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FY2014 10/16/2013
AMY REAVILIN, CPA CLERK OF CIRCUR COURT &COMPTROLLER MoxROE caxm, FLORIDA DATE: November S, 2013 TO: Tina Boan, Director Office of Budget & Management ATTN: Laura DeLoach- Hartle FROM. Vitia Fernandez, D.C, At the October 16, 2013, Board of County Commissioner's meeting the Board granted approval and authorized execution of Item C4 Agreements with Guidance Care Center for the Jail In- House Program, the Baker Act Transportation Services and Community Transportation for the Disadvantaged and the Substance Abu M ental He alth local match funding for FY 2014. Enclosed is a duplicate original of the above - mentioned for your handling. Should you have any questions, please feel free to contact our office. cc: County Attorney (w /o documents) Financ/ File .,; , ,, 1, . „,, _ , _ . ,. � . �m 1 „ . �� ... , , .... _. �, n� . �> .. _ -, I � -1 , 1, .1 � I'll-, 500 Whitehead Street Suite 101, PO Box 1980, Key West FL 33040 Phone: 305 -295 -3130 Fax: 305 - 295 -3663 3117 Overseas Highway, Marathon, FL 33050 Phone: 305 -289 -6027 Fax: 305 - 289 -6025 88820 Overseas Highway, Plantation Key, FL 33070 Phone: 852 -7145 Fax: 305 - 852 -7146 AGREEMENT This Agreement is made and entered into this 16th day of October, 2013, 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 contracts between the PROVIDER and South Florida Behavioral Health Network (ME225 -4 -27 and PPG -1 -06) 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 2013 -2014. 3. TERM. This Agreement shall commence on October 1, 2013, and terminate September 30, 2014, 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 FY14; 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 S. 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 FY14; 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 -4 -27 and PPG- 1 -06); (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 and PPF- 1 -06); (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; (1) 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 2013 -2014 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, 2015. 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 FY14; 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 FY14; 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 FY14; 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 1100 Simonton Street Key West, FL 33040 Monroe County Attorney PO Box 1026 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 FY14; 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 FY14; page 7 IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as of the day and year first written above. EAVILIN, CLERK BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA By r Mayor /Chairm n Guidance /Care Center (Federal ID No. Witness B Dir ctor, Outrea &Advocacy uidance /Care Center MONROE COUNTY ATTORNEY APPROVED AS TO FORM: , CHRISTINE M. LIMBERT -BAR - BARROWS ASSISTANT COUNTY ATTORNEY Date Witness Guidance Care Center -SAMH Contract FY14; page 8 CD +) W c::: CL- Q ` L :i = -.. - M C) L.L N _ Witness Guidance Care Center -SAMH Contract FY14; page 8 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 FY14; 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 FY14; 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 who is personally known to me. Notary Public day of Notary Stamp 20_ by Guidance Care Center -SAMH Contract FY14; page 11 ATTACHMENT C Services to be provided: Local match portion of State - Funded Substance Abuse Mental Health Services, inclusive of Baker Act services per Florida Statutes and contracts between Guidance Care Center and the South Florida Behavioral Health Network (ME225 -4 -27 and PPG- 1 -06). Guidance Care Center -SAMH Contract FY14; page 12 ATTACHMENT D GCC's Contracts with South Florida Behavioral Health Network Contracts (ME225 -4 -27 and PPG -1 -06) Guidance Care Center -SAMH Contract FY14; page 13 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 FY14; page 14 SWORN STATEMENT UNDER ORDINANCE NO. 10 -1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE warrants that he /it has not employed, retained or erwise had act on his /its behalf any former County officer or employee in violation of Section 2 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 employee. r�AJ�A'u PA-0���� signature) Date: STATE OF COUNTY 0 PERSONALLY APPEARED BEFORE ME, the undersigned authority, who, after first being sworn by me, affixed his /her signature (name of individual signing) in the space provide1z: �TUDW , 20-5-- NOTARY PUBLI My commission expires: OMB - MCP FORM #4 No" 1Mi • lMlt �f Aet11� M1► ama wn Ay 6.1016 W 6•a am? Guidance Care Center -SAMH Contract FY14; page 15 DRUG -FREE WORKPLACE FORM The,pndersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: 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.. STATE OF (Sig ature of Respondent) COUNTY OF l 1 3 D to PERSONAL BEFORE ME, the undersigned authority, . 1—_-A-"!l V M5 D7`r who, after first being sworn by me, (name of individual signing) affixed his /h r signature in the space provided above on this 5,r day of , 20-(-3!. My commission expires: SIC It ASKUM Ny GeMn. bon AN 6.2016 CoNARk O 0 ff UM7 Guidance Care Center -SAMH Contract FY14; page 16 ,� South Florida // Behavioral 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 ME 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. In the event of a conflict between the provisions of the documents of this contract, the documents shall be interpreted in the order of precedence listed in Paragraph 46, of this Standard Contract. 4. Effective and Ending Dates This contract shall begin on July 1. 2013 It shall end at midnight, local time in Miami -Dade County, Florida on June 30, 2014 S. 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 the Certification Regarding Lobbying form, Attachment III 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 Order 11 -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 (to include funds used to meet the local match requirements per 65 -E -14 F.A.C., if a pp] icable)provided by the ME under this contract. The network provider shall establish and maintain books, records and documents (including electronic storage media) sufficient to reflect that the Department is the payer of last resort for substance abuse and mental health services. Guidance /Care Center, Inc. Standard Contract Contract No. ME225 -4 -27 Page 1 of 10 V A South Florida Behavioral Health Network, Inc. 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 seven (7) 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 II . 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. Inspections and Corrective Action 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, the scope of review being conducted, 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 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 ME shall not be liable for any cost, expense, or compromise incurred or made by the Network Provider in any legal action without the Network Provider's without the ME'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) and in accordance with the requirements in Attachment I. 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 Guidance /Care Center, Inc. Standard Contract Contract No. ME225 -4 -27 Page 2 of 10 / South Florida Behavioral Health Network, Inc. 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. The network provider shall notify the ME'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. 11. Confidentiality of Client Information a. The Network Provider shall only access information concerning a recipient for a permitted purpose and shall abide by all applicable state and federal data privacy laws including, but not limited to HIPAA and 42 CFR Part 2. b. 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, at any tier, for work contemplated under this contract, adhere to all of the requirements of the ME's Prime Contract with the department and all the requirements of this contract. A copy of the Prime Contract 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. 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, sub - grantees 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. Guidance /Care Center, Inc. Standard Contract Contract No. ME225 -4 -27 Page 3 of 10 South Florida Behavioral Health Network, Inc. 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. 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 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, per the requirements stipulated in the Method of Payment section of this Contract, 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 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 Guidance /Care Center, Inc. Standard Contract Contract No. ME225 -4 -27 Page 4 of 10 South Florida ' Behavioral Health Network, Inc. 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 HIPPA and Security Awareness Training to its staff and subcontractors who have access to ME and DCF data system, information and /or who have access to Protected Health Information regardless of format (e.g. electronic, written, audio, video or still image recording) or function. Security and HIPAA requirements extend to non - clinical or non - administrative personnel if such persons can access Protected Health Information.. The Network Provider shall ensure that proof of training is maintained in each employee file. d. All Network Provider employees who have access to ME or DCF data system or information, including but not limited to access to Knight Information Software (KIS), or any data system designated by the ME, Substance Abuse and Mental Health Information System (SAMHIS), Incident Reporting and Analysis System (IRAS), Temporary Assistance for Needy Family (TANF), 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 ME's contract manager and the ME'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. The Network Provider shall also at its own cost implement measures deemed appropriate by the ME to avoid or mitigate potential injury to any person due to a breach of personal and confidential ME and /or DCF data. 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. 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 Guidance /Care Center, Inc. Standard Contract Contract No. ME225 -4 -27 Page 5of10 � South Florida � Behavioral Health Network, Inc. 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 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. The Network Provider's Single Point of Contact and that of its subcontractors will process the compliance data into the Department of Children and Families HHS Compliance reporting database at https:// fs16.formsite.com /dcfuser /form3 /secure index.htmi by the 4 working day of the month, covering the previous month's reporting, and forward the confirmation of submission to the ME's Contract Manager. The name and contact information for the Network Provider's Single Point of Contact shall be furnished to the ME's Contract Manager within fourteen (14) calendar days of the effective date of this requirement. d. The network provider shall contractually require that its subcontractors comply with Section 504, the ADA, and CFOP 60 -10, Chapter 4. A Guidance /Care Center, Inc. Standard Contract Contract No. ME225 -4 -27 Page 6 of 10 /rte' South Florida �/ Behavioral Health Network, Inc. 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. e. 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. f. 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: htto: / /www.dcf. state .fl.us /admin /civilrights.html g. 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 distribute Customer Feedback forms to customers or companions, and submission to the Department of Children and Families Office of Civil Rights. . h. 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. I. The network provider's and its subcontractors' direct service employees shall complete the online training: Serving our Customers who are Deaf or Hard of Hearing, (as requested of all Department of Children and Families and ME 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. 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 prescribed in the Method of Payment section of this contract. 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 (a) The network provider shall request payment monthly through submission of a properly completed invoice, per the requirements of this contract, within ten (10) calendar days following the end of the month for which payment is being requested. (b) 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 ten (10) calendar days following the end of the month. Should the network provider fail to submit an invoice or written documentation (should no services be due to be invoiced from the preceding month), within thirty (30) calendar days following the end of the month, then the ME at sole discretion will consider these funds as lapse and may reallocate these funds within the network of providers. If the Network Provider fails to submit an invoice or written documentation for two (2) consecutive months within a twelve (12) month period, the ME at its sole discretion can terminate the contract or whole or in part. (c) The ME has ten (10) working days, subject to the availability of funds, to inspect, and approve for 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 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 contract, 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 in whole or in part 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, Guidance /Care Center, Inc. Standard Contract Contract No. ME225 -4 -27 Page 7 of 10 South Florida Behavioral Health Network, Inc. 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. 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. The ME at is sole discretion may terminate a contract in whole or in part for failure to comply with requirements for corrective action. 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 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 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 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. e. Should the termination of the contract be inevitable, the network provider shall work in collaboration with the ME to develop a transition plan, in accordance with the Network Service Provider Contract Non - Renewal /Termination /Record Transition Plan, incorporated herein by reference, and timeline to ensure the uninterrupted continuum of services to individuals served under this contract, to include but not limited to the transfer client records. A copy of the Network Service Provider Contract Non - Renewal /Termination /Record Transition Plan may be obtained from the ME's website at www.sfbhn.org. 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 (a) It is the sole responsibility of the ME to resolve differences with the Network Provider pertaining to this contract. The Network Provider and the ME 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 President/Chief Executive Officer of the respective parties. Upon referral to this second step, the President/Chief Executive Officer of the parties Guidance /Care Center, Inc. Standard Contract Contract No. ME225 -4 -27 Page 8 of 10 /rte' South Florida /� Behavioral Health Network, Inc. shall confer in an attempt to amicably resolve the issue. If the President/Chief Executive Officer of the parties cannot resolve the issue, then in that event, the decision of the ME 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. (b) In the event of a dispute as to the ME's determination regarding client eligibility and /or placement into the appropriate level of care, the ME's dispute resolution process, incorporated herein by reference and available upon request from the ME's contract manager, shall be followed. An eligibility dispute shall not preclude the provision of services to Individuals Served, unless the dispute resolution process reverses the ME's determination. (c) In the event of a general dispute arising out of, or relating to this contract the parties mutually agree to resolve the disagreement amicably by following the ME's dispute resolution process. 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. 44. 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: hftp://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 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. Guidance /Care Center, Inc. Standard Contract Contract No. ME225 -4 -27 Page 9 of 10 � ,� South Florida / Behavioral ,,,,,� Health Network, Inc. 45. 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 mailing address of the official payee to whom the payment shall be made is: Guidance /Care Center, Inc. 3000 41 st Street Ocean Marathon, FL 33050 c. The name of the contact person and street address where the Provider's financial and administrative records are maintained is: Marianne K. Benvenuti, Regional Controller 3000 41 st Street Ocean Marathon, FL 33050 Tel: (305) 434 -7660 Ext. 31131 Fax: (305) 434 -9040 Cell: (305) 393 -0925 E -mail: marianne.benvenuti @ westcare.com b. The name, address, and telephone of the Contract Manager for the ME for this contract is: Cara Zuckerman South Florida Health Network, Inc. 7205 Corporate Center Drive, Suite 200 Miami, FL 33126 Tel. (786) 507 -7474 E -Mail: CZuckerman @sfbhn.org d. The name, address, and telephone number of the representative of the Provider responsible for the administration of the oroaram under this contract is: Frank C. Rabbito, Senior Vice - President 169 E. Fiagler Street, Suite 1300 Miami, FL 33131 Tel: (305) 573 -3784 Fax: (305) 381 -7733 Cell: (305) 799 -1286 E -mail: frabbito@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. 46. All Terms and Conditions Included This contract and it attachments, I. ti. III, IV & V and any exhibits referenced in said attachments, together with any documents incorporated by reference, including the ME prime contract (which can be found at http: / /www.sfbhn.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 I, 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 46. 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: Guidance/Care Center, Inc. SIGNED BY: r t ` NAME: Frank Rabbito t, TITLE: Senior Vice Presid-ent DATE: �- Federal Tax ID# (or SSN) 59- 1458324 SOUTH FLORIDA BEHAVIORAL HEALTH NETWORK, INC. SIGNED , �f BY: John W. Dow TITLE: President and CEO DATE: -? Network Provider Fiscal Year Ending Date 6/30 Guidance /Care Center, Inc. Standard Contract Contract No. ME225 -4 -27 Page 10 of 10 South Ulorida Beim%iorM IIcAth NetNs ork. Ine. 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 ME contract manager. b. Program /Service Specific Terms Additional Program /Service Specific Terms can be found in the South Florida Behavioral Health Network's Glossary of Program /Service Specific Terms, which is incorporated herein by reference, and can be obtained from the following internet location: htto:// www. sfbhn. org /R5 %20Contracting %2OPage.htm (1) "Behavioral Health Services" are mental health services and substance abuse prevention and treatment services as defined in chapters 394, 397, F.S. which are provided using state and federal funds. (2) "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. (3) "Consolidated Program Description" is the combination of all of the ME network providers' program descriptions and the ME program description organized according to the description provided in 65E- 14.021 (8) (d) 1.d.(111), Florida Administrative Code (F.A.C). (4) "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. (5) "Contract Manager' is the ME 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 ME and the network provider. All actions related to the contract shall be initiated by or coordinated with the contract manager. (6) "Co- occurring Disorder' is any combination of mental health and substance abuse in any individual, whether or not they have been already diagnosed. (7) "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 provide appropriately matched, integrated services to the individuals and families with co- occurring disorders that are routinely presenting for care in that program. Should services not be available at the network provider then then the consumer must be linked to an agency with the capability to meet the consumer's needs. (8) "Cost Analysis" is the review of the proposed cost elements to determine if they are necessary, Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 1 of 39 South Plorida t,chueioral l {calth Nettiv ork. tnc. allowable, appropriate and reasonable. (9) Cultural and Linguistic Competence' is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professional that enable effective work in cross - cultural situations that provides services that are respectful and /or responsive to cultural and linguistic needs. (10) TCF 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.shtm1, and is incorporated herein by reference. (11) "Department" means the State of Florida Department of Children and Families. (12) "Electronic Health Record (EHR)" is defined pursuant to section 408.051, F.S. (13) "Evidence -Based Practices" are those practices that are based on accepted practices in the profession and are supported by research, field recognition, or published practice guidelines. For substance abuse prevention services evidence -based prevention practice are prevention programs, practices or strategies in the substance abuse profession that are supported by research. For Evidence -Based Practices, Center for Substance Abuse Prevention (CSAP) Options of the Strength of Evidence upon which this program or strategy was selected provides the definitions of the options below: Option 1) this proposed program or strategy is recognized by a Federal registry of evidence -based prevention programs and environmental strategies as having a strong and consistent positive effect on an outcome that is relevant to the identified intermediate outcome. Federal registries include National Registry of Evidence -Based Programs and Practices (NREPP) with relevant element scores, Blueprints for Violence Prevention, Models of Exemplary, Effective and Promising Alcohol or Other Drug Abuse Prevention Programs on College Campuses. Option 2) this proposed program or strategy is reported in one or more peer- reviewed journals as having positive effect on an outcome that is relevant to the identified intermediate outcome. Provide a detailed description of the evidence of a positive effect on an outcome that is relevant to the identified intermediate outcome and how the relevance was determined, Option 3) this proposed program or strategy is supported by other sources of information, such as unpublished evaluation reports. When claiming this CSAP Option, include a) a description of the theory of change and a logic model, b) a discussion of how the content and structure of this proposed program or strategy is similar to programs or strategies that appear in Federal registries or in the peer- reviewed literature or how it is based on sound scientific principles of community prevention or public health, c) documentation of the program or strategy has being implemented in the past, including the number of times; if any, it was implemented, the fidelity with which it was implemented and the results of any outcome evaluations, d) and documentation of a review by and consent of a Panel of Informed Prevention Experts indicating that the implementation of this proposed program or strategy is appropriate for the community and likely to have a positive effect on the identified intermediate outcome and what evidence their decision was based upon. (14) "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 (15) "Forensic Mental Health Services" are services provided to individuals with mental illness pursuant to Chapter 916, Florida Statutes. (16) "HIPAA" is the acronym for Health Insurance Portability and Accountability Act (42 U.S.C. 1320d, and 45 CFR Parts 160, 162, and 164). Guidance/Care Center, Inc. Attachment t HCO2 (a) Contract No. ME225 -4 -27 Page 2 of 39 S(mth Florida Mitt-, .d Ilealth Network. hic. (17) "Individual(s) Served" (synonymous with Consumer or Client) is any person 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 or Local Match. (18) "KIT Solutions" is the entity that maintains the database called Performance Based Prevention System (PBPS) and the data system, or other system designated by the ME that substance abuse prevention network providers must utilize to upload prevention data required by this contract. (19) "Knight Information Software Database (KIS)" is the ME'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 ME's Substance Abuse and Mental Health (SAMH) contract, Medicaid, or local match. The KIS, or other system designated by the ME, shall be utilized to upload client - related data as required by this contract. (20) "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. (21) "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. (22) "Medicaid Eligibility" The consumer must be enrolled in Medicaid and have a Medicaid number (a) If the consumer is enrolled in Medicaid and has a Medicaid number, then the following is billable to the ME: i. Services not covered by Medicaid (i.e. peer services, residential services); ii. Medicaid covered services for a consumer whose service limit(s) has (have) been exhausted and an appeal denial is on file. (b) If the consumer is enrolled in Medicaid and has a Medicaid number, then the following Medicaid eligible services are non - billable: i. Services are non - billable to the ME, if providers' staff are not properly credentialed staff as per the applicable Medicaid Handbook credentialing requirements for the identified service(s); ii. Services are non - billable to the ME, if the provider is not a Medicaid provider or approved Provider Service Network (i.e. Magellan, UMBH, etc.) for the consumer seeking the service(s). (23) "Mental Health Services" is defined pursuant to Chapter 394, F.S. (24) "Network Provider" is an entity that Contracts with the ME and receives funding to provide services to clients; in this contract the network provider is synonymous with provider or subcontractor. (25) "Outcome for Individual Service Recipient" is a measure of the quantified result, impact, or benefit of services on the individual service recipient. (26) "Outcome for Managing Entity Performance" is a standard to evaluate performance of the Managing Entity and any Network Service Provider relative to compliance with the contract and the performance and outcome measures therein. (27) "Payer class" Medicare, Medicare HMO, Medicaid, Medicaid HMO, private- pay health insurance, Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 3 of 39 South Horida Belno i €oral Health Net +vork, Inc. private -pay health maintenance organization, private preferred provider organization, the Department of Children and Family Services, other government programs, self -pay patients, charity care and any other payer class other than the Department. (28) Payer of last resort is a standard that is applied by the network provider to ensure that all options to collect payment for services rendered under this contract from "First party payer" (consumer), "Second Party Payer or Responsible Party", and /or "Third Party Payer", as defined in Rule 65E -14, F.A.C. are pursued prior to billing the ME. The ME is always the payer of last resort. (29) "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 /. (30) "Performance Measures" are quantitative indicators, outcomes and outputs that are used by the Department to objectively measure performance and are used by the ME and network providers to improve services. (31) "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. (32) "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.). (33) "Prime Contract" is the contract between the Department of Children and Families and the ME. (34) "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. (35) "Projects for Assistance in Transition from Homelessness (PATH)" is a federal grant to support homeless individuals with mental illnesses, who may also have co- occurring substance abuse and mental health treatment needs. (36) "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, 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. (37) "Provider Network" (subcontractor or network provider) refers to the direct service agencies that are under contract with a ME 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. (38) "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. Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 4 of 39 Somb Florida Behar -iond Ifealth ,Neoiork. Inc. (39) "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. (40) "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. (41) "SAMH" stands for the Substance Abuse and Mental Health Programs within the Department. (42) "SAVE/VIS Program" is the U.S. Department of Homeland Security (DHS) administers 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 SAVE/VIS Program can and may provide assistance in verifying eligibility in cases where a client does not possess sufficient documentation. (43) "Service Units" means those units of measure specified in Rule 65E- 14.021, F.A.C. and in the Substance Abuse Recovery Support Services, and Clinical Supervision for Evidence Based Practices exhibits. (44) "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. (45) "Stakeholder(s)" are individuals /groups with an interest in the provision of treatment services for substance abuse, mental health services, and /or co- occurring disorders in the circuits outlined in Section A.2.c.(2), of this Contract. This includes, but is not limited to, the key community constituents included in section 394.9082(6)(f)5., F.S. (46) "Statewide Inpatient Psychiatric Programs (SIPP)" )" are residential inpatient facilities under contract with the Agency for Health Care Administration (AHCA) under the Medicaid Institutes for Mental Disease (IMD) 1915B waiver for children under age 18 to provide diagnostic and active treatment services in a secure setting. (47) "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. Substance abuse prevention and treatment services, pursuant to Chapter 397, F.S., which are provided using state or federal funding. (48) "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) contract, Medicaid, or local match. Instructions on how to access the system can be found in DCF PAM 155 -2. (49) "System of Care" is defined pursuant to section 397.311, F.S., and interpreted to include the comprehensive array of Behavioral Health Services per section 394.9082(1)(e), F.S., that includes the following elements: (a) Prevention and early intervention; (b) Emergency care; (c) Acute care; Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 5 of 39 Strout I lorida Helwi ioral I,tealth Net8A ork, inc. (d) Residential treatment; (e) Outpatient treatment; (f) Rehabilitation; (g) Supportive intervention; (h) Recovery support; and (i) Consumer support services. Services provided as the SOC must be assessable and responsive to the needs of individuals' substance, their families, and community Stakeholders. (50) "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. (51) "Temporary Assistance to Needy Families (TANF)" are cash assistance for families, including any family receiving cash assistance payments or TANF diversion services from any state program pursuant to the provisions of sections 414.045, and 414.0252(9), F.S. (52) "Unit Measurement" is used in billing the ME for services. The definition of each unit of measure can be found in Rule 65E- 14.021, F.A.C. (53) "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. (54) "Verifiable Service" is a service provision that is documented in compliance with the requirements contained in Rule 65E- 14.021, F.A.C. (55)Wait List" is a list maintained by the ME and each Network Service Provider that shows the number of persons waiting for access to the recommended level of care. 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 and /or children with behavioral health issues as authorized in section 394.9082, F.S., consistent with Chapters 394, 397, 916, section 985.03, F.S. (as applicable), State Behavioral Health Services Plan dated January 2011, or the latest version thereof, and in the Prime Contract (ME's contract with the Department), which is incorporated herein by reference The network provider shall work in partnership with the ME to better meet the needs of individuals with co- occurring substance abuse and mental health disorders, trauma informed care. 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 ME will require that the network provider participate in the process of improving co- occurring disorder service capability system wide and trauma informed care services. The network provider shall work in collaboration and shall assist, upon request of the ME, 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; Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 6 of 39 S�rertlr Ulorida Helm%ior°al I tcalth .Nch) orh. Inc, (6) Disaster Planning and Responsiveness b. Authority Section 394.9082, F.S., and the Prime Contract provides the ME with the authority to contract for these services. c. 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 /Participants to be Served, and in accordance with the tasks outlined in 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 d. Major Program Goals (1) The primary goal of the SAMH Program is to promote the reduction of substance use, abuse, and dependence and improve the mental health and lives of the people of Florida by making substance abuse and mental health treatment and support services available through a comprehensive, integrated community-based System of Care and to engage and encourage persons with or at risk of substance abuse and /or mental illness to live, work, learn, and participate fully in their community. (2) It is the goal of the ME 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, trauma informed care, 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 ME 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/. e. 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. Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 7 of 39 S €smb Florida Belntlioral IleAth Network. Ine. 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 ME and the Department for substance abuse, mental health treatment and /or co- occurring disorders, substance abuse prevention services, 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; (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, and (g) Gender responsive. 3. Clients to be Served See Exhibit A, Clients /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. Any change in the array of services shall be justified in writing and submitted to the ME's contract manager for review and approval. (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 ensure that EBPs are accessible to children and families who are involved in the Child Welfare System. (4) The network provider shall adhere to treatment 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 activities shall include the following: Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 8 of 39 '"milt 1 Helm%ior.d Ilealth Net%�4)rk, Inc. (a) Data Elements: I. Service Documentation -Group Sign in Sheet 1. Recipient name and identification number; ii. Staff name and identification number iii. Service date; IV. Start time V. Duration; V1. Cost Center; Vii. Brief description of type of group; viii. Program (AMH, ASA, CMH, CSA) 11. Audit Documentation - Recipient Service or Non - Recipient Chart: I. 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 Paragraph 25., Information Security Obligations, of the Standard Contract. The network provider shall submit to the Managing Entities Contract manager, by 08101/2013, verification that all network provider employees and subcontractors who have access to ME and Department information systems have completed the Security Agreement form as identified in Paragraph 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 ME shall suspend payment for services delivered by the network provider under such license(s) until said license(s) are reinstated. (7) By 08/01/2013 the network provider shall submit to the ME's contract manager grievance procedures, which include an appeal process with the ME, 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 ME about contracted services. (8) The network provider shall use the approved assessment tool designated by the ME. Standardized tools and assessments approved by the ME must be used to determine placement and level of care. (9) If the network provider provides medication management services, the network provider shall 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. (10) By 08101/2013, the network provider shall submit to the ME's contract manager a disaster plan consistent with Paragraph 29., Emergency Preparedness, of the Standard Contract. (11) Should the ME conduct a mock emergency drill, the network provider shall participate by activating their emergency /disaster plan and reporting on preparedness activities, response activities, and post- recovery activities. (12) By 08/0112013 the network provider shall submit to the ME's contract manager a completed Civil Rights Compliance Questionnaire. Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 9 of 39 Smith Horida llehw ioral llealth Network, lice. (13) Continuous Quality Improvement Programs i. The 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. ii. The network provider shall develop a plan, with a copy made available upon request to the ME, 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, in good faith, 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. (h) Evidence-based practices (EBPs) utilized by the agency and how these EBPs are monitored to ensure fidelity to the model. Ili. 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. iv. 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. V. 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. (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. Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME2254-27 Page 10 of 39 South Horida Heharioral health Netsiork, Inc. (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. (14) By 08101/2013, 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. (15) By 08/0112013 the network provider shall establish a Quality Improvement Plan, which is herein incorporated by reference, which includes the quality improvement activities for fiscal year 2013 -2014 to improve performance. The Quality Improvement Plan may be submitted with the Quality Assurance Plan as one document or separately, but must include, at minimum, the performance measures and activities listed below. The network provider shall submit quarterly reports on the implementation of the plan to the ME's contract manager. (16) 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 QI report and submit the report to the ME's Contract Manager by the dates specified in Exhibit C, Required Reports: 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 O8- In Home/ On -Site 34- FACT 09-Inpatient 35- Outpatient Grou 12- Medical Services (psychiatric) 39- Short-term Residential Treatment 14-Outpatient Individual 18- Residential Level 1 (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. Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 11 of 39 South Horida Helw i€ nd Health Network. hw. (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. ii. Substance Abuse Services (Admission type): Cost Centers (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. (17) 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: (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. (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 the ME 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: Guidance /Care Center, Inc. Attachment t HCO2 (a) Contract No. ME225 -4 -27 Page 12 of 39 South 1 °loricla Belia%ioral Ilealth Network. hic. 1. 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) Evidence of the implementation of the Trauma Informed Care initiative throughout the agency, including progress on the implementation of the TIC Commitment Plan shall be documented in quarterly QI Report, and submitted the report to the ME's Contract Manager by the dates specified in Exhibit C, Required Reports. (18) 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. (19) 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. (20) By 0810112013 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. Such services include, but are not limited to, linkages with community programs such as housing, employment and parenting supports. The network provider is responsible for tracking and ensuring that the proper linkages are made and documented in accordance with the requirements in the Utilization Management Manual (UM). Network providers are required to submit all required Guidance/Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 13 of 39 South 1 Beha Nior'al Ilealth Neovork. lire. documentation for the initiated referral. (21) Linkage and Referral Process: The network provider may only refer a consumer to a provider that offers the service for which the network provider created the referral. If the network provider is a receiving provider then the network provider must inform the referring provider that the consumer was admitted /not admitted within seven (7) calendar days, unless otherwise required by applicable state, federal rules and /or statues. If the network provider is the receiving provider, the network provider will have seventy-two (72) hours to respond to a new referral, unless otherwise required by applicable state, federal rules and /or statues. If the network provider is the receiving provider, and if upon assessing a referred consumer on intake, determines that the consumer requires a service that is different from the service for which the consumer has been referred, the network provider will admit the consumer for the service that the consumer needs if the network provider offers the service and has availability to offer the service. In the event the network provider does not offer the service nor has availability to offer the service, the network provider will create a referral for the consumer to receive the service at a different provider. (22) The network provider shall perform the following tasks related to the co- occurring disorder service capability initiative: (a) Complete network provider co- occurring disorder service capability as directed by the ME using the COMPASS; (b) Following evaluation of each program using the COMPASS, evaluate clinicians' co- occurring disorder service capabilities as directed by the ME using the CODECAT. (c) Develop and submit to the ME a summary report tine 30 of each year of the contract term that details: (i) The types of network provider involvement in state and local co- occurring planning processes; (ii) An overview of the network provider's co- occurring disorder service capabilities with regard to service structure (assessment, stabilization, treatment, support, and other services); (iii) Networking capacities with local network providers in the community for persons with co- occurring disorders; (iv) Strategies and activities to develop or improve co- occurring disorder service capability; (v) Scope of services and programs to be included in the process; (vi) Any changes to the co- occurring disorder service structure including new programs, training, or changes in policy and procedures (copies of training guidelines or curricula and co- occurring policies should be included); (vii) The number of times the COMPASS was used and the composition of the focus group(s) for each use; (viii) The number of clinicians evaluated using the CODECAT; AND (ix) In addition, the summary report shall include an Action Plan that details the following: Guidance /Care Center, Inc. Attachment 1 HCO2 (a) Contract No. ME225 -4 -27 Page 14 of 39 'Sowh I� forida Belimi €oral Itcalth Network. Inn, a. Brief narrative detailing the findings from the COMPASS, the action steps developed, and progress made for each action step; b. Brief narrative detailing the findings from the CODECAT and action steps developed to enhance clinicians' co- occurring attitudes, knowledge, values and skills; and c. Overall progress toward co- occurring disorder service capability development in accordance with timeframes specified in the action plan. (x) Evidence of the implementation of co- occurring capabilities, including progress on the implementation of the co- occurring action plan shall be documented in the quarterly QI report, and submitted to the ME's Contract Manager by the dates specified in Exhibit C, Required Reports. (23) The network provider shall ensure access to services that meet linguistic and cultural needs of recipients. (24) 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. (25) The network provider, in partnership with the ME, will implement a Cultural and Linguistic Competence Action Plan for developing strategies to increase cultural competence among board members, staff, and family members were appropriate. The network provider shall: (a) Implement standards and document specific strategies, tools and other resources focused on how to improve culturally and linguistically competent service delivery, coaching and training, and evaluation and assessment in a way that can enhance the system of care and achieve positive outcomes for consumers; (b) Collaborate with the ME to identify and utilize the network provider's data to (1) identify sub - populations (i.e., racial, ethnic, LGBTQI -2S, minority groups) vulnerable to disparities and (2) implement strategies to decrease the differences in access, service use, and outcomes among sub - populations. These strategies should include the use of the enhanced National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care; (c) By 10/3112013 the network provider shall submit the Cultural and Linguistic Competence Action Plan; (d) Implementation of the Cultural and Linguistic Competence will be documented in the quarterly QI Report, and submitted to the ME's Contract Manager by the dates specified in Exhibit C, Required Reports. (26) The network provider shall assure the delivery of services based on Evidence-Based Practices /Promising Practices Guidelines in accordance with the approved Program Description. (27) Evidence-based practices (EBPs) utilized by the agency and how these EBPs are monitored to ensure fidelity to the model shall be documented in the quarterly QI plan and submitted to the ME's Contract Manager by the dates specified in Exhibit C, Required Reports. (28) Financial Audit Reports (a) The network provider shall submit quarterly financial statements consisting of Balance Sheet and Statement of Activity (income statement) per the schedule and to the individual(s) identified in the Exhibit C, Required Reports. The network provider agrees to provide the ME with any requests for additional financial statements /documentation. (b) The network provider shall submit a copy of Form 941, Employer's Quarterly Federal Tax Guidance/Care Center, Inc. Attachment 1 HCO2 (a) Contract No. ME225 -4 -27 Page 15 of 39 SF mit I�Iorida Bclia %ioral Iicalth Netmork, hic. Return, United States Department of the Treasury- Internal Revenue Service (IRS), as completed and submitted to the Internal Revenue Service. The network provider shall also submit copies of the bank statements for each months within the quarter for which the 941 form is prepared, demonstrating proof of payment to the IRS. These reports are due on the dates and to the individual(s) identified in the Exhibit C, Required Reports. (29) 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 ME policies and procedures. (30) The network provider shall also make available and communicate all plans, policies, procedures, and manuals to ME staff, Department staff, network provider staff, and to clients /stakeholders if applicable and appropriate. (31) 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 httpJ /www. dcf. state.f1. us/ news /h um an researchpol icy. s htm 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. (32) 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 to 45 CFR 96.136. (33) The network provider shall execute or maintain if executed 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 the due date(s) as specified in Exhibit C, Required Reports. The network provider shall submit copies of any amendment to the MOU, to the ME's contract manager, within thirty (30) days of execution. The MOU provides for integration of primary care services to the medically underserved. Federally Qualified Health Centers are required to submit policies and procedures that explain the access to primary care services to the medically underserved behavioral health client. (34) The network provider shall meet with the ME's staff at regularly scheduled or specially called meetings when notified by the ME. (35) The network provider shall ensure that individuals needing treatment services will receive services, depending on the severity of individual need, consistent with industry standards for distance and travel time, and as specified in the Utilization Management Manual (UM), herein incorporated by reference. Non - compliance with timely access to care for services terms will result in a corrective action and may result in a financial penalty as specified in Paragraph 36. of the Standard Contract. (36) The network providerwill 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. Guidance /Care Center, Inc. Attachment 1 HCO2 (a) Contract No. ME225 -4 -27 Page 16 of 39 Smith Ulorida tfelia%i €tral Ilealth Network. ins. (37) The network provider shall take appropriate steps to obtain or maintain national accreditation during state fiscal year 2013 -2014 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. (38) 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 ME 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 L, Assisted Living Facilities with a Limited Mental Health License, if services to such 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. (39) 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. (40) 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. (41) Assist Stakeholder Involvement in Planning, Evaluation, and Service Delivery (a) At the ME's request, the network provider will assist the ME in engaging local stakeholders, per section 394.9082 F.S., in its support activities for the Department's local plans. (b) The network provider shall work with the ME to provide performance, utilization, and other information for the Department's Substance Abuse and Mental Health Services Plan, and annual updates thereof, and to provide appropriate information for the Department's Long Range Program Plan and its Annual Business Plan. (42) 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 ME's contract manager. The ME reserves the right to reject reports as incomplete, inadequate or unacceptable. (43) Client Satisfaction Survey Guidance/Care Center, Inc. Attachment 1 HCO2 (a) Contract No. ME225 -4 -27 Page 17 of 39 S""th Horid.a Ifeh:a %ionA Health Nct%rork. Inc. The network provider shall conduct satisfaction surveys of individuals served pursuant to DCF PAM 155- 2. The network provider shall utilize a Department- approved satisfaction survey instrument. Failing to provide the required number of satisfaction surveys and /or utilizing a survey instrument other than that approved by the Department will result in a corrective action and an imposed financial penalty. (44) The network provider agrees to assist in the development and implementation of a Utilization Management Predictive Model data system and shall maintain the capacity to perform the following functions including, but not limited to: (a) ME- approved automated, standardized, and evidence -based screening and assessment instruments to improve proper evaluation and placement of individuals; (b) Automated referral and electronic consent for release of confidential information with the ME and other network providers, to the extent permitted by law; (c) Integrated processes for intake, admission, discharge and follow -up; (d) Encounter and progress notes to support all services provided under this contract and that automatically generate state and Medicaid billing and payment in the event Medicaid compensable services are provided to individuals eligible for Medicaid; (e) Utilization management, including but not limited to Wait Lists and capacity management; (f) Determination of financial and clinical eligibility of Individuals Served; (g) Processes to ensure the Department is the payer of last resort; (h) Electronic capability for billing, invoice payment and claims adjudication, and /or Medicaid billing and payment (HIPAA 837 and 835 Transactions); (i) Automated processes for state and federal data analysis and reporting; and (j) Full compliance with federal and state laws, rules and regulations pertaining to security and privacy of protected health information. (45) 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 contractlamendment execution or by August 1 sa 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 establishment and management of individual client trust accounts (20 CFR 416 and 31 CFR 240). (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 Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 18 of 39 South Ho ida Bcha� ioral MAO Network. inc. 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. b. Task Limits The network provider shall perform services in accordance with applicable, rules, statutes, licensing standards and policies and procedures. 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. 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 efforts to maintain as much as possible staff with the ethnic and racial composition of the clients served. The ME, at its sole discretion may request documentation evidencing recruitment efforts. b. Professional Qualifications (1) The network provider shall comply with applicable rules, statutes, requirements, and standards 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 chief executive officers, 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, IT Director, Dispute Resolution Officer, Data Security Officer, Single Point of Contact in accordance with Section 504 of the Rehabilitation Act of 1973 as required by Paragraph 33. of the Standard Contract, or any individuals with similar functions. 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, Paragraph 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 Guidance /Care Center, Inc. Attachment 1 HCO2 (a) Contract No. ME225 -4 -27 Page 19 of 39 South Horicla Beho%iord Health elm)rk. Inv. 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 ME policies and procedures, in addition to identifying the ME'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 ME's contract manager. (4) The network provider shall not subcontract for substance abuse /mental health services with any person, entity, vendor, purchase orders or any like purchasing arrangements 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 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 ME, 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), Guidance/Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 20 of 39 South Horida 1k111 r- i(ff %11 11C3101 4e[%ror€:. lnvc 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. us /mentalhealth /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 ME within forty -eight (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. (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 M E'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 the Network Provider Inventory List, incorporated herein by reference, and by the date(s) listed in Exhibit C, Required Reports. The Network Provider Inventory List form may be requested from ME Contract Manager upon request. 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), 42 CFR Part 2, and any other applicable State, and Federal laws, rules, and regulations. c. Reports Where this contract requires the delivery of reports to the ME, mere receipt by the ME shall not be construed to Guidance /Care Center, Inc. Attachment 1 HCO2 (a) Contract No. ME225 -4 -27 Page 21 of 39 South I:Jorida Beluoiond Ilealth Nct +cork, laic. 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 ME reserves the right to reject reports as incomplete, inadequate, or unacceptable according to the parameters set forth in the resulting contract. The ME, at its sole option, may allow additional time within which the network provider may remedy the objections noted by the ME or the ME 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 or as requested by ME staff. (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. and submitted within the timeframes specified in Exhibit C, Required Reports. (3) 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. (4) 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 - Community Forensic Beds 18 GX018 -PATH (5) In addition to utilizing the modifiers to procedure codes for block grant funds identified in Section B. 4. (4) above, the network provider, upon request by the ME 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. (6) Data shall be submitted electronically to the ME by the 4 of each month following the month of service into the Knight Information Software database (KIS), PBPS maintained by KIT Solutions or other data reporting system designated by the ME. Notwithstanding, if the network provider is funded to provide substance abuse prevention services, the network provider shall submit prevention services data to PBPS, or other data reporting system, electronically by the 4 ffi 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. Ensure that substance abuse prevention services data entered into PBPS, or other data reporting system designated by the ME, clearly documents all program participants, programs and strategies which occurred under this contract, if applicable; (b) Ensure that all data submitted to the KIS, or other data reporting system designated by the ME is consistent with the data maintained in the network provider's clients' files. Ensure that substance abuse prevention services data entered into PBPS, or other data reporting system designated by the ME, is consistent with the data maintained in the network provider files, if applicable; (c) Review the ME'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, or other data reporting system designated by the ME; (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 5% 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 Guidance/Care Center, Inc. Attachment f HCO2 (a) Contract No. ME225 -4 -27 Page 22 of 39 South Ulorida lidia%ior3l health ,Netxi irk. Inn, 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 ME and after receiving due notice, shall be grounds for contract termination. (7) A facility designated as a public receiving or treatment facility under this contract shall report the following Payer 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, or other data reporting system designated by the ME, 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 payer class; (b) Number of contract days by payer class; (c) Number of persons served (unduplicated) in program by payer class and diagnoses; (d) Number of utilized bed days by payer class; (e) Average length of stay by payer class; and (f) Total revenues by payer class. (8) The network provider shall obtain the format and directions for submitting Payer Class data from the ME. (9) The network provider shall submit Payer Class data to the ME no later than 90 days following the end of the ME's fiscal year and by the date specified in Exhibit C, Required Reports. (10) 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. Should an overpayment be detected upon reconciliation of payments, the network provider shall immediately refund any overpayment to the ME. . 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, PBPS, and SAMHIS, or other data reporting system designated by the ME, 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 ME. Any conflicts will be clarified by the ME and the network provider shall adhere to the ME'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) 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 B. 1.a. (16), Performance Measures for Continuous Quality Improvement Programs. b. Performance Measurement Terms Guidance /Care Center, Inc. Attachment f HCO2 (a) Contract No. ME225 -4 -27 Page 23 of 39 So"th I Belia%i €oral I,Icalth Network, Inc. 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 ME 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 (1) The network provider shall collect information and submit performance data and individual client outcomes, to the ME data system in compliance with DCF PAM 155 -2 requirements. The specific methodologies for each performance measure may be found at the following website: htto: / /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 B. 1.a. (16), Performance Measures for Continuous Quality Improvement Programs. (5) Performance data information may be found on the department's web -based performance Dashboard at: htto:/ /dcfdashboard.dcf.state.fl.us / . Additional substance abuse 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) In the event of a dispute as to the ME's determination regarding client eligibility and /or placement into the appropriate level of care, the ME's dispute resolution process, incorporated herein by reference and available upon request from the ME's contract manager, shall be followed. An eligibility dispute shall not preclude the provision of services to Individuals Served, unless the dispute resolution process reverses the ME's determination. (2) The network provider is responsible for the satisfactory performance of the tasks referenced in 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. (3) 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 ME's contract manager or an authorized ME staff member. The department through the ME 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. (4) 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 and reconciled with KIS, PBPS, or other data reporting system designated by the ME. (5) 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 and Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 24 of 39 Sow It Florida BelmN coral Ilcalth .Vetivor€:. Ittc, ME policies and procedures (6) 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. (7) 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). (8) 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. (9) 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. (10) 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 and the ME 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 ME that if any PHI received from the Department or the ME, or received by the network provider on the Department's or the ME'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. (� The network provider agrees to incorporate any amendments to PHI in accordance with 45 C.F.R. 164.526 into its operating procedures. (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 ME or created or received by the network provider on behalf of the Department or the ME 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 destroy all PHI received from the Department or ME or received by the network provider on behalf of the department and the ME 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. (11) 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 Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 25 of 39 Soaatla Florida ticlaaa�ioral IIcalth 4ctrrork. Inc. plan. (12) The network provider shall cooperate with the ME and the Department when investigations are conducted regarding a regulatory complaint of the network provider. (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. The network provider's financial management and accounting system must have the capability to generate financial reports on individual service recipient utilization, cost, claims, billing, and collections for the ME. The network provider must 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 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. The network provider shall implement a process for tracking all corrective action plans and submit a copy of the tracking log to the ME upon request. (15) 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 /or ME of the same. (16) The network provider shall assist the ME and the Department in developing legislative budget requests based upon identified needs of the community. (17) The network provider shall make available source documentation of units billed by network provider upon request from the ME staff. The network provider shall track all units billed to the ME by program and by Other Cost Accumulator (OCA). (18) 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. (19) The network provider shall maintain in one place for easy accessibility and review by ME and /or Department 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 ME operating procedures. (20) 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. (21) The network provider agrees to allow the ME and the Department access to all records pertaining to service delivery, to include but not limited to, invoicing, fiscal management, data management, incident reporting, client records, and such documents determined to assure accountability of service provision and the expenditure of state and federal funds. (22) Records relating solely to actions taken in carrying out the requirements of this contract and records obtained by the ME and /or the Department to determine a network provider's compliance with this section are confidential and exempt from s. 119.07 and s. 24(a), Access to Public Records and Meetings, Article. I, Constitution of the State of Florida. 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 F. S. b. Coordination with other Providers /Entities Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 26 of 39 South Ulori&i Ile €tali €prat HeAth Network, Ine. (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. 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. (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 the ME (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. Priority for behavioral health services shall be given to families with children that have been determined to be "unsafe" by child protective investigators. Such priority is limited to individuals that are not Medicaid eligible, or require services that are not included as reimbursable by Medicaid, as defined in Exhibit A, Clients /Participants to be Served. (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 ME shall only subcontract with entities that are fiscally sound, and that can adequately ensure the accountability of public funds. (2) The ME shall assess the network provider's financial stability, using a risk assessment approach; the risk assessment approach will examine the impact of programmatic requirements on the network provider's financial stability. Any issues identified as a result of the financial risk assessment shall be reported to the Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 27 of 39 Smith l Beluo.iaral Ilealth Ncot iwk.Ine. Department during the quarterly /monthly reconciliation and performance review identified in the Prime Contract. (3) The ME will provide administrative and programmatic oversight to ensure that network providers comply with all consumer - related services and other requirements of this contract. (4) The ME 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 ME for consideration and resolution between the network provider and the ME. In any event, the ME's decision on all issues is final and solely subject to the ME's appeal process and legal rights of the network provider. (5) The ME reserves the right terminate this contract in whole or in part, for non - performance as determined by the ME and to procure the services purchased through this contract to another entity and /or network provider. (6) The ME is responsible for the administration, management, and oversight, and through subcontracts, the provision of behavioral health services in Miami Dade and Monroe Counties and to include statewide beds as specified in the Prime Contract, and in this contract. (7) The ME shall monitor and take action when necessary so that services which meet the standards defined herein will be provided throughout the contract period. (8) The ME will ensure that the network provider utilizes the approved consumer assessment and placement tool designated by the ME. Standardized tools and assessments approved by the ME must be used to determine placement and level of care. (9) The ME shall implement the administrative cost reduction plan developed by the ME and approved by the Department, which is incorporated herein by reference. This plan is designed to achieve administrative and service provision cost savings and efficiencies through, but not limited to; the streamlining of the Subcontractor network; the reduction, elimination, and consolidation of duplicative Subcontractor and ME administrative structures; coordinated procurements with parallel state, local, and private entities; and other reductions to service delivery overhead costs. (10) The ME shall work with the Department to redirect administrative cost savings into improved access to quality care, promotion of service continuity, required implementation of EBPs, the expansion of the services array, and necessary infrastructure development. It acknowledges the benefits to be realized, include improved access to quality care, promotion of service continuity, implementation of EBPs, improved performance and outcomes, expansion of the service array, and necessary infrastructure development. b. Monitoring Requirements (1) The ME will monitor the network provider in accordance with this contract and the ME's Contract Accountability Policies and 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 ME'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. (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 conclusion 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 ME, 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 ME and after receiving due notice, shall be grounds for contract termination in whole or in part. Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 28 of 39 1 Louth 11orida HeIno -iond Health Network. Ine. 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 ME 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. In addition, the ME may convene cross - organizational training and assistance to help non - accredited network providers become accredited. (4) The ME implements a training program for its staff and the network provider staff. The trainings assure that staff receives externally mandated and internal training. The ME 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 service compliance with criteria and practice guidelines, such as retrospective reviews to ensure the level of placement of clients is appropriate. The ME 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) Authorization of Services (a)The ME shall conduct authorization and reauthorizations for applicable levels of care as described in the approved Utilization Management Manual (UM) in order to ensure timely access to behavioral health services and eliminate the wait lists. The authorization processes includes: (i) Timeliness standards for authorization review must adhere to timelines standards referenced in the approved Utilization Management Manual 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) 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. (4) 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. Guidance/Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 29 of 39 South Horida Bdil oion l health Network. Ine. (5) The ME has the right to review the network provider's policies, procedures, and plans. Once reviewed by the ME, 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. (6) The ME may request supporting documentation and review source documentation of units billed to the ME. (7) Juvenile Incompetent to Proceed Program The ME will manage the Juvenile Incompetent of Proceed Program as per section 985.19, F.S. and as per the Department of Children and Families operating procedure. In addition, the ME 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. (8) Residential Level 1 Services The ME will insure that Residential Level 1 is available to children in the community. Management of this resource is a complex issue. The ME 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 ME will establish a system of intensive in -home services for the most severely disturbed children and families as an alternative to residential. e. Managing Entity Determinations 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): (1) 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. (2) The ME reserves the exclusive right to make certain determinations in these specifications. The absence of the ME setting forth a specific reservation of rights does not mean that all other areas of this contract are subject to mutual agreement. The ME reserves the right to make exclusively any and all determinations that it deems are necessary to protect the best interests of the State of Florida and the health, safety, and welfare of the clients who are served by the ME either directly or through any one of its contracted network providers. (3) In the event of any disputes regarding the eligibility of individuals served, the determination made by the ME is final and binding on all parties. C. Method of Payment Exhibit B, Method of Payment Exhibit E -1, Monthly Payment/Advance Request (Non -TANF Invoice) (Incorporated herein by reference and available at following website: http: / /www. sfbhn. ora /R5 %20Contractinct %20Page.htm). Exhibit E -2, Monthly Payment/Advance Request (TANF Invoice) (Incorporated herein by reference and available at following website: http: / /www. sfbhn. org /RS %20Contracting %20Page.htm) 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 10.28% or less for Fiscal Year 2013 -2014 for SAMH services purchased under this contract. The cost savings shall be reallocated to support the increase of direct services, improved access to quality care, promotion of service continuity, and the implementation and /or expansion in the use of evidence-based practices. The network provider's Projected Cost Center Operating and Capital Budget shall evidence the reduction and redistribution of the cost savings. Guidance/Care Center, Inc. Attachment f HCO2 (a) Contract No. ME225 -4 -27 Page 30 of 39 South 1 °forida Beim %ioral health Network. Inv. 2. Utilization Management Program: The network provider shall assist the ME in the reporting and managing of the Substance Abuse and Mental Health Waiting List for all levels of care (a) The Network Provider agrees to adhere to the utilization management protocols pursuant to the South Florida Behavioral Health Network Utilization Management Manual, herein incorporated by reference and available upon request from the Contract Manager. (b) 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. (c) The goals of utilization management include elimination /management of wait lists, the maximum utilization of treatment resources, and the delivery of clinically appropriate services in the least restrictive setting and most cost effective manner. Utilization management systems 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, at the right frequency and for the appropriate duration. It also includes financial screening to ensure maximization of fiscal resources including other third party payors such as, but not limited to KidCare, Medicaid, Medicare, and other HMOs. 