilitated; Data collected and entered in database; Data analyzed; Program improvement activities Outputs: 10 of 12 sessions 50 youth will receive Teen 1. Data entered into the At admission into the Prior to delivery of 1 Intervene annually PBPS system & GCC program session database 2. Client enrollment forms At end of sessions youth Sessions delivered will complete a post Survey administered survey ;wow - -Breve; ;tiro -a: -� ^t Gt i Itnct # Guidance Care Center, Inc. 129 Contract No. ME225 -3 -27 07/01/2012 85% of the youth will complete 1. Attendance records 1. Youth sign attendance Youth sign the at least the required 10 sessions 2. Service deliver data records for each session attendance record at of TGFDV /TGFD curricula entered into GCC database 2. Staff enter service the beginning of each delivery data daily session 3. Post surveys Post surveys administered at the end administered and data of the sessions collected and analyzed 85% of the high school students 1. Attendance records 1. Youth sign attendance Youth sign the will complete at least the 3 2. Data entered into GCC records at each session attendance record at required sessions of Teen database 2. Staff enter service the beginning of each Intervene delivery data daily /based session on services rendered 3. Post surveys Post surveys administered at the end administered and data of the sessions collected and analyzed 85% of the youth will improve TGFDV/TGFD pre /post tests Collected immediately During the first/last their attitudes and beliefs prior to the 1 session sessions of the related to risk of harm of and immediately curriculum; for youth underage drinking following the last session only completing the required 10 sessions, the research assistant will contact/meet with youth to collect the post test 85% of the youth will report no Timeline follow back Collected immediately Youth will complete alcohol use in past 30-day by prior to the 1 session the surveys; for youth curriculum completion and immediately only completing the following the last session required 3 sessions, the research assistant will contact /meet with youth to collect the post test. Data will be analyzed and reported. Staff shall enter 100% of data PBPS and /or SFBHN data Monthly Research and requested into the PBPS and /or systems Evaluation does a SFBHN systems monthly audit of information in the system compared to hard copy The agency shall submit 90% of Data submission reports Monthly Staff will review data the data on schedule completed following submission process Increased collaboration with the Increase by 2015 the Sept. 1, 2012 -June Increased DUI arrests State Attorney's Office, conviction rate from 26% to 30,2013 by Law Enforcement & campaign materials targeting 36 %, promote Parents Who Monthly reporting form Increased prosecution parents, increase /sustain EBP's, Host Campaign from SAO by SAO of DUI cases by and increase Law Enforcement 10%. capacity for Saturation Patrols in MOU's with SAO, GCC, the Lower, Middle and Upper Monroe coalition and Keys HSA. All to attend monthly Monroe Increased enforcement County Coalition /prosecution of parents Monitor police 2 parties Meetings to increase Guidance Care Center, Inc. 130 Contract No. ME225 -3 -27 07/01/2012 providing alcohol enforcement/ monitor targeted /monthly collaboration. prosecutions Monthly meeting with SAO to monitor Increased Saturation prosecution activity Patrols /arrests in Lower, Middle Key West Police, Monroe Sept. 1, 2012 -June and time expended to and Upper Keys County Sheriff 30,2012 log data. HSA(if funded by PPG) Increase arrests by Key West to monitor Police by 20 - enforcements /Monroe For Monroe Co. Sheriff by 10 County Coalition to Lower Keys, by 12 Middle Keys, Monitor prosecutions. and by 22 Upper Keys Data collected monthly by reporting forms and analyzed by Committee named by Coalition( to be determined) Monitor # of increased arrests by Key West Police and for Monroe Co. Sheriff through HSA (if funded by PPG) and share report with the Coalition at monthly meetings. EVIDENCE BASED PROGRAMS (EBP) All strategies funded by South Florida Behavioral Health Network should deliver high quality, evidence - based practices that are strength- based, child /youth /family centered, accessible, respectful of diversity and mindful of community context and connections, or constitute best practices that have been approved by South Florida Behavioral Health Network because, when performed with fidelity, they should deliver analogously high quality services. Listed are the evidence -based programs that will be used during activities /service delivery. Evidence Based Program Designating Agency Strength of Evidence Too Good for Drugs and Violence (TGFDV), SAMSHA approved, NREPP Option 1 Too Good for Drugs (TG FD) Teen Intervene SAMSHA approved, NREPP Option 1 Parents Who Host, Lose the Most Promising Practice with research to support it Option 2 TASK LIST Activities Year 1 Activities /Service Name & Description # & Type of EBP %to Participants Recommended < Meet this Sessions or Outcome Hours Activity Title; Too Good For Violence/Too Good For Drugs 1,123 youth 1 hour for 12 85% Activity Description: Participants will be recruited from designated schools sessions and will receive a pretest assessment of their risk and protective factors. The curriculum will be administered once per week for 12 sessions and the posttest will be administered at the end of the sessions Ci e Car C;:ertc:r — ! e -"Age of t ■_;orirract Guidance Care Center, Inc. 131 Contract No. ME225 -3 -27 07/01/2012 Frequency: One time upon program entry. Intensity: 10 -12 sessions Duration: 1 hour per session. Activity Title: Teen Intervene Curriculum 50 3 sessions @ 85% Activity Description: Participants will be required to attend 90 minute 1.5 hour per sessions session Frequency: One time per week Intensity: Three sessions Duration: One 90 minute session Activity Title: Parents Who Host, Lose the Most 60,619 422 50% Activity Description:. Participants will be reached by ads, radio and cinema PSA's, mailings, community meetings, posters placed at local businesses Frequency: PSA's 44 weeks Intensity: 3x /day for 3 days per week Duration: 30 seconds each Activity Title: Parents Who Host, Lose the Most 15 -20 10 sessions 85% Activity Description: Com munity Meetings parents, Frequency: 1x monthly Sept 2012 -June 2013 teachers,cit intensity: 10 meetings y &,county Duration: 60 minute meetings personnel, business leaders, community members Activity Title: Parents Who Host, Lose the Most 50 mailings Mailings =36 100% Description:. Mailings & Poster placement each Cycle hrs /Cycle - Frequency & intensity: 6x Mailings, Poster placement ix cycle 1, lx cycle2 to key Posters =40 Duration: 6 months contacts in Hrs. community for outreach support, 20 Poster /Stick er Placements at local businesses. Ctuicia' ?ce(T r C: ; ter — ..xrtia nti -crt # Guidance Care Center, Inc. 132 Contract No. ME225 -3 -27 ATTACHMENT E Contract Between Florida Department of Children and Families and South Florida Behavioral Health Network Contract (KH -225) Guidance Care Center -SAMH Contract; FY13; page 14 Contract No. KH225 Client ® Non - Client ❑ CFDA No. 93.959 FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES STANDARD CONTRACT THIS CONTRACT is entered into between the Florida Department of Children and Families, hereinafter referred to as the "department" and South Florida Behavioral Health Network. Inc., hereinafter referred to as the "provider ". I. THE PROVIDER AGREES: A. Contract Document To provide services in accordance with the terms and conditions specified in this contract including all attachments and exhibits, which constitute the contract document. B. Requirements of Section 287.058, Florida Statutes (F.S.) The provider shall provide units of deliverables, including reports, findings, and drafts, as specified in this contract. These deliverables must be received and accepted by the contract manager in writing prior to payment. The provider shall submit bills for fees or other compensation for services or expenses in sufficient detail for proper pre -audit and post- audit; where itemized payment for travel expenses are permitted in this contract, submit bills for any travel expenses in accordance with section 112.061, F.S., or at such lower rates as may be provided in this contract. To allow public access to all documents, papers, letters, or other public records as • defined in subsection 119.011(12), F.S. and as prescribed by subsection 119.07(1) F.S., made or received by the provider in conjunction with this contract except that public records which are made confidential by law must be protected from disclosure. It is expressly understood that the provider's failure to comply with this provision shall constitute an immediate breach of contract for which the department may unilaterally terminate the contract. C. Governing Law, Jurisdiction and Venue 1. State of Florida Law This contract is executed and entered into in the State of Florida, and shall be construed, performed and enforced in all respects in accordance with Florida law, • without regard to Florida provisions for conflict of laws. Courts of competent jurisdiction in Florida shall have exclusive jurisdiction in any action regarding this contract and venue shall be as provided in PUR 1000. (see Section I.BB) • 2. Federal Law a. If this contract contains federal funds, the provider shall comply with the provisions of 45 Code of Federal Regulations (CFR), Part 74, 45 CFR, Part 92, and other applicable regulations. • b. If this contract contains over $100,000 of federal funds, the provider shall comply with all applicable standards, orders, or regulations issued under section 306 of the Clean Air Act, as amended (42 United States Code (U.S.C.) 7401 et seq.), section 508 of the Federal Water Pollution Control Act, as amended (33 U.S.C. 1251 et seq.), Executive Order 11738, as amended and where applicable, and Environmental Protection Agency regulations (40 CFR, Part 30). The provider shall report any violations of the above to the department. c. No federal funds received in connection with this contract may be used by the provider, or agent acting for the provider, or subcontractor to influence legislation or appropriations pending before the Congress or any State legislature. If this contract contains federal funding in excess of $100,000, the provider must, prior to contract execution, complete the Certification Regarding Lobbying form, Attachment II. If a Disclosure of Lobbying Activities form, Standard Form LLL, is required, it may be obtained from the contract manager. All disclosure forms as required by the Certification Regarding Lobbying form must be completed and returned to the contract manager, prior to payment under this contract. d. Unauthorized aliens shall not be employed. The department shall consider the employment of unauthorized aliens a violation of section 274A(e) of the Immigration and Nationality Act (8 U.S.C. 1324 a) and section 101 of the Immigration Reform and Control Act of 1986. Such violation shall be cause for unilateral cancellation of this contract by the department. e. If this contract contains $10,000 or more of federal funds, the provider shall comply with Executive Order 11246, Equal Employment Opportunity, as amended by Executive Order 11375 and others, and as supplemented in Department of Labor regulation 41 CFR, Part 60 and 45 CFR, Part 92, if applicable. f. If this contract contains federal funds and provides services to children up to age 18, the provider shall comply with the Pro - Children Act of 1994 (20 U.S.C. 6081). Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000 for each violation or the imposition of an administrative compliance order on the responsible entity, or both. D. Audits, Inspections, Investigations, Records and Retention 1. The provider shall establish and maintain books, records and documents (including electronic storage media) sufficient to reflect all income and expenditures of funds provided by the department under this contract. 2. Retention of all client records, financial records, supporting documents, statistical records, and any other documents (including electronic storage media) pertinent to this contract shall be maintained by the provider for a period of six (6) years after completion of the contract or longer when required by law. In the event an audit is required by this contract, records shall be retained for a minimum period of six (6) years after the audit report is issued or until resolution of any audit findings or litigation based on the terms of this contract, at no additional cost to the department. 3. Upon demand, at no additional cost to the department, the provider will facilitate the duplication and transfer of any records or documents during the required retention period in Section I, Paragraph D. 2. 4. These records shall be made available at all reasonable times for inspection, review, copying, or audit by Federal, State, or other personnel duly authorized by the department. CF Standard Contract 06/2010 1 Contract # KH225 5. At all reasonable times for as long as records are maintained, persons duly authorized by the department and Federal auditors, pursuant to 45 CFR, section 92.36(i)(10), shall be allowed full access to and the right to examine any of the provider's contracts and related records and documents, regardless of the form in which kept. 6. A financial and compliance audit shall be provided to the department as specified in this contract and in Attachment 11I. 7. The provider shall comply and cooperate immediately with any inspections, reviews, investigations, or audits deemed necessary by The Office of the Inspector General (section 20.055, F.S.). E. Monitoring by the Department The provider shall permit all persons who are duly authorized by the department to inspect and copy any records, papers, documents, facilities, goods and services of the provider which are relevant to this contract, and to interview any clients, employees and subcontractor employees of the provider to assure the department of the satisfactory performance of the terms and conditions of this contract. Following such review, the department will deliver to the provider a written report of its findings, and request for development, by the provider, of a corrective action plan where appropriate. The provider hereby agrees to timely correct all deficiencies identified in the corrective action plan. F. Indemnification 1. The provider shall be fully liable for the actions of its agents, employees, partners, or subcontractors and shall fully indemnify, defend, and hold harmless the department and its officers, agents, and employees, from suits, actions, damages, and costs of every name and description, including attorneys' fees, arising from or relating to any alleged act or omission by the provider, its agents, employees, partners, or subcontractors, provided, however, that the provider shall not indemnify for that portion of any loss or damages proximately caused by the negligent act or omission of the department. 2. Further, the provider shall, without exception, indemnify and save harmless the department and its employees from any liability of any nature or kind whatsoever, including attomeys fees, costs and expenses, arising out of, relating to or involving any claim associated with any trademark, copyrighted, patented, or unpatented invention, process, trade secret or intellectual property right, information technology used or accessed by the provider, or article manufactured or used by the provider, its officers, agents or subcontractors in the performance of this contract or delivered to the department for the use of the department, its employees, agents or contractors. The provider may, at its option and expense, procure for the department, its employees, agents or contractors, the right to continue use of, replace, or modify the product or article to render it non - infringing. If the provider is not reasonably able to modify or otherwise secure the department the right to continue using the product or article, the provider shall remove the product and refund the department the amounts paid in excess of a reasonable rental for past use. However, the department shall not be liable for any royalties. The provider has no liability when such claim is solely and exclusively due to the department's alteration of the product or article or the department's misuse or modification of the provider's products or the department's operation or use of vendor's products in a manner not contemplated by this contract. The provider shall provide prompt written notification to the department of any claim of copyright, patent or other infringement arising from the performance of this contract. 3. Further, the provider shall protect, defend, and indemnify, including attorneys' fees and costs, the department for any and all claims and litigation (including litigation initiated by the department) arising from or relating to provider's claim that a document contains proprietary or trade secret information that is exempt from disclosure or the scope of the provider's redaction, as provided for under Section I.EE. 4. The provider's inability to evaluate liability or its evaluation of liability shall not excuse its duty to defend and indemnify after receipt of notice. Only an adjudication or judgment after the highest appeal is exhausted finding the department negligent shall excuse the provider of performance under this provision, in which case the department shall have no obligation to reimburse the provider for the cost of their defense. If the Provider is an agency or subdivision of the State, its obligation to indemnify, defend and hold harmless the department shall be to the extent permitted by law and without waiving the limits of sovereign immunity. G. Insurance Continuous adequate liability insurance coverage shall be maintained by the provider during the existence of this contract and any renewal(s) and extension(s) of it. By execution of this contract, unless it is a state agency or subdivision as defined by subsection 768.28(2), F.S., the provider accepts full responsibility for identifying and determining the type(s) and extent of liability insurance necessary to provide reasonable financial protections for the provider and the clients to be served under this contract. The limits of coverage under each policy maintained by the provider do not limit the provider's liability and obligations under this contract. Upon the execution of this contract, the provider shall furnish the department written verification supporting both the determination and existence of such insurance coverage. Such coverage may be provided by a self - insurance program established and operating under the laws of the State of Florida. The department reserves the right to require additional insurance as specified in this contract. H. Confidentiality of Client Information The provider shall not use or disclose any information concerning a recipient of services under this contract for any purpose prohibited by state or federal law or regulations except with the written consent of a person legally authorized to give that consent or when authorized by law. 1. Assignments and Subcontracts 1. The provider shall not assign the responsibility for this contract to another party without prior written approval of the department, upon the department's sole determination that such assignment will not adversely affect the public interest; however, in no event may provider assign or enter into any transaction having the effect of assigning or transferring any right to receive payment under this contract which right is not conditioned on full and faithful performance of provider's duties hereunder. Any sublicense, assignment, or transfer otherwise occurring without prior approval of the department shall be null and void. The provider shall not subcontract for any of the work contemplated under this contract without prior written approval of the department, which shall not be unreasonably withheld. 2. To the extent permitted by Florida Law, and in compliance with Section I.F. of this Standard Contract, the provider is responsible for all work performed and for all commodities produced pursuant to this contract whether actually furnished by the provider or its subcontractors. Any subcontracts shall be evidenced by a written document. The provider further agrees that the department shall not be liable to the subcontractor in any way or for any reason. The provider, at its expense, will defend the department against such claims. CF Standard Contract 06/2010 2 Contract # KH225 3. The provider shall make payments to any subcontractor within seven (7) working days after receipt of full or partial payments from the department in accordance with section 287.0585, F.S., unless otherwise stated in the contract between the provider and subcontractor. Failure to pay within seven (7) working days will result in a penalty that shall be charged against the provider and paid by the provider to the subcontractor in the amount of one -half of one percent (.005) of the amount due per day from the expiration of the period allowed for payment. Such penalty shall be in addition to actual payments owed and shall not exceed fifteen (1 5 %) percent of the outstanding balance due. 4. The State of Florida shall at all times be entitled to assign or transfer, in whole or part, its rights, duties, or obligations under this contract to another governmental agency in the State of Florida, upon giving prior written notice to the provider. In the event the State of Florida approves transfer of the provider's obligations, the provider remains responsible for all work performed and all expenses incurred in connection with the contract. This contract shall remain binding upon the successors in interest of either the provider or the department. 5. The provider shall include, or cause to be included, in all subcontracts (at any tier) the substance of all clauses contained in this Standard Contract that mention or describe subcontract compliance. J. Return of Funds The provider shall return to the department any overpayments due to unearned funds or funds disallowed that were disbursed to the provider by the department and any interest attributable to such funds pursuant to the terms and conditions of this contract. In the event that the provider or its independent auditor discovers that an overpayment has been made, the provider shall repay said overpayment immediately without prior notification from the department. In the event that the department first discovers an overpayment has been made, the contract manager, on behalf of the department, will notify the provider by letter of such findings. Should repayment not be made forthwith, the provider will be charged interest at the lawful rate of interest on the outstanding balance after department notification or provider discovery. K. Client Risk Prevention and Incident Reporting 1. If services to clients are to be provided under this contract, the provider and any subcontractors shall, in accordance with the client risk prevention system, report those reportable situations listed in CFOP 215 -6 in the manner prescribed in CFOP 215 -6 or circuit or region operating procedures. 2. The provider shall immediately report any knowledge or reasonable suspicion of abuse, neglect, or exploitation of a child, aged person, or disabled adult to the Florida Abuse Hotline on the statewide toll -free telephone number (I- 800- 96ABUSE). As required by Chapters 39 and 415, F.S., this provision is binding upon both the provider and its employees. L. Purchasing 1. Articles which are the subject of or are required to carry out this contract shall be purchased from Prison Rehabilitative Industries and Diversified Enterprises, Inc., (PRIDE) identified under Chapter 946, F.S., in the same manner and under the procedures set forth in subsections 946.515(2) and (4), F.S. For purposes of this contract, the provider shall be deemed to be substituted for the department insofar as dealings with PRIDE. This clause is not applicable to subcontractors unless otherwise required by law. An abbreviated list of products /services available from PRIDE may be obtained by contacting PRIDE, (800) 643 -8459. 2. The provider shall procure any recycled products or materials, which are the subject of or are required to carry out this contract, in accordance with the provisions of sections 403.7065, and 287.045, F.S. M. Civil Rights Requirements 1. In accordance with Title VII of the Civil Rights Act of 1964, the Americans with Disabilities Act of 1990, or the Florida Civil Rights Act of 1992, as applicable the provider shall not discriminate against any employee (or applicant for employment) in the performance of this contract because of race, color, religion, sex, national origin, disability, age, or marital status. Further, the provider agrees not to discriminate against any applicant, client, or employee in service delivery or benefits in connection with any of its programs and activities in accordance with 45 CFR 80, 83, 84, 90, and 91, Title VI of the Civil Rights Act of 1964, or the Florida Civil Rights Act of 1992, as applicable and CFOP 60 -16. These requirements shall apply to all contractors, subcontractors, subgrantees or others with whom it arranges to provide services or benefits to clients or employees in connection with its programs and activities. 2. Complete the Civil Rights Compliance Checklist, CF Form 946 in accordance with CFOP 60 -16 and 45 CFR 80. This is required of all providers that have fifteen (15) or more employees. 3. Subcontractors who are on the discriminatory vendor list may not transact business with any public entity, in accordance with the provisions of 287.134, F.S. N. Independent Capacity of the Contractor 1. In performing its obligations under this contract, the provider shall at all times be acting in the capacity of an independent contractor and not as an officer, employee, or agent of the State of Florida, except where the provider is a state agency. Neither the provider nor its agents, employees, subcontractors or • assignees shall represent to others that it has the authority to bind the department unless specifically authorized in writing to do so. 2. This contract does not create any right to state retirement, leave benefits or any other benefits of state employees as a result of performing the duties or obligations of this contract. 3. The provider shall take such actions as may be necessary to ensure that each subcontractor of the provider will be deemed to be an independent contractor and will not be considered or permitted to be an agent, servant, joint venturer, or partner of the State of Florida. 4. The department will not furnish services of support (e.g., office space, office supplies, telephone service, secretarial or clerical support) to the provider, or its subcontractor or assignee, unless specifically agreed to by the department in this contract. 5. All deductions for social security, withholding taxes, income taxes, contributions to unemployment compensation funds and all necessary insurance for the provider, the provider's officers, employees, agents, subcontractors, or assignees shall be the sole responsibility of the provider. CF Standard Contract 06/2010 3 Contract # KH225 O. Sponsorship As required by section 286.25, F.S., if the provider is a non - governmental organization which sponsors a program financed wholly or in part by state funds, including any funds obtained through this contract, it shall, in publicizing, advertising, or describing the sponsorship of the program state: "Sponsored by (provider's name) and the State of Florida, Department of Children and Families ". If the sponsorship reference is in written material, the words "State of Florida, Department of Children and Families" shall appear in at least the same size letters or type as the name of the organization. P. Publicity Without limitation, the provider and its employees, agents, and representatives will not, without prior departmental written consent in each instance, use in advertising, publicity or any other promotional endeavor any State mark, the name of the State's mark, the name of the State or any State affiliate or any officer or employee of the State, or represent, directly or indirectly, that any product or service provided by the provider has been approved or endorsed by the State, or refer to the existence of this contract in press releases, advertising or materials distributed to the provider's prospective customers. Q. Final Invoice The final invoice for payment shall be submitted to the department no more than 31 days after the contract ends or is terminated. If the provider fails to do so, all rights to payment are forfeited and the department will not honor any requests submitted after the aforesaid time period. Any payment due under the terms of this contract may be withheld until all reports due from the provider and necessary adjustments thereto, have been approved by the department. R. Use of Funds for Lobbying Prohibited The provider shall comply with the provisions of sections 11.062 and 216.347, F.S., which prohibit the expenditure of contract funds for the purpose of lobbying the Legislature, judicial branch, or a state agency. S. Public Entity Crime Pursuant to section 287.133, F.S., the following restrictions are placed on the ability of persons convicted of public entity crimes to transact business with the department. When a person or affiliate has been placed on the convicted vendor list following a conviction for a public entity crime, he /she may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or the repair ofa public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in section 287.017, F.S., for CATEGORY TWO for a period of thirty -six (36) months from the date of being placed on the convicted vendor list. T. Gratuities The provider agrees that it will not offer to give or give any gift to any department employee. As part of the consideration for this contract, the parties intend that this provision will survive the contract for a period of two years. In addition to any other remedies available to the department, any violation of this provision will result in referral of the provider's name and description of the violation of this term to the Department of Management Services for the potential inclusion of the provider's name on the suspended vendors list for an appropriate period. The provider will ensure that its subcontractors, if any, comply with these provisions. U. Patents, Copyrights, and Royalties 1. It is agreed that all intellectual property, inventions, written or electronically created materials, including manuals, presentations, films, or other copyrightable materials, arising in relation to provider's performance under this contract, and the performance of all of its officers, agents and subcontractors in relation to this contract, are works for hire for the benefit of the department, fully compensated for by the contract amount, and that neither the provider nor any of its officers, agents nor subcontractors may claim any interest in any intellectual property rights accruing under or in connection with the performance of this contract. It is specifically agreed that the department shall have exclusive rights to all data processing software falling within the terms of section 119.084, F.S., which arises or is developed in the course of or as a result of work or services performed under this contract, or in anyway connected herewith. Notwithstanding the foregoing provision, if the provider is a university and a member of the State University System of Florida, then section 1004.23, F.S., shall apply. 2. If the provider uses or delivers to the department for its use or the use of its employees, agents or contractors, any design, device, or materials covered by letters, patent, or copyright, it is mutually agreed and understood without exception that the compensation paid pursuant to this contract includes all royalties or costs arising from the use of such design, device, or materials in any way involved in the work contemplated by this contract. 3. All applicable subcontracts shall include a provision that the Federal awarding agency reserves all patent rights with respect to any discovery or invention that arises or is developed in the course of or under the subcontract. V. Construction or Renovation of Facilities Using State Funds Any state funds provided for the purchase of or improvements to real property are contingent upon the provider granting to the state a security interest in the property at least to the amount of the state funds provided for at least five (5) years from the date of purchase or the completion of the improvements or as further required by law. As a condition of receipt of state funding for this purpose, the provider agrees that, if it disposes of the property before the department's interest is vacated, the provider will refund the proportionate share of the state's initial investment, as adjusted by depreciation. • W. Information Security Obligations 1. An appropriately skilled individual shall be identified by the provider to function as its Data Security Officer. The Data Security Officer shall act as the liaison to the department's security staff and will maintain an appropriate level of data security for the information the provider is collecting or using in the performance of this contract. An appropriate level of security includes approving and tracking all provider employees that request or have access to any departmental data system or information. The Data Security Officer will ensure that user access to the data system or information has been removed from all terminated provider employees. 2. The provider shall provide the latest departmental security awareness training to its staff and subcontractors who have access to departmental information. CF Standard Contract 06/2010 4 Contract # KH225 3. All provider employees who have access to departmental information shall comply with, and be provided a copy of CFOP 50 -2, and shall sign the DCF Security Agreement form CF 0114 annually. A copy of CF 0114 may be obtained from the contract manager. 4. The provider shall make every effort to protect and avoid unauthorized release of any personal or confidential information by ensuring both data and storage devices are encrypted as prescribed in CFOP 50 -2. If encryption of these devices is not possible, then the provider shall assure that unencrypted personal and confidential departmental data will not be stored on unencrypted storage devices. The provider shall require the same of all subcontractors. 5. The provider agrees to notify the contract manager as soon as possible, but no later than five (5) business days following the determination of any breach or potential breach of personal and confidential departmental data. The provider shall require the same notification requirements of all subcontractors. 6. The provider shall provide notice to affected parties no later than 45 days following the determination of any potential breach of personal or confidential departmental data provided in section 817.5681, F.S. The provider shall require the same notification requirements of all subcontractors. X. Accreditation The department is committed to ensuring provision of the highest quality services to the persons we serve. Accordingly, the department has expectations that where accreditation is generally accepted nationwide as a clear indicator of quality service, the majority of the department's providers will either be accredited, have a plan to meet national accreditation standards, or will initiate a plan within a reasonable period of time. Y. Provider Employment Opportunities 1. Agency for Workforce Innovation and Workforce Florida: The provider understands that the department, the Agency for Workforce Innovation, and Workforce Florida, Inc., have jointly implemented an initiative to empower recipients in the Temporary Assistance to Needy Families Program to enter and remain in gainful employment. The department encourages provider participation with the Agency for Workforce Innovation and Workforce Florida. 2. Transitioning Young Adults: The provider understands the department's Operation Full Employment initiative to assist young adults aging out of the dependency system. The department encourages provider participation with the local Community-Based Care Lead Agency Independent Living Program to offer gainful employment to youth in foster care and young adults transitioning from the foster care system. Z. Health Insurance Portability and Accountability Act The provider shall, where applicable, comply with the Health Insurance Portability and Accountability Act (42 U. S. C. 1320d.) as well as all regulations promulgated thereunder (45 CFR Parts 160, 162, and 164). AA. Emergency Preparedness 1. If the tasks to be performed pursuant to this contract include the physical care or supervision of clients, the provider shall, within 30 days of the execution of this contract, submit to the contract manager an emergency preparedness plan which shall include provisions for records protection, alternative accommodations for clients in substitute care, supplies, and a recovery plan that will allow the provider to continue functioning in compliance with the executed contract in the event of an actual emergency. For the purpose of disaster planning, the term supervision includes the responsibility of the department, or its contracted agents to ensure the safety, permanency and well -being of a child who is under the jurisdiction of a dependency court. Children may remain in their homes, be placed in a non - licensed relative /non - relative home, or be placed in a licensed foster care setting. 2. The department agrees to respond in writing within 30 days of receipt of the plan accepting, rejecting, or requesting modifications. In the event of an emergency, the department may exercise oversight authority over such provider in order to assure implementation of agreed emergency relief provisions. 3. An updated emergency preparedness plan shall be submitted by the provider no later than 12 months following the acceptance of an original plan or acceptance of an updated plan. The department agrees to respond in writing within 30 days of receipt of the updated plan, accepting, rejecting, or requesting modification to the plan. BB. PUR (Purchasing) 1000 Form The PUR 1000 Form is hereby incorporated by reference. In the event of any conflict between the PUR 1000 Form, and any terms or conditions of this contract (including the department's Standard Contract), the terms or conditions of this contract shall take precedence over the PUR 1000 Form. However, if the conflicting terms or conditions in the PUR 1000 Form are required by any section of the Florida Statutes, the terms or conditions contained in the PUR 1000 Fonn shall take precedence. CC. Notification of Legal Action The provider shall notify the department of legal actions taken against them or potential actions such as lawsuits, related to services provided through this contract or that may impact the provider's ability to deliver the contractual services, or adversely impact the department. The department's contract manager will be notified within 10 days of provider becoming aware of such actions or from the day of the legal tiling, whichever comes first. DD. Whistleblower's Act Requirements In accordance with subsection 112.3187(2), F.S., the provider and its subcontractors shall not retaliate against an employee for reporting violations of law, rule, or regulation that creates substantial and specific danger to the public's health, safety, or welfare to an appropriate agency. Furthermore, agencies or independent contractors shall not retaliate against any person who discloses information to an appropriate agency alleging improper use of governmental otfice, gross waste of funds, or any other abuse or gross neglect of duty on the part of an agency, public officer, or employee. The provider and any subcontractor shall inform its employees that they and other persons may file a complaint with the Office of Chief Inspector General, Agency Inspector General, the Florida Commission on Human Relations or the Whistle- blower's Hotline number at 1- 800 -543 -5353. CF Standard Contract 06/2010 5 Contract # 1(H225 EE. Proprietary or Trade Secret Information 1. Unless exempted by law, all public records are subject to public inspection and copying under Florida's Public Records Law, Chapter 119, F.S. Any claim by provider of proprietary or trade secret confidentiality for any information contained in provider's documents (reports, deliverables or workpapers, etc., in paper or electronic form) submitted in connection with this contract will be waived, unless the claimed confidential information is submitted in accordance with paragraph 2 below. 2. The provider must clearly label any portion of the documents, data or records submitted that it considers exempt from public inspection or disclosure pursuant to Florida's Public Records Law as proprietary or trade secret. The labeling will include a justification citing specific statutes and facts that authorize exemption of the information from public disclosure. If different exemptions are claimed to be applicable to different portions of the protected information, the provider shall include information correlating the nature of the claims to the particular protected information. 3. The department, when required to comply with a public records request including documents submitted by the provider, may require the provider to expeditiously submit redacted copies of documents marked as confidential or trade secret in accordance with paragraph 2 above. Accompanying the submission shall be an updated version of the justification under paragraph 2, correlated specifically to redacted information. The redacted copy must exclude or obliterate only those exact portions that are claimed to be proprietary or trade secret. If the provider fails to promptly submit a redacted copy and updated justification in accordance with this paragraph, the department is authorized to produce the records sought without any redaction of proprietary or trade secret information. 4. The department is not obligated to agree with the provider's claim of exemption on the basis of proprietary or trade secret confidentiality and the provider shall be responsible for defending its claim that each and every portion of the redactions of proprietary or trade secret information are exempt from inspection and copying under Florida's Public Records Law. FF. Support to the Deaf or Hard -of- Hearing The provider and its subcontractors, where direct services are provided, shall comply with section 504 of the Rehabilitation Act of 1973, 29 U.S.C. 794, as implemented by 45 C.F.R. Part 84 (hereinafter referred to as Section 504), the Americans with Disabilities Act of 1990, 42 U.S.C. 12131, as implemented by 28 C.F.R. Part 35 (hereinafter referred to as ADA), and the Children and Families Operating Instruction (CFOP) 60 -10, Chapter 4, entitled "Auxiliary Aids and Services for the Deaf or Hard -of- Hearing." 1. If the provider or any of its subcontractors employs 15 or more employees, the provider shall designate a Single- Point -of- Contact (one per firm) to ensure effective communication with deaf or hard -of- hearing customers or companions in accordance with Section 504, the ADA, and CFOP 60 -10, Chapter 4. The name and contact information for the provider's Single- Point -of- Contact shall be furnished to the department's Grant or Contract Manager within 14 calendar days of the effective date of this requirement. 2. The provider shall, within 30 days of the effective date of this requirement, contractually require that its subcontractors comply with section 504, the ADA, and CFOP 60 -10, Chapter 4. A Single- Point -of- Contact shall be required for each subcontractor that employs 15 or more employees. This Single - Point-of- Contact will ensure effective communication with deaf or hard -of- hearing customers or companions in accordance with Section 504 and the ADA and coordinate activities and reports with the provider's Single- Point -of- Contact. 3. The Single- Point -of- Contact shall ensure that employees are aware of the requirements, roles & responsibilities, and contact points associated with compliance with Section 504, the ADA, and CFOP 60 -10, Chapter 4. Further, employees of providers and its subcontractors with 15 or more employees shall attest in writing that they are familiar with the requirements of Section 504, the ADA, and CFOP 60 -10, Chapter 4. This attestation shall be maintained in the employee's personnel file. 4. The provider's Single- Point -of- Contact will ensure that conspicuous Notices which provide information about the availability of appropriate auxiliary aids and services at no -cost to the deaf or hard -of- hearing customers or companions are posted near where people enter or are admitted within the agent locations. Such Notices must be posted immediately by providers and subcontractors. The approved Notice can be downloaded through the Internet at http://www.dcfstate.fl.us/admin/igkivilrights.shtml 5. The provider and its subcontractors shall document the customer's or companion's preferred method of communication and any requested auxiliary aids /services provided in the customer's record. Documentation, with supporting justification, must also be made if any request was not honored. The provider shall submit compliance reports monthly, by the 5 business day following the reporting month, to the department's Grant or Contract Manager. The provider shall distribute Customer Feedback forms to customers or companions, and provide assistance in completing the forms as requested by the customer or companion. 6. If customers or companions are referred to other agencies, the provider must ensure that the receiving agency is notified of the customer's or companion's preferred method of communication and any auxiliary aids/service needs. 11. THE DEPARTMENT AGREES: A. Contract Amount The department shall pay for contracted services according to the terms and conditions of this contract of an amount not to exceed $362,976,259.00 or the rate schedule, subject to the availability of funds. The State of Florida's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. Any costs or services paid for under any other contract or from any other source are not eligible for payment under this contract. B. Contract Payment Pursuant to section 215.422, F.S., the department has five (5) working days to inspect and approve goods and services, unless the bid specifications, purchase order, or this contract specify otherwise. With the exception of payments to health care providers for hospital, medical, or other health care services, if payment is not available within forty (40) days, measured from the latter of the date a properly completed invoice is received by the department or the goods or services are received, inspected, and approved, a separate interest penalty set by the Chief Financial Officer pursuant to section 55.03, F.S., will be due and payable in addition to the invoice amount. Payments to health care providers for hospital, medical, or other health care services, shall be made not more than thirty-five (35) days from the date eligibility for payment is determined. Financial penalties will be calculated at the daily interest rate of .03333 %. Invoices returned to a provider due to preparation errors will result in a non - interest bearing payment delay. Interest penalties less than one (1) dollar will not be paid unless the provider requests payment. CF Standard Contract 06/2010 6 Contract # KH225 C. Vendor Ombudsman A Vendor Ombudsman has been established within the Department of Financial Services. The duties of this office are found in section 215.422, F.S., which include disseminating information relative to prompt payment and assisting vendors in receiving their payments in a timely manner from a state agency. The Vendor Ombudsman may be contacted at (850) 413 -5516. D. Notice Any notice that is required under this contract shall be in writing, and sent by U.S. Postal Service or any expedited delivery service that provides verification of delivery or by hand delivery. Said notice shall be sent to the representative of the provider responsible for administration of the program, to the designated address contained in this contract. III. THE PROVIDER AND DEPARTMENT MUTUALLY AGREE: A. Effective and Ending Dates This contract shall begin on October 1, 2010, or on the date on which the contract has been signed by the last party required to sign it, whichever is later. It shall end at midnight, local time in Miami Dade County, Florida, on September 30. 2015. B. Financial Penalties for Failures to Comply with Requirement for Corrective Actions I . In accordance with the provisions of section 402.73(1), F.S., and Rule 65- 29.001, F.A.C., corrective action plans may be required for noncompliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed for failures to implement or to make acceptable progress on such corrective action plans. 2. The increments of penalty imposition that shall apply, unless the department determines that extenuating circumstances exist, shall be based upon the severity of the noncompliance, nonperformance, or unacceptable performance that generated the need for corrective action plan. The penalty, if imposed, shall not exceed ten percent (l0 %) of the total contract payments during the period in which the corrective action plan has not been implemented or in which acceptable progress toward implementation has not been made. Noncompliance that is determined to have a direct effect on client health and safety shall result in the imposition of a ten percent (10 %) penalty of the total contract payments during the period in which the corrective action plan has not been implemented or in which acceptable progress toward implementation has not been made. 3. Noncompliance involving the provision of service not having a direct effect on client health and safety shall result in the imposition of a five percent (5 %) penalty. Noncompliance as a result of unacceptable performance of administrative tasks shall result in the imposition of a two percent (2 %) penalty. 4. The deadline for payment shall be as stated in the Order imposing the financial penalties. In the event of nonpayment the department may deduct the amount of the penalty from invoices submitted by the provider. C. Termination 1. This contract may be terminated by either party without cause upon no less than thirty (30) calendar days notice in writing to the other party unless a sooner time is mutually agreed upon in writing. Said notice shall be delivered by U.S. Postal Service or any expedited delivery service that provides verification of delivery or by hand delivery to the contract manager or the representative of the provider responsible for administration of the program. 2. In the event funds for payment pursuant to this contract become unavailable, the department may terminate this contract upon no Tess than twenty-four (24) hours notice in writing to the provider. Said notice shall be sent by U.S. Postal Service or any expedited delivery service that provides verification of delivery. The department shall be the final authority as to the availability and adequacy of funds. In the event of termination of this contract, the provider will be compensated for any work satisfactorily completed. 3. This contract may be terminated for the provider's non - performance upon no less than twenty-four (24) hours notice in writing to the provider. If applicable, the department may employ the default provisions in Rule 60A- 1.006(3), F.A.C. The department's failure to demand performance of any provision of this contract shall not be deemed a waiver of such performance. The department's waiver of any one breach of any provision of this contract shall not be deemed to be a waiver of any other breach and neither event shall be construed to be a modification of the terms and conditions of this contract. The provisions herein do not limit the department's right to remedies at law or in equity. 4. Failure to have performed any contractual obligations with the department in a manner satisfactory to the department will be a sufficient cause for termination. To be terminated as a provider under this provision, the provider must have: (1) previously failed to satisfactorily perform in a contract with the department, been notified by the department of the unsatisfactory performance, and failed to correct the unsatisfactory performance to the satisfaction of the department; or (2) had a contract terminated by the department for cause. D. Renegotiations or Modifications Modifications of provisions of this contract shall be valid only when they have been reduced to writing and duly signed by both parties. The rate of payment • and the total dollar amount may be adjusted retroactively to reflect price level increases and changes in the rate of payment when these have been established through the appropriations process and subsequently identified in the department's operating budget. CF Standard Contract 06/2010 7 Contract # ICH225 E. Official Payee and Representatives (Names, Addresses. 'Telephone Nunthers, and e-mail addresses): 1 The provider name. as shown on page 1 atlas contract, and mailing 3. The name, address. telephone number and e-mail address of the contract manager address ()Ellie official payee to whom the payment shall he made is: for the department for this contract is: 'U.ime: South Florida Behavioral Health Network. Inc. Name. Jessica Rc dritru t ress: 2140 South Dixie Highway. Suite 2114 _ Address: 401 NW 2' Avenue Suite N -826 City: Miami State:lI Zip Cnde;33133 City: Miami State: F1 Zip Code:: 33121E Phone: 305 -85S -3335 Phone: 30-377 -7650 ext est: e -mail: Jessica Radri rue wddcf.state.fl.us 2. The name of the contact person and street address s where financial and 4. The name_ address, telephone number and e-mail of the representative of the administrative records are maintained is: provider responsible for administration of the program under this contract is: Name. Stephen Zuckerman Name: Stephen Zuckerman Address: 2140 South Dixie Highway. Suite 204 Address: 2140 South Dixie Highway, Suite: 204 City: Miami State:Fl ZipCode:33133 City: Miami State:F1 ZipCode:33133 Phone: 305- X58 -3335 Phone: 305 - 5158.3335 ext. 306 ext. e-mail: szuo kernatxuslbhn.ortt e-mail sxuckertnamnsthhn. eg 5 Upon change of represeinativcs (names, addresses, telephone numbers and c mail addresses) by either patty, notice shalt be provided in writing ua the tither party and the notification attached to the originals of this contract. F. All 'terms and Conditions Included 'this contract and its attachments, 1,11 antl,I11 and any exhibits referenced in said attachments. together witlt any documents incarporatcal by reference, contain all the terms and conditions agreed upon by the parties. There are no provision. tenns, conditions, or obligations other than those contained herein, and this eontntct shall supersede all previous communications. representations, or agreements, either verbal or written between the patties. If any term or provision of this contract is legally determined unlawful or unenforceable the renaninde the contract shall remain in full force and effect and such term or provision shall be stricken. By signing this contract. the parties agree that they have read and agree to the entire contract, as described in Paragraph 111. F. above. IN WITNESS THEREOF, the parties ) aran have caused this 0166 page contract for he executed by their undersignexl officials as duly authorized. PROVIDER: South Florida Behaviors) Health Network, Inc. FLORIDA DEI A TMENT OF CHILDREN I.N11) FAMfL.IES / f , j . is i / i _..