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 ME is enhancing its automated utilization management system to include additional treatment services authorization. (d) The network provider will comply with the utilization management protocols pursuant to the South Florida Behavioral Health Network Utilization Management Manual. The network provider will offer clients a multi -level continuum of care services for treatment of behavioral health services. Each level of care as identified below have durations or length of stay as specified in the Utilization Management Manual: (e) The network provider shall obtain written authorization from the ME prior to providing the services as specified in the Utilization Management Manual. A written authorization will also be required, prior to the expiration of the initial length of stay, in order to extend services. The request for an extension must be justified in accordance with the ME approved consumer assessment and placement tool and in accordance with the Utilization Management Manual. (f) When a client has been provided residential services as a non -ME 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. (g) The network provider agrees to: (i) 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 Utilization Management Program. (ii) Request and receive an authorization number from the ME for all clients requiring admission into a substance abuse and /or mental health service as specified in the Utilization Management Manual prior to the client being admitted to the program for treatment. (iii) Complete all required assessment components outlined in the Utilization Management Manual for all consumers requiring substance abuse and /or mental health treatment services. The information will be submitted to the ME prior to the authorization request. (iv) Participate and cooperate in the centralized waiting list in accordance with the waiting list policies and procedures outlined in the Utilization Management Manual. Guidance /Care Center, Inc. Attachment 1 HCO2 (a) Contract No. ME225 -4 -27 Page 31 of 39 South Horida tfchaoktrail licalth \et8rork, Ine. 3. Waiting List and Interim Services (a) In the event that waiting lists develop, the network provider will collaborate with the ME to implement procedures for managing the substance abuse and mental health waiting list for all applicable levels of care including provision of interim services through utilization management strategies. The authorization of services is specified in Section B. 7., Managing Entity Responsibilities. (b) For children and parents who are not Medicaid eligible or who need services that are not covered by Medicaid, and who are in or placed from households that the Department's Child Protective Investigators determined were "unsafe" without additional services, will have priority for substance abuse and mental health services provided by the network provider. Per section 394.674(a)(2), F.S., eligibility for adult mental health services for the parents is based upon the emotional crisis experienced from the potential removal of children. Substance abuse eligibility is based on parents who put children at risk due to a substance abuse disorder, pursuant to section 394.674(c)3, F.S. These individuals may not be placed on a wait list without receiving interim services for longer than seven (7) calendar days. 4. Pre - Authorization Utilization Management Roster for Services Specified in the Utilization Management Manual The network provider shall submit a request for reimbursement on the approved ME invoices found on Exhibit E -1 and /or Exhibit E -2 of this contract, incorporated herein by reference and available at following website: http:// www. sfbhn. org /R5 %20Contractingt %20Page.htm as applicable. 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 Exhibit K, SAMH Pre - Authorization Utilization Management Roster of this contract and attached to the approved ME's invoice, Exhibit E -1 or Exhibit E -2 as a prerequisite for payment. The network provider shall maintain back -up documentation for step -down services for a period of seven (7) years from the expiration date of the contract per Paragraph 7. of the Standard Contract. 5. 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. 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 or documentation. When additional information or documentation is requested, the 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. 6. 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: Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 32 of 39 S€owlt Florida Bclw: iforal health ,4ct�ti rh, Inc. (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. 7. Contracted Mental Health network providers shall participate in the Department's aftercare referral process for formerly incarcerated individuals with severe and persistent mental illness or serious mental illness who are released to the community or who are determined to be in need of long -term hospitalization is required. Participation shall be as specified in Children and Families Operating Procedure 155-47 (CFOP 155 -47), Processing Referrals from the Department Of Corrections which can be obtained at: http: / /www.dcf. state. fl. us /admin /publications /policies.shtm1, and is incorporated herein by reference. 8. Crisis Stabilization Unit Monthly Census The network provider contracted to provide Crisis Stabilization services shall submit a monthly Crisis Stabilization Unit Census report by the date and to the individual(s) identified in Exhibit C, Required Reports. The network provider must utilize the approved ME CSU Monthly Census report format, which is available upon request from the Contract Manager. 9. The network provider shall comply with the provisions of Exhibit I, Family Intervention Services (FIS) and Adult Intervention Services (AIS) Provider Protocols and Exhibit J, Family /Adult Intervention Specialist (FIS /AIS) Treatment Summary Report. 10. Involuntary Outpatient Placements If referred, the Network Provider agrees to provide services to persons who have been court ordered into involuntary outpatient placement in accordance with section 394.4655, F.S. 11. Children's Mental Health Services, including services for Severely Emotionally Disturbed Children, Emotionally Disturbed Children and their Families, if services to such consumers are offered. (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 2014 -2016, or the latest revision thereof, which is incorporated herein by reference, and available at the following website: http: / /www. dcf. state, fl. us/ program s /sa mh /publications /2014- 2016 %20SAMH %20Services %20PIan.pdf 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 family - centered. Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 33 of 39 South Honda Beharional 11calth NetNaork, laic. (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 (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 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 network provider shall 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: (i) 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. 12. Service Provision Requirements for Substance Abuse Prevention and Treatment Block Grants, if applicable. (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.shtmI and which are incorporated herein by reference. (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 10 11 12 Short Description 27CHV- Children IV 27HIV -IV Drug Usage 27WOM- Services to Women (c) The network provider agrees to comply with applicable data submission requirements outlined Guidance /Care Center, Inc. Attachment 1 HCO2 (a) Contract No. ME225 -4 -27 Page 34 of 39 Smith Uloricla Behsa%i €rral Itcalth Netavurk, laic. 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. (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. 13. The network provider agrees to maximize the use of state residents, state products, and other Florida- based businesses in fulfilling their contractual duties under this contract. 14. 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 ME. Additional services can only be increased if the network provider demonstrates competence in the provision of contractual services and meets whatever criteria are established by the ME from time to time. The ME 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. IS. 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 Rule 65E- 14.018(4), F.A.C. shall be furnished to the ME within thirty (30) days of contract execution. 16. 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. 17. Medicaid Enrollment (a) Those network providers with SAMH contracts that meet Medicaid provider criteria and with funding in excess of $500,000 annually 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 and Mental Health Program Office, 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. Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 35 of 39 Bomb Florida Beha%iond I l alth Networtc, Inc. (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: (1) The Florida Medicaid HIPAA located at: http: / /www.fdhc .state.fl.us /hipaa /index.shtmI (2) The National Plan and Provider Enumeration System (NPPES) located at: https://nppes.cms.hhs.gov/NPPESMelcome.do (3) The CMS NPI located at: http:// www. cros. hhs,gov /Nationa]ProvldentStand/ 19. 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 Paragraph 20. of the Standard Contract of this contract. The network provider understands that the ME 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 ME and the network provider are public record and subject to full disclosure. The network provider understands that attempting to exercise undue influence on the ME, 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. 20. Information Technology Resources If applicable, the network providers must receive written approval from the ME prior to purchasing any Information Technology Resource (ITR) with contract funds. The Contract Manager is responsible for serving as the liaison between the network provider and the ME 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 ME's written approval. 21. 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, 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 ME contract manager's file. Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 36 of 39 Somh Ulorida Beha%i €rral Ilealth ,Net%sork. hie. 22. 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 Paragraph 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. 23. 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 departure and return, per diem or meals allowance, map mileage, incidental expenses, signature of payee and payee's supervisor. 24. Property and Title to Vehicles a. Property (1) Nonexpendable property is defined as tangible personal property of a non - consumable 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 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 Network Provider Inventory List, incorporated herein by reference, and available from the designated ME Contract Manager upon request, 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 Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME225 -4 -27 Page 37 of 39 Smith 1°Horicla Been oi«rai Health Network, lite. 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 operations of any motor vehicle purchased by or transferred to the provider pursuant to this contract. 25. Business Associate Agreement The network provider shall adhere to the terms and conditions of the Business Associate Agreement, incorporated herein by reference. E. List of Exhibits The network provider agrees to comply with the exhibits listed below. The following exhibits, or the latest revisions thereof, are incorporated in and made a part of the contract. 1. Exhibit A, Clients /Participants to be Served 2. Exhibit B, Method of Payment Guidance /Care Center, Inc. Attachment I HCO2 (a) Contract No. ME2254-27 Page 38 of 39 South i °lori&i Beh;oior.3( health Ncowork. Tic. 3. Exhibit C, Required Reports 4. Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs 5. Exhibit E, Monthly Payment/Advance Request (Non -TANF and TANF Invoices) 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, Family Intervention Services (FIS) and Adult Intervention Services (AIS) Provider Protocols 10. Exhibit J, Family /Adult Intervention Specialist (FIS /AIS) Treatment Summary Report 11. Exhibit K, SAMH Pre - Authorization Utilization Management Roster 12. Exhibit L, Assisted Living Facilities with Limited Mental Health License 13. Exhibit M, Clinical Supervision for Evidence -Based Practices 14. Exhibit N, Special Provisions for the Indigent Drug Program 15. Exhibit O, Incidental Fund Invoice and Expenditure Log for Adult Mental Health Services 16. Exhibit Q, Missing Children 17. Exhibit R, Our Kids Miami - Dade /Monroe Child Welfare Quarterly Clinical Report 18. Exhibit V, Special Provisions for the Forensic Services Program 19. Exhibit X, Special Provisions for Projects for Assistance in Transition from Homelessness (PATH) Services 20. Exhibit AA, Substance Abuse Family Intervention Specialist Services 21. Exhibit AC, Special Provisions for Substance Abuse Prevention Services Guidance /Care Center, Inc. Attachment [ HCO2 (a) Contract No. ME225 -4 -27 Page 39 of 39 South Ulor €(la Bela<aiioral flealth Neo5 ork. Inc. Exhibit A Clients /Participants to be Served A. General Description The network provider shall furnish services funded by this contract to the target population(s) checked below: I LN Adult Substance Abuse I l Children's Substance Abuse B. Client/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 and as described in the Department of Children and Families Pamphlet 155 -2 (PAM 155 -2), based on the availability of resources. Pamphlet 155 -2 is available on the Department's website (www.dcf. state.fl.us/ programs /samh /pubs_reports.shtmi) and is incorporated herein by reference. (2) This contract precludes the Network Provider from billing the ME for services provided to Medicaid eligible individuals, which are reimbursable by Medicaid. (3) Priority for Behavioral Health Services shall be given to families with children that have been determined to be "unsafe" by child protective investigators. Such priority is limited to individuals that are not Medicaid eligible, or require services that are not included as reimbursable by Medicaid. Eligibility for services is found, pursuant to: (a) section 394.674(a)(2), F.S., for adult mental health services for the parents, based upon the emotional crisis experienced from the potential removal of children. (b) section 394.674(c)3., F.S. Substance abuse eligibility is based on parents who put children at risk due to a substance abuse disorder. (4) Mental health crisis intervention and crisis stabilization facility services, and 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/Participant Determination (1) Determination of client eligibility is the responsibility of the network provider. The network provider shall adhere to the eligibility requirements as specified in Exhibit F, Minimum Services Requirements. The ME reserves the right to review the network Guidance /Care Center, Inc. Exhibit A Contract No. ME225 -4 -27 Page 1 of 2 South Florida Belm %ioral Ilealth Network, In e. provider's determination of client eligibility and override the determination of the network provider. When this occurs the network provider will immediately provide services to the consumer until such time the consumer completes his /her treatment, voluntarily leaves the program, or the ME's decision is overturned as a result of the dispute resolution. (2) In the event of a dispute as to the ME's determination regarding eligibility, dispute resolution, as described in Paragraph 42. of the Standard Contract, shall be entered into. An eligibility dispute shall not preclude the provision of services to Individuals Served, unless the dispute resolution process reverses the ME's determination. The determination made by the ME is final and binding on all parties. (3) The ME may delegate the Individuals Served eligibility determinations to the Network Provider, subject to the determination of the Department. (4) 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 ME 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 specified in Exhibit G, State Funding by Program and Activity, subject to the availability of funds. An exception is granted at the end of the contract term, when the ME at it sole discretion may pay, subject to the availability of funds, the network provider for "Uncompensated Units Reimbursement Funds ", 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. (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) The provision of services required under this contract are limited to eligible residents, children, and adults receiving authorized services within the counties outlined in Attachment I, Section A. 2. c. (2) and limited by the availability of funds. (4) The network provider may not authorize or incur indebtedness on behalf of the ME or the Department. Guidance /Care Center, Inc. Exhibit A Contract No. ME225 -4 -27 Page 2 of 2 South Horida 14dia %ioral I(calth ` t:( v trk. leas. Exhibit B Method of Payment 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. The network provider is granted the flexibility to shift funds between and among cost centers within a program and activity up to thirty percent (30 %) or twenty -five thousand dollars ($25,000.00), whichever is greater, without the need for a contract amendment. Any shift of funds in excess of the aforementioned amount will need a formal contract amendment. c. 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. d. Pursuant to s. 394.76(3), Florida Statutes (F.S.), the provider agrees to provide local matching funds in the amount of $939.008.00 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 L 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 Exhibit B Guidance /Care Center, Inc. Page 1 of 5 Contract No. ME225 -4 -27 South Horida t dwh ioral I #ca#th Network, Inc. operated by a public receiving facility) FACT Teams ii. CMH Programs (100435 Category & 102780 (PRTS) Category) that are not grant funded. e. 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, to include contract termination in whole or in part, for failures to implement or to make acceptable progress on such corrective action plans. f. The ME 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. g. The ME's decision to reduce or withhold funds will be submitted to the network 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 network provider. h. If the Provider closes or suspends the provision of services funded by this contract, the provider agrees to notify the ME in writing thirty (30) calendar days prior to their intent to close, suspend or end service(s). If the provider fails to notify the ME, 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. L The ME 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. 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. 3. Medicaid Billing a. The Department is always the payer 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: L Any liable first, second, and /or third party payers, 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). iv. The network provider shall identify and report Medicaid earnings separate Guidance /Care Center, Inc. Exhibit B Contract No. ME225 -4 -27 Page 2 of 5 Smith Ulorida tichmioral l"IcAO Ncovork. Inc. 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. 4. 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 sub - capitated contracts and provided to persons covered by these contracts must not be billed to the department. 5. Temporary Assistance to Needy Families (TANF) Billing a. The provider's attention is directed to its obligations under applicable parts of Part A or Title IV of the Social Security Act and the provider agrees that TANF funds shall be expended for TANF participants as outlined in the Temporary Assistance to Needy Families (TANF) Guidelines. TANF Guidelines can be obtained from the contract manager, or can be found at the following web site: http: / /www.dcf. state. fl. us / programs /samh /contractitanf.pdf b. The contract shall specify the unit cost rate for each cost center contracted for TANF funding, which shall be the same rate as for non -TANF funding, but the contract shall not specify the number of TANF units or the amount of TANF funding for individual cost centers. 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. An exception is granted to the network provider whose rates were grandfathered in upon the transition from contracting directly with Department of Children and Families to the ME, providing that the network provider continue to meet criteria. Guidance /Care Center, Inc. Exhibit B Contract No. ME225 -4 -27 Page 3 of 5 South Hori€ a Beh.iN fond I lealth Nets +o °k, Inc. 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/Advance and /or Exhibit E -2, Substance Abuse and Mental Health Monthly Request for TANF Payment/Advance, within ten (10) days following the end of the month for which payment is being requested for the delivery of service. Payment to the network provider by the ME is subject to the availability of funds and payments received from the Department. Exhibits E -1 and E -2 are incorporated herein by reference and available at the following website: http://Www.sfbhn.org/R5`/`2OContractin_q%2OPa_qe.htm d. 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 ten (10) days following the end of the month. The network provider shall request payment monthly through submission of a properly completed invoice, per the requirements of this contract, within ten (10) calendar days following the end of the month for which payment is being requested. 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 ten (10) calendar days following the end of the month. Should the network provider fail to submit an invoice or written documentation if no services are due to be invoiced from the preceding month, within thirty (30) calendar days following the end of the month, then the ME at sole discretion can reallocate funds. If the Network Provider fails to submit an invoice or written documentation for two (2) consecutive months within a twelve (12) month period, the ME at sole discretion can terminate the contract. 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. L Invoices shall be submitted in detail sufficient for a proper pre -audit and post- audit. Guidance /Care Center, Inc. Exhibit B Contract No. ME225 -4 -27 Page 4 of 5 South Vlorida t ehw ioral health \coiork. late. 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. The network provider shall track all units billed to the ME by program and by Other Cost Accumulator (OCA). Proper service documentation for each SAMH cost center is outlined in Rule 65E- 14.021, F.A.C., and Exhibit AB, Cost Center Description- Substance Abuse Recovery Support Services (Individual and Group), Exhibit M, Cost Center Description - Clinical Supervision Cost Center, Exhibit Y, TANF SAMH Guidelines and TANF SAMH Incidental Expenditures for Housing Assistance, if applicable. 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, PBPS, or other data system designated by the ME. 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 ME, 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 provider's total amount of funding by reducing same in order to prevent the potential lapse. Additionally, the network provider's funding may be reduced and reallocated within the system of care, as determined by the ME and its sole discretion, in order to meet the changing needs of the system of care. 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. Exhibit B Contract No. ME225 -4 -27 Page 5 of 5 South I-lorida Beh;oi €,rat I lealth 4itiiork, Inc. Exhibit C Required Reports Guidance /Care Center, Inc. Exhibit C Contract No. ME225 -4 -27 Page 1 of 6 # of Required Reports Due Date Copies Send to: Response to Monitoring Reports and Corrective Action Within 10 calendar days from the day the report 1 ME Contract Plans is received. Manager Sliding Fee Scale [reflecting the uniform schedule of Within 30 calendar days after the execution 1 ME Contract discounts referenced in 65E- 14.018(4)] of the contract or by August 1 of each fiscal year. Manager final FY 2013 -2014 1) Network Providers Agency Service Capacity Report, 2) Projected Cost Center Operating and Capital Within 30 calendar days after Contract execution ME Contract Budget (If applicable), or by August 1 of each fiscal year or upon request 1 Manager 9 3) Cost Center Personnel Detail of the Contract Manager eport (If applicable), & 4) Program Description. Monthly Data Required by DCF PAM 155-2 Within 4 calendar days after end of month Electronic Submission ME IT Office Incident Report Within 24 hours of occurrence, in IRAS accordance 1 with CFOP 215 -6. ME VP of Quarterly Financial Statements (Balance Sheet and October 31, 2013 (Period: 07101/13 — 09/30/13) 1 Finance Statement of Activity) January 31, 2014 (Period: 10/01/13- 12/31/13) E Contract April 30, 2014 (Period: 01/01/14- 03/31/14) Manager July 31, 2014 (Period: 04/01/14- 06/30/14) October 31, 2013 (Period: 07/01/13 — 09130/13) ME VP of Form 941 and Bank Statement January 31, 2014 (Period: 10/01/13- 12/31/13) 1 inance April 30, 2014 (Period: 01/01/14- 03/31/14) ME Contract July 31, 2014 (Period: 04 /01/14- 06/30/14) Manager Year -End Financial Reports for Network Providers Not Requiring Audits Per Attachment 11 ME Schedule of State Earnings Due 45 calendar days after the end of the fiscal 1 Contract year. Manager ME Schedule of Related Party Transaction Adjustments Due 45 calendar days after the end of the fiscal 1 Contract year. Manager Projected Cost Center Operating and Capital Budget Due 45 calendar days after the end of the fiscal 1 ME ontract ctual Expenses &Revenues Schedule year. Manager Guidance /Care Center, Inc. Exhibit C Contract No. ME225 -4 -27 Page 1 of 6 South Horida BehaAi €rrM Itealth Net%tiork, tne. Guidance /Care Center, Inc. Exhibit C Contract No. ME225 -4 -27 Page 2 of 6 Due 45 calendar days after the end of the fiscal ME Schedule of Bed -Day Availability Payments year. 1 Contract Manager ME Agency Prepared Financial Statements (Balance Sheet Due 45 calendar days after the end of the 1 ontract and Statement of Activity) fiscal year. Manager Year -End Financial Reports for Network Providers Requiring Audits Per Attachment II 180 calendar days after the end of the network Financial & Compliance Audit to include the necessary provider's fiscal year or 30 calendar days after its 1 ME ontract schedules per Attachment II completion, whichever comes first. Manager (See Attachment 11) Other Reports, as applicable ME Contract Monthly, by the 10 calendar day 1 Manager Monthly Service Invoice after the month of service ME Sr. Accountant ME Contract Manager Invoice Review Supporting Documentation As requested by the contract manager 1 ME Sr. Accountant DA Client Communication Assessment Auxiliary Aid By the 4"' business day following the 1 ME Contract Manager Service Record Monthly Summary Report, if applicable reporting month ME Contract By July 15 of each fiscal year and /or 15 days 1 Manager & Final Invoice after contract end date ME Sr. Accountant Within 30 days of contract execution. Submit Provider's Grievance Procedures updates as amended within 30 days of 1 ME Contract Manager execution of the amendment Provider Informed Consent Forms Within 30 days of contract execution 1 ME Contract Manager Provider's Emergency Preparedness Plan Within 30 days of contract execution 1 ME Contract Manager Provider's Civil Rights Compliance Questionnaire Wthin 30 days of contract execution 1 ME Contract Manager rovider's Security Agreements, per Standard Contract Within 30 days of contract execution 1 ME Contract Manager Guidance /Care Center, Inc. Exhibit C Contract No. ME225 -4 -27 Page 2 of 6 Stmth I €da fkhaNioral Health Network, Inc. Affidavit Regarding Debarment Annually, prior to contract execution, or as 1 ME Contract requested by the contract manager. Manager Inventory Report, if applicable Within 30 days of contract execution 1 ME Contract Manager 'No Wrong Door" Policy and Procedure August 1, 2013 1 ME Contract Manager Quality Assurance /Quality Improvement Plan August 1, 2013 1 ME Contract Manager 1 October 31, 2013 Quarterly Report on Implementation of Quality January 31, 2014 ME Contract Improvement Report April 30, 2014 Manager July 31, 2014 1 ME Contract Co-occurring Summary Report and Action Plan 06130/2014 Manager 1 ME Contract Cultural and Linguistic Competence Action Plan October 31, 2013 Manager Report on Implementation of Cultural and Linguistic January 31, 2014 April 30, 2014 1 ME Contract Manager Competence Initiative (included in the Quarterly QI Plan) July 31, 2014 ME Contract Trauma Informed Care (TIC)- Agency Self- Assessment December 30th of each fiscal year of the 1 Manager contract 1 ME Contract Trauma Informed Care (TIC)- Commitment Plan January 15"' of each fiscal year of the Manager contract Within 30 days of execution of the 1 ME Contract Cooperative Agreements agreements Manager 1 ME Contract (thin 90 calendar days of the effective date of Manager Memorandum of Understanding (MOU) with a Federally the contract (for newly executed MOU's) Qualified Health Center (FQHC) OR within 30 days for renewed MOU's As per the contract and/or as requested by 1 ME TANF ANF SAMH Program Logs and Service Data, if applicable the contract manager Supervisor 1 ME Contract Client Trust Fund Letter, if applicable August 1, 2013 Manager 1 Quality Electronic Assurance/ Submission Quality Improvement risis Stabilization Unit Census, if applicable Monthly by the 10"' for the preceding month's Specialist census ME Contract Manager Guidance/Care Center, Inc. Exhibit C Contract No. ME225 -4 -27 Page 3 of 6 South t lorida helm -6orat health Network. Inn. amily /Adult Intervention Specialist Treatment Summary Per Exhibit J, FIS /AIS Intervention Services 1 Per Exhibit J, Report, if applicable Provider Protocols FIS /AIS Intervention 1 ME Payer Class Data, if applicable October 1, 2013 Contract Manager 1 External Quality Assurance Reviews, Monitoring As per the contract and/or as requested by ME Reports, Surveys & Corrective Action Plans, if applicable the contract manager Contract Manager Reports Required for Children's Mental Health Providers, if applicable hildren's Mental Health Quarterly clinical reports on all Per the contract and Exhibit R. 1 Copy in chart ependent children, if applicable hildren's Mental Health Quarterly clinical reports on all As per the contract and/or as requested by 1 Copy in chart ommunity children, if applicable the contract manager ME Contract Manager By the 15` of every month following the month 1 Infant Mental Health — Demographic Report, if applicable of service ME VP of Behavioral Health Services ME on rac Manager October 15, 2013 Infant Mental Health- Narrative Milestones Report On January 15, 2014 1 Client Outcomes, if applicable April 15, 2014 ME VP of July 15, 2014 Behavioral Health Services ME Contract Manager Infant Mental Health- Narrative Summary Report On July 15, 2014 1 Client Outcomes & Effectiveness of Treatment, if applicable ME VP of Behavioral ealth Services Reports Required for Adult Mental Health Providers, if applicable ME Contract Incidental Fund Invoice and Expenditure Log for Adult Mental Manager Health Services (Exhibit O), if applicable Monthly by the 10"' of each month following 1 the month of service ME System of Care Staff PATH Annual Data Report to SAMHSA, if applicable Per PATH Per PATH Grant Application Instructions Grant Application Instructions ME Contract PATH Annual Reports, if applicable Drafts to be submitted to ME for Southern Manager Region SAMH Program Office, DCF Central 1 Office in Tallahassee in April or May of each ME System of fiscal year as requested l Care Staff Guidance /Care Center, Inc. Exhibit C Contract No. ME225 -4 -27 Page 4 of 6 Smith [lorida Bcluni €rrai Ilealth Ncoiork, lite. Reports Required for Forensic Services Providers, if applicable ME Forensic 1 Coordinator/ Report for Individuals on Conditional Release, if Monthly p By 15 of each month Mental Health applicable Administrator Office 1 ME SAMH Statewide Forensic Bed Census Report, if Weekly (Every Thursday by 5:00 pm) Forensic applicable Coordinator Reports Required for Consumer - Driven Agencies October 31, 2013 Membership Report January 31, 2014 1 ME Contract April 30, 2014 Manager July 31, 2014 Reports Required for Substance Abuse Services Providers, as applicable ME Contract Manager & Annual Report for HIV Early Intervention Services, SAPT Substance Block Grant Set Aside Funded Services Only Upon Request 1 Abuse Program Office ME Contract Annual Report for Evidenced -based Injection Drug User Manager & Outreach Services, SAPT Block Grant Mandate, Designated 1 Substance Providers Only Upon Request Abuse Program Office ME Contract Annual Report for Pregnant Women and Women With Manager & Dependent Children SAPT Block Grant Set Aside Funded Upon Request 1 Substance Services Only Abuse Reports Required for Substance Abuse Prevention Services Providers E Contract Performance Based Prevention System (PBPS) Data Manager Entry Training for Prevention Program Coordinator and Within 30 calendars days of hire and annually 1 any data entry staff , if applicable thereafter ME Director f Prevention ervices Guidance /Care Center, Inc. Exhibit C Contract No. ME225 -4 -27 Page 5 of 6 South Florida Heha-ioral Ile: lth Network.lnc. Guidance /Care Center, Inc. Exhibit C Contract No. ME2254-27 Page 6 of 6 E Contract anager Prevention Planning Tool (PPT), if applicable Within 30 calendars days of contract execution and 1 annually thereafter E Director I Prevention Services E Contract Prevention Services Invoices Back -Up Report printed from Submitted with the monthly invoice 1 anager BPS, if applicable E Sr. ccountant ME Contract October 31, 2013 Manager January 31, 2014 1 Coalition Activities Report, if applicable April 30, 2014 ME Director July 31, 2014 of Prevention ervices ME Contract Within 90 calendar days of the effective date of anager Memorandum of Understanding the contract (for newly executed MOU's) OR within 30 days for renewed MOU's E Director f Prevention Waitlist Wait List until automated system is operational) As detailed in the Utilization Management 1 ME Contract Manual Manager Guidance /Care Center, Inc. Exhibit C Contract No. ME2254-27 Page 6 of 6 vp South Florida � Behavioral Health Network, Inc. Exhibit D Substance Abuse & Mental Health Reguired Performance Outcomes & Outputs (Part 1) Provider Name: Guidance /Care Center, Inc. Contract #: ME225 -4 -27 Date: 07/01/2013 Revision #: 1. .Mental health Contracted Services A. Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH, and Local Match) Numbers to Be Served 1. Adult Mental Health a. Adults with Severe and Persistent Mental Illness (SPMI) (M0016) /(MH016) 2021 b. Adults with Serious and Acute Episodes of Mental Illness (M05301)/(MH5301) 75 c. Adults with Mental Health Problems (M05302)/(MH5302) 333 d. Adults with Forensic Involvement (MOO 18) /(MH018) 17 2. Children's Mental Health a. Children with Serious Emotional Disturbances (SED) (M003 1)/(MH03 1) 204 b. Children with Emotional Disturbances (ED) (M0032)/(MH032) 406 c. Children at -risk of Emotional Disturbances (M0033)/(MH033) N/A B. Required Performance Outcome Standards for Each Target Population Minimum Contract (GAA/NOMS) 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 o 90 /o housing environment will be at least (M0742)/MH742) b. Average annual number of days (post admission assessments) worked for pay for 40 adults with severe and persistent mental illness will be at least (M0003) /(MH003) 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) 86% 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 o 24/0 be at least (M0703)/MH703) 4. Adult Mental Health - Forensic Involvement a. Percent of adults in forensic involvement who live in stable housing environment o 67/0 will be at least (M0743)/MH743) 5. Adult Mental Health -(All Target Populations identified in Section I. A. 1. A. -d. above) Percent of persons served by the Department of Children and Families' funds that TBD show a reduction in clinical and co- occurring symptoms from admission to discharge. (GAA 1) 6. Adult Mental Health -(All Target Populations identified in Section I. A. 1. A. -d. above) Percent of persons served by the Department of Children and Families' funds that TBD improve their ability to care for themselves and manage their activities of daily living from admission to discharge (GAA 2) 7. Adult Mental Health -(All Target Populations identified in Section I. A. 1. A. -d. TBD above) Percent of persons served by the Department of Children and Families' funds that show improvement in their interpersonal and family relationships, family environment or Guidance /Care Center, Inc. Exhibit D Contract No. ME225 -4 -27 Page 1 of 4 � South Florida Behavioral Health Network, Inc. behavior in their home setting, and their work or school environments from admission to discharge. (GAA 3) 8. Adult Mental Health -(All Target Populations identified in Section 1. A. 1. A. -d. above) Percent of Persons served by Department of Children and Families' funds that are satisfied with the services they receive (GAA 6) 9. Adult Mental Health -(All Target Populations identified in Section I. A. 1. A. -d. above) Percent of Persons served by Department of Children and Families' funds will show a reduction in criminal /juvenile justice involvement, harmful behavior to self or others, and security management needs. (GAA 7) 6. Children Mental Health - Seriously Emotionally Disturbed a. Percent of children who live in stable housing environment will be at least (M0779)/(MH779) b. Percent of children who improve their level of functioning will be at least (M0378)/MH378) c. Percent of school days seriously emotionally disturbed children attended will be at least (MOO 12) /(MH404) 7. Children Mental Health - Emotionally Disturbed a. Percent of children who live in stable housing environment will be at least (M0778)/(MH778) b. Percent of children who improve their level of functioning will be at least (M0377)/(MH377) 8. Children Mental Health - At -Risk of Emotional Disturbance a. Percent of children who live in stable housing environment will be at least (M0780)/(MH780) 9. Children's Mental Health -(All Target Populations identified in Section I. A. 2. a. — c. above) Percent of persons served by the Department of Children and Families' funds that show a reduction in clinical and co- occurring symptoms from admission to discharge. (GAA 1) 10. Children's Mental Health -(All Target Populations identified in Section I. A. 2. a. — c. above) Percent of persons served by the Department of Children and Families' funds that improve their ability to care for themselves and manage their activities of daily living from admission to discharge (GAA 2) 11. Children's Mental Health -(All Target Populations identified in Section I. A. 2. a. — c. above) Percent of persons served by the Department of Children and Families' funds that show improvement in their interpersonal and family relationships, family environment or behavior in their home setting, and their work or school environments from admission to discharge. (GAA 3) 12. Children's Mental Health -(All Target Populations identified in Section I. A. 2. a. — c. above) Percent of Persons served by Department of Children and Families' funds that are satisfied with the services they receive (GAA 6) 13. Children's Mental Health -(All Target Populations identified in Section I. A. 2. a. — c. above) Percent of Persons served by Department of Children and Families' funds will show a reduction in criminal /juvenile justice involvement, harmful behavior to self or others, and security management needs. (GAA 7) 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) TBD N1 93% 65% 86% 95% 64% 96% TBD TBD TBD TBD 1:0 95% Guidance /Care Center, Inc. Exhibit D Contract No. ME225 -4 -27 Page 2 of 4 ; South Florida //,/� Behavioral /., Health Network, Inc. Exhibit D Substance Abuse & Mental Health Required Performance Outcomes & Outputs (Part II) 11. Substance Abuse Contracted Services A. Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH, and Local Match) Numbers to Be Served 1. Adults with Substance Abuse Problems a. Number of Adults Served (M0063)/(SA063) 592 2. Children with Substance Abuse Problems Minimum Contract a. Number of Children Served (M0052)/(SA052) 205 3. Adult At -Risk of Substance Abuse Problems - (NonGAA) a. Number of adults participating in Prevention Services (M0785)/(SA785) 25309 b. Number of adults participating in Level 1 Prevention Programs N/A (M0767)/(SA767) 10% c. Number of adults participating in Level 2 Prevention Programs N/A (M0768)/(SA768) 94% d. Number of adults participating in Level 1 Prevention Programs who complete N/A 85 percent of the program's schedule of activities (M0769)/(SA769) 14.60% e. Number of adults participating in Level 2 Prevention Programs who complete 85 N/A percent of the program's schedule of activities (M0770)/(SA770) 4. Children At -Risk of Substance Abuse Problems - (Baseline - NonGAA) TBD a. Number of children participating in Prevention Services (M0762)/(SA762) 5000 b. Number of children participating in Level 1 Prevention Programs 1123 (M076 1)/(SA76 1) TBD c. Number of children participating in Level 2 Prevention 50 Programs(M0695) /(SA695 ) TBD d. Number of children participating in Level 1 Prevention Programs who complete 955 85 percent of the program's schedule of activities (M0763)/(SA763) e. Number of children participating in Level 2 Prevention Programs who complete 43 85 percent of the program's schedule of activities (M0764)(SA764) TBD 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 services 51% will be at least (M0755)/SA755) b. Percent change in clients who are employed from admission to discharge will be 10% at least (M0753)/SA405) c. Percent of adults who live in a stable housing environment at the time of 94% discharge will be at least (M0756)/SA756) d. Percent change in the number of adults arrested 30 days prior to admission 14.60% versus 30 days prior to discharge (M0754/SA754) e. Percent of persons served by the Department of Children and Families' funds that show a reduction in clinical and co- occurring symptoms from admission to discharge. TBD (GAA 1) f. Percent of persons served by the Department of Children and Families' funds that improve their ability to care for themselves and manage their activities of daily living TBD from admission to discharge (GAA 2) g. Percent of persons served by the Department of Children and Families' funds that TBD show improvement in their interpersonal and family relationships, family environment or behavior in their home setting, and their work or school environments from admission to discharge. (GAA 3) h. Percent of Persons served by Department of Children and Families' funds that are TBD Guidance /Care Center, Inc. Exhibit D Page 3 of 4 Contract No. ME225 -4 -27 �/ � South Florida /A Behavioral .' Health Network, Inc. satisfied with the services they receive (GAA 6) i. Percent of Persons served by Department of Children and Families' funds will TBD show a reduction in criminal /juvenile justice involvement, harmful behavior to self or others, and security management needs. (GAA 7) 2. Adult At -Risk of Substance Abuse Problems - (Baseline -Non GAA) a. Percent of adults participating in Level 1 Prevention Programs who complete 85 85% percent of the program's schedule of activities will be at least (M0771)/(SA771) b. Percent of adults participating in Level 2 Prevention Programs who complete 85 85 %u percent of the program's schedule of activities will be at least (M0772)/(SA772) 3. Children with Substance Abuse Problems a. Percent of children who successfully complete substance abuse treatment 48% services will be at least (M0725)/(SA725) b. Percent of children who live in a stable housing environment will be at least 93% (M0752)/SA752) c. Percent change in the number of children arrested 30 days prior to admission 19.60% versus 30 days prior to discharge will be at least (M075 l/SA75 1) d. Percent of persons served by the Department of Children and Families' funds that show a reduction in clinical and co- occurring symptoms from admission to discharge. TBD (GAA 1) e. Percent of persons served by the Department of Children and Families' funds that improve their ability to care for themselves and manage their activities of daily living TBD from admission to discharge (GAA 2) f. Percent of persons served by the Department of Children and Families' funds that TBD show improvement in their interpersonal and family relationships, family environment or behavior in their home setting, and their work or school environments from admission to discharge. (GAA 3) g. Percent of Persons served by Department of Children and Families' funds that are TBD satisfied with the services they receive (GAA 6) h. Percent of persons served by Department of Children and Families' funds will TBD show a reduction in criminal /juvenile justice involvement, harmful behavior to self or others, and security management needs. (GAA 7) 4. Children At -Risk of Substance Abuse Problems - (Baseline -Non GAA) a. Percent of children participating in Level 1 Prevention Programs who complete 85 % 85 percent of the program's schedule of activities will be at least (M0765)/(SA765) b. Percent of children participating in Level 2 Prevention Programs who complete 85% 85 percent of the program's schedule of activities will be at least (M0766)/(SA766) 5. Data Submission for Prevention Program Tool (baseline - Non GAA) a. Percent of approved Prevention Descriptions completed within 30 days of 50% 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) admission records in 95% the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0758) Guidance /Care Center, Inc. Exhibit D Contract No. ME225 -4 -27 Page 4 of 4 South I Behmiora3 IIeAth .Ncovork, lnc. Exhibit E Monthly Payment/Advance Request (Non -TANF and TANF Invoices) 1. Exhibit E -1, Monthly Payment/Advance Request (Non -TANF Invoice) 2. Exhibit E -2, Monthly Payment/Advance Request (TANF Invoice) These exhibits are incorporated by reference and available at following website: htta:// www. sfbhn. orq /R5 %2OContractina %2OPage.htm Guidance /Care Center, Inc. Exhibit E Contract No. ME225 -4 -27 1 of 1 Simth Horida Bcluo ioral I lealth Neo, irk. Ine. Exhibit F Minimum Reauirements The network 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.law.cornell.edu/uscode/42/ch6AschXVIIPB.htmI 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.cornel1 .edu /uscode /htm1/uscode42 /usc sec 42 00000290- -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 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 03131cfr240 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. Exhibit F Guidance /Care Center, Inc. Page 1 of 5 Contract No. ME225 -4 -27 South Florida Behavioral Ilealth Network. Inc. hftp://www.leg,state.fl.us/statutes/index.cfm?App mode = Display Statute &Search String = &URL= 0400 - 0499 /0414 /Section s/0414.1585. htm I 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/htm1/uscode42/usc sup 01 42 10 6A 20 III -A 30 C.html Stewart B. McKinney Homeless Assistance Amendments Act of 1990, Public Law 101 -645 http: / /www4,law.cornell.edu /usc -cqi /get external. cgi ?type =pubL &target= 101 -645 42 CFR, Part 54 http:// www. access.gpo.gov /nara /cfr /waisidx 03/42cfr54 03.html 1. Americans with Disabilities Act of 1990 42 U.S.C. 12101 et seq. http://www.law.cornel1.edu/uscode/htm1/uscode42/usc sec 42 00012101 ---- 000 -.html II. FLORIDA STATUTES All State of Florida Statutes can be found at the following website: httr): / /www. lea, state.fl. us /statutes/ index. cfm ?Mode= View Statutes &Submenu =1 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 Exhibit F Guidance /Care Center, Inc. Page 2 of 5 Contract No. ME2254-27 South Florida Behavioral llealth Net%rurk, lane. 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 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 .govANelcome /index.cfm?CFID= 105701865 &CFTOKEN = 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 quide.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.firules.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. Rule 65D -30, F.A.C. Rule 65E-4, F.A.C. Rule 65E -5, F.A.C. Rule 65E -10, F.A.C. Rule 65E -12, F.A.C. Rule 65E -14, F.A.C. Rule 65E -15, F.A.C. Rule 65E -20, F.A.C. C. Financial Penalties Rule 65 -29, F.A.C. Reduction /withholding of funds Rule 65- 29.001, F.A.C. Emergency Shelter Care Substance Abuse Services Office Community Mental Health Regulation Mental Health Act Regulation Psychotic and Emotionally Disturbed Children Purchase of Residential Services Rules Public Mental Health, Crisis Stabilization Units, Short Term Residential Treatment Programs Community Substance Abuse and Mental Health Services - Financial Rules Continuity of Care Case Management Forensic Client Services Act Regulation Penalties on Service Providers Financial Penalties for a Provider's Failure to Comply With a Requirement for Corrective Action Exhibit F Guidance /Care Center, Inc. Page 3 of 5 Contract No. ME225 -4 -27 South {° oritla BehaNi €oral Health :L'vo*ork.Inc. 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/1 55-10. 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.gov /omb /circulars a087 2004 OMB Circular Al 02, 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 /al33/al33 revised 2007.pdf Section 215.97, F.S., Florida Single Audit Act http: / /www.leg.state,fl.us /statutes /index.cfm ?App mode = Display Statute &Search Strinq = &URL= 0200 - 0299 /0215 /Sections /0215.97. htm I Comptrollers Memorandum #03 (1999- 2000): Florida Single Audit Act Implementation http://www.mvfloridacfo.com/aadir/cmO/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.htmi 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 Al 10, Uniform Administrative Requirements for Grants and Other Agreements http://www.wh itehouse.gov /omb /circulars /al 1 01a 10. 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 &Search Strinq= &URL= 0300 - 0399 /0397 /Sections /0397.321. html Exhibit F Guidance /Care Center, Inc. Page 4 of 5 Contract No. ME225 -4 -27 Swath Horida t dwl ioral Health Network, ire. Section 394.74(3)(e), F.S., Data Submission http: / /www.leg,state.fl. us /Statutes /index.cfm ?App mode = Display Statute &Search String = &URL= 0300 - 0399/0394 /Sections /0394.74. htm I 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 &Search String= &URL= 0300 - 0399 /0394 /Sections /0394.77. htm I CFP 155 -2, Mental Health and Substance Abuse Data Measurement Handbook http: / /www.dcf.state.fl.us /programs /samh /pubs reports.shtml Exhibit F Guidance /Care Center, Inc. Page 5 of 5 Contract No. ME225 -4 -27 07/01/2013 Exhibit G: STATE FUNDING BY PROGRAM & ACTIVITY Fiscal Year 2013 -2014 -F' ` Provider Name: I Guidance /Care Center, Inc. I Contract #: ME2254-27 Revision 4: Adult Mental Health Children Mental Health Activity / Cost Center TANF $ Unit TANF S Unit X = Yes Rate X = Yes Rate 1 2 3 4 5 6 7 $ 63.21 $ 68,140 $ 63.21 Emergency Stabilization 41,930.00 r�. x 03. Crisis Stabilization (No TANF) Unit: bed -day Unit: 4-hr day $ 323.77 $ 1,026,903 04. Crisis Support/Emergency Unit: staffhour S 40.44 $ 86,000 $ 40.44 $ 15,677 09. Inpatient (No TANF) -- - -� Unit: 4 -hr day Unit: 24 -hr day �� Non -TANF= $ 1,112,903 Total Emergency Stabilization= $ 1,112,903 Uncompensated Units= $ 222,581 Non -TANF = $ 15,677 Total Emergency Stabilization = $ 15,677 Uncompensated Units= $ 3,135 Recovery & Resiliency -F' ` 01. Assessment Unit: contact hour $ 80.76 $ 170,166 $ 80.76 $ 36,922.00 02. Case Management Unit: direct staff hour $ 63.21 $ 68,140 $ 63.21 $ 41,930.00 05. Day Care Unit: 4-hr day 06. Day /Night - -- -- - -� Unit: 4 -hr day ��------•-••� �� 07. Drop- In/Self Help Centers (No-TANF) Unit: facility day $ 2 % $ 65,000 O& In -Home and On Site Unit: direct staffhour 0 $ 70.20 $ 280 $ 70.20 $ 325,445.00 10. Intensive Case Management Unit: direct staffhour 11. Intervention - Individual Unit: direct staffhour $ 62.98 $ 60,641 12. Medical Services (No TANF) Unit: contact hour S 390.47 $'' 505,826 $ 390.47' $ 63,974.00 14. Outpatient - Individual Unit: contact hour $ 91.09 $ 124,524 $ 91.09 $ 1,606.00 15. Outreach Unit: non - direct staffhour $ 43.04 $ 20,500 16. Prevention Unit: non - direct staff hour 17. Prevention/Intervention - Day Unit: 4 -hr day 1& Residential Level I Unit: 24 -hr day _ $ 265.11 $ 71,266 19. Residential Level TI Unit: 24 -hr day C== 20. Residential Level III Unit: 24 -hr day 21. Residential Level IV _ Unit 24-hr day 22. Respite Services �-----•••••--� Unit: contact hour t, _ _ �3 �� t� L 23. Sheltered Employment (No TANF) Unit: 4 -hr day, 25. Supported Employment Unit: direct staffhour 26. Supportive Housing/Living Unit: direct staffhour S 51.94 $ 90,827 #�-- €- 29. Aftercare - Individual Unit: direct staff hour $ 63.21 $ 7,000 $ 63.21 $ 84.00 30. Information and Referral (No TANF) Unit: staffhour S 27.08 $ 6,050 35. Outpatient - Group Unit: contact hour $ 22.77 $ 10,000 $ 22.77 $ 23.00 36. Room and Board w /Supervision Level 1 Unit: 24 -hr day 37. Room and Board w /Supervision Level II Unit: 24 -hr day� F 3& Room and Board w/Supervision Level HI' Unit: 24 -hr day _$ 71.37 $' 52,000 39. Short-term Residential Treatment _ Unit: Bed -Day Exhibit G Guidance /Care Center, Inc. Page 1 of 4 Contract No. ME225 -4 -27 07/01/2013 Exhibit G: STATE FUNDING BY PROGRAM & ACTIVITY Fiscal Year 2013 -2014 Provider Name: I Guidance/Care Center, Inc. I Contract #: ME225 -4 -27 Revision #: 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 r- Unit: Clubhouse staffhour —{ f $ 37.71 $ 3,000 42. Intervention - Group Unit: contact hour [ $ 15.75 $ 15,000 43. Aftercare - Group Unit: contact hour $ 15.80 $ 1,000 S 15.80 $ 16 48. Clinical Supervision for Evidence -Based Practices �--------°°-� Unit: contact hour C == Non -TANF = $ 1,27 Non -TANF = $ 470,000 TANF= ._$_.._.___._......._.._._� TANF= 4 Total Recovery & Resiliency = $ Total Recovery & Resiliency = Uncom pensated Units= Uncompensated Units= $ 94,000 Recovery & Resiliency - FACT Team >: 34. FACT Teams (No TANF) Unit: staffhour E== FACT = $ Total FACT = $ Uncompensated Units = Recovery & Resiliency - Community Forensic 19. Residential Level H Unit: 24 -hr day E::=� 39. Short -term Residential Treatment T Unit: Bed-Day r! Non -TANF = $' Non- TANF = $ TANF - $ TANF = Total Forensic Services = Total Forensic Services = $ Uncompensated Units = Uncompensated Units= Recovery & Resiliency - Incidental Expenses 28. Incidental Expenses: General — —} Unit: each $50 spent r----- 28. Incidental Expenses: - F.A.C.E.S. Unit: each $50 spent 0 28. Incidental Expenses: Forensic Unit: each $50 spent Non -TANF = $ 23,900 Non -TANF = $ TANF = F $ -- TANF = Total Incidental Expenses = $ 23 Total Incidental Expenses = $ Uncompensated Units= $ 4,780 Uncompensated Units= Total Non -TANF = $ 2 Total Non -TANF = $ 485,677.00 Total TANF = �....,, - Total TANF = Total Mental Health Funds = $ 2,408,023 Total Mental Health Funds = $ 485,677.00 Exhibit G Guidance /Care Center, Inc. Page 2 of 4 Contract No. ME225 -4 -27 07/01/2013 Exhibit G: STATE FUNDING BY PROGRAM & ACTIVITY Fiscal Year 2013 -2014 Provider Name: I Guidance/Care Center, Inc. Contract #: I ME225 -4 -27 Revision #:0 Adult Substance Abuse Children's Substance Abuse Activity / Cost Center TANF $ Unit X = Yes Rate TANF $ Unit X = Yes Rate 0 1 Detoxification 24. Substance Abuse Detoxification (No TANF) Unit bed -day 32. Outpatient Detoxification (No TANF) Unit: 4 -hr day 2 3 4 5 6 RM $ 204.94 $ 186,643.00,' r Total Non -TANF = $ Total Detoxification = $ Uncompensated Units = 16. Prevention Unit non - direct staff hour 17. Prevention/Intervention -Day Unit: 4 -hr day 30. Information and Referral (No TANF) Unit: staffhour Treatment and Aftercare 01. Assessment Unit: contact hour 02. Case Management' Unit: direct staffhour 04. Crisis Support/Emergency Unit: staff hour 05. Day Care Unit 4 -hr day 06. Day/Night Unit: 4 -hr day 08. In -Home & On Site Unit: direct staff hour 10. Intensive Case Management Unit: direct staff hour 11. Intervention - Individual Unit direct staffhour 12. Medical Services (No TANF) Unit: contact hour 13. Methadone Maintenance (No TANF) Unit: dosage 14. Outpatient - Individual Unit: contact hour 15. Outreach Unit non - direct staffhour 18. Residential Level I Unit: 24 -hr day 19. Residential Level 11 Unit: 24-hr day 20. Residential Level III Unit: 24 -hr day 21. Residential Level IV Unit: 24 -hr day 22. Respite Services Unit: contact hour 25. Supported Employment Unit: direct staff hour 26. Supportive Housing/Living Unit: direct staffhour 27. TASC Unit: direct staffhour 29. Aftercare Unit: direct staffhour Total Non -TANF = $ Total Prevention = $ Uncompensated Units = REI $ 80.76 1 $ 42,665 $ 63.21 $ , 46,585 $ 40.44 $ 6,000 0 755 $ '' 79,585 172,262 100 $ 86,270 L_= 17,299 r = E== [S:= 62.05 $ 30,879 5= $ 14,223 172,262 Total Non -TANF = $ 172,262 Total Prevention = $ 172,262 Uncompensated Units = $ 34,452 $ 80.76 $ 24,725 $ 63.21 $ 5,000 $ 40.36 E== $ 30,000 1,400 $ 153,725 $ 389.86 $ 100 $$ $ 182 i 13,957 r �� r �� $ 62.05' $ 50,000 E== [T_ 63.21 $ 50 Exhibit G Guidance /Care Center, Inc. Page 3 of 4 Contract No. ME225 -4 -27 07101/2013 Exhibit Fiscal Year 2013 -2014 Provider Name: I Guidance /Care Center, Inc. Adult Substance Abuse Activity / Cost Center 35. Outpatient - Group' Unit: Contact Hour 36. Room and Board w /Supervision Level I Unit: 24 -hr day 37. Room and Board w /Supervision Level II Unit: 24 -hr day 38. Room and Board w /Supervision Level III Unit: 24 -hr day 42. Intervention - Group Unit: Contact hour- 43. Aftercare - Group Unit: contact hour 46. Recovery Support - Individual Unit: direct staff hour 47. Recovery Support - Group Unit: contact hour 48. Clinical Supervision for Evidence -Based Practices Unit: contact hour Incidental Expenses 28. Incidental Expenses Unit: each $50 spent TANF $ Unit X = Yes Rate Contract #: I ME225 -4 -27 7 Revision #: Children's Substance Abuse TANF $ Unit X = Yes Rate 2 3 4 $ Z2.77 $ 20,000 C am_ 0 1,618 Total Non -TANF = $ 345,979 Total TANF = { $ Total Treatment & Aftercare = $ 345,979 Uncompensated Units= $ 69,196 E$ 44, 154 Total Non -TANF = $ 44,1 Total TANF = F$$_�_ ^� Total Incidental Expenses = $ 44,154 Total Non -TANF = $ 576,776 Total TANF = F - Total Substance Abuse Funds = $ 576,776 5 6 7 E== E.= E= E= C = E: Total Non -TANF = $ 279,139 Total TANF Total Treatment & Aftercare = S 279,139 Uncompensated Units= $ 55,828 Total Non -TANF = $ Total TANF = Total Incidental Expenses = $ Total Non -TANF = $ 451,401 Total TANF = Li -- i Total Substance Abuse Funds = $ 451,401 Exhibit G Guidance/Care Center, Inc. Page 4 of 4 Contract No. ME225 -4 -27 07/01/2013 FY 2013 -2014 EXHIBIT H: FUNDING DETAIL Provider Name: Guidance /Care Center, Inc. I Contract N: ME2254 -27 Revision N MENTAL HEALTH Budget Entity 60910506 - Adult's Mental Health OCA AMOUNT Budget Entity 60910506. Children'S Mental Health OCA AMOUNT 502004- EMERGENCY STABILIZATION 503001- EMERGENCY STABILIZATION GIA -ADULT COMM. MENTAL HEALTH (100610) GIA- CHILDREN'S MENTAL HEALTH (100435) ADAMH Trust Fund I (027005)' AESSI ADAMH Trust Fund TF (027005)' ('FSSI General Revenue (00032326)• AESSI $ General Revenue (00032326)' CFSS I $ 15,677 TSTF(122023)* General Revenue AESSI $ SMHA I [1:777771 FGTF- Title XXI(261015) 89901 $ (000326)* G/A -BAKER ACT SERVICES (100611) G /A- CHILDREN'S BAKER ACT (104257) General Revenue (000326)* AESSI $ 1,112,903 General Revenue (000326)* CFSSI $ Social Services Block Grant (639022) CFSS I Emergency Stabilization Total = S 1.112903 Emergency Stabilization Total= S 15 Uncompensated Units S 222,581 Uncompensated Units $ 3,135 502018- RECOVERY & RESILIENCY 503013- RECOVERY & RESILIENCY GIA -ADULT COMM. MENTAL HEALTH (100610) G /A- CHILDREN'S MENTAL HEALTH (100435) ADAMH Trust Fund TF (027005) ARKS 1 $ - i ADAMH Trust Fund TF (027005)• CRRS I General Revenue (000326) ARKS I $ 1,038,348 General Revenue (000326)• CRRS I GR/AGAPE Fain Ministry (000326)* AF'S1MD f $ - General Revenue-Children At Risk of ED(000326) CARED GR/Comm Forensic Beds -Aduh Svc (000326) CF'B.AS $ 060000 M216 FGTF - MIAMI -DADE Wrap Around Pg. (261015) GMDW'1 ADAMH Trust Fond - FACT Admin (027005) F fA 19 I Federal Grant Trust Fund (261015) CRRS I General Revenue - FACT Admin (000326) FFA 19 IIS FGTF - Title XXI (261015) 89Q 13 FGTF - FMGPMA - Medicaid Admin (261015) FTA 19 $--- ...$--- ..- ...._._.__�y General Revenue - FACT sves (000326) F S I9 FGTF - FGGGPT -Trans From Homelessness (261015) GXO I8 E $ 90,827 General Revenue (000326) SMHA2 G /A- PURCHASED RESIDENTIAL WTTF TANF(401001) 39A18 , $$ TREATMENT SERVICES (102780) General Revenue (000326) 1PPME = $ -�� GR/MCAID & Non -MCAID MOE (000326)* 9PRNM ! $ Tobacco Se ttlement Trust Fund (122023) ARRSI ' $ Federal Grant Trust Fund (261015) ARRSI 5� -7 G/A-INDIGENT PSYCH MEDS PROGRAM (101350) General Revenue (000326)• ARRSI $ _5,945 j Total Non - TANF $ 1,295,120 Total Non - TANF $ 470,000 Recovery &Resiliency Total %j 2� Recovery & Resiliency Total me j Uncompensated Units $ 259,024 Uncompensated Units $ 94,000 TOTAL ADULT'S MENTAL HEALTH= S 2.408,023 TOTAL CHILDREN'S MENTAL HEALTH= S 485,677 SUBSTANCE ABUSE Budget Entity 60910604 - Adult's Substance Abuse OCA AMOUNT Budget Entity 60910604 - Children's Substance Abuse OCA AMOUNT 603005 - DETOXIFICATION 602001- DETOXIFICATIONIARF GIA -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SVCS (100420) ADAMH Trust Fund TF (027005)••• DTXAS I ADAMH Trust Fund TF (027005)••• DTXC'S General Revenue (000326) ** DTXAS ($ 102284 a ... _. _ .... _... _ ........ _.... General Revenue (000326)•• DTXC'S i $ - _ _ _ TSTF(122023)•• DTXAS [__$,____ ............'.._.. Detoxification Total = S 186,64 Detoxification Total = S Uncompensated Units $ 37,329 Uncompensated Units $ - 603006- PREVENTION SERVICES 602002- PREVENTION SERVICES GIA -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SVCS (100420) General Revenue (000326)•• PRV.AS l $ - i ADAMH Trust Fund TF (027005) PRVC'S + $ 172,262 ADAMH Trust Fund TF (027005) * * *• PRV.AS I $ = General Revenue (000326) *• PRVC'S I $ Prevention Services Total = $ Prevention Services Total = $ 17 Uncompensated Units $ - Uncompensated Units $ 34,452 603007- TREATMENT & AFTERCARE 602003-TREATMENT & AFTERCARE G /A -COMM SUBSTANCE ABUSE SVCS (100618) G /A- CHILD /ADOL SUBSTANCE ABUSE SVCS (100420) ADAMH Trust Fund TF (027005) * ** General Revenue (000326) ** TRTCS E . - - IRTAS 1 $ 64,595 i General Revenue (000326)•* T RTCS $ - O &M TF (516015) ;....._....._.._.._........ - 17t 'LAS l $ - I .. TSTF (122023)•• TRTCS i $ 279,139 ADAMH Trust Fund TF (027005)••• .......__._._._..._........ y 27111V I $ 3,600 __...._...._.._... O &MTF (516015)•* TRTCS S ADAMH Trust Fund TF (027005) * ** 273V061 $ - ADAMH Trust Fund TF (027005)••• 27CHV $ - General Revenue (000326) - 9 i $ - ._._._ ............._._......... WTTF TANF (40 100 3'+'rC' I �$ ...... _....__..........._... I. WTTF TANF 40100 1) ( : "IVO $ .._ General Revenue 000326 •• SPJCS S - ( ) GR- Indigent Drug Pro MOE (000326)** D, -0- $ ADAMH Trust Fund TF (027005)••' SPJCS ! $ General Revenue (000326)•• SPJ,4S $ SSBG TF (639002) IRTC'S $ ADAMH Trust Fond TF (027005) *•* SPJCS Total Non -TANF $ 390,133 Total Non -TANF $ 279,139 Treatment & Aftercare Total = S 390,133 Treatment & Aftercare Total = S 279,139 Uncompensated Units $ 78,027 Uncompensated Units S 55,828 TOTAL ADULT'S SUBSTANCE ABUSE = S776 TOTAL CHILDREN'S SUBSTANCE ABUSE= S 451,401 TOTAL ALL PROGRAMS = S 3.921,877 TOTAL ALL UNCOMPENSATED UNITS = S 784,375 FUNDS NOT REQUIRING MATCH: GRAND TOTAL OF PROGRAMS & UNCOMPENSATED UNITS z: S 4,706,252 Drug Abuse S ervice 518,882 1 TOTAL FUNDS REQUIRING MATCH = SS 2�817 D einstitutionalization Project S 210 ,000 11 LOCAL MATCH REQUIRED = S CMH Program $ j ADDITIONAL LOCAL MATCH = 1,,,,,, ................................................................................. MH Block Grant ............................... ........375,970 $ - „,,,,,,,,,,,,,,,,,,,,,,,,,,,,, TOTAL FUNDS NOT REQUIRING MATCH = S 1,104,852 GRAND TOTAL LOCAL MATCH = $ 939,008 'Cammuntity Mental Iie*Ilh Black G— •• F,penditute must be Subslanee Abuse Prevetxion and Treemxnt Bleek C em eligible ” Snb—ee Abu. Ne�entian and Treatment Black Grant - FmNi�i; Agreen— - RES IRICI'IONS APPLY Guidance /Care Center, Inc. exhibit" Contract No. ME225 -4 -27 Page 1 of 1 0710112013 PART III - NEW LOC At., MA I CII PLAN FV 2013-20"'1 Agency Nam Guidance/Care Center. loo. Contract Number ME2254-27 Date: 7112013 OR AMH Total S 543,849.00 CMH Total $ - ASA Total S 290,008.42 CSA Toml S 105,151.00 ' Grand Total $ 939M.42 1, Assessment I -.-at 1. A-..,.t 1. Assessment a. Total Match a. Total Match a. Total Match a. Total Match b. Rate Rate b. Rate . b. Rate 1 4" c. Units Purchased Units Purchased Na c. Units Purchased c. Units Purchased 2. Cox Management 2. Case Mitmilitmat 2. Case M ... gerstat 2. Ca. M.-g-ad a. Total Match $ 20,000.00 a. Total Match a. Total Match a. Total Match b. Rat 6' " b. Rate b. Rat b. Rate c U nits Purchased 3 16 . 41 c. U nits Purchased Na c. Units Purchased 761.09 c. Units Purchased Na 3 Crisis Stabilization 3. Crisis Stultification 3, Crisis Stabilization 3. Crisis Stbilintimi a. Total Match a. Total Match a. Total Match I a. Total Match b Rate b Rate b. Rate b. Rate c Unns Purchased c Units Purchased Na c, Units Purchased Na c. Units Purchased n1a 4. Crisis Support/Emergency 4, Crisis Support(Emergemy 3 . Crisis Support/Emergemy 4. Cii,S.pprtfE-rpmy a. Tom] Match ... . a. Total Match .................... a Total Match i S 2 U00 00 a Total Match S 33,000.00 b. Rate b. Rate b. Rate i S 40.44 b. Rate S 30.44 c. Units Purchased 4% c. Units Purchased i Na c. Units Purchased 49.46 c. Units Purchased 1.063,30 5, Day Can ..... . ...... 5. Day can . ................... . .. 5. Day Can 5, Day Cam . ........ . . .... . .... . ... a. Total Match a. Total Match a. Total Match a. Total Match b. Rate b. Rate b. Rate b. Ram c. Units Purchased Na c. Units Purchased Na c. Units Purchased Na c. Units Purchased Na 6, Day -Night 6. Day-Night 6. Day -Night 6. Day-Night a. Tow Match a. Total Match a. Total Match a. Total Match b. Rate b. Rate b. Ram b. Rate c. Units Purchased Na c. Units Purchased Na c. Units Purchased i Na c. Units Purchased Na 7. Drop- lo/Self -Help Cema,ra 7. Drop-Iii/Self-Help Centers 7. D.p"4.1SelF-HeIpCente 7. Drup-la/Self-HelpCente a. Total Match NIS a. Total Match a. Total Match a. Total Match It Rate_ y b. Rate b. Rate b. Rate c' Units Purchased c. Units Purchased Na c. Units Purchased Na c. Units Purchased Na 8. Is -Nome and On-Site Services I.Horse and O.Sit, Services 8, la-Hons, and On-Site Services 8. le -Home and On-Site Services a . Total Match ; a. Total Match I a, Total Match : a. Total Match b Raw b. Rate b, Raw b. Rate c. Units Purchased Na c. Units Purchased Na c. Units Purchased Na c. Units P..t..d Na 9. I.P.deirt inpatient 9 . Input .... . ......... . . . ........ 9 Inpa tient a. Total Match a. Total Match a Tom] Match ._ ...._........__..... a Total Match h Rate b. Rate b. Rate b. Rate c Units Purchased Na c. Units Purchased Na c. Units Purchased Na c. Units Purchased Na 10. Inte Case Miumg-m, 10. Intensive Caw Management 10. Intensive Case Ma me at ..................... 10. Intensive Case Management a. Total Match a, Tow Match .. Tom[ Match a. Total Match b Rate b. Rate b. Rate b. Rate c. Units Purchased Na c. Units Purchased Na c. Units Purchased i Na c. Urdu Purchased Na 11. Intervention 11. Intervention 11. Intervention 11. Intervention a. Total Match 11_1 a. 1 W Match a Total Match a. Total Match T 23 000.00 b Rate �'!22 �ti b Ra 1, Rate �k b. Rule 62 c. Units Purchased 317.56 c. Units Purchased i Na c. Units Purchased c. Units Purchased 12. Medical Services 12. Medical Service 12, Medical Services 12. Medical Services a. Total Match a. Total Match a. Total Match a. Total Match b Rate b. Rate b. Rate b. Ram c, Units Purchased c. Units Purchased Na c. Units Purchased Na c. Urdu Purchased Na 13, Methadone Maintenance 13. Methadone Maintenance 13. Methadone Maintenance 13. Methadone Maintenance a. Total Match a. Total Match a. Tot.] Match a. Total Match b. Rate b. Ram b. Rate b Rate c. Units Purchased Na c. Units Purchased Na c. Units Purchased Na c, Units Purchased Na 14. Outpatient - Individual 14, Outpatient - Individual 14. Outpatient - Individual 14. Outpatient - Individual a, Total Match a Total Match a. Total Match a. Tom] Match b Rate b. Rate b. Ram b. Rate U nits Purchased c U WAS,'c, Units Na c. Units Purchased 2),9,W c. Units Purchased Na 15 Outreach 15. Outreach 15. o.tm..b 15. Outreach a Total Match a. Total Match t a. Total Mulch a. Total Match 1'i 7 b Rate b Rate b. Rate b. Ra te c. Units Purchased ILW c. Urdu Purchased Na c. Units Purchased c. Units Purchased 16. Pm-mio. 16, Prevention 16 P-,.ti.. 16, Prevention a. Total Match a. Total Match a Total Match a. Total Match b. Rate b. Rate b. Rate b. Rate c. Units Purchased Na c. Units Purchased Na c. Units Purchased Na .. Units Purchased 17. Prevendou/Intervention - Dal 17. Preventiou/Intervention- Day_ 17. Prevention/Interventiom - Day . . ......................... 17. fte-iitimilliste-tio. - Day ,,,,... . .. . ........ . . ........... a. Total Match a Total Match a. Total Match a. Total Match b Rate i i b. Rate b. Rat. b. Raw c. Units Purchased Na c Units Purchased Na c. Units Purchased Na c. Units Purchased Na 18, Residential Level 1 18. Residential Level 1 18. Residential Level 1 18. Residential Level I a Total Match a Total Match i a. Total Match a. Total Match b Ram x 5,11f b. Rat. b. Ram b. Rate c, Units Purchased 3 40, 07- c Units Purchased Na c. Units Purchased Na c. Units Purchased Ne 19, Residential Level 11 19. Residential Level If 19. Residential Level 11 19. Residential Level II a. Total Match a. Total Match a. Total Match a. Total Match b. Ram b. Rate b. Rate b, Rate c. Units Purchased Na c. Units Purchased Na c. Units Purchased Na c. Units Purchased Na 20. Residential Level 111 2 Residential Level 111 20, Residential Level 111 20. Residential Level III a. Total Match a. Total Match a. Total Match a. Total Match b Rate b. Rate b. Rate b. Rate c. Units Purchased Na c, Units Purchased Na c. Units Purchased Na c. Units Purchased Na Loral Match Guidance/Care Center, Inc. Page I of 2 Contract No. ME225-4-27 07/01/2013 PART III - NEW LOCAL MATCH PLAN FV 20112013 Agency Name: Guidance/Carc Center, Inc. Contract Nun ME2254 -27 Dale: 7/I2013 21. Residential Level IV a. Total Match b. Rate c. Units Purchased 22. Respite Services a. Total Match b. Rate r- c. Units Purchased 23, Sheltered Employment a. Total Match 3 b. Rate _ c. Laos Purchased i 24. Substance Abuse Demxifkution a. Total Match _ b. Rate c. Units Purchased ~ 25. Supported Employment a. Total Match b. Rate c. Units Purchased 26. Supported Housing/Living a. Total Match b. Rate c. Units Purchased 27. TASC a. Taal Match b. Rate c. Units Purchased 28, Incidental Expenses a. Total Match I, Raw c. Units Purchased 29. Aftercare a. Tom] Match b. Raw c. Units Purchased 30. Ioformatio o sad Referral a. Total Mawh b. Rate c. Units Purchased 31. Reserved 32. Outpatient Detoxification a. Tom[ Match b. Raw c. Units Purchased 33. Reserved 31. FACT Team a. Total Match b. Raw c. Units Purchased 35. Outpatient - Group a. Total Match b. Raw c. Units Purchased 36. Room & Board with Supervi Level I a. Tom[Mawh b. Sum Rate c. Hours or Units Purchased 37. Room & Baard with Supervi Le vel 1 a. Total Match b. State Raw C . Horns or Unim Purchased 38. Room & Board with Si a. Tom[ Match b. Stave Raw c HoursorUmm Purchased Short-term Residential Toml Match Rate Units Purchased Mental Health Clubhouse Tom] Match Rate Units Purchased Total March Rate Units Purchased Respite Services Total Match Rate Units Purchased Sheltered Employment Tout Match Rate Units Purchased .Substance Abase Detm Tom[ Match Rate Units Purchased Supported Employment Total Match Rate Units Purchased 26. Supported HoasingfLiviag a. Total Match b. Raw c. Units Purchased TASC Tom] Match Rate Units Purchased Incidental Expenses Total Match Rate Units Purchased Aftercare Total Match Rate Units Purchased . Information sad Referral Total Match Rate Units Purchased 1. Reserved Z. Outpatient Detoxification Total Match Rate Units Purchased 33. Reserved 33. FACT Team a. Total Match b. Rate c. Units Purchased 35. Outpatient - Group a. Total Match b. Rate c. Units Purchased 36. Room & Board with St a. Total Match b. Rate c. Hours or Units Purchased Room & Board with Supervis Level 11 Total Match Rate Hours or Units Purchased Room & Board with Supervision Level 11: Tom] Match Raw Hours or Units Purchased . Short-term Residential Treatment ........__.- ............. Total March Raw Units Purchased . Mental Health Clubhouse Services Total Match Rate Units Purchased 21. Residential I& a. Total Match b. Rate c. Units Purchased Respite Services Total Match Rate Units Purchased . Sheltered Employmeot Total Match Rate Units Purchased 23. Substance Abuse Detoxification a. Total Match b. Rate c. Units Purchased 25. Supported Employmeat a. Tout Match b. Rate c. Units Purchased r 26. Supported Housing/Living a. Total Match b. Rate c. Units Purchased _ 27. TASC a. Total Match b. Rate c. Units Purchased > Incidental Expenses Total Match Rate Units Purchased Aftercare Total Match Rate Units Purchased . [.formal!.. aad Referral Total Match Raw Units Purchased I. Reserved 2. Outpatient Detoxification Total Match Raw Units Purchased 33. Reserved 34. FACT Team a. Total Match b. Raw c. Units Purchased 35. Outpatient - Group a. Total Match S b. Raw S c. Units Purchased 36. Room & Board with Supervi Level I a. Total Match & Rate c. Hours or Units Purchased 37. Room At Board with Supervi Level II a. Total Match b. Rate c. Hours or Units Purchased 38. Room & Board with Supervision Level III ............. _..... ..... .. a. Total Match b. Rate c. Hours or Units Purchased 39. Short-term Residential Treatmeat a. Total Match b Rate c. Units Purchased Mental Health Clubhouse Services. - ............ Total Match Rate Units Purchased a. Total Match b. Rate Na c. Units Purchased 22. Respite Services a. Total Match b. Rate Na c. Units Purchased 23. Sheltered Employmeot a. Total Match b. Rate Na c. Units Purchased 23. Substance Abuse Detoxi a. Total Match b. Rate -. c. Units Purchased 25. Supported Employment a. Total Match b. Rate Na c. Units Purchased 26. Supported Honsing/Liviog a. Total Match b. Rate c. Units Purchased 27. TASC a. Total March b. Raw c. Units Purchased 28. Incidental Expenses a. Total Match b. Rate c. Units Purchased 29. Aftercare a. Tout Match b. Rate c. Units Purchased 30. Information and Referral a. Total Match b. Raw c. Units Purchased Reserved Outpatient Detoxification Total Match Rate Units Purchased Reserved FACT Team Total Match Rate Units Purchased . Outpatient - Group Total Match Rate Units Purchased 36. Room & Board with Supervision level 1 AMH Total S 533,839.00 CMH Total S - ASATotal S 290,00842 CSA Total S 115.15100 Grand Total $ 939 21. Residential Level IV a. Total Match b. Rate c. Units Purchased 22. Respite Services a. Total Match b. Rate r- c. Units Purchased 23, Sheltered Employment a. Total Match 3 b. Rate _ c. Laos Purchased i 24. Substance Abuse Demxifkution a. Total Match _ b. Rate c. Units Purchased ~ 25. Supported Employment a. Total Match b. Rate c. Units Purchased 26. Supported Housing/Living a. Total Match b. Rate c. Units Purchased 27. TASC a. Taal Match b. Rate c. Units Purchased 28, Incidental Expenses a. Total Match I, Raw c. Units Purchased 29. Aftercare a. Tom] Match b. Raw c. Units Purchased 30. Ioformatio o sad Referral a. Total Mawh b. Rate c. Units Purchased 31. Reserved 32. Outpatient Detoxification a. Tom[ Match b. Raw c. Units Purchased 33. Reserved 31. FACT Team a. Total Match b. Raw c. Units Purchased 35. Outpatient - Group a. Total Match b. Raw c. Units Purchased 36. Room & Board with Supervi Level I a. Tom[Mawh b. Sum Rate c. Hours or Units Purchased 37. Room & Baard with Supervi Le vel 1 a. Total Match b. State Raw C . Horns or Unim Purchased 38. Room & Board with Si a. Tom[ Match b. Stave Raw c HoursorUmm Purchased Short-term Residential Toml Match Rate Units Purchased Mental Health Clubhouse Tom] Match Rate Units Purchased Total March Rate Units Purchased Respite Services Total Match Rate Units Purchased Sheltered Employment Tout Match Rate Units Purchased .Substance Abase Detm Tom[ Match Rate Units Purchased Supported Employment Total Match Rate Units Purchased 26. Supported HoasingfLiviag a. Total Match b. Raw c. Units Purchased TASC Tom] Match Rate Units Purchased Incidental Expenses Total Match Rate Units Purchased Aftercare Total Match Rate Units Purchased . Information sad Referral Total Match Rate Units Purchased 1. Reserved Z. Outpatient Detoxification Total Match Rate Units Purchased 33. Reserved 33. FACT Team a. Total Match b. Rate c. Units Purchased 35. Outpatient - Group a. Total Match b. Rate c. Units Purchased 36. Room & Board with St a. Total Match b. Rate c. Hours or Units Purchased Room & Board with Supervis Level 11 Total Match Rate Hours or Units Purchased Room & Board with Supervision Level 11: Tom] Match Raw Hours or Units Purchased . Short-term Residential Treatment ........__.- ............. Total March Raw Units Purchased . Mental Health Clubhouse Services Total Match Rate Units Purchased 21. Residential I& a. Total Match b. Rate c. Units Purchased Respite Services Total Match Rate Units Purchased . Sheltered Employmeot Total Match Rate Units Purchased 23. Substance Abuse Detoxification a. Total Match b. Rate c. Units Purchased 25. Supported Employmeat a. Tout Match b. Rate c. Units Purchased r 26. Supported Housing/Living a. Total Match b. Rate c. Units Purchased _ 27. TASC a. Total Match b. Rate c. Units Purchased > Incidental Expenses Total Match Rate Units Purchased Aftercare Total Match Rate Units Purchased . [.formal!.. aad Referral Total Match Raw Units Purchased I. Reserved 2. Outpatient Detoxification Total Match Raw Units Purchased 33. Reserved 34. FACT Team a. Total Match b. Raw c. Units Purchased 35. Outpatient - Group a. Total Match S b. Raw S c. Units Purchased 36. Room & Board with Supervi Level I a. Total Match & Rate c. Hours or Units Purchased 37. Room At Board with Supervi Level II a. Total Match b. Rate c. Hours or Units Purchased 38. Room & Board with Supervision Level III ............. _..... ..... .. a. Total Match b. Rate c. Hours or Units Purchased 39. Short-term Residential Treatmeat a. Total Match b Rate c. Units Purchased Mental Health Clubhouse Services. - ............ Total Match Rate Units Purchased a. Total Match b. Rate Na c. Units Purchased 22. Respite Services a. Total Match b. Rate Na c. Units Purchased 23. Sheltered Employmeot a. Total Match b. Rate Na c. Units Purchased 23. Substance Abuse Detoxi a. Total Match b. Rate -. c. Units Purchased 25. Supported Employment a. Total Match b. Rate Na c. Units Purchased 26. Supported Honsing/Liviog a. Total Match b. Rate c. Units Purchased 27. TASC a. Total March b. Raw c. Units Purchased 28. Incidental Expenses a. Total Match b. Rate c. Units Purchased 29. Aftercare a. Tout Match b. Rate c. Units Purchased 30. Information and Referral a. Total Match b. Raw c. Units Purchased Reserved Outpatient Detoxification Total Match Rate Units Purchased Reserved FACT Team Total Match Rate Units Purchased . Outpatient - Group Total Match Rate Units Purchased 36. Room & Board with Supervision level 1 a. Total Match b. Rate c. Hours or Urdu Purchased 37. Room & Board with Supervisio Level I a. Total Match b. Rate c Hours or Units Purchased Room & Board with S. Taal Match Rate Hours or Units Purchased Short-term Residential Total Match Raw Units Purchased Ei Mental Health Clubhouse Total Match Raw Units Purchased Local Page 2 Guidance /Care Center, Inc. P o f 2 Contract No. ME225 -4 -27 Page 2 of 2 South Horida Belw%iora( Health Net��ork. Isar. Rev. 01/10/2013 Exhibit I Family Intervention Services (FIS) and Adult Intervention Services (AIS) Provider Protocols POLICY: It is the policy of South Florida Behavioral Health Network ( SFBHN) to establish protocols for treatment providers that receive referrals and /or provide services to consumers that have been identified as FIS /AIS consumers. These protocols have been established to ensure that this high -risk, priority population receives expedited services. PROCEDURE: In accordance to the SFBHN Contract, the items delineated below are the contractually required protocols for any consumer that has been identified as an FIS or AIS and has been referred to an SFBHN treatment provider. SFBHN will be notified by the FIS /AIS program if a provider is not complying within these established protocols. FIS Screeninci: a) The FIS /AIS Case Manager conducts a screening at the request of the DCF Protective Investigator (PI) b) Should the initial screening determine that the consumer is in need of behavioral health services, the FIS /AIS Case Manager will make a referral to a treatment provider for a full assessment and linkage to services as specified below. Referrals: a) The FIS /AIS Case Manager will contact the treatment provider to request an appointment for an individual that has been identified by the DCF Protective Investigator (PI) as being in need of FIS /AIS services. i. The FIS /AIS Case Manager will submit the SFBHN Consent to Release Information and the FIS /AIS Referral form as part of the referral packet. b) The Provider must provide the FIS /AIS case manager an appointment for intake within seven 7 calendar days of the initial phone call. An appointment must be provided within this timeframe regardless of the indigent consumer's ability to pay. Consumers will be financially assessed utilizing the sliding fee scale as specified in SFBHN main contract with the network provider. For consumers with insurance, referrals will be made directly to a provider who accepts that insurance. i. Should the consumer be a no -show at the appointment, the provider will notify the FIS /AIS case manager within 24 hours of the no -show. ii. Should the consumer need services not available at the provider, the provider will ensure linkage to recommended services and notify the FIS /AIS case manager. Substance Abuse: a) Assessment: Prior to the referral to the treatment provider, the FIS /AIS Case Manager will complete an initial screening assessment and a copy will be provided to the treatment provider at the time of referral. The FIS /AIS consumer must have a GAIN I assessment completed within 20 days of admission into Outpatient SA Treatment. The completed assessment must be provided to the FIS /AIS Case Manager within this timeframe. If the consumer is placed in Residential SA Treatment, the GAIN I is due within 5 days of admission. Upon completion of the GAIN, the provider will provide a copy to the FIS /AIS case manager. Guidance/Care Center, Inc. Exhibit I Contract No. ME225 -4 -27 Page 1 of 2 South Horida I ia- .iaral Health Net %tiork, Ine. Rev. 01/10/2013 b) Drug Testing: The initial drug test is conducted by the FIS /AIS worker prior to the referral to the treatment provider. Subsequent weekly random drug testing will be conducted by the treatment provider commencing the date of admission. At minimum, all FIS /AIS consumers must be drug tested once a week during the first 2 weeks of treatment. After the initial 2 weeks, random drug testing will occur by the provider based on the consumer's progress in treatment and the results of those drug screening will be provided to the FIS /AIS Case Manager until the case has been closed. Should the consumer be court involved, drug screenings will be conducted at the intervals required by the courts. When the consumer is discharged from the FIS /AIS program, subsequent random drug screenings will be conducted as specified in the consumer's individualized treatment plan. Mental Health: a) Assessment: The FIS /AIS consumer must have a complete Bio- psychosocial assessment completed within 20 days of admission into Outpatient MH Treatment. If the consumer is placed in Residential MH Treatment, the assessment is due within 5 days of admission. The completed assessment must be provided to the FIS /AIS Case Manager within these timeframes. Upon the implementation by the Managing Entity of a network mental health assessment, the provider will use the identified assessment for all FIS /AIS consumers. Documentation a) The Provider will submit weekly progress reports during the first two weeks of treatment to the FIS /AIS Case Manager. After the initial two weeks, monthly treatment summaries will be submitted until such time as the case is closed with the DCF Protective Investigations Unit (PI). b) The standardize FIS /AIS Treatment Summary Form will be utilized. i. The form must be submitted at the required intervals as specified above. ii. It must be completely filled out including: client demographic information, diagnostic information, progress in treatment, and urinalysis results (if applicable). iii. The form must be signed and dated by the treating clinician. c) The Provider will coordinate with the FIS /AIS Case Manager and /or the DCF PI to participate in staffings as required. Direct Referrals from Protective Investigators (Pis) a) Should a provider receive a direct referral from a PI, the provider will accept the consumer into treatment and notify the Managing Entity of the occurrence. Guidance /Care Center, Inc. Exhibit I Contract No. ME225 -4 -27 Page 2 of 2 S<owh Horida Kcluv coral health Nv(Nv irk. Inc. Exhibit J Family /Adult Intervention Specialist (FIS /AIS) Treatment Summary Report Initial ❑ Weekly ❑ Monthly ❑ Agency: Date: Client Name: Social Security Number: DOB: Axis I: Axis II: Axis III: Axis IV: Axis V: Progress in Treatment: Urinalysis Results: Therapist Signature and Title: Print Name: Guidance /Care Center, Inc. Exhibit J Contract No. ME225 -4 -27 Page 1 of 1 s K w s i 71 0 0 a Cd cn a M W) 1 6 y ,� U ❑ > 0 U .= N et b Q cl tt z -v 0 r. b14 C , y d G w _z 0 F o e U ^ cr O a R a� L .o u Y a+ d ^zw _ 0 L I C A �z F U O U z A d W U U C � O a b� �F L �I � F ^O aI .o W s, U I�1 A i c bA 'C . O a F a F C a_ I'! ti N LO LO N N w O z t0 c 0 U Y o n� x N x rn w CL U C C N U U_ c m v c� Sowlt Hor €da tteh a.i €sra6 9teaith Network, ttte. Exhibit L 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 the ALF -LMH where the consumer is residing at, or referred to, maintains a current Agency for Health Care Administration (AHCA) license for ALF -LMH facilities. The network provider shall maintain a copy of the AHCA ALF -LMH facility license in each consumer file. Referrals to unlicensed ALF -LMH are unlawful and are subject to sanctions by AHCA. The ME shall monitor the network provider's compliance with the terms and conditions of this exhibit. 2) 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. 3) 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. 4) 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. 5) 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. 6) 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. 7) Ensure that the Cooperative Agreement is annually updated between the provider and the ALF -LMH Administrator. 8) 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 Exhibit L Guidance /Care Center, Inc. Page 1 of 2 Contract No. ME225 -4 -27 South Horida Bcha%ioral Ilealth Network. hte. 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. 9) 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 at 1- 800 - 962 -2873. Exhibit L Guidance /Care Center, Inc. Page 2 of 2 Contract No. ME225 -4 -27 Sowlt Horida Behasiaral Health Network, hic. Rev. 07/01/2011 Exhibit M Clinical Supervision for Evidence -Based Practices 1. Description: Clinical Supervision for Evidence Based Practices takes place in either a one -on -one or group setting. The clinical supervision is an intervention that is provided to agency personnel by a professional qualified by degree, licensure, certification, or specialized training in the implementation of evidence -based practices. In the case of specific evidence -based practices with defined clinical supervision protocols, the clinical supervisor is a person who is credentialed in those protocols. For the purposes of this document, an evidence -based practice is one that is based on accepted practices in the profession and is supported by research, field recognition, or published practice guidelines. Clinical supervision for evidence -based practices is intended to continuously improve the skills of individuals who provide services directly to clients. The supervision is an evaluative process, extending over time, and has the simultaneous purposes of enhancing the professional functioning of the clinician or group of clinicians, monitoring the quality of services provided to clients and providing feedback regarding those services to the trainee. The functional areas of clinical supervision for evidence -based practices include the following: • Monitor clinicians via observance of direct service provision or review of clinical documentation to ensure fidelity and consistency in adherence to accepted evidence -based treatment principles and practices • Supplement formal training knowledge with "real world knowledge" so clinicians can learn the practical application of evidence -based treatment practices • Determine the accuracy of clinicians' assessment and referral skills • Evaluate staff performance linked to utilization of evidence -based practices • Determine the appropriateness of the treatment or service intervention selected relative to the specific needs of the client served • Support the clinician in adopting new clinical practices through the provision of focused supervision, guidance and feedback Provide clinician(s) a structured process to ensure efficient use of time and resources and allow time in supervision for reflection /practice on the quality of services offered to the clients • Reinforce positive attitudes among clinicians to adopt and implement the evidence -based practices Clinical Supervision services may be provided to groups (no more than 4 direct service staff per group) or to individuals in face -to -face and /or web -based learning setting. Both individual and group services are billable on the basis of a contact hour in increments of 1 hour per week, at a minimum. Reimbursement for clinical supervision service hours shall not exceed the contracted staff hour rate with a total annual reimbursement rate not to exceed $1,754.00 annually per clinician supervised. Total annual reimbursement for the provider agency shall not exceed $50,000.00. The billable hours of supervision will be documented by time log maintenance including date, start time, end time, names of supervisor and supervised clinician(s), and the functional area of supervision. The time log will be signed by both the supervisor and the clinician(s) receiving the supervision. An implementation plan must be approved by the department prior to the commencement of any activities reimbursable under this cost center. The clinical supervision plan will include the following: • Detailed description of the proposed evidence -based practice implementation • Description of how the practice will be integrated into the provider's clinical practices with an emphasis on minimizing negative impact on direct service provision • Listing of positions within the agency designated to provide the supervision and the required qualifications (degree, licensure, or specialized training in the implementation of evidence - based practices) position incumbents must have • Listing of positions within the agency identified to receive the supervision and the proposed number of billable hours of supervision per individual trainee • Presentation of the method to be used to measure the effectiveness of the chosen evidence - based practice, including expected outcomes and objectives (quantify via pre /post training tests) Guidance /Care Center, Inc. Exhibit M Contract No. ME225 -4 -27 Page 1 of 2 Sca0h Florida Belierioral health Nefv ark. (sic. Rev. 07/01/2011 Programs: Adult Substance Abuse, Children's Substance Abuse 3. Unit of Measure: Contact Hour — direct supervision 4. Data Elements: a. Service Documentation — Duty Roster; (1) Recipient of Clinical Supervision name and identification number; (11) Clinical Supervisor name and identification number; (III) Date of Supervision; (IV) Duration, beginning and end time; (V) Cost Center; and (VI) Program Audit Documentation — Time Log; (1) Recipient of Clinical Supervision name and identification number; (II) Clinical Supervisor name and identification number; (III) Date of Supervision; (IV) Duration, beginning and end time; (V) Cost Center; and (VI) Program 5. Unit cost rate: $ 67.44 per hour Guidance /Care Center, Inc. Exhibit M Contract No. ME225 -4 -27 Page 2 of 2 South l�lovida Beim%ioral Ilcalth Nct+sork. Inc. Exhibit N Special Provisions For the Indigent Drug Program 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: (a) Have an annual income that is at or below 150% of the Federal Poverty Income Guidelines, as published annually in the Federal Register. (b) 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. (c) 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. (d) 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. (e) 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 Louis de la 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 : / /fimedicaidbh.fmhi.usf.edu / (f) 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. Guidance /Care Center, Inc. Exhibit N Contract No. ME225 -4 -27 Page 1 of 1 . � q w \ z B B / 2 f .§ k M KI ƒ� � § $ G C 0 2 AD k \ � Q. 0 L/ \ ) 0 5 e c f � : R k/ ƒ k 0 � 2 k g 9f $ $ k k \ \ k / / wee � e > k LO LO 2 k k \ 02 4� o x w(L k \ 3 \_ � 'D / a e g vE k k 2 0 � § E % _ 4 $ 2 U k � � b V J 2 o 4) 2 � § g \ k�E o �CL 2 i z ■a � k �§k E § g 0 k $ 2 g� $ Ix § $k CL w f § CL 2 to w c O% _ 4_ @ m o� \ > § x U. 0 : Y \ � -0 ° - i 13 kkk om s 2 0 2 2 c EEE r-�/ �g 2 2 J - 0§ CL� CL f E ■2« § ■z# / / / F- k LO LO 2 k k \ 02 4� o x w(L k \ 3 \_ � 'D / South Ulorid:a Beim%ior;al health `ref% -,ork. Ine. Exhibit Missing Children Rev. 07/01/2011 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. 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: Guidance /Care Center, Inc. Exhibit Q Contract No. ME225 -4 -27 Page 1 of 3 South Horida k3eha%itjral health Notti ork, Inn, Rev. 07/01/2011 (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; (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, Guidance /Care Center, Inc. Exhibit Q Contract No. ME2254-27 Page 2 of 3 Soutit I rid a Heha%ioraI Ilea Ith `tieo ork, Igiv, Rev. 07/01/2011 (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. f. 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. g. 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. h. 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. Exhibit Q Contract No. ME2254-27 Page 3 of 3 South Florida IIehto ioral Ilealth `tier+ ork, lni . Exhibit R Child Welfare Quarterly Clinical Report M.*hftftAWN&khX I. The network provider shall complete typed quarterly progress report, as shown in Section II. below, and shall file it in the medical record. The network provider is required to provide to the Department of 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. 11. k;MILU WtLtAKL Mental Health Agency Name: Name of Person Completing Report: Child's Name: School: School Performance: Full Case Management Agency: Full Case Manager's Name: Relevant Incidents: Date of Report: Title: DOB: DOA: Grade: School Placement: Phone #: Cell #: 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 Y UUNIUAL Ktl'VKI Supervisor Signature Guidance /Care Center, Inc. Exhibit R Contract No. ME225 -4 -27 Page 1 of 1 South Horida Bclm%i rral Health Network, Inv. Exhibit V Special Provisions for the Forensic Services 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 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 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 Forensic Coordinator. The network provider must submit written findings and recommendations to the referral source and the ME's Forensic Coordinator within 48 hours of client interview. (c) The network providers' 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. (d) The network providers' case manager will immediately consult the Forensic Specialist regarding any apparent conditional release violation. Network Provider staff will be responsible for 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) Diversion The network provider will be responsible for the provision of services and the monitoring of individuals charged 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 by the Forensic Team. i. The network provider will facilitate and coordinate the provision of mental health treatment, competency restoration training, residential care or housing with supervision, medical and auxiliary services if appropriate, case management and monitoring of individuals who are being diverted from commitment to the Department of Children and Families, pursuant to chapter 916, F. S. Guidance /Care Center, Inc. Exhibit V Contract No. ME225 -4 -27 Page 1 of 3 Smith 1�forida Heharioral Ilcaith 'Network, loc. ii. The network provider will facilitate and support the activities of the Forensic Team by providing accommodations for the provision of competency restoration training at the provider's facility(ies). iii. The network provider 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. (h) Discharge Planning — The network provider will be responsible for ensuring the active collaboration with the forensic specialists in discharge planning activities for forensic clients at state treatment facilities L The network provider will, per the request of the forensic specialists, participate in treatment team, and discharge planning meetings for forensic clients in state treatment facilities. ii. The network provider will assist the Forensic Team in the development and submission of conditional release plans, discharge plans to state treatment facilities and to the committing court. iii. If requested, the network provider will attend court hearings in the cases of individuals being discharged from state treatment facilities and ensure effective linkage to their service continuum. (i) 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. L 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 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 Forensic Coordinator. iv. The network provider will maintain current copies of conditional release orders. (j) Utilization Management - The network provider shall facilitate the Forensic Specialists' requirement to manage the residential treatment beds funded by community forensic dollars and the statewide community forensic beds in the Southern Region. This includes a short -term residential treatment facility and residential level 2 beds. (k) Statewide Community Forensic Residential Services L Citrus Health Network, Inc .: The network provider agrees to make available eight (8) residential beds in the STAR Program, for eligible consumers from other circuits in need Guidance /Care Center, Inc. Exhibit V Contract No. ME225 -4 -27 Page 2 of 3 Smith 1 Heha -iora0 lfeaith ,Neon ork, Inc. of forensic mental health services placed by the ME. It is agreed that during the term of this agreement, these beds shall not be used for any other purpose. The network provider agrees that the ME's decision for placement is final and binding on all parties. The network provider shall submit weekly census reports by the dates and times specified in Exhibit C, Required Reports and to the individuals identified. ii. Psychosocial Rehabilitation Center, Inc. d /b /a Fellowship House The network provider agrees to make available four (4) residential beds for eligible consumers from other circuits in need of forensic mental health services placed by the ME. It is agreed that during the term of this agreement, these beds shall not be used for any other purpose. The network provider agrees that the ME's decision for placement is final and binding on all parties. The network provider shall submit weekly census reports by the dates and times specified in Exhibit C, Required Reports and to the individuals identified. iii. Passageway Residence of Dade County, Inc. The network provider agrees make available fourteen (14) residential level 2 beds for eligible consumers from other circuits in need of forensic mental health services placed by the ME. It is agreed that during the term of this agreement these beds shall not be used for any other purpose. The network provider agrees that the ME's decision for placement is final and binding on all parties. The network provider shall submit weekly census reports by the dates and times specified in Exhibit C, Required Reports and to the individuals identified. Guidance/Care Center, Inc. Exhibit V Contract No. ME225 -4 -27 Page 3 of 3 Smith Horiala Helm i€ rai I lea1th Netm)r€c, Inc. Exhibit X Special Provisions for Proiects for Assistance in Transition from Homelessness (PATH) Services 1. The network provider shall: (a) Submit an annual PATH application to the Mental Health Program Office as requested; (b) 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) Implement services and provide deliverables as set forth and described in each approved and signed Local Intended Use Application which is a requirement of the PATH grant application; (d) Submit Annual Data Report to SAMHSA; (e) Submit the Annual reapplication for the PATH Grant. 11. 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 Guidance /Care Center, Inc. Exhibit X Contract No. ME225 -4 -27 Page 1 of 1 South Horid:a tiehn%ior<al health Network, lane. Exhibit AA Substance Abuse Family Intervention Specialist Services A. The network provider agrees to comply with the provisions of this exhibit and agrees to collaborate with the ME and the Department in executing the action steps identified in the Southern Region SAMH Integration with Child Welfare plan, herein incorporated by reference. 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. 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 location of Key West. Marathon and Key Lar-go 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 Guidance /Care Center, Inc. Exhibit AA Contract No. ME225 -4 -27 Page 1 of 5 &atafh Florida Bchaii €aril health Network. Ina. 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 -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. REFERRALS TO FIS a. A referral shall be made when the child protective investigator suspects that parent(s)' /caregiver(s)' behavioral health disorders 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 Guidance /Care Center, Inc. Exhibit AA Contract No. ME225 -4 -27 Page 2 of 5 Smith l lot ida Bvliarioral 9tcalth Ne work, Inc, 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. 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 of Miami -Dade /Monroe, Inc. within the community. 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 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; Il. 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 Guidance /Care Center, Inc. Exhibit AA Contract No. ME225 -4 -27 Page 3 of 5 4<nwh Hori(hi Bvlw%ioral Ilealth Network. Inn. 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 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; ll. 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 MEs 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, Required Reports. Guidance /Care Center, Inc. Exhibit AA Contract No. ME225 -4 -27 Page 4 of 5 Smith I� forida Bel €ttti ioral Ilcahlt Next Ine. 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. 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 Expense 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 ME's System of Care staff. The ME's System of Care staff 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 ME's Sr. Accountant, 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 Expense 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. Exhibit AA Contract No. ME225 -4 -27 Page 5 of 5 South Florida Behavioral Health Network, Inc. Exhibit AC Special Provisions for Substance Abuse Prevention Services I. Special Provisions (1) The substance abuse prevention services 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, Scope of Work. (2) Evidence Based Prevention: The network provider is required to use an evidence -based prevention program. If the network provider is involved in the validation process for prevention programs, the network provider must notify the ME's Director of Prevention Services annually on the progress of the validation process. (3) 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 ME's contract manager for approval within thirty (30) days of contract execution. The ME shall review and approve the Prevention Program Tool (PPT). (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 submit an attestation certifying the completion of the data entry to the contract manager within thirty (30) days of completion. This applies to network providers, including subcontractors who have their own data system and upload data to PBPS. (5) 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. II. Performance Specifications a. Performance Measures I. 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 ME. The network provider shall submit all service related data for clients funded, in whole or in part, by SAMH and /or local match funds. ii. 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 the online or face -to -face training within thirty (30) calendar days of hire, and annually thereafter. The network providers shall maintain the certificate of Guidance /Care Center, Inc. Exhibit AC Contract No. ME225 -4 -27 Page 1 of 5 South Florida Behavioral Health Network. tne. 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. iii. In addition to the performance standards and required outcomes specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs, in Section D. 6. Special Provisions, Performance Measures for Continuous Quality Improvement Programs, the provider shall also meet the requirements set forth in Attachment V, Scope of Work. b. Performance Evaluation Methodology The ME will monitor the standards and outcomes specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes /Outputs, the standard and outcomes in Section D. 6. Performance Measures for Continuous Quality Improvement Programs, and in Attachment V, Scope of Work, during the contract period, to determine if the network provider is achieving the levels that are specified. 111. Network Provider Responsibilities a. Network Provider Unique Activities 1. The network provider shall adhere to the deliverables as set forth in Attachment V, Scope of Work. ii. 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. iii. 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, Scope of Work , for the types of prevention strategies under this contract. IV. To help develop and support capacity to address community substance abuse needs prevention services providers and substance abuse coalitions funded by the ME are required to enter into and /or maintain a memorandum of understanding. The network provider is required to submit a copy (ies) of the fully executed MOU to the ME Contract Manager by the date specified in the Exhibit C, Required Reports. IV. Co- Occurring Initiative (1) The substance abuse prevention services funded network provider shall perform the following tasks related to the co- occurring disorder service capability initiative: (a) Evaluate network provider co- occurring disorder service capability as directed by the Guidance /Care Center, Inc. Exhibit AC Contract No. ME225 -4 -27 Page 2 of 5 South Florida Behavioral Health Network, inc. ME using the COMPASS - Prevention Tool with: i. A focus group of administrators and prevention services staff, ii. A minimum of one program or a sample of programs on or before June 30' of each year. iii. Follow -up evaluations done at least annually for each program or sample of programs; and iv. Programs or a sample of programs in accordance with timeframes outlined in the action plan for each contract year. (b) Develop and submit to the ME for approval an action plan for referring clients with co- occurring disorders by June 30 of each year of the contract term that details: (1) Networking capacities with local network providers in the community for persons with co- occurring disorders; (ii) Strategies and activities to develop or improve co- occurring disorder educational and referral capability; (iii) Timeframes for reviewing co- occurring disorder educational and referral capability within the prevention program. (c) Develop and submit to the ME a summary report by June 30 of each year that details: 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; iv. Overall progress toward co- occurring disorder educational and referral capability development in accordance with timeframes specified in the action plan. V. Continuous Quality Improvement Programs for Substance Abuse Prevention Services Network Providers (1) The 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. Guidance /Care Center, Inc. Exhibit AC Contract No. ME225 -4 -27 Page 3 of 5 South HoHda Behr vioi health Netwoi . Inc. (2) The network provider must have a quality assurance and improvement plan and processes through which quality is continually monitored to achieve the program's planned outcomes. A copy of this plan must be submitted to the ME upon request. Best practices for quality performance measures should be incorporated: experienced, well- trained staff, adequate participant -staff ratio, theory- driven programs, retention of research -based core elements, variety of teaching methods and interactive approaches, sufficient exposure to the services /intensity, Long -term prevention programs /duration and complementary components, positive relationships, cultural sensitivity and relevance, meaningful performance measures that are valid and reliable, and data for decision- making. Additionally, a minimum guideline for the network provider's continuous quality improvement program, including, but not limited to: (a) Ongoing efforts to improve products, services or processes to include ME initiatives; (b) Records maintenance, tracking and compliance as applicable; (c) Staff competencies, training, and development standards; (d) Evidence -based practices (EBPs) utilized by the agency and how these EBPs are monitored to ensure fidelity to the model; (e) Service - environment safety and infection control standards; (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, in good faith, may not be subjected to any civil action by virtue of that incident report; and (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 provider 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) Provide a framework for evaluating outcomes including: L Output measures, such as capacities, technologies, and infrastructure that make up the system of care; H. Process measures, such as administrative and supervision components; iii. Outcome measures pertaining to the outcomes of services; (b) Provide for a system of analyzing those factors which have an effect on performance; (c) Provide for a system of reporting the results of continuous quality improvement reviews; and, (d) Incorporate best practice models for use in improving performance in those areas which are deficient. (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 ME 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 Guidance /Care Center, Inc. Exhibit AC Contract No. ME225 -4 -27 Page 4 of 5 South Florida Behavioral Realth Netw wk, tne. 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. Guidance /Care Center, Inc. Exhibit AC Contract No. ME225 -4 -27 Page 5 of 5 V A South Florida Behavioral Health Network, Inc. ATTACHMENT II Rev. 07/01/2012 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 /omb /circulars /al02 /a102.html. (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 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 /al33 /al33.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 Attachment 11 Guidance /Care Center, Inc. Page 1 of 3 Contract No. ME225 -4 -27 South Florida �,// Behavioral /,AQ Health Network Inc. Rev. 07/01/2012 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 ) 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: hftp://harvester.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. 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 Attachment II Guidance /Care Center, Inc. Page 2 of 3 Contract No. ME225 -4 -27 ��/ South Florida � Behavioral Health Network, Inc. Rev. 07/0112012 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. Attachment [I Guidance /Care Center, Inc. Page 3 en 3 Contract No. ME225 -4 -27 r - South Florida Behavioral Health Network, Inc. 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 ofa 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 sub - awards at all tiers (including subcontracts, sub - grants, and contracts under grants, loans and cooperative agreements) and that all sub - recipients 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. — Y" t tv 7/0_� Signature Dale EC4W K- ?,mss rFD Name of Authorized Individual HIE 2 _2-r- Y- 2 7 Application or Contract Number Gwdancz" G*Vt.e' . Name of Organization 30010 yZir = "-ect (pe �"I � , e, 330510 Address of Organization CF 1123, PDF 03196 Guidance /Care Center, Inc. Attachment III Contract No. ME225 -4 -27 Page I or I ,.� South Florida Behavioral Health Network, Inc. ATTACHMENT IV Working Agreement for SSI /SSDI Outreach, Access, and Recovery (SOAR) Initiative Community Provider Agency The CommunWPmviderAgencyshalfhave deslgnatedSOAR tralaedstaffwho agree to do thefoNond 1. Participate in the SOAR Initiative to include the submission of SOAR web -based data outlined in this World rig Agreement. 2. 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 utilized for all initial SOAR applications. The proceduwe should include the agreed upon preferred method of communication with the SSA liaison ar..: ,w the protective filing date will be established for each claim. 3. Submit claims for SOAR applicants as soon as possible but within two weeks of the notification, at the latest. 4. Complete and submit a SSA 1696 Appointment of Representative form that will list the name of the individual and the agency that will serve as the SOAR claimant's representative. This form will be submitted with the application. 5. Follow up on any additional needed non- medical information for SSA within two working days of notification of the need for information. '['his follow -up will either provide the documentation needed or notify SSA of the steps being taken to obtain the notification. 6. Receive notification from the SSA claims representative once the claim has cleared the non - medical process and has been sent to the Division of Disability Determinations (DDD). This notification will take place within 24 hours of sending the claim to the DDD. 7. Obtain all existing medical information and submit it to the DDD, once the application for SSI /SSDI is completed. 8. Contact the DDD office within one week of notification of the claim having gone to the DDD to determine who the disability adjudicator is and make contact by phone with that adjudicator, notifying him /her of working with a SOAR claimant, confirming the authorized representative status, and informing the examiner of the records being collected. 9. Maintain contact with the DDD adjudicator as appropriate, to check on the status of the claim and to continue to submit information. 1.0. Submit all existing medical information and additional evaluation information to the DDD within 30 calendar clays of the submission of the application to the DDD by SSA. 11. Submit the medical summary report to the DDD within 30 calendar days as well. 12. Collect data regarding SOAR applications and submit it on an ongoing basis, via the Policy Research Associat , web -based data entry program. In VIA- CCU, r � Executive D' ctor (Print Nam) Community Provider Agency Signattu'e Date Guidance /Care Center, Inc. Attachment IV Contract No. ME225 -4 -27 Page 1 of I // '� South Florida Behavioral Health Network, Inc. ATTACHMENT V Scope of Work The Guidance /Care Center's (G /CC) program consists of three evidenced -based practices and an environmental strategy to address the specific long -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): Youth living in Monroe County 1 1,1231 Teens living in Monroe County Environmental Strategy: "Parents Who Host, Lose the Most" 1 60.6191 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, 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 living at Florida Keys Children's Shelter in Tavernier. The TGFD Program will be available to 5 and 6 graders attending Big Pine Academy, 7th and 8 graders attending Key Largo Middle School, and Plantation Key Middle School, and K -5 graders attending Stanley Switlik School, and 6 graders at Marathon Middle School. Site Name Street Address City Zip Code. Children/ Youtft , = = # parents # Other. 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 Fla Keys Children's Shelter 73 High Point Rd. Tavernier 33070 40 0 0 Big Pine Academy 30220 Overseas Highway Big Pine 33043 281 0 1 0 Guidance /Care Center, Inc. Contract No. ME225 -4 -27 Attachment V Page 1 of 8 /.� South Florida Behavioral Health Network, Inc. PERFORMANCE MEASURES ;Quantity Activitles/Ser4tce Name & Description (tnelude ,. = - # # # # Required %To Meet Activity frequen ,jntensity, & duration of.sessions, as well as ` Children/' Parents,' Other, Sessions Required' level (I ar k the number of cycles expected to. be offered and ` Youth tentative 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 each 2014 cohort Teen Intervene 50 0 0 85% 2 50 served from July 1, 2013 through June, 30, 2014 1 assessment 3 sessions for 1.5 hours each Environmental Strategy — Parents Who Host, Lose 5,000 20,109 5,000 100% NA The Most 822 Environmental Public education, Social Marketing, Media Advocacy activities Strategy 400 Public Service Announcements on radio and monthly newspaper ads 5 press releases 250 Monthly Newsletters "Monroe Parents Know" distributed to community agencies /doctor offices /hospitals /schools 1 media campaign 10 presentations in the community 20 campaign posters in windows of local businesses 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 https : / /www.drugfreeactionaIliance .org/parents -who- host /prevention Quantity Performance Measures Activity/ Service Name and # of participants to receive -- ` , Required # of sessions for % of participants:. Description service partidpants' 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 Guidance /Care Center. Inc. Contract No. ME225 -4 -27 Attachment V Page 2 of 8 South Florida I Behavioral Health Network, Inc. Too Good For Drugs Too Good For 1,123 10 sessions 85% = 955 Violence a At the end of each cohort of (Participant Retention) Participants Teen Intervene 50 1 assessment and 85% = 43 complete Too Good for Drugs, Too Good for 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 60,619 822 activities I 85 %= 51,527 Parents Who Host, Lose the Most TGFD /TGFDV program 85% of 50 or 43 participants complete the participants Quality Description of the required program Quality measures. Quality Measure: Measurement and Reporting tool Timing Average number of sessions attended Participant sign -in sheets collected at each a At the end of each cohort of (Participant Retention) session — Pre and Post tests from each group sessions 85% of 1,123 participants or 955 will participant and each cohort • NOTE: Letters of Agreement complete Too Good for Drugs, Too Good for with all participating schools Drugs and Violence post test and a minimum will be submitted prior to of 8 sessions Participant satisfaction surveys implementation of each TGFD /TGFDV program 85% of 50 or 43 participants complete the Participant sign -in sheets collected at each *Propose one (1) by July 31, 2013, two Teen Intervene sessions —a minimum of session (2) by August 30, 2013, four (4) by sessions September 30, 2013, six (6) by October Pre and Post tests from each participant 31, 2013, five (5) by November 30, 2013, three (3) by December 31, 2013, Participant satisfaction surveys five (5) by January 31, 2014, six (6) by February 28, 2014, six (6) by March 31, 2014, one (1) by April 30, 2014, eight (8) by May 31, 2014, and three (3) by June 30, 2014 for a total of 50 youth. NOTE: Monroe County FCAT's tentatively scheduled for April, 2014 Measure: (Survey and Logs) Guidance /Care Center, Inc. Contract No. ME225 -4 -27 Attachment V Page 3 of 8 �►� South Florida Behavioral Health Network, Inc. # and % of youth satisfied with services 90% • At the end of each TGFD V provided Satisfaction survey sessions for youth in TGFDV At admission into program NOTE: Continued staff • At the end of each Teen PEPS system & The GCC Intervene session — or by June database 30, 2014 for youth in Teen Foundation Intervene Observation of service delivery/ Fidelity Curriculum fidelity checklist One time for each cohort (school) checklist Propose in October and March Documentation of structured supervision Supervisory Tool /Checklist and Notes During regular supervisory sessions TGFCV /TGFD for each staff and not less than one as follows: Key West High, sessions facilitated; time per month # and % of staff with necessary 100% At the time of contract monitoring training/certification 2014 Participant Outcomes Outcome Data Source /Measurement Timinj Associated Activity 1,123 youth will receive the 1. Data entered into the At admission into program NOTE: Continued staff TGFDV /TGFD curricula annually PEPS system & The GCC training per Mendez database At end of sessions Foundation 2. Client enrollment forms recommendations 3. Pre /post surveys Propose (every two (2) years). Each cohort to begin TGFD / TGFDV TGFCV /TGFD as follows: Key West High, sessions facilitated; September 2013, and February, Data collected and 2014 entered in database; Stanley Switlik School, August, Data analyzed; 2013 and ongoing for four(4) Program improvement quarters each 9 weeks activities Big Pine Academy, September, 2013 Outputs: 8 Of 10 Marathon Middle School, sessions September, 2013 Marathon High School, February, 2014 NOTE: Monroe County Coral Shores High School, August, FCAT's are tentatively 2013 scheduled for April, Florida Keys Children's Shelter, 2014 July 1, 2013 Plantation Key School, October, 2013 Plantation Key School, October, 2013 50 youth will receive Teen 1. Data entered into the At admission into the program Prior to delivery of 1 Intervene annually PBPS system & GCC session database At end of sessions youth will 2. Client enrollment forms complete a post survey Sessions delivered vui�an�.civaic �.crnci, nw• Contract NO. Mt'ZZb - - Attachment V Page 4of8 Pr� South Florida // Behavioral Health Network, Inc. Attachment V Page 5 of 8 Survey administered 85% of the youth will complete 1. Attendance records 1. Youth sign attendance records Youth sign the at least the required 10 2. Service deliver data for each session attendance record at sessions of TGFDV /TGFD entered into GCC database 2. Staff enter service delivery data the beginning of each curricula daily session 3. Post surveys administered at Post surveys the end of the sessions administered and data collected and analyzed 85% of the high school 1. Attendance records 1. Youth sign attendance records Youth sign the students will complete at least 2. Data entered into GCC at each session attendance record at the 3 required sessions of Teen database 2. Staff enter service delivery data the beginning of each Intervene daily /based on services rendered session 3. Post surveys administered at the end of the sessions Post surveys administered and data collected and analyzed 85% of the youth will improve TGFDV /TGFD pre /post tests Collected immediately prior to the During the first /last their attitudes and beliefs 1St session and immediately sessions of the related to risk of harm of following the last session curriculum; for youth underage drinking 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 prior to the Youth will complete alcohol use in past 30 -day by 1 session and immediately the surveys; for youth curriculum completion following the last session only completing the 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 Campaign materials targeting Promotion Parents Who July. 1, 2013 -June 30,2014 MOU's with SAO, GCC, parents and adults in the Host Campaign "Monroe Parents Know" monthly Monroe Co. Coalition community to include monthly newsletters distributed and HSA. newsletters (Monroe Parents throughout Monroe County the Know), monthly newspaper first week of each month, PSA's on State Attorney's Office, ad r three (3) radio stations covering r Attachment V Page 5 of 8 South Florida Behavioral Health Network, Inc. different radio stations Monroe County, each and Human Services throughout Monroe County, broadcasting the PSA's a minimum Associates to be ads on Monroe County Sheriff's of fifteen (15) times monthly at represented at the website, handouts at monthly targeted times of the day and Monroe County Student Advisory Council night, ads on Monroe County Coalition monthly meetings, Parents Who Host Sheriff's website corresponding to meetings the 3' Stickers on front page of local major teen events in the County Tuesday of each newspapers such as Homecoming in October, month in Key West, Fl Quarterly meetings with 2014, Spring Break in Feb, March, and to collaborate to Increased collaboration with Monroe County Sheriff's April, achieve outcomes of Law Enforcement in Monroe Office /Key West Police 2014,ProminMay,2014,Graduation EBP's; outcomes County to increase Department in June, 2014; monthly ads on the measured by monthly enforcement of Florida's Social Monroe Co.Schools website reports of each agency Hosting law of parents and reminding parents of the Florida at monthly Coalition adults providing alcohol to Host Law, Parents Who Host meetings; information minors handouts at monthly Student compiled by Coalition Advisory Council meetings 1st Tuesday of each month at all three NOTE: Due to the (3) high schools beginning 9/2/13 elimination of — 6/3/2014; Parents Who Host attorney's position at stickers placed on Keynoter and SAO, the money paid Increase arrests by both Key Free Press newspapers 1x in to hire him ($30,000), West Police and Monroe October, 2013, 1x in December, will be incorporated County Sheriff as a result of the 2013, 1x in April, 2014, 1x in May, back into Parents Who collaborations with both 2014. Host Campaign — departments proposed uses include video PSA's at three (3) Increased awareness of the movie theaters — one community as to the Florida Increased calls to Key West Call both police departments by in Key West, one in Host Law Police Department and to 15 of each month to get reports Marathon, and one in Monroe County Sheriff s of calls Tavernier, Florida; Department to report underage cinema PSA's to run drinking parties throughout 2013 -2014 depending on cost;. Mailings, more staff time to distribute brochures, newsletters, and window clings, and placing of additional stickers on home - delivered newspapers; more radio PSA "s and more community presentations EVIDENCE BASED PROGRAMS (EBP) Guidance /Care Center, Inc. Contract No. ME225 -4 -27 Attachment V Page 6 of 8 South Florida ":;05400 Behavioral Health Network, Inc. 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. Too Good for Drugs and Violence (TGFDV), SAMSHA approved, NREPP Option 1 Too Good for Drugs (TGFD) Teen Intervene SAMSHA approved, NREPP Option 1 Parents Who Host, Lose the Most Promising Practice with research to support it Option 2 https : / /www.drugfreeactionaIIiance .org/parents- who- host /prevention TASK LIST Activities Year 1 Activities /Service Name & Description # & Type of EBP % to Meet Participants Recommended this Sessions or Hours Outcome Activity Title: Too Good For Violence /Too Good For Drugs 1,123 youth 1 hour for 10 85% Activity Description: Participants will be recruited from designated sessions schools and will receive a pretest assessment of their risk and protective factors. The curriculum will be administered once per week for 10 sessions and the post -test will be administered at the end of the sessions Frequency: One time upon program entry. Intensity: 8 -10 sessions Duration: 1 hour per session. Activity Title: Teen Intervene Curriculum 50 youth 3 sessions @ 1.5 85% Activity Description: Participants will be required to attend 90 minute hour per session sessions Frequency: One time per week Intensity: Three sessions Duration: One 90 minute session Activity Title: Parents Who Host, Lose the Most 5000 822 100% Activity Description: Participants will be reached by ads, radio PSA's, children /youth, mailings, community meetings, posters placed at local businesses, 20,109 parents, newsletters placed at local agencies 5000 others Frequency: PSA's 44 weeks Intensity: 3x 1day for 3 days per week Duration: 30 seconds each Activity Title: Parents Who Host, Lose the Most 15 -20 parents, 12 sessions 85% Activity Description: Community Meetings teachers,city Frequency: 1x monthly Aug 2013 -July 2014 &,county Intensity: 12 meetings personnel, Duration: 60 minute meetings business Attachment V Page 7 of 8 PPM PPM South Florida Behavioral Health Network, Inc. Guidance /Care Center, Inc. Contract No. ME225 -4 -27 Attachment V Page 8 of 8 leaders, community members Activity Title: Parents Who Host, Lose the Most 50 mailings Mailings =36 100% Description: Mailings & Poster placement each Cycle to hrs /Cycle - Frepuency & Intensity 4x Mailings, Poster placement 1x cycle 1, 1x key contacts in Posters =40 cycle2, Newsletters distributed 1x monthly, 2 cycles, Stickers placed on community for hrs. Free Press Newspapers /Keynoter Newspapers lxcycle 1 and lxcycle 2 outreach Newsletters Duration 6 months support, 20 = 40hrs, Poster /Sticker Newspapers =20hrs Placements at local businesses. Guidance /Care Center, Inc. Contract No. ME225 -4 -27 Attachment V Page 8 of 8 07/01/2012 South Florida Behavioral 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." Contract Document The Network provider shall provide services in accordance with the terms and conditions specified in this contract including all attachments, exhibits, the application filed with the Department of Children and Families by the Network Provider dated 06/12/2012, incorporated herein by reference, and any other documents incorporated by reference which constitute the contract document. 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 November 1. 2012 It shall end at midnight, local time in Miami -Dade County, Florida on June 30. 2015 subject to the satisfactory performance by the network provider and subject to the availability of funds. 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, Guidance /Care Center, Inc. Page 1 of 121 Contract # PPG -1 -06 07/01/2012 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 the Certification Regarding Lobbying form, Attachment Ill. 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 Order11 -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. Guidance /Care Center, Inc. Page 2 of 121 Contract # PPG -1 -06 07/01/2012 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(1)(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 IV 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 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 Guidance /Care Center, Inc. Page 3 of 121 Contract # PPG -1 -06 07/01/2012 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, and all the requirements of this contract. A copy of the contract 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 Guidance /Care Center, Inc. Page 4 of 121 Contract # PPG -1 -06 07/01/2012 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. 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 agrees that it will award sub - grants to PPG Partners as described in its application and that it will do all things which it asserted that it will do in that application including, but not limited to, supervising and coordinating expenditures made by sub - providers. The Network Provider further agrees to assure that funds are expended for the purposes intended and that a full accounting for these grants funds is made. g. 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 Guidance /Care Center, Inc. Page 5 of 121 Contract # PPG -1 -06 07/01/2012 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 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 Guidance /Care Center, Inc. Page 6 of 121 Contract # PPG -1 -06 07/01/2012 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. Page 7 of 121 Contract # PPG -1 -06 07/01/2012 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 Guidance /Care Center, Inc. Page 8 of 121 Contract # PPG -1 -06 07/01/2012 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. 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. Guidance /Care Center, Inc. Page 9 of 121 Contract # PPG -1 -06 07/01/2012 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 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 Guidance /Care Center, Inc. Page 10 of 121 Contract # PPG -1 -06 07/01/2012 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: hftp://www.dcf.state.fl.us/admin/civilri-ghts/ 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 $433.341.00 subject to the availability of funds and satisfactory performance of all terms by the Network Provider. The remaining amount of $0.00 represents "Uncompensated Units Reimbursement Funds ", which the ME, at its sole discretion and subject to the availability of Guidance /Care Center, Inc. Page 11 of 121 Contract # PPG -1 -06 07/01/2012 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, approve, and issue payment to the network provider for good 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 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 Guidance /Care Center, Inc. Page 12 of 121 Contract # PPG -1-06 07/01/2012 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 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 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 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. e. Should the termination of the contract be inevitable, the network provider shall work in collaboration with the ME to develop a transition plan and timeline to ensure the uninterrupted continuum of services to individuals served under this contract, to include but not limited to the transfer of client records. 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 Guidance /Care Center, Inc. Page 13 of 121 Contract # PPG -1 -06 07/01/2012 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. Page 14 of 121 Contract # PPG -1 -06 07101/2012 a. The Provider name, as shown on page 1 of this Contract, and mailing address of the official payee to whom the payment shall be made is: Guidance /Care Center, Inc. 3000 41 Street Ocean Marathon, Florida 33050 b. The name of the contact person and street address where the representative Provider's financial and administrative records are m aintained is: Marianne Benvenuti, Regional Controller 3000 41 s ` Street Ocean Marathon, Florida 33050 Tel: (305) 434 -7660 EXL31131 E -mail: Marianne.be r!uti westcare.,..... c. The name, address, and telephone of the Contract Manager for the ME for this contract is: Evelyn Kelly South Florida Behavioral Health Network, Inc. 7205 Corporate Center Drive, Suite #200 Miami, Florida 33126 Tel: (786) 507 -7461 E -Mail: ekelly0Z,§khn,0rq d. The name, address, and telephone number of the representative of the Provider responsible for the administration of the ro ram under this contract is: Frank Rabbito, Sr. Vice President 3050 Biscayne Boulevard, Suite 900 Miami, Florida 33137 Tel: (305) 571 -8600 E -mail: frabl it OiCi? w stcar ,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, I ll IIL and IV and any exhibits referenced in said attachments, together with any documents incorporated by reference, including the ME Prime Contract (which can be found at http:Uwww.sfbhn.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: Guidan re Center, Inc. SIGNED BY: NAME: Frank Rabbito SOUTH FLORIDA BEHAVIORAL HEALTH NETWORK, INC. BY: NED NE� ahn W. Dow ;,T` IT.CE�: President/CEO TITLE: Sr. Vice President DATE: Federal Tax ID# (or SSN #): 59- 1458324 DATE: / Provider Fiscal Year Ending Date: 06130 Guidance /Care Center, Inc. Page 15 of 121 Contract # PPG -1-06 07/01/2012 ATTACHMENT 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" means an educational process or procedure intended to stimulate learning. (3) "Adaptation" is a modest to significant modification of an intervention to meet the needs of different people, situations, or settings. (4) "Adolescent" means a client who is receiving substance abuse treatment prevention services who is between the ages of 12 and 17. (5) "Adult" is an individual 18 years of age or older. (6) "Approaches" mean the methods used in dealing with or accomplishing a task or goal. (7) "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. (8) "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. (9) "Available Appropriations" means State and other governmental funds allocated for mental health and substance abuse services including Guidance /Care Center, Inc. Page 16 of 121 Contract # PPG -1 -06 07/01/2012 prevention and the associated local matching funds. (10) "Baseline" is the initial time point in service interventions just before the intervention or treatment begins. The information gathered at baseline is used to measure change in targeted outcomes over the course of the services. (11) "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 (12) "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. (13) "ChildrenNouth" is an individual 0 -17 years of age. (14) Client" (synonymous with recipients of services /individual(s) served) means 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" 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. (16) 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. (17) "Community" means a specific geographic or demographic population. Geographic includes counties and municipalities. Demographic includes race, ethnicity, age, gender or any combination thereof. In terms of the Prevention Partnership program "Community" is a collaborative partnership between local community substance abuse coalitions with the primary goal of addressing underage alcohol issues in the surrounding communities. Guidance /Care Center, Inc. Page 17 of 121 Contract # PPG -1 -06 07/01/2012 (18) "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. (19) "Community Events" mean 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 (Indirect Prevention only). (20) "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. (21) "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. (22) "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. (23) "COMPASSTM (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. (24) "Comprehensive Community Action Plan" means a plan developed by a local, department recognized, community substance abuse coalition which Guidance /Care Center, Inc. Page 18 of 121 Contract # PPG -1 -06 07/01/2012 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: 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. (25) "Consequences" is 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. (26) "Consolidated Program Description" means the combination of all of the managing entity network providers' program descriptions and the managing entity program description. (27) "Consumer Price Index" is a measure of the average change in prices over time of goods and services purchased. (28) "Continuous Quality Improvement" means 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. (29) "Contract Manager" means 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. (30) "Contributing Factors" are more specific dimensions or aspects of constructs which collectively can be used to measure the theory to which they are linked. (31) "Co- occurring Disorder' means any combination of mental health and substance abuse in any individual, whether or not they have been already Guidance /Care Center, Inc. Page 19 of 121 Contract # PPG -1 -06 07/01/2012 diagnosed. (32) "Co- occurring disordered family" means 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. (33) "Co- occurring Disorder Service Capability means 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. (34) "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). (35) "Cost Analysis" means the review of the proposed cost elements to determine if they are necessary, allowable, appropriate and reasonable. (36) "Cost Center" means 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. (37) "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 the service. (38) "Data Management" means activities that use data elements to track cost, utilization, quality of care and access to services within the network of providers. (39) TCF PAM 155 -2" means 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. (40) "Department" means the State of Florida Department of Children and Guidance /Care Center, Inc. Page 20 of 121 Contract # PPG -1 -06 07/01/2012 Families. (41) "Direct Contact" means activities conducted by a 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). (42) "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. (43) "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. (44) "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. (45) "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. Guidance /Care Center, Inc. Page 21 of 121 Contract # PPG -1 -06 07/01/2012 (46) "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. (47) "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. (48) "Evidence- Based" means those practices that are based on accepted practices in the profession and are supported by research, field recognition, or published practice guidelines. (49) "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. (50) "Fidelity" is the degree to which the evidence -based practice implemented adheres to the practice's implementation design. (51) "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. (52) "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. (53) "Governing Board" means the Commission, Board of Directors, Board Guidance /Care Center, Inc. Page 22 of 121 Contract # PPG -1 -06 07/01/2012 of Trustees, Governing Body, etc. (54) "HIPAA" is the acronym for Health Insurance Portability and Accountability Act. (55) "Implementation" is the use of a prevention or service interventions in a specific community -based or other setting with a particular target audience. (56) "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. (57) "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 (58) "Indirect 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. 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." (59) "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). (60) "KIT Solutions" means the entity that maintains the database called Performance Based Prevention System (PEPS). (61) "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. (62) "Logic Model" is a tool that allows key stakeholders to develop a Guidance /Care Center, Inc. Page 23 of 121 Contract # PPG -1 -06 07/01/2012 strategic plan to address an identified community problem. (63) "Managing Entity (ME)" means pursuant to section 394.9082(2)(4), 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. (64) "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. (65) "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. (66) "Needs Assessment Logic Model (NALM)" is a written rationale developed from epidemiology data that illustrates the connection between local substance use /abuse consumption patterns, consequences and intervening variables. This information determines the long -term outcome and is used in the development of the Comprehensive Community Action Plan to inform the identification of strategies and approaches to achieve that outcome. (67) "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. (68) "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. (69) "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. (70) "Overpayment" is for the purposes of this contract, the amount of Guidance /Care Center, Inc. Page 24 of 121 Contract # PPG -1 -06 07/01/2012 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. (71) "Participant" is 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 through the ME. (72) "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/. (73) "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. (74) "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. (75) "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. (76) "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. (77) "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. (78) "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). (79) "Prevention Service" is a structured schedule of activities designed so Guidance /Care Center, Inc. Page 25 of 121 Contract # PPG -1 -06 07/01/2012 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). (80) "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. (81) "Promising Practices" is the use of practices that incorporate the best objective information available regarding effectiveness and acceptability. (82) "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. (83) "Protected Health Information" (PHI) is 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. (84) "Provider Network" (subcontractor or network provider) is 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. (85) "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. (86) "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 Guidance /Care Center, Inc. Page 26 of 121 Contract # PPG -1 -06 07/01/2012 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. (87) "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. (88) "SAMH" means the Substance Abuse and Mental Health Programs within the Department. (89) "SAVENIS Program" is the U.S. Department of Homeland Security (DHS) administers 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. (90) "Schedule of Activities" is the written instructional content, materials, resources, and processes necessary to attain educational objectives (91) "Selective prevention" refers to strategies that are targeted to subpopulations identified as being at elevated risk for a disorder. (92) "Selective prevention" refers to strategies that are targeted to subpopulations identified as being at elevated risk for a disorder. (93) "Service Units" are 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. (94) "Stakeholder" means individuals /groups with an interest in the provision of behavioral health services. (95) "State Designated Prevention Evaluation Contractor" is a comprehensive drug research center Contracted by the Department to Guidance /Care Center, Inc. Page 27 of 121 Contract # PPG -1 -06 07/01/2012 evaluate prevention outcomes. (96) "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. (97) "Strategies" is a plan of action or policy designed to achieve a major goal. (98) "Substance abuse" means a pattern of chronic or harmful use of alcohol, illicit or prescribed drugs that result in adverse physical, psychological, or social consequences. (99) "Substance Abuse and Mental Health Information System (SAMHIS)" means 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) contract, Medicaid, or local match. Instructions on how to access the system can be found in DCF PAM 155 -2. (100) "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. (Contract managers may delete if there is no prevention in this contract.) (101) "Sustainability" is the long -term survival and continued effectiveness of an intervention. (102) "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. (103) "Targeted Prevention" means education and other evidenced - based practices conducted with groups of individuals to reduce personal risk factors or substance abuse or strengthen protective factors. Guidance /Care Center, Inc. Page 28 of 121 Contract # PPG -1 -06 07/01/2012 (104) "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. (105) "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. (106) "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. (107) "Verifiable Service" is a service provision that is documented in compliance with the requirements contained in Rule 65E- 14.021, F.A.C. General Description a. General Statement The services provided under this Prevention Partnership Grant (PPG) agreement are to fund rigorous, effective, evidence - based, substance abuse prevention programs and strategies intended to prevent or reduce Florida substance use and abuse rates at the community level. PPG activities must relate to the local community department- approved local Needs Assessment Logic Model (NALM) to show target population and subpopulation problems to be addressed. The goals and objectives of the Comprehensive Community Action Plan (CCAP) calls for evidence -based prevention program activities or strategies for which there is a demonstrated need. The target population, according to the state priorities, to be addressed through this agreement: x Past 30 day youth alcohol use _ Past 30 day youth marijuana use Prescription drug misuse (youth to age 20) 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 and /or children with behavioral health issues as authorized in section 394.9082, F.S., section 397.99, F.S. and in the Prime Contract, which is incorporated herein by reference. The Network Provider shall also collaborate with the Managing Entity to Guidance /Care Center, Inc. Page 29 of 121 Contract # PPG -1 -06 07/01/2012 better meet the needs of individuals receiving services through this contract. 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 lives of the people 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. Authority Section 394.9082, F.S., and the Prime Contract provides the Managing Entity with the authority to contract for these services. c. 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, Participants to be Served, and in accordance with the tasks outlined in Section 13.1.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 Cl. Major Program Goals Guidance /Care Center, Inc. Page 30 of 121 Contract # PPG -1 -06 07/01/2012 (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 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 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/ and /or from the contract manager. e. 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. (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; Guidance /Care Center, Inc. Page 31 of 121 Contract # PPG -1 -06 07/01/2012 (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. 