�� Slgnat.i re: ���- ^,f`a' ` a :� ., � `„.. -, c:. �.: - ..'""° S ignatur�3:� , . Print /Type �,� ' Prini/Eype Name: .l tt`►n Dow Nam : — ! Jaci.L I. Title: Exeeutivc Director Tit : - Regional Director j Date: z 1 G f, , Date. I . ` 0 .,. STATE AGENCY 29 DIGIT FLAIR CODE: _ Federal Tax ID # for SSNl :59- 3;385099 Provider Fiscal Tear Ending Date: 061 APPROVED AS TO FORM AND LEGAL SUFFICIENCY i i / . «h (GAL 'r lac'' z G IONA GAL COUNSEL DATE / I't' Standard Contract 06! -'010 8 Contract .r hH22 10/01/2010 Managing Entity ATTACHMENT 1 A. SERVICES TO BE PROVIDED 1. Definition of Terms a. Contract Terms Contract terms used in this document can be found in the Florida Department of Children and Families Glossary of Contract Terms, which is incorporated herein by reference. b. Program /Service Specific Terms (1) "Accessible" — Children, families and community members should be helped to become knowledgeable about how to ask for and receive services that are timely, comprehensive and family - friendly without facing unreasonable barriers. (2) "Activity" means an educational process or procedure intended to stimulate learning. (3) "Annual Action Plan" means an annual plan developed by the managing entity and approved by the department that contains the deliverables for the ten baseline functions and other requirements for the behavioral health services needs for the Southern Region. (4) "Approaches" mean the methods used in dealing with or accomplishing a task or goal. (5) "Approved Regional Plan" means a plan established by the department in accordance with section 394.674, F.S. and section 394.675, F.S. and updated annually or as required. (6) "ASAM PPC -2R Florida Supplement" means the American Society of Addiction Medicine, Patient Placement Criteria for the Treatment of Substance Related Disorders, second edition - revised, July 1, 2001, or the latest revised edition thereof. (7) "Assessment Instrument" means a tool used for collection of detailed information concerning an individual's substance abuse, emotional and physical health, social roles, and other areas that may reflect the severity of the individual's abuse of alcohol or drugs, as a basis for identifying an appropriate treatment regimen. (8) "Available Appropriations" means State and other governmental funds allocated for mental health and substance abuse services including prevention and the associated local matching funds. South Florida Behavioral Health Network, Inc. 9 KH225 10/01/2010 Managing Entity (9) Behavioral Health Services" means mental health services and substance abuse prevention and treatment services as defined in chapters 394, 397 and 916, F.S. which are provided using state and federal funds. (10) "CFP 155 -2 Department of Children & Families, Pamphlet 155 -2 - Mental Health and Substance Abuse Measurement and Data, effective September 2008 (9th edition, version 1) ", or the latest revised edition thereof means a document promulgated by the department that contains required data - reporting elements for substance abuse and mental health services, hereafter referred to as "CFP 155 -2 ", and which can be found at: http:// www .dcf.state.fl.us /mentalhealth /publications /index.shtml, and is incorporated herein by reference. (11) "Client Fees" means compensation to the managing entity's contracted network providers for services rendered to the client, who has been authorized to receive services pursuant to this contract, from any source of funds, including city, county, state, federal, private sources and client paid. (12) "Clinical Assessment" means the collection of detailed information concerning an individual's behavioral health, emotional and physical health, social roles, and other areas that may reflect the individual's overall health as a basis for identifying an appropriate treatment regimen. (13) "Clinician" means a substance abuse or mental health professional that provides one or more of the following services: assessment; individual, group, or family counseling services; or case management. (14) "CODECATTM (Co- occurring Disorders Educational Competency Assessment Tool)" means a tool used to evaluate clinicians' training needs based on a competency assessment to determine knowledge, skills, attitudes, and values relative to persons with co- occurring disorders. (15) Comprehensive Community Action Plan" means a plan developed by a local, department recognized, community substance abuse coalition which is based on an assessment of substance abuse related epidemiology data and the resources needed to address identified needs. The plan includes goals to reduce the community's prioritized substance use problems and the approaches to take to achieve them. (16) "Community -Based Services" means behavioral health services provided outside of a state facility. South Florida Behavioral Health Network, Inc. 10 KH225 10/01/2010 Managing Entity (17) "Community- Focused" means the process of planning, management and decision - making to ensure resources are designed to build on the unique strengths and meet the specific needs of the local community. (18) "Community Prevention" means strategies and activities aimed at changing community conditions related to substance abuse. It includes environmental strategies designed to change one or more community conditions. Community prevention is aimed at larger universal populations and selected sub - populations and does not track specific individuals. (19) "COMPASS"' (Comorbidity Program Audit and Self- Survey for Behavioral Health Services)" means a tool that can be used by behavioral health care systems to assess program competencies in multiple areas that reflect the basic expectations of program performance for mental health services, substance abuse disorder services and integrated systems of care. (20) "Comprehensive Continuous Integrated System of Care (CCISC)" means the model for improving service system wide to individuals with co- occurring psychiatric and substance disorders. "Comprehensive, Continuous, Integrated System of Care (CCISC) model" means a system design and implementation model for organizing services for individuals and families with co- occurring disorders that is designed to improve services capability on a statewide or regional basis to achieve: system level change; efficient use of resources; use of evidence -based and consensus based practices; and integrated mental health and substance abuse services throughout the system, by organizing a process in which every program improves their provision of co- occurring disorder services, and every clinical staff person improves their level of co- occurring disorder service competency based on their job and level of training. (21) Consolidated Program Description" means the combination of all of the managing entity network providers' program descriptions and the managing entity program description. (22) "Continuous Quality Improvement" means continuous internal improvements in service provision and administrative functions. These include the systematic ongoing process of improving performance, both in process and end of process indicators. (23) "Continuum of Services" Recovery- oriented systems of care will offer a full array of services, including pretreatment, treatment, continuing care and support throughout recovery. Individuals will have a full range of stage- appropriate services from which to choose at any point in the recovery process. South Florida Behavioral Health Network, Inc. 11 KH225 10/01/2010 Managing Entity (24) "Contract Manager" means the department employee who is responsible for enforcing the compliance with administrative and programmatic terms and conditions of a contract. The contract manager is the primary point of contact through which all contracting information flows between the department and the provider. All actions related to the contract shall be initiated by or coordinated with the contract manager. (25) "Co- occurring Disorder" means any combination of mental health and substance abuse in any individual, whether or not they have been already diagnosed. Families impacted by co- occurring disorders are characterized by a family where one member has one kind of problem, like a child with an emotional disturbance, and another member has another kind of problem, like a family member or caregiver with a substance abuse issue. (26) "Co- occurring Disorder Service Capability" means the ability of any program to coordinate every aspect of its program infrastructure (policies, procedures, practices, documentation, and /or staff competencies), within its existing resources, to be able to provide and /or coordinate appropriately matched, integrated services to the individuals and families with co- occurring disorders that are routinely presenting for care in that program. (27) "Cost Analysis" means the review of the proposed cost elements to determine if they are necessary, allowable, appropriate and reasonable. (28) "Cost Center" means a grouping of services that is similar in time, intensity and function where the average cost for service is generally the same, and are specified in the State Funding by Program and Activity which is incorporated herein by reference. See Rule 65E- 14.021(7), Florida Administrative Code (F.A.C.), and the Substance Abuse Recovery Support Services (Individual and Group), Comprehensive Community Service Teams, and Clinical Supervision for Evidence -Based Practices (which are incorporated herein by reference) for a complete listing of services that comprise the cost centers. The Children's Mental Health Comprehensive Community Service Team (CCST) cost center is described in Exhibit H, Children's Mental Health Community Service Team. (29) "Data Management" means activities that use data elements to track cost, utilization, quality of care and access to services within the network of providers. "CFP 155 -2 Department of Children & Families, Pamphlet 155 -2 - Mental Health and Substance Abuse Measurement and Data, effective September 2008 (9th edition, version 1) ", or the latest revised edition thereof means a document promulgated by the department that contains required data - reporting elements for substance abuse and mental health services, hereafter referred to as "CFP 155 -2 ", and which can be found at: South Florida Behavioral Health Network, Inc. 12 KH225 10/01/2010 Managing Entity http: / /www.dcf. state. fl. us /mentalhealth /publications /index.shtml, and is incorporated herein by reference. (30) "Epidemiology data" means data relating to factors affecting the health and illness of populations that serve as the foundation and logic of interventions made in the interest of public health. (31) "Evidence -Based Practices" means those practices that are based on accepted practices in the profession and are supported by research, field recognition, or published practice guidelines. (32) "Family Intervention Specialists /Adult Intervention Specialists (FIS)" means individuals employed to provide adult behavioral health outreach, screening, intervention, and case management to families involved in the child welfare system and /or the Abuse Hotline. (33) "Family Intervention Specialist Services" means services designed to reduce the incidence of child abuse and neglect resulting from parents' or caregivers' behavioral health and to improve outcomes for families in the child welfare system and /or community based care. (34) "Florida Department of Children and Families Strategic Intent" means the Secretary's Strategic Intent gives guidance and summarizes the department's major initiatives. This document provides the Secretary's intent on what the department and its partners must accomplish during a specific period of time. The Secretary's guidance drives the development of the department's Strategic Plan, which depicts how the department will achieve these initiatives, when they will be accomplished and the metrics used to measure progress. (35) "Forensic Mental Health Services" means Forensic Mental Health Services provide services to individuals with mental illness pursuant to Chapter 916, Florida Statutes. (36) "Global Assessment of Individual Needs (GAIN)" means one of the department approved evidenced -based assessment instrument. Information regarding this instrument can be obtained from the following website: http: / /www.chestnut.orq /LI /gain/ (37) "Governing Board" means the Commission, Board of Directors, Board of Trustees, Governing Body, etc. (38) "HIPAA" is the acronym for Health Insurance Portability and Accountability Act. (39) "Incompetent to Proceed (ITP)" as defined in chapter 916 F.S., means unable to proceed at any material stage of a criminal South Florida Behavioral Health Network, Inc. 13 KH225 10/01/2010 Managing Entity proceeding, which shall include trial of the case, pretrial hearings involving questions of fact on which the defendant might be expected to testify, entry of a plea, proceedings for violation of probation or violation of community control, sentencing, and hearings on issues regarding a defendant's failure to comply with court orders or conditions or other matters in which the mental competence of the defendant is necessary for a just resolution of the issues being considered. (40) "Indigent Drug Program (IDP)" means the program that allows the Department of Children and Families to purchase medications for individuals who are indigent. (41) "Individual(s)Served" is (synonymous with recipients, individual(s), and persons who are receiving services, also synonymous with client/consumer) — Any individual who is receiving services in any substance abuse treatment or prevention program or mental health treatment program whose cost of care is paid, in part or in whole, by the department, Medicaid, Medicaid capitated managed care entities, or local match. (42) "Juvenile Incompetent to Proceed (JITP)" means a "child" or "juvenile" or "youth" as defined in chapter 985, F.S., as any unmarried person under the age of 18 who has not been emancipated by order of the court and who has been found or alleged to be dependent, in need of services, or from a family in need of services; or any married or unmarried person who is charged with a violation of law occurring prior to the time that person reached the age of 18 years. (43) "KIT Solutions" means the entity that maintains the database called Performance Based Prevention System (PBPS). (44) "Local Match" means funds received from governing bodies of local government, including city commissions, county commissions, district school boards, special tax districts, private hospital funds, private gifts both individual and corporate, bequests and funds received from community drives or any other sources. See section 394.67(14), F.S. and 65E- 14.005, F.A.C. (45) "Managing Entity (ME)" means pursuant to section 394.9082(2)(d), F.S., a corporation that is organized in the State of Florida, is designated or filed as a non - profit organization under section 501(c)(3) of the Internal Revenue Code, and is under contract to the department to manage the day -to -day operational delivery of behavioral health services through an organized system of care. (46) "Monitoring Subcontracts" is the process whereby the managing entity conducts a systematic organized review of a network provider's performance in order to give reasonable assurance that the network South Florida Behavioral Health Network, Inc. 14 KH225 10/01/2010 Managing Entity provider is complying with subcontract requirements, rules, regulations and laws applicable to contract performance. (47) "Overpayment" means for the purposes of this contract, the amount of money the department has paid the managing entity for administrative expenses and /or program expense over and above what was properly earned for these expenses by the managing entity according to the approved line item budget. (48) "Participant" means any individual who takes part in targeted substance abuse prevention programs, activities or services which are paid, in part or in whole, by the department. (49) "Payor class" means Medicare, Medicare HMO, Medicaid, Medicaid HMO, private -pay health insurance, private -pay health maintenance organization, private preferred provider organization, the Department of Children and Family Services, other government programs, self -pay patients, and charity care. (50) "PBPS" means the Performance Based Prevention System that collects data related to Substance Abuse Prevention programs and activities. The system can be accessed by contacting technical support at 1- 888 - 600 -4777 or https : / /kitprevention.kithost.net/. (51) "Performance Measures" means quantitative indicators, outcomes and outputs that are used by the department to objectively measure performance and are used by the managing entity and network providers to improve services. (52) "Prevalence" means the count of all individuals affected by a disease /condition within a particular period of time, compared with the entire population of concern. (53) "Prevention" means a process involving strategies aimed at the individual or the environment which preclude, forestall, or impede the development of substance abuse problems and promote healthy development of individuals, families and communities. (54) "Prevention Program Description (PPD)" means the report generated by the PPT that contains the information required for a program description pursuant to Rule 65E- 14.021, Florida Administrative Code (F.A.C.). (55) "Program Planning Tool (PPT)" means the data collection module contained in the Performance Based Prevention System that collects a variety of program information. It is designed to assure substance abuse prevention contracts reflect best practices and level of effort, inform the department's provider support system, and set the stage for determining effectiveness in achieving prevention outcomes. South Florida Behavioral Health Network, Inc. 15 KH225 10/01/2010 Managing Entity (56) "Program" means a structured Schedule of Activities designed so that participants will attain so far as possible, certain educational, attitudinal, social and behavioral objectives. This is an unduplicated count of participants. (57) "Program Description" means the document the provider prepares and submits to the department for approval prior to the start of the contract period, which provides a detailed description of the services to be provided under the contract pursuant to Rule 65E- 14.021, F.A.C. It includes but is not limited to the provider's organizational profile, a detailed description of each program and cost center funded in the contract, the geographic service area, service capacity, staffing information, and client and target population to be served. (58) "Projects for Assistance in Transition from Homelessness (PATH)" means the Federal grant to support homeless individuals with behavioral health needs. (59) Promising Practices" means the use of practices that incorporate the best objective information available regarding effectiveness and acceptability. (60) "Prorated Share" means the total number of unpaid units or funds divided by the number of months remaining between the time the prorated share is calculated and the end date of the contract. (61) "Protected Health Information" (PHI) means any information whether oral or recorded in any form or medium that is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual. (62) "Provider Network" (subcontractor or network provider) means the direct service agencies that are under contract with a managing entity and that together constitute a comprehensive array of emergency, acute care, residential, outpatient, recovery support, and consumer support services or other services as designated by this contract. See section 394.9082, F.S. (63) "Quality Improvement/Continuous Quality Improvement" means a management technique to assess and improve internal operations and network services. It focuses on organizational systems rather than individual performance and seeks to continuously improve quality. The process involves setting goals implementing systematic changes, measuring outcomes, and making subsequent appropriate South Florida Behavioral Health Network, Inc. 16 KH225 10/01/2010 Managing Entity improvements. Quality improvement activities will assess compliance with contract requirements, state and Federal law and associated administrative rules, regulations, and operating procedures and validate quality improvement systems and findings. (64) "Readiness Assessment" means a formalized process to determine the operational capacity of a managing entity to satisfactorily perform required duties. (65) "Recovery" means an on -going process which enables a person with behavioral health issues to live a meaningful life in a community of his or her choice while striving to achieve his or her potential. This allows individuals to improve their health, wellness, and quality of life. (66) "Recovery Based" is based upon a personal process of overcoming the negative impact of substance abuse addiction or mental illness. A system of care provides treatment and supports that promote recovery and functioning in the community. (67) Representative Payee" means an entity /individual who is legally authorized to receive Supplemental Security Income, Social Security Income, Veterans Administration benefits, or other federal benefits on behalf of an individual served. (68) "SAMH" means the Substance Abuse and Mental Health Programs within the department. (69) "Schedule of Activities" means the defined instructional content, materials, resources, and processes in order to attain educational objectives. (70) "Service Units" means those units of measure specified in Rule 65E- 14.021(7), F.A.C. and in Substance Abuse Recovery Support Services, Comprehensive Community Service Teams, and Clinical Supervision for Evidence Based Practices. (71) "SOAR" stands for "SSI /SSDI Outreach, Access and Recovery" and is a technical assistance initiative. This strategy helps States and communities increase access to SSI and SSDI for people through training, technical assistance and strategic planning. (72) "Stakeholder" means individuals /groups with an interest in the provision of behavioral health services. (73) "Statewide Inpatient Psychiatric Programs (SIPP)" means residential inpatient facilities under contract with the Agency for Health Care Administration under the Medicaid IMD waiver for children under age 18 to provide diagnostic and active treatment services in a secure setting. South Florida Behavioral Health Network, Inc. 17 KH225 10/01/2010 Managing Entity (74) "Substance Abuse and Mental Health Information System (SAMHIS)" means the department's online data system which providers are required to use to collect and report data and performance outcomes on persons served whose services are paid for, in part or in whole, by the department's Substance Abuse and Mental Health (SAMH) contract, Medicaid, or local match. Instructions on how to access the system can be found in CFP 155 -2. (75) "System of Care" means behavioral health services that are coordinated and developed into an integrated network of services accessible and responsive to the needs of individuals served, their families, and community stakeholders. (76) "TANF Participant" means a person or family member of that person defined in 45 CFR Part 260.30 and section 414.1585 and subsection 414.0252(9), F.S. (77) "Targeted Prevention" means prevention programs or other Schedule of Activities conducted with individuals or groups of individuals to educate them on personal prevention concepts and skills and consists of prevention programs or curricula. (78) "Temporary Assistance to Needy Families (TANF)" means cash assistance for families, including any family receiving cash assistance payments or TANF diversion services from the state program pursuant to the provisions of section 414.045, F.S., and Part A of Title IV of the Social Security Act. (79) "Transformation" means a process that strives to change the form and function of the behavioral health services delivery system to better meet the needs of the individuals and families it is designed to serve. (80) "Utilization Management" means a system to ensure maximum, cost - effective, and clinically appropriate utilization of behavioral health services. The goal of the program is to eliminate waitlists and maximize utilization as well as diverting individuals served to more clinically appropriate services when applicable. 2. General Description a. General Statement This contract is for the purchase of the administration, management, and oversight of a consumer - centered and family- focused comprehensive coordinated system of care by a managing entity. The contract requires the managing entity to subcontract with qualified, direct service, community -based network providers who will provide services for adults and children with behavioral health issues as authorized in section 394.9082, F.S. and which are consistent with the Approved Regional Plan. South Florida Behavioral Health Network, Inc. 18 KH225 10/01/2010 Managing Entity The managing entity will provide administrative and programmatic oversight to ensure that network providers comply with all consumer - related services and other requirements of this contract. b. Approved Annual Action Plan The managing entity will develop and operationalize an annual action plan in partnership with the department, which is incorporated herein by reference. This action plan will be approved by the department on an annual basis and may be modified by mutual agreement and approved /dated by the managing entity Executive Director and the approved department Representative i.e., the Southern Region SAMH Program Supervisor. A copy of any revisions to the approved annual action plan shall be provided to the department's contract manager. c. Baseline Functions There are ten (10) baseline functions that the Managing Entity must provide. Performance on these functions will be provided in the Approved Annual Action Plan. The deliverables are outlined in the Annual Action Plan. These functions are as follows: (1) Function 1. System of Care Development and Management Behavioral health services that are coordinated and developed into an integrated network of services accessible and responsive to individuals in need of substance abuse and mental health services, families, and community stakeholders. To accomplish this, managing entities support the application of evidence based practices through contracting requirements, program development and design, training, quality improvement activities, and the development of mechanisms for care management and service coordination. (2) Function 2. Utilization Management Systems to ensure cost - effective and clinically appropriate utilization of treatment services. For the purposes of this contract, the specific goals of utilization management include the elimination /management of wait lists, the maximum utilization of treatment resources, and the delivery of clinically appropriate services. Utilization management systems will include preauthorization for some services as well as retrospective reviews and focused reviews of individuals receiving services and subcontractors whose utilization of services is outside of expected parameters. Utilization management includes methods used to manage the system of care to ensure access to the appropriate level of care. These methods may include programs of intervention and /or diversion. Utilization management includes not only managerial and supervisory strategies, methods and tools to ensure timely access to care, but also includes processes to promote continuous improvement to manage resources. The managing entity will develop an automated utilization management system that includes treatment authorization and management reports for the system of care as outlined in the approved annual action plan. South Florida Behavioral Health Network, Inc. 19 KH225 10/01/2010 Managing Entity (3) Function 3. Network/Subcontract Management The process whereby the managing entity conducts a systematic organized review of a subcontractor's operations and service provision in order to give reasonable assurance that the subcontractor is complying with subcontract requirements, rules, regulations and laws applicable to the subcontractor's contract performance. For the purposes of this contract network management includes processes by which accountability for performance and quality of services from subcontractors will be ensured. (4) Function 4. Quality Improvement A series of management techniques and processes used to assess and improve internal managing entity operations and network services. Quality improvement focuses on organizational systems of network members' performance and seeks to continuously improve quality of services provided. The managing entity will establish a clearly delineated quality improvement program that provides for the meaningful involvement of managing entity staff members, subcontractor organizations, and individuals served and other stakeholders. (5) Function 5. Technical Assistance/Training The managing entity will provide technical assistance and training in two broad areas. First, they will provide training and technical assistance to help subcontractors perform network- functions, such as invoice submission and participation in network quality improvement activities. The second area is training and technical assistance to help subcontractors implement quality of care including the implementation of evidence -based practices, such as the application of process improvement methods to improve coordination and access, the use of evidence -based treatment protocols, and providing services that are culturally and linguistically appropriate. The managing entity will provide the technical assistance and training directly or arrange for the provision of technical assistance or training in the most fiscally responsible manner. (6) Function 6. Data Collection, Reporting, and Analysis The managing entity will manage activities that use data elements to track cost, utilization, quality of care, access to services, and individuals served outcomes within the network of subcontractors. The managing entity will describe the implementation of the electronic health records (EHR) for the subcontractors in the approved annual action plan. (7) Function 7. Financial Management Financial management activities include the following elements: (a) Negotiating and developing administrative costs and service rates within the parameters established by the department; (b) Developing contracts that allocate funds according to department utilization targets and reallocating funds according to shifts in utilization patterns, all funds are allocated in accordance with the approved operating South Florida Behavioral Health Network, Inc. 20 KH225 10/01/2010 Managing Entity budget and approved annual action plan, incorporated herein by reference. Paying invoices in a timely manner and verifying the accuracy of the invoices submitted by subcontractors. The managing entity will pay subcontractors within 15 working days of receiving a valid invoice, based upon or subject to the availability of funds. (c) Managing contracted funds according to State and Federal requirements; (d) Complying with Local Match requirements. (e) Securing, managing and leveraging other sources of funding. Resource maximization to include pursuit of third party payments prior to the billing of SAMH funding; (f) The managing entity will pursue additional sources of revenue particularly grant applications in accordance with the approved annual action plan; (g) Achieving efficiencies by consolidating subcontractor operational functions; (h) Reinvesting efficiencies into the system of care or infrastructure development designed to continuously improve the quality of services and maximize capacity in partnership with department staff; and (i) Redirecting service dollars from restrictive care settings (as defined in the approved annual action plan) to community -based recovery services. (8) Function 8. Planning The managing entity will be the source of performance, utilization, and other network information used by the department in formulating its plans, including the Annual Action Plan. The managing entity's approved annual action plan, subject to the approval of the department, is the vehicle for identifying the network's goals, objectives, and improvements. The managing entity will participate in departmental planning processes at the State, regional, and circuit levels as appropriate. (9) Function 9. Board Development and Governance The managing entity will maintain a governing body that is representative of the community and that includes individuals served and family members, relevant community stakeholders and organizations, and subcontractors of behavioral health services. (10) Function 10. Disaster Planning and Responsiveness Includes working collaboratively with the department and taking direction from department staff for any disaster - related preparedness, response activities, and the Regional Disaster Plans and /or as specified in the approved annual action plan. South Florida Behavioral Health Network, Inc. 21 KH225 10/01/2010 Managing Entity d. Minimum Programmatic Requirements The managing entity, either individually or through the management and oversight of services provided by subcontractors, shall maintain the following minimum programmatic requirements: (1) System Of Care The consumer - centered and family- focused comprehensive coordinated system of care will: (a) Be driven by the needs and choices of the customers; (b) Promote family and personal self- determination and choice; (c) 'Be ethically, socially, and culturally responsible; and (d) Be dedicated to excellence and quality results. There is a commitment to expand clinical treatment to include the Behavioral Health Transformation Initiative, evidence -based practices and recovery support services for the full continuum of care based on priorities established by the department for substance abuse, mental health treatment and /or co- occurring disorders, substance abuse and mental health treatment capacity, children and families, criminal and juvenile justice, HIV and hepatitis. (2) Guiding Principles Guiding principles specify that services are as follows: (a) Inclusive - involve and engage families and consumers as full partners to participate in the planning and delivery of services; (b) Comprehensive - incorporating a broad array of service and supports (e.g. physical, emotional, clinical, social, educational and spiritual); (c) Individualized - meeting the individual's exceptional needs and strengths; (d) Community -based - provided in the least restrictive, clinically appropriate setting; and (e) Coordinated - both at the system and service delivery levels to ensure that multiple services are provided and change as seamlessly as possible when warranted. (f)Cultural and linguistic competence. South Florida Behavioral Health Network, Inc. 22 KH225 10/01/2010 Managing Entity e. Programmatic Authority Sections 20.19, 39.001(2), 39.001(4), 394.457(3), 394.74, 394.9082, 397.305(2) and 397.321(5), 916, F.S, provide the department with the authority to contract for these services. f. Scope Of Service The following scope of service applies to each fiscal year of this five (5) year contract and any renewal or extension: The managing entity is responsible for the administration, management, and oversight, and through sub - contracts, the provision of behavioral health services in Miami -Dade and Monroe counties as stipulated in this contract. Prevention services designed to preclude the development and /or exacerbation of substance abuse problems and mental health disorders by addressing risk factors with children and families and in the community at large are a part of the behavioral health services. g. Major Program Goals (1) The primary goal of the Substance Abuse and Mental Health Programs is to reduce or prevent substance abuse and promote and improve the mental health of the citizens of the state by making behavioral health services available through a community -based system of care. (2) It is the goal of the managing entity to improve accountability, ensure quality of care through best practice models and seek to ensure delivery of Behavioral Health Services across the provider network and across systems resulting in systematic access to a full continuum of care for all children, adolescents and adults who enter the publicly- funded behavioral health services systems. (3) Construct a system of care design that will facilitate and improve co- occurring capability and expertise in all programs and for all service network providers. (4) Promote and improve the behavioral health of Florida's Southern Region communities by strategically applying substance prevention programs, activities and services available as part of the community -based system action plan. 3. Clients to be Served a. Client General Description South Florida Behavioral Health Network, Inc. 23 KH225 10/01/2010 Managing Entity Pursuant to section 394.9082(7)(b), F.S., the managing entity shall ensure that services funded by the contract are furnished to eligible adults and children with or at risk of developing behavioral health disorders . ® Adult Mental Health — Forensic Involvement ® Adult Mental Health — Severe and Persistent Mental Illness ® Adult Mental Health — Serious and Acute Episodes of Mental Illness ® Adult Mental Health — Mental Health Problems ® Children's Mental Health — Seriously Emotionally Disturbed ® Children's Mental Health — Emotionally Disturbed ® Children's Mental Health — At Risk of Emotional Disturbance ® Adults with Substance Abuse Problems ® Children with Substance Abuse Problems ® Adults at Risk of Substance Abuse Problems ® Children at Risk of Substance Abuse Problems b. Client Eligibility (1) The managing entity shall ensure that all persons meeting the target population descriptions in paragraph A.3.a. above, and as described in CFP 155 -2, receive services through its subcontractors based on the availability of resources. However, department funding shall be targeted for the medically indigent. A detailed description of each target population is contained in CFP 155 -2. (2) The managing entity shall ensure that substance abuse detoxification and addiction receiving facility services are provided to all persons meeting the criteria for admission, subject to the availability of funds. (3) Mental Health Crisis: The managing entity shall ensure that all crisis services are provided for both children and adults meeting criteria pursuant to chapter 394, F.S.; Rule 65E -5, F.A.C.; and Rule 65E -12, F.A.C. This includes but is not limited to, mobile crisis services and inpatient hospitalization at receiving facilities and crisis stabilization units. c. Client Determination The department is exclusively responsible for defining client eligibility for services provided through this contract. The managing entity shall apply this definition to persons on a case -by -case basis, and the managing entity may delegate the client eligibility determinations to the network providers. The department reserves the right to make final determinations of client eligibility. If the managing entity disputes the department's determination regarding eligibility of a client, dispute resolution, as described on in Section D.2. shall be implemented. Services shall be provided to the client unless and until the dispute resolution process reverses the department's determination. South Florida Behavioral Health Network, Inc. 24 KH225 10/01/2010 Managing Entity The managing entity shall work with the Southern Region to coordinate admissions and discharges from state forensic hospitals and residential treatment centers. d. Client Contract Limits (1) The managing entity is not authorized to receive funding from the department for more dollars than are allocated. (2) The managing entity shall ensure that funds provided in this contract will not be used to serve persons outside the target population(s) specified in Section A.3.a. and A.3.b. above. (3) Services provided under this contract are limited by the availability of funds, with the exception of Section A.3.b(3) above. The managing entity may not authorize or incur indebtedness on behalf of the department. B. MANNER OF SERVICE PROVISION 1. Service Tasks a. Task List The following tasks shall be completed for each fiscal year of the contract unless otherwise noted: (1) Develop, Maintain, and Improve the Provider Network The managing entity shall develop and maintain a network of qualified, direct service, community -based providers to provide services for adults and children with behavioral health and /or co- occurring disorders as authorized in section 394.9082, F.S. This network shall deliver all services in accordance with the Consolidated Program Description on file in the department contract manager's file. The managing entity shall continue to assess the adequacy of the network and modify the network as indicated by department plans and requirements, consumer and stakeholder needs and preferences, data analysis and best practice findings scientific findings, and improvement opportunities identified in the managing entity approved annual action plan based upon the most current Florida Department of Children and Families Strategic Intent 2008 -2010, or the latest revision thereof, and through quality management processes. The exact array of services, the required features of particular services, priorities for service development and improvement, and service coordination efforts are made at the Regional level within the broader framework of Department of Children and Families (DCF) priorities and policies. Each year, the department, with the assistance of the local regional planning councils, will identify the service requirements that the managing entity will address in its approved annual action plan. The managing entity will develop the network according to the general values and features described in this contract and the specific dimensions that follow: South Florida Behavioral Health Network, Inc. 25 KH225 10/01/2010 Managing Entity (a) Ensure Timely Access to Care for Services The standards for timely access to care are along the lines of those required by managing entity accrediting bodies and the Medicaid prepaid plans: (i) Immediate /Crisis: seen immediately for life behavioral health life threatening emergencies (ii) Within 24 hours of initial contact for non -life threatening emergencies; (iii) Within 48 hours for urgent care; (iv) The offer of an appointment for routine care within 7 business days. The managing entity shall monitor compliance with the timely access standard, and if a pattern of noncompliance develops with any network provider, the managing entity will take corrective action and monitor the results of corrective action. Please refer to approved annual action plan for deliverables. (b) Ensure Geographic Access to Services Aspects of geographic access include drive times, the location of services on public transportation routes, and proximity to other services and locations often used by members of the covered population. Standards for acceptable geographic access are: (i) Thirty (30) mile drive for outpatient services in Miami -Dade County and fifty (50) mile drive within Monroe County; (ii) Sixty (60) mile drive for inpatient and residential services in Miami- Dade County and one hundred twenty (120) mile drive for Monroe County; (iii) Services located on available public transportation routes where public transportation is available. As with the timeliness standards, these standards define acceptable performance that when not achieved trigger corrective action, consistent with the approved annual action plan. (c) Promote Family and Personal Self Determination The managing entity will promote personal self- determination and choice by: (I) Providing oversight so that the needs and preferences of consumers and their families drive treatment planning and service delivery, and South Florida Behavioral Health Network, Inc. 26 KH225 10/01/2010 Managing Entity that consumers and their families (with consent) are involved in all aspects of treatment (pre, during and post); (ii) Engaging service recipients, family members, and advocates in the design, development, and evaluation of services; (iii) Giving consumers a choice of provider and services, whenever possible; (iv) Assessing and improving consumer satisfaction. (d) Develop and Assure the Delivery of Services Based on Evidence - Based Practices /Promising Practices Guidelines The managing entity shall identify specific services provided by the network and service features in the managing entity's department- approved annual action plan. These include such service features as evidence -based practices (EBPs) and promising practice guidelines, as specified in the approved annual action plan, endorsed by expert panels. The managing entity shall assure that the service requirements are identified in subcontracts and that the services are provided according to service guidelines (see Section B.a(2)). (e) Ensure Access to Services that Meet Linguistic and Cultural Needs of Recipients The managing entity shall assure that the network provides sign language, translation, and interpretive services required to meet the communication needs of service recipients, including English, Spanish and Creole. Services will meet the cultural needs and preferences of the covered populations. The managing entity shall identify, through the approved annual action plan, specific service characteristics that will include features designed to meet the needs and preferences of cultural groups. In addition, the managing entity will address in its approved annual action plan, improving the ability of the network to provide services that meet the cultural needs, languages and preferences of the covered populations. The managing entity shall provide processes so that the contracted network providers engage in recruitment to maintain as much as possible staff with the ethnic and racial composition of the clients served. (f) Facilitate National Accreditation of Network Providers The department intends that most of the services it purchases through managing entities be delivered by nationally accredited provider organizations. To that end, the managing entity will subcontract with organizations that are accredited, or working towards accreditation, in order to promote best practices and the highest quality of care, as specified in the approved annual action plan. However, national accreditation might not be South Florida Behavioral Health Network, Inc. 27 KH225 10/01/2010 Managing Entity realistic or useful for some smaller niche providers of such important services as recovery support services, and consumer operated services. Consequently, the department may grant exceptions to the requirement for accreditation on a case -by -case basis. (g) Coordinate Services for Persons with Co occurring Disorders The managing entity shall develop and operate a system of care to ensure the provision of appropriate services in the least restrictive setting for adults and children with substance abuse, mental health and /or co- occurring disorders. Those services are needed in order to provide a seamless Comprehensive Continuous Integrated System of Care (CCISC) for this population that will increase access to services and improve outcomes in the most cost effective manner. The managing entity shall implement a "no wrong door" model by developing a process for assessing and referring clients with co- occurring disorders to increase access of persons identified as co- occurring to provide services for both disorders regardless of the initial point of contact. As used in conjunction with the CCISC model, "no wrong door" (See http : / /www.kenminkoff.com /ccisc.html ) requires that systems develop policies and procedures that mandate a welcoming approach to individuals with co- occurring psychiatric and substance disorders in all system programs, eliminate arbitrary barriers to initial evaluation and engagement, and specify mechanisms for helping each client (regardless of presentation and motivation) to get connected to a suitable program as quickly as possible. The managing entity must collect and review Required Reports as identified in Exhibit G and as identified in the Annual Action Plan submit these reports to the department's contract manager and the SAMH Program Office in Tallahassee. (h) Ensure Provision of Services to Clients with Special Needs The managing entity shall ensure the coordination of specialty services including employability skills training and linkage, victimization and trauma services, infant mental health services, the elderly, and services to families in recovery. The managing entity shall also ensure the availability of appropriate services to consumers with special needs such as those who are blind, deaf or hard of hearing, developmentally disabled, physically handicap, criminally involved, or forensic clients. The department reserves the right to modify this list as the needs of the consumers change. (i) Providing early diagnosis and treatment intervention to enhance recovery and prevent hospitalization (ii) Promote specialized behavioral health services to residents of assisted living facilities. (iii) The managing entity shall work with the state and other stakeholders to reduce the admissions and the length of stay for dependent South Florida Behavioral Health Network, Inc. 28 KH225 10/01/2010 Managing Entity children and adults with mental illness in residential treatment services. (2) Develop, Maintain, and Improve Contract Management and Provider Relations The managing entity will rely on national accreditation and State licensing to deal with the network providers' compliance with the rules and regulations covered by accreditation and licensing requirements. The managing entity will focus its contract management and oversight activities on the contract requirements. Network providers will be required to provide the managing entity with their full accreditation and licensing reports upon request. (a) Establish Contract Management Procedures The managing entity shall develop and implement procedures for subcontract procurement, development, performance, and management that meet contract management and provider relations requirements and establish a process to regularly update contract procedure directives as specified in the in the approved annual action plan. The managing entity shall submit a copy of the procedures and any updates to the department's contract manager for department approval. (b) Establish a Process for Approving Subcontracted Organizations and Terminating Contracts The managing entity's formal processes for approving subcontracting organizations and terminating contracts shall include: (i) Responding to provider organization inquiries (ii) Formal applications, reviews, and approvals as well as onsite visits, primary verifications of licensing and accreditation status, receipt of liability insurance documents, and, for non - accredited providers, verifications that the organization's credentialing process meet the requirements outlined in this task list (iii) A grievance or appeal procedure to the managing entity's governing body or highest ranking local officer for adverse decisions (iv) Contract termination The managing entity shall not terminate a subcontract agreement between a network provider and the managing entity without prior written approval from the department. To the extent possible, the managing entity will confer with the department regarding any potential termination of contracts as soon as identified. The managing entity shall submit to the department's Contract Manager, a written request for approval at least 15 fifteen days prior to the South Florida Behavioral Health Network, Inc. 29 KH225 10/01/2010 Managing Entity intended notification of the network provider of termination of a subcontract between a network provider and the managing entity. This request for approval shall include evidence of due diligence on the part of the managing entity to address the performance deficiencies of the network provider, including, but not limited to, provision of technical assistance and the implementation of Corrective Action Plans. (v) The specific make -up of the network, including the organizations identified to provide services, is subject to the prior written approval of the department. (c) Develop Terms of Subcontracts with Subcontracted Organizations The managing entity shall enter into subcontract agreements with network providers for the provision of substance abuse, mental health and /or co- occurring, and prevention services which adopt the applicable terms of the managing entity's contract KH225 with the department and abide by all terms of the department's standard contract. The managing entity will develop contracts with subcontracted organizations that include: (i) A Detailed Scope of Work with Clear and Specific Deliverables [a] Service delivery requirements, features, and improvements as specified in the Consolidated Program Description and approved annual action plan, including the staffing levels and qualifications needed for particular services [b] Access to care, coordination of care, and service integration requirements [c] Requirements for the involvement of consumers and other stakeholders [d] Recipient eligibility requirements [e] Client rights and grievance procedures [f] Performance outcomes and outputs (ii) Performance Standards and Administrative Requirements [a] Detailed documentation requirements [b] Requirements that subcontractors meet Substance Abuse Prevention and Treatment Block Grant (SAPTBG) and Community Mental Health Services Block Grant (CMHSBG) requirements applicable to their organizations and services along with a listing of these requirements South Florida Behavioral Health Network, Inc. 30 KH225 10/01/2010 Managing Entity [c] Reporting, service, and administrative requirements from the department, federal block grants and other funding streams [d] Liability insurance requirements [e] Accreditation and licensing requirements, and, for non - accredited providers, the additional credentialing requirements presented in this task list. Also, a requirement that subcontracted providers provide the managing entity with their full accreditation and licensing reports upon request [f] Agreements to participate in network training events [g] Agreements to follow the procedures outlined in the network's provider manual, as specified in the approved annual action plan, or similar document which outlines network procedures and policies [h] Requirements for security agreements (incorporated herein by reference) [i] Requirements for emergency plans (iii) Monitoring and Sanctions for Non - Performance [a] Programmatic and fiscal monitoring requirements, including requirements to allow the department to review client, programmatic, and fiscal records [b] Sanctions for non - performance and processes for problem correction [c] Agreement to participate in managing entity and the department quality assurance and quality management activities, including peer reviews, critical incident reporting, and evaluations, including reviews of client and administrative records, and to comply with contract management requirements [d] The process for contract termination, including the transfer or continued treatment of recipients (iv) Fiscal Requirements [a] Funding activity levels and rates for each cost center will be negotiated in accordance with rule and statute. [b] Sliding fee scale amounts and procedures South Florida Behavioral Health Network, Inc. 31 KH225 10/01/2010 Managing Entity [c] Financial management, billing and invoice verification requirements [d] Innovations leading to the reduction of administrative costs as specified in the approved annual action plan (d) Conduct Contract Monitoring The managing entity shall monitor the performance of all subcontractors and perform follow up actions as necessary. The managing entity shall notify the department verbally within 24 hours and in writing within 48 hours of conditions related to subcontractor performance that could impair continued service delivery and /or include a health and safety violation. The managing entity shall monitor subcontracts, according to the departments operating procedure 75 -8, Contract Monitoring, using a systematic review of the subcontracted organization's compliance with their subcontract requirements. Contract monitoring may include desk audits and onsite reviews. Onsite reviews will occur at least annually, for high risk network providers, with more frequent visits triggered by patterns of compliance problems. Within 30 days of contract execution, and by July 30 of each subsequent fiscal year of the contract, the managing entity shall develop and distribute a monitoring schedule to network providers. The managing entity shall submit a copy of the monitoring schedule and any revisions to the monitoring schedule to the department's contract manager and to the SAMH Program Office. The managing entity shall submit copies of the monitoring reports, including any requests for corrective action plans, to the contract manager within 30 calendar days of the completed contract monitoring exit conference with the network provider. Copies of corrective action plans received from subcontractors shall be forwarded to the contract manager and to the SAMH Program Office within 30 days of receipt. While contract monitoring addresses compliance with all requirements, the managing entity's reviews shall focus on the subcontracted providers' compliance with section B.1.a(2)(c) above particularly: (i) Federal Substance Abuse Prevention and Treatment Block Grant requirements or Community Mental Health Block Grants. (ii) Primary source verification that the subcontracted organization is maintaining their licenses and national accreditation. (The managing entity shall submit to the department's contract manager (6) six -month reports containing each of the network providers name and expiration date of their license and accreditation.); (iii) Performance outcomes; (iv) Service delivery requirements; South Florida Behavioral Health Network, Inc. 32 KH225 10/01/2010 Managing Entity (v) Access to care, coordination of care, and service integration requirements; (vi) Invoice verification and financial management; (vii) Recipient eligibility. (e) Establish Fiscal Operations and the Invoice Payment Process (i) Develop and implement fiscal operational procedures as specified in the approved annual action plan. These procedures shall contain, but not be limited to, procedures relating to overpayments, charge -backs that directly apply to subcontractors and documentation of cost sharing (match) that comply with state and federal regulations, and invoice review procedures. The managing entity shall submit a copy of the procedures to the department's contract manager. (ii) Prior to entering into any subcontract, or an amendment which modifies the negotiated unit cost rate or adds additional cost centers, the managing entity shall conduct a cost analysis for said subcontract, in accordance with Rule 65E- 14.021. These analyses may be based on projections for new or significantly modified services and on retrospective cost studies for current services. All requests to the department by the managing entity for approval of subcontracts must include evidence of cost analysis. (iii) Establish quantifiable units of deliverables that must be received and accepted in writing by the managing entity before payment. Each deliverable must be directly related to the scope of work and must specify the required minimum level of service to be performed and the criteria for evaluating the successful completion of each deliverable. (iv) Verify client eligibility and avoid payment for those not included in the service population. (v) Reimburse network providers within 15 working days of receiving a valid invoice based upon or subject to the availability of funds. (vi) Enforce requirements for sliding fee scales. (vii) Manage flexible funding administration, such as capitation and case rates, as may be specified in the Annual Action Plan. (viii) Monitor expenditures by subcontracted organization, service level, and funding source. South Florida Behavioral Health Network, Inc. 33 KH225 10/01/2010 Managing Entity (ix) Reallocate funds (with prior department approval) to respond to utilization trends and needs throughout the contract year. (x) Assure the fiscal integrity of all funds under this contract, and for demonstrating that a comprehensive audit and tracking system exists to account for funding by client, by region, by network provider. (f) Develop and Distribute a Provider Manual Outlining Processes for Network Participation The managing entity shall develop a provider manual that summarizes network procedures for subcontracted provider organizations and provide a copy of this manual to the department as specified in the approved annual action plan. managing entity will be responsible for keeping the manual up to date and informing the subcontracted providers of changes. (g) Identify a Subcontractor Provider Liaison The designated contract manager for the managing entity will serve as point of contact between the managing entity and subcontractor. (h) Provide Technical Assistance The managing entity will provide technical assistance to help subcontractors meet the reporting and other contract requirements for participating as a network provider. (i) Maintain Subcontractor Records and Reports The managing entity shall provide copies of all subcontracts and any amendments to the subcontracts to the department's contract manager within ten (10) days of execution of those documents. In addition, the managing entity will provide a quarterly report listing all active subcontracts and all outstanding invoices, including service period and invoice amount. (j) Coordinate Network Services and Operations The managing entity is responsible for all of the network services and operations required under this contract including the approved annual action plan. Any failure to perform on the part of a network provider does not relieve the managing entity of any accountability for tasks or services that the managing entity is obligated to perform pursuant to this contract. (k) Substance Abuse Prevention and Treatment Block Grant Requirements and Community Mental Health Block Grants for the Managing Entity (i) The managing entity shall comply and agrees to ensure that its South Florida Behavioral Health Network, Inc. 34 KH225 10/01/2010 Managing Entity network providers that receive federal Substance Abuse Prevention and Treatment Block Grant and /or Community Mental Health Block Grants, comply with Subparts I and II of Part B of Title XIX of the Public Health Service Act, s. 42 U.S.C. 300x -21 et seq. (as approved September 22, 2000) and the Health and Human Services (HHS) Block Grant regulations (45 CFR Part 96). (ii) The managing entity shall ensure that a network provider that receives funding from the Substance Abuse Prevention and Treatment Block Grant certifies compliance with all of the requirements of the Substance Abuse and Mental Health Services Administration (SAMHSA) Charitable Choice provisions and the implementing regulations of 42 CFR54a. (iii) Guidance for contracting SAPTBG funds can be obtained from the SAMH Funding Restrictions Resource Guide at the following website: http: / /www.dcf.state.fl.us/ programs /samh /publications /samhfund.doc (I) Adhere to Prohibitions Against Subcontracting with Certain Entities See Section.B.2.d. (m) Incident Reporting The managing entity will be responsible for the review, input, follow - up /corrective action, and tracking of monthly reports related to client risk prevention and incidents. Lotus Notes will be used unless another acceptable format is mutually agreed upon. (I) The managing entity will establish an electronic system utilizing Lotus Notes for the usage of the incident report system. (ii) Each Network provider will submit an incident report (Circuit 11 & 16 SAMH Incident Report, incorporated herein by reference) on all reportable incidents per CFOP 215 -6 within 24 hours via fax machine to the managing entity. The managing entity will review incident reports for completeness and input into the system. If a report is incomplete, the managing entity will contact the provider for additional information. The managing entity shall ensure that timely notification is /has been made by the provider in the incident report to the appropriate individuals and agencies. Such notifications may include, but are not limited to: the Florida Abuse Hotline; Law Enforcement; Fire Department; parent, guardian, relative; Death Review Coordinator; Building Manager; Safety Coordinator; Local Advocacy Council; etc. Within forty -eight (48) hours, incident reports with any corresponding follow- up should be forwarded to the department's Regional Incident Report Liaison. South Florida Behavioral Health Network, Inc. 35 KH225 10/01/2010 Managing Entity [a] In the event an incident has an immediate impact on the health or safety of a client, has potential media impact, or involves employee - related incidents of criminal activity (CFOP 180 -4), the managing entity must notify the Department of Children and Families (DCF) Substance Abuse and Mental Health (SAMH) Program Supervisor as soon as possible after notification but not to exceed 24 hours. [b] Employee related incidents of criminal activity or other types of serious wrongdoing per CFOP 180-4 must be submitted to the Office of the Inspector General utilizing the Notification/ Investigation Request form CF 1934 after notifying the DCF SAMH Program Supervisor. This must be e- mailed to the Office of Inspector General at ig_complaints @dcf.state.fl.us. The provider and subcontractor may also mail the completed form to the Office of Inspector General, 1317 Winewood Boulevard, Building 5, 2nd Floor, Tallahassee, Florida, 32399 -0700; or via fax at (850) 488 -1428. A reportable incident is defined in CFOP 180-4, which can be obtained from the contract manager. [c] For all deaths, the managing entity should request the following information from all providers: 1) Cause of Death; 2) Medication(s) consumer was taking; 3) Medical Examiner's report; 4) What services was the consumer receiving from your agency; and 5) Dates of contact by case manager and /or therapist with consumer for the last 3 months; include a summary of the consumer's status during this time. (iii) The managing entity shall ensure that appropriate corrective action is /was taken to minimize both immediate and future risk. If a plan for corrective action is necessary, the administrator or designee shall oversee plan development and implementation. (iv) It is the responsibility of the managing entity to maintain a monthly log listing all incidents including those submitted to the Office of the Inspector General with the following information: the Provider name, IR tracking number from Lotus Notes, or another agreed upon format, client's initials, incident report category number, date South Florida Behavioral Health Network, Inc. 36 KH225 10/01/2010 Managing Entity and time of incident, and description of follow -up action taken. In addition, a monthly report needs to be generated by provider the total number of incidents by category, number of untimely reports, and description of follow -up action necessary. (v) Certain incidents may require managing entity staff to conduct a monitoring of the facility or other types of investigation. (vi) A quarterly trends analysis regarding incident reports will be developed by the managing entity that analyzes and reports on the quality improvement mechanisms in place to ensure that providers successfully correct deficiencies. This needs to be submitted to the SAMH Program Office quarterly upon which a meeting will commence to review the results of the quarterly trends analysis between the managing entity and the department. (3) Develop, Maintain and Improve, Utilization Management (UM) The managing entity shall apply UM systems and processes to: ensure maximum, cost - effective, and clinically appropriate utilization of substance abuse and mental health treatment services. All items will be addressed more specifically in the managing entity's approved annual action plan. (a) Establish Utilization Management Procedures The managing entity shall develop and implement written utilization management procedures inclusive of and not limited to agreed upon behavioral health services which meets the department's requirements and which details what process will be utilized to prevent over and under utilization of services. The Utilization Management procedures minimum requirements are specified in the managing entity's approved annual action plan. (b) Submit Utilization Management Reports The managing entity will submit quarterly utilization management reports to the department. These reports will include utilization activity relative to utilization goals, corrective actions, and a monthly report of the substance abuse /mental health waiting list for residential treatment. (c) Oversee Application of Utilization Management Criteria The utilization management criteria for substance abuse is the ASAM PPC- 2R Florida Supplement, American Society of Addiction Medicine, Patient Placement Criteria for the Treatment of Substance Related Disorders, second edition - revised, July 1, 2001, or the latest revised edition thereof. The State may specify an alternate assessment tool that may replace the current tool. Consumer placement criteria specific to mental health services will be developed by the managing entity and approved by the Southern Region South Florida Behavioral Health Network, Inc. 37 KH225 10/01/2010 Managing Entity SAMH Program Office. Standardized tools and assessments approved by the department must be used to determine placement and level of care. The managing entity will ensure that subcontractors use the GAIN, when appropriate, as the behavioral health assessment and placement tool for ages 12 and up in the Southern Region, or as otherwise specified in the approved annual action plan. (d) Develop Service Utilization Goals as Part of the Managing Entity's Approved Annual Action Plan and Monitor Performance The managing entity will develop utilization projections to be incorporated in the Utilization Management Section of the Approved Annual Action Plan. These projections will be developed for program service area and include the number of persons to be served, average length of stay, and the application of dollars from the funding source managed by the department. The managing entity will generate and analyze quarterly utilization reports that compare actual utilization of services by program service area in relation to these goals by subcontractor and for the region. The managing entity will work with subcontractors to address and resolve service delivery practices that do not conform to client placement criteria and utilization targets. (e) Review Compliance with Utilization Management Criteria As part of the quality improvement program, the managing entity will provide or coordinate reviews of service compliance with criteria and practice guidelines, such as retrospective reviews to ensure the level of placement of clients is appropriate. (See the Quality Improvement section.) The managing entity will take corrective action to resolve situations in which the subcontracted provider is not following the guidelines or working to help the system meet its utilization goals. (f) Manage Waiting List and Interim Services The managing entity shall conduct oversight, reporting and management of the behavioral health plan for individuals served. In the event that waiting lists do develop, the managing entity will develop and implement procedures for managing the substance abuse and mental health waiting list for all applicable levels of care including provision of interim services. (g) Authorize Services The managing entity shall conduct authorization and reauthorizations for applicable levels of care as described in the approved Annual Action Plan in order to ensure timely access to behavioral health services and eliminate the wait lists. The authorization processes will include: (i) Timeliness standards for authorization review must adhere to timelines standards referenced in section B.1.a.(1) (a) for the South Florida Behavioral Health Network, Inc. 38 KH225 10/01/2010 Managing Entity services provided and departmental, statutory, and judicial regulations or requirements. (ii) Processes for making the criteria on which decisions are made available to practitioners, including any standardized tools and assessments for use in determining placement and /or level of care. (iii) Provisions for providing timely appeals, or second opinions, when a request for authorization for a particular service is denied. (An appeal differs from a grievance in that grievances are used when a recipient or member of the covered population believes that he or she has been treated improperly, whereas an appeal is a request to review a judgment.) The second opinion shall be obtained according to the timeliness standards for the service in question. (h) Manage Resources and Recommend Reallocations of Funds, Provide Cost Allocation Plan and Submit Annually The managing entity shall manage resources by funding source, cost center, and network provider. Within 30 days of contract execution, and annually by July 30 of each subsequent fiscal year, the managing entity shall submit a funding allocation plan for department approval. Any subsequent changes to the approved allocation plan must be submitted to the department for approval prior to implementation. The managing entity will recommend reallocation of funds during the contract year as a result of patterns of underutilization of funds, high demand that reflects the needs and preferences of consumers and the department targets and plans. (4) Develop, Maintain, and Improve Care Coordination and Integrated Care Systems (a) Develop Initial Service Agreements The managing entity shall develop and /or maintain written cooperative agreements with the judicial system and the criminal justice system which define strategies and alternatives for diverting persons from the criminal justice system and address the provision of appropriate services to persons with substance abuse, mental health and /or co- occurring disorders who are involved with the criminal justice system, as specified in the approved annual action plan. These agreements must also address the provision of appropriate services to persons who have behavioral health problems and leave the criminal justice system. The managing entity shall submit a copy of the agreements to the department's contract manager. The managing entity shall execute a department- approved working agreement with the department's contracted Community Based Care (CBC) providers in support of the Southern Region's SAMH Program Office's working agreement with the CBC. The intent of the working agreement is to establish a formal linkage of partnerships with a shared vision for improving outcomes for South Florida Behavioral Health Network, Inc. 39 KH225 10/01/2010 Managing Entity families involved in the child welfare system by providing integrated community support and services. The working agreement shall be submitted to the department's contract manager, as specified in the approved annual action plan. (b) Develop a Plan for Care Coordination The managing entity will develop written cooperative agreements with other external stakeholders as described in the approved Annual Action Plan. (1) The managing entity will oversee the regional SOAR Initiative by ensuring that providers with co- occurring clients participate in the SOAR Initiative. The managing entity staff should be trained in SOAR and assist the department in training needs including technical assistance and data collection. (5) Develop, Maintain, and Improve Processes Advocating for Consumer Rights and Network Access (a) Establish Procedures The managing entity shall establish and maintain a consumer rights and grievance procedure which applicants for, and recipients of, contracted services may use to present grievances to the managing entity, if their grievances were not resolved at the subcontractors level and to achieve resolution. The managing entity shall submit a copy of their rights and grievance procedure to the department's contract manager for review and approval within thirty (30) days of contract execution. (b) Develop and Disseminate Consumer Manual The managing entity shall develop and maintain a format for subcontractor service recipients which includes information about access procedures, recipient rights and responsibilities (including grievance and appeal procedures). This information will be placed in a manual available for use by the consumers within each subcontractor location. In addition, the managing entity shall maintain updated information of each subcontractor on their website. The managing entity shall submit a copy to the department's contract manager for review and approval as specified in the approved annual action plan. (c) Assist Consumers in Choosing Network Providers At a minimum, the managing entity will assist consumers in choosing Network Providers by providing 24 hour /7 days a week access as specified in the approved annual action plan for individuals who need assistance in accessing behavioral health services. South Florida Behavioral Health Network, Inc. 40 KH225 10/01/2010 Managing Entity (d) Work and Social Opportunities A Peer Services Coordinator will be employed to develop work and social opportunities for consumers and make recommendations to the managing entity and subcontractors for a consumer - driven system. (6) Assist Stakeholder Involvement in Planning, Evaluation, and Service Delivery (a) Participate in Planning The managing entity will engage local stakeholders, per section 394.9082 F.S., in its support activities for the department's local plans and in the development of its Annual Action Plan (see section B.1.a(9)). (b) Configure Network Administration Through a Governing Board The Managing Entity Governing Board shall be responsible for the following: (i) serving as a bridge between the managing entity, local stakeholders, (including consumers), and the community; (ii) establishing and monitoring all managing entity subcommittees and advisory groups involved in the services provided through the managing entity for this contract; (iii) assessing the adequacy of the network and deciding network composition; (iv) deciding the content of the Annual Action Plan; (v) annually approving the standard contract between the managing entity and network providers; and (vi) approving and distributing board policies and procedures and providing copy of such to the department's contract manager. (c) The Managing Entity Governing Board shall meet at least quarterly and more frequently if required. Its composition shall be no less than 25 and no more than 35 Board Members. The Board Members shall be minimally comprised of the following members: 2 Consumers 2 Family Members of Consumers 8 Substance Abuse and Mental Health Service Providers 1 Local Government Representative (Non -State agency) 1 Judge or Senior Court Official South Florida Behavioral Health Network, Inc. 41 KH225 10/01/2010 Managing Entity 1 Elected City, County or State Official 1 Faith -based Leader 1 Local NAMI or other Advocacy Group Director 1 Behavioral Health Community Leader 1 Youth Representative 1 Public Health Representative (7) Develop, Maintain, and /or Improve Quality Improvement processes Quality Improvement (QI) reviews address reviews of network provider compliance with clinical and programmatic requirements. Continuous Quality Improvement (CQI) activities address outcomes management and systematic activities using data to improve services. The goal is to improve the accountability for a local system of behavioral health care services to meet performance outcomes and standards through the use of reliable and timely data. (a) Develop Procedures for Quality Management The managing entity shall develop and implement the Quality Improvement Procedures. The procedures will describe how the managing entity ensures that the network meets service and administrative requirements and uses data to improve services. The elements of the Quality Management Procedures are specified in the approved Annual Action Plan. The managing entity shall submit a copy of the Quality Management Procedures, a copy of all quality assurance reviews, a copy of all monitoring reports within 30 days of completion, a copy of all corrective action plans, and a quarterly quality management report to the department's contract managers. (8) Provide Training and Technical Assistance The managing entity shall develop and implement a training program for its staff and the subcontractor staff. The training shall assure that staff receives externally mandated and internal training. , The managing entity may coordinate training or directly provide training to subcontractor staff. In addition, the managing entity will encourage cross - organizational training and assistance to help non - accredited providers become accredited. The managing entity shall submit a quarterly report on the training received by the subcontractors and managing entity staff. The managing entity shall submit an annual training plan (see approved Action Plan for specifics). (9) Develop, Maintain, and Improve Planning Support and Plan Development The local department plans and the managing entity Annual Action plan are the vehicles for identifying the services and improvements that the managing entity will develop and provide on a year -to -year basis. (a) Provide Support for Local Department Planning South Florida Behavioral Health Network, Inc. 42 KH225 10/01/2010 Managing Entity The managing entity will support the planning efforts of the department and develop an Annual Action plan, subject to the approval of the department. The department plans supported by the managing entity are the Annual Regional Plan and the strategic plan developed every three years. The managing entity will support the department's local plan by providing: (i) A summary of the network's performance in relation to the previous year's Annual Action Plan; (ii) Demographic, population and prevalence data as specified by the Region. These should include demographic comparisons among the entire population of the Region, the population being served by the network, and the persons providing direct treatment services; (iii) Other summaries of reports already compiled by the managing entity as part of its reporting requirements, such as performance management reports; grievance, appeals, and other complaint information; and the results of satisfaction surveys; (iv) Ad hoc utilization reports identified by the planning participants; (v) The perspectives of consumers, advocates, and other stakeholders on a county -by county basis; (vi) The schedule and formats for these reports will be identified in the approved Annual Action Plan. (b) Maintain Regular Communication with the Department The managing entity representative will meet at least quarterly with the Southern Region SAMH program supervisor to discuss the status of the network's operations. This meeting can be in person or by phone. (c) Develop a Contingency Transition Plan The managing entity shall, in coordination with the department, develop a Contingency Transition Plan in the event of termination or non - renewal of this contract. The Contingency Transition Plan shall be submitted to the contract manager in accordance with the approved annual action plan and is incorporated herein by reference. (10) Develop, Maintain and Improve Reporting The managing entity shall submit reports included in Exhibit G, Required Reports. In addition, the managing entity will provide the department ad hoc reports at its request because the managing entity is the department's primary source for network reporting. In all cases, the delivery of reports, ad hoc or scheduled, shall not be construed to mean acceptance of those reports. Acceptance, in writing, of required reports shall constitute a separate act and shall be approved by the South Florida Behavioral Health Network, Inc. 43 KH225 10/01/2010 Managing Entity department's contract manager. The department reserves the right to reject reports as incomplete, inadequate or unacceptable. (11) The managing entity will ensure that subcontractors have updated emergency /disaster plans annually within 30 days of the beginning of hurricane season, and they are activated upon notification of disasters from the department. The managing entity will conduct post disaster assessments of damage incurred by providers and submit to the department. (12) The managing entity provider shall ensure that prevention services subcontractor contained in the Performance Based Prevention System. The "final" PPT shall be printed from PBPS and sent to the managing entity's contract manager for approval within 30 days of contract execution. The managing entity shall review and approve the Prevention Program Tool (PPT). (13) The managing entity shall ensure that Prevention Program Coordinators and any other personnel responsible for entering data into the Prevention data system, including subcontractors who upload data from their own system, must register and complete training on use of the PPT at least annually. (14) The managing entity shall ensure that Substance Abuse Treatment subcontractors contracted for HIV Early Intervention Services will designate a representative to participate in the local Department of Health HIV /AIDS planning body's meetings. The managing entity shall ensure that subcontractors participate in a minimum of 50% of the meetings involving community service partners. (15) The managing entity shall ensure that subcontractors collaborate with the local community substance abuse coalitions (where available) to help develop and support capacity to address community substance abuse needs. Activities shall be specified in the Prevention Activities Exhibit, which is incorporated herein by reference, and as specified in the approved annual action plan. (16) Based on the most recent local department approved comprehensive community action plan, the managing entity agrees to ensure that its subcontractors, administer and deliver appropriate evidence -based programs or strategies as specified in the Consolidated Program Description required by Rule 65E- 14.021, F.A.C., and is on file in the department contract manager's file and incorporated herein by reference. (17) The provider shall comply, and ensure that its subcontractors comply with Children and Families Operating Procedure 215 -8, OVERSIGHT OF HUMAN SUBJECT RESEARCH AND INSTITUTIONAL REVIEW BOARD DESIGNATION. The policy and guidance can be found at: http://www.dcf.state.fl.us/news/humanresearchpolicv.shtml. Approval from the department is mandatory for all research conducted by any department employee, contracted organization or individual, or any public or private vender, even if the aforementioned has their own Institutional Review Board which has granted approval. South Florida Behavioral Health Network, Inc. 44 KH225 10/01/2010 Managing Entity (18) Client Satisfaction Survey The managing entity shall ensure all network providers conduct client satisfaction surveys pursuant to CFP 155 -2. (19) Client Files Upon contract execution, the managing entity will accept and maintain all current and subsequent SAMH client files. (20) The managing entity shall ensure that all subcontractors that provide SAMH Treatment Services execute a Memorandum of Understanding (MOU) with the appropriate Federally Qualified Health Center as listed in the Annual Action Plan. The MOU provides for integration of primary care services to the medically underserved. (21) The managing entity will demonstrate and encourage efforts from its subcontractors to initiate and support local county implementation of the Medicaid Substance Abuse Local Match Program in order to expand community service capacity through draw down of Federal funding. (22) TANF Guidelines The managing entity agrees to comply, and require its subcontractors to comply with the provisions of the TANF Guidelines, which is incorporated herein by reference, for any TANF funds provided under this contract. (23) Family Intervention Specialist The provider agrees to comply, and require its subcontractors to comply, with the provisions of the Substance Abuse Family Intervention Specialist Services, which is incorporated herein by reference, if the services of Family Intervention Specialists are being provided under this contract. (24) Clinical Supervision for Evidence Based Practices The provider agrees to comply, and require its subcontractors to comply with the provisions of Clinical Supervision for Evidence Based Practices, which is incorporated herein by reference, if these services are being provided by the managing entity or its subcontractors. (25) Prevention Services Invitation to Negotiate (ITN) As existing prevention contracts end, or as otherwise specified in the approved annual action plan, the managing entity shall use the department's Evidence -Based Practices Procurement for the Prevention of Underage Drinking and Other Alcohol - Related Problems ITN template, which is incorporated herein by reference, for contracting SAPT Block Grant funding for prevention services. South Florida Behavioral Health Network, Inc. 45 KH225 10/01/2010 Managing Entity (26) Forensic Service Program The provider agrees to comply, and require that its subcontractors comply with the provisions of Forensic Mental Health Specialist Services, which is incorporated herein by reference. The managing entity will be responsible for ensuring the provision of mental health, substance abuse and ancillary services to individuals charged with felony offenses and have been committed or may be at risk of commitment to the Department of Children and Families, pursuant to chapter 916, F. S. The managing entity will ensure the development of a comprehensive forensic program that meets all requirements of chapter 916, F.S., Forensic Client Services Act, the Forensic Mental Health Services Exhibit and established forensic performance measures. The managing entity will ensure the development and implementation of an automated system to track the activities of the program and to generate reports pertinent to the program. Additionally, the forensic program will contain the following components: a. Diversion The managing entity will be responsible for the identification of individuals charge with felonies in the Miami -Dade and Monroe County Jails who are at risk of commitment to the Department of Children and Families, but who may be diverted to the community with appropriate services and monitoring. (1) CFOP 155 -38, entitled "Procedures for Post Commitment Diversion" establishes eligibility criteria to be used for both pre- commitment and post commitment diversion. (2) Referrals sources for diversion include the Offices of the Mental Health Administrator, Public Defender, State Attorney, Corrections Health Services and Prison Health Services the judiciary, and the Jail Diversion Program. The managing entity or its subcontractors may establish through cooperative agreement with these entities, an alternative source or methodology for obtaining referrals and /or identifying individuals who meet criteria for diversion. (3) The managing entity will ensure that all referrals for diversion are screened to ensure eligibility and suitability for diversion to a community program. The screening will include review of all documentation, including arrest reports, criminal histories, court ordered evaluations and court orders. (4) The managing entity will ensure that appropriate referrals for services in the community are initiated and dispositions are received in writing. (5) The managing entity will ensure the development and submission of an appropriate plan for conditional release to the committing court. The plan will include mental health treatment, competency restoration training, South Florida Behavioral Health Network, Inc. 46 KH225 10/01/2010 Managing Entity residential care or housing with supervision, medical and auxiliary services if appropriate, case management and monitoring. (6) The managing entity will ensure attendance at court hearings, obtain conditional release order s and ensure individuals are monitored in the community in accordance with the terms of the conditional release order. b. Discharge Planning — The managing entity will be responsible for ensuring the active participation of forensic specialists in discharge planning activities for forensic clients at state treatment facilities. (1) The managing entity will ensure the forensic specialists conduct quarterly face- to- face meetings with forensic clients in both civil and forensic state treatment facilities and provide written assessments that include mental status, barriers to discharge, and discharge plans. (2) The managing entity will ensure that forensic specialists participate in treatment team, and discharge planning meetings for forensic clients in state treatment facilities. (3) The managing entity will ensure the review reports to court generated by the state treatment facilities in order to determine action necessary to comply with treatment team recommendations and /or resulting court orders. (4) The managing entity will ensure the development and submission of conditional release plans, discharge plans to state treatment facilities and to the committing court. The content of the plans is described above in the Forensic Mental Health Specialist Services exhibit which is incorporated herein by reference. (5) The managing entity will ensure attendance of forensic specialists court hearings in the cases of individuals discharged from state treatment facilities and ensure effective linkage to the new mental health service provider. c. Conditional Release Monitoring —The managing entity will ensure that individuals on conditional release order in Dade and Monroe Counties, including individuals transferred into the counties from other circuits are monitored. (1) The managing entity will ensure that individuals on conditional release order are monitored in accordance with the requirements of Rule 65E -15. F.A.C., Continuity of Care Case Management and the court order to ensure compliance with the order and department rules. (2) The managing entity will ensure the committing court is immediately notified by phone and in writing of any deviations from the conditional South Florida Behavioral Health Network, Inc. 47 KH225 10/01/2010 Managing Entity release order. The managing entity will ensure the Circuit Forensic Coordinator is copied on written correspondence to the court. (3) The managing entity will ensure the review of required monthly monitoring reports in order to intervene in problematic situations, to provide alternative treatment modalities when necessary, and to identify trends and issues that illustrate opportunities for improvement in service delivery. The managing entity will bring the aforementioned situations, trends and issues to the immediate attention of the Circuit Forensic Coordinator. (4) The managing entity will ensure the distribution of copies of conditional release orders and modifications to the agency providing mental health and substance abuse services to the individual and to the SAMH Regional and Headquarters Office in Tallahassee. d. Prison Aftercare Services -The managing entity will ensure the provision of aftercare services for inmates returning to Dade and Monroe Counties following end of sentence (EOS), in accordance with the Interagency Agreement between The Florida Department of Corrections (Office of Health Services) and The Florida Department of Children and Families (Mental Health Program Office). (1) The managing entity will ensure the development and implementation of a procedure for the receipt and review of referrals for services from prisons throughout the state and/ or from SAMH. (2) The managing entity will ensure that appointments are scheduled for the appropriate levels of services required by the inmate, including hospitalization and provide notification of appointment and /or arrangements for hospitalization or stabilization to the referring prison facility. (3) The managing entity will ensure the provision of follow -up services for a period of at least 60 days to ensure the individual keeps the scheduled appointments and that they do not run out of prescribed medication. e. Utilization Management - The managing entity will be responsible for managing the utilization of residential treatment beds funded by community forensic dollars in Circuit 11 and the statewide community forensic beds located in Circuits 11 & 17. This includes a short -term residential treatment facility and residential level 2 beds. The managing entity will be responsible for managing the appropriate utilization of community forensic residential treatment beds. f. Administrative Functions- The managing entity will ensure that adequate administrative support staff is assigned to the forensic program. In addition, the managing entity and /or it's contracted providers will: South Florida Behavioral Health Network, Inc. 48 KH225 10/01/2010 Managing Entity (1) Actively participate in all related workshops and training, meetings, performance improvement teams, and other activities designed to increase the knowledge and skill levels of staff assigned to the forensic program. (2) Ensure that applicable staff obtains certification of attendance from the Florida Forensic Examiner Training within one year of employment. (3) Conduct biweekly case staffing of individuals committed to DCF, pending discharge from a state treatment facility, currently on conditional release or pending release from state prison. (4) Timely request technical assistance from the Circuit Forensic Coordinator on issues related to service delivery, interactions with state treatment facilities and the circuit court. (27) Comprehensive Community Service Teams Case Management Comprehensive Community Service Teams (CCST) Cost Centers, must continue to provide Adult Mental Health Case Management Services as defined by the Continuity of Care Guidelines for Geo Care, Inc. /South Florida State Hospital (on file at the Southern Region SAMH Program Office). Additionally, CCST Cost Centers must provide appropriate Adult Mental Health services to CCST team consumers with the availability to increase or decrease intensity and frequency of similar services, as needed. CCST services must be delivered by staff working in a multidisciplinary team that includes Peer Specialists who are consumers of mental health services. See the CCST cost center model cost description, incorporated herein by reference. Children's Mental Health Comprehensive Community Service Teams (Exhibit H), together with the Incidental Cost Center, will be the vehicle for provision of services to children and families under the Miami Dade Wraparound Cooperative Agreement #1 U79SM059055 -01. (28) Florida Assertive Community Team (FACT) The managing entity will provide oversight monitoring and service validation for FACT Team Providers, as per the state's existing allocations when this contract is executed. The managing entity will ensure that the FACT teams provide intensive, assertive community -based treatment that includes rehabilitation and support services for persons with symptoms of severe and persistent mental illnesses. The managing entity will ensure that FACT teams adhere to the fidelity of the program as described in Attachment I PSMA 1 HC08 FACT Program document, incorporated herein by reference, and the NAMI Published Program Standards for ACT Teams. The managing entity FACT Liaison must be a qualified mental health professional with experience in the mental health field. a. The managing entity will monitor FACT Enrollment, Referrals, and Membership as follows: South Florida Behavioral Health Network, Inc. 49 KH225 10/01/2010 Managing Entity 1) Maintaining a Referral Tracker 2) Reviewing referrals for completeness & eligibility criteria within 48 hours. 3) Contacting the referral source and requesting additional information if needed for determination of eligibility within 24 hours 4) Ensuring FACT Teams conduct screening (face -to -face) within 72 hours of referral receipt 5) Making referral approvals, reviewing disposition outcomes, and /or providing alternative referral sources. 6) Approving FACT Team discharges and oversight of discharge planning 7) Approving and coordinating enrollee transfers within FACT Teams 8) Ensuring attendance of the FACT Teams to monthly Treatment Team Meetings and Discharge Planning Meetings at the South Florida State Hospital as applicable. 9) Ensuring that FACT teams utilize the SOAR (SSI /SSDI Outreach Access and Recovery) application process for all eligible enrollees. b. The managing entity will provide oversight monitoring of FACT Supports and Day -to -Day Operations as follows: 1) Providing technical assistance and consultation on -site at least bi- monthly for each provider 2) Approving request for the use of flexible funding. 3) Approving any changes in FACT Team services, location, and business hours. 4) Participating in the Quarterly Advisory Board Meetings 5) Maintaining communication with local AHCA representatives for the administration of managed care enrolled individuals 6) Advocating for FACT enrollees with other public entities c. The managing entity will monitor required FACT Reports and Utilization as follows: 1) Requesting a Corrective Action Plan (CAP) to ensure compliance and requesting approval for a CAP from the Southern Region SAMH Program Office: South Florida Behavioral Health Network, Inc. 50 KH225 10/01/2010 Managing Entity 2) Overseeing FACT Team staffing levels (a) Reviewing the Monthly Vacant Position Report and maintaining a Monthly Vacant Position Report tracker (b) Ensuring that FACT Teams are fully and appropriately staffed as described in the Attachment I PSMA 1 HC08 FACT Program document, which is incorporated herein by reference. The managing entity may not authorize any staff substitutions without obtaining prior written approval from the Southern Region SAMH Program Office. (c) Ensuring prompt communication if FACT Team provider fails to maintain appropriate staffing level for thirty (30) consecutive calendar days 3) Monitoring utilization of Enhancement Funds (a) Reviewing the Quarterly FACT Enhancement Reconciliation Report and maintaining a FACT Enhancement Reconciliation Report Tracker (b) Sending copies to Southern Region SAMH Program Office and Central Program Office of Quarterly FACT Enhancement Reconciliation Report and Tracker 4) Monitoring the FACT Team Enrollment Report (a) Reviewing the Monthly Enrollment Report and maintaining a Monthly Report Tracker (b) Verifying Quarterly FACT Monthly Report for accuracy, track and evaluate trends and provide constructive feedback to FACT Teams 5) Ensuring accuracy of the FACT Ad Hoc Report (a) Reviewing the FACT Ad Hoc Report and maintaining an Ad Hoc Report Tracker (b) Ensuring that FACT Teams submit the Ad Hoc Report to Tallahassee Mental Health Program Office (c) Sending copies of the Quarterly FACT Ad Hoc Report to Southern Region SAMH Program Office 6) Reviewing FACT Managed Care enrolled individuals (a) Reviewing the FACT AHCA Report and maintaining an AHCA Report Tracker South Florida Behavioral Health Network, Inc. 51 KH225 10/01/2010 Managing Entity (b) Sending copies of FACT AHCA Report to the local AHCA Managed Care Representative 7) Ensuring that FACT Team Performance Measures are met (a) Reviewing the Monthly Performance Measure Data and monitoring for compliance of outcome measures (b) Presenting on Performance Measures during the Quarterly Performance Measure Review Meetings to the Southern Region (c) Sending copies of Monthly Performance Measures Report to Southern Region SAMH Program Office 8) Reviewing FACT Team Incident Reports (a) Maintaining an Incident Report Tracker (b) Identifying and addressing significant trends revealed by incident reports (c)Sending copies of significant incidents and interventions as needed to Southern Region SAMH Program Office (29) Projects for Assistance in Transition from Homelessness (PATH) The managing entity will provide oversight monitoring and service validation for the PATH network providers who have funds allocated (see Funding Detail) for support services for individuals who have a serious mental illness and /or substance abuse and are homeless or at imminent risk of becoming homeless as per the state's existing allocation when this contract is executed. a. The managing entity will manage PATH services and ensure dissemination of deliverables as set forth and described in each approved and signed Local Intended Use Application. b. Eligible PATH local matching funds must be expended in the provision of PATH eligible services to PATH eligible persons. The expenditures must match the types of services outlined in the Local Intended Use Plan. The formula to be followed is cited in Section 524 of the Public Health Services Act, as amended by Public Law 101 -645. c. The managing entity will manage the PATH Grant as follows: 1) Maintaining a Quarterly Report Tracker 2) Verifying Quarterly Reports for accuracy and utilization of funds and clients served. 3) Sending the Southern Region SAMH Program Office copies of the Tracker South Florida Behavioral Health Network, Inc. 52 KH225 10/01/2010 Managing Entity and Quarterly Reports. 4) Overseeing the Annual reapplication process for the PATH Grant 5) Compiling Annual report information and sending a final draft to the Southern Region SAMH Program Office for approval. 6) Ensuring providers submit final Annual report to Tallahassee. (30) Contingency Funds for Adult Mental Health The managing entity will provide oversight monitoring to network providers to ensure utilization of allocated Contingency Funds for housing, medication and other emergency expenses for indigent consumers as per the state's existing allocations when this contract is executed. a. The managing entity will oversee that providers itemize contingency funds expenditures by consumer, including expense description, time period and dollar amount. b. The managing entity will manage Contingency Funds as follows: 1) Maintaining a Quarterly Report Tracker 2) Verifying Quarterly Reports (separate Forensic /Civil Reports) for accuracy and utilization of funds. 3) Monitoring providers to ensure utilization & prevent lapsed funds 4) Sending copies of the Tracker and Quarterly Report to the Southern Region SAMH Program Office and Contract Manager. (31) Children's Mental Health Services, including services for Severely Emotionally Disturbed Children, Emotionally Disturbed Children and their Families The key strategic objectives and strategies that support the department's mission and direct the provision of services to Florida's citizens are detailed in the Substance Abuse and Mental Health Services Plan 2010 -2013, which is incorporated herein by reference. They represent the primary focus of the Substance Abuse and Mental Health programs, and it is expected that the managing entity will ensure adherence to them, including but not limited to the following: a. Ensure that families and youth are full partners in the development and implementation of individual recovery plans and have a prominent voice in designing supports and services. South Florida Behavioral Health Network, Inc. 53 KH225 10/01/2010 Managing Entity b. Prioritize services and supports for children who are involved with the child welfare and juvenile justice systems. Within these priority groups, children birth to five years of age, youth transitioning to adulthood and children at risk of residential treatment are the focus of specific activities and initiatives. System transformation is the driving force for current and future activities, with an emphasis on evidence based practices that are culturally competent, focused on prevention, early identification and intervention, and family- centered. c. Ensure that services and supports for children, youth, and families are sensitive to the impact of trauma, and are designed to address treatment issues and minimize system elements that might produce further trauma. d. Address the critical need for better information, planning, and assistance for eligible children transitioning into the adult mental health system. e. Develop coordinated systems of care for children that provide services and supports that promote recovery and resiliency by being: 1) Community -based 2) Culturally competent 3) Strength -based 4) Evidenced -based practices for children and adolescents - including Multisystemic Therapy for children and youth with or at risk of juvenile justice involvement, Therapeutic Foster Care, Family Support and Education, Cognitive Behavioral Therapy for traumatic stress, Dyadic Therapy for infants and toddlers, and the Wraparound Approach. 5) Individualized, child focused, and family directed. 6) Inclusive of early intervention with the child and family. 