3. Clients to be Served See Exhibit A, 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) The network provider shall adhere to the services as outlined in the approved Prevention Program Description and in as set forth in Attachment II, Scope of Work. (2) The network provider shall submit an activity work plan by 12/07/2012, and by July 31 of each fiscal year thereafter, to ensure that the program will be successful and on schedule and which shall be detailed as follows: For indicated (Level 2) programs, all steps necessary to select the individual participants to participate in the program; for universal and selective programs (Level 1), all steps necessary to obtain authorization to conduct activities to the proposed groups. • A detailed 3 year plan for all intended activities to be performed during the grant period. Changes to the initial plan must be approved, in writing, by the Contract Manager prior to implementation. Guidance /Care Center, Inc. Page 32 of 121 Contract # PPG -1 -06 07/01/2012 • All steps necessary for tracking outcomes of programs and strategies in the 3 year plan. Changes to the initial plan must be approved, in writing, by the Contract Manager prior to implementation. • Resource estimates and assignments in each step must include all resources needed including staff, hardware, software, physical locations and materials. • Gantt charts showing planned start and end dates of all steps, milestones, and decision points. • A schedule, which provides adequate department SFBHN review time, revision time, if needed, and additional subsequent review time, with specific due dates of all outputs and deliverables. (3) The network provider shall submit a monthly status report, along with the monthly invoice, by the due dates specified in Exhibit C, Required Reports, until full implementation of the work plan is reached. The objective of the monthly status report is to demonstrate the accomplishments towards achieving the goals detailed in the 3 year plan. The activities incorporated into the monthly status report shall include at a minimum the following: • Verify needed accommodations to complete program such as school board authorization, media, accessibility (if applicable), dates, and space requirements. • Prepare staff and purchase supplies and other required materials. • Prepare information technology (IT) capabilities. • The network provider shall complete the Prevention Program Tool (PPT) contained in the Performance Based Prevention System (PEPS) during the initial contract negotiations or when negotiating an amendment to the agreement, and submit to the Contract Manager for review. Once the contract has been signed, the "final" approved PPT shall be printed from PBPS and sent to the Contract Manager within thirty (30) days of execution of this contract. • The network provider's Prevention Program Coordinator and any other personnel responsible for entering data into the Prevention data system, including providers who upload data from their own system, shall register and complete training on use of the PPT at least annually. Guidance /Care Center, Inc. Page 33 of 121 Contract # PPG -1 -06 07/01/2012 The provider shall submit, to the Contract Manager, an attestation affirming the completion of the PPT training within thirty (30) of execution of this contract. The provider shall execute a memorandum of understanding with the local community substance abuse coalitions within sixty (60) days of execution of this agreement to help develop prevention capacity to implement relevant and appropriate evidence -based practices in support of a department- approved Comprehensive Community Action Plan. Based on the most recent local department approved Comprehensive Community Action Plan, the provider agrees to administer and deliver appropriate evidence -based programs or strategies as specified in the Program Description required by Rule 65E- 14.021, F.A.C., and is on file in the SFBHN Contract Manager's file and incorporated herein by reference. (4) The network provider shall submit a monthly invoice support report, by the due dates specified in Exhibit C, Required Reports. The invoice support report shall document the following: • Provide prevention programming as specified in proposal and administer pre -and post -tests within the timeframes as specified in Attachment II, Scope of Work. Provide report evidencing that the strategies for prevention services and activities measures were met. Identify staff time spent performing prevention program services and activities. (5) The network provider shall complete a Fidelity Checklist after each cohort and submit it to the contract manager by the dates specified in Exhibit C, Required Reports. (6) The network provider shall ensure supervision for fidelity and program implementation is documented on a monthly basis. Documentation shall be maintained at the provider's location and submitted to SFBHN upon request. (7) The network provider shall complete an annual Evidence -based Fidelity Self - Assessment Survey by May 1 St of each fiscal year. The Department will provide the link for the yearly Fidelity Self- Assessment survey in SurveyMonkey©. If warranted, the network provider shall complete a Fidelity Improvement Plan Guidance /Care Center, Inc. Page 34 of 121 Contract # PPG -1 -06 07/01/2012 by June 15 of each fiscal year. The objectives of the evidence -based fidelity self- assessment survey and fidelity improvement plan are to ensure fidelity to the chosen program or prevention strategy and ensure quality of the data being submitted. The activities in this process include but are not limited to: Verify automated pre -and post -test and demographic data with a sample of actual data collection forms. Institute quality fidelity improvement measures that monitor the faithfulness of the evidence -based program or strategy. • Complete the fidelity checklist as part of the Fidelity Self- Assessment Survey. (8) The network provider shall provide prevention services as outlined in 65D- 30.013, F.A.C., and in accordance with this contract and the approved Prevention Program Description. (9) The network provider shall ensure that a PPT is completed in the Performance Based Prevention System. (10) 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. (11) Based on the most recent local department approved comprehensive community action plan, the network provider agrees to ensure to administer and deliver appropriate evidence -based programs or strategies. (12) 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. (13) 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, the approved Prevention Program Description and in Attachment II, Scope of Work. (14) 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. Guidance /Care Center, Inc. Page 35 of 121 Contract # PPG -1 -06 07/01/2012 (15) For licensable services, the network provider shall have and maintain correct and current Department of Children and Families 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. (16) By 12/01/2012, 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. (17) By 12/01/2012 establish a Quality Improvement Plan, which is herein incorporated by reference, of quality improvement activities for fiscal year 2012 -2013 and every fiscal year thereafter, 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. (18) By 12/01/2012 the network provider shall submit to the ME's contract manager a plan describing how fidelity to the evidence -based practice(s) purchased under this contract will be guaranteed. The fidelity plan shall be in a format developed by the network provider and acceptable to SFBHN. (19)The network provider shall submit quarterly status reports to the original Fidelity Plan, evidencing the fidelity to the evidence -based practice(s). The report shall be submitted to the ME's contract manager by the dates specified in Exhibit C, Required Reports, in a format developed by the network provider and acceptable to SFBHN. (20) By 12/01/2012 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. (21) By 12/01/2012, the network provider shall submit to the ME's contract manager a disaster plan consistent with Section 29., Emergency Preparedness, of the Standard Contract. (22)On an annual basis, within thirty (30) days of the beginning of hurricane Guidance /Care Center, Inc. Page 36 of 121 Contract # PPG -1 -06 07/01/2012 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. (23) By 12/01/2012 the network provider shall submit to the ME's contract manager a completed Civil Rights Compliance Questionnaire. (24) The network provider shall submit to the managing entity an annual follow - up report, by June 30 of each fiscal year of the contract, on their implementation of the co- occurring action plans. (25) The network provider shall perform the following tasks related to the co- occurring disorder service capability initiative: (a) Evaluate network provider co- occurring disorder service capability as directed by the ME using the COMPASS - Prevention Tool with: A focus group of administrators and prevention services staff, ii. A minimum of one program or a sample of programs on or before June 30 of each year. iii. Follow -up evaluations done at least annually for each program or sample of programs; and iv. Programs or a sample of programs in accordance with timeframes outlined in the action plan for each contract year. (b) Develop and submit to the managing entity for approval an action plan for referring clients with co- occurring disorders by June 30 of each year of the contract term that details: L Networking capacities with local network providers in the community for persons with co- occurring disorders; ii. Strategies and activities to develop or improve co- occurring disorder educational and referral capability; iii. Timeframes for reviewing co- occurring disorder educational and referral capability within the prevention program. (c) Develop and submit to the managing entity a summary report by June 30 of each year that details: L The types of network provider involvement in state and local co- Guidance /Care Center, Inc. Page 37 of 121 Contract # PPG -1 -06 07/01/2012 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; iv. Overall progress toward co- occurring disorder educational and referral capability development in accordance with timeframes specified in the action plan. (26)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. (27) 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. (28) The network provider shall attend the Regional Prevention Meetings and any called meetings when notified by the ME. (29)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 regulations. (30) The network provider shall comply with all requests for information and /or documentation to enable the managing entity to complete the billing validation process. (31)The network provider shall develop and assure the delivery of services based on Evidence - Based Practices Guidelines in accordance with the approved Prevention Program Description. (32) The network provider shall ensure access to services that meet linguistic and cultural needs of recipients. (33) The network provider agrees to provide sign language, translation, and Guidance /Care Center, Inc. Page 38 of 121 Contract # PPG -1 -06 07/01/2012 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. (34) 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. (35)The network provider shall take appropriate steps to obtain 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. (36) 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. (37) 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. (38) Develop, Maintain and Improve Reporting The network provider shall submit reports included in Exhibit C, Required Reports and Attachment II, Scope of Work. 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 entity's contract manager. The managing entity reserves the right to reject reports as incomplete, inadequate or unacceptable. (39)The network 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 Guidance /Care Center, Inc. Page 39 of 121 Contract # PPG -1 -06 07/01/2012 at: http: / /www.dcf. state. fl. us / news /humanresearchpolicy.shtm1 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 vender, even if the aforementioned has their own Institutional Review Board which has granted approval. b. Task Limits The network provider shall perform services in accordance with applicable, rules, statutes, licensing standards the approved Prevention Program Description and with the deliverables as set forth in Attachment II, Scope of Work. The network provider is not authorized by the ME to perform any tasks related to the project other than those described and referenced in in this contract, without the express written consent of the ME. 2. Staffing Requirements a. Staffing Levels (i) The network provider shall maintain staffing levels in compliance with applicable rules, statutes, and licensing standards. 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 (i) The network provider shall comply with applicable rules, statutes, requirements, and standards 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(l)(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. Guidance /Care Center, Inc. Page 40 of 121 Contract # PPG -1 -06 07/01/2012 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. Cl. 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 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 requirements, as well as includes managing entity pre approval. (3) The network provider shall maintain individual subcontractor files for each subcontractor and provide a copy of all 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, 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, Guidance /Care Center, Inc. Page 41 of 121 Contract # PPG -1 -06 07/01/2012 (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.us /mentaIhealth /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 Guidance /Care Center, Inc. Page 42 of 121 Contract # PPG -1 -06 07/01/2012 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 Prevention Program Description required by Rule 65E- 14.021(8)(d)1.d.(III), F.A.C. and /or as specified in Attachment II, Scope of Work. b. Service Times (1) A continuum of services shall be provided on the days and times as specified in the approved Program Description and /or Attachment II, Scope of Work. (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. Cl. Equipment The network provider shall furnish all appropriate equipment necessary for the effective delivery of the services purchased. 4. Deliverables a. Services The network provider shall deliver the services specified in and described in the approved Prevention Program Description submitted by the network provider, as set forth in Exhibit G, State Funding by Program and Activity and in Attachment II, Scope of Work. 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 Guidance /Care Center, Inc. Page 43 of 121 Contract # PPG -1 -06 07/01/2012 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 and as outlined in Attachment II, Scope of Work 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. (3) The network provider shall submit prevention data to PBPS. The network provider shall submit the data electronically by the 4th of each month. The network provider shall also: (a) Ensure that the data submitted clearly documents all program participants, programs and strategies which occurred under this contract; (b) Ensure that one hundred percent (100 %) of all data submitted to PBPS is consistent with the data maintained in the network provider's clients' files; (c) Review the network provider's File Upload History screen in PBPS 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 network provider records were rejected and to make sure that the rejected records are corrected and resubmitted in the PBPS. (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 ten percent (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 s. 402.73(1), F. S., and Rule 65- 29.001 F.A.C., corrective action plans may be required for non - compliance, Guidance /Care Center, Inc. Page 44 of 121 Contract # PPG -1 -06 07/01/2012 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. (4) Upon request, the network provider shall submit to the ME and the Department information regarding the amount and number of services paid for by the Substance Abuse Prevention and Treatment Block Grant. 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 and as outlined in Attachment II, Scope of Work. (2) 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 and Attachment II, Scope of Work. The network provider shall submit all service related data for clients funded, in whole or in part, by SAMH funds. (3) 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 and submit an attestation affirming the completion of the PPT training within thirty (30) days of execution of this contract. This applies to network providers, including subcontractors who have their own data system and upload data to PBPS. 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 (1) The network provider shall collect information and submit performance data and individual client outcomes, to the managing entity data system in compliance with Guidance /Care Center, Inc. Page 45 of 121 Contract # PPG -1 -06 07/01/2012 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, and in Attachment II, Scope of Work, 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:/ /defdashboard.dcf.state.fl.us / . Additional prevention data information may be found on the Exhibit D Substance Abuse and Mental Health Required Performance Outcomes /Outputs 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 in of 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 Guidance /Care Center, Inc. Page 46 of 121 Contract # PPG -1 -06 07/01/2012 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 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. (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. (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 II, Scope of Work, 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 to prevent use or disclosure of PHI other than as provided for by this contract or applicable law. (c) The network provider agrees to report to the department any use or Guidance /Care Center, Inc. Page 47 of 121 Contract # PPG -1 -06 07/01/2012 disclosure of the information not provided for by this contract or applicable law. (d) The network provider hereby assures the department that if any PHI received from the department, or received by the network provider on the department'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 created or received by the network provider on behalf of the department 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 destroy all PHI received from the department 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. Guidance /Care Center, Inc. Page 48 of 121 Contract # PPG -1 -06 07/01/2012 (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. b. Coordination with other Providers /Entities (1) The network provider shall develop, maintain, and improve care coordination and integrated care systems as follows: L Develop Initial Service Agreements (a) The network provider shall fulfill their designated role in developing, implementing and /or maintaining a system of care in support of the agreements with the substance abuse prevention coalition providers funded by the ME. (b) The network provider agrees to fulfill their designated role in Guidance /Care Center, Inc. Page 49 of 121 Contract # PPG -1 -06 07/01/2012 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 engaged by the managing entity for the development of cooperative agreements with other external stakeholders. (d) 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. (e) The network provider shall execute a Memorandum of Understanding (MOU) with a local community coalition. The MOU shall be submitted to the ME's contract manager on or before November 30, 2012, and on July 31 of each fiscal year thereafter. 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 participant- 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 are designed to preclude the development Guidance /Care Center, Inc. Page 50 of 121 Contract # PPG -1 -06 07/01/2012 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. (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. b. Monitoring Requirements (1) The ME will monitor the network provider in accordance with this contract and the managing entity's 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 entity's or Department 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. c. Training and Technical Assistance (1) The ME's contact manager will provide technical assistance concerning the terms and conditions of this contract. The ME will provide technical assistance and support to the network provider to ensure the continued integration of services and support for clients. 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 Attachment 11, Scope of Work. In addition, the ME may convene cross - organizational training and assistance to help non - accredited network providers become accredited. (2) The managing entity implements a training program for its staff and the network provider staff. The trainings assure that staff receives externally Guidance /Care Center, Inc. Page 51 of 121 Contract # PPG -1 -06 07/01/2012 mandated and internal training. The managing entity may coordinate training or directly provide training to network provider staff. Cl. 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, II, III, and IV and 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 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% for Fiscal Year 2012 -2013, 10.28% for fiscal year 2013 -2014 and 9.9% for fiscal year 2014 -2015, 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 should be engaged in performance improvement activities to improve its ability to recognize accurate prevalence of co- occurring disorders in its data system. 3. 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 Managing Entity's Director of Prevention Services of progress annually. 4. Continuous Quality Improvement Programs for Substance Abuse Prevention Services Network Providers Guidance /Care Center, Inc. Page 52 of 121 Contract # PPG -1 -06 07/01/2012 (1) The 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) Each service provider must have a quality assurance and improvement plan and processes through which quality is continually monitored to achieve the program's planned outcomes. A copy of this plan must be submitted to the managing entity upon request. Best practices for quality performance measures should be incorporated: experienced, well- trained staff, adequate participant - staff ratio, theory- driven programs, retention of research -based core elements, variety of teaching methods and interactive approaches, sufficient exposure to the services /intensity, Long -term prevention programs /duration and complementary components, positive relationships, cultural sensitivity and relevance, meaningful performance measures that are valid and reliable, and data for decision - making. Additionally, a minimum guideline for the network provider's continuous quality improvement program, including, but not limited to: (a) Ongoing efforts to improve products, services or processes to include managing entity initiatives. (b) Records maintenance, tracking and compliance as applicable. (c) Staff competencies, training, and development standards. (d) service- environment safety and infection control standards. (e) Incident reporting policies and procedures that include verification of corrective action and a provision that specifies that a person who files an incident report, in good faith, may not be subjected to any civil action by virtue of that incident report. (f) 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 provider 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. Guidance /Care Center, Inc. Page 53 of 121 Contract # PPG -1 -06 07/01/2012 (5) The quality improvement program must also: (a) Provide a framework for evaluating outcomes including" (i) Output measures, such as capacities, technologies, and infrastructure that make up the system of care. (ii) Process measures, such as administrative and supervision components (iii) Outcome measures pertaining to the outcomes of services; (b) Provide for a system of analyzing those factors which have an effect on performance; (c) Provide for a system of reporting the results of continuous quality improvement reviews; and, (d) Incorporate best practice models for use in improving performance in those areas which are deficient. The ME and the Department 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 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 5. Incident Reports 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. 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 Guidance /Care Center, Inc. Page 54 of 121 Contract # PPG -1 -06 07/01/2012 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. All network providers (inpatient and outpatient) will report seclusion and restraint events in accordance with Rule 65E- 5.180(7)(g), F.A.C. into SAMHIS. 6. Mandatory Reporting Requirements 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: 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 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. 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. 7. 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 are 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. 8. 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 Guidance /Care Center, Inc. Page 55 of 121 Contract # PPG -1 -06 07/01/2012 uniform schedule of discounts referenced in Rule 65E- 14.018(4), F.A.C. shall be furnished to the managing entity within thirty (30) days of contract execution. 9. National Provider Identifier (NPI) All network providers shall obtain and use an NPI, a HIPAA standard unique health identifier for health care providers. An application for an NPI may be submitted online at hfps: / /nppes.cros. hhs.gov /NPPES /StatieForward.do ?forward = static.npistart. Additional information can be obtained from one of the following websites: The Florida Medicaid HIPAA located at: http: / /www.fdhc .state.fl.us /hipaa /index.shtml The National Plan and Provider Enumeration System (NPPES) locat at: https: / /nppes .cros.hhs.gov /NPPES/Welcome.do The CMS NPI located at: http: / /www. cros. hhs.gov /NationalProvldentStand/ 10. 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 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 42., of the Standard Contract and 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. Guidance /Care Center, Inc. Page 56 of 121 Contract # PPG -1 -06 07/01/2012 11. 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. 12. 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. 13. 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. 14. 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 42., 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. 15. 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 Guidance /Care Center, Inc. Page 57 of 121 Contract # PPG -1 -06 07/01/2012 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 departure and return, per diem or meals allowance, map mileage, incidental expenses, signature of payee and payee's supervisor. For prevention services that are paid on the basis of direct staff hour, as specified in Chapter 65E -14, F.A.C., this unit of measure represents the actual time spent on activities directly associated with a single client, including case staffing. Time may include travel if the travel is integral to a service event otherwise billable to the Managing Entity. Direct staff hour shall be paid on the basis of utilization. For prevention services that are paid on the basis of non - direct staff hour, as specified in Chapter 65E -14, F.A.C., this unit of measure represents the actual time spent on activities that cannot be directly associated with a single client, but are integral to the program and described in the approved Prevention Program Description. Time may include travel if the travel is integral to a service event otherwise billable to the Managing Entity. Non - direct staff hour shall be paid on the basis of utilization. The network provider agrees to maximize the use of state residents, state products, and other Florida -based businesses in fulfilling their contractual duties under this contract. 16. 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 network provider /grantee to perform work pursuant to this contract within the United States and its territories, and all persons (including subcontractors) assigned by the network provider to perform work pursuant to the contract with the ME. "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 Guidance /Care Center, Inc. Page 58 of 121 Contract # PPG -1 -06 07/01/2012 or services to or for a prime provider or another subcontractor. (b) Enrollment and verification requirements. (1) The network provider shall - (i) Enroll. Enroll as a network provider in the E- Verify program within thirty (30) calendar days of contract award; (ii) Verify all new employees. Within ninety (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 network provider /subcontractor to perform work pursuant to the contract with the ME shall be verified as employment eligible within three (3) business days after the date of hire; and (2) The network provider 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 network provider's enrollment and deny access to the E- Verify system in accordance with the terms of the enrollment. In such case, the network provider 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 network provider 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 network provider 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.goy /E- Verify . (d) Individuals previously verified. The network provider 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. The network provider 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 network provider through the E- Verify program. (f) Evidence of the use of the E- Verify system will be maintained in the employee's personnel file. Guidance /Care Center, Inc. Page 59 of 121 Contract # PPG -1 -06 07/01/2012 (g) Subcontracts. The network provider shall include the requirements of this clause, including this paragraph (g) (appropriately modified for identification of the parties), in each subcontract. (h) The subcontractor at any tier level must comply with the E- Verify clause as subject to the same requirements as the network provider. E. List of Exhibits The following exhibits, or the latest revisions thereof, are incorporated in and made a part of the contract. Exhibit A, Participants to be Served Exhibit B, Method of Payment Exhibit C, Required Reports Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs Exhibit E -1, Substance Abuse and Mental Health Monthly Request for Non - TANF Payment/Advance Exhibit F, Minimum Service Requirements Exhibit G, State Funding by Program and Activity Exhibit H, Funding Detail & Local Match Plans Guidance /Care Center, Inc. Page 60 of 121 Contract # PPG -1 -06 07/01/2012 EXHIBITA PARTICIPANTSTO BE SERVED 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 Substance Abuse Adult Mental Health- Severe & Persistent Mental Illness Children's Substance Abuse Adult Mental Health- Serious & Acute Episodes of Mental Illness Community Prevention -Adult Substance Abuse ❑ Adult Mental Health - Mental Health Problems ❑ Community Prevention- Children Substance Abuse 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/Participant Eligibility 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. C. Participant Determination a. Determination of client eligibility is exclusively the responsibility of the network provider. b. 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 a. 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 specified in Exhibit G, State Funding by Program and Activity. b. 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. c. 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. Page 61 of 121 Contract # PPG -1 -06 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 $ 433.341.00 , 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 $ 433.341.00 subject to the delivery and billing for services. The remaining amount of $ 0.00 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 ten 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 $108,336.00 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 Guidance /Care Center, Inc. Page 62 of 121 Contract # PPG -1 -06 07/01/2012 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. Children's Mental Health Programs (100435 Category & 102780 (PRTS) Category) that are not grant funded. Cl. 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 Guidance /Care Center, Inc. Page 63 of 121 Contract # PPG -1 -06 07/01/2012 This contract is exempt from the MyFloridaMarketPlace Transaction Fee in accordance with Rule 60A- 1.032(l)(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 (if applicable) 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: i. 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). 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. Cl. 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 Guidance /Care Center, Inc. Page 64 of 121 Contract # PPG -1 -06 07/01/2012 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 ME. 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/Advance within seven (7) days following the end of the month for which payment is being requested for the delivery of service. d. 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 seven (7) days following the end of the month. e. 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. f. 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 Guidance /Care Center, Inc. Page 65 of 121 Contract # PPG -1 -06 07/01/2012 exceed the total number of units reported and accepted in the ME's data system pursuant to Rule 65E- 14.022, F.A.C. g. 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. h. Invoices shall be submitted in detail sufficient for a proper pre -audit and post- audit. 7. Supporting Documentation 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. The provider shall maintain and /or submit as defined in Attachment I, Section B.1.a. by the dates specified in Exhibit C, Required Reports, documentation to support all units billed to the ME and units subtracted for SAMH client services on each monthly request for payment. The network provider shall ensure that all services provided are entered into the PBPS. 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 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. Page 66 of 121 Contract # PPG -1 -06 07/01/2012 EXHIBIT C REQUIRED REPORTS Required Reports Due Date # oJFF end to: Co Response to Monitoring Reports and Corrective Action Within 10 days from the day the report is BHN Contra ct Plans received. 1 anager Sliding Fee Scale [reflecting the uniform schedule of Within 30 days after the beginning of each BHN Contract discounts referenced in 65E- 14.018(4)] fiscal year. 1 Manager Final FY 2012 -2013 (1) Network Providers Agency Service Capacity Report, (2) Within 30 days after Contract execution or Projected Cost Center Operating and Capital upon request of the Contract Manager 1 FBHN Contract Budget (If applicable), Manager (3) Cost Center Personnel Detail Report (If applicable), & (4) Program Description. Monthly Data Required by DCF PAM 155 -2 Within 4 days after end of month following the Electronic SFBHN MIS Office month of service Submission Incident Report Within 24 hours of occurrence 1 IRAS Audit Schedules for Network Providers, as applicable Due 180 days after the end of the fiscal year Schedule of State Earnings r 30 days upon completion of audit, 1 SFBHN Contract whichever comes first. Manager Due 180 days after the end of the fiscal year Schedule of Related Party Transaction Adjustments r 30 days upon completion of audit, 1 SFBHN Contract whichever comes first. Manager Program /Cost Center Actual Expenses &Revenues Due 180 days after the end of the fiscal year SFBHN Contract Schedule r 30 days upon completion of audit, 1 Manager ichever comes first. Due 180 days after the end of the fiscal year Schedule of Bed -Day Availability Payments r 30 days upon completion of audit, 1 SFBHN Contract whichever comes first. Manager 180 days after the end of the managing Financial & Compliance Audit per Attachment IV entity's fiscal year or 30 days after its 1 SFBHN Contract completion, whichever comes first. Manager (See Attachment IV) Other Reports Monthly Service Invoice Monthly, by the 7 4t after the 1 SFBHN Contract month of service Manager Activity Work Plan December 7, 2012 and by July 31' of each fiscal 1 SFBHN Contract ear Mana er Memorandum of Understanding (MOU) with a Coalition November 30 th , 2012 and by July 31 of 1 SFBHN Contract each fiscal year Manager Monthly Status Report (Tracking Implementation of Activity Monthly, by the 7` after the month of service 1 SFBHN Contract Work Plan) ntil full implementation is reached for each p Manager fiscal year Guidance /Care Center, Inc. Page 67 of 121 Contract # PPG -1 -06 07/01/2012 Invoice Support Report Monthly, by the 7' after the 1 SFBHN Contract Manager month of service SFBHN Contract Fidelity Plan for Evidence -Based Practice December 1, 2012 1 Mana er SFBHN Contract Quarterly Fidelity Plan for Evidence Based Practice Status January 15, 2013 1 Manager Report April 15, 2013 July 15, 2013 Two (2) weeks following the completion of 1 SFBHN Contract Fidelity Checklist (After the completion of each cohort) ach cohort Manager Monthly 1 Network Provider Site Supervision for Fidelity and Program Implementation submitted to SFBHN upon request. May 1" of each fiscal year 1 SFBHN Contract Evidence -based Fidelity Self- Assessment Survey Manager June 15" of each fiscal year 1 SFBHN Contract Fidelity Improvement Plan, if needed Manager Within 30 days of contract execution Prevention Program Tool Training Attestation 1 na eContract Mag9 By July 15 of each fiscal year and/or 15 days SFBHN Contract Final Invoice after contract end date 1 Manager Within 30 days of contract execution. Submit SFBHN Contract Provider's Grievance Procedures updates as amended within 30 days of 1 Manager execution of the amendment Provider Informed Consent Forms Within 30 days of contract execution 1 SFBHN Contract Manager SFBHN Contract Provider's Emergency Preparedness Plan Within 30 days of contract execution 1 Manager SFBHN Contract Provider's Civil Rights Compliance Questionnaire Within 30 days of contract execution 1 Manager SFBHN Contract Provider's Security Agreements, per Standard Contract Within 30 days of contract execution 1 Manager Annually, prior to contract SFBHN Contract Affidavit Regarding Debarment execution, or as requested by the contract 1 Manager manager. SFBHN Contract Inventory Report Within 30 days of contract execution 1 Manager "No Wrong Door" Policy and Procedure December 1, 2012 I SFBHN Contract Manager December, 2012 1 SFBHN Contract Quality Improvement Plan Manager Quarterly Report on Implementation of Quality January 15, 2013 1 SFBHN Contract Improvement Plan April 15, 2013 Manager my 15, 2013 I ecember 1, 2012 1 SFBHN Contract Quality Assurance Plan Manager Guidance /Care Center, Inc. Page 68 of 121 Contract # PPG -1 -06 07/01/2012 Quarterly Report on the Implementation of Quality January 15, 2013 1 SFBHN Contract Assurance Plan April 15, 2013 Manager July 15, 2013 SFBHN Contract Co-occurring Action Plans 6/30/2013 1 Manager COMPASS Follow -up Self - Assessment 6/30/2013 1 FBHN Contract Manager ithin 30 days of execution of the SFBHN Contract Cooperative Agreements reements 1 Manager DA Client Communication Assessment Auxiliary Aid the 4th business day following the 1 SFBHN Contract Service Record Monthly Summary Report [eporting month Manager External Quality Assurance Reviews, Monitoring s per the contract and /or as requested by 1 SFBHN Contract Reports, Surveys & Corrective Action Plans e contract manager Manager Guidance /Care Center, Inc. Page 69 of 121 Contract # PPG -1 -06 07/01/2012 Exhibit D SUBSTANCE ABUSE & MENTAL HEALTH REQUIRED PERFOMANCE OUTCOMES /OUTPUTS For Fiscal Year 2012 -2013 Provider Name: Guidance /Care Center, Inc. Contract #: PPG -1 -06 Date: 11/01/2012 Revision #: NA 1. Mental Health Contracted Services A. Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH, and Local Match) Numbers to Be Served 1. Adult Mental Health a. Adults with Severe and Persistent Mental Illness (SPMI) (M0016) /(MH016) NA b. Adults with Serious and Acute Episodes of Mental Illness (M05301)/(MH5301) NA c. Adults with Mental Health Problems (M05302)/(MH5302) NA d. Adults with Forensic Involvement (MOO 18) /(MH018) NA 2. Children's Mental Health a. Children with Serious Emotional Disturbances (SED) (M003 1)/(MH03 1) NA b. Children with Emotional Disturbances (ED) (M0032)/(MHO32) NA c. Children at -risk of Emotional Disturbances (M0033)/(MHO33) NA B. Required Performance Outcome Standards for Each Target Population Minimum Contract 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 30 (M0003) /(MH003) 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)/MH703) 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. Page 70 of 121 Contract # PPG -1 -06 07/01/2012 b. Percent of children who improve their level of functioning will be at least 65% (M0378)/MH378) c. Percent of school days seriously emotionally disturbed children attended will be at least (MOO 12) /(MH404) 86% 6. Children Mental Health - Emotionally Disturbed a. Percent of children who live in stable housing environment will be at least 95% (M0778)/(MH778) b. Percent of children who improve their level of functioning will be at least 64% (M0377)/(MH377) 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) 1I. Substance Abuse Contracted Services A. Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH, and Local Match) Numbers to Be Served 1. Adults with Substance Abuse Problems a. Number of Adults Served (M0063)/(SA063) NA 2. Children with Substance Abuse Problems a. Number of Children Served (M0052)/(SA052) NA 3. Adult At -Risk of Substance Abuse Problems - (NonGAA) a. Number of adults to include parents of children/youth at risk of substance abuse 170 participating in Prevention Services (M0785)/(SA785) b. Number of adults to include parents of children/youth at risk of substance abuse 23 participating in Level 1 Prevention Programs (M0767)/(SA767) c. Number of adults to include parents of children/youth at risk of substance abuse NA participating in Level 2 Prevention Programs (M0768)/(SA768) d. Number of adults to include parents of children/youth at risk of substance abuse 20 participating in Level 1 Prevention Programs who complete 85 percent of the program's schedule of activities (M0769)/(SA769) e. Number of adults to include parents of children/ youth at risk of substance NA abuse participating in Level 2 Prevention Programs who complete 85 percent of the program's schedule of activities (M0770)/(SA770) 4. Children/Youth At -Risk of Substance Abuse Problems - (Baseline -Non GAA) a. Number of children/youth participating in Prevention Services 2,370 (M0762)/(SA762) b. Number of children /youth participating in Level 1 Prevention Programs ( 330 M0761)/(SA761) c. Number of children /youth participating in Level 2 Prevention 206 Programs(M0695) /(SA695 ) d. Number of children/youth participating in Level 1 Prevention Programs who 281 complete 85 percent of the program's schedule of activities (M0763)/(SA763) Guidance /Care Center, Inc. Page 71 of 121 Contract # PPG -1 -06 07/01/2012 e. Number of children /youth participating in Level 2 Prevention Programs who 175 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 services 50% will be at least (M0755)/SA755) b. Percent change in clients who are employed from admission to discharge will be 20% at least (M0753)/SA405) c. Percent of adults who live in a stable housing environment at the time of 80% discharge will be at least (M0756)/SA756) d. Percent change in the number of adults arrested 30 days prior to admission 35% versus 30 days prior to discharge (M0754/SA754) 2. Adult At -Risk of Substance Abuse Problems - (Baseline -Non GAA) a. Percent of adults to include parents of children/youth at risk of substance abuse participating in Level 1 Prevention Programs who complete 85 85% percent of the program's schedule of activities will be at least (M0771)/(SA771) b. Percent of adults to include parents of children/youth at risk of substance abuse participating in Level 2 Prevention Programs who complete 85 percent of the 85% program's schedule of activities will be at least (M0772)/(SA772) 3. Children with Substance Abuse Problems a. Percent of children who successfully complete substance abuse treatment 55% services will be at least (SA725)/(SA755) b. Percent of children who live in a stable housing environment will be at least 85% (M0752)/SA752) c. Percent change in the number of children arrested 30 days prior to admission 20% 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/youth participating in Level 1 Prevention Programs who complete 85 percent of the program's schedule of activities will be at least 85% (M0765)/(SA765) b. Percent of children/youth participating in Level 2 Prevention Programs who complete 85 percent of the program's schedule of activities will be at least 85% (M0766)/(SA766) 5. Data Submission for Prevention Program Tool (baseline - Non GAA) a. Percent of approved Prevention Descriptions completed within 30 days of 50% 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) admission records in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0758) 95% Guidance /Care Center, Inc. Page 72 of 121 Contract # PPG -1 -06 07/01/2012 D. In addition to the above performance measures above, the network provider will use at least three (3) additional performance measures based upon their evidence -based program or strategy. 1. Percentage of decrease in the overall quantity and frequency of high -risk drinking. 2. Percentage of change in the number of alcohol and other drug (AOD)- related problems. 3. Improvements in number of underlying community conditions (as percentage). 4. Percent changes in alcohol sales and service techniques and policies in social or commercial hosting situations that cater to students. 5. Improvements in evidence -based implementation fidelity (as percentage). 6. Improvements in use of culturally competent prevention content (as percentage). 7. Increase in the percentage of individuals involved in AOD abuse prevention efforts. 8. Decrease in the percentage of media advertisements promoting high -risk drinking. E. Process Measure Minimum Contract Standard 1. Total number of persons, youth and 18 -20 year olds served monthly and Monthly: 175 yearly. Yearly: '2,100 2. Total number of capacity enhancement activities. NA 3. Total number of relationship building activities with other community partners. NA 4. Total number and frequency of alcohol -free social activities. NA Guidance /Care Center, Inc. Page 73 of 121 Contract # PPG -1 -06 07/01/2012 Exhibit D SUBSTANCE ABUSE & MENTAL HEALTH REQUIRED PERFOMANCE OUTCOMES/OUTPUTS For Fiscal Year 2013 -2014 Provider Name: Guidance /Care Center, Inc. Contract #: PPG -1 -06 Date: 07/01 /2013 Revision #: NA 1. Mental Health Contracted Services A. Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH, and Local Match) Numbers to Be Served 1. Adult Mental Health a. Adults with Severe and Persistent Mental Illness (SPMI) (M0016) /(MH016) NA b. Adults with Serious and Acute Episodes of Mental Illness (M05301)/(MH5301) NA c. Adults with Mental Health Problems (M05302)/(MH5302) NA d. Adults with Forensic Involvement (MOO 18) /(MH018) NA 2. Children's Mental Health a. Children with Serious Emotional Disturbances (SED) (M0031) /(MH031) NA b. Children with Emotional Disturbances (ED) (M0032)/(MHO32) NA c. Children at -risk of Emotional Disturbances (M0033)/(MHO33) NA B. Required Performance Outcome Standards for Each Target Population Minimum Contract 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 30 (M0003) /(MH003) 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)/MH703) 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 95% (M0779)/(MH779) Guidance /Care Center, Inc. Page 74 of 121 Contract # PPG -1 -06 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 (MOO 12) /(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) 11. Substance Abuse Contracted Services A. Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH, and Local Match) Numbers to Be Served 1. Adults with Substance Abuse Problems a. Number of Adults Served (M0063)/(SA063) NA 2. Children with Substance Abuse Problems a. Number of Children Served (M0052)/(SA052) NA 3. Adult At -Risk of Substance Abuse Problems - (NonGAA) a. Number of adults to include parents of children/youth at risk of substance abuse 170 participating in Prevention Services (M0785)/(SA785) b. Number of adults to include parents of children/youth at risk of substance abuse 42 participating in Level 1 Prevention Programs (M0767)/(SA767) c. Number of adults to include parents of children/youth at risk of substance abuse NA participating in Level 2 Prevention Programs (M0768)/(SA768) d. Number of adults to include parents of children/youth at risk of substance abuse 38 participating in Level 1 Prevention Programs who complete 85 percent of the program's schedule of activities (M0769)/(SA769) e. Number of adults to include parents of children/ youth at risk of substance NA abuse participating in Level 2 Prevention Programs who complete 85 percent of the program's schedule of activities (M0770)/(SA770) 4. Children/Youth At -Risk of Substance Abuse Problems - (Baseline -Non GAA) a. Number of children/youth participating in Prevention Services 2,370 (M0762)/(SA762) b. Number of children /youth participating in Level 1 Prevention Programs ( 410 M0761)/(SA761) c. Number of children/youth participating in Level 2 Prevention 206 Programs(M0695) /(SA695 ) d. Number of children/youth participating in Level 1 Prevention Programs who 349 complete 85 percent of the program's schedule of activities (M0763)/(SA763) Guidance /Care Center, Inc. Page 75 of 121 Contract # PPG -1 -06 07/01/2012 e. Number of children/youth participating in Level 2 Prevention Programs who 175 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 services 50% will be at least (M0755)/SA755) b. Percent change in clients who are employed from admission to discharge will be 20% at least (M0753)/SA405) c. Percent of adults who live in a stable housing environment at the time of 80% discharge will be at least (M0756)/SA756) d. Percent change in the number of adults arrested 30 days prior to admission 35% versus 30 days prior to discharge (M0754/SA754) 2. Adult At -Risk of Substance Abuse Problems - (Baseline -Non GAA) a. Percent of adults to include parents of children/youth at risk of substance abuse participating in Level 1 Prevention Programs who complete 85 85% percent of the program's schedule of activities will be at least (M0771)/(SA771) b. Percent of adults to include parents of children/youth at risk of substance abuse participating in Level 2 Prevention Programs who complete 85 percent of the 85% program's schedule of activities will be at least (M0772)/(SA772) 3. Children with Substance Abuse Problems a. Percent of children who successfully complete substance abuse treatment 55 % services will be at least (SA725)/(SA755) b. Percent of children who live in a stable housing environment will be at least 85% (M0752)/SA752) c. Percent change in the number of children arrested 30 days prior to admission 20% 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 /youth participating in Level 1 Prevention Programs who complete 85 percent of the program's schedule of activities will be at least 85% (M0765)/(SA765 ) b. Percent of children/youth participating in Level 2 Prevention Programs who complete 85 percent of the program's schedule of activities will be at least 85% (M0766)/(SA766) 5. Data Submission for Prevention Program Tool (baseline - Non GAA) a. Percent of approved Prevention Descriptions completed within 30 days of 50% 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) admission records 95% in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0758) Guidance /Care Center, Inc. Page 76 of 121 Contract # PPG -1 -06 07/01/2012 D. In addition to the above performance measures above, the network provider will use at least three (3) additional performance measures based Minimum Contract upon their evidence -based program or strategy. Standard 1. Percentage of decrease in the overall quantity and frequency of high -risk drinking. 5% 2. Percentage of change in the number of alcohol and other drug (AOD)- NA related problems. 3. Improvements in number of underlying community conditions (as NA percentage). 4. Percent changes in alcohol sales and service techniques and policies in NA social or commercial hosting situations that cater to students. 5. Improvements in evidence -based implementation fidelity (as percentage). g% 6. Improvements in use of culturally competent prevention content (as NA percentage). 7. Increase in the percentage of individuals involved in AOD abuse prevention 5 % efforts. 8. Decrease in the percentage of media advertisements promoting high -risk NA drinking. E. Process Measure 1. Total number of persons, youth and 18 -20 year olds served monthly and Monthly 175 yearly. Yearly 2,100 2. Total number of capacity enhancement activities. NA 3. Total number of relationship building activities with other community partners. NA 4. Total number and frequency of alcohol -free social activities. NA Guidance /Care Center, Inc. Page 77 of 122 Contract # PPG -1 -06 07/01/2012 Exhibit D SUBSTANCE ABUSE & MENTAL HEALTH REQUIRED PERFOMANCE OUTCOMES/OUTPUTS For Fiscal Year 2014 -2015 Provider Name: Guidance /Care Center, Inc. Contract #: PPG -1 -06 Date: 07/01/2014 Revision #: NA 1. Mental Health Contracted Services A. Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH, and Local Match) Numbers to Be Served 1. Adult Mental Health a. Adults with Severe and Persistent Mental Illness (SPMI) (M0016) /(MH016) NA b. Adults with Serious and Acute Episodes of Mental Illness (M05301)/(MH5301) NA c. Adults with Mental Health Problems (M05302)/(MH5302) NA d. Adults with Forensic Involvement (MOO 18) /(MH018) NA 2. Children's Mental Health a. Children with Serious Emotional Disturbances (SED) (M003 1)/(MH03 1) NA b. Children with Emotional Disturbances (ED) (M0032)/(MHO32) NA c. Children at -risk of Emotional Disturbances (M0033)/(MHO33) NA B. Required Performance Outcome Standards for Each Target Population Minimum Contract 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 30 (M0003) /(MH003) 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)[MH703) 15% 4. Adult Mental Health - Forensic Involvement a. Percent of adults in forensic involvement who live in stable housing 70% environment will be at least (M0743)/MH743) S. 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. Page 78 of 121 Contract # PPG -1 -06 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 (MOO 12) /(MH404) 86% 6. Children Mental Health - Emotionally Disturbed a. Percent of children who live in stable housing environment will be at least 42 (M0778)/(MH778) 95% b. Percent of children who improve their level of functioning will be at least NA (M0377)/(MH377) 64% 7. Children Mental Health - At -Risk of Emotional Disturbance 36 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) II. Substance Abuse Contracted Services A. Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH, and Local Match) Numbers to Be Served 1. Adults with Substance Abuse Problems a. Number of Adults Served (M0063)/(SA063) NA 2. Children with Substance Abuse Problems a. Number of Children Served (M0052)/(SA052) NA 3. Adult At -Risk of Substance Abuse Problems - (NonGAA) a. Number of adults to include parents of children/youth at risk of substance abuse 170 participating in Prevention Services (M0785)/(SA785) b. Number of adults to include parents of children/youth at risk of substance abuse 42 participating in Level 1 Prevention Programs (M0767)/(SA767) c. Number of adults to include parents of children/youth at risk of substance abuse NA participating in Level 2 Prevention Programs (M0768)/(SA768) d. Number of adults to include parents of children/youth at risk of substance abuse 36 participating in Level 1 Prevention Programs who complete 85 percent of the program's schedule of activities (M0769)/(SA769) e. Number of adults to include parents of children/ youth at risk of substance NA abuse participating in Level 2 Prevention Programs who complete 85 percent of the program's schedule of activities (M0770)/(SA770) 4. Children /Youth At -Risk of Substance Abuse Problems - (Baseline -Non GAA) a. Number of children/youth participating in Prevention Services 2,370 (M0762)/(SA762) b. Number of children /youth participating in Level 1 Prevention Programs ( 410 M0761)/(SA761) c. Number of children /youth participating in Level 2 Prevention 206 Programs(M0695) /(SA695 ) d. Number of children/youth participating in Level 1 Prevention Programs who 349 complete 85 percent of the program's schedule of activities (M0763)/(SA763) Guidance /Care Center, Inc. Page 79 of 121 Contract # PPG -1 -06 07/01/2012 e. Number of children/youth participating in Level 2 Prevention Programs who 175 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 services 50% will be at least (M0755)/SA755) b. Percent change in clients who are employed from admission to discharge will be 20% at least (M0753)/SA405) c. Percent of adults who live in a stable housing environment at the time of 80% discharge will be at least (M0756)/SA756) d. Percent change in the number of adults arrested 30 days prior to admission 35% versus 30 days prior to discharge (M0754/SA754) 2. Adult At -Risk of Substance Abuse Problems - (Baseline -Non GAA) a. Percent of adults to include parents of children/youth at risk of substance abuse participating in Level 1 Prevention Programs who complete 85 85% percent of the program's schedule of activities will be at least (M0771)/(SA771) b. Percent of adults to include parents of children/youth at risk of substance abuse participating in Level 2 Prevention Programs who complete 85 percent of the 85% program's schedule of activities will be at least (M0772)/(SA772) 3. Children with Substance Abuse Problems a. Percent of children who successfully complete substance abuse treatment 55% services will be at least (SA725)/(SA755) b. Percent of children who live in a stable housing environment will be at least 85% (M0752)/SA752) c. Percent change in the number of children arrested 30 days prior to admission 20% versus 30 days prior to discharge will be at least (M0751/SA751) 4. Children At -Risk of Substance Abuse Problems - (Baseline -Non CAA) a. Percent of children/youth participating in Level 1 Prevention Programs who complete 85 percent of the program's schedule of activities will be at least 85% (M0765)/(SA765) b. Percent of children/youth participating in Level 2 Prevention Programs who complete 85 percent of the program's schedule of activities will be at least 85% (M0766)/(SA766) 5. Data Submission for Prevention Program Tool (baseline - Non GAA) a. Percent of approved Prevention Descriptions completed within 30 days of 50% 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) admission records 95% in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0758) Guidance /Care Center, Inc. Page 80 of 121 Contract # PPG -1 -06 07/01/2012 D. In addition to the above performance measures above, the network Minimum Contract provider will use at least three (3) additional performance measures based Standard upon their evidence -based program or strategy. 1. Percentage of decrease in the overall quantity and frequency of high -risk 5% drinking. 2. Percentage of change in the number of alcohol and other drug (AOD)- NA related problems. 3. Improvements in number of underlying community conditions (as NA percentage). 4. Percent changes in alcohol sales and service techniques and policies in NA social or commercial hosting situations that cater to students. 5. Improvements in evidence -based implementation fidelity (as percentage). 8% 6. Improvements in use of culturally competent prevention content (as NA percentage). 7. Increase in the percentage of individuals involved in AOD abuse prevention 5% efforts. 8. Decrease in the percentage of media advertisements promoting high -risk NA drinking. E. Process Measure 1. Total number of persons, youth and 18 -20 year olds served monthly and Monthlv:175 yearly. Yearly 2,100 2. Total number of capacity enhancement activities. NA 3. Total number of relationship building activities with other community partners. NA 4. Total number and frequency of alcohol -free social activities. NA Guidance /Care Center, Inc. Page 81 of 121 Contract # PPG -1 -06 07/01/2012 Exhibit E -1 a. AGENCY NAME: I b. AGE- T No.: EXHIBIT -s CHILDREN'S SUBSTANCE ABUSE c. MONTFYYEAR Non -TANF tM1e remeini 1] MONTHLY PAYMENT /ADVANCE REQUEST FEDERAL O #. f. VENDOR D (y tlilleronl lean F- I'm N be CU D qp um r. 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TASC Maroare- kMlvMUal xxxxxxx '. xxxxxxx $O.DO $0.00 SO.00 EO.00 SGoo EO.00 xxxxxxx xxxxxxx '. 50.00 50.00 0.00000 0.00000 rou Aaeroara -Gp xxxxxxx $0.00 $000 EO.00 xxxxxxx SO.00 0.00000 Room 8 Board w/SUpeMSbn Lev I ' %XX % %XX EO.00 f0 00 30.00 xxxxxxx ; $0.00 .0000 00 Room 6 Boam S.--n Lev II ', xX %XX %X $0.00 $0.00 $0.00 xxxxxxx 80.00 O 00000 m 6 Board wBUpeMaion Lsv Ill %XXX %XX SO.00 $O 00 $O 00 xxxxxxx $0.00 0.00000 Recovery Support - Ir,tlivltlual XXX %XXX $0.00 $0.00 $0.00 xxxxxxx $O 00 O 00000 Recovery Support -croup - xxxxxxx $O.00 SO 00 SO.00 '. xxxxxxx $0.00 0.00000 --n 6 Rerertal TrfNm•m i M•rure Tetal � X %XXXX% SO 00 SO.00 50.00 SO.00 SO.00 %XXXXXX 50.00 $0.00 0.00000 ca Abuse U.- %XXXXXX $0.00 $0.00 xxxxxxx SO 00 0.00000 OWpatbm DetoxMCetbn xxxxxxx � $O DO $0.00 xxxxxxx s000 0.00000 Daoxmaagpn Total - o.o o.00 ' o.00 �'. o.00 d.00 ' S.-.-d Non '. -F Fundirlq YTD To tal EIIg1bN Non- YTD SAMH Non- -F F P•Itl ror DHHr•nc• I- Unpaid '. Proralfd SMTf -: Mount Dw (-d) (d) Coft C•M•r R- UnH R • e/ Non -TMF nHa Pald Tor U tM1la PMT 1 - EMNINGS Continwd : Laval 1M ' Actly On TMF f --d Earnings Earninga) MomH '. ' '. ' Enter and enters from that '. '. FOr ACtIV ICY (,(cal. 1. -col n)1 o al ror ach ActivttY la ' Butlq•t -,,I 6091080] 1 H rN '' l is sear W '. 1 0l B u1 Icol9 T ADTM TY /Coat C•nbra rn E- � W leant J .nil 3'o twain > :oI.R. >a Wr ks Prevmbn -00100][ ' Prewnnon xxxxxxx $0.00 SO.00 xxxxxxx SO 00 0.00000 PraverHioNk,terventbn -Dey X %X % %XX $0.00 fD.DD xxxxxxx $0.00 - 0.00000 lnlonnetbn 6 Refertel %XXXXXX SO 00 $0.00 XXX %Xx% SO.00 0.00000 Prewntbn Tof•I � SO.00 SO.00 SO.00 SO.00 SO.00 I n IW nfal Expfna•a ra!ans.a xxxxxxx Eo 00 so.00 xxxxxxx so 00 0.00000 Ibpa.maln I elefn[d Total fo.00 fo oo fo.00 fo.00 fo.00 TOTAL: " No IlertlbilXy is allowed n Iuntled via .-T.. 50.00 SO.00 50.00 50.00 so.- $0.00 • unleaa one pomremor reyuaale and IM1e M= - - b -111 or me prormed snare. h. L•sa R.eoupm.nt or Interest - so.Do . TOTAL I. Las. Racoupm•nt of Advance - AMOUNT 50.00 YTD InbreN YTO I-m- -1 F- -1 Advne• Efrwd R•ep d -.-.d .-I-0 PMT 1- FUNDING DISTRIBUTION For ME uae Far ME uae For Prov. use For PP-1 use For ME uae YO. Go _GO s0.00 ORG-N TION CODE For ME Use x:a Number TR -DT FUND # CAT # OGA # EON Amp Curtant Ptivanca R est R-..-.. Dw aw. 0.00 O 00 o.00 a.00 o.00 o o oD.o o o.00 o.00 o.00 o. o o ,- o o o o.00 o.o 0.0o o. Woo so.00 So.00 - k. TOTAL AMOUNT OF ME ADVANCE � so.- I. TOTAL AMOUNT OF ME PAYMENT 0.00 PART J - CERTIFICATION i APPROVAL m I caniry IM above Io ba act..... in preamam vdlM1 the a'Q-Y' Ys rewrds erM v Ib the Canna of this aOercya wmreG >MM tM ME. Addil -Ily. I candy that all Glam demographic aM data s saMaa ayem Me bean tM epppmanpe ariM the wmrect. to ME In si ne one Dale ME USE ONLY For ME uae only: Data Invoice -....d: Date Gootla/Setvlcea Received: Date In sp•cted and Approved: A ved B / D.- Guidance /Care Center, Inc. Page 82 of 121 Contract #PPG -i -06 OF ME PAYMENT /ADVANCE � $D.DD Guidance /Care Center, Inc. Page 82 of 121 Contract #PPG -i -06 07/01/2012 ia. AGENCY NAME: CLIENT NON-SPEC FIC PERFORMANCE CONTRACT ' WORKSHEET FOR REQUEST FOR PAYMENT FOr absittenteft poldfot`ont 1@ �b. CONTRACT No.: Children's Substance Abuse 6ia1# ofud1t B1Aon,CoWifriis V &'al c FROM TO: MUST NOTBErthan;andColumn,'- I d PROGRAM: E MUST NOT tte a than the # of �e FEDERAL ID # UnitS repotted to the MWJA Dates g. :VENDOR ID (If different than Fed ID): �h. Warehouse , 'ADDRESS Number, City, State, Z : Non-TANF- Units & Earnings TANF -Units & Earnings ' YTD Total 1 YTD Local Units to 3 Match Units' YTD Total Enrolled ,YTD Billable . to Enrolled YTD Total Non -TANF YTD Total YTD Total Clients & i Medicaid Clients & ! Units Units :YTD Total Non TANF Units , TANF $ Non - Client- 1 Units to ` Non - Client- Eligible to Eligible to ' TANF $ Eligible to Amount for Contracted : Specific 3 Enrolled Speck be Billed to be Billed to Amount for be Billed to Eligible ACTIVITY Rate Units E Clients Units SAMH SAMH Eligible Units SAMH Units Cost Center 1 i D E +F CxH CxJ A B C D E F G H I J K Assessment $0.00: 0.00000:; 0.00000 0.00000 0.00000 0.00000, $0.00 0.00000, $0.00 Case Management $0.00; 0.000001, 0.00000'. 0.00000, 0.00000 0.00000, $0.00 0.00000; $0.00 Crisis Support(Emergency $0.00': 0.00000? 0.00000' 0.00o00 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'. 0.000001 0.00000: 0.000001 0.00000 0.000001 $0.00 0.000001 $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 0.000003 $0.00 0.00000; $0.00 Intervention - Individual $0.00 0.00000 j 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 0.000001 $0.00 0 00000' $0.00 Medical Services (No TANF) $0.00' 0.00000; 0.00000. 0.00000' 0.00000 0.00000' $0.00 r Methadone Maintenance No TAN $0.00' 0.00000; 0.00000: 0.00000 0.00000 ( F) 0.00000 $0.00 Outpatient - Individual $0.001 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 0.000001 $0.00 Outreach $0.00 - : 0.000001 0.00000'. 0.00000' 0.00000 aGoo00 $0.00 0.00000 $0.00 Residential Level 1 $0.00. 0.000003 0.00000; 0.000003 0.00000 0.00000; $0.00 0.000003 $0.00 Residential Level 1- Enhanced Rates $0.00'. 0.00000: 0.00000: 0.000001 0.00000 0.00000, $0.00 0.00000 $0.00 Residential Level $0.00' 0.00000; 0.00000' 0.00000 0.00000 0.000001 $0.00 0.00000{ $0.00 Residential Level 111 $0.00, 0.00000.` 0.00000! 0.00000 0.00000 0.00000 $0.00 0.00000` $0.00 Residential Level rV $0.00. 0.00000 0.00000! 0.00000; 0.00000 0.00000; $0.00 0.00000;. $0.00 Respite Services $0.00, 0.00000', 0.00000'. 0.00000; 0.00000 0.00000; $0.00 0.00000; $0.00 Supported Employment $0.001 0.00000; 0.00000, 0.000001 0.00000 0.00000' $0.00 0.000001 $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 0.000003 $0.00 0.00000' $0.00 Aftercare - Individual $0.00! 0.00000; 0.00000, 0.000001 0.00000 0.00000, $0.00 0.00000; $0.00 Aftercare- Group $0.00, 0.00000' 0.00000' 0.00000 0.000001 $0.00 0.00000 $0.00 Room & Board w /Supervision Lev 1 $0.00; 0.00000 0.00000' 0.00000' 0.00000 0.00000' $0.00 0.00000 $0.00 Room & BoardwlSupervision Lev II $0.00: 0.000001 0.00000' 0.000003 0.00000 0.000003 $0.00 0.000003 $0.00 Room & Boardw /Supervision Lev 111 $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 0.000001 $0.00 0.000001 $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; 0.000003 0.00000; 0.000003 0.00000 0.000003 $0.00 ? y w... Detoxification - 602001 i 1 ; 1 1 Substance Abuse Detox (No TAN F) $0.001 0.000001 0.000001 0.00000 0.00000 0.00000+ $0.00 4111 s E W ,W Outpatient Detoxification (No TANF) $o.o0' 0.00000E 0.00000; 0.00000 0.00000 0.00000' $0.00 Prevention - 602002 Prevention $0.00; 0.000003 0.00000: 0.00000; 0.00000 0.00000 $0.00 0.000001 Woo PreventioNlntervention - Day $0.00: 0.000001 0.00000: 0.000001 0.00000 0.000001 $0.00 0.00000 $0.00 Information &Referral (No TANF) ' $0.00' 0.00000 1 0.00000' 0.00000 0.00000` $0.00 � �5�` Incidental Expenses , Incidental Expenses $0.00 0.000001 0.00000: 0.000001 0.00000 0.000001 $0.00 0.00000 Guidance /Care Center, Inc. Page 83 of 121 Contract # PPG -1 -06 07/01/2012 EXHIBIT F Minimum Service Requirements The network 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.law.corneli.edu/uscode/42/ch6AschXVIIpB.htmi 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 /htm1/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 /htm1/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. pq o.gov /nara /cfr /waisidx 03/45cfr96 03.html Restrictions on expenditures of SAPTBG 45 CFR 96.135 http://www.access.qpo.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 Guidance /Care Center, Inc. Page 84 of 121 Contract # PPG -1 -06 07/01/2012 D. Health Insurance Portability and Accountability Act (HIPAA) 45 CFR 164 http: / /www.access.gpo.gov /nara /cfr /waisidx 03/45cfr164 03.html 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.leg.state.fl.us /statutes /index.cfm ?App mode = Display Statute &Search Strinq = &U RL= 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. corneI1 .edu /uscode /htm1 /uscode42 /usc sup 01 42 10 6A 20 III -A 30 C.html Stewart B. McKinney Homeless Assistance Amendments Act of 1990, Public Law 101 -645 http: / /www4.law.cornell.edu /usc -cqi /get external.cgi ?type =pubL &target= 101 -645 Guidance /Care Center, Inc. Page 85 of 121 Contract # PPG -1 -06 07/01/2012 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://www,law.corneil.edu/uscode/htm1/uscode42/usc sec 42 00012101 ---- 000 - .html 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 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. Chapter 491, F.S. Chapter 1002, F.S. Section 402.3057, F.S. Section 414.295, F.S. B. Substance Abuse an( Psychological Services Clinical, Counseling and Psychotherapy services Student and Parental Rights and Educational Choices Persons not required to be refingerprinted or rescreened Temporary Cash Assistance; Public Records Exemptions I 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 Guidance /Care Center, Inc. Page 86 of 121 Contract # PPG -1 -06 07/01/2012 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. Chapter 985, F.S. Section 985.19, F.S. Section 985.24, F.S. F. Florida Assertive Cor Mentally Deficient and Mentally III Defendants. Juvenile Justice; Interstate Compact on Juveniles Incompetency in Juvenile Delinquency Cases Interstate Compact on Juveniles; Use of detention; prohibitions; nmunity Treatment (FACT) General Appropriations Act http://www.flsenate.govNVelcome/index.cfm?CFID=105701865&CFTOKE N= 34016817 Guidance /Care Center, Inc. Page 87 of 121 Contract # PPG -1 -06 07/01/2012 G. State Administrative Procedures and Services Chapter 120, F.S. Chapter 287, F.S. Chapter 815, F.S. Section 112.061, F.S. Section 112.3185, F.S. Section 215.422, F.S. Administrative Procedures Act Procurement of Personal Property and Services Computer - Related Crimes Per diem and Travel Expenses* Additional Standards for State Agency Employees 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 %SFguide /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 /defauIt.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.0 Rule 65C -15, F.A.0 Group Care Child Placing Agencies B. Substance Abuse and Mental Health Services Rule 65C -12, F.A.C. Rule 65D -30, F.A.C. Rule 65E-4, F.A.C. Rule 65E -5, F.A.C. Emergency Shelter Care Substance Abuse Services Office Community Mental Health Regulation Mental Health Act Regulation Guidance /Care Center, Inc. Page 88 of 121 Contract # PPG -1 -06 07/01/2012 Rule 65E -10, F.A.C. Rule 65E -12, F.A.0 Rule 65E -14, F.A.0 Rule 65E -15, F.A.C. Rule 65E -20, F.A.0 C. Financial Penalties Rule 65 -29, F.A.C. Psychotic and Emotionally Disturbed Children Purchase of Residential Services Rules Public Mental Health, Crisis Stabilization Units, Short Term Residential Treatment Programs Community Substance Abuse and Mental Health Services - Financial Rules Continuity of Care Case Management Forensic Client Services Act Regulation Penalties on Service Providers D. 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.gov /omb /circulars a087 2004 OMB Circular Al 02, Grants and Cooperative Agreements with State and Local Governments Guidance /Care Center, Inc. Page 89 of 121 Contract # PPG -1 -06 07/01/2012 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 /al 33/al33 revised 200 TO Section 215.97, F.S., Florida Single Audit Act http://www.leg.state.fl.us/statutes/index.cfm?App mode = Display Statute &Search String =&U R L= 0200- 0299/0215/Sections/0215.97. html Comptrollers Memorandum #03 (1999- 2000): Florida Single Audit Act Implementation http://www.myfloridacfo.com/aadir/cmO/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.-qpo.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/al 10 /al 10.html E. Data Collection and Reporting Requirements Rule 65E- 14.022, F.A.C. https://www.firules.org/. ateway /ru IeNo.asp ?I D =65E- 14.022 Section 397.321(3)(c), F.S., Data collection & dissemination system Guidance /Care Center, Inc. Page 90 of 121 Contract # PPG -1 -06 07/01/2012 http: / /www.leg.state.fl.us /Statutes /index.cfm ?App mode = Display Statute &Searc h String = &URL= 0300 -0399 /0397 /Sections /0397.321.htmI Section 394.74(3)(e), F.S., Data Submission http: / /www.leg.state.fl.us /Statutes /index.cfm ?App mode = Display Statute &Searc h String = &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.shtml Guidance /Care Center, Inc. Page 91 of 121 Contract # PPG -1 -06 07/01/2012 EXHIBIT G 2012 -2013 Ftwal Yew 3012 -2019 I Provider No-: [f iiitmict C m'e C.a II1C l6 n1atCls) __ .......- --....._. ...__.i Cmtrad n.�17Yr l-tW Rcgicirn n: Aed%ity TAFSFS Lilt X -i'ea Rate 1 2 3 erienty StsfAlUsfian a C64%ailtlizalim (NoTANF) Unit: bedday (A. C'risip ppnrtlPtnavmcy tint: vixffhaa bpstiad (No T'AN7) Unt: 2 44v day :Ovwy a Reswency 01. Arxe t:tlt,: conlaCF IKan° U2 Cane Manams" art titt:. direst ANMRaA 0. Day Cara Uut:1 -Ir day ,-1 ti Day -NWK Unit: a-M day ir, Drq �bvself help Crntaa (,NwTANn Unit: fleriFity day oal. In -Harts aid (Mt Site Unit direct +tafrhour iek In[eMR'!C'asle!�tanagem4lt Unit:. direst gaff hotr 11, Unaveaiwt - l"divdal Unit: direct oaff 11 f2 \ted"Structs (NoTANt) Unit conraa Fawn Id. 0.1pa1iml - hldivirhaxl Unit:: rwaad bca. 15. oubvach Unit: not-direct slaWlox r ld. Prcvatim I tnie nwt -direct staff haur 1?, Prevaaieacbiaervendan Day' unite 44v day lx Reaidadial t.evcl I Unit: 2.14r do) 19, FUsWadial Level a Unit: 244. day M Reaidrr4ialIAvelOf Unit 241r day 21. RevidertialLcvclIV. Unit U -1v dq 22 Respite Services thait a.aad W. 23 . Rbelternd FJnp)aynns (No TAfln Unit Aitr day 2t. SuppateclEnployment Unit: direct wrff bvtir 2t R,W divrlltaraoglT.ivigp Unit: direct xtaff it" 29. Aftercare - individual Unit: drat asfflwlr :Mt Inrimutim and Retimol (No TA.`tF) .. i7nit� aalrfln,r 35. O'apAsern - CAMP I!.& cndad I.— .fri. Roost and Board WSupti vision Lrvd I Unki 214r dev 31 Room mod Mond takrpaviam Lcvcl 11 Unit: 241. day 3x Road and board wryuperviaim tAwd Ill Unit: 2 day 39. SIKst -tmn Roidadal Tmafman Unic Fled-Roy TANF S Uldt ..1 - Yes Role minim Ni Nan -TANF NoM TANF- "total 11nergmtey'Aa Milaatlon -- S0 Total Enterpmy Wabilitatlwt - 50 Untomp"'motd 1 3Rita - -� Unronpeasalyd Unks -� 1 s..,a 1 - Guidance /Care Center, Inc. Page 92 of 121 Contract # PPG -1 -06 ... .. � .. 1 a. �- moon ...., ... .._._.._._._.. _... 22MOM t _i ,.... ..... t I �. s..,a 1 - Guidance /Care Center, Inc. Page 92 of 121 Contract # PPG -1 -06 07/01/2012 EXHIBIT G 2012 -2013 Fl" Year 2012 -2011 P—dcr Nn[c: iGtidatKt C'arc Carca, htt. f8 tnattlte! C.'mlrect ft lR'Crl -fKfK� Retisin[tt. � .. Adlvlry i C'oR Cents I 4u memal H"w C'k"WR';ln cm Unit: C:6d+Imm .Uff h atr -12 lntervm6m - Cratp Vint corttad Iwu 41. Allen= - Urmp UnA ovary &R"Alme. - FACT Team A1. FACTTcnx tNoT.ANF) Unit 1.f hoir "very & Re.W mey C:C4T 44 . CC'ST-htdivi[Wal Umt statr sway &rm0lmcy CCSP- F.A.C.E& 44 CC'ST- hidwidual Unit Statyllmr eowey &Re4lency- Owwwnhy Formde 19: Rmideraiai Lma a (*47 241- day 3u. Shut -term Reaidattal Tetwm it unit: Hod -vay c~y & R"Ntmcy - luetdmtA Eapmrm Incukrdal F_'gxrne.: General Unit each SM.-pad �l tncukntal fltpeam: CC�T • P. A.t1,F 3. tWL cad[ $54 gad t IueAMW Ztpaxees: ta Vult each SA) vto Nm. TAN F Fatal Nart'YA1F ... Taal TA,NF 1 ..�._ . Tutal M.AW ITedth Funds = • • so 71NF S C'tdt X - =1'm Rata Ymr2'.ANF- ti', +z a. tats em I ANY - TOW TANF _UjM" Tata1 M mlal Mvuh Fund. •• s o I Guidance /Care Center, Inc. Page 93 of 121 Contract # PPG -1 -06 07/01/2012 EXHIBIT G 2012 -2013 Fiscal Yew 2012 -2(113 Provida Naas- Guidance Cart Cater. bw (Bmundn) Contact at I'J'Cnl W �- � R-Woum t� Ad1{1tY 1 Cast Canto t 24. SnbstatceAbtweDdoxiftcation (N OTANF) thtit: b d.,bor 12 Clu¢tatian UetO.MrK Iim (No "t:A:Vt) Unit a •Ir day 16 PMV.Alm I111lr: n0k1- direct shIYIUM V. PreveraiwWc vmnm • Day Unit: 44r day 30 Inforo atim and Refarai (NOTANF) Unit Stditkxff 'd--1 and Aftercae M. Arsaetrlad Unit: contact hour rr Case Manaipen,at Uni: dived nalThdv 01. Crisis suppinfluapalcy Una: stsdThar 0.. llav Care Urit7 4 -M day 06,, AaY /*Sight Unit: 4{r dry OK In-time 8•. On Sae Unit: ducat adMxw 14 tntcaive Casc Matngmxan Unit: died ltalfhor II. trunweton - • IndiAduai unit direct ,talrnolr 12. MedicalSmmic- (NOTANn Unit: contact IV" 13: A(edtadomMainuumc4(No TANF) Unit: dosage fi. fnlgranad - Galividnal Utrt c ontact tour C3. outrescit (brit: non-ducd staff hour iR Residetial Lc ci f Unit: 24-hr day 19. R— It"tai t—I n Unit; 244r day W. Rcsidaaiai txvc4 W Unit :4-Ir day 21. Re_sidt dial Ts L4t4 llwl- ^-4 -h, dry 22 "At Savica Unit contact hour 25. Suppatcd FiMloynxnt Urrt dired ARITIlnlr ?A Suppo flowingfl ring Veit: dir-t dan•t -r 2'. 'I'ASC Uldt: dredstafl'twrr 2!!. Aillmare tinit: dirts9,WYfaar TAW S Unit K - Ve. Rate Guidance /Care Center, Inc. Page 94 of 121 Contract # PPG -1 -06 07/01/2012 Exhibit G 2012 -2013 CNdbtt G: StA lB K;NDING BY PROGRAM & AVI "ITY Flteal Yew 1OM2013 14wider Nmae�(CiutdaneeCsre C`.etNCr. lnr. t3 utmdtal Cmlrarl.fl'i'Ci -I-tW Retvim sk ........ ....___..__ .........................___.._......_._......._...._.._.._......._........_........................._....... .._......_.........._........_. ....................._..... Adult Substance Abuw ChUdren's Subsanee Abuse ActiAly ,' 0 ('carer 'TANF S 1,*u1t VLNF S UMt X _. Yea Rate X = Yea Role 1 2 3 c 6 ? 33. O"Alian - Orutp Onit CadaR tit" 36 Room and Board %WSttpervisim lzvei 1 lWr2d -hrdxy ?. Ramt ail Board w Superb sim I^cl 11 3& Rams atrl Board wSupe Omm I..cvel M 4nt 1 . , Wc ot 42 Intervadim - Cam-p L 43. Adacats - Ckmp Una: cmtad hwr . Recovery support • Iralivicbal . Unit -dlmrtsa0'hdu 13 Re(ovay Suppat • Omp I'na:cmhct 1µ%1r — 46. C1nlicol Supra isim for t vldet"-Ba!xd Awlkes Uni: cpnact lac w Total N - -TANF �_ Total NowTANF - Total V00 -._, Fold LOW Total Treatment & Aftercare = Total Trwromt & ARereare > �� Vnmaipmseted Units < - �SO) Uncaupemated l,'ldts Tremnent & Afar - MST •Ft CC'.4'f•indmtbml (roil! stattllmr Nat -TANF Nsn =tANF- rANF 3 Taal CM Services ��1 ..... _ Feta1.CC5T 5ern � MC �� Sfi Uttemapm aced Units :- Uitto hpewated Volts . Inddetttal F.xpm+ 211 loadadai Mpntsea t Intt. each 530 gXre Total Non- TAvF =. Total-NoaTA:YF ._......, Total TANF ={ ,,..,_....... _a V Total TVNF = —_. _,.. _. .. .EU 'fetal luddentd ExPetWN- So j dotal Inddental Cgtmsea- total Not - toW Non LUNI 5144,4 'total "1,U?7F IotsITANF Trial 3➢rt»Irare Abusr Funds __ -_.__ _S Total Std,sim a Alaur Funds - 3141 Guidance /Care Center, Inc. Page 95 of 121 Contract # PPG -1 -06 07/01/2012 EXHIBIT G 2013 -2014 :ovay dt Retlienq Final Year 2013 -2014 ass Fravida Naar: t tluI mitt Care Center. hw, C.4mi {i_€ I'F*G -I-i14 Revitimt Ol. Arvnvmml Atktit %larval liealk C4tlilm %lama! Heels Arthity ? Cog Carta TANF S l TANF S Unk X,„ Yes Rate N - Yen Rde t....._.. ._. 02 C 'F* MaaaRanem Emercatcy StWASI on 1 deed 4AI'tiwr 113. Crisis StabilaWc,ii (No'IANM ..., .,....... land: bed -clay Mow= i>.___ I ,.. ,. .. ,. _. - ...i Ot Cribs SmppatrFinaRemy Unit: 4 -try' , thik sWTtnv r . ., G...,..,..,,. --. _ ......... - - MMI_._. I.W. li"fina Und: 44v day Unit: 2444 day man= � W, IRnp- b0WfJk4p Ca#— (Np:TANF) NgF tANF „, Noat'ANF- LhtY: twility day "t "otal rMagetio slowliaaUan .. � o I 'rotd Eawtgeney StablfxaUaa - � Uriemailim ded Unit. - Unramp —IM Udta :ovay dt Retlienq ass Ol. Arvnvmml Und: contact Itottt �_......__ 1 .. ................� t....._.. ._. 02 C 'F* MaaaRanem 1 deed 4AI'tiwr ..., -- - 05 Day Cam ., Unit: 4 -try' I ....................._...:.>. __... , _ r . ., G...,..,..,,. --. (ki. Day!NipM Und: 44v day man= � W, IRnp- b0WfJk4p Ca#— (Np:TANF) LhtY: twility day Ul, At -Harm aid on Site — `. Una: eimt Gaff hour MENINI 17 =71 In Imerdm CamMarmpemtnt UM-1 (11100 a� _ It. Itdarvaatat- hubvidual llnt direst aadr hmr 12 4iedintl Servit" (No I'A"iM vnit cmact hcwr t4. ( iiividmal ,,,,,. -I Unit camlact Funs. - IA 041rcadi .. __..._� •• .",-, - ., -...�, . Und: nawkrat sWTl NU Cam ,_„ __ 7 Ib. 1'rn'nmim Unit: naEdirett.Matrkaa I { I M111111111111111 L= 1 Ptesaaimbttavamiat -D'4 Unit: 44” day .: t.... .._ IM Residnaial Lcvti 1 Unit:. 24 - irday { .m I ._..._ ........_ .. ..W.. 19. ResidaYial Level U Un4:244trday ... ._z I ...... , t._ _.._[ N1 Reiidereial lxvel Ut Unit ^ -4 -M day 21. xesidaMial LaYi IV Unit: 244rday. _ -. " Re"te FAmees -1 1?mie cats luau f 23. Shellmed Faplrymalt (IVa TANF) 25. SuppatedFatploymail Unit direct aalTlwv _ 2Cr. 3tggncriirr kiatvinty'I>ivulkt _ _: ,,...__� Lhdt d(at mnrtttwr 29. AReca v- Individual Unit: drect i ndThotr ..- �..:I _ (,TW. ,NI. Infivirmas tandRetest (No'rANF) .. -._:.. .. . Unit statThmr L { 3[ Canpminn - Camp . Unit miloct twit F � 1 .. .. f ..... . ...._I . ..... ... "... l_.. .. ........... . 35 Roost wd ford w,'Supaviatoti Ltvd I _ - . Unir-24-kdiY _ -. -_ . 3 Room wd Board w;'Supa"mim Level U Unit 244r day :18 Roattend