7) Coordinated across agencies and time lines f. The managing entity will agree to ensure that its subcontractors provide a full continuum of services to address the needs of Severely Emotionally Disturbed Children, Emotionally Disturbed Children and their Families. These services must include but not be limited to: 1) Dyadic Therapy for children under 5, 2) Behavior Analysis services for children with behavior problems, 3) Life skills and Wellness Recovery Action Plan services to children transitioning to the adult system, South Florida Behavioral Health Network, Inc. 54 KH225 10/01/2010 Managing Entity (32) Children's Mental Health- The Miami Dade Wraparound Cooperative Agreement #1 U79SM059055 -01 The Miami Dade Wraparound Cooperative Agreement #1 U79SM059055 -01 while espousing many of the same principles as Children's' Mental Health Services will be a separate responsibility for the managing entity. SAMHSA grant #1 U79SM059055 -01 was awarded to the Department of Children and Families, Substance Abuse and Mental Health on September 9, 2010. The purpose of the grant (Miami -Dade Wraparound Project) is to transform the existing Children's Mental Health system of care. The "Miami -Dade Wraparound Project" (MDWP) is a collaborative effort to enhance, expand and strengthen the existing community - based family and youth mental health services in Miami -Dade County, in order to better serve children who have serious emotional disturbances (SED) and their families or caretakers in Miami Dade County, Florida. The Miami Dade Wraparound Project (MDWP) will enable youth with multiple and changing needs to remain in the least restrictive settings in their community, in school, out of the juvenile justice /legal system and attain and maintain a physical- mental - emotional- spiritual recovery. The target population of this project is "SED adolescents, ages 12 to 17, who also have a co- occurring substance abuse diagnosis ". The Project intends to provide culturally grounded, linguistically competent services to targeted youth residing within a unique racial /ethnic and culturally diverse, Miami Dade County, populated by a Hispanic majority. The MDWP will transform the existing system by offering a comprehensive range of integrated treatment services, made possible by a cross county, cross systems interagency collaboration. "System of care" values (i.e. Child/Youth- centered and family focused, community- based, culturally, and linguistically competent) are implemented using, a wraparound process, and further guided by a wellness maintenance model adapted for youth (e.g. Wellness Recovery Action Plan). This approach transforms the children's mental health system into a recovery- oriented mental health and co- occurring disorder system of care for children. The Project is committed to adhering to the values and guiding principles that support and encourage Family- Driven, youth guided and culturally and linguistically competent care. a. The goal of the Project is to provide youths and families with the services and supports they may need in the following "life domain" areas: 1) basic needs (e.g. housing, transportation, food) 2) family environment (e.g. family counseling, parenting skills, daily living skills, respite) 3) social environment (peer relations, psychosocial skills; recreation); 4) school /vocational (e.g. tutoring and job training, functional skills) South Florida Behavioral Health Network, Inc. 55 KH225 10/01/2010 Managing Entity 5) mental health /co- occurring substance abuse treatment (counseling, medication compliance, rehabilitation; legal and safety (e.g. legal counsel, crisis management); 6) System level (e.g. advocacy, support, utilization of services). b. With respect to services delivery, the following basic service components will be implemented: (1) Enrollment and strength -based Needs Assessment; (2) Youth Clinical Diagnostic Evaluation /Assessment; (3) Immediate Crisis Stabilization; (4) Individualized Wraparound Team formation, (5) Service /Care Plan development; (6) Service /Care Plan Implementation (using community - based treatment providers; (7) Crisis and Safety planning, (ongoing); (8) Tracking, Monitoring and Adapting Service /Care Plan, and (9) Transition Services and support. c. SAMHSA Grant #1 U79SM059055 -01 will be transferred to the Managing Entity. The Managing Entity will develop the infrastructure necessary to support the transformation effort, implement the service components as outlined in the grant #1 U79SM059055 -01 narrative, and negotiated by the Substance Abuse and Mental Health program office, as specified in the approved annual action plan. The managing entity will manage all aspects of the Children's Mental Health system of care under the direction of the Substance Abuse and Mental Health program office. (33) The Children's Crisis Response Team (CCRT) a. The Children's Crisis Response Team (CCRT) is a crisis mobile team that is attached to the Children's Crisis Stabilization Unit. They are led by a psychologist, have a behavior analyst, individual therapist, family therapist and a case manager. One on ones and other wraparound services are provided as needed. When The Southern Region is referred an indigent child for residential treatment we send out the team to do an assessment and to decide if the child can be maintained in the community. If the answer is yes, they provide an intense array of services until the family is more stable. The Children's Crisis Response Team may at times provide non - Medicaid eligible services to Medicaid recipients. b. The managing entity will oversee the Children's Crisis Response Team. The goals of the CCRT are: 1) To respond to children and their families in the community who are experiencing crisis because of their mental health issues. 2) To ensure that indigent children receive services in the least restrictive level possible to meet their needs. 3) That residential treatment for indigent children remains with the allowed Purchased Residential Treatment Services (PRTS) budget South Florida Behavioral Health Network, Inc. 56 KH225 10/01/2010 Managing Entity (34) Juvenile Incompetent to Proceed Program The managing entity will manage the Juvenile Incompetent of Proceed Program as per section 985.223, F.S. and as per the Department of Children and Families operating procedure. In addition, the managing entity will insure that all children involved with the JITP program are linked with the appropriate mental health services and reduce the time to access treatment services. (35) Residential Level 1 Services The managing entity will insure that Residential Level 1 is available to children in the community. Management of this resource is a complex issue. The managing entity will establish a comprehensive assessment process to determine when children are most appropriate served within residential facilities or as is often the case in their home. The managing entity will establish a system of intensive in- home services for the most severely disturbed children and families as an alternative to residential. (36) KidCare Insurance Program a. The Florida KidCare Program was created by the 1998 Florida Legislature in response to State Children's Health Insurance Program (SCHIP) legislation. Florida KidCare is the state's children's health insurance program for uninsured children under age 19. It includes four different parts, or programs: MediKids, Healthy Kids, Children's Medical Services and Medicaid. Florida KidCare covers primary health and mental health care. b. It is essential in order to maximize the use of Substance Abuse and Mental Health funding that as many eligible children as possible be enrolled in KidCare. The Southern Region has many children eligible for, but not receiving, KidCare services. This lack of enrollment often leads to services being funded by Substance Abuse and Mental Health. The State is in support of a foundation to be established to pay the family's monthly fee, which has been a barrier. The Managing Entity's responsibilities include: 1) Ensuring that all children who apply for Substance Abuse and Mental Health funded services are screened for KidCare within a month of initial assessment 2) Putting a process in place to facilitate the application procedure for families and provide all needed assistance 3) Addressing barriers to signing up and to family involvement. Provide timely responses to families c. BNET is a Kid Care partner developed to provide mental health and substance abuse services to children between 5 and 18 years old who require South Florida Behavioral Health Network, Inc. 57 KH225 10/01/2010 Managing Entity services beyond the scope of Kid Care. The Managing Entity's BNET responsibilities include: 1) Managing the contract with the current BNET provider 2) Ensuring that the available slots are used for children with the highest need and medical necessity 3) Addressing barriers to signing up and to family involvement. Provide timely responses to families (37) Functional Family Therapy (FFT) is a highly structured, short -term family intervention for youths with multicultural needs and effective delinquency prevention for siblings of offenders. It has been developed for use with highly dysfunctional families at risk of serious problems, including delinquency and family violence. FFT is designed to target children between the ages of 11 and 17. The goals of FFT are to engage and motivate the youth and their families by decreasing negative interactions, and thus breaking the patterns that attribute to negative consequence for the youth and the rest of the family. Each family will develop a specific behavior change plan to reduce and eliminate problem behaviors and negative family relational patterns. For the final goal, the family will generalize changes acquired in therapy across problem situations, and learn to successfully utilize community resources. The managing Entity will create and implement a utilization management process to manage this valuable resource in the children's mental health system. b. Task Limits Within the scope of this contract, the managing entity shall perform only those tasks and services set out above in Section B.1.a., and shall ensure that the network providers do the same as applicable. Services shall only be provided in the Southern Region (Miami -Dade and Monroe Counties), with the exception of clients residing in state hospitals, or Short-Term Residential Treatment programs that are Southern Region clients, or by exception with approval by the department. The managing entity agrees to abide by the Consolidated Program Description, CFP 155 -2 and Rule 65E -14, F.A.C., and is not authorized by the department to perform any tasks related to the project other than those described in Section B.1 .a. without the express written consent of the department. The managing entity may unbundle Medical Services from the Substance Abuse Residential Levels II, III, and IV cost centers for clients with co- occurring disorders, unbundle Psychological Evaluations from the Children's Mental Health Residential Levels I and II, and unbundle Psychological Evaluations from the Children's Substance Abuse Residential Levels II, III, and IV cost centers. The managing entity shall ensure that services are performed in accordance with applicable rules, statutes, and licensing standards. South Florida Behavioral Health Network, Inc. 58 KH225 10/01/2010 Managing Entity 2. Staffing Requirements a. Staffing Levels (1) The managing entity shall require that all network providers maintain staffing levels in compliance with applicable rules, statutes and licensing standards. See Exhibit F, Minimum Service Requirements. (2) The managing entity shall provide oversight so that the subcontractors engage in recruitment to maintain as much as possible staff with the ethnic and racial composition of the clients served. b. Professional Qualifications (1) The following positions /functional areas listed below shall require the minimum qualifications: (a) Chief Executive Officer /President/Executive Director Management or supervisory experience providing services to persons with Behavioral Health issues, including at least ten years in a management position. Masters Degree in Behavioral Health field or business (four years experience in addition to any other experience required may be substituted for a Masters Degree providing the individual has a Bachelors Degree). Must have a demonstrated working knowledge of contractual and government regulations, Behavioral Health treatment, fiscal management, Quality Assurance, data management and development, and Community Organization. Experience in the management of a nonprofit organization is preferred. (b) Deputy Director and Chief Financial Officer Masters Degree in Behavioral Health field or business. Eight years of experience in a Senior Management position of which five years must be in the Behavioral Health field. Must have a demonstrated working knowledge of contractual and government regulations, Behavioral Health treatment, fiscal management, Quality Assurance, data management and development, and Community Organization. Experience in the management of a nonprofit organization is preferred. (c) Medical Director The Medical Director will possess a valid Florida license to practice medicine in the State of Florida and a certification by the American Board of Psychiatry and five to seven years of experience in providing services to persons with psychiatric disabilities. The Medical Director shall be involved in the development and approval of clinical - medical policies and procedures, including those for service authorization and the review of the South Florida Behavioral Health Network, Inc. 59 KH225 10/01/2010 Managing Entity provision of medical services. The Medical Director shall also be involved in quality management. This position can be part -time. (d) Peer Services Coordinator The Peer Services Coordinator must be a Behavioral Health Services consumer who is in recovery and is either a certified Peer Specialist or working towards a certification. (e) Chief Clinical Officer Masters Degree in a Behavioral Health discipline with a current Florida license allowing the individual to provide services in a Behavioral Health service discipline. A minimum of six years experience in providing or managing the delivery of Behavioral Health services of which three or more years must be at a supervisory level. Must have a demonstrated working knowledge of Behavioral Health, community resources, funding sources, statistical reporting, best practices, recovery and resiliency concepts, quality improvement, and statistical report preparation. Must be able to define problems, collect data, establish facts and draw valid conclusions. Must be able to write policies and procedures and develop and implement treatment services and prevention protocols. Must be able to manage and prepare reports on multiple grants and contracts. (f) Director of Finance The Director of Finance must have demonstrated knowledge and experience in generally accepted accounting principles, auditing standards, financial evaluations, and funds management. A Bachelors Degree or its equivalent from an accredited institution with a focus on business, finance, economics or related field is required. Must be able to interpret and analyze audits and other financial reports, prepare electronic spreadsheets, and interpret and present financial data in an understandable format. Five years experience in fund accounting and grants management required. (g) Director of Behavioral Health Services Masters Degree in a Behavioral Health discipline with a minimum of five years experience in providing or managing the delivery of Behavioral Health services of which three or more years must be at a supervisory level. Must have a demonstrated working knowledge of community resources, best practices, resiliency and recovery concepts, CCISC model and utilization management processes. Supports the Chief Clinical Officer in managing complex systems of care. (2) The managing entity shall require that all subcontractors comply with applicable rules, statutes, requirements, and standards with regard to professional qualifications. See Exhibit F, Minimum Service Requirements. South Florida Behavioral Health Network, Inc. 60 KH225 10/01/2010 Managing Entity (3) The managing entity shall require that all network providers provide Level II background screening for mental health personnel and all owners, directors, and chief financial officers of service providers in accordance with chapter 435 and section 408.809, F.S., and, as specified in section 394.4572(1)(a) -(c), F.S. "Mental Health personnel" includes all program directors, professional clinicians, staff members, and volunteers working in public or private mental health and substance abuse programs and facilities who have direct contact with or who are providing direct services to consumers of mental health services. It is the expectation of the department to support the SAMH Transformation Initiative by employing Peer Specialists and in turn following regional procedures. (4) The managing entity shall require that all subcontractors comply with Level II employment screening for substance abuse personnel as specified in section 397.451, F.S. (5) The managing entity shall require all managing entity staff receive a Level II employment screening set forth in section 435.04, F.S. regardless of whether staff have direct contact with individuals served. c. Staffing Changes The managing entity shall staff the project with key personnel identified in B.2.b.(1) who are considered by the department to be essential to this project. Prior to substituting any of the proposed individuals the managing entity shall notify and obtain written approval from the department for the proposed substitution. Written justification should include documentation of the circumstances requiring the changes and a list of the proposed substitutions in sufficient detail to permit evaluation of the impact on the project. The department, at its discretion, may agree to accept personnel of equal or superior qualifications in the event that circumstances necessitate the replacement of previously assigned personnel. Any such substitution shall be made only after consultation with department staff. The managing entity shall notify the department's contract manager, in writing within (10) calendar days of staffing changes regarding the positions of Chief Executive Officer, Deputy Director /Chief Financial Officer, Medical Director, Chief Clinical Officer, and Director of Finance pursuant to Rule 65E- 14.021(8)(d)1.d.(I)(iii), F.A.C. for the managing entity and for all of the network providers. Additionally, the managing entity will notify the contract manager in writing of changes in the executive director or any senior management position of the managing entity. The managing entity shall submit for approval a table of organization (TO), that will reflect all necessary staff to operate this contract prior to implementation. d. Subcontractors (1) Section 394.9082, F.S. provides the department with the authority to contract with a managing entity for the provision or management of behavioral health services. By design and intent, the managing entity is to subcontract with network providers to provide community -based services for adults and children with South Florida Behavioral Health Network, Inc. 61 KH225 10/01/2010 Managing Entity substance abuse, mental health disorders and /or co- occurring disorders, as authorized in section 394.74, F.S., subject to the provisions of Section 1.1.1 -3 of the standard contract. (2) In accordance with Section 1.1 of the Standard Contract, the managing entity may, only with the prior written consent of the department, enter into written subcontract(s) with the approval of the Southern Region SAMH Program Supervisor or designee. In order to comply with this requirement, a request for approval must be submitted to the contract manager 14 days prior to contract negotiation which includes the name of the proposed subcontractor and a notarized affidavit of assurance that the conditions listed in section B.2.d.(5) do not exist. (3) The managing entity may subcontract the management and oversight of the network providers which lead to cost efficiencies with the written approval of the department. (4) The managing entity shall offer all existing department and South Florida Behavioral Health Network, Inc. providers subcontracts through, at a minimum, the end of State Fiscal Year 2011 -2012. (5) The managing entity shall not subcontract for substance abuse /mental health services with any person or entity which: (a) is barred, suspended, or otherwise prohibited from doing business with any government entity, or has been barred, suspended, or otherwise prohibited from doing business with any government entity within the last 5 years; (b) is under investigation or indictment for criminal conduct, or has been convicted of any crime which would adversely reflect on their ability to provide services, or which adversely reflects their ability to properly handle public funds; (c) is currently involved, or has been involved within the last 5 years, with any litigation, regardless of whether as a plaintiff or defendant, which might pose a conflict of interest to the department, the state or its subdivisions, or a federal entity providing funds to the department; (d) had a contract terminated by the department for failure to satisfactorily perform or for cause; or, (e) failed to implement a corrective action plan approved to the satisfaction of the managing entity, the department, and other governmental entities, after having received due notice. (6) No subcontract which the managing entity enters into with respect to performance under the contract shall in any way relieve the managing entity of any responsibility for performance of its duties. All payments to subcontractors shall be made by the managing entity. No reimbursement of payment made to a subcontracted network provider will be processed by the department unless there is prior written approval from the department for said subcontract. South Florida Behavioral Health Network, Inc. 62 KH225 10/01/2010 Managing Entity (7) All subcontracts with network providers shall adopt the applicable terms of the provider's contract with the department. The managing entity shall include in all subcontract agreements a detailed scope of work; clear and specific deliverables; and performance standards. Each of the subcontractors will be required to follow the managing entity's Policies and Procedures and Contract. (8) Unless DCF agrees to an alternative payment method as authorized in section 394.9082, F.S., and prior to entering into any subcontract, or an amendment which modifies the previously negotiated unit cost rate or adds additional cost centers, the managing entity shall conduct a cost analysis for said subcontract, in accordance with Rule 65E- 14.021. A cost analysis is the review of the proposed cost elements to determine if they are necessary, allowable, appropriate and reasonable. Subcontractors will be required to comply with Rule 65E- 14.021, Unit Cost Method of Payment, including but not limited to, cost centers, unit measurements, descriptions, program areas, data elements, maximum unit cost rates, required fiscal reports, program description, setting unit cost rates, payment for services including allowable and unallowable units and requests for payments. (9) The managing entity shall conduct competitive procurements for new discretionary funds that they subcontract in excess of $300,000 in accordance with established procurement operating procedures. 3. Service Location and Equipment a. Service Delivery Location (1) Services shall be delivered at the locations provided in the Consolidated Program Description developed pursuant to Rule 65E- 14.021(8)(d)1.d.(III), F.A.C. (2) The managing entity must maintain an administrative office in the Southern Region and a managing presence in each circuit if appropriate given geographic and population factors. b. Service Times (1) A continuum of services shall be provided during the days and times as specified in the consolidated program description on file in the department contract manager's office and incorporated by reference. (2) The managing entity shall notify the department's contract manager, in writing, within (10) calendar days of any changes in days and times where services are being provided pursuant to Rule 65E- 14.021(8)(d)5., F.A.C. c. Changes In Location The managing entity upon notification, shall in turn, notify the department's contract manager, in writing, a minimum of ten (10) calendar days prior to making changes which will affect the department's ability to contact the managing entity by telephone or South Florida Behavioral Health Network, Inc. 63 KH225 10/01/2010 Managing Entity facsimile transmission or as set out in Rule 65E- 14.021(8)(d)d(III), F.A.C. The managing entity shall be available and will be responsible for providing an immediate response 24 hours a day, seven days a week. d. Equipment Any nonexpendable property purchased with departmental funds under this contract either by managing entity or network providers must comply with Tangible Property Requirements (Exhibit I) and department operating Policies and Procedures as outlined in CFOP 40 -5, 50 -9, CFOP 80 -2, Rule 65E -14, F.A.C., which are incorporated herein by reference. 4. Deliverables a. Services The managing entity will provide administration, management and oversight to the network of providers to ensure the delivery of client services in accordance with the Consolidated Program Description on file with the department. The funding allocated for this administration is listed in the Funding Detail (Exhibit A). An administrative unit of service is defined as one month of costs associated with the administration, management, and oversight of the provider network by the managing entity in accordance with this contract. The unit rate for this service is specified in Section C, Method of Payment. b. Records And Documentation To the extent that information is utilized in the performance of this contract or generated as a result of it, and to the extent that information meets the definition of "public records" as defined in section 119.011, F.S., said information is hereby declared to be and is hereby recognized by the parties to be a public record and absent a provision of law or administrative rule or regulation requiring otherwise, shall be made available for inspection and copying by any interested person upon request as provided in section 119.01(2)(f), F.S., or otherwise. It is expressly understood that the managing entity's refusal to comply with chapter 119, F.S., shall constitute an immediate breach of the contract, which entitles the department to unilaterally cancel the contract agreement. The managing entity will be required to promptly notify the department of any requests made for public records. Unless a greater retention period is required by state or federal law, all documents pertaining to the contract shall be retained by the managing entity for a period of six (6) years after the termination of the resulting contract or longer as may be required by any renewal or extension of the contract. During the records retention period, the managing entity agrees to furnish, when requested to do so, all documents required to be retained. The managing entity shall maintain such records in whatever reasonable format is required by the department at the time, at the managing entity's expense. Data files will be provided in a format readable by the department. South Florida Behavioral Health Network, Inc. 64 KH225 10/01/2010 Managing Entity The managing entity agrees to maintain the confidentiality of all records required by law or administrative rule to be protected from disclosure. The managing entity further agrees to hold the department harmless from any claim or damage including reasonable attorney's fees and costs or from any fine or penalty imposed as a result of an improper disclosure by the managing entity of confidential records whether public records or not and promises to defend the department against the same at its expense. (1) The managing entity shall require that all network providers will protect, confidential records from disclosure and protect client confidentiality in accordance with subsections 397.501(7), 394.455(3), sections 394.4615, 414.295, F.S. and also the Health Insurance Portability and Accountability Act (HIPAA), and any other applicable State, and Federal laws, rules, and regulations. (2) The managing entity, through the network providers, is responsible for maintaining documentation of all tasks and deliverables and shall maintain records documenting the total number of clients and names (or unique identifiers) of clients to whom services were provided and the date(s) that the services were provided so that an audit trail documenting service provisions can be maintained. (3) It is preferred that all correspondence, reports, records and documentation may be provided to the department's contract manager electronically, if this is not feasible, or is not received by the department's contract manager, then hard copies must be mailed to the department's contract manager to be received by the appropriate due dates. (4) The managing entity shall comply with activities related to information systems in compliance with the department's CFP 155 -2, which is incorporated herein by reference and is maintained on the department's website. c. Reports Where this contract requires the delivery of reports to the department, mere receipt by the department shall not be construed to mean or imply acceptance of those reports. It is specifically intended by the parties that acceptance of required reports shall require a separate act in writing. The department reserves the right to reject reports as incomplete, inadequate, or unacceptable according to the parameters set forth in the resulting contract. The department, at its option, may allow additional time within which the managing entity may remedy the objections noted by the department or the department may, after having given the managing entity a reasonable opportunity to comply with the report requirements, declare this agreement to be in default. (1) The managing entity shall submit to the department financial and programmatic reports specified in B.1.a.(10) above and Exhibit G, Required Reports by the dates specified. (2) The managing entity shall monitor and ensure that network providers submit treatment data, as set out in subsection 394.74(3) (e), F.S. and Rule 65E- 14.022, F.A.C. Data shall be submitted electronically to the department by the managing entity by the 15 of each month as specified in Department of Children and South Florida Behavioral Health Network, Inc. 65 KH225 10/01/2010 Managing Entity Families' Pamphlet 155 -2 - Mental Health and Substance Abuse Measurement and Data (CFP 155 -2). The managing entity shall also monitor and ensure that: (i) Ensure that the data submitted clearly documents all client admissions and discharges which occurred under this contract; (ii) Ensure that all data submitted to the Substance Abuse and Mental Health Information System (SAMHIS) is consistent with the data maintained in the provider's clients' files; (iii) Review the department's File Upload History screen in SAMHIS to determine the number of records accepted, updated and rejected. Based on this review, the provider shall download any associated error files to determine which provider records were rejected and to make sure that the rejected records are corrected and resubmitted in the SAMHIS; (iv) Resubmit corrected records no later than the next monthly submission deadline. The failure to submit any data set or the provider's total monthly submission per data set, which results in a rejection rate of 10% or higher of the number of monthly records submitted will require the provider to submit a corrective action plan describing how and when the missing data will be submitted or how and when the rejected records will be corrected and resubmitted; and (v) In accordance with the provisions of section 402.73(7), F. S., and Rule 65- 29.001, F.A.C., corrective action plans may be required for non- compliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed for failures to implement or to make acceptable progress on such corrective action plans. (3) Upon request, the managing entity shall submit to the department information regarding the amount and number of services paid for by the Community Mental Health Services Block Grant and /or the Substance Abuse Prevention and Treatment Block Grant. (4) The managing entity shall submit audit reports for the managing entity and its subcontracted network providers. The managing entity shall ensure that all audit reports will include the standard schedules that are outlined in Rule 65E- 14.003, F.A.C. The managing entity shall submit to the department's contract manager copies of their and all subcontractors' financial and compliance audit reports. (5) The managing entity shall provide oversight so that all network providers comply with section I.D. (Audits, Inspections, Investigations, Records and Retention) of the Standard Contract and with Financial and Compliance Audit attachment. (6) The managing entity must ensure that all children's mental health providers complete a typed quarterly progress report that is filed in the medical record. The provider is required to provide Children and Families or Community Based Care workers, immediately upon request, with the most recent quarterly written report South Florida Behavioral Health Network, Inc. 66 KH225 10/01/2010 Managing Entity detailing the progress, current status and therapeutic needs of the named child. 5. Performance Specifications a. Performance Measures (1) The managing entity shall meet the performance standards and required outcomes as specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes /Outputs and Indirect Prevention Performance Measures, which is incorporated herein by reference, or by obtaining a waiver from SAMH or implementing a corrective action plan as approved by SAMH to ensure that its subcontracted network providers meet these performance standards and required outcomes. (2) The managing entity agrees that the Substance Abuse and Mental Health Information System (SAMHIS) Data System will be the source for all data used to determine compliance with performance standards and outcomes in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes /Outputs Indirect Prevention Performance Measures, which is incorporated herein by reference. The managing entity shall provide oversight to ensure that all network providers submit all service related data for clients funded, in whole or in part, by SAMH funds and local match. (3) The managing entity shall ensure that all subcontractors providing prevention services submit prevention data to the Performance Based Prevention System (PBPS) which is maintained by KIT Solutions. (4) The managing entity agrees that the Performance Based Prevention System will be the source for all data used to determine compliance with substance abuse prevention related performance standards and outcomes in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes /Outputs Indirect Prevention Performance Measures, which is incorporated herein by reference. The managing entity shall submit all service related data for clients funded, in whole or in part, by SAMH funds. (5) The managing entity shall monitor and ensure that Prevention Program Coordinator at applicable subcontractor agencies and any other personnel responsible for directly entering data into the Prevention data system must register for data entry training on PBPS and complete online or face -to -face training within 30 days of hire, and annually thereafter. Subcontractors must maintain the certificate of attendance for all participants for all trainings. This does not apply to providers who have their own data system and upload data to PBPS. b. Performance Measurement Terms CFP 155 -2 provides the definitions of the data elements used for various performance measures which are quantitative indicators, outcomes, and outputs used by the department to objectively measure a provider's performance, and contains policies and procedures for submitting the required data into the department's data system. South Florida Behavioral Health Network, Inc. 67 KH225 10/01/2010 Managing Entity c. Performance Evaluation Methodology (1) The managing entity shall require that the network providers collect information and submit performance data and individual client outcomes, to the department data system in compliance with CFP 155 -2 requirements. The specific methodologies for each performance measure may be found at the following website: http://dashboard.dcfstate.fl.us/index.cfm?page=menu programs details (2)The managing entity agrees that its performance under this contract must meet the standards set forth above and will be bound by the conditions set forth in this contract. If the managing entity fails to meet these standards, the department, at its exclusive option, may allow a reasonable period, not to exceed 6 months, for the managing entity to correct performance deficiencies. If performance deficiencies are not resolved to the satisfaction of the department within the prescribed time, and if no extenuating circumstances can be documented by the managing entity to the department's satisfaction, the department must terminate the resulting contract. The department has the sole authority to determine whether there are extenuating or mitigating circumstances. (3) The department's contract manager will monitor the standards and outcomes specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes /Outputs and Indirect Prevention Performance Measures (incorporated herein by reference), during the contract period, to determine if the managing entity is achieving the levels that are specified. 6. Managing Entity (ME) Responsibilities a. Managing Entity Unique Activities The managing entity is responsible for the satisfactory performance of the tasks referenced in Section B.1.a. of this contract. By executing this contract, the managing entity recognizes its responsibility for the tasks, activities, and deliverables described herein and warrants that it has fully informed itself of all relevant factors affecting the accomplishment of the tasks, activities and deliverables and agrees to be fully accountable for the performance thereof whether performed by the managing entity or its subcontractors. In addition, the managing entity shall: (1) Provide performance information or reports other than those required by this agreement at the request of the Southern Region's SAMH Program Supervisor, or their designee. For requests that are complex and difficult to address, the managing entity and the department will develop and implement a mutually viable work plan. (2) Cooperate with the department when investigations are conducted regarding a regulatory complaint of the managing entity subcontractors. South Florida Behavioral Health Network, Inc. 68 KH225 10/01/2010 Managing Entity (3) Provide oversight so that clients receive assistance in making an informed choice of network provider services that are appropriate for their condition and are of high quality. (4) Upon request, assist network providers with development and implementation of client admission, continued stay, discharge criteria specific to each level of care, diagnosis, presenting problems, and the establishment of review dates. (5) Make available and communicate all plans, policies, procedures, and manuals to the managing entity staff, network provider staff, and to clients/ stakeholders if applicable. The managing entity shall use the department's operating procedures for all agency procedures that have not been previously approved by the department for implementation. While strict interpretation of the department's procedures may not be translatable to the managing entity's organizational or operating structure, the intent of the procedure or process should be adhered to. If there are procedural issues that result in ambiguity, the parties shall meet to resolve the issue. The managing entity shall have their operating procedures submitted for review and approval not later than March 31, 2011, or as otherwise specified in the approved annual action plan. (6) Maximize all potential sources of revenue to increase services, and institute efficiencies that will consolidate infrastructure and management functions in order to maximize funding, as specified in the approved annual action plan. (7)Have a data system in place that adequately supports the collection, tracking, and analysis of data necessary to perform utilization management activities, reviews of clinical /administrative performance related to levels of care, clinical outcomes, and adherence to clinical /administrative standards. (8) Make available to the department all subcontractor reports and corrective action plans, pertaining to outside licensure, accreditation, or other funding entities. (9) Integrate current and /or new state /federal requirements and policy initiatives into its operations upon provision by the department of the same. (10) Assist the department in developing legislative budget requests based upon identified needs of the community. (11) Maintain policies and procedures and documents that permit the reconciling of the invoices submitted to the department. The invoices shall reconcile with the amount of funding and services specified in this contract as well as the agency's audit report and client information system. (12) Make individual subcontract files available to the department, State auditors, and Federal auditors upon request. (13) Make available source documentation of units billed by sub - contracted network providers upon request from the department's contract manager. South Florida Behavioral Health Network, Inc. 69 KH225 10/01/2010 Managing Entity (14) Client Trust Funds (CTF) (a) If the network providers are the representative payee of clients, the managing entity shall provide oversight so that network providers comply with the applicable federal laws regarding the establishment and management of individual client trust accounts (20 CFR 416 and 31 CFR 240). (b) The managing entity shall provide oversight so that the network providers' assuming responsibility for administration of the personal property and funds of clients shall follow the department's Accounting Procedures Manual APM Volume 7, Chapter 6, incorporated herein by reference (7APM6). The department personnel or their designees, upon request, may review all records relating to this section. Any shortages of client funds that are attributable to the network providers shall be repaid, plus applicable interest, within one week of the determination. (c)The managing entity shall provide oversight so that, the subcontractors maintain all reconciliation records on -site for review, not withstanding 7 APM 6 Section 15. (15) Provide management and oversight so that all network providers that receive federal block grant funds from the Substance Abuse Prevention and Treatment or Community Mental Health Block Grants shall comply with Subparts I and II of Part B of Title XIX of the Public Health Service Act, sections 42 U.S.C. 300x -21 et seq. (as approved September 22, 2000) and the Health and Human Services (HHS) Block Grant regulations (45 CFR Part 96). (a) If funding is received from the Substance Abuse Prevention and Treatment Block Grant, the managing entity shall comply and take the steps necessary such that all network providers comply with the data submission requirements outlined in CFP 155 -2 and within the funding restrictions outlined in "SAMH OCA's and Funding Restrictions" incorporated herein by reference. (b) The managing entity shall make available through its subcontractors, either directly or by arrangement with others, tuberculosis services to include counseling, testing and referral for evaluation and treatment. (c) Funds under this grant may be used to support substance abuse treatment services for individuals with a co- occurring mental disorder as long as the funds allocated are used to support substance abuse prevention and treatment services and mental health treatment and supports can be tracked to the specific substance abuse or mental health activity as listed in the State Funding by Program and Activity, which is incorporated herein by reference. (d) If funding is received from the Substance Abuse Prevention and South Florida Behavioral Health Network, Inc. 70 KH225 10/01/2010 Managing Entity Treatment Block Grant, the managing entity shall ensure that all network providers are required to participate in the State's Peer Review process if applicable to assess the quality, appropriateness, and efficacy of treatment services provided to individuals under this contract pursuant to 45 CFR 96.136. (16) Maintain data, pursuant to section 402.73, F.S., on performance standards specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes /Outputs and Indirect Prevention Performance Measures (incorporated herein by reference), for the types of services provided under this contract and shall submit such data to the department upon request. All data submission requirements can be found in CFP 155 -2. (17) Require that all network providers comply with Exhibit E, Missing Children, which is incorporated herein by reference and available from the contract manager, if the provider is providing these services. (18) Maintain any collaborative agreements between the department and other governmental /non - governmental agencies as mutually agreed upon by the department. (19) Prevention Partnership Grants The managing entity shall be responsible for the contracting and oversight of the Prevention Partnership grants, incorporated herein by reference, and shall ensure compliance with the language and provisions of the awarded grants. (20) Indigent Drug Program The managing entity will provide oversight monitoring and service validation for the IDP network providers to ensure that all funds allocated (see Funding Detail) are utilized for purchasing psychotropic medications or medications accessed through the "Line of Credit" from the Indigent Drug Program (IDP), as per state's existing allocations when this contract is executed: (a) The managing entity will monitor subcontractors so that they utilize IDP funds for individuals who meet any of the following criteria: 1) Have an annual income that is at or below 150% of the Federal Poverty Income Guidelines, as published annually in the Federal Register. 2) Have no liable third -party insurance or other source of psychotropic medications available, nor is the individual a participant in a program where psychotropic medications are paid for by any other funding source. 3) If the individual has third party insurance for psychotropic medications but has temporarily been denied benefits for these medications, they South Florida Behavioral Health Network, Inc. 71 KH225 10/01/2010 Managing Entity may receive IDP medications until such time as eligibility has been reestablished. (b) The managing entity will manage the IDP allotment as follows: 1) Disseminating IDP Year -To -Date (YTD) Activity Reports to all providers as received from Florida State Hospital. 2) Monitoring providers to ensure utilization & prevent lapsed funds. b. Coordination with other Providers /Entities (1) The provider agrees to coordinate services with other providers and state entities rendering services to children, adults, and families as the need is identified by either the department or the provider or as defined in the approved annual action plan. (2) The failure of other providers or entities does not relieve the provider of any accountability for tasks or services that the provider is obligated to perform pursuant to this contract. (3) The managing entity will ensure through its subcontractors that crisis mental health services are available to Protective Investigators to support the principle of keeping children in the home whenever possible. c. Minimum Service Requirements See Exhibit F, Minimum Service Requirements. 7. Department Responsibilities a. Department Obligations (1) The department will provide information related to any part of this contract's budget, training events, and changes in applicable state and federal laws, regulations, administrative rules, operating procedures, or department policies, including those references listed in Exhibit F, Minimum Service Requirements to designated managing entity personnel in a timely manner. (2) The department will provide technical assistance and support to the managing entity and the network providers to ensure the continued integration of services and support for clients. The department will provide technical assistance and support to the managing entity for the maintenance and reporting of data on the performance standards that are specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes /Outputs and Indirect Prevention Performance Measures (incorporated herein by reference). (3) The department will participate in developing the Contingency Transition Plan, which is incorporated herein by reference. South Florida Behavioral Health Network, Inc. 72 KH225 10/01/2010 Managing Entity (4) If the managing entity is under a corrective action plan, the department will conduct monthly oversight activities to ensure compliance with the plan. (5) The department will participate in the collaborative development and implementation of the working agreement with the Community Based Care and substance abuse and mental health providers to ensure the integration of services and support within the community. The department will support the development and implementation of the working agreement by providing an example of a policy working agreement, system of care information, data reporting requirements and technical assistance. (6) The department will review the managing entity's proposed policies, procedures, and plans required to be submitted by the managing entity and will respond in writing with comments, or will approve within 30 working days from the day of receipt. Once reviewed by the department, the managing entity's policies and procedures may be amended without further departmental review, provided that they conform to state and federal laws, the state Administrative Code, and federal regulations. (7) At a minimum, the Southern Region's SAMH Program Supervisor will meet quarterly with the managing entity to obtain a briefing on the network's operations. The meeting can be in person or by the phone. (8) The department will request supporting documentation and review source documentation of units billed to the department. (9) The department will make available to the managing entity any inter or intra- departmental collaborative agreements and /or any other collaborative agreements between the department and other governmental /non - governmental agencies. b. Department Determinations The managing entity agrees that services other than those set out in this contract will be provided only upon receipt of a written authorization from the department's contract manager or an authorized department staff member. The department has final authority to make any and all determinations that affect the health safety and well being of the citizens of the State of Florida. c. Monitoring Requirements (1) The department will monitor the managing entity in accordance with section 394.741, F.S. and CFOP 75 -8, Contract Monitoring Operating Procedures and be obtained from the contract manager, and is incorporated herein by reference. The managing entity shall comply with any coordination or documentation required by the department's evaluator(s) to successfully evaluate the programs, and shall provide complete access to all budget and financial information related to services provided under this contract, regardless of the source of funds. South Florida Behavioral Health Network, Inc. 73 KH225 10/01/2010 Managing Entity (2) The department will monitor the managing entity on its performance of all tasks and special provisions of the contract. (3) The department will provide a written report to the provider within 30 days of the monitoring. If the report indicates corrective action is necessary, the provider shall have 30 days from receipt of the monitoring report to respond in writing to the request. Except in the case of threat to life or safety of clients, in which case the corrective action will be immediate. C. Method of Payment 1. Payment Clauses a. This is an advance cost reimbursement and fixed price, fixed payment contract, comprised of Federal sources and a grant of State funds. The Funding Detail is the document that identifies the amount of Federal and Grant resources. The department will ensure that any applicable appropriated funding for direct substance abuse and mental health services is contracted with the managing entity. Any increases will be documented through a contract amendment, resulting in a current fiscal year funding and corresponding services increase. Such increases in services must be supported by additional deliverables as outlined in the amendment. At the beginning of each fiscal year, the Funding Detail will be amended into this contract, and the total contract amount will be adjusted accordingly. The department shall pay the Managing Entity for the delivery of services provided in accordance with the terms of this contract for a total dollar amount not to exceed $362,976,259.00 subject to the availability of funds. A summary of the Funding Detail is attached as follows: Exhibit A- 1 Fiscal Year 10 -11 $54,851,259.00 Exhibit A- 2 Fiscal Year 11 -12 $TBD Exhibit A- 3 Fiscal Year 12 -13 $ TBD Exhibit A- 4 Fiscal Year 13 -14 $ TBD Exhibit A- 5 Fiscal Year 14 -15 $ TBD Exhibit A- 6 Fiscal Year 15 -16 $ TBD (1) Network Provider Service Expenses — Cost Reimbursement (a) The department shall reimburse the payment of the delivery of service units provided by approved network providers that are provided in accordance with the terms and conditions of this contract, not to exceed the following, based on the Funding Detail, subject to the availability of funds. Fiscal Year Subcontracted Services Total Amount 2010 -2011 $51,703,875.00 2011 -2012 $ TBD 2012 -2013 $ TBD 2013 -2014 $ TBD 2014 -2015 $ TBD 2015 -2016 $ TBD South Florida Behavioral Health Network, Inc. 74 KH225 10/01/2010 Managing Entity (b) The department will make payment to the managing entity, on a cost reimbursement basis, for the delivery of behavioral health services. Payments to the managing entity shall be made based upon the actual payments made to approved network providers and invoices will require submission of the approved subcontractors' paid invoices. No reimbursement will be made by the department for payments made by the Managing Entity to subcontractors not previously approved by the department. (2) Administrative Expenses — Fixed Price, Fixed Payment The department shall make a fixed monthly payment to the managing entity for the administration, management, and oversight of the Behavioral Health System of Care, not to exceed the following, subject to the availability of funds: Service Unit Fixed Fee # of Units Total Amount One Month of Administration, Management and Oversight $ 287,828.00 9 $ 2,590,452.00 (10/01/10-06/30/11) One Month of Administration, Management and Oversight $ TBD 12 $ TBD (07/01/11-06/30/12) One Month of Administration, Management and Oversight $ TBD 12 $ TBD (07/01/12-06/30/13) One Month of Administration, Management and Oversight $ TBD 12 $ TBD (07/01/13-06/30/14) One Month of Administration, Management and Oversight $ TBD 12 $ TBD (07/01/14-06/30/15) One Month of Administration, Management and Oversight $ TBD 3 $ TBD (07/01/15-09/30/15) (a) The department will make payment to the managing entity for the administration, management, and oversight of the Behavioral Health System of Care (to include the administration of special projects as identified in the approved annual action plan) based on a fixed price, fixed payment method of payment. A fee equal to one twelfth of the annual administrative expenses will be paid monthly. The monthly payment for administrative expenses is based on the final negotiated approved Line Item Operating Budget (Exhibit B) and Budget Narrative, incorporated herein by reference. The department during a given fiscal year may require the managing entity to prepare and negotiate a revised line item operating budget and scope of work South Florida Behavioral Health Network, Inc. 75 KH225 10/01/2010 Managing Entity for the allowable administrative expenses charged to the department based on decreases and increases of the approved Line Item Operating Budget (Exhibit B). (b) The managing entity will submit monthly expenditure reports for department review, no later than 30 days after the end of the month for which payment is being requested. The expenditure reports must reconcile actual administrative expenditures incurred by the managing entity versus payments for administrative expenses disbursed to the managing entity by the department. The managing entity will submit a final expenditure report within 30 days of the end of the fiscal year for department review to determine if there are any unspent funds /overpayments that need to be returned and /or reallocated to the department. Any unearned administrative funds identified in the reconciliations will be considered overpayments and will be recouped by the department. Repayment, if applicable, should be made immediately per section 1.J. of the Standard Contract. (c) The managing entity will have a total of 10% flexibility within the approved Line Item Operating Budget (Exhibit B) for allowable administrative expenses. Any budget revision that is required beyond the 10% flexibility must be submitted to the department and approved by the designated representative prior to its implementation. Any line item funding allocated under Special Projects in the Line Item Operating Budget will have no flexibility. Any budget revision shall be submitted to the contract manager and maintained in the contract manger's file. (d) Payment may be authorized only for allowable monthly expenditures, which are in accordance with the approved Line Item Operating Budget (Exhibit B). b. Renewal Clause - This is a multiple year contract for five (5) years. This contract may be renewed for a term of up to five (5) years. Such renewal shall be made by mutual agreement and shall be contingent upon satisfactory performance evaluations as determined by the department and shall be subject to the availability of funds. Any renewal shall be in writing and shall be subject to the same terms and conditions as set forth in the initial contract, including amendments. c. The managing entity shall provide local match on its own or through its network providers, according to Rule 65E- 14.005, F.A.C., up to the amount specified in Exhibit A, Funding Detail. d. If the managing entity intends to close or suspend the provision of subcontracted services funded by this contract, the managing entity agrees to notify the department in writing at least sixty (60) calendar days prior to their intent to close, suspend or end service(s). 2. MyFloridaMarketPlace Transaction Fee South Florida Behavioral Health Network, Inc. 76 KH225 10/01/2010 Managing Entity This contract is exempt from the MyFloridaMarketPlace Transaction Fee in accordance with Rule 60A- 1.032(1) (d), F.A.C. 3. Advance Payment a. The managing entity may request an advance for the first and second month of each fiscal year, based on anticipated cash needs, subject to approval by the Department of Financial Services. b. In accordance with subsection 216.181(16)(b), F.S., any interest earned on advanced funds shall be returned to the department. The managing entity must submit back up documentation from the financial entity where interests were accrued supporting the Annual Percentage Rate and actual interest earned for each month. c. The initial invoices for advances will not require the submission of supporting documentation at the time of the request for the advance, but supporting documentation will be required for all invoices submitted after actual costs have been incurred. d. After the initial advance period, the managing entity agrees to request payment based on actual payments made to the subcontractors beginning with the first month that was advanced in accordance with the scheduled in Section f. below. e. Any funds that were advanced to the managing entity for administrative expenses and /or subcontracted services that were not accounted for and recouped through the final fiscal year end reconciliation of actual expenditures shall be returned to the department at the end of each state fiscal year with the submission of the final invoice for the fiscal year. f. Scheduling the Advance Payment: The following is an example of how to schedule the submission of advance and reimbursement requests: For Fiscal Year 2010 -2011: Month Type of Request Based On: Date of Submission October Advance Anticipated Cash Needs October 1st November Advance Anticipated Cash Needs October 1 December Reimbursement October Actual Expenditures November 30th January Reimbursement November Actual Expenditures December 30 February Reimbursement December Actual Expenditures January 30 March Reimbursement January Actual Expenditures February 30th April Reimbursement February Actual Expenditures March 30th May Reimbursement March Actual Expenditures April 30 June Reimbursement April Actual Expenditures May 30 Reconciliation Recoupment May Actual Expenditures June 30th Reconciliation Recoupment June Actual Expenditures July 30th Final FY Invoice Reconciliation — Final Year to date Actual Expenditures July 30th Expenditure Report as of June 30 South Florida Behavioral Health Network, Inc. 77 KH225 10/01/2010 Managing Entity For Fiscal Year 2011 -2015 Month Type of Request Based On: Date of Submission July Advance Anticipated Cash Needs July 1 August Advance Anticipated Cash Needs July 1st September Reimbursement July Actual Expenditures August 30 October Reimbursement August Actual Expenditures September 30th November Reimbursement September Actual Expenditures October 30 December Reimbursement October Actual Expenditures November 30th January Reimbursement November Actual Expenditures December 30 February Reimbursement December Actual Expenditures January 30 March Reimbursement January Actual Expenditures February 30th April Reimbursement February Actual Expenditures March 30th May Reimbursement March Actual Expenditures April 30 June Reimbursement April Actual Expenditures May 30 Reconciliation Recoupment May Actual Expenditures June 30th Reconciliation Recoupment June Actual Expenditures July 30 Final Invoice Reconciliation — Final Year to date Actual Expenditure July 30 Expenditure Report as of June 30 Fiscal Year 2015 -2016 Month Type of Request Based On: Date of Submission July Advance Anticipated Cash Needs July 1 August Advance Anticipated Cash Needs July 1st September Reimbursement July Actual Expenditures August 30 Reconciliation Recoupment August Actual Expenditures September 30th Final Invoice Reconciliation — Final Year to Date Actual Expenditure October 30 Expenditure Report as of September 30th 4. Reconciliation of Advanced Funds a. Monthly expenditure reports for the month which reimbursement is being requested shall be submitted by the managing entity along with their request for reimbursement in accordance with the above schedule. b. During g the first year of this contract, a reconciliation report will be required after the 6 and 8t month. During the remaining years of this contract, a reconciliation report will be required monthly. c. All of the interest earned on advanced funds shall be returned to the department on a monthly basis, either through the submission of a monthly check or an adjustment to the monthly invoice. d. The department reserves the right to request reimbursement for advances issued to the provider that exceed actual provider expenditures that cannot be reasonably justified through these expenditure reconciliation reports. South Florida Behavioral Health Network, Inc. 78 KH225 10/01/2010 Managing Entity e. Advanced funds shall be reconciled during the final two months of each fiscal year, either through the submission of a check or an adjustment to the invoice. 5. Additional Release of Funds At its sole discretion the department may approve the release, of more than the monthly - prorated amount when the managing entity submits a written request justifying the release of additional funds, if funds are available and the services have been provided. 6. Medicaid Billing a. Medicaid earnings cannot be used as local match. In the absence of the Medicaid Electronic Verification report, the managing entity will rely on the subcontractors billing information. b. Subject to the availability of the Medicaid Electronic Verification, the managing entity shall require that the Medicaid enrolled network providers will not bill the department for Medicaid billable services provided to Medicaid eligible recipients. FACT services for Medicaid clients can be billed to the department. c. However, when services are covered under the Florida Medicaid program for Medicaid recipients and the recipient does not have other third party coverage, the department shall not be considered a liable third party for Mental Health and Substance Abuse Program payments funded through the department. Services shall then be billed to Medicaid and not the department; d. The managing entity shall monitor that authorized subcontractor services only be billed to the department if services are provided to non - Medicaid recipients, and /or for non - Medicaid covered services, and no other non - Medicaid first or third party payors are available; e. The managing entity shall monitor to ensure that in no event subcontractor's bill the Medicaid program for services or expenses for Medicaid recipients for which the subcontractor has already been paid by any other liable third party payor; f. The managing entity shall monitor Network Provider subcontractors to ensure that Medicaid earnings separate from all other fees; g. The managing entity shall monitor Network Provider subcontractors to ensure that Medicaid payments are accounted for in compliance with federal regulations; h. In no event shall both Medicaid and the department be billed for the same service; i. The managing entity shall monitor to ensure that subcontractor operating a facility licensed as a crisis stabilization unit, detoxification facility, short-term residential treatment facility, residential treatment facility Levels 1 or 2, or therapeutic group home that is greater than 16 beds is not permitted to bill or knowingly access Medicaid Fee - South Florida Behavioral Health Network, Inc. 79 KH225 10/01/2010 Managing Entity For - Service programs for any services for recipients while in these facilities; j. The managing entity shall monitor to ensure that subcontractors operating a children's residential treatment center of greater than 16 beds is not permitted to bill or knowingly access Medicaid Fee - For - Service programs for any services for recipients in these facilities except as permitted under the Medicaid State Inpatient Psychiatric Program Waiver; k. The managing entity shall monitor that subcontractors assist clients who need assistance and who may be eligible for Medicaid to make application including assistance with medical documentation required in the disability determination process; and I. The managing entity shall monitor to ensure that subcontractors agree to assist Medicaid recipients covered by a Medicaid capitated entity who need and request assistance to obtain covered mental health services that the treating provider considers to be medically necessary. This assistance shall include assisting clients in appealing a denial of services. 7. Billing for Non - Medicaid Recipient and /or Medicaid Covered Children Mental Health Services The managing entity will insure that all providers agree that prior to billing the department for non - Medicaid recipient or for non - Medicaid covered services; the provider will seek payment from all other first or third party - payor. In no event shall the provider bill the department for services already paid by any other liable first or third party payor. 8. Payments from Medicaid Health Maintenance Organizations, Prepaid Mental Health Plans, or Provider Services Networks. Unless waived in Section D (Special Provisions) of this contract, the managing entity agrees that payments from a health maintenance organization, prepaid mental health plan, or provider services network will be considered to be "third party payer" contractual fees as defined in Rule 65E- 14.001(2)(z), F.A.C. Services which are covered by the subcapitated contracts and provided to persons covered by these contracts must not be billed to the department. 9. Temporary Assistance to Needy Families (TANF) Billing The managing entity shall fulfill its obligations under applicable parts of Part A or Title IV of the Social Security Act and ensure that TANF funds shall be expended for TANF participants as outlined in the Temporary Assistance to Needy Families (TANF) Guidelines. Subcontractors' contracts shall specify the unit cost rate for each cost center contracted for TANF funding. TANF Guidelines can be obtained from the contract manager, or can be found at the following web site: http://www.dcf.state.fLusimentalhealth/contract/index.shtml South Florida Behavioral Health Network, Inc. 80 KH225 10/01/2010 Managing Entity 10. TANF SAMH Incidental Expenditures for Housing Assistance The managing entity shall comply with the provision of TANF SAMH Incidental Expenditures for Housing Assistance, which is incorporated herein by reference. 11. Invoice Requirements a. The reimbursement for the administrative costs incurred in the administration, management and oversight for behavioral health services and the reimbursement for costs incurred in the delivery of service units or other agreed upon methods of payments provided by subcontracted network providers shall be invoiced separately by the managing entity using the following invoice formats or other agreed upon formats: See Exhibit C - Managing Entity Administrative Services Monthly Request for Payment/Advance and Exhibit C - Network Provider Services Cost Reimbursement Report of Expenditures and Request for Payment/Advance. b. Subcontracted Network Providers (1) The rates negotiated with any subcontracted network provider may not exceed the model rate as specified in Rule 65E -14, F.A.C. Any exception to this must be approved in advance in writing by the department. (2) Subcontractors will be required to comply with Rule 65E- 14.021, Unit Cost Method of Payment, including but not limited to, cost centers, unit measurements, descriptions, program areas, data elements, maximum unit cost rates, required fiscal reports, program description, setting unit cost rates, payment for services including allowable and unallowable units and requests for payments. If agreed upon with the department, other payment methods may be permitted. c. The managing entity's final invoice of each fiscal year must reconcile actual expenditures during the fiscal year with the amount paid by the department. The managing entity shall submit its fiscal year final invoice and expense report to the department within thirty (30) days after the end of each state fiscal year in the contract period. d. If no services are due to be invoiced from the preceding month, the managing entity shall submit a written document to the department indicating this information within thirty (30) days following the end of the month e. Invoices shall be submitted in detail sufficient for a proper pre -audit and post- audit. f. Supporting Documentation Requirements The managing entity shall submit the following documentation in support of their invoices. South Florida Behavioral Health Network, Inc. 81 KH225 10/01/2010 Managing Entity (1) Administrative Services To support the administrative services unit of service (Exhibit C - 1), the managing entity will submit a properly completed invoice along with an expense reports as required in section C.1.a. and a report of any interest earned on advanced funds. (2) Subcontracted Network Provider Service Delivery (a) To support subcontracted network providers line item invoices (Exhibit C - 2), the managing entity shall submit to the contract manager a copy of the properly completed invoice submitted for payment by each subcontracted network provider and a copy of the managing entity's proof of payment (copy of subcontractors' paid invoice) to each subcontracted network provider for the month for which reimbursement is requested. (b) The amount paid under this contract cannot exceed the total amount of funding as specified in the Funding Detail. The Southern Region SAMH Program Office allocates the funding for this line item. (c) The managing entity is responsible for verifying the accuracy of each subcontracted network provider's invoice. (d) The managing entity shall ensure that all services provided by its subcontracted network providers are entered into the SAMHIS or other data system designated by the department. 12. The managing entity shall complete and submit to the department a Utilization /Lapse Report as per the approved annual action plan. 13. A separate detailed annualized line item budget with corresponding narrative for the operational costs for the administration and oversight must be submitted at least sixty (60) days before the beginning of each fiscal year during the proposed contract and renewal period. D. Special Provisions (1) Option for Increased Services The managing entity acknowledges and agrees that the contract may be amended to include additional, negotiated, services as deemed necessary by the department. Additional services can only be increased if the managing entity demonstrates competence. (2) Dispute Resolution a. The parties agree to cooperate in resolving any differences in interpreting the contract. Within five (5) working days of the execution of this contract, each party shall designate one person to act as the its representative for dispute resolution purposes, South Florida Behavioral Health Network, Inc. 82 KH225 10/01/2010 Managing Entity and shall notify the other party of the person's name and business address and telephone number. Within five (5) working days from delivery to the designated representative of the other party of a written request for dispute resolution, the representatives will conduct a face to face meeting to resolve the disagreement amicably. If the representatives are unable to reach a mutually satisfactory resolution, either representative may request referral of the issue to the Executive Director and the Program Supervisor of the respective parties. Upon referral to this second step, the Executive Director and the Program Supervisor shall confer in an attempt to resolve the issue. b. If the Program Supervisor and Executive Director are unable to resolve the issue within ten (10) days, the parties' appointed representatives shall meet within ten (10) working days and select a third representative. These three representatives shall meet within ten (10) working days to seek resolution of the dispute. If the representatives' good faith efforts to resolve the dispute fail, the representatives shall make written recommendations to the Assistant Secretary, or designee, who will work with both parties to resolve the dispute. The parties reserve all their rights and remedies under Florida law. Venue for any court action will be in Leon County, Florida. (3) Termination Paragraph III. C.1. of the Standard Contract is deleted in its entirety, and the following language is inserted in lieu thereof: "This contract may be terminated by either party without cause upon no Tess than ninety (90) calendar days notice in writing to the other party unless a sooner time is mutually agreed upon in writing. Said notice shall be delivered by US Postal Service or any expedited delivery service that provides verification of delivery or by hand delivery to the contract manager or the representative of the provider responsible for administration of the program. If either party terminates this contract without cause, that party shall coordinate a transition plan, as described in the "Contingency Transition Plan ", which is incorporated herein by reference, with the other party within 30 calendar days of making such notification. This provision shall not limit the department's ability to terminate this contract for cause according to other provisions herein. (4) Sliding Fee Scale The managing entity shall require the network providers to comply with the provisions of Rule 65E- 14.018, F.A.C. A copy of the subcontractors sliding fee scales that reflects the uniform schedule of discounts referenced in Rule 65E- 14.018(4), F.A.C. shall be furnished by the managing entity to the department's contract manager within thirty (30) days of contract execution. The managing entity shall submit to the contract manager, within thirty (30) days of the execution of this contract, a validation that all sliding fee scales have been received from all network providers and reviewed by the managing entity for compliance. (5) Transportation Disadvantaged The managing entity agrees to comply with and provide oversight so that all network providers will comply with the provisions of chapter 427, F.S., Part I, Transportation Services, and chapter 41 -2, F.A.C., Commission for the Transportation Disadvantaged, if South Florida Behavioral Health Network, Inc. 83 KH225 10/01/2010 Managing Entity public funds provided under this contract will be used to transport consumers. The managing entity agrees to comply with and provide oversight so that all network providers will comply with the provisions of (CFOP 40 -50) if public funds provided under this contract will be used to purchase vehicles, which will be used to transport consumers. (6) Agreements with Health Maintenance Organizations /Managed Care Organizations a. The managing entity shall notify the department's contract manager, in writing, prior to entering into a contract for the provision of substance abuse and mental health services with a health maintenance organization or other managed care organization that is capitated by Medicaid to provide substance abuse and mental health services or an agent of any such health maintenance organization or other managed care organization. b. Copies of the contract shall be furnished to the department's contract manager within thirty (30) days of execution. (7) Medicaid Enrollment Those providers with substance abuse and mental health contracts in excess of $500,000 annually and rendering substance abuse services shall enroll as a Medicaid provider. This process shall be initiated within 90 days of contract execution. A waiver of this requirement may be granted, in writing, by the Director of Substance Abuse. (8) National Provider Identifier a. All health care providers are eligible to be assigned a Health Insurance Portability and Accountability Act National Provider Identifiers (NPIs); however, health care providers who are covered entities (which include all State - Contracted Community SAMH providers and State Treatment Facilities) must obtain and use NPIs. b. An application for an NPI may be submitted online at: https: / /nppes.cros.hhs.gov /NPPES /StaticForward.do ?forward= static.npistart. c. Additional information can be obtained from one of the following websites: (1) The Florida Medicaid Health Insurance Portability and Accountability Act web site: http: / /www.fdhc.state.fl.us /Medicaid /hipaa /NPI /npi.shtml (2) The National Plan and Provider Enumeration System (NPPES) located at: https: / /nppes .cros.hhs.qov /NPPES/Welcome.do, (3) The CMS NPI web page located at: http:// www. cros. hhs .qov /NationalProvldentStand /. (9) Ethical Conduct The managing entity understands that performance under this contract involves the expenditure of public funds from both the state and federal governments, and that the acceptance of such funds obligates the provider to perform its services in accordance with South Florida Behavioral Health Network, Inc. 84 KH225 10/01/2010 Managing Entity the very highest standards of ethical conduct. No employee, director, officer, agent of the provider or network provider shall engage in any business, financial or legal relationships that undermine the public trust, whether the conduct is unethical, or lends itself to the appearance of ethical impropriety. Provider's and network providers' directors, officers or employees shall not participate in any matter that would inure to their special gain, and shall recuse themselves accordingly. Public funds may not be used for purposes of lobbying, or for political contributions, or for any expense related to such activities, pursuant to Section I. R.of the Standard Contract of this contract. The provider understands that the department is a public agency which is mandated to conduct business in the sunshine, pursuant to section 286.011, F.S., and chapter 119, Florida Law, and that all issues relating to the business of the department and the provider are public record and subject to full disclosure. The provider understands that attempting to exercise undue influence on the department and its employees to allow deviation or variance from the terms of this contract other than a negotiated, publicly disclosed amendment, is prohibited by the State of Florida, pursuant to Section III. C. of the Standard Contract and section 286.011, F.S. The provider's conduct is subject to all state and federal laws governing the conduct of entities engaged in the business of providing services to government. (10) Mandatory Reporting Requirements a. The provider and any subcontractor must comply with and inform its employees of the following mandatory reporting requirements. Each employee of the provider, and of any subcontractor, providing services in connection with this contract who has any knowledge of a reportable incident shall report such incident as follows: (1) Reportable incidents that may involve an immediate or impending impact on the health or safety of a client shall be immediately reported to the contract manager; and (2) Other reportable incidents shall be reported to the department's Office of Inspector General by completing a Notification /Investigation Request (form CF 1934) and emailing the request to the Office of Inspector General at ig_complaints @dcf.state.fl.us. The provider and subcontractor may also mail the completed form to the Office of Inspector General, 1317 Winewood Boulevard, Building 5, 2nd Floor, Tallahassee, Florida, 32399 -0700; or via fax at (850) 488- 1428. b. A reportable incident is defined in CFOP 180 -4, which can be obtained from the contract manager. (11) Liability Insurance Coverage The managing entity shall notify the department's Contract Manager within 30 calendar days if there is a modification to the terms of insurance, to include but not limited to, cancellation or modification to policy limits. South Florida Behavioral Health Network, Inc. 85 KH225 10/01/2010 Managing Entity (12) Informed Consent for Follow -Up Surveys The provider agrees to comply, and require its subcontractors to comply with the provisions of the Informed Consent for Follow - up Survey Guidelines, which is incorporated herein by reference, when drafting consent forms for post treatment follow - up surveys. (13) Contracting with a Managing Entity (a) The managing entity shall allow the department to retain the right to perform the service or activity, directly or with another contractor, if service levels are not being achieved. (b) The managing entity shall identify a clear and specific transition plan that will be implemented in order to complete all required activities needed to transfer the services or activity from the department to the provider and operate the service or activity successfully. (c) The managing entity shall interview and consider for employment with the provider each state employee (displaced as a result of this outsourcing) who is interested in such employment. (d) The managing entity shall meet all requirements for retaining records and transfer to the department, at no cost, all public records in possession of the provider upon termination of the contract and destroy any duplicate public records that are exempt or confidential and exempt. All records stored electronically must be provided to the department in a format that is compatible with the information technology systems of the department. (e) The managing entity shall, if applicable, allow the department to purchase from the provider, at its depreciated value, assets used by the provider in the performance of the contract. If assets have not depreciated, the department shall retain the right to negotiate to purchase at an agreed -upon cost. (14) Information Technology Resources All department contract providers must receive written approval from the department prior to purchasing any Information Technology Resource (ITR) with contract funds. The provider agrees to secure prior written approval by means of an Information Resources Request (IRR) Form before the purchase of any ITR. The Contract Manager is responsible for serving as the liaison between the provider and the department during the completion of the IRR in accordance with Children and Families Operating Procedure (CFOP) 50 -9, Policy on Information Resource Requests. The provider will not be reimbursed for any ITR purchases made prior to obtaining the department's written approval. (15) Emergency Disaster Response Grant The managing entity will coordinate and implement any disaster /emergency grants South Florida Behavioral Health Network, Inc. 86 KH225 10/01/2010 Managing Entity awarded to the Southern Region. (16) Documents incorporated by reference in this contract are available in the department's contract manager's file. E. List of Exhibits 1. Exhibit A -1 - A -6, Funding Detail 2. Exhibit B - — B - 6, Line Item Operating Budget 3. Exhibit C - Managing Entity Administrative Services Monthly Request for Payment/Advance 4. Exhibit C - 2, Network Provider Services Cost Reimbursement Report of Expenditures and Request for Payment/Advance 5. Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes /Outputs 6. Exhibit E, Missing Children 7. Exhibit F, Minimum Service Requirements 8. Exhibit G, Required Reports 9. Exhibit H, Children's Mental Health Comprehensive Community Service Team 10. Exhibit!, Tangible Property Requirements South Florida Behavioral Health Network, Inc. 87 KH225 10/01/2010 Exhibit A - Performance Contract SAMH Services Program MENTAL HEALTH • FUNDING DETAIL Provider Name [South Florida Behavioral Health Network, Inc. 1 Contract 6 1KH225 1 Revision 6 IFY 2010 -11 (9 Mos) Budget Entity 60910502 - Adult Mental Health OCA AMOUNT Budget Entity 60910503 - Children's Mental Health OCA AMOUNT • 502004- EMERGENCY STABILIZATION 503001- EMERGENCY STABILIZATION G/A -ADULT COMM. MENTAL HEALTH (100610) G /A- CHILDREN'S MENTAL HEALTH (100435) ADAMH Trust Fund* 19004 f $544,210 I ADAMH Trust Fund" 190C1 $328,491 General Revenue/TSTF 19ME4 [ $604,191 1 General Revenue 19ME1 $66,633 GR/TS TF /G &D TF Citrus Health CSU SP5CH $341,250 ' FGTF - Title XXI 89Q01 $23,638 GR/Family Emergency Treatment Ctr- Manatee SP503 1 GR/Manatee Glens Child Baker Act SP532 GR/Cooper CSU SP516 I GR/Child Comprehensive Behavioral Services SP540 GR/Family Emergency Treatment - Pinellas SP525 ___I GR/CSU District 08 SP542 GR/Apalachee CSU -Leon SP549 1 GR/Marion- Citrus MH- Children CSU SP550 GR/Family Emergency Treatment - Sarasota SP553 I i General Revenue SP5EB GR/Lifestream CSU - Lake,Sumter SP559 1 FGTF -Title IVB W0027 510,029 GR/Ruth Cooper CSU -Lee SP560 1 — [ GR/Seminole County CSU SP561 L TSTF /Orange County Receiving Center SP572 j ' GR/APALACHEE SHRT -TERM RESID FAC SPAC9 I G/A -BAKER ACT SERVICES (100611) G /A- CHILDREN'S BAKER ACT (104257) General Revenue 19ME4 i 56,058,860 { General Revenue 19ME1 $1,101,913 TSTF /Adult Emerg Baker Act Services - Hernando, Pasco SP592 f 1 General Revenue SP581 Emergency Stabilization Total = 51,530,704 ; G /A- OUTPATIENT BAKER ACT SERVICES PILOT (100612) General Revenue 19ME4 [ 1 Emergency Stabilization Total = $7,548,511 502018- RECOVERY & RESILIENCY 503013- RECOVERY & RESILIENCY . G/A -ADULT COMM. MENTAL HEALTH (100610) G /A- CHILDREN'S MENTAL HEALTH (100435) ADAMH Trust Fund* 19018 1 5826,598 I ADAMH Trust Fund" 19C13 $723,063 ADAMH Trust Fund/FACT 19019 I _ $241,362 ! General Revenue 19M13 $1,489,883 General Revenue/TSTF I9M18 1 58,823,458 1 GR/TSTF 32NO3 General Revenue /FGTF 9QPSR t � FGTF - Title XXI 89Q13 $1,191,233 GR/AGAPE FAM MINISTRY AFMMD I 5600,000 1 GR/RTC Non - Medicaid Eligible 9PRNM 521,750 WTTF TANF 39A18 1 $1,540,806 i GR/Henderson MH Center - Broward SP506 FGTF /ADAMH/GR/Comm Forensic Beds -Adult Svc CFBAS i $2,365,890 j ADAMH TF.9nfant & Young Special Project SP533 FGTF PATH GXOI8 1 $396,695 i Federal Grants FT GMDW 1 $500,000 • GR/TSTF/FGTF - FACT Admin FTA19 1 ___________ ._....... 1 GR/FACT Svcs FTSl9 �$572,400, O &MTF/FGTF /Com MH Srvs Contract -NEFSH MHS18 1 1 G /A- PURCHASED RESIDENTIAL G.R. LPPME 1 5750,000 1 TREATMENT SERVICES (102780) GR/Court Cottages in the Pines SP502 GR/RTC Non- Medicad Eligible 9PRNM $270,214 GR/TSTF/Wayne Densch Center - Orange SP504 1 I GR/Purch Res Treatment - Medicaid Svcs 9PRTS Gil/Charlotte County CMH Center SP505 GR/Short-Term Residential Treat - Hillsborough SP511 Generl Revenue/TSTF/Doug Gardens CMH Ctr SP512 $236,250 [ G /A- PURCHASE/THERA SVCS CHILD (100800) GR/Miami -Dade Homeless Trust SP513 L $135,000 j General Revenue 19MCB 1 l GR/Camillus Life Center -Dade SP551 I $187,500 GR/FACT Team -Bay, Gulf SP552 1 GR/Miami Behavioral 1-11th Ctr- Uninsured Dade SPS55 . $187,500 ■ GR/The Village - Campaneros En Recup -Dade SP558 I $225,000 CAMILLUS BEHAVIOR HLTH TRT CTR SP5CB 1 I F • AM EMERG TRMT CTR 19 CIRCUIT SPSFE i i JUV CO -OCCUR ADDTNS Dade/Broward/Monroe SPJC9 1 GR/NEW HORIZON'S CENTER SPNH9 G /A- INDIGENT PSYCH MEDICATION PROGRAM (101350) Generl Revenue 19M18 1 $85,495 • G/A -BAKER ACT SERVICES (100611) General Revenue 19M18 Recovery & Resiliency Total = 519,182,580 Recovery & Resiliency Total = $4,201,143 TOTAL ADULT COMM. MH = 526,731,091 TOTAL CHILDREN'S MENTAL HEALTH = $5,731,847 * Community Mental Health Block Grant • Rev.10 /01/2010 Contract No. KH225 South Florida Behavioral Health Network, Inc. 88 1010112010 Exhibit A - Performance Contract SAMH Services Program SUBSTANCE ABUSE FUNDING DETAIL Provider Name South Florida Behavioral Health Network, Inc. I Contract 6 KH225 I Revision 6 L 1 IFY 2010-11 (9 Mos)) • i. Budget Entity 60910603 - Adult Substance Abuse OCA AMOUNT Budget Entity 60910602 - Children's Substance Abuse OCA AMOUNT • 603005 - DETOXIFICATION 602001- DETOXIFICATION /ARF G/A -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SVCS (100420) • SAPTBG 270G5 $254,987 SAPTBG 27061 $277,047 GR/Tobacco Settlement Trust Fund 27ME5 $165,153 GR/Tobacco Settlement Trust Fund 27MEI $313,086 GR/Adult Detox ADDEX $156,132 GR/Child Detox CHDEX 886,771 Detoxification Total = $576,272 Detoxification Total = $676,904 • 603006- PREVENTION SERVICES 602002 - PREVENTION SERVICES G /A -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SVCS (100420) General Revenue 27ME6 $60,000 I Prevention Services - SIG / ADAMHTF * ** 27F02 ADAMH Trust Fund Prevention Services ••• 27PR6 $136,096 General Revenue 27ME2 $0 ADAMH Trust Fund - Prevention Services ••• 27PR2 $1,669,384 Prevention Partnership Services * ** 27PR3 $584,875 GR/Child Prevention Svcs. CHPRV $843,750 General Revenue SP613 . GR/Stewart Marchman Trmt. Ctr.- 1312 SP643 Prevention Services Total = $196,096 Prevention Services Total = $3,098,009 603007- TREATMENT & AFTERCARE 602003- TREATMENT & AFTERCARE G/A -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SVCS (100420) SAPTBG 270G7 $5,232,931 SAPTBG 270G3 ADAMHTF Administrative Expenditures 27AD7 ADAMH Trust Fund Administrative Expenditures 27AD3 $30,892 ADAMI{1F Intravenous Drug Usage ••• 27HIV 8902,608 ADAMH Trust Fund 27CHV GR/TSTF /O &MTF 27ME7 $1,658,936 GR/TSTF /O &MTF /CASATF 27ME3 $2,753,361 ADAMHTF Services to Women *** 27WOM $1,547,218 WTTFTANF 39TC1 $128,034 WTTF TANF 39TC0 . $980,514 GR/Tx & Aftercare - child CHTRT $93,146 . Trust Fund ADTRT $167,445 ADAMH Trust Fund HIV 27CHV $33, 556 SSBGTF /Camillus Life Center - Dade BS631 ADAMH Trust Fund -Roots n'Wings SP602 General Revenue DPG08 $13,765 GR/Adol. Tx Dually Diagnosed Girls - DI 1 SP606 $375,000 . FEDERAL GRANTS TRUST FUND SB004 GR/fhe Compass Program SP608 $168,750 ADAMHTF- Steward Marchman Ctr. D12 SP614 GR/ADAMHTF -The starting Place SP610 ADAMHTF -New Horizons Dual Diagnosis SP615 $67,500 _ ADAMHTF - Adolescent Res. SA Tx Facility SP6I I ADAMHTF- Addiction Trtmt Services SP616 GR/Project Warm -D12 SP644 , ADAMHTF -New Beginnings Prog Renewal SP617 _ GR/Phoenix House -R23 SP645 ADAMHTF- Coconut Grove -Behav Hth Ctr SP618 $135,000 GR/1ST STEP/MOTHERS /INFANT SP646 ADAMHTF -River Regions Services, Inc. SP619 GR/Drug Abuse Comprehensive Cord Ofc. SP647 ADAMHTF- Passage Way Aftercare Project SP622 GR/Here's Help SP692 8150,000 • ADAMHTF - Emerg. Wait List Reduc. Project SP623 $67,500 • ADAMHTF- Project Warm SP624 GR/AGAPE AGAPE $187,500 GR/River Region Women's SA SP651 GR/Circles of Care - Brevard SP652 GR/Center for Drug Free Living SP669 GR/Center for Drug Free Living - Brevard SP670 Treatment & Aftercare Total = $10,960,917 Treatment & Aftercare Total = $3,732,739 • TOTAL CHILD /ADOL SUB. ABUSE _ $7,507,652 TOTAL ADULT SUB. ABUSE = $11,733,285 • GRAND TOTAL ALL PROGRAMS = 851,703,875 MATCH CALCULATIONS APPLICABLE TO CONTRACT • FUNDS NOT REQUIRING MATCH: • !Deinstitutionalization Projects $12,602,615 ' TOTAL FUNDS REQUIRING MATCH= $21,544,051 (Children "e Mental Health Base Funding $3,859,720 [MH Exempt Block Grant Allocation $669,397 LOCAL MATCH REQUIRED = 57,181,350 1 Drug Abuse Services $9,620,469 ADDITIONAL LOCAL MATCH =l 'FACT $3,407,624 GRAND TOTAL LOCAL MATCH = 87,181,350 • • TOTAL FUNDS NOT REQUIRING MATCH = $30159,825 •• Expenditure must he Substance Abuse Prevention nod Treatment Block Grant eligibk ••• Substance Abuse Prevention and Treatment Block Grant - Funding Agreement - RESTRICTIONS APPLY • • Rev.10/012010 South Flonda Behavioral Health Network, Inc 89 Contract No. KH225 10/01/2010 Exhibit A - Performance Contract SAMH Services Program MENTAL .............................._........_._........__.. ......._..._.__...._..._..._.._ FUNDING DETAIL ` Provider Name 1South Florida Behavioral Health Network, Inc. I Contract k :KH225 j Revision It . _1 IFY 2011-2012 (12 Mot Budget Entity 60910502 - Adult Mental Health OCA AMOUNT Budget Entity 60910503 - Children's Mental Health OCA AMOUNT • 502004- EMERGENCY STABILIZATION 503001- EMERGENCY STABILIZATION G/A -ADULT COMM. MENTAL HEALTH (100610) G /A- CHILDREN'S MENTAL HEALTH (100435) ADAMH Trust Fund" 19004 ! i ADAMH Trust Fund* 190C1 General Revenue/TSTF 19ME4 ! General Revenue 19MEI ADAMHTF /Consumer Self- Directed Care Pilot SP501 I FGTF - Title XXI 89Q01 GR/Family Emergency Treatment Ctr- Manatee SP503 GR/Manatee Glens Child Baker Act SP532 �! GR/Cooper CSU SP516 I GR/Child Comprehensive Behavioral Services SP540 GR/Family Emergency Treatment - Pinellas SP525 l GR/CSU District 08 SP542 GR/Apalachee CSU -Leon SP549 I 1 GR/Marion - Citrus MH- Children CSU SP550 GR/Family Emergency Treatment - Sarasota SP553 ! I General Revenue SP5EB GR/Lifestream CSU- Lake,Sumter SP559 { FGTF -Title IVB W0027 GR/Ruth Cooper CSU -Lee SP560 GR/Seminole County CSU SP561 1I a t TSTF /Orange County Receiving Center SP572 1 . GR/APALACHEE SHRT -TERM RESID FAC SPAC9 1 1 G/A -BAKER ACT SERVICES (100611) G /A- CHILDREN'S BAKER ACT (104257) General Revenue 19ME4 I j General Revenue 19ME1 • TSTF /Adult Emerg Baker Act Services - Hernando, Pasco SP592 , i General Revenue SPS81 Emergency Stabilization Total = $0 G /A- OUTPATIENT BAKER ACT SERVICES PILOT (100612) General Revenue 19ME4 I j Emergency Stabilization Total = $0 502018- RECOVERY & RESILIENCY 503013- RECOVERY & RESILIENCY G/A -ADULT COMM. MENTAL HEALTH (100610) G /A- CHILDREN'S MENTAL HEALTH (100435) ADAMH Trust Fund* 19018 i 7 ADAMH Trust Fund* 19C 13 ADAMH Trust Fund /FACT 19019 —i General Revenue 19M13 General Revenue/TSTF 19M18 1 j GR/TSTF 32NO3 General Revenue /FGTF 9QPSR ! I FGTF - Title XXI 89Q13 GR/AGAPE FAM MINISTRY AFMMD i 1 GR/RTC Non - Medicaid Eligible 9PRNM WTTF TANF 39A18 ! dnMHSward SP506 FGTF/ F /ADAMWGR/Comm Forensic Beds -Adult Svc CFBAS r $0 j ADAMH TF/Infant & Young H TF /Infant Young Special Project SP533 FGTF PATH GX018 1 . General Revenue SP5MA aIIIIIIIIIIIIIIIII GR/TSTF/FGTF - FACT Admin FTA 19 GR FACT Svcs FCSl9 L _.... .......__..-- .- ..- -- ._...__..__ . O&MTF/FGTF/Com MH Srvs Contract -NEFSH MHS18 1 G /A- PURCHASED RESIDENTIAL FGTF MHTTI 1 TREATMENT SERVICES (102780) GR Court Cottages in the Pines SP502 r 1 GR/RTC Non - Medicad Eligible 9PRNM GR/TSTF/Wayne Densch Center - Orange SP504 1 I GR/Purch Res Treatment - Medicaid Svcs 9PRTS GR/Charlotte County CMH Center SP505 1 i GR/Short-Term Residential Treat - Hillsborough SP511 Generl Revenue/TSTF/Doug Gardens CMH Ctr SP512 1 1 G /A- PURCHASE /THERA SVCS CHILD (100800 ) GR/Miami -Dade Homeless Trust SP5I3 1 1 General Revenue I9MCB I I GR/Camillus Life Center -Dade SP551 I ' - GR/FACT Team -Bay, Gulf SP552 i _______ ________________._.— _..__...._. 1 GR/Miami Behavioral Hlth Ctr- Uninsured Dade SP555 1 1 ■ GRTfhe Village - Campaneros En Recup -Dade SP558 i CAMILLUS BEHAVIOR HLTH TRT CTR SP5CB FAM EMERG TRMT CTR 19 CIRCUIT SP5FE JUV CO-OCCUR ADDTNS Dade /Broward /Monroe SPJC9 GR/NEW HORIZON'S CENTER SPNH9 1 1 - G /A- INDIGENT PSYCH MEDICATION PROGRAM (101350) Generl Revenue 19M18 1 • G/A -BAKER ACT SERVICES (100611) . • General Revenue 19M18 ' Recovery & Resiliency Total = $0 Recovery & Resiliency Total = $0 TOTAL ADULT COMM. MH = $0 TOTAL CHILDREN'S MENTAL HEALTH = $0 • " Community Mental Health Block Grant Rev.10 /01/2010 Contract No. KH225 South Florida Behavioral Health Network, Inc. 90 10/01/2010 Exhibit A -2 Performance Contract SAMH Services Program SUBSTANCE ABUSE FUNDING DETAIL Provider Name (South Florida Behavioral Health Network, Inc. 1 Contract # 1KH225 1 Revision # 1 1 1FY 2011 -12 (12 Mon) Budget Entity 60910603 - Adult Substance Abuse OCA AMOUNT Budget Entity 60910602 - Children's Substance OCA AMOUNT 603005 - DETOXIFICATION 602001- DETOXIFICATION /ARF G/A -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SV( (100420) SAPTBG 270G5 SAPTBG 270G1 GR/Tobacco Settlement Trust Fund 27ME5 GR/Tobacco Settlement Trust Fund 27ME1 I GR/Adult Detox ADDER GR/Child Detox CHDEX Detoxification Total = $0 Detoxification Total = 50 603006 - PREVENTION SERVICES 602002- PREVENTION SERVICES G/A -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SVCS (100420 General Revenue 27ME6 - Prevention Services - SIG /ADAMHTF * ** 27F02 ADAMH Trust Fund Prevention Services * ** 27PR6 , General Revenue 27ME2 ADAMH Trust Fund- Prevention Services * ** 27PR2 Prevention Partnership Services * ** 27PR3 GR/Child Prevention Svcs. CHPRV General Revenue SP613 GR/Stewart Marchman Trmt. Ctr.- D12 SP643 • Prevention Services Total = $0 Prevention Services Total = $0 603007- TREATMENT & AFTERCARE 602003 - TREATMENT & AFTERCARE G/A -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SVCS (100420) SAPTBG 270G7 SAPTBG 270G3 ADAMHTF Administrative Expenditures 27AD7 ADAMH Trust Fund Administrative Expenditu 27AD3 ADAMHTF Intravenous Drug Usage * ** 27HIV ADAMH Trust Fund 27CHV GR/TSTF /O &MTF 27ME7 GR/TSTF /O &MTF /CASATF 27ME3 ADAMHTF Services to Women * ** 27WOM _ WTTF TANF 39TCI WTTF TANF 39TC0 GR/Tx & Aftercare - child CHTRT Trust Fund ADTRT ADAMH Trust Fund HIV 27CHV , i SSBGTF /Camillus Life Center - Dade BS631 ADAMH Trust Fund -Roots nWings SP602 General Revenue DPG08 GR/Adol. Tx Dually Diagnosed Girls - Dl 1 SP606 FEDERAL GRANTS TRUST FUND SB004 GR/The Compass Program SP608 ADAMHTF- Steward Marchman Ctr. D12 SP614 GR/ADAMHTF -The starting Place SP610 ADAMHTF -New Horizons Dual Diagnosis SP615 ADAMHTF- Adolescent Res. SA Tx Facility SP6I 1 a ADAMHTF- Addiction Trtmt Services SP6I6 GR/Project Warm -D12 SP644 j ADAMHTF -New Beginnings Prog Renewal S P6 I 7 GR/Phoenix House -R23 SP645 ADAMHTF- Coconut Grove -Behav Hth Ctr SP6I8 GR/1ST STEP /MOTHERS/INFANT SP646 ADAMHTF -River Regions Services, Inc. SP619 GR/Drug Abuse Comprehensive Cord Ofc. SP647 ADAMHTF- Passage Way Aftercare Project SP622 OPERATION & MAIN TF SP648 1 ADAMHTF - Emerg. Wait List Reduc. Project SP623 ADAMHTF- Project Warm SP624 ADAMHTF- Elderly Compliance SA & Mil SP625 GR/River Region Women's SA SP651 GR/Circles of Care - Brevard SP652 GR/Center for Drug Free Living SP669 GR/Center for Drug Free Living - Brevard SP670 Treatment & Aftercare Total = $0 Treatment & Aftercare Total = $0 TOTAL CHILD /ADOL SUB. ABUSE = 50 TOTAL ADULT SUB. ABUSE _ 50 — ESTIMATED GRAND TOTAL ALL PROGRAMS = $72,500,000 MATCH CALCULATIONS APPLICABLE TO CONTRACT FUNDS NOT REQUIRING MATCH: $44,600,000 - TOTAL FUNDS REQUIRING MATCH = 527,900,000 LOCAL MATCH REQUIRED = $9,300,000 [ .. ‘ ADDITIONAL LOCAL MATCH =[ j1. GRAND TOTAL LOCAL MATCH = 59,300,000 TOTAL FUNDS NOT REQUIRING MATCH = 544,600,000 •• Expenditure must be Substance Abuse Prevention and Treatment Block Grant eligible •• • Substance Abuse Prevention and Treatment Block Grant - Funding Agreement - RESTRICTIONS APPLY Rev.10/01/2010 South Florida Behavioral Health Network, Inc 91 Contract No. KH225 10/01/2010 Exhibit A - Performance Contract SAMH Services Program ' • MENTAL HEALTH ................................................._.............._......_......_. ......._.._._............._..._ FUNDING DETAI _._............_.........�.. L Provider Name South Florida Behavioral Health Network, Inc. j Contract 4 !KH225 Revision 0 { 3 IFY 2012 -2013 (12 Mop Budget Entity 60910502 - Adult Mental Health OCA AMOUNT Budget Entity 60910503 - Children's Mental Health OCA AMOUNT 502004- EMERGENCY STABILIZATION 503001- EMERGENCY STABILIZATION G/A -ADULT COMM. MENTAL HEALTH (100610) G /A- CHILDREN'S MENTAL HEALTH (100435) ADAMH Trust Fund• 19004 ADAMH Trust Fund* 190C1 General Revenue/TSTF 19ME4 I j General Revenue I9MEI ADAMHTF /Consumer Self- Directed Care Pilot SP501 1 FGTF - Title XXI 89Q01 GR/Family Emergency Treatment Ctr- Manatee SP503 I GR/Manatee Glens Child Baker Act SP532 GR/Cooper CSU SP516 1 ---i GR/Child Comprehensive Behavioral Services SP54U GR/Family Emergency Treatment - Pinellas SP525 GR/CSU District 08 SP542 GR/Apalachee CSU -Leon SP549 %--W GR/Marion - Citrus MH- Children CSU SP550 GR/Family Emergency Treatment - Sarasota SP553 General Revenue SP5EB GR/Lifestream CSU - Lake,Sumter SP559 FGTF -Title IVB W0027 GR/Ruth Cooper CSU -Lee SP560 GR/Seminole County CSU SP56I ,— TSTF /Orange County Receiving Center SP572 I GR/APALACHEE SHRT -TERM RESID FAC SPAC9 1 I G/A -BAKER ACT SERVICES (100611) G /A- CHILDREN'S BAKER ACT (104257) . General Revenue 19ME4 j I General Revenue 19MEI TSTF /Adult Emerg Baker Act Services - Hernando, Pasco SP592 j j General Revenue SP581 Emergency Stabilization Total = $0 G /A- OUTPATIENT BAKER ACT SERVICES PILOT (100612) General Revenue 19ME4 1 1 Emergency Stabilization Total = 50 502018- RECOVERY & RESILIENCY 503013- RECOVERY & RESILIENCY G/A -ADULT COMM. MENTAL HEALTH (100610) G /A- CHILDREN'S MENTAL HEALTH (100435) ADAMH Trust Fund* 19018 ADAMH Trust Fund* 19C13 ADAMH Trust Fund /FACT 19019 I J. General Revenue 3 General Revenue/TSTF 1901M1 8 GR/1'STF 32NO3 32NO3 General Revenue /FGTF 9QPSR 1 W i FGTF - Title XXI 89Q13 GR/AGAPE FAM MINISTRY AFMMD 1 GR/RTC Non - Medicaid Eligible 9PRNM 1111111111111111111111 , WTTF TANF 39A18 1 GR/Henderson MH Center - SP506 ���� FGTF /ADAMH/GR/Comm Forensic Beds -Adult Svc CFBAS 50 ADAMH TF /Infant & Young g Special Project SP533 FGTF PATH GX018 i General Revenue SP5MA GR/FSTF/FGTF - FACT Admin FTAI9 I GR/FACT Svcs FTS19 I O &MTF/FGTF /Com MH Srvs Contract -NEFSH MHSIS j 1 G /A- PURCHASED RESIDENTIAL FGTF MHTTI 1 I TREATMENT SERVICES (102780) GR/Court Cottages in the Pines SP502 GR/RTC Non - Medicad Eligible 9PRNM GR/FSTF/Wayne Densch Center -Orange SP504 { y GR/Purch Res Treatment - Medicaid Svcs 9PRTS GR/Charlotte County CMH Center SP505 GR/Short-Term Residential Treat - Hillsborough SP5I 1 j Generl Revenue/TSTF/Doug Gardens CMH Ctr SP512 ! I G /A- PURCHASE/FHERA SVCS CHILD (100800) GR/Miami -Dade Homeless Trust SP5I3 General Revenue 19MCB I. 3 GR/Camillus Life Center -Dade SP551 l GR/FACT Team -Bay, Gulf SP552 GR/Miami Behavioral Hlth Ctr- Uninsured Dade SP555 a • GR/The Village- Campaneros En Recup -Dade SP558 i +; CAMILLUS BEHAVIOR HLTH TRT CTR SP5CB • FAM EMERG TRMT CTR 19 CIRCUIT SP5FE 1 JUV CO-OCCUR ADDTNS DadeBroward /Monroe SPJC9 1 GR/NEW HORIZON'S CENTER SPNH9 I , G /A- INDIGENT PSYCH MEDICATION PROGRAM (101350) _ Generl Revenue 19M18 G/A -BAKER ACT SERVICES (100611) General Revenue 19M18 i Recovery & Resiliency Total = $0 Recovery & Resiliency Total = $0 TOTAL ADULT COMM. MH = $0 TOTAL CHILDREN'S MENTAL HEALTH = $0 • Community Mental Health Block Grant • Rev.10/01/2010 Contract No. KH225 South Florida Behavioral Health Network, Inc. 92 10/01/2010 Exhibit A - Performance Contrail SAMH Services Program • SUBSTANCE ABUSE FUNDING DETAIL Provider Name 'South Florida Behavioral Health Network, Inc. I Contract #'KH225 J Revision # I I IFY 2012 -13 (12 Mon) Budget Entity 60910603 - Adult Substance Abuse OCA AMOUNT Budget Entity 60910602 - Children's Substance OCA AMOUNT 603005 - DETOXIFICATION 602001- DETOXIFICATION /ARF G/A -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SV( (100420) SAPTBG 270G5 SAPTBG 270G1 GR/Tobacco Settlement Trust Fund 27ME5 GR/fobacco Settlement Trust Fund 27ME1 _— GR/Adult Detox ADDEX GR/Child Detox CHDEX .111111111111111111 Detoxification Total = $0 Detoxification Total = $0 603006 - PREVENTION SERVICES 602002- PREVENTION SERVICES G/A -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SVCS (100420 General Revenue 27ME6 Prevention Services - SIG /ADAMHTF a ** 27F02 ADAMH Trust Fund Prevention Services * ** 27PR6 General Revenue 27ME2 ADAMH Trust Fund - Prevention Services * ** 27PR2 Prevention Partnership Services * ** 27PR3 GR/Child Prevention Svcs. CHPRV General Revenue SP613 GR/Stewart Marchman Trmt. Ctr.- D12 SP643 Prevention Services Total = $0 Prevention Services Total = $0 603007- TREATMENT & AFTERCARE 602003- TREATMENT & AFTERCARE G/A -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SVCS (100420) SAPTBG 270G7 SAPTBG 270G3 ADAMHTF Administrative Expenditures 27AD7 ADAMH Trust Fund Administrative Expenditu 27AD3 ADAMHTF Intravenous Drug Usage * ** 27HIV ADAMH Trust Fund 27CHV GR/TSTF /O &MTF 27ME7 GRJTSTF /O &MTF /CASATF 27ME3 ADAMHTF Services to Women * ** 27WOM WTTF TANF 39TC1 WTTF TANF 39TC0 GR/Tx & Aftercare - child CHTRT Trust Fund ADTRT ADAMH Trust Fund HIV 27CHV SSBGTF /Camillus Life Center - Dade BS631 ADAMH Trust Fund -Roots n'Wings SP602 General Revenue DPG08 GR/Adol. Tx Dually Diagnosed Girls - DI I SP606 FEDERAL GRANTS TRUST FUND SB004 GR/The Compass Program SP608 ADAMHTF- Steward Marchman Ctr. D12 SP614 GR/ADAMHTF -The starting Place SP610 ADAMHTF -New Horizons Dual Diagnosis SP615 ADAMHTF- Adolescent Res. SA Tx Facility SP6I 1 ADAMHTF- Addiction Trtmt Services SP6I6 GR/Project Warm -D I2 SP644 ADAMHTF -New Beginnings Prog Renewal SP617 GR/Phoenix House -R23 SP645 ADAMHTF- Coconut Grove -Behav Hth Ctr SP618 GR/1ST STEP /MOTHERS /INFANT SP646 ' ADAMHTF -River Regions Services, Inc. SP619 GR � Drug Abuse Comprehensive Cord Ofc. SP647 ADAMHTF- Passage Way Aftercare Project SP622 OPERATION & MAIN TF SP648 ADAMHTF- Emerg. Wait List Reduc. Project SP623 ADAMHTF - Project Warm SP624 ADAMHTF - Elderly Compliance SA & MH SP625 GR/River Region Women's SA SP651 GR/Circles of Care - Brevard SP652 GR/Center for Drug Free Living SP669 GR/Center for Drug Free Living - Brevard SP670 Treatment & Aftercare Total = $0 Treatment & Aftercare Total = $0 TOTAL CHILD /ADOL SUB. ABUSE = SO TOTAL ADULT SUB. ABUSE = $0 — ESTIMATED GRAND TOTAL ALL PROGRAMS = 572,500,000 MATCH CALCULATIONS APPLICABLE TO CONTRACT FUNDS NOT REQUIRING MATCH: Deinstitutionalization Projects $44,600,000 . TOTAL FUNDS REQUIRING MATCH = 527,900,000 Children "e Mental Health Base Funding s MH Exempt Block Grant Allocation LOCAL MATCH REQUIRED = 59,300,000 Drug Abuse Services ADDITIONAL LOCAL MATCH = . 1 GRAND TOTAL LOCAL MATCH = 59,300,000 TOTAL FUNDS NOT REQUIRING MATCH = 544,600,000 •• Expenditure must be Substance Abuse Prevention and Treatment Block Grant eligible ••• Substance Abuse Prevention and Treatment Block Grant - Funding Agreement - RESTRICTIONS APPLY Rev.10 /01/2010 South Florida Behavioral Health Network, Inc 93 Contract No. KH225 10/01/2010 Exhibit A - 4 SAMH Pedonnance Contract Services Program MENTAL HEALTH I ............_ ...................................._......_.........._........ _..........._.._.__._...._.... FUNDING DETAIL DET _._._......._ ...._....._...............__... I 2013-2014 (12 Mo. Provider Name South Florida Behavioral Health Network, Inc. j Contract 6 ':KH225 Revision k r FY 4 12 • Budget Entity 60910502 - Adult Mental Health OCA AMOUNT Budget Entity 60910503 - Children's Mental Health OCA AMOUNT 502004-EMERGENCY STABILIZATION 503001- EMERGENCY STABILIZATION G/A -ADULT COMM. MENTAL HEALTH (100610) G /A- CHILDREN'S MENTAL HEALTH (100435) ADAMH Trust Fund* 19004 I ADAMH Trust Fund' 190C1 11111111111111111111 . General RevenueTSTF 19ME4 . General Revenue 19ME1 ADAMHTF /Consumer Self- Directed Care Pilot SP501 J FGTF - Title XXI 89Q0I IIII GR/Family Emergency Treatment Ctr- Manatee SP503 1 1 GR/Manatee Glens Child Baker Act SP532 GR/Cooper CSU SP516 I GR/Child Comprehensive Behavioral Services SP540 GR/Family Emergency Treatment - Pinellas SP525 I I GR/CSU District 08 SP542 I1 =N=� • GR/Apalachee CSU -Leon SP549 GR/Marion- Citrus MH- Children CSU SP550 I GR/Family Emergency Treatment - Sarasota SP553 1 1 General Revenue SPSEB GR/Lifestream CSU - Lake,Sumter SP559 i FGTF -Title IVB W0027 GR/Ruth Cooper CSU -Lee SP560 i GR/Seminole County CSU SP56I TSTF /Orange County Receiving Center SP572 L d GR/APALACHEE SHRT -TERM RESID FAC SPAC9 I ...... .............__..........,,__.j G/A -BAKER ACT SERVICES (100611) G /A- CHILDREN'S BAKER ACT (104257) ___.. 19ME4 �' General Revenue General Revenue 19MEI 1 i TSTF /Adult Emerg Baker Act Services - Hernando, Pasco SP592 1 General Revenue SP581 Emergency Stabilization Total = $0 G /A- OUTPATIENT BAKER ACT SERVICES PILOT (100612) 1 General Revenue 19ME4 Emergency Stabilization Total = $0 502018- RECOVERY & RESILIENCY 503013- RECOVERY & RESILIENCY G/A -ADULT COMM. MENTAL HEALTH (100610) G /A- CHILDREN'S MENTAL HEALTH (100435) ADAMH Trust Fund* 19018 I i ADAMH Trust Fund' I9C 13 • ADAMH Trust Fund/FACT 19019 3 _ General Revenue 19MI3 General Revenue/TSTF 19M18 i f GR/TSTF 32NO3 General Revenue /FGTF 9QPSR 1 FGTF - Title XXI 89Q13 GR/AGAPE FAM MINISTRY AFMMD 4 l GR/RTC Non - Medicaid Eligible 9PRNM WITF TANF 39A18 GR/I- Ienderson MH Center-Broward SP506 FGTF /ADAMWGR/Comm Forensic Beds -Adult Svc CFBAS I SO ADAMH TF /Infant & Young Special Project SP533 FGTF PATH GX0I8 I General Revenue SP5MA GR/TSTF/FGTF - FACT Admin FTAI9 I GR/FACT Svcs FTS19 5.. .........._.... .__..--- ..._ ..............._._. O &MTF/FGTF /Com MH Srvs Contract -NEFSH MHSI8 1„„ ; . G /A- PURCHASED RESIDENTIAL FGTF MHTTI TREATMENT SERVICES (102780) GR/Court Cottages in the Pines SP502 i 1 GR/RTC Non - Medicad Eligible 9PRNM GR/FSTF/Wayne Densch Center - Orange SP504 i j GR/Purch Res Treatment- Medicaid Svcs 9PRTS GR/Charlotte County CMH Center SP505 I GR/Short-Term Residential Treat - Hillsborough SP511 ; Generl Revenue/TSTF/Doug Gardens CMH Ctr SP5I2 I 1 G /A- PURCHASE/FHERA SVCS CHILD (100800) GR/Miami -Dade Homeless Trust SP513 I r General Revenue 19MCB l GR/Camillus Life Center -Dade SP55I F GR/FACT Team - Bay, Gulf SP552 1__ ..__.._....... ...._ ................_..__._.._ GR/Miami Behavioral Hlth Ctr- Uninsured Dade SP555 j _ .....__..__.__ .............. GR/The Village - Campaneros En Recup -Dade SP558 I ' CAMILLUS BEHAVIOR HLTH TRT CTR SP5CB 1 FAM EMERG TRMT CTR 19 CIRCUIT SP5FE L_ . JUV CO -OCCUR ADDTNS Dade /Broward /Monroe SP1C9 GR/NEW HORIZONS CENTER SPNH9 t — • G /A- INDIGENT PSYCH MEDICATION PROGRAM (101350) Generl Revenue 19M18 I G/A -BAKER ACT SERVICES (100611) General Revenue 19M18 ......_ .. ......................_'__... ��....... Recovery & Resiliency Total = 80 Recovery & Resiliency Total = 50 TOTAL ADULT COMM. MH = 50 TOTAL CHILDREN'S MENTAL HEALTH = $0 • ' Community Mental Health Block Grant Rev.10/01/2010 Contract No. KH225 South Florida Behavioral Health Network, Inc. 94 E xhibit A - 4 Performance Contract 10/01/2010 SAMH Services Program SUBSTANCE ABUSE FUNDING DETAIL Provider Name (South Florida Behavioral Health Network, Inc. 1 Contract # 1KH225 1 Revision # 1 1 (FY 2013 -14 (12 Mon) Budget Entity 60910603 - Adult Substance Abuse OCA AMOUNT Budget Entity 60910602 - Children's Substance OCA AMOUNT 603005 - DETOXIFICATION 602001- DETOXIFICATION /ARF G/A -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SV( (100420) SAPTBG 270G5 _ SAPTBG 270G1 GR/Tobacco Settlement Trust Fund 27ME5 GR/Tobacco Settlement Trust Fund 27ME1 IIIIIIIIIIIIIIIIIIIIII GR Adult Detox ADDEX GR /Child Detox CHDEX Detoxification Total = $0 Detoxification Total = $0 603006 - PREVENTION SERVICES 602002- PREVENTION SERVICES G/A -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SVCS (100420 General Revenue 27ME6 Prevention Services - SIG /ADAMHTF * ** 27F02 ADAMH Trust Fund Prevention Services * ** 27PR6 General Revenue 27ME2 ' ADAMH Trust Fund- Prevention Services * ** 27PR2 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Prevention Partnership Services * ** 27PR3 __..__......._.._...._..._... GR/Child Prevention Svcs. CHPRV General Revenue SP613 GR/Stewart Marchman Trmt. Ctr.- D12 SP643 Prevention Services Total = $0 Prevention Services Total = 603007 - TREATMENT & AFTERCARE 602003 - TREATMENT & AFTERCARE G/A -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SVCS (100420) SAPTBG 270G7 SAPTBG 270G3 , ADAMHTF Administrative Expenditures 27AD7 ADAMH Trust Fund Administrative Expenditu 27AD3 ADAMHTF Intravenous Drug Usage * ** 27H1V ADAMH Trust Fund 27CHV GRJTSTF /O &MTF 27ME7 GRTSTF /O &MTF /CASATF 27ME3 ADAMHTF Services to Women * ** 27WOM WTTF TANF 39TC1 WTTF TANF 39TC0 GR/Tx & Aftercare - child CHTRT Trust Fund ADTRT , ADAMH Trust Fund HIV 27CHV SSBGTF /Camillus Life Center - Dade BS63 1 ADAMH Trust Fund -Roots n'Wings SP602 General Revenue DPG08 GR/Adol. Tx Dually Diagnosed Girls - DI I SP606 FEDERAL GRANTS TRUST FUND SB004 GRlihe Compass Program SP608 ADAMHTF- Steward Marchman Ctr. D12 SP614 GR/ADAMHTF -The starting Place SP6I0 ADAMHTF -New Horizons Dual Diagnosis SP615 ADAMHTF- Adolescent Res. SA Tx Facility SP611 ADAMHTF-Addiction Trtmt Services SP616 GR/Project Warm -D12 SP644 ADAMHTF -New Beginnings Prog Renewal SP617 GR/Phoenix House -R23 SP645 ADAMHTF- Coconut Grove -Behav Hth Ctr SP618 GR/1ST STEP /MOTHERS /INFANT SP646 ) ADAMHTF -River Regions Services, Inc. SP619 GR/Drug Abuse Comprehensive Cord Ofc. SP647 ADAMHTF- Passage Way Aftercare Project SP622 OPERATION & MAIN TF SP648 ADAMHTF- Emerg. Wait List Reduc. Project SP623 ADAMHTF- Project Warm SP624 ADAMHTF- Elderly Compliance SA & MH SP625 GR/River Region Women's SA SP65 1 , GR/Circles of Care - Brevard SP652 , GR/Center for Drug Free Living SP669 GR/Center for Drug Free Living - Brevard SP670 Treatment & Aftercare Total = $0 Treatment & Aftercare Total = $0 TOTAL CHILD /ADOL SUB. ABUSE _50 TOTAL ADULT SUB. ABUSE _ $0 — ESTIMATED GRAND TOTAL ALL PROGRAMS = $72,500,000 MATCH CALCULATIONS APPLICABLE TO CONTRACT FUNDS NOT REQUIRING MATCH: `Deinstitutionalization Projects 544,600,000 TOTAL FUNDS REQUIRING MATCH = $27,900,000 � Children "e Mental Health Base Fundin8 MH Exempt Block Grant Allocation 111111111111111111111. LOCAL MATCH REQUIRED = 59,300,000 ,Drug Abuse Services ADDITIONAL LOCAL MATCH =t 1 GRAND TOTAL LOCAL MATCH = �S9 300000 TOTAL FUNDS NOT REQUIRING MATCH = $44,600,000 •• Expenditure must be Substance Abuse Prevention and Treatment Block Grant eligible • • • Substance Abuse Prevention and Treatment Block Grant - Funding Agreement - RESTRICTIONS APPLY Rev.10 /01/2010 South Florida Behavioral Health Network, Inc 95 Contract No. KH225 10/01/2010 Exhibit A -5 Pertormance Contract SAMH Services Program MENTAL HEALTH ............._......___........_......................_.._............__....... _...._...._._...._............. :.............. DETAIL Provider Name [South Florida Behavioral Health Network Inc. .i Contract 6 IKH225 . Revision 9 I J IFY 2014 -2015 (12 Mt): Budget Entity 60910502 - Adult Mental Health OCA AMOUNT Budget Entity 60910503 - Children's Mental Health OCA AMOUNT 502004-EMERGENCY STABILIZATION 503001- EMERGENCY STABILIZATION . G/A -ADULT COMM. MENTAL HEALTH (100610) G /A- CHILDREN'S MENTAL HEALTH (100435) ADAMH Trust Fund• 19004 I ADAMH Trust Fund' 190C1 General Revenue/TSTF 19ME4 r i General Revenue 19MEI ' ADAMHTF /Consumer Self- Directed Care Pilot SP501 . FGTF - Title XXI 89Q01 GR/Family Emergency Treatment Ctr- Manatee SP503 ! GR/Manatee Glens Child Baker Act SP532 GR/Cooper CSU SP5I6 iw • i GR/Child Comprehensive Behavioral Services SP540 , GR/Family Emergency Treatment - Pinellas SP525 GR/CSU District 08 SP542 GR/Apalachee CSU -Leon SP549 ! I GR/Marion - Citrus MH- Children CSU SP550 , GR/Family Emergency Treatment - Sarasota SP553 I General Revenue SP5EB GR/Lifestream CSU - Lake,Sumter SP559 i ! FGTF -Title IVB WO027 , GR/Ruth Cooper CSU -Lee SP560 GR/Seminole County CSU SP561 TSTF /Orange County Receiving Center SP572 l j GR/APALACHEE SHRT -TERM RESID FAC SPAC9 r G/A -BAKER ACT SERVICES (100611) G /A- CHILDREN'S BAKER ACT (104257) General Revenue 19ME4 j General Revenue 19MEI TSTF /Adult Emerg Baker Act Services - Hernando, Pasco SP592 1 i General Revenue SP581 Emergency Stabilization Total = SO . G /A- OUTPATIENT BAKER ACT SERVICES PILOT (100612) General Revenue 19ME4 Emergency Stabilization Total = 50 • 502018- RECOVERY & RESILIENCY 503013- RECOVERY & RESILIENCY • G/A -ADULT COMM. MENTAL HEALTH (100610) _ G /A- CHILDREN'S MENTAL HEALTH (100435) ADAMH Trust Fund' 19018 L ' ADAMH Trust Fund* 19C13 • ADAMH Trust Fund /FACT 19019 I General Revenue 19M13 IIIIIIMOIIIIIII General Revenue/TSTF 19M18 I GR/TSTF 32NO3 IIIIIIIIIIIMIIII General Revenue/FGTF 9QPSR I FGTF - Title XXI 89 GR/AGAPE FAM MINISTRY AFMMD I GR/RTC Non - Medicaid Eligible 9PRNM WTTF TANF 39A18 I GR/Henderson MH Center - Broward SP506 FGTF /ADAM WGR /Comm Forensic Beds -Adult Svc CFBAS I 50 ADAMH TF/Infant & Young Special Project SP533 FGTF PATH GX018 I 3 General Revenue SP5MA 111.111111111111111 , GR/TSTF/FGTF - FACT Admin FTAI9 i • GR/FACT Svcs FTSI9 I O &MTF/FGTF /Com MH Srvs Contract -NEFSH MHS18 I . G /A- PURCHASED RESIDENTIAL FGTF MHTTI L i TREATMENT SERVICES (102780) GR/Court Cottages in the Pines SP502 'i. GR/RTC Non - Medicad Eligible 9PRNM GR/TSTF/Wayne Densch Center- Orange SP504 j I GR/Purch Res Treatment - Medicaid Svcs 9PRTS GR/Charlotte County CMH Center SP505 i GR/Short-Term Residential Treat - Hillsborough SP511 1 Generl Revenue/TSTF/Doug Gardens CMH Ctr SP512 1 G /A- PURCHASE/I'HERA SVCS CHILD (100800) GR/Miami -Dade Homeless Trust SP513 I General Revenue 19MCB r • GR/Camillus Life Center -Dade SP551 ! GR/FACT Team -Bay, Gulf SP552 , 1 GR/Miami Behavioral Hlth Ctr- Uninsured Dade SP555 I GR/The Village - Campaneros En Recup -Dade SP558 + • CAMILLUS BEHAVIOR HLTH TRT CTR SP5CB FAM EMERG TRMT CTR 19 CIRCUIT SP5FE 1 3 JUV CO -OCCUR ADDTNS Dade /Broward /Monroe SPJC9 GR/NEW HORIZONS CENTER SPNH9 , G /A- INDIGENT PSYCH MEDICATION PROGRAM (101350) Generl Revenue 19M18 . G/A -BAKER ACT SERVICES (100611) • General Revenue 19M18 s Recovery & Resiliency Total = SO Recovery & Resiliency Total = SO TOTAL ADULT COMM. MH = 50 TOTAL CHILDREN'S MENTAL HEALTH = SO • Community Mental Health Block Grant Rev.10/01/2010 Contract No. KH225 South Florida Behavioral Health Network, Inc. 96 • 10/01/2010 Exhibit A -5 Performance Contract SAMH Services Program SUBSTANCE ABUSE FUNDING DETAIL Provider Name (South Florida Behavioral Health Network, Inc. I Contract # KH225 I Revision # I 1 IFY 2014 -15 (12 Mon) Budget Entity 60910603 - Adult Substance Abuse OCA AMOUNT Budget Entity 60910602 - Children's Substance OCA AMOUNT 603005 - DETOXIFICATION 602001- DETOXIFICATION /ARF G/A -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SV( (100420) SAPTBG 270G5 SAPTBG 270G1 GR/Tobacco Settlement Trust Fund 27ME5 GR/Tobacco Settlement Trust Fund 27MEI ' GR/Adult Detox ADDEX GR/Child Detox CHDEX Detoxification Total = $0 Detoxification Total = 603006 - PREVENTION SERVICES 602002 - PREVENTION SERVICES G/A -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SVCS (100420 General Revenue 27ME6 Prevention Services - SIG /ADAMHTF * ** 27F02 ADAMH Trust Fund Prevention Services * ** 27PR6 General Revenue 27ME2 ADAMH Trust Fund - Prevention Services * ** 27PR2 Prevention Partnership Services * ** 27PR3 GR/Child Prevention Svcs. CHPRV General Revenue SP613 GR/Stewart Marchman Trmt. Ctr.- D12 SP643 Prevention Services Total = 50 Prevention Services Total = 50 603007- TREATMENT & AFTERCARE 602003 - TREATMENT & AFTERCARE G/A -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SVCS (100420) SAPTBG 270G7 11111.11111.1.1.1111 SAPTBG 270G3 ADAMHTF Administrative Expenditures 27AD7 1.111111111111111111111111111111 ADAMH Trust Fund Administrative Expenditu 27AD3 ADAMHTF Intravenous Drug Usage * ** 27HIV ADAMH Trust Fund 27CHV j GR/TSTF /O &MTF 27ME7 GR/TSTF /O &MTF /CASATF 27ME3 ADAMHTF Services to Women * ** 27WOM WTTF TANF 39TC1 WTTF TANF 39TC0 GR/Tx & Aftercare - child CHTRT Trust Fund ADTRT IIIIII ADAMH Trust Fund HIV 27CHV , SSBGTF /Camillus Life Center - Dade BS631 ADAMH Trust Fund -Roots n'Wings SP602 General Revenue DPG08 IIIIII GR/Adul. Tx Dually Diagnosed Girls - DI 1 SP606 FEDERAL GRANTS TRUST FUND SB004 IIIIIIIIIMIIIIIIIIIIIIII GR/The Compass Program SP608 ADAMHTF - Steward Marchman Ctr. D12 SP614 IIIIIII GR/ADAMHTF -The starting Place SP610 ADAMHTF -New Horizons Dual Diagnosis SP615 1111.1.1.1111- ADAMHTF- Adolescent Res. SA Tx Facility SP6I 1 ADAMHTF- Addiction Trtmt Services SP616 GR/Project Warm -D12 SP644 ADAMHTF -New Beginnings Prog Renewal SP617 IIIIIIIIIIIIIIMINS GR/Phoenix House -R23 SP645 ; ADAMHTF- Coconut Grove -Behav Hth Ctr SP618 11111111.11111111111111.111111 GR/1ST STEP /MOTHERS /INFANT SP646 ADAMHTF -River Regions Services, Inc. SP619 GR/Drug Abuse Comprehensive Cord Ofc. SP647 ADAMHTF- Passage Way Aftercare Project SP622 OPERATION & MAIN TF SP648 - , ADAMHTF - Emerg. Wait List Reduc. Project SP623 111111111/111111111111111 ADAMHTF- Project Warm SP624 ADAMHTF- Elderly Compliance SA & MH SP625 GR/River Region Women's SA SP651 GR/Circles of Care - Brevard SP652 GR/Center for Drug Free Living SP669 11111111111111111111111111 GR/Center for Drug Free Living - Brevard SP670 Treatment & Aftercare Total = $0 Treatment & Aftercare Total = $0 TOTAL CHILD /ADOL SUB. ABUSE = $0 TOTAL ADULT SUB. ABUSE _ 50 ESTIMATED GRAND TOTAL ALL PROGRAMS = 572,500,000 MATCH CALCULATIONS APPLICABLE TO CONTRACT FUNDS NOT REQUIRING MATCH: Deinstitutionalization Projects $44,600,000' TOTAL FUNDS REQUIRING MATCH = 5� 27,900,000 1Children "e Mental Health Base Fund* MH Exempt Block Grant Allocation LOCAL MATCH REQUIRED = 59,300,000 !Drug Abuse Services ADDITIONAL LOCAL MATCH =( �, GRAND TOTAL LOCAL MATCH = 59,300,00 TOTAL FUNDS NOT REQUIRING MATCH = $44,600,000 •• Expenditure most be Substance Abuse Prevention and Treatment Block Grant eligible •• • Substance Abuse Prevention and Treatment Block Grant - Funding Agreement - RESTRICTIONS APPLY Rev.10/0112010 South Florida Behavioral Health Network, Inc 97 Contract No. KH225 10/01/2010 Exhibit A -6 Performance Contract SAMH Services Program MENTAL HEALTH I _..........__....._ .................................___......._............... ..............._..........__ FUNDING DETAIL ....___.._.._ ............ .............................. IFY 2 0 15 20 - 16 3 Mos) Name (( South Florida Behavioral Health Network, Inc. Contract # KH225 Revision # ; I ( ) Budget Entity 60910502 - Adult Mental Health OCA AMOUNT Budget Entity 60910503 - Children's Mental Health OCA AMOUNT 502004- EMERGENCY STABILIZATION 503001- EMERGENCY STABILIZATION G/A -ADULT COMM. MENTAL HEALTH (100610) G /A- CHILDREN'S MENTAL HEALTH (100435) . ADAMH Trust Fund• 19004 '• 1 ADAMH Trust Fund* 190C1 , General Revenue/TSTF 19ME4 i ': General Revenue 19ME1 3 ADAMHTF /Consumer Self- Directed Care Pilot SP501 i ..............I FGTF - Title XXI 89Q01 ___, ,__....._...__._.._.__._......, GR/Family Emergency Treatment Ctr- Manatee SP503 I 1 GR/Manatee Glens Child Baker Act SP532 GR/Cooper CSU SP516 GR/Child Comprehensive Behavioral Services SP540 GR/Family Emergency Treatment - Pinellas SP525 r--- j GR/CSU District 08 SP542 GR/Apalachee CSU -Leon SP549 3 GR/Marion- Citrus MH- Children CSU SP550 • GR/Family Emergency Treatment - Sarasota SP553 1, # General Revenue SP5EB GR/Lifestream CSU - Lake,Sumter SP559 1 I FGTF -Title IVB W002 i GR/Ruth Cooper CSU -Lee SP560 L . GR/Seminole County CSU SP561 i 1 TSTF /Orange County Receiving Center SP572 GR/APALACHEE SHRT -TERM RESID FAC SPAC9 ..__._._..........1 • G/A -BAKER ACT SERVICES (100611) G /A- CHILDREN'S BAKER ACT (104257) . General Revenue 19ME4 1 1 General Revenue 19ME1 TSTF /Adult Emerg Baker Act Services - Hernando, Pasco SP592 I i General Revenue SP581 Emergency Stabilization Total = $0 G /A- OUTPATIENT BAKER ACT SERVICES PILOT (100612) General Revenue 19ME4 , , Emergency Stabilization Total = $0 502018- RECOVERY & RESILIENCY 503013- RECOVERY & RESILIENCY • G/A -ADULT COMM. MENTAL HEALTH (100610) G /A- CHILDREN'S MENTAL HEALTH (100435) ADAMH Trust Fund' 19018 1 I ADAMH Trust Fund' 19C 13 ADAMH Trust Fund/FACT 19019 — 1 General Revenue 19M13 ____ '.. General Revenue/TSTF 19M18 _ j GR/TSTF 32NO3 General Revenue/FGTF 9QPSR L FGTF - Title XXI 89Q13 GR/AGAPE FAM MINISTRY AFMMD 1, I GR/RTC Non - Medicaid Eligible 9PRNM WTTF TANF 39A18 I 1 GR/Henderson MH Center - Broward SP506 FGTF /ADAMH/GR/Comm Forensic Beds -Adult Svc CFBAS I 80 { ADAMH TF /Infant & Young Special Project SP533 IIIIIIIIIIIIIIIIIII FGTF PATH GXOI8 _ j General Revenue SP5MA GR/TSTF/FGTF - FACT Admin FTA 19 GR/FACT Svcs FTS19 ..............._...._._........ ' O &MTF/FGTF /Com MH Srvs Contract -NEFSH MHS18 I { G /A- PURCHASED RESIDENTIAL FGTF MHTTI 1 TREATMENT SERVICES (102780) GR/Court Cottages in the Pines SP502 GR/RTC Non - Medicad Eligible 9PRNM GR/TSTF/Wayne Densch Center -Orange SP504 i ' GR/Purch Res Treatment - Medicaid Svcs 9PRTS • GR/Charlotte County CMH Center SP505 1 GR/Short-Term Residential Treat-Hillsborough SP5I 1 Generl Revenue/TSTF/Doug Gardens CMH Ctr SP512 1 G /A- PURCHASE/rHERA SVCS CHILD (100800) • GR/Miami -Dade Homeless Trust SP513 s i General Revenue 19MCB 1 3 GR/Camillus Life Center -Dade SP551 ---- GR/FACT Team -Bay, Gulf SP552 GR/Miami Behavioral Hlth Ctr- Uninsured Dade SP555 GR/The Village- Campaneros En Recup -Dade SP558 CAMILLUS BEHAVIOR HLTH TRT CTR SPSCB FAM EMERG TRMT CTR 19 CIRCUIT SP5FE JUV CO -OCCUR ADDTNS Dade /Broward /Monroe SPJC9 w t _ i GR/NEW HORIZONS CENTER SPNH9 ! G /A- INDIGENT PSYCH MEDICATION PROGRAM (101350) Generl Revenue 19M18 , • • G/A -BAKER ACT SERVICES (100611) General Revenue 19M 18 Recovery & Resiliency Total = SO Recovery & Resiliency Total = $0 TOTAL ADULT COMM. MH = SO TOTAL CHILDREN'S MENTAL HEALTH = 80 ' Community Mental Health Block Grant Rev.10/01/2010 Contract No. KH225 South Florida Behavioral Health Network, Inc. 98 10/01/2010 Exhibit A - Performance Contract SAMH Services Program SUBSTANCE ABUSE FUNDING DETAIL Provider Name (South Florida Behavioral Health Network, Inc. I Contract # IKH225 I Revision # ( 1 (FY 2015 -16 (3 Mon) Budget Entity 60910603 - Adult Substance Abuse OCA AMOUNT Budget Entity 60910602 - Children's Substance OCA AMOUNT 603005 - DETOXIFICATION 602001 - DETOXIFICATION /ARF G/A -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SV( (100420) SAPTBG 270G5 1.111111.111111 SAPTBG 270GI 11.11111111111111 GR/Tobacco Settlement Trust Fund 27ME5 allillilliall GR/Tobacco Settlement Trust Fund 27ME1 • GR/Adult Detox ADDEX GR/ChiId Detox CHDEX 3 Detoxification Total = 0 Detoxification Total = $0 603006 - PREVENTION SERVICES 602002- PREVENTION SERVICES G/A -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SVCS (100420 General Revenue 27ME6 - Prevention Services - SIG /ADAMHTF * ** 27F02 ) ADAMH Trust Fund Prevention Services * ** 27PR6 General Revenue 27ME2 ADAMH Trust Fund - Prevention Services * ** 27PR2 Prevention Partnership Services * ** 27PR3 • GR/Child Prevention Svcs. CHPRV General Revenue SP613 i GR/Stewart Marchman Trmt. Ctr.- D12 SP643 Prevention Services Total = $0 Prevention Services Total = $0 603007 - TREATMENT & AFTERCARE 602003 - TREATMENT & AFTERCARE G/A -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SVCS (100420) SAPTBG 270G7 SAPTBG 270G3 ADAMHTF Administrative Expenditures 27AD7 ADAMH Trust Fund Administrative Expenditu 27AD3 ADAMHTF Intravenous Drug Usage * ** 27HIV ADAMH Trust Fund 27CHV GR/TSTF /O &MTF 27ME7 GR/TSTF /O &MTF /CASATF 27ME3 ADAMHTF Services to Women * ** 27WOM WTTF TANF 39TC1 WTTF TANF 39TC0 GR/Tx & Aftercare - child CHTRT Trust Fund ADTRT ADAMH Trust Fund HIV 27CHV SSBGTF /Camillus Life Center - Dade BS63 I ADAMH Trust Fund -Roots n'Wings SP602 General Revenue DPG08 GR/Adol. Tx Dually Diagnosed Girls - DI 1 SP606 FEDERAL GRANTS TRUST FUND SB004 GR/The Compass Program SP608 ' j ADAMHTF - Steward Marchman Ctr. D12 SP614 GR/ADAMHTF -The starting Place SP610 ADAMHTF -New Horizons Dual Diagnosis SP615 ADAMHTF- Adolescent Res. SA Tx Facility SP6I 1 ADAMHTF - Addiction Trtmt Services SP616 GR/Project Warm -D12 SP644 ADAMHTF -New Beginnings Prog Renewal SP617 GR/Phoenix House -R23 SP645 ADAMHTF- Coconut Grove -Behav Hth Ctr SP618 GR/1ST STEP /MOTHERS /INFANT SP646 ADAMHTF -River Regions Services, Inc. SP619 GR/Drug Abuse Comprehensive Cord Ofc. SP647 ADAMHTF- Passage Way Aftercare Project SP622 OPERATION & MAIN TF SP648 ADAMHTF - Emerg. Wait List Reduc. Project SP623 ADAMHTF- Project Warm SP624 ADAMHTF- Elderly Compliance SA & MH SP625 GR/River Region Women's SA SP651 GR/Circles of Care - Brevard SP652 GR/Center for Drug Free Living SP669 GR/Center for Drug Free Living - Brevard SP670 Treatment & Aftercare Total = $0 Treatment & Aftercare Total = $0 TOTAL CHILD /ADOL SUB. ABUSE _ $0 TOTAL ADULT SUB. ABUSE = $0 ESTIMATED GRAND TOTAL ALL PROGRAMS = $18,125,000 MATCH CALCULATIONS APPLICABLE TO CONTRACT FUNDS NOT REQUIRING MATCH: Deinstitutionalization Projects $12,083,333 TOTAL FUNDS REQUIRING MATCH = $6,041,667 Children "e Mental Health Base Funding { MH Exempt Block Grant Allocation LOCAL MATCH REQUIRED = 82,013,889 Drug Abuse Services ADDITIONAL LOCAL MATCH = L GRAND TOTAL LOCAL MATCH = 82,013,889 TOTAL FUNDS NOT REQUIRING MATCH = 812,083,333 •• Expenditure most be Substance Abuse Prevention and Treatment Block Grant eligible ••• Substance Abuse Prevention and Treatment Block Grant - Funding Agreement - RESTRICTIONS APPLY Rev.10/01/2010 South Florida Behavioral Health Network, Inc 99 Contract No. KH225 10/01/2010 SAMH Services Program EXHIBIT B -1 LINE ITEM OPERATING BUDGET AGENCY: South Florida Behavioral Health Network, Inc. CONTRACT # KH225 CONTRACT PERIOD: FROM: 10/01/2010 TO 06/30/2011 DATE PREPARED: 10/01/2010 Special Projects - Administration, CMH SAMSHA Management & Wraparound Other Special Oversight Grant Projects LINE ITEMS AMOUNTS AMOUNTS AMOUNTS TOTAL I. PERSONNEL SERVICES (a) SALARIES $1,561,741 $174,289 $ $1,736,030 (b) FRINGE $325,111 $22,170 $ $347,281 TOTAL PERSONNEL = $1,886,852 $196,459 $0 $2,083,311 II. EXPENSES (a) BUILDING OCCUPANCY $114,000 $ $ $114,000 (b) PROFESSIONAL SERVICES $62,500 $0 $ $62,500 (c) TRAVEL $42,049 $2,540 $ $44,589 (d) EQUIPMENT COSTS $ $ $ $ (e) FOOD SERVICES $ $ $ $ (f) MEDICAL AND PHARMACY $ $ $ $ (g) SUBCONTRACTED SERVICES $ $ $ $ (h) INSURANCE $15,000 $ $ $15,000 (i) INTEREST $ $ $ $ (j) OPERATING SUPPLIES & $278,711 $ $278,711 EXPENSES (k) OTHER $ $ $ $ (I) DONATED ITEMS $ $ $ $ TOTAL EXPENSES = $512,260 $2,540 $0 $514,800 III. NONEXPENDABLE PROPERTY (a) EQUIPMENT $39,931 $ $ $39,931 (b) PROPERTY $0 $ $ $0 TOTAL NONEXPENDABLE PROPERTY = $39,931 $0 $0 $39,931 IV. COMPUTER HARDWARE, SOFTWARE, & SERVICES $101,409 $0 $0 $101,409 TOTAL COMPUTER EXPENSES = $101,409 $0 $0 $101,409 V. SPECIAL PROJECTS $0 $407,933 $0 $407,933 GRAND TOTAL = $2,540,452 $606,932 $0 $3,147,384 Rev 10/01/2010 South Florida Behavioral Health Network, Inc. 100 Contract No. KH225 10/01/2010 SAMH Services Program EXHIBIT B -2 LINE ITEM OPERATING BUDGET AGENCY: South Florida Behavioral Health Network, Inc. CONTRACT # KH225 CONTRACT PERIOD: FROM: 07/01/2011 TO 06/30/2012 DATE PREPARED: 10/01/2010 Administration, Special Projects - Management & CMH SAMSHA Other Special Oversight Wraparound Grant Projects LINE ITEMS AMOUNTS AMOUNTS AMOUNTS TOTAL I. PERSONNEL SERVICES (a) SALARIES $ $ $ $ (b) FRINGE $ $ $ $ TOTAL PERSONNEL = $ $ $ $ II. EXPENSES (a) BUILDING OCCUPANCY $ $ $ $ (b) PROFESSIONAL SERVICES $ $ $ $ (c) TRAVEL $ $ $ $ (d) EQUIPMENT COSTS $ $ $ $ (e) FOOD SERVICES $ $ $ $ (f) MEDICAL AND PHARMACY $ $ $ $ (g) SUBCONTRACTED SERVICES $ $ $ $ (h) INSURANCE $ $ $ $ (i) INTEREST $ $ $ $ (j) OPERATING SUPPLIES & $ $ $ $ EXPENSES (k) OTHER $ $ $ $ (I) DONATED ITEMS $ $ $ $ TOTAL EXPENSES = $ $ $ $ III. NONEXPENDABLE PROPERTY (a) EQUIPMENT $ $ $ $ (b) PROPERTY $ $ $ $ TOTAL NONEXPENDABLE PROPERTY = $ $ $ $ IV. COMPUTER HARDWARE, SOFTWARE, & SERVICES $ $ $ $ TOTAL COMPUTER EXPENSES = $ $ $ $ V. SPECIAL PROJECTS $ $ $ $ GRAND TOTAL = $TBD $TBD $TBD $TBD Rev. 10/01/2010 South Florida Behavioral Health Network, Inc. 101 Contract No. KH225 10/01/2010 SAMH Services Program EXHIBIT B -3 LINE ITEM OPERATING BUDGET AGENCY: South Florida Behavioral Health Network, Inc. CONTRACT # KH225 CONTRACT PERIOD: FROM: 07/01/2012 TO 06/30/2013 DATE PREPARED: 10/01/2010 Administration, Special Projects -CMH Management & SAMSHA Wraparound Oversight Grant Other Special Projects LINE ITEMS AMOUNTS AMOUNTS AMOUNTS TOTAL I. PERSONNEL SERVICES (a) SALARIES $ $ $ $ (b) FRINGE $ $ $ $ TOTAL PERSONNEL = $ $ $ $ II. EXPENSES (a) BUILDING OCCUPANCY $ $ $ $ (b) PROFESSIONAL SERVICES $ $ $ $ (c) TRAVEL $ $ $ $ (d) EQUIPMENT COSTS $ $ $ $ (e) FOOD SERVICES $ $ $ $ (f) MEDICAL AND PHARMACY $ $ $ $ (g) SUBCONTRACTED SERVICES $ $ $ $ (h) INSURANCE $ $ $ $ (i) INTEREST $ $ $ $ (j) OPERATING SUPPLIES & $ $ $ $ EXPENSES (k) OTHER $ $ $ $ (I) DONATED ITEMS $ $ $ $ TOTAL EXPENSES = $ $ $ $ III. NONEXPENDABLE PROPERTY (a) EQUIPMENT $ $ $ $ (b) PROPERTY $ $ $ $ TOTAL NONEXPENDABLE PROPERTY = $ $ $ $ IV. COMPUTER HARDWARE, & SERVICES $ $ $ $ TOTAL COMPUTER EXPENSES = $ $ $ $ V. SPECIAL PROJECTS $ $ $ $ GRAND TOTAL = $TBD $TBD $TBD $TBD Rev. 10/01/2010 South Florida Behavioral Health Network, Inc. 102 Contract No. KH225 10/89/2010 SAMH Services Program EXHIBIT B-4 LINE ITEM OPERATING BUDGET AGENCY: South Florida Behavioral Health Network, Inc. CONTRACT # KH225 CONTRACT PERIOD: FROM: 07/01/2013 TO 06/30/2014 DATE PREPARED: 10/01/2010 Special Projects - Administration, CMH SAMSHA Management & Wraparound Other Special Oversight Grant Projects LINE ITEMS AMOUNTS AMOUNTS AMOUNTS TOTAL I. PERSONNEL SERVICES (a) SALARIES $ $ $ $ (b) FRINGE $ $ $ $ TOTAL PERSONNEL = $ $ $ $ II. EXPENSES (a) BUILDING OCCUPANCY $ $ $ $ (b) PROFESSIONAL SERVICES $ $ $ $ (c) TRAVEL $ $ $ $ (d) EQUIPMENT COSTS $ $ $ $ (e) FOOD SERVICES $ $ $ $ (f) MEDICAL AND PHARMACY $ $ $ $ (g) SUBCONTRACTED SERVICES $ $ $ $ (h) INSURANCE $ $ $ $ (i) INTEREST $ $ $ $ (j) OPERATING SUPPLIES & $ $ $ $ EXPENSES (k) OTHER $ $ $ $ (I) DONATED ITEMS $ $ $ $ TOTAL EXPENSES = $ $ $ $ III. NONEXPENDABLE PROPERTY (a) EQUIPMENT $ $ $ $ (b) PROPERTY $ $ $ $ TOTAL NONEXPENDABLE PROPERTY = $ $ $ $ IV. COMPUTER HARDWARE, & SERVICES $ $ $ $ TOTAL COMPUTER EXPENSES = $ $ $ $ V. SPECIAL PROJECTS $ $ $ $ GRAND TOTAL = $TBD $TBD $TBD $TBD Rev. 10/01/2010 South Florida Behavioral Health Network, Inc. 103 Contract No. KH225 10/01/2010 SAMH Services Program EXHIBIT B -5 LINE ITEM OPERATING BUDGET AGENCY: South Florida Behavioral Health Network, Inc. CONTRACT # KH225 CONTRACT PERIOD: FROM: 07/01/2014 TO 06/30/2015 DATE PREPARED: 10/01/2010 Administration, Special Projects - Management & CMH SAMSHA Other Special Oversight Wraparound Grant Projects LINE ITEMS AMOUNTS AMOUNTS AMOUNTS TOTAL I. PERSONNEL SERVICES (a) SALARIES $ $ $ $ (b) FRINGE $ $ $ $ TOTAL PERSONNEL = $ $ $ $ II. EXPENSES (a) BUILDING OCCUPANCY $ $ $ $ (b) PROFESSIONAL SERVICES $ $ $ $ (c) TRAVEL $ $ $ $ (d) EQUIPMENT COSTS $ $ $ $ (e) FOOD SERVICES $ $ $ $ (f) MEDICAL AND PHARMACY $ $ $ $ (g) SUBCONTRACTED SERVICES $ $ $ $ (h) INSURANCE $ $ $ $ (i) INTEREST $ $ $ $ (j) OPERATING SUPPLIES & $ $ $ $ EXPENSES (k) OTHER $ $ $ $ (I) DONATED ITEMS $ $ $ $ TOTAL EXPENSES = $ $ $ $ III. NONEXPENDABLE PROPERTY (a) EQUIPMENT $ $ $ $ (b) PROPERTY $ $ $ $ TOTAL NONEXPENDABLE PROPERTY = $ $ $ $ IV. COMPUTER HARDWARE, & SERVICES $ $ $ $ TOTAL COMPUTER EXPENSES = $ $ $ $ V. SPECIAL PROJECTS $ $ $ $ GRAND TOTAL = $TBD $TBD $TBD $TBD Rev. 10/01/2010 South Florida Behavioral Health Network, Inc. 104 Contract No. KH225 10/01/2010 SAMH Services Program EXHIBIT B -6 LINE ITEM OPERATING BUDGET AGENCY: South Florida Behavioral Health Network, Inc. CONTRACT # KH225 CONTRACT PERIOD: FROM: 07/01/2015 TO 09/30/2015 DATE PREPARED: 10/01/2010 Special Projects - Administration, CMH SAMSHA Management & Wraparound Other Special Oversight Grant Projects LINE ITEMS AMOUNTS AMOUNTS AMOUNTS TOTAL I. PERSONNEL SERVICES (a) SALARIES $ $ $ $ (b) FRINGE $ $ $ $ TOTAL PERSONNEL = $ $ $ $ II. EXPENSES (a) BUILDING OCCUPANCY $ $ $ $ (b) PROFESSIONAL SERVICES $ $ $ $ (c) TRAVEL $ $ $ $ (d) EQUIPMENT COSTS $ $ $ $ (e) FOOD SERVICES $ $ $ $ (f) MEDICAL AND PHARMACY $ $ $ $ (g) SUBCONTRACTED SERVICES $ $ $ $ (h) INSURANCE $ $ $ $ (i) INTEREST $ $ $ $ (j) OPERATING SUPPLIES & $ $ $ $ EXPENSES (k) OTHER $ $ $ $ (I) DONATED ITEMS $ $ $ $ TOTAL EXPENSES = $ $ $ $ III. NONEXPENDABLE PROPERTY (a) EQUIPMENT $ $ $ $ (b) PROPERTY $ $ $ $ TOTAL NONEXPENDABLE PROPERTY = $ $ $ $ IV. COMPUTER HARDWARE, & SERVICES $ $ $ $ TOTAL COMPUTER EXPENSES = $ $ $ $ V. SPECIAL PROJECTS $ $ $ $ GRAND TOTAL = $TBD $TBD $TBD $TBD Rev. 10/01/2010 South Florida Behavioral Health Network, Inc. 105 Contract No. KH225 Exhibit C -1 Fixed Price MANAGING ENTITY ADMINSTRATIVE SERVICES MONTHLY REQUEST FOR PAYMENT /ADVANCE Administrative Services a. AGENCY NAME: South Florida Behavioral Health Network, Inc. b. CONTRACT NO.: KH225 c. REQUEST MONTH / YEAR OF: d. FEDERAL ID #: g. Remaining Months in Contract: e. VENDOR ID (If different than Fed ID): f. ADDRESS (Number, City, State, Zip): Part I -FIXED PRICE /FIXED PAYMENT - - -- . 1 2 3 4 5 Number of Units Current Month UNIT OF MEASURE UNIT COST Billed this Month Request YTD Expenditure I One (1) Month of Administration, Mana•ement and Oversi•ht M, ' ■ MI= 1 Totals $0.00 $0.00; $0.00 $0.00 PART 2 - FUNDING DISTRIBUTION Cols E - F - G A B C D E H II II - - - - - -- © E © 1 - - - - - -- $ - $ - $ - $ - PART 3 - CERTIFICATION & APPROVAL h. I certify the above to be accurate and in agreement with this agency's records and with the terms of this agency's contract with the department. Additionally, I certify that all client demographic and service event data has been submitted to the department in accordance with the contract. Signature Title Date i. For DCF Contract Manager use only: YTD Advance Balance Date Invoice Received: Total: Date Goods /Services Received: Date Inspected and Approved: Approved By: Contract Manager 10/01/2010 South Florida Behavioral Health Netowrk, Inc. 106 KH225 Subcontracted Provider Network Exhibit C - Cost Reimbursement NETWORK PROVIDER SERVICES COST REIMBURSEMENT REPORT OF EXPENDITURES AND REQUEST FOR PAYMENT /ADVANCE Adult Mental Health Services a. AGENCY NAME: South Florida Behavioral Health Network, Inc. b CONTRACT NO.. KH225 c. REQUEST MONTH / YEAR OF. d. FEDERAL ID #: g Remaining Months in Contract e. VENDOR ID (If different than Fed ID): I. ADDRESS (Number, C State, Zi• PART 1 - EARNINGS XXXXXXXXX<XXXX>0 '1X� • t 2 1 4 55 .6 44 ' ' + 9.9.4409.4. 0.4 • VOA, 'Oa ' ,y y ' #'�' Total Contract Network Providers r (Fr." Request *' 9 # + j m �9 4 *# ` * '9 + *. 9 + � TAOt ACTIVITY Amount Paid YTD Paymanb Period) *+* *+* *+ * + *+ ** **,� * * * 9 9 Wilo * + +/h +W + 1* + t+ ;' ... 5045 moo so 00 XXXXX5MM © W 00.00 00.00 5Z5Z593Z5Z556Z56556.56 =5M561 © 9229S so.00 so.00 922222222566660. 9 k so 00 so.00 MMQQQ Q .W2 MXX KXXXX 80.00 $o. 'st XXXX '1�'r s{QQ 54XXX5 80.00 $0.00 XXXXX50 Ii RS& $0.00 $0.00 22225, so 00 so.00 Q �M� !r �' � i ^ ) 00.00 80. �+ f ?fixx I 00000rxxx ( o' Grand Totals $0.00: 80.00 $0.00) 1�QX 9 ( � ; lQQ Q QQQ' PART 2 - FUNDING DISTRIBUTION � - oo ©oo ©o - 10 $ - $ - $ $ PART 1- CERTIFICATION 8 APPROVAL h I certify the above to be accurate and n agreement with this agencys records and with the terms of this agencys contract with the department Additionally, I certify that all client demographic and service event data has been submitted to the department in accordance with the contract Signature Title Date For DCF Contract Mane • er use on! : Date Invoice Received: Dab Goods/Services Received: Total: Dab Inspected and Approved: Approved By: Contract Manager 10/01/2010 South Florda Behavioral Health Network. Inc. 107 KH225 Subcontracted Provider Network Exhibit C - Cost Reimbursement NETWORK PROVIDER SERVICES COST REIMBURSEMENT REPORT OF EXPENDITURES AND REQUEST FOR PAYMENT /ADVANCE Children Mental Health Services South Florida Behavioral Health Network, a. AGENCY NAME: Inc. b. CONTRACT NO.: KH225 c. REQUEST MONTH / YEAR OF: d. FEDERAL ID #: g. Remaining Months in Contract: e. VENDOR ID (If different than Fed ID): f. ADDRESS (Number, City, State, Zip): PART 1 - EARNINGS r�*jr� * **jrlte. .'.' i 'M jo4/ , t!' 'g '�,�ii' '�, `R q L,L,If M ,ip 1 2 3 4 1. * * * +� ** • fir *0 * * ' * *64 * .i(t .* * *air * ** * * * * * * * * * ** • * * * * * * * * *** * * * * * * *� * * * * * * * ** *** 44 * * * ** * * * * ** * * ** * 4.,o: * * ** *OA,* Amount r *•� * **,�,'l ** * .....•..... * * * * '� * '�' * '� * * * ** * ** '� * * ** * * * ** Requested (From t * * orwr* * ,* * * * ,-A ** * * * 4 * * * * aniera * **IMF * * * 4, * + } * * * * a (E * * Total Contract Network Providers I * * * *' * * * . ** *** * , * * * i * * * *,� ****, **** * * * *, ** , ** ** * * * ** ACTIVITY Amount Paid YTD Payments for Request Perod) r �, * * * * * * * * * ,o, *, * �, * * * * * *, 1 ! r * +► ** • * *� $o.00 $0. r* * * dr, * * +1, t * * * +Ir * * * * * + I r lr* * * * ** *+! * * ,. * * * * * ,. * * * * * * * * * * 04 * fir * * * 4r * * * s * *•it*4*.* * *. * **+tr* 2 +•• * *; $0.00 $0.00 * * * * ** * * * * * * * * * * *► * * * ** * * * * ** 3 $0.00 $0.00 * # *+ .Ir *#r * *4 * **+�* ......500 ' • 4 , #* # $0.00 $o.00 * t * ► * " * ,* * +►,*�* s Vi i * * *, * *, * *�+ * ► " i " * *+ * ►�j i * * + * , * ►• * w •t •11* •• 5 ** * * ** $0.00 $0.00+/+Y+R **+► +R * * * � ( * *+��r+1+1+lF +► *+11r *+R** 6 y �l''k $0.00 $0.00 .. 40. * WitiO NR x Misi t'St�3(l I N 8 **,*, * $o.00 $o.00 # f * i * r * * * * * + * ► * * * * + l * 'M, * * *• * * *, * * * w i t. * * * *• * • `* * , * , * * * *+ 9 *.aR, *. *.rrr $o.00 $o.00 k, + * *4* ** ****** * * * � * * * * * * * � 'I` tr * *► * * * * * * * * * * *w #r * *' Grand Totals $0.00 $0.00 $0.00 * * *, * * *, ** ** * * * * * ** lr * * * ** * * * * ** . PART 2 - FUNDING DISTRIBUTION Columns G-H-I A B C D E F G H 1 J 1 2 3 4 5 6 7 8 9 10 $ - $ - $ - $ - PART 3 - CERTIFICATION 8, APPROVAL h. I certify the above to be accurate and in agreement with this agencys records and with the terms of this agencys contract with the department. Additionally, I certify that all client demographic and service event data has been submitted to the department in accordance with the contract. Signature Title Date i. For DCF Contract Manager use only: I Date Invoice Received: YTD Advance Balance 1 Date Goods /Services Received: 1 Total: Date Inspected and Approved: Approved By: Contract Manager I f 10/01/2010 South Florida Behavioral Health Network, Inc. 108 KHoor Subcontracted Provider Network Exhibit C - Cost Reimbursement NETWORK PROVIDER SERVICES COST REIMBURSEMENT REPORT OF EXPENDITURES AND REQUEST FOR PAYMENT /ADVANCE Adult Substance Abuse Services a AGENCY NAME: South Florida Behavioral Health Network, Inc. b. CONTRACT No.: KH226 c. REQUEST MONTH / YEAR OF: d. FEDERAL ID #: g. Remaining Months in Contrail: e. VENDOR ID (If different than Fed ID): f. ADDRESS (Number, Cdy, State, Zip). PART 1 - EARNINGS I. 7107.v 4747. 271 Veil 4:0 t, �r,�� * ." Amount Requested F 4 # 4 R 4 #� 4 + 400+440 4 4,444, *4+4+ R 4 # 4 + 4 # * +IM +4+44 (Ron ProvidersforRe / +4444 410.04404411.4444 +4 4 +44+ ACTIVITY Total Vaot Am Conour* d Y PaiTD Payments f Penodl � * 4 + 4 4 ; 4 + 4 + 4 + 4 4 �' 4 + + Mt 4 '0 4 l�' 40,4 .0 4 'N 4 +It 4 +► 4 ' 4 + 1 4 4 4 4 4 4 4 4 4 4 4 4 4 4 $o.0 $O .00 44 4 4 4 4 #���+1 � 1 .. i. 40 , . ��i 41 +► 4 Y ♦ 94► .011140. + � . + + 4► x , 14 ,, i + �r + • � + + + + +,� 2 4 �� 4 �� 44 [ 4, ' � [ 4 ] � (( $o.00 $o.00 � 4 � 0 (( + ] #+R4++ + {� +4 � 0 [ ,0 ]]f�� •4#40 44x,4, � ' 3 � $0.00 m00'4 ^C.�i75��.7�]6 �Cr .T6r+6 4 "WC.� �9 moo $0.00 • 4'♦ • • 5 � I 1 5 f � � � VC 5 56566066 $0.00 $O .00 4 44 4 4 M�X�cX�y '�6}�� SJS.f 6 , C,�cw!'t,.)+c5 $0.00 $O .00 4 + 4 4 * xX�)IU[ �r�c, M 4)cti , +X ]cxx 7 0.00 +tir $0.00 $0.00 4 4 4 4 4 ^rvr1� I�H 1✓ X V'XI"+�t+til"r" L^,� " 9 .4 8 ^ r^,e+" "r+1 so.00 so.00 f 4 # +� + 4 + u' ' 0 � �[�, +M 4 • • +l.4 $0.00 $0.00 r '': tt?5? +► Grand Totals $0.00 50.00 $0.0011Valt + .+. '+4 4 ,• ilta eiti's d,� AVIV. PART 2 - FUNDING DISTRIBUTION columns c-H-1 A B C D E F O H J 1 2 3 4 5 6 7 8 9 10 1 $ - $ - $ - $ PART 3 - CERTIFICATION 8 APPROVAL h. 1 certify the above to be accurate and in agreement with this agencys records and with the terms of this agencys contract with the department. Additionally, 1 certify that all client demographic and service event data has been submitted to the department in accordance with the contract. Signature Title Date i. For DCF Contract Manager use only: Datelnvolce Received: YTD Advance Balance Date Goods/Services Received: Total: Date Inspected and Approved: Approved By: Contract Manager 10/01/2010 South Florida Behavioral Heahh Network, Inc. 109 KH225 Subcontracted Provider Network Exhibit C - Cost Reimbursement NETWORK PROVIDER SERVICES COST REIMBURSEMENT REPORT OF EXPENDITURES AND REQUEST FOR PAYMENT /ADVANCE Children Substance Abuse Services a. AGENCY NAME: South Florida Behavioral Health Network, Inc. b. CONTRACT No.: KH225 c. REQUEST MONTH / YEAR OF: d. FEDERAL ID #: g. Remaining Months in Contract: e. VENDOR ID (If different than Fed ID): t. ADDRESS (Number, City, State, Zip)'. _ PART 1 - EARNINGS * se * /1, R + `. +*,*° 4 7 4o lr g i w '', + t + +rr + ..+'i +P *1. * :+ rl +7+r+V. 1 2 I 3 I 4 + Cord �Y +1 ►� VA" P ► �, N%% ' r ►' Amount Re 't♦ # +e . 4 4 +4 4 % 1/ w, (From Network . + + + ++ ++ + ++ ++ +, •'�' +44444 '#'' - 444+% + ++4 '+ "� '�' +'�' +'� *�`+ ' Provitlers for Request ,�,'*,� +, +,� + +. + '� + '.'* + + + + ' + +'* + + + + +'� +'� + + +'* +. e+.41.40— + + ACTIVITY Total rad A,„0.4 Paid YTD Paymerds Period) + 4 4 + + ++ + + + + + + # • } + + • + + 1 I 'illr'Se $0.00 $0.00,l'y''S�'tS1'� 0000 �( ' �/1 2 ei tK/K� $0.00 $0.00 YRYHi „ ti h�i hi�XX M55 YMeK50i 3 + + + + # ++ $0.00 $ 0.0 0 + +4, +�, + * . +R�,+ 1►,�+! +it +i' + + +►s+ +R +f� +R�► +, # + +R + +R�: 4 * + + $0.00 moo 4/ • + +. + • *' • * 4 *44” BIB ►* • 5 BVIMP4twe $0.00 $0. *' ++++. '�+++++++'�'4t ++R+ + +++++ 6 8 + + ++ $0.00 $o.00+ +*�G +'r ►: + ► ++ ' 4" 4"' 9 + && +. &&. $o.00 $0 +► ++ 4 +1+' +* �► + + ++ + + +** + ++ + +G * + 4 + + ++ * + + ++ Grand Totals $OOOt: $0.00 $0.00 + + + + + + + + + + + +*+++ + . + + ++ + +*+'+` PART 2 - FUNDING DISTRIBUTION cow mss E -F c A B C D E + F p N 0 � 1 2 3 4 5 6 7 8 9 10 $ - $ - $ - $ - PART 3 - CERTIFICATION 8. APPROVAL h. 1 certify the above to be accurate and in agreement with this agencys records and with the terms of this agency's contract with the department. Additionally, I certify that all client demographic and service event data has been submitted to the department in accordance with the contract. Signature Title Date For DCF Contract Manager use only: Date Invoice Received: YTD Advance Balance Date Goods /Services Received: Total: Date Inspected and Approved: Approved By: Contract Manager 10/01/2010 South Florida Behavioral Health Network, Inc. 110 KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2010 -2011 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: I. Mental Health Contracted Services A. Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH, Medicaid and Local Match) Numbers to *Please explain in the comment section below if a target population is indicated in the section below, but there is no be Served corresponding outcome standard for that population. 1. Adult Mental Health a. Adults with Severe and Persistent Mental Illness (SPMI) (M0016)/(MH016) 21,742 b. Adults with Serious and Acute Episodes of Mental Illness (M05301)/(MH5301) 555 c. Adults with Mental Health Problems (M05302)/(MH5302) 1,676 d. Adults with Forensic Involvement (M0018)/(MH018) 274 2. Children's Mental Health a. Children with Serious Emotional Disturbances (SED) (M0031)/(MH031) 10,503 b. Children with Emotional Disturbances (ED) (M0032)/(MH032) 5,501 c. Children at -risk of Emotional Disturbances (M0033)/(MH033) 92 B. Required Performance Outcome Standards for Each Target Population Minimum *Please explain in the comment section below if there is an Outcome Standard but there is no corresponding target Contract population indicated. Standard 1. Adult Mental Health - Adults with Severe and Persistent Mental Illness a. Percent of adults with severe and persistent mental illnesses who live in stable housing environment will be at least (M0742)/MH742) (Statewide Target — 93 %) 93% b. Average annual number of days (post admission assessments) worked for pay for adults with severe and persistent mental illness will be at least (M0003)/(MH003) — (Statewide Target — 30) 30 2. Adult Mental Health - Adults in Mental Health Crisis, including Adults with Serious and Acute Episodes of Mental Illness and Adults with Mental Health Problems a. Percent of adults in mental health crisis who live in stable housing environment will be at least (M0744)/MH744) — (Statewide Target — 90 %) 90% 3. Adult Mental Health — Adults with Serious Mental Illness (SPMI, MH Crisis, Forensic) a. Percent of adults with serious mental illness who are competitively employed will be at least (M0703)/MH703) — (Statewide Target — 15%) 15% 4. Adult Mental Health - Forensic Involvement a. Percent of adults in forensic involvement who live in stable housing environment will be at least (M0743)/MH743) — (Statewide Target — 70 %) 70% 5. Children's Mental Health - Seriously Emotionally Disturbed a. Percent of children with serious emotional disturbance who live in stable housing environment will be at least (M0779)/(MH779) — (Statewide Target — 95 %) 95% b. Percent of children with serious emotional disturbance who improve their level of functioning will be at least (M0378)/MH378) — (Statewide Target — 65 %) 65% c. Percent of school days seriously emotionally disturbed children attended will be at least (M0012)/(MH012) — (Statewide Target — 86 %) 86% 6. Children's Mental Health - Emotionally Disturbed a. Percent of children who live in stable housing environment will be at least (M0778)/(MH778) — (Statewide Target — 95 %) 95% b. Percent of children who improve their level of functioning will be at least (M0377)/(MH377) — (Statewide Target — 64 %) 64% 10/01/2010 111 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2010 -2011 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: 7. Children's Mental Health — At -Risk of Emotional Disturbance a. Percent of children who live in stable housing environment will be at least (M0780) (MH780) — (Statewide Target — 90 %) 90% C. Required Internal Measures 1. Data Submission Outcomes for Mental Health a. Percent of persons receiving state - contracted mental health service event records which have matching mental health initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0759) The standard target for this measure is at least 95% 95% II. Substance Abuse Contracted Services A. Required Performance Output Standards for Each Target Population (including all clients Minimum paid for by SAMH, Medicaid and Local Match) Numbers to *Please explain in the comment section below if a target population is indicated in the section below, but there is no be Served corresponding outcome standard for that population. 1. Adults with Substance Abuse Problems a. Number of Adults Served (M0063)/(SA063) 12,354 2. Children with Substance Abuse Problems a. Number of Children Served (M0052)/(SA052) 4,520 3. Adults At -Risk of Substance Abuse Problems- (Non GAA) a. Number of Adults participating in Prevention Services (M0785)(SA785) 18,087 b. Number of Adults participating in Level 1 Prevention Programs (M0767)/(SA767) 150 c. Number of Adults participating in Level 2 Prevention Programs (M0768)/(SA768) 10 d. Number of adults participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities (M0769)/(SA769) 112 e. Number of adults participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities (M0770)/(SA770) 7 4. Children At -Risk of Substance Abuse Problems- (Non GAA) a. Number of children participating in Prevention Services (M0762)/(SA762) 14,983 b. Number of children participating in Level 1 Prevention Programs (M0761)/(SA761) 9,735 c. Number of children participating in Level 2 Prevention Programs(M0695) /(SA695) 354 d. Number of children participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities (M0763)/(SA763) 2,164 e. Number of children participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities (M0764)(SA764) 143 B. Required Performance Outcome Standards for Each Target Population Minimum *Please explain in the comment section below if there is an Outcome Standard but there is no corresponding target Contract population indicated. Standard 1. Adults with Substance Abuse Problems a. Percent of adults who successfully complete substance abuse treatment services will be at least (M0755)/SA755) - (Statewide Target — 50 %) 50% b. Percent change in clients who are employed from admission to discharge will be at least (M0753)/(SA753) (Statewide Target — 20 %) 20% c. Percent of adults who live in a stable housing environment at the time of discharge will be at least (M0756)/SA756) - (Statewide Target — 80 %) 80% d. Percent change in the number of adults arrested 30 days prior to admission versus 30 days 10/01/2010 112 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2010 - 2011 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: prior to discharge (M0754/SA754) (Statewide Target — 35 %) 35% 2. Adults At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for Each 50 %) a. Percent of adults participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0771)/(SA771) 50% b. Percent of adults participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0772)/(SA772) 50% 3. Children with Substance Abuse Problems a. Percent of children who successfully complete substance abuse treatment services will be at least (SA725)/M0725) - (Statewide Target — 55 %) 55% b. Percent of children who live in a stable housing environment will be at least (M0752)/SA752) - (Statewide Target — 85 %) 85% c. Percent change in the number of children arrested 30 days prior to admission versus 30 days prior to discharge will be at least (M0751/SA751) - (Statewide Target — 20 %) 20% 4. Children At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for each 50 %) a. Percent of children participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0765)/(SA765) 50% b. Percent of children participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0766)/(SA766) 50% 5. Data Submission for Prevention Program Tool (Baseline — Non GAA) a. Percent of approved Prevention Descriptions completed within 30 days of contract execution. (Statewide Target — 50 %) 50% C. Required Internal Measures 1. Data Submission Outcomes for Substance Abuse a. Percent of persons receiving state - contracted substance abuse service event records which have matching substance abuse initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0758) The standard target for this measure is at least 95% 95% 111. Managing Entity Contracted Services a. Performance Measures (1) 80 percent of Network Providers surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" or higher. (2) 80 percent of stakeholders surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" or higher. (3) 80 percent of consumers surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" or higher. (4) 90 percent of the Network Providers will receive reimbursement for verified services from the provider within 15 days following the managing entity receipt of a valid invoice. (5) TBD percent reduction in the average number of days people are on the residential substance abuse wait list. 10/01/2010 113 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2010 -2011 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: (6) TBD percent reduction in the average number of people waiting on the residential substance abuse wait list. (7) TBD percent reduction in the average number of days people are on the adult mental health wait list. (8) TBD percent reduction in the average number of people waiting on the adult mental health wait list. (9) TBD percent reduction in the average number of days people are on the children's mental health wait list. (10) TBD percent reduction in the average number of people waiting on the children's mental health wait list. (11) TBD percent reduction in the average number of days people are on the forensic wait list. (12) TBD percent reduction in the average number of people waiting on the forensic wait list. (13) The ME will manage the utilization of contracted service dollars to prevent any lapse in service dollars. b. Methodology (1) The numerator is the number of Network Providers indicating ratings of "satisfactory" or higher on the satisfaction survey. The denominator is the number of Network Providers responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (2) The numerator is the number of stakeholders indicating ratings of "satisfactory" or higher on the satisfaction survey. The denominator is the number of stakeholders responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (3) The numerator is the number of consumers indicating ratings of "satisfactory" or higher on the satisfaction survey. The denominator is the number of consumers responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (4) The numerator is the number of properly prepared invoices received from Network Providers that are paid within 15 days of receipt from Network Providers. The denominator is the number of properly prepared invoices with all required backup data received from the Network Providers for each month. The measure is based on attaining an average of 90 percent or greater rate over a 12 -month period. (5) One minus the fraction whose numerator is the average number of days people were on the residential substance abuse wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (6) One minus the fraction whose numerator is the average number of people waiting on the residential substance abuse wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (7) One minus the fraction whose numerator is the average number of days people were on the adult mental health wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. 10/01/2010 114 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2010 -2011 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: (8) One minus the fraction whose numerator is the average number of people waiting on the adult mental health wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (9) One minus the fraction whose numerator is the average number of days people were on the children's mental health wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (10) One minus the fraction whose numerator is the average number of people waiting on the children's mental health wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (11) One minus the fraction whose numerator is the average number of days people were on the forensic wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (12) One minus the fraction whose numerator is the average number of people waiting on the forensic wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (13) The numerator is the amount of service dollars utilized by Network Providers at the end of each fiscal year. The denominator is the total amount of service dollars allocated to the ME during each fiscal year. IV. Comments / Explanations 'There should be a number, baseline, or N/A inserted for each target or outcome in the sections above. *Please explain if a target population is indicated but there is no corresponding outcome standard for that population, or if there is an Outcome Standard but there is no corresponding target population indicated. 10/01/2010 115 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2011 -2012 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: I. Mental Health Contracted Services A. Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH, Medicaid and Local Match) Numbers to *Please explain in the comment section below if a target population is Indicated in the section below, but there is no be Served corresponding outcome standard for that population. 1. Adult Mental Health a. Adults with Severe and Persistent Mental Illness (SPMI) (M0016)/(MH016) TBD b. Adults with Serious and Acute Episodes of Mental Illness (M05301)/(MH5301) TBD c. Adults with Mental Health Problems (M05302)/(MH5302) TBD d. Adults with Forensic Involvement (M0018)/(MH018) TBD 2. Children's Mental Health a. Children with Serious Emotional Disturbances (SED) (M0031)/(MH031) TBD b. Children with Emotional Disturbances (ED) (M0032)/(MH032) TBD c. Children at -risk of Emotional Disturbances (M0033)/(MH033) TBD B. Required Performance Outcome Standards for Each Target Population Minimum *Please explain in the comment section below if there is an Outcome Standard but there is no corresponding target Contract population indicated. Standard 1. Adult Mental Health - Adults with Severe and Persistent Mental Illness a. Percent of adults with severe and persistent mental illnesses who live in stable housing environment will be at least (M0742)/MH742) (Statewide Target — 93 %) 93% b. Average annual number of days (post admission assessments) worked for pay for adults with severe and persistent mental illness will be at least (M0003) /(MH003) — (Statewide Target — 30) 30 2. Adult Mental Health - Adults in Mental Health Crisis, including Adults with Serious and Acute Episodes of Mental Illness and Adults with Mental Health Problems a. Percent of adults in mental health crisis who live in stable housing environment will be at least (M0744)/MH744) — (Statewide Target — 90 %) 90% 3. Adult Mental Health — Adults with Serious Mental Illness (SPMI, MH Crisis, Forensic) a. Percent of adults with serious mental illness who are competitively employed will be at least (M0703)/MH703) — (Statewide Target — 15%) 15% 4. Adult Mental Health - Forensic Involvement b. Percent of adults in forensic involvement who live in stable housing environment will be at least (M0743)/MH743) — (Statewide Target — 70 %) 70% 5. Children's Mental Health - Seriously Emotionally Disturbed a. Percent of children with serious emotional disturbance who live in stable housing environment will be at least (M0779)/(MH779) — (Statewide Target — 95 %) 95% b. Percent of children with serious emotional disturbance who improve their level of functioning will be at least (M0378)/MH378) — (Statewide Target — 65 %) 65% c. Percent of school days seriously emotionally disturbed children attended will be at least (M0012)/(MH012) — (Statewide Target — 86 %) 86% 6. Children's Mental Health - Emotionally Disturbed a. Percent of children who live in stable housing environment will be at least (M0778)/(MH778) — (Statewide Target — 95 %) 95% b. Percent of children who improve their level of functioning will be at least (M0377)/(MH377) — (Statewide Target — 64 %) 64% 10/01/2010 116 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2011 -2012 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: 7. Children's Mental Health — At -Risk of Emotional Disturbance a. Percent of children who live in stable housing environment will be at least (M0780) (MH780) — (Statewide Target — 90 %) 90% C. Required Internal Measures 1. Data Submission Outcomes for Mental Health a. Percent of persons receiving state - contracted mental health service event records which have matching mental health initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0759) The standard target for this measure is at least 95% 95% II. Substance Abuse Contracted Services A. Required Performance Output Standards for Each Target Population (including all clients Minimum paid for by SAMH, Medicaid and Local Match) Numbers to • lease explain in the comment section below if a target population is indicated in the section below, but there is no be Served corresponding outcome standard for that population. 1. Adults with Substance Abuse Problems a. Number of Adults Served (M0063)/(SA063) TBD 2. Children with Substance Abuse Problems a. Number of Children Served (M0052)/(SA052) TBD 3. Adults At -Risk of Substance Abuse Problems- (Non GAA) a. Number of Adults participating in Prevention Services (M0785)(SA785) TBD b. Number of Adults participating in Level 1 Prevention Programs (M0767)/(SA767) TBD c. Number of Adults participating in Level 2 Prevention Programs (M0768)/(SA768) TBD d. Number of adults participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities (M0769)/(SA769) TBD e. Number of adults participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities (M0770)/(SA770) TBD 4. Children At -Risk of Substance Abuse Problems- (Non GAA) a. Number of children participating in Prevention Services (M0762)/(SA762) TBD b. Number of children participating in Level 1 Prevention Programs (M0761)/(SA761) TBD c. Number of children participating in Level 2 Prevention Programs(M0695) /(SA695) TBD d. Number of children participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities (M0763)/(SA763) TBD e. Number of children participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities (M0764)(SA764) TBD B. Required Performance Outcome Standards for Each Target Population Minimum *Please explain in the comment section below if there is an Outcome Standard but there is no corresponding target Contract population indicated. Standard 1. Adults with Substance Abuse Problems a. Percent of adults who successfully complete substance abuse treatment services will be at least (M0755)/SA755) - (Statewide Target — 50 %) 50% b. Percent change in clients who are employed from admission to discharge will be at least (M0753)/(SA753) (Statewide Target — 20 %) 20% c. Percent of adults who live in a stable housing environment at the time of discharge will be at least (M0756)/SA756) - (Statewide Target — 80 %) 80% 10/01/2010 117 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2011 -2012 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: d. Percent change in the number of adults arrested 30 days prior to admission versus 30 days prior to discharge (M0754/SA754) (Statewide Target — 35 %) 35% 2. Adults At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for Each 50 %) a. Percent of adults participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0771)/(SA771) 50% b. Percent of adults participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0772)/(SA772) 50% 3. Children with Substance Abuse Problems a. Percent of children who successfully complete substance abuse treatment services will be at least (SA725)/M0725) - (Statewide Target — 55 %) 55% b. Percent of children who live in a stable housing environment will be at least (M0752)/SA752) - (Statewide Target — 85 %) 85% c. Percent change in the number of children arrested 30 days prior to admission versus 30 days prior to discharge will be at least (M0751/SA751) - (Statewide Target — 20 %) 20% 4. Children At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for each 50 %) a. Percent of children participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0765)/(SA765) 50% b. Percent of children participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0766)/(SA766) 50% 5. Data Submission for Prevention Program Tool (Baseline — Non GAA) a. Percent of approved Prevention Descriptions completed within 30 days of contract execution. (Statewide Target — 50 %) 50% C. Required Internal Measures 1. Data Submission Outcomes for Substance Abuse a. Percent of persons receiving state - contracted substance abuse service event records which have matching substance abuse initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0758) The standard target for this measure is at least 95% 95% III. Managing Entity Contracted Services a. Performance Measures (1) 80 percent of Network Providers surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" or higher. (2) 80 percent of stakeholders surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" or higher. (3) 80 percent of consumers surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" or higher. (4) 90 percent of the Network Providers will receive reimbursement for verified services from the provider within 15 days following the managing entity receipt of a valid invoice. (5) TBD percent reduction in the average number of days people are on the residential substance abuse wait list. 10/01/2010 118 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2011 -2012 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: (6) TBD percent reduction in the average number of people waiting on the residential substance abuse wait list. (7) TBD percent reduction in the average number of days people are on the adult mental health wait list. (8) TBD percent reduction in the average number of people waiting on the adult mental health wait list. (9) TBD percent reduction in the average number of days people are on the children's mental health wait list. (10) TBD percent reduction in the average number of people waiting on the children's mental health wait list. (11) TBD percent reduction in the average number of days people are on the forensic wait list. (12) TBD percent reduction in the average number of people waiting on the forensic wait list. (13) The ME will manage the utilization of contracted service dollars to prevent any lapse in service dollars. b. Methodology (1) The numerator is the number of Network Providers indicating ratings of "satisfactory" or higher on the satisfaction survey. The denominator is the number of Network Providers responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (2) The numerator is the number of stakeholders indicating ratings of "satisfactory" or higher on the satisfaction survey. The denominator is the number of stakeholders responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (3) The numerator is the number of consumers indicating ratings of "satisfactory" or higher on the satisfaction survey. The denominator is the number of consumers responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (4) The numerator is the number of properly prepared invoices received from Network Providers that are paid within 15 days of receipt from Network Providers. The denominator is the number of properly prepared invoices with all required backup data received from the Network Providers for each month. The measure is based on attaining an average of 90 percent or greater rate over a 12 -month period. (5) One minus the fraction whose numerator is the average number of days people were on the residential substance abuse wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (6) One minus the fraction whose numerator is the average number of people waiting on the residential substance abuse wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (7) One minus the fraction whose numerator is the average number of days people were on the adult mental health wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. 10/01/2010 119 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2011 -2012 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: (8) One minus the fraction whose numerator is the average number of people waiting on the adult mental health wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (9) One minus the fraction whose numerator is the average number of days people were on the children's mental health wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (10) One minus the fraction whose numerator is the average number of people waiting on the children's mental health wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (11) One minus the fraction whose numerator is the average number of days people were on the forensic wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (12) One minus the fraction whose numerator is the average number of people waiting on the forensic wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (13) The numerator is the amount of service dollars utilized by Network Providers at the end of each fiscal year. The denominator is the total amount of service dollars allocated to the ME during each fiscal year. IV. Comments / Explanations *There should be a number, baseline, or N/A inserted for each target or outcome in the sections above. *Please explain if a target population is indicated but there is no corresponding outcome standard for that population, or if there is an Outcome Standard but there is no corresponding target population indicated. 10/01/2010 120 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2012 -2013 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: I. Mental Health Contracted Services A. Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH, Medicaid and Local Match) Numbers to 'Please explain in the comment section below if a target population is indicated in the section below, but there is no be Served corresponding outcome standard for that population. 1. Adult Mental Health a. Adults with Severe and Persistent Mental Illness (SPMI) (M0016)/(MH016) TBD b. Adults with Serious and Acute Episodes of Mental Illness (M05301)/(MH5301) TBD c. Adults with Mental Health Problems (M05302)/(MH5302) TBD d. Adults with Forensic Involvement (M0018)/(MH018) TBD 2. Children's Mental Health a. Children with Serious Emotional Disturbances (SED) (M0031)/(MH031) TBD b. Children with Emotional Disturbances (ED) (M0032)/(MH032) TBD c. Children at -risk of Emotional Disturbances (M0033)/(MH033) TBD B. Required Performance Outcome Standards for Each Target Population Minimum *Please explain in the comment section below if there is an Outcome Standard but there is no corresponding target Contract population indicated. Standard 1. Adult Mental Health - Adults with Severe and Persistent Mental Illness a. Percent of adults with severe and persistent mental illnesses who live in stable housing environment will be at least (M0742)/MH742) (Statewide Target — 93 %) 93% b. Average annual number of days (post admission assessments) worked for pay for adults with severe and persistent mental illness will be at least (M0003)/(MH003) — (Statewide Target — 30) 30 2. Adult Mental Health - Adults in Mental Health Crisis, including Adults with Serious and Acute Episodes of Mental Illness and Adults with Mental Health Problems a. Percent of adults in mental health crisis who live in stable housing environment will be at least (M0744)/MH744) — (Statewide Target — 90 %) 90% 3. Adult Mental Health — Adults with Serious Mental Illness (SPMI, MH Crisis, Forensic) a. Percent of adults with serious mental illness who are competitively employed will be at least (M0703)/MH703) — (Statewide Target — 15%) 15% 4. Adult Mental Health - Forensic Involvement a. Percent of adults in forensic involvement who live in stable housing environment will be at least (M0743)/MH743) — (Statewide Target — 70 %) 70% 5. Children's Mental Health - Seriously Emotionally Disturbed a. Percent of children with serious emotional disturbance who live in stable housing environment will be at least (M0779)/(MH779) — (Statewide Target — 95 %) 95% b. Percent of children with serious emotional disturbance who improve their level of functioning will be at least (M0378)/MH378) — (Statewide Target — 65 %) 65% c. Percent of school days seriously emotionally disturbed children attended will be at least (M0012)/(MH012) — (Statewide Target — 86 %) 86% 6. Children's Mental Health - Emotionally Disturbed a. Percent of children who live in stable housing environment will be at least (M0778)/(MH778) — (Statewide Target — 95 %) 95% b. Percent of children who improve their level of functioning will be at least (M0377)/(MH377) — (Statewide Target — 64 %) 64% 10/01/2010 121 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2012 -2013 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: 7. Children's Mental Health — At -Risk of Emotional Disturbance a. Percent of children who live in stable housing environment will be at least (M0780) (MH780) — (Statewide Target — 90 %) 90% C. Required Internal Measures 1. Data Submission Outcomes for Mental Health a. Percent of persons receiving state - contracted mental health service event records which have matching mental health initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0759) The standard target for this measure is at least 95% 95% II. Substance Abuse Contracted Services A. Required Performance Output Standards for Each Target Population (including all clients Minimum paid for by SAMH, Medicaid and Local Match) Numbers to *lease explain in the comment section below if a target population is indicated in the section below, but there is no be Served corresponding outcome standard for that population. 1. Adults with Substance Abuse Problems a. Number of Adults Served (M0063)/(SA063) TBD 2. Children with Substance Abuse Problems a. Number of Children Served (M0052)/(SA052) TBD 3. Adults At -Risk of Substance Abuse Problems- (Non GAA) a. Number of Adults participating in Prevention Services (M0785)(SA785) TBD b. Number of Adults participating in Level 1 Prevention Programs (M0767)/(SA767) TBD c. Number of Adults participating in Level 2 Prevention Programs (M0768)/(SA768) TBD d. Number of adults participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities (M0769)/(SA769) TBD e. Number of adults participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities (M0770)/(SA770) TBD 4. Children At -Risk of Substance Abuse Problems- (Non GAA) a. Number of children participating in Prevention Services (M0762)/(SA762) TBD b. Number of children participating in Level 1 Prevention Programs (M0761)/(SA761) TBD c. Number of children participating in Level 2 Prevention Programs(M0695) /(SA695) TBD d. Number of children participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities (M0763)/(SA763) TBD e. Number of children participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities (M0764)(SA764) TBD B. Required Performance Outcome Standards for Each Target Population Minimum *Please explain in the comment section below if there is an Outcome Standard but there is no corresponding target Contract population indicated. Standard 1. Adults with Substance Abuse Problems a. Percent of adults who successfully complete substance abuse treatment services will be at least (M0755)/SA755) - (Statewide Target — 50 %) 50% b. Percent change in clients who are employed from admission to discharge will be at least (M0753)/(SA753) (Statewide Target — 20 %) 20% c. Percent of adults who live in a stable housing environment at the time of discharge will be at least (M0756)/SA756) - (Statewide Target — 80 %) 80% 10/01/2010 122 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2012 -2013 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: d. Percent change in the number of adults arrested 30 days prior to admission versus 30 days prior to discharge (M0754/SA754) (Statewide Target — 35 %) 35% 2. Adults At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for Each 50 %) a. Percent of adults participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0771)/(SA771) 50% b. Percent of adults participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0772)/(SA772) 50% 3. Children with Substance Abuse Problems a. Percent of children who successfully complete substance abuse treatment services will be at least (SA725)/M0725) - (Statewide Target — 55 %) 55% b. Percent of children who live in a stable housing environment will be at least (M0752)/SA752) - (Statewide Target — 85 %) 85% c. Percent change in the number of children arrested 30 days prior to admission versus 30 days prior to discharge will be at least (M0751/SA751) - (Statewide Target — 20 %) 20% 4. Children At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for each 50 %) a. Percent of children participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0765)/(SA765) 50% b. Percent of children participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0766)/(SA766) 50% 5. Data Submission for Prevention Program Tool (Baseline — Non GAA) a. Percent of approved Prevention Descriptions completed within 30 days of contract execution. (Statewide Target — 50 %) 50% C. Required Internal Measures 1. Data Submission Outcomes for Substance Abuse a. Percent of persons receiving state - contracted substance abuse service event records which have matching substance abuse initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0758) The standard target for this measure is at least 95% 95% III. Managing Entity Contracted Services a. Performance Measures (1) 80 percent of Network Providers surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" or higher. (2) 80 percent of stakeholders surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" or higher. (3) 80 percent of consumers surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" or higher. (4) 90 percent of the Network Providers will receive reimbursement for verified services from the provider within 15 days following the managing entity receipt of a valid invoice. 10/01/2010 123 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2012 -2013 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: (5) TBD percent reduction in the average number of days people are on the residential substance abuse wait list. (6) TBD percent reduction in the average number of people waiting on the residential substance abuse wait list. (7) TBD percent reduction in the average number of days people are on the adult mental health wait list. (8) TBD percent reduction in the average number of people waiting on the adult mental health wait list. (9) TBD percent reduction in the average number of days people are on the children's mental health wait list. (10) TBD percent reduction in the average number of people waiting on the children's mental health wait list. (11) TBD percent reduction in the average number of days people are on the forensic wait list. (12) TBD percent reduction in the average number of people waiting on the forensic wait list. (13) The ME will manage the utilization of contracted service dollars to prevent any lapse in service dollars. b. Methodology (1) The numerator is the number of Network Providers indicating ratings of "satisfactory" or higher on the satisfaction survey. The denominator is the number of Network Providers responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (2) The numerator is the number of stakeholders indicating ratings of "satisfactory" or higher on the satisfaction survey. The denominator is the number of stakeholders responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (3) The numerator is the number of consumers indicating ratings of "satisfactory" or higher on the satisfaction survey. The denominator is the number of consumers responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (4) The numerator is the number of properly prepared invoices received from Network Providers that are paid within 15 days of receipt from Network Providers. The denominator is the number of properly prepared invoices with all required backup data received from the Network Providers for each month. The measure is based on attaining an average of 90 percent or greater rate over a 12 -month period. (5) One minus the fraction whose numerator is the average number of days people were on the residential substance abuse wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (6) One minus the fraction whose numerator is the average number of people waiting on the residential substance abuse wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. 10/01/2010 124 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2012 -2013 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: (7) One minus the fraction whose numerator is the average number of days people were on the adult mental health wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (8) One minus the fraction whose numerator is the average number of people waiting on the adult mental health wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (9) One minus the fraction whose numerator is the average number of days people were on the children's mental health wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (10) One minus the fraction whose numerator is the average number of people waiting on the children's mental health wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (11) One minus the fraction whose numerator is the average number of days people were on the forensic wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (12) One minus the fraction whose numerator is the average number of people waiting on the forensic wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (13) The numerator is the amount of service dollars utilized by Network Providers at the end of each fiscal year. The denominator is the total amount of service dollars allocated to the ME during each fiscal year. IV. Comments / Explanations *There should be a number, baseline, or N/A inserted for each target or outcome in the sections above. Please explain if a target population is indicated but there is no corresponding outcome standard for that population, or if there is an Outcome Standard but there is no corresponding target population indicated. 10/01/2010 125 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2013 -2014 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: I. Mental Health Contracted Services A. Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH, Medicaid and Local Match) Numbers to *Please explain in the comment section below if a target population is indicated in the section below, but there is no be Served corresponding outcome standard for that population. 1. Adult Mental Health a. Adults with Severe and Persistent Mental Illness (SPMI) (M0016)/(MH016) TBD b. Adults with Serious and Acute Episodes of Mental Illness (M05301)/(MH5301) TBD c. Adults with Mental Health Problems (M05302)/(MH5302) TBD d. Adults with Forensic Involvement (M0018)/(MH018) TBD 2. Children's Mental Health a. Children with Serious Emotional Disturbances (SED) (M0031)/(MH031) TBD b. Children with Emotional Disturbances (ED) (M0032)/(MH032) TBD c. Children at -risk of Emotional Disturbances (M0033)/(MH033) TBD B. Required Performance Outcome Standards for Each Target Population Minimum *Please explain in the comment section below if there is an Outcome Standard but there is no corresponding target Contract population indicated. Standard 1. Adult Mental Health - Adults with Severe and Persistent Mental Illness a. Percent of adults with severe and persistent mental illnesses who live in stable housing environment will be at least (M0742)/MH742) (Statewide Target — 93 %) 93% b. Average annual number of days (post admission assessments) worked for pay for adults with severe and persistent mental illness will be at least (M0003)/(MH003) — (Statewide Target — 30) 30 2. Adult Mental Health - Adults in Mental Health Crisis, including Adults with Serious and Acute Episodes of Mental Illness and Adults with Mental Health Problems a. Percent of adults in mental health crisis who live in stable housing environment will be at least (M0744)/MH744) — (Statewide Target — 90 %) 90% 3. Adult Mental Health — Adults with Serious Mental Illness (SPMI, MH Crisis, Forensic) a. Percent of adults with serious mental illness who are competitively employed will be at least (M0703)/MH703) — (Statewide Target — 15%) 15% 4. Adult Mental Health - Forensic Involvement a. Percent of adults in forensic involvement who live in stable housing environment will be at least (M0743)/MH743) — (Statewide Target — 70 %) 70% 5. Children's Mental Health - Seriously Emotionally Disturbed a. Percent of children with serious emotional disturbance who live in stable housing environment will be at least (M0779)/(MH779) — (Statewide Target — 95 %) 95% b. Percent of children with serious emotional disturbance who improve their level of functioning will be at least (M0378)/MH378) — (Statewide Target — 65 %) 65% c. Percent of school days seriously emotionally disturbed children attended will be at least (M0012)/(MH012) — (Statewide Target — 86 %) 86% 6. Children's Mental Health - Emotionally Disturbed a. Percent of children who live in stable housing environment will be at least (M0778)/(MH778) — (Statewide Target — 95 %) 95% b. Percent of children who improve their level of functioning will be at least (M0377)/(MH377) — (Statewide Target — 64 %) 64% 10/01/2010 126 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2013 -2014 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: 7. Children's Mental Health — At -Risk of Emotional Disturbance a. Percent of children who live in stable housing environment will be at least (M0780) (MH780) — (Statewide Target — 90 %) 90% C. Required Internal Measures 1. Data Submission Outcomes for Mental Health a. Percent of persons receiving state - contracted mental health service event records which have matching mental health initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will be at Ieast(SAMHIS) (M0759) The standard target for this measure is at least 95% 95% II. Substance Abuse Contracted Services A. Required Performance Output Standards for Each Target Population (including all clients Minimum *Please aid for by SAMH, Medicaid and Local Match) Numbers to explain in the comment section below if a target population is indicated in the section below, but there is no be Served corresponding outcome standard for that population. 1. Adults with Substance Abuse Problems a. Number of Adults Served (M0063)/(SA063) TBD 2. Children with Substance Abuse Problems a. Number of Children Served (M0052)/(SA052) TBD 3. Adults At -Risk of Substance Abuse Problems- (Non GAA) a. Number of Adults participating in Prevention Services (M0785)(SA785) TBD b. Number of Adults participating in Level 1 Prevention Programs (M0767)/(SA767) TBD c. Number of Adults participating in Level 2 Prevention Programs (M0768)/(SA768) TBD d. Number of adults participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities (M0769)/(SA769) TBD e. Number of adults participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities (M0770)/(SA770) TBD 4. Children At -Risk of Substance Abuse Problems- (Non GAA) a. Number of children participating in Prevention Services (M0762)/(SA762) TBD b. Number of children participating in Level 1 Prevention Programs (M0761)/(SA761) TBD c. Number of children participating in Level 2 Prevention Programs(M0695) /(SA695) TBD d. Number of children participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities (M0763)/(SA763) TBD e. Number of children participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities (M0764)(SA764) TBD B. Required Performance Outcome Standards for Each Target Population Minimum *Please explain in the comment section below if there is an Outcome Standard but there is no corresponding target Contract population indicated. Standard 1. Adults with Substance Abuse Problems a. Percent of adults who successfully complete substance abuse treatment services will be at least (M0755)/SA755) - (Statewide Target — 50 %) 50% b. Percent change in clients who are employed from admission to discharge will be at least (M0753)/(SA753) (Statewide Target — 20 %) 20% c. Percent of adults who live in a stable housing environment at the time of discharge will be at least (M0756)/SA756) - (Statewide Target — 80 %) 80% 10/01/2010 127 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2013 -2014 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: d. Percent change in the number of adults arrested 30 days prior to admission versus 30 days prior to discharge (M0754/SA754) (Statewide Target — 35 %) 35% 2. Adults At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for Each 50 %) a. Percent of adults participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0771)/(SA771) 50% b. Percent of adults participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0772)/(SA772) 50% 3. Children with Substance Abuse Problems a. Percent of children who successfully complete substance abuse treatment services will be at least (SA725)/M0725) - (Statewide Target — 55 %) 55% b. Percent of children who live in a stable housing environment will be at least (M0752)/SA752) - (Statewide Target — 85 %) 85% c. Percent change in the number of children arrested 30 days prior to admission versus 30 days prior to discharge will be at least (M0751/SA751) - (Statewide Target — 20 %) 20% 4. Children At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for each 50 %) a. Percent of children participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0765)/(SA765) 50% b. Percent of children participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0766)/(SA766) 50% 5. Data Submission for Prevention Program Tool (Baseline — Non GAA) a. Percent of approved Prevention Descriptions completed within 30 days of contract execution. (Statewide Target — 50 %) 50% C. Required Internal Measures 1. Data Submission Outcomes for Substance Abuse a. Percent of persons receiving state - contracted substance abuse service event records which have matching substance abuse initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0758) The standard target for this measure is at least 95% 95% III. Managing Entity Contracted Services a. Performance Measures (1) 80 percent of Network Providers surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" or higher. (2) 80 percent of stakeholders surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" or higher. (3) 80 percent of consumers surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" or higher. (4) 90 percent of the Network Providers will receive reimbursement for verified services from the provider within 15 days following the managing entity receipt of a valid invoice. 10/01/2010 128 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2013 -2014 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: (5) TBD percent reduction in the average number of days people are on the residential substance abuse wait list. (6) TBD percent reduction in the average number of people waiting on the residential substance abuse wait list. (7) TBD percent reduction in the average number of days people are on the adult mental health wait list. (8) TBD percent reduction in the average number of people waiting on the adult mental health wait list. (9) TBD percent reduction in the average number of days people are on the children's mental health wait list. (10) TBD percent reduction in the average number of people waiting on the children's mental health wait list. (11) TBD percent reduction in the average number of days people are on the forensic wait list. (12) TBD percent reduction in the average number of people waiting on the forensic wait list. (13) The ME will manage the utilization of contracted service dollars to prevent any lapse in service dollars. b. Methodology (1) The numerator is the number of Network Providers indicating ratings of "satisfactory" or higher on the satisfaction survey. The denominator is the number of Network Providers responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (2) The numerator is the number of stakeholders indicating ratings of "satisfactory" or higher on the satisfaction survey. The denominator is the number of stakeholders responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (3) The numerator is the number of consumers indicating ratings of "satisfactory" or higher on the satisfaction survey. The denominator is the number of consumers responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (4) The numerator is the number of properly prepared invoices received from Network Providers that are paid within 15 days of receipt from Network Providers. The denominator is the number of properly prepared invoices with all required backup data received from the Network Providers for each month. The measure is based on attaining an average of 90 percent or greater rate over a 12 -month period. (5) One minus the fraction whose numerator is the average number of days people were on the residential substance abuse wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (6) One minus the fraction whose numerator is the average number of people waiting on the residential substance abuse wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (7) One minus the fraction whose numerator is the average number of days people were on the adult mental health wait list during the past fiscal, and whose denominator is the average number of days people were on 10/01/2010 129 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2013 -2014 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (8) One minus the fraction whose numerator is the average number of people waiting on the adult mental health wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (9) One minus the fraction whose numerator is the average number of days people were on the children's mental health wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (10) One minus the fraction whose numerator is the average number of people waiting on the children's mental health wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (11) One minus the fraction whose numerator is the average number of days people were on the forensic wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (12) One minus the fraction whose numerator is the average number of people waiting on the forensic wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (13) The numerator is the amount of service dollars utilized by Network Providers at the end of each fiscal year. The denominator is the total amount of service dollars allocated to the ME during each fiscal year. IV. Comments / Explanations *There should be a number, baseline, or N/A inserted for each target or outcome in the sections above. Please explain if a target population is indicated but there is no corresponding outcome standard for that population, or if there is an Outcome Standard but there is no corresponding target population indicated. 10/01/2010 130 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2014 -2015 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: I. Mental Health Contracted Services A. Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH, Medicaid and Local Match) Numbers to Please explain in the comment section below if a target population is indicated in the section below, but there is no be Served corresponding outcome standard for that population. 1. Adult Mental Health a. Adults with Severe and Persistent Mental Illness (SPMI) (M0016)/(MH016) TBD b. Adults with Serious and Acute Episodes of Mental Illness (M05301)/(MH5301) TBD c. Adults with Mental Health Problems (M05302)/(MH5302) TBD d. Adults with Forensic Involvement (M0018)/(MH018) TBD 2. Children's Mental Health a. Children with Serious Emotional Disturbances (SED) (M0031)/(MH031) TBD b. Children with Emotional Disturbances (ED) (M0032)/(MH032) TBD c. Children at -risk of Emotional Disturbances (M0033)/(MH033) TBD B. Required Performance Outcome Standards for Each Target Population Minimum *Please explain in the comment section below if there is an Outcome Standard but there is no corresponding target Contract population indicated. Standard 1. Adult Mental Health - Adults with Severe and Persistent Mental Illness a. Percent of adults with severe and persistent mental illnesses who live in stable housing environment will be at least (M0742)/MH742) (Statewide Target — 93 %) 93% b. Average annual number of days (post admission assessments) worked for pay for adults with severe and persistent mental illness will be at least (M0003)/(MH003) — (Statewide Target — 30) 30 2. Adult Mental Health - Adults in Mental Health Crisis, including Adults with Serious and Acute Episodes of Mental Illness and Adults with Mental Health Problems a. Percent of adults in mental health crisis who live in stable housing environment will be at least (M0744)/MH744) — (Statewide Target — 90 %) 90% 3. Adult Mental Health — Adults with Serious Mental Illness (SPMI, MH Crisis, Forensic) a. Percent of adults with serious mental illness who are competitively employed will be at least (M0703)/MH703) — (Statewide Target — 15%) 15% 4. Adult Mental Health - Forensic Involvement a. Percent of adults in forensic involvement who live in stable housing environment will be at least (M0743)/MH743) — (Statewide Target — 70 %) 70% 5. Children's Mental Health - Seriously Emotionally Disturbed a. Percent of children with serious emotional disturbance who live in stable housing environment will be at least (M0779)/(MH779) — (Statewide Target — 95 %) 95% b. Percent of children with serious emotional disturbance who improve their level of functioning will be at least (M0378)/MH378) — (Statewide Target — 65 %) 65% c. Percent of school days seriously emotionally disturbed children attended will be at least (M0012)/(MH012) — (Statewide Target — 86 %) 86% 6. Children's Mental Health - Emotionally Disturbed a. Percent of children who live in stable housing environment will be at least (M0778)/(MH778) — (Statewide Target — 95 %) 95% b. Percent of children who improve their level of functioning will be at least (M0377)/(MH377) — (Statewide Target — 64 %) 64% 10/01/2010 131 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2014 -2015 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: 7. Children's Mental Health — At -Risk of Emotional Disturbance a. Percent of children who live in stable housing environment will be at least (M0780) (MH780) — (Statewide Target — 90 %) 90% C. Required Internal Measures 1. Data Submission Outcomes for Mental Health a. Percent of persons receiving state - contracted mental health service event records which have matching mental health initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0759) The standard target for this measure is at least 95% 95% II. Substance Abuse Contracted Services A. Required Performance Output Standards for Each Target Population (including all clients Minimum paid for by SAMH, Medicaid and Local Match) Numbers to * explain in the comment section below if a target population is indicated in the section below, but there is no corresponding outcome standard for that population. be Served 1. Adults with Substance Abuse Problems a. Number of Adults Served (M0063)/(SA063) TBD 2. Children with Substance Abuse Problems a. Number of Children Served (M0052)/(SA052) TBD 3. Adults At -Risk of Substance Abuse Problems- (Non GAA) a. Number of Adults participating in Prevention Services (M0785)(SA785) TBD b. Number of Adults participating in Level 1 Prevention Programs (M0767)/(SA767) TBD c. Number of Adults participating in Level 2 Prevention Programs (M0768)/(SA768) TBD d. Number of adults participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities (M0769)/(SA769) TBD e. Number of adults participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities (M0770)/(SA770) TBD 4. Children At -Risk of Substance Abuse Problems- (Non GAA) a. Number of children participating in Prevention Services (M0762)/(SA762) TBD b. Number of children participating in Level 1 Prevention Programs (M0761)/(SA761) TBD c. Number of children participating in Level 2 Prevention Programs(M0695) /(SA695) TBD d. Number of children participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities (M0763)/(SA763) TBD e. Number of children participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities (M0764)(SA764) TBD B. Required Performance Outcome Standards for Each Target Population Minimum *Please explain in the comment section below if there is an Outcome Standard but there is no corresponding target Contract population indicated. Standard 1. Adults with Substance Abuse Problems a. Percent of adults who successfully complete substance abuse treatment services will be at least (M0755)/SA755) - (Statewide Target — 50 %) 50% b. Percent change in clients who are employed from admission to discharge will be at least (M0753)/(SA753) (Statewide Target — 20 %) Y0% c. Percent of adults who live in a stable housing environment at the time of discharge will be at least (M0756)/SA756) - (Statewide Target — 80 %) 80% d. Percent change in the number of adults arrested 30 days prior to admission versus 30 days 10/01/2010 132 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2014 -2015 • Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: prior to discharge (M0754/SA754) (Statewide Target — 35 %) 35% 2. Adults At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for Each 50 %) a. Percent of adults participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0771)/(SA771) 50% b. Percent of adults participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0772)/(SA772) 50% 3. Children with Substance Abuse Problems a. Percent of children who successfully complete substance abuse treatment services will be at least (SA725)/M0725) - (Statewide Target — 55 %) 55% b. Percent of children who live in a stable housing environment will be at least (M0752)/SA752) - (Statewide Target — 85 %) 85% c. Percent change in the number of children arrested 30 days prior to admission versus 30 days prior to discharge will be at least (M0751/SA751) - (Statewide Target — 20 %) 20% 4. Children At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for each 50 %) a. Percent of children participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0765)/(SA765) 50% b. Percent of children participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0766)/(SA766) 50% 5. Data Submission for Prevention Program Tool (Baseline — Non GAA) a. Percent of approved Prevention Descriptions completed within 30 days of contract execution. (Statewide Target — 50 %) 50% C. Required Internal Measures 1. Data Submission Outcomes for Substance Abuse a. Percent of persons receiving state - contracted substance abuse service event records which have matching substance abuse initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will be at Ieast(SAMHIS) (M0758) The standard target for this measure is at least 95% 95% III. Managing Entity Contracted Services a. Performance Measures (1) 80 percent of Network Providers surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" or higher. (2) 80 percent of stakeholders surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" or higher. (3) 80 percent of consumers surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" or higher. (4) 90 percent of the Network Providers will receive reimbursement for verified services from the provider within 15 days following the managing entity receipt of a valid invoice. (5) TBD percent reduction in the average number of days people are on the residential substance abuse wait list. 10/01/2010 133 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2014 -2015 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: (6) TBD percent reduction in the average number of people waiting on the residential substance abuse wait list. (7) TBD percent reduction in the average number of days people are on the adult mental health wait list. (8) TBD percent reduction in the average number of people waiting on the adult mental health wait list. (9) TBD percent reduction in the average number of days people are on the children's mental health wait list. (10) TBD percent reduction in the average number of people waiting on the children's mental health wait list. (11) TBD percent reduction in the average number of days people are on the forensic wait list. (12) TBD percent reduction in the average number of people waiting on the forensic wait list. (13) The ME will manage the utilization of contracted service dollars to prevent any lapse in service dollars. b. Methodology (1) The numerator is the number of Network Providers indicating ratings of "satisfactory" or higher on the satisfaction survey. The denominator is the number of Network Providers responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (2) The numerator is the number of stakeholders indicating ratings of "satisfactory" or higher on the satisfaction survey. The denominator is the number of stakeholders responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (3) The numerator is the number of consumers indicating ratings of "satisfactory" or higher on the satisfaction survey. The denominator is the number of consumers responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (4) The numerator is the number of properly prepared invoices received from Network Providers that are paid within 15 days of receipt from Network Providers. The denominator is the number of properly prepared invoices with all required backup data received from the Network Providers for each month. The measure is based on attaining an average of 90 percent or greater rate over a 12 -month period. (5) One minus the fraction whose numerator is the average number of days people were on the residential substance abuse wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (6) One minus the fraction whose numerator is the average number of people waiting on the residential substance abuse wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (7) One minus the fraction whose numerator is the average number of days people were on the adult mental health wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. 10/01/2010 134 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D • Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2014 -2015 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: (8) One minus the fraction whose numerator is the average number of people waiting on the adult mental health wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (9) One minus the fraction whose numerator is the average number of days people were on the children's mental health wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (10) One minus the fraction whose numerator is the average number of people waiting on the children's mental health wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (11) One minus the fraction whose numerator is the average number of days people were on the forensic wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (12) One minus the fraction whose numerator is the average number of people waiting on the forensic wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (13) The numerator is the amount of service dollars utilized by Network Providers at the end of each fiscal year. The denominator is the total amount of service dollars allocated to the ME during each fiscal year. IV. Comments / Explanations *There should be a number, baseline, or N/A inserted for each target or outcome in the sections above. Please explain if a target population is indicated but there is no corresponding outcome standard for that population, or if there Is an Outcome Standard but there is no corresponding target population indicated. 10/01/2010 135 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year July 1, 2015- September 30, 2015 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: I. Mental Health Contracted Services A. Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH, Medicaid and Local Match) Numbers to *Please explain in the comment section below if a target population is indicated in the section below, but there is no be Served corresponding outcome standard for that population. 1. Adult Mental Health a. Adults with Severe and Persistent Mental Illness (SPMI) (M0016)/(MH016) TBD b. Adults with Serious and Acute Episodes of Mental Illness (M05301)/(MH5301) TBD c. Adults with Mental Health Problems (M05302)/(MH5302) TBD d. Adults with Forensic Involvement (M0018)/(MH018) TBD 2. Children's Mental Health a. Children with Serious Emotional Disturbances (SED) (M0031)/(MH031) TBD b. Children with Emotional Disturbances (ED) (M0032)/(MH032) TBD c. Children at -risk of Emotional Disturbances (M0033)/(MH033) TBD B. Required Performance Outcome Standards for Each Target Population Minimum *Please explain in the comment section below if there is an Outcome Standard but there is no corresponding target Contract population indicated. Standard 1. Adult Mental Health - Adults with Severe and Persistent Mental Illness a. Percent of adults with severe and persistent mental illnesses who live in stable housing environment will be at least (M0742)/MH742) (Statewide Target — 93 %) 93% b. Average annual number of days (post admission assessments) worked for pay for adults with severe and persistent mental illness will be at least (M0003)/(MH003) — (Statewide Target — 30) 30 2. Adult Mental Health - Adults in Mental Health Crisis, including Adults with Serious and Acute Episodes of Mental Illness and Adults with Mental Health Problems a. Percent of adults in mental health crisis who live in stable housing environment will be at least (M0744)/MH744) — (Statewide Target — 90 %) 90% 3. Adult Mental Health — Adults with Serious Mental Illness (SPMI, MH Crisis, Forensic) a. Percent of adults with serious mental illness who are competitively employed will be at least (M0703)/MH703) — (Statewide Target — 15%) 15% 4. Adult Mental Health - Forensic Involvement a. Percent of adults in forensic involvement who live in stable housing environment will be at least (M0743)/MH743) — (Statewide Target — 70 %) 70% 5. Children's Mental Health - Seriously Emotionally Disturbed a. Percent of children with serious emotional disturbance who live in stable housing environment will be at least (M0779)/(MH779) — (Statewide Target — 95 %) 95% b. Percent of children with serious emotional disturbance who improve their level of functioning will be at least (M0378)/MH378) — (Statewide Target — 65 %) 65% c. Percent of school days seriously emotionally disturbed children attended will be at least (M0012)/(MH012) — (Statewide Target — 86 %) 86% 6. Children's Mental Health - Emotionally Disturbed a. Percent of children who live in stable housing environment will be at least (M0778)/(MH778) — (Statewide Target — 95 %) 95% b. Percent of children who improve their level of functioning will be at least (M0377)/(MH377) — (Statewide Target — 64 %) 64% 10/01/2010 136 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year July 1, 2015- September 30, 2015 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: 7. Children's Mental Health — At -Risk of Emotional Disturbance a. Percent of children who live in stable housing environment will be at least (M0780) (MH780) — (Statewide Target — 90 %) 90% C. Required Internal Measures 1. Data Submission Outcomes for Mental Health a. Percent of persons receiving state - contracted mental health service event records which have matching mental health initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0759) The standard target for this measure is at least 95% 95% II. Substance Abuse Contracted Services A. Required Performance Output Standards for Each Target Population (including all clients Minimum paid for by SAMH, Medicaid and Local Match) Numbers to *Please explain in the comment section below if a target population is indicated in the section below, but there is no be Served corresponding outcome standard for that population. 1. Adults with Substance Abuse Problems a. Number of Adults Served (M0063)/(SA063) TBD 2. Children with Substance Abuse Problems a. Number of Children Served (M0052)/(SA052) TBD 3. Adults At -Risk of Substance Abuse Problems- (Non GAA) a. Number of Adults participating in Prevention Services (M0785)(SA785) TBD b. Number of Adults participating in Level 1 Prevention Programs (M0767)/(SA767) TBD c. Number of Adults participating in Level 2 Prevention Programs (M0768)/(SA768) TBD d. Number of adults participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities (M0769)/(SA769) TBD e. Number of adults participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities (M0770)/(SA770) TBD 4. Children At -Risk of Substance Abuse Problems- (Non GAA) a. Number of children participating in Prevention Services (M0762)/(SA762) TBD b. Number of children participating in Level 1 Prevention Programs (M0761)/(SA761) TBD c. Number of children participating in Level 2 Prevention Programs(M0695) /(SA695) TBD d. Number of children participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities (M0763)/(SA763) TBD e. Number of children participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities (M0764)(SA764) TBD B. Required Performance Outcome Standards for Each Target Population Minimum *Please explain in the comment section below if there is an Outcome Standard but there is no corresponding Contract target population indicated. Standard 1. Adults with Substance Abuse Problems a. Percent of adults who successfully complete substance abuse treatment services will be at least (M0755)/SA755) - (Statewide Target — 50 %) 50% b. Percent change in clients who are employed from admission to discharge will be at least (M0753)/(SA753) (Statewide Target — 20 %) 20% c. Percent of adults who live in a stable housing environment at the time of discharge will be at least (M0756)/SA756) - (Statewide Target — 80 %) 80% d. Percent change in the number of adults arrested 30 days prior to admission versus 30 days 10/01/2010 137 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year July 1, 2015- September 30, 2015 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: prior to discharge (M0754/SA754) (Statewide Target — 35 %) 35% 2. Adults At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for Each 50 %) a. Percent of adults participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0771)/(SA771) 50% b. Percent of adults participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0772)/(SA772) 50% 3. Children with Substance Abuse Problems a. Percent of children who successfully complete substance abuse treatment services will be at least (SA725)/M0725) - (Statewide Target — 55 %) 55% b. Percent of children who live in a stable housing environment will be at least (M0752)/SA752) - (Statewide Target — 85 %) 85% c. Percent change in the number of children arrested 30 days prior to admission versus 30 days prior to discharge will be at least (M0751/SA751) - (Statewide Target — 20 %) 20% 4. Children At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for each 50 %) a. Percent of children participating in Level 1 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0765)/(SA765) 50% b. Percent of children participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities will be at least (M0766)/(SA766) 50% 5. Data Submission for Prevention Program Tool (Baseline — Non GAA) a. Percent of approved Prevention Descriptions completed within 30 days of contract execution. (Statewide Target — 50 %) 50% C. Required Internal Measures 6. Data Submission Outcomes for Substance Abuse a. Percent of persons receiving state - contracted substance abuse service event records which have matching substance abuse initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0758) The standard target for this measure is at least 95% 95% III. Managing Entity Contracted Services a. Performance Measures (1) 80 percent of Network Providers surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" or higher. (2) 80 percent of stakeholders surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" or higher. (3) 80 percent of consumers surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" or higher. (4) 90 percent of the Network Providers will receive reimbursement for verified services from the provider within 15 days following the managing entity receipt of a valid invoice. (5) TBD percent reduction in the average number of days people are on the residential substance abuse wait list. 10/01/2010 138 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year July 1, 2015- September 30, 2015 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: (6) TBD percent reduction in the average number of people waiting on the residential substance abuse wait list. (7) TBD percent reduction in the average number of days people are on the adult mental health wait list. (8) TBD percent reduction in the average number of people waiting on the adult mental health wait list. (9) TBD percent reduction in the average number of days people are on the children's mental health wait list. (10) TBD percent reduction in the average number of people waiting on the children's mental health wait list. (11) TBD percent reduction in the average number of days people are on the forensic wait list. (12) TBD percent reduction in the average number of people waiting on the forensic wait list. (13) The ME will manage the utilization of contracted service dollars to prevent any lapse in service dollars. b. Methodology (1) The numerator is the number of Network Providers indicating ratings of "satisfactory" or higher on the satisfaction survey. The denominator is the number of Network Providers responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (2) The numerator is the number of stakeholders indicating ratings of "satisfactory" or higher on the satisfaction survey. The denominator is the number of stakeholders responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (3) The numerator is the number of consumers indicating ratings of "satisfactory" or higher on the satisfaction survey. The denominator is the number of consumers responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (4) The numerator is the number of properly prepared invoices received from Network Providers that are paid within 15 days of receipt from Network Providers. The denominator is the number of properly prepared invoices with all required backup data received from the Network Providers for each month. The measure is based on attaining an average of 90 percent or greater rate over a 12 -month period. (5) One minus the fraction whose numerator is the average number of days people were on the residential substance abuse wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (6) One minus the fraction whose numerator is the average number of people waiting on the residential substance abuse wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (7) One minus the fraction whose numerator is the average number of days people were on the adult mental health wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. 10/01/2010 139 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year July 1, 2015- September 30, 2015 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: (8) One minus the fraction whose numerator is the average number of people waiting on the adult mental health wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (9) One minus the fraction whose numerator is the average number of days people were on the children's mental health wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (10) One minus the fraction whose numerator is the average number of people waiting on the children's mental health wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (11) One minus the fraction whose numerator is the average number of days people were on the forensic wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (12) One minus the fraction whose numerator is the average number of people waiting on the forensic wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (13) The numerator is the amount of service dollars utilized by Network Providers at the end of each fiscal year. The denominator is the total amount of service dollars allocated to the ME during each fiscal year. IV. Comments / Explanations *There should be a number, baseline, or N/A inserted for each target or outcome in the sections above. Please explain if a target population is indicated but there is no corresponding outcome standard for that population, or if there is an Outcome Standard but there is no corresponding target population indicated. 10/01/2010 140 South Florida Behavioral Health Network, Inc. KH225 07/01/2010 EXHIBIT E Missing Children The provider agrees to follow the procedures outlined in Rule 65C- 30.019, F.A.C. and Rule 65C- 29.013, F.A.C. and in Children and Families Operating Procedure (CFOP) 175 -85, entitled "Prevention, Reporting, and Services to Missing Children ". The provider will perform the departmental functions as described in Rule 65C- 30.019, F.A.C. and CFOP 175 -85 which correspond to the functional role of this contract. 1. Definitions a. Designee - a person, contractual provider or other agency or entity named by the department. b. Exigent Circumstances - situations that require immediate actions, such as the child is under the age of thirteen, believed to be out of the zone of safety for their age and development, mentally incapacitated, in a life threatening situation, in the company of others who could endanger their welfare or is absent under circumstance inconsistent with established behaviors. c. FDLE -MCIC - Florida Department of Law Enforcement - Missing Children's Information Center. d. Family Services Counselor - a professional position responsible for case management for children placements. The term includes Department of Children and Families staff and staff working for an agency named as a designee. e. Missing Child - a person who is under the age of 18 years; whose location has not been determined; is currently placed in an out -of -home care setting; court order in -home placement; or is the subject of an active abuse investigation in which the child has been sheltered, would have been sheltered if their location had become known, or who was in the physical custody of the department or a provider when they went missing; and who has been or will be reported as missing to a law enforcement agency. 2. Reporting Missing Children The provider agrees to instruct caregivers, including relative and non - relative caregivers, family services counselors, and all other staff that might be required to report a child as missing to local law enforcement to immediately undertake the following activities, as applicable, and document all actions and activities related to any efforts made to report and /or locate any child who is determined to be missing from their care or supervision: a. If exigent circumstances exist, the caregiver, family services counselor, or provider employee who has identified that a child is missing from their care or supervision shall immediately call local law enforcement as soon as a determination has been made that a child is missing and they shall request that the responding office: (1) Take a report of the missing child. (2) Assign a case number to the missing child report and provide the case number back to the caregiver or person who is reporting the child missing. South Florida Behavioral Health Network, Inc. 141 KH225 07/01/2010 EXHIBIT E (3) Provide local law enforcement with a recent high quality photo of the child, or provide local law enforcement with a recent high quality photo when one becomes available. (4) Request that a copy of the police report be provided to the family services counselor once a police report becomes available. (5) If the responding law enforcement officer refuses to take a missing child report, for any reason, the individual attempting to report the child as missing will document the officer's name and specific local law enforcement agency name and request to speak to the law enforcement agency Watch /Shift Commander. If the law enforcement agency Watch Commander refuses to take a missing child report and it is a caregiver that is attempting to report the child as missing, the caregiver will immediately contact the family services counselor or on -call staff and provide them with all information related to local law enforcement not issuing a missing child report. Once the family services counselor or on -call staff have learned that a local law enforcement agency will not issue a missing child report they will immediately seek assistance from the local area Community Based Care (CBC) Child Location Specialist or the Department of Children and Families Regional Criminal Justice Services Coordinator on resolving any issue related to reporting the child as missing to local law enforcement. (6) If it is a caregiver who has reported the child as missing to local law enforcement or attempted to report a child as missing to local law enforcement, they shall immediately notify the child's family services counselor or emergency on -call staff and provide them with the following information: (a) The law enforcement agency name that the child was reported as missing to or attempted to be reported as missing to; (b) The law enforcement missing child case number if one was issued by local law enforcement; (c) A copy of the law enforcement report when one is made available; (d) Detailed information on the child's overall state of mind and behavior prior to the child going missing; (e) Detailed description of what the child was last seen wearing; (f) Detailed information on possible locations that the child might be going to; and (g) Detailed information on any individuals that the child might be traveling with. b. If exigent circumstances do not exist, the caregiver , family services counselor, or other provider staff will within the first four (4) hours of learning that a child might be missing check to see what, if any, of the child's personal belongings are missing or if the child left a note; and, (1) Contact the following persons as appropriate to ascertain if the child has been seen, or has given any indications that may explain the child's missing status: South Florida Behavioral Health Network, Inc. 142 KH225 07/01/2010 EXHIBIT E (a) School /child's teachers and school resource officer; (b) The child's relatives /parents, both local and non - local, if appropriate, and the caregiver has the means for such contact; (c) Any friends or places that the child generally frequents, the local runaway shelter, if there is one in the community; and, (d) The child's employer, if applicable. (2) Write down any information gathered that might help locate the child. (3) Provide telephone /beeper numbers and ask for the individuals above to call back and share information if they have further information or see the child. c. If at any time during the initial four (4) hour search for the child, if the caregiver, family services counselor, or any other provider employee becomes concerned about the immediate safety and well -being of the child, or the child's location remains unknown after four (4) hours from the time that the caregiver, family services counselor, or provider employee learned that the location of the child was unknown, they shall immediately call local law enforcement and they shall follow the steps outlined in Section 2.a., above. d. If at any time, the child is located or returns to the caregivers home after law enforcement has been notified of the missing child case, all law enforcement agencies and other agencies that were notified of the missing child episode must be contacted immediately by the caregiver, family services counselor, or other provider employee. If at any time new information is obtained on a possible location of the missing child, the caregiver, family services counselor, or any other employee of the provider shall immediately contact all law enforcement agencies and other agencies that were notified of the missing child episode as to the possible location of the child. e. All of the department's documentation related to the missing child episode shall be completed and entered into the department's approved missing child reporting system within one working day of the family services counselor, on -call staff, or Community Based Care (CBC) Child Location Specialist learning of a missing child episode regardless of whether local law enforcement has issued a missing child report number. This includes the uploading of a recent high quality photograph of the child into the department's approved missing child reporting system. If local law enforcement has refused to issue a missing child report a dummy local law enforcement case number of 00000 and the name of the local law agency that refused to issue the missing child report shall be used to complete and enter the missing child episode into the department's approved missing child reporting system. South Florida Behavioral Health Network, Inc. 143 KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit F Minimum Service Requirements The provider and its subcontractors shall be knowledgeable of and fully comply with all applicable state and federal laws, rules and regulations, as amended from time to time, that affect the subject areas of the contract. Authorities include but are not limited to the following: I. PROGRAMMATIC AUTHORITY (FEDERAL) A. Mental Health 42 U.S.C. 300x to 300x -9 (Block Grant for community Mental Health Services) http://www4.1aw.cornell.edu/uscode/42/ch6AschXVIIpB.html B. Substance Abuse Prevention and Treatment Block Grant (SAPTBG) 42 U.S.C. 290kk, et seq.(Limitation on use of funds for certain purposes) http: // www4. law. cornell .edu /uscode /html /uscode42 /usc sec 42 0000029 0-- kk000- .html 42 U.S.C. 300x -21 to 300x -35 and 300x -51 to 300x -66(SA Treatment & Prevention Block Grants) http: / /www4.law.cornell.edu /uscode /html /uscode42 /usc sup 01 42 10 6 A 20 XVII 30 B 40 ii.html 42 CFR, Part 54 (Charitable choice) http: / /www.access.gpo.gov /nara /cfr /waisidx 03/42cfr54 03.html 45 CFR 96.120 — 137 (SA Treatment & Prevention Block Grants) http: / /www.access.gpo.gov /nara /cfr /waisidx 03/45cfr96 03.html Restrictions on expenditures of SAPTBG 45 CFR 96.135 http: / /www.access.gpo.gov /nara /cfr /waisidx 01/45cfr96 01.html C. Substance Abuse - Confidentiality 42 CFR, Part 2 http: / /www.access.gpo.gov /nara /cfr /waisidx 03 /42cfr2 03.html D. Health Insurance Portability and Accountability Act (HIPAA) 45 CFR 164 http: / /www.access.gpo.gov /nara /cfr /waisidx 03/45cfr164 03.html Rev.07/01/2010 144 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit F E. Social Security Income for the Aged, Blind and Disabled 20 CFR 416 http: / /www.access.gpo.gov /nara /cfr /waisidx 03/20cfr416 03.html F. Endorsement and Payment of Checks Drawn on the United States Treasury 31 CFR 240 relating to SSA http: / /www.access.gpo.gov /nara /cfr /waisidx 03/31 cfr240 03.html G. Temporary Assistance to Needy Families (TANF) Part A, Title IV of the Social Security Act 45 CFR, Part 260 http: / /www.access.gpo.gov /nara /cfr /waisidx 03/45cfr260 03.html Section 414.1585, F.S. http: / /www.leq. state.fl.us/ statutes /index.cfm ?Mode = ViewStatutes &Submenu =1 H. Positive Alternatives to Homelessness (PATH) Public Health Services Act, Title V, Part C, Section 521, as amended 42 U.S.C. 290cc -21 et. seq. http : / /www4.law.cornell.edu /uscode/ Stewart B. McKinney Homeless Assistance Amendments Act of 1990, Public Law 101 -645 http : / /www4.law.cornell.edu /usc -cgi /get external.cgi ?type =pubL &target= 101 -645 42 CFR, Part 54 http: / /www.access.gpo.gov /nara /cfr /waisidx 03/42cfr54 03.html I. Americans with Disabilities Act of 1990 42 U.S.C. 12101 et seq. http : / /www4.law.cornell.edu /uscode/ II. FLORIDA STATUTES All State of Florida Statutes can be found at the following website: http: / /www.leg.state. fl. us/ statutes /index.cfm ?Mode= ViewStatutes &Subme nu =1 Rev.07/01/2010 145 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit F A. Child Welfare and Community Based Care Chapter 39, F.S. Proceedings Relating to Children Chapter 119, F.S. Public Records Chapter 402, F.S. Health and Human Services; Miscellaneous Provisions Chapter 435, F.S. Employment Screening Chapter 490, F.S. Psychological Services Chapter 491, F.S. Clinical, Counseling and Psychotherapy services Chapter 1002, F.S. Student and Parental Rights and Educational Choices Section 402.3057, F.S. Persons not required to be refingerprinted or rescreened Section 414.295, F.S. Temporary Cash Assistance; Public Records Exemptions B. Substance Abuse and Mental Health Services Chapter 381, F.S. Public Health General Provisions Chapter 386, F.S. Particular Conditions Affecting Public Health Chapter 395, F.S. Hospital Licensing and Regulation Chapter 394, F.S. Mental Health Chapter 397, F.S. Substance Abuse Services Chapter 400, F.S. Nursing Home and Related Health Care Facilities Chapter 435, F.S. Employment Screening Chapter 458, F.S. Medical Practice Chapter 459, F.S. Osteopathic Medicine Chapter 464, F.S. Nursing Chapter 465, F.S. Pharmacy Chapter 490, F.S. Psychological Services Chapter 491, F.S. Clinical, Counseling and Psychotherapy Services Chapter 499, F.S. Drug, Cosmetic and Household Products Chapter 553, F.S. Building Construction Standards Chapter 893, F.S. Drug Abuse Prevention and Control Section 409.906(8), F.S. Optional Medicaid — Community Mental Health Services C. Developmental Disabilities Chapter 393, F.S. Developmental Disabilities D. Adult Protective Services Chapter 415, F.S. Adult Protective Services E. Forensics Chapter, F.S.916, F.S. Mentally Deficient and Mentally 111 Defendants. Chapter 985, F.S. Juvenile Justice; Interstate Compact on Juveniles Section 985.19, F.S. Incompetency in Juvenile Delinquency Cases Section 985.24, F.S. Interstate Compact on Juveniles; Use of detention; prohibitions; Rev.07/01/2010 146 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit F F. Florida Assertive Community Treatment (FACT) General Appropriations Act http:// www. flsenate .gov/Welcome /index.cfm ?CFID= 105701865 &CFTOKE N= 34016817 G. State Administrative Procedures and Services Chapter 120, F.S. Administrative Procedures Act Chapter 287, F.S. Procurement of Personal Property and Services Chapter 815, F.S. Computer - Related Crimes Section 112.061, F.S. Per diem and Travel Expenses* Section 112.3185, F.S. Additional Standards for State Agency Employees Section 215.422, F.S. Payments, Warrants & Invoices; Processing Times Section 216.181(16)(b), F.S. Advanced funds invested in interest bearing accounts *Travel Expenses are specified in the DFS Reference Guide for State Expenditures http: / /www.myfloridacfo.com /aadir /reference %5Fguide /reference guide.htm III. FLORIDA ADMINISTRATIVE CODE (RULES) A. Child Welfare and Community Based Care All references to F.A.C. may be found at the following website: https : / /www.flrules.org /default.asp Rule 65C -12, F.A.C. Emergency Shelter Care Rule 65C -13, F.A.C. Substitute Care of Children Rule 65C -14, F.A.C. Group Care Rule 65C -15, F.A.C. Child Placing Agencies B. Substance Abuse and Mental Health Services Rule 65C -12, F.A.C. Emergency Shelter Care Rule 65D -30, F.A.C. Substance Abuse Services Office Rule 65E -4, F.A.C. Community Mental Health Regulation Rule 65E -5, F.A.C. Mental Health Act Regulation Rule 65E -10, F.A.C. Psychotic and Emotionally Disturbed Children Purchase of Residential Services Rules Rule 65E -12, F.A.C. Public Mental Health, Crisis Stabilization Units, Short Term Residential Treatment Programs Rule 65E -14, F.A.C. Community Substance Abuse and Mental Health Services - Financial Rules Rule 65E -15, F.A.C. Continuity of Care Case Management Rule 65E -20, F.A.C. Forensic Client Services Act Regulation Rev.07/01/2010 147 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit F C. Financial Penalties Rule 65 - 29, F.A.C. Penalties on Service Providers Reduction /withholding of funds Rule 65- 29.001, F.A.C. Financial Penalties for a Provider's Failure to Comply With a Requirement for Corrective Action IV. MISCELLANEOUS A. Department of Children and Families Operating Procedures CFOP 155 -10, Services for Children with Mental Health & Any Co- occurring Substance Abuse Treatment Needs In Out of Home Care Placements http: / /www.dcf.state.fl.us /publications /policies /cfop155- 10.pdf CFOP 215 -6, Incident Reporting and Client Risk Prevention http: / /www.dcf.state.fl.us/ publications /policies /215 -6.pdf B. Federal Cost Principles OMB Circular A-21, Cost Principles for Educational Institutions http: / /www.whitehouse .qov /omb /circulars /a021 /a021.html OMB Circular A -87, Cost Principles for State, Local and Indian Tribal Governments http: / /www.whitehouse.gov/ omb /circulars /a087 /a087- all.html OMB Circular A102, Grants and Cooperative Agreements with State and Local Governments http://www.whitehouse.dov/omb/circularsia102/a102.html OMB Circular A -122, Cost Principles for Non - profit Organizations http://www.whitehouse.dov/omb/circulars/a122/a122.html C. Audits OMB Circular A -133, Audits of States, Local Governments and Non - Profit Organizations http: / /www.whitehouse.gov /omb /circulars /a133/a133.html Section 215.97, F.S., Florida Single Audit Act http: / /www. leg. state. fl. us / statutes /index.cfm ?Mode = ViewStatutes &Submenu =1 Comptrollers Memorandum #03 (1999- 2000): Florida Single Audit Act Implementation http: // www. fldfs .com /aadir /cmmaster9900.htm Rev.07/01/2010 148 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit F D. Administrative Requirements 45 CFR, Part 74 - Uniform Administration Requirements for Awards and Subawards to Institutions of Higher Education, Hospitals, other Non - Profit Organizations and Other Commercial Organizations http: / /www.access.gpo.gov /nara /cfr /waisidx 06/45cfr74 06.html 45 CFR, Part 92 - Uniform Administration Requirements (State and Local Governments)\ http: / /www.access.gpo.gov /nara /cfr /waisidx 06145cfr92 06.html OMB Circular A110, Uniform Administrative Requirements for Grants and Other Agreements http: / /www.whitehouse.gov /omb /circulars /a110 /a110.html E. Data Collection and Reporting Requirements Rule 65E- 14.022, F.A.C. https: / /www.flrules.orq /gateway /ruleNo.asp ?ID =65E- 14.022 Section 397.321(3)(c), F.S., Data collection & dissemination system http: / /www.leg.state.fl.us /statutes /index.cfm ?App mode = Display Statute &URL =ChO 397/tit10397.htm Section 394.74(3)(e), F.S., Data Submission http: / /www.leq.state.fl.us /Statutes /index.cfm ?App mode = Display Statute &URL =ChO 394 /tit10394.htm Section 394.77, F.S., Uniform management information, accounting, and reporting systems for providers. http: / /www.leq.state.fl.us /Statutes /index.cfm ?App mode = Display Statute &URL =ChO 394 /tit10394.htm CFP 155 -2, Mental Health and Substance Abuse Data Measurement Handbook http: / /www.dcf. state. fl. us /mentalhealth /publications /index.shtml Rev.07/01/2010 149 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 Exhibit G Required Reports Rev.07 /01 /2010 150 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 EXHIBIT G Performance Contract SAMH Services Program REQUIRED REPORTS Provider Name: South Florida Behavioral Health Network, Inc. Contract No. KH225 Date: October 1, 2010 Amendment # Due Date # of Send to: Copies Required Reports Response to Monitoring Reports and Corrective Action Within 30 days from the day the 1 Contract Manager Plans report is received. Validation of review of subcontractor's Sliding Fee Scale Within 30 days of contract 1 Contract Manager [reflecting the uniform schedule of discounts referenced in execution 65E- 14.018(4)] Validation of review of subcontractor's Agency Service Prior to contracting for year 2 of 1 Contract Manager Capacity Report , Projected Cost Center Operating and the contract and every other year Capital Budget, Cost Center Personnel Detail Report (if thereafter. applicable) Consolidated Program Description Prior to contracting for year 2 of 1 Contract Manager the contract and every other year thereafter , or any updates thereafter. Monthly Data Required by CFP 155 -2 Within 15 days after end of month Electronic SAMH Program Submission Office as appropriate Incident Report Within 48 hours of occurrence 1 to Region As specified in Incident CFOP 215 -6, 215 -3 Report Liaison and other Regional 1 to Lotus language as Notes directed by the contract. Audit Schedules (for client non - specific unit cost The ME's Audit Schedule is due 1 to Region Contract Manager performance contracts) 180 days after the end of the ME fiscal year or 45 days upon completion of audit, whichever comes first. The ME shall submit the network provider's audit schedules 30 days after receipt from the network provider. Schedule of State Earnings Due 180 days after the end of the 1 to Region Region SAMH Schedule of related Party Transaction Adjustments fiscal year or 45 days upon Program /Cost Center Actual Expenses & Revenues completion of audit, whichever Schedule comes first. Schedule of Bed -Day Availability Payments Financial & Compliance Audit per Attachment II 180 days after the end of the 1 See Attachment II managing entity's fiscal year or 45 SAMH Contract days after its completion, Manager whichever comes first. South Florida Behavioral Health Network, Inc. 150 KH225 10/01/2010 EXHIBIT G Performance Contract SAMH Services Program REQUIRED REPORTS Reports Required for Substance Abuse Providers Annual Report for HIV Early Intervention Services, SAPT Upon Request of the department 1 to Circuit Circuit Contract Block Grant Set Aside Funded Services Only 1 to Manager Substance Headquarters Abuse Program Office Annual Report for Evidenced -based Injection Drug User Upon Request of the department 1 to Circuit Circuit Contract Outreach Services, SAPT Block Grant Mandate, Designated 1 to Manager Substance Providers Only Headquarters Abuse Program Office Annual Report for Pregnant Women and Women With Upon Request of the department 1 to Circuit Circuit Contract Dependent Children SAPT Block Grant Set Aside Funded 1 to Manager Substance Services Only Headquarters Abuse Program Office Other Reports Quarterly Annual Action Plan Reports on Accomplishments As identified in the Annual Action 1 Contract Manager and Deliverables Plan Monthly Service Invoice By 15 of each month 1 Contract Manager Final Invoice By July 31 of each fiscal year and 1 Contract Manager 31 days after contract end date Wait List (until department's automated system is Monthly for SA services. 1 Contract Manager operational) Monthly for MH services as per the approved annual action plan. Monitoring Schedule Within 30 days of receipt of the 1 Contract Manager risk assessment prepared by the Department's Contract Oversight Unit. Contingency Transition Plan 90 days after contract execution 1 Contract Manager Validation of receipt and review of Network Providers Within 30 days of contract 1 Contract Manager grievance procedures execution Validation that all Network Providers produced copies of Within 30 days of contract 1 Contract Manager their Informed Consent Forms execution Validation of receipt and review of Network Providers Within 30 days of contract 1 Contract Manager Emergency Preparedness Plan execution and by June 1 of each fiscal year Validation of Network Providers Civil Rights Compliance Within 30 days of contract 1 Contract Manager Questionnaire execution Validation of Network Providers Security Agreements Within 30 days of contract 1 Contract Manager execution Affidavit Regarding Debarment Annual for the ME and 1 Contract Manager 15 days prior to contract negotiation with subcontractor, or as requested by the contract manager. Beginning Inventory Report Within 30 days of contract 1 Contract Manager execution Training Schedule Within 15 days prior to the training 1 Contract Manager quarter. Invoice Review Supporting Documentation As per the contract and /or as 1 Contract Manager requested by the contract manager South Florida Behavioral Health Network, Inc. 151 KH225 10/01/2010 EXHIBIT G Performance Contract SAMH Services Program REQUIRED REPORTS Lapse Analysis Report 30 days after the month of 1 Contract Manager services Annualized Line Item Budget & Narrative 60 days before the beginning of 1 Contract Manager each fiscal year. Annual Inventory Report May 15 of each fiscal year 1 Contract Manager Closeout Inventory Report By July 31, 2015 1 Contract Manager Cooperative Agreements /MOU /MOA/Procedures As identified in the Annual Action 1 Contract Manager Plan and the contract Quality Assurance Reviews, Monitoring Reports & Within 30 days after exit 1 Contract Manager Corrective Action Plans conference Region Specific Children's Mental Health (see annual action plan and Contract) Adult Mental Health Quarterly and Annual PATH Report FACT Reports Subcontractors to submit to the 1 Contract Manager (1) Quarterly FACT Enhancement Reconciliation managing entity by October 15"'' and SAMH Program Report and Tracker January 15, April 15 and July 15 Office /Headquarters (2) Quarterly FACT Ad Hoc Reports of each fiscal year. The managing as specified in the (3) Monthly Performance Measures Report entity is to submit to the contract (4) Reporting of significant incidents & department the reports one (1) interventions, as needed week after the due dates listed above Quarterly Contingency Funds Report Subcontractors to submit to the 1 Contract Manager managing entity by October 31, and SAMH Program January 30, April 30 and July 31 Office of each fiscal year. The managing entity is to submit to the department a summary of the quarterly expenditures one (1) week after the due dates listed above Path Quarterly Reports Subcontractors to submit to the 1 Contract Manager managing entity by October 31, and SAMH Program January 30, April 30 and July 31 Office of each fiscal year. The managing entity is to submit to the department the reports one (1) week after the due dates listed above PATH Annual Reports Drafts to be submitted to Southern 1 Southern Southern Region Region SAMH Program Office, Region SAMH SAMH Program DCF Central Office in Tallahassee for Prior Office, Contract in April or May of each fiscal year Approval, Manager, and On- as requested line Site South Florida Behavioral Health Network, Inc. 152 KH225 10/01/2010 EXHIBIT G Performance Contract SAMH Services Program REQUIRED REPORTS 1 final to DCF Central Office in Tallahassee Forensic Services Monthly Report for Individuals on Conditional Release By 15 of each month 1 Forensic Coordinator /MH Administrator Office Census Report Weekly 1 SAMH Forensic Coordinator Admission Waiting List Weekly 1 SAMH Forensic Coordinator Staffing Reports As required, every six month per 1 SAMH Forensic clients Coordinator South Florida Behavioral Health Network, Inc. 153 KH225 Exhibit H Children's Mental Health Comprehensive Community Service Team Description: Comprehensive Community Service Team (CCST) services take place in either an outpatient or community -based setting and provide adults and children with mental illness assistance in identifying goals and making choices to promote resiliency and facilitate recovery. For individuals /families with mental health problems, recovery is the personal process of overcoming the negative impact of a psychiatric disability despite its continued presence. CCST services are intended to restore the individual's function and participation in the community. The services are designed to assist and guide individuals /families in reconnecting with society and rebuilding skills in identified roles in their environment. The focus is on the individual's and family's strengths and resources as well as their readiness and phase of recovery. A team approach for delivery of services will be used to guide and support the adults and children served with development of a recovery plan focusing on the areas of individual and family living, learning, working and socialization. The expectation is that therapy will be determined by the clinical needs of the child and family. a. The treatment approach must be delivered by staff working in a Multi- Disciplinary Team that includes "Peers" (Peer Specialists or Family Coaches who are or have been consumers of services)* and meets at least weekly. Staff must be trained and competent in utilizing Recovery concepts and language. The family and youth's voice and choice should be seen throughout, starting with a recovery-based self- assessment tool and continuing with statements of needs, goal- setting and decision - making. b. The goal is to implement a System of Care that encompasses a coordinated network of community -based services and supports aimed at utilizing the client's strengths while simultaneously addressing the multiple and changing needs of youth and their families. c. Treatment and services should be based on the following values: (1) Family Driven Care (2) Youth Guided Care (3) Cultural and Linguistic Competence (4) Evidence -Based practices (5) Streamlining and expediting access to services (6) Continuous Quality Assurance (7) Process Evaluation Rev. 10/01/2010 Contract No. KH225 South Florida Behavioral Health Services, Inc. 154 Exhibit H (8) Data Driven Outcomes d. There should be evidence that staff are aware of consumers' needs and documentation in the service record that identified needs are addressed by the CCST and the person receiving services. Staff should facilitate families to obtain benefits (insurance, Social Security and income). Documentation in the service record must reflect efforts, progress and barriers to individualized goals and treatment objectives, including school performance. Documentation is necessary to identify changes in services and continuity of services (i.e., treatment plan updates indicating new /revised /achieved goals). e. There must be evidence that the person /family receiving services was offered support in self- managing wellness via activities such as, but not limited to, education, supportive counseling, or skills training and was made aware of appropriate self -help or support groups. Evidence is required that the people receiving services actively takes part in achieving his /her service goal(s) and chooses the people who are involved in their recovery (as in Wellness Recovery Action Planning "WRAP Plans" Crisis Management tools). These persons could be family members, friends or significant others. CCST staff, Peer support in particular, should have as a primary goal the creation of natural support systems. There should be evidence that the CCST staff partners with the consumer, assisting and building confidence in their decision - making ability. f. Services provided include Assessment, Case Management, Intensive Case Management, Supported Housing, Aftercare, Supported Employment, Outreach, Outpatient, In- home /On -Site, Intervention, Information and Referral, Prevention, Prevention /Intervention and other transition, e- therapy for those who are part of the Miami Wraparound Grant and non - traditional support services as negotiated by the department and the Provider The above listed services are reimbursed in a bundled staff hour rate and may not be contracted for separately. Incidental Expenses may be utilized for persons served through CCST to purchase medications and other enhancement and support services not included in this bundled rate that are in concert with the individuals recovery plan. We expect that there will be no more than 20 clients for each full time equivalent staff. g. Productivity: It is our expectation that a minimum of 50% of the staffs time is spent in direct contact hours. h. Staff training requirements include: (1) Motivational Interviewing for all on CCST Team (2) Wellness Recovery Action Planning for all staff (3) SSI /SSDI, Outreach, Access and Recovery (SOAR) training for clinical staff Rev. 10/01/2010 Contract No. KH225 South Florida Behavioral Health Services, Inc. 155 Exhibit H (4) Wraparound Best Practice for all on CCST Team (5) Other Best Practices as approved by SAMH i. Programs: Children's Mental Health Unit of Measure: Staff Hour Maximum unit cost rate: $ 37.86 Data Elements: (1) Service Documentation — Duty Roster (a) Staff name and identification number (b) Date (c) Hours scheduled to work — Beginning & Ending Time (d) Cost Center (e) Program, and (f) Signature of Supervisor (2) Audit Documentation — Time Sheet (a) Staff name and identification number (b) Date (c) Hours Worked — Beginning & Ending Time (d) Program (e) Cost Center (f) Signature of Supervisor j. Some of the additional elements SAMH will be reviewing include the following: (1) Number of families linked to Medicaid with the length of time for approval of benefits Rev. 10/01/2010 Contract No. KH225 South Florida Behavioral Health Services, Inc. 156 Exhibit H (2) Number of family groups (3) Number of treatment team meetings (4) Number of children receiving Evidence -Based Practices (EBP) and which EBP's are used (5) Staff productivity * A Certified Recovery Peer Specialist must either be certified or working towards certification by the Florida Certification Board and must be a true peer; which means that the peer specialist is also a consumer of public or private mental health services. A Certified Recovery Peer Specialist — Family provides peer mentoring and support to families that include at least one child diagnosed with a mental illness before his or her 24th birthday. This position must be a true peer; which means that the peer specialist must be a first - degree relative or primary caregiver of a child diagnosed with a mental illness, and either be certified or working towards certification by the Florida Certification Board. Rev. 10/01/2010 Contract No. KH225 South Florida Behavioral Health Services, Inc. 157 10/01/2010 Exhibit Tangible Property Requirements 1. Definitions a. As used in this section, "nonexpendable property" is defined as tangible personal property of a nonconsumable nature that has an acquisition value or cost of $1,000 or more per unit and an expected useful life of at least one year, and hardback covered bound books that are not circulated to students or the general public, the value or cost of which is $250 or more. Hardback books with a value or cost of $100 or more should be classified as nonexpendable property only if they are circulated to students or to the general public. All computers, including all desktop and laptop computers, regardless of the acquisition cost or value are classified as nonexpendable property. b. As used in this section, "motor vehicles" includes any automobile, truck, airplane, boat, or other mobile equipment used for transporting persons or cargo. c. As used in this section, "subcontractor" is an entity under contract with the managing entity funded from funds contained in this contract. 2. State Property Transferred to the Managing Entity a. When state property will be assigned to a managing entity for use in performance of a contract, the title for that property or vehicle shall be immediately transferred to the managing entity where it shall remain until this contract is terminated or until other disposition instructions are furnished by the contract manager. When property is transferred to the managing entity, the department shall pay for the title transfer. The managing entity's responsibility starts when the fully accounted for property or vehicle is assigned to and accepted by the managing entity. Business arrangements made between the managing entity and its subcontractors shall not permit the transfer of title of state property to subcontractors. While such business arrangements may provide for subcontractor participation in the use and maintenance of the property under their control, the department shall hold the managing entity solely responsible for the use and condition of said property. Property inventories shall be conducted in accordance with CFOP 80 -2. (The managing entity shall use the Managing Entity Property Inventory and Disposition Form.) b. Before transferring property from the department, all property to be transferred shall be inventoried, and the inventory shall be agreed upon and signed by both parties. The property decal for each property item shall be removed by the department prior to transfer. The department shall be responsible for adjusting the department's property records to reflect this transfer and change of ownership. Annually thereafter, the managing entity shall submit to the South Florida Behavioral Health Network, Inc. 158 KH225 10/01/2010 Exhibit Tangible Property Requirements department a complete inventory of all property transferred from the department. The inventory shall include all data elements described in Section 3. below, and clearly reflect any replacement or disposition of the property. 3. Property Items Purchased by Managing Entity a. If the managing entity purchases any property with funds provided by this contract, the managing entity shall inventory all such property, and on an annual basis, the managing entity shall submit a complete inventory of all such property to the department. b. The inventory shall include, at a minimum, a description of the property /unique identifier, manufacturer's serial number, acquisition date, original acquisition cost, current location, condition, and clearly reflect any replacement or disposition of the property. c. The managing entity's contract with a subcontractor funded from funds contained in this contract shall not permit the purchase of any motor vehicles. However, the managing entity may purchase a motor vehicle and subsequently enter into a lease agreement with the subcontractor for the use of the motor vehicle. 4. Property Items transferred from Former Department Contractors and Current Subcontractors a. Property transferred to or purchased by former contractors through prior agreements with the department shall be inventoried, agreed upon and signed by the department and the former contractors. This property shall then be transferred from the department to the managing entity where the title will vest until this contract is terminated. The managing entity may not transfer title to any subcontractor. Any property transferred to or purchased by the managing entity and used by a subcontractor will be authorized through a written agreement between the managing entity and the subcontractor. Under the written agreement, the managing entity will hold the subcontractor responsible for all repairs, maintenance and insurance for said property. Any property purchased by the subcontractor must be maintained by the subcontractor and returned to the managing entity upon termination of the written agreement. This property will be included on the managing entity's inventory. South Florida Behavioral Health Network, Inc. 159 KH225 10/01/2010 Exhibit Tangible Property Requirements b. All subcontractors, regardless of the method of payment in the contract, must provide an annual inventory of all property to the managing entity for inclusion in the managing entity's annual inventory report. The subcontractor's inventory shall include all data elements described in 3.b. above. 5. Disposition a. If the managing entity replaces or disposes of property transferred to or purchased by the managing entity pursuant to this contract, the managing entity is required to provide accurate and complete information pertaining to replacement or disposition of the property on the managing entity's annual inventory as required by paragraph 3.b. b. If the subcontractor replaces or disposes of property transferred to or purchased by the subcontractor pursuant to that contract, the subcontractor is required to provide accurate and complete information pertaining to replacement or disposition of the property on the subcontractor's annual inventory as required by paragraph 3.b. c. The contract manager must provide disposition instructions to the managing entity prior to the end of the contract period. The managing entity cannot dispose of any property that reverts to the department without the contract manager's approval. 6. Termination a. The managing entity shall furnish a closeout inventory no later than 30 days before the completion or termination of this contract. The closeout inventory shall include all property transferred to or purchased by the managing entity including any property leased by the managing entity to any subcontractor and all property purchased by any subcontractor. b. The closeout inventory shall contain, at a minimum, the same annual inventory information required by paragraph 3.b. c. Title (ownership) to and possession of all property transferred to or purchased by the managing entity pursuant to this contract shall be vested in the department upon completion or termination of this contract. Upon return to the department, all property must be in good working order. The managing entity hereby agrees to pay the cost of transferring title to and possession of any property for which ownership is evidenced by a certificate of title. Property items purchased with funds from the federal Miami —Dade Wraparound Project (MDWP) Cooperative Agreement # 1 U79SM059055 -01 and given to MDWP eligible youth may remain with the client and may not be vested in the department. South Florida Behavioral Health Network, Inc. 160 KH225 10/01/2010 Exhibit Tangible Property Requirements d. The managing entity shall be responsible for repaying to the department the replacement cost of any property inventoried and not returned to the department upon completion or termination of this contract. 7. General a. All inventories required by these sections shall be updated and accurate to the date of inventory certification. b. With the exception of lease agreements entered into as described in section 3.a. above, during the term of this contract, the managing entity is responsible for insuring all property included in its annual inventory report and maintaining such property in good working order. c. The managing entity hereby agrees to indemnify the department against any claim or Toss arising out of the operations of any motor vehicle transferred to or purchased by the managing entity pursuant to this contract. d. A formal contract amendment is required prior to the purchase of any property item not specifically listed in the approved budget. South Florida Behavioral Health Network, Inc. 161 KH225 07/01/2008 Exhibit I Tangible Property Requirements Managing Entity Property Inventory & Disposition Managing Entity Name and Contract # Contact person: Phone Number: Address: City, State, Zip: Inventory Description of Property/ DCF Transfer ME Original Current Condition Disposition Unique Identifier Serial # Date If Acquisition Acquisition Location Applicable Date Cost (E- G -F -P) Remarks/Comments Disposition Description of Property/ DCF Transfer ME Original Current Condition Disposition Uni ue Identifier Serial # Date If Acquisition Acquisition q Applicable Date Cost Location (E- G -F -P) Remarks /Comments By my signature below, I hereby certify that all confidential data, including protected health information, has been permanently removed from all computer related media that has been transferred to or from my custody. Furthermore, I certify that the removal of this information has been done so in the manner described in the Department of Children and Families Operating Procedure CFOP 50 -2. I understand that any violation of that procedure may result in substantial fines and /or criminal prosecution according to provisions of Federal and State statutes. I hereby certify that all items of equipment included in this inventory list have been physically checked and are in custody of this contract provider, except as noted in the remarks section of this inventory, as of this date. I also certify to the location and condition of this equipment and /or furniture as noted. CONTRACT ME's SIGNATURE: DATE: (Acknowledging Receipt or inventory of Property) CONTRACT MANAGER'S SIGNATURE: DATE: (Acknowledging Receipt which contains a Copy of the Inventory and /or Disposition Property) South Florida Behavioral Health Network, Inc. 162 KH225 Attachment 11 CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or an employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Signature Date John Dow KH225 Name of Authorized Individual Application or Contract Number South Florida Behavioral Health Network, Inc. Name of Organization 2140 South Dixie Highway, Suite #204 -205, Miami Florida 33133 Address of Organization CF 1123, PDF 03/96 Page 163 ATTACHMENT III The administration of resources awarded by the Department of Children & Families to the provider may be subject to audits as described in this attachment. MONITORING In addition to reviews of audits conducted in accordance with OMB Circular A -133 and Section 215.97, F.S., as revised, the department may monitor or conduct oversight reviews to evaluate compliance with contract, management and programmatic requirements. Such monitoring or other oversight procedures may include, but not be limited to, on -site visits by department staff, limited scope audits as defined by OMB Circular A -133, as revised, or other procedures. By entering into this agreement, the recipient agrees to comply and cooperate with any monitoring procedures deemed appropriate by the department. In the event the department determines that a limited scope audit of the recipient is appropriate, the recipient agrees to comply with any additional instructions provided by the department regarding such audit. The recipient further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the department's inspector general, the state's Chief Financial Officer or the Auditor General. AUDITS PART I: FEDERAL REQUIREMENTS This part is applicable if the recipient is a State or local government or a non - profit organization as defined in OMB Circular A -133, as revised. In the event the recipient expends $500,000 or more in Federal awards during its fiscal year, the recipient must have a single or program - specific audit conducted in accordance with the provisions of OMB Circular A -133, as revised. In determining the Federal awards expended during its fiscal year, the recipient shall consider all sources of Federal awards, including Federal resources received from the Department of Children & Families. The determination of amounts of Federal awards expended should be in accordance with guidelines established by OMB Circular A -133, as revised. An audit of the recipient conducted by the Auditor General in accordance with the provisions of OMB Circular A -133, as revised, will meet the requirements of this part. In connection with the above audit requirements, the recipient shall fulfill the requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A -133, as revised. The schedule of expenditures should disclose the expenditures by contract number for each contract with the department in effect during the audit period. The financial statements should disclose whether or not the matching requirement was met for each applicable contract. All questioned costs and liabilities due the department shall be fully disclosed in the audit report package with reference to the specific contract number. South Florida Behavioral Health Network, Inc. Contract No. KH225 164 PART II: STATE REQUIREMENTS This part is applicable if the recipient is a nonstate entity as defined by Section 215.97(2), Florida Statutes. In the event the recipient expends $500,000 or more in state financial assistance during its fiscal year, the recipient must have a State single or project - specific audit conducted in accordance with Section 215.97, Florida Statutes; applicable rules of the Department of Financial Services; and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for - profit organizations), Rules of the Auditor General. In determining the state financial assistance expended during its fiscal year, the recipient shall consider all sources of state financial assistance, including state financial assistance received from the Department of Children & Families, other state agencies, and other nonstate entities. State financial assistance does not include Federal direct or pass- through awards and resources received by a nonstate entity for Federal program matching requirements. In connection with the audit requirements addressed in the preceding paragraph, the recipient shall ensure that the audit complies with the requirements of Section 215.97(8), Florida Statutes. This includes submission of a financial reporting package as defined by Section 215.97(2), Florida Statutes, and Chapters 10.550 or 10.650, Rules of the Auditor General. The schedule of expenditures should disclose the expenditures by contract number for each contract with the department in effect during the audit period. The financial statements should disclose whether or not the matching requirement was met for each applicable contract. All questioned costs and liabilities due the department shall be fully disclosed in the audit report package with reference to the specific contract number. PART III: REPORT SUBMISSION i Any reports, management letters, or other information required to be submitted to the department pursuant to this agreement shall be submitted within 180 days after the end of the provider's fiscal year or within 30 days of the recipient's receipt of the audit report, whichever occurs first, directly to each of the following unless otherwise required by Florida Statutes: A. Contract manager for this contract (2 copies) B. Department of Children & Families (1 electronic copy and management letter, if issued ) Office of the Inspector General Single Audit Unit Building 5, Room 237 1317 Winewood Boulevard Tallahassee, FL 32399 -0700 Email address: sinle audivatdcfstate.fl.us South Florida Behavioral Health Network, Inc. Contract No. KH225 165 v C. Reporting packages for audits conducted in accordance with OMB Circular A -133, as revised, and required by Part I of this agreement shall be submitted, when required by Section .320(d), OMB Circular A -133, as revised, by or on behalf of the recipient directly to the Federal Audit Clearinghouse using the Federal Audit Clearinghouse's Internet Data Entry System at: http://haryester.census.gov/fac/collect/ddeindex.html and other Federal agencies and pass- through entities in accordance with Sections .320(e) and (f), OMB Circular A -133, as revised. D. Copies of reporting packages required by Part II of this agreement shall be submitted by or on behalf of the recipient directly to the following address: Auditor General Local Government Audits /342 Claude Pepper Building, Room 401 111 West Madison Street Tallahassee, Florida 32399 -1450 Email address: flaudgen _localgovt @aud.state.fl.us Providers, when submitting audit report packages to the department for audits done in accordance with OMB Circular A -133 or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit or for - profit organizations), Rules of the Auditor General, should include, when available, correspondence from the auditor indicating the date the audit report package was delivered to them. When such correspondence is not available, the date that the audit report package was delivered by the auditor to the provider must be indicated in correspondence submitted to the department in accordance with Chapter 10.558(3) or Chapter 10.657(2), Rules of the Auditor General. PART IV: RECORD RETENTION The recipient shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six years from the date the audit report is issued and shall allow the department or its designee, Chief Financial Officer or Auditor General access to such records upon request. The recipient shall ensure that audit working papers are made available to the department or its designee, Chief Financial Officer or Auditor General upon request for a period of three years from the date the audit report is issued, unless extended in writing by the department. South Florida Behavioral Health Network, Inc. Contract No. KH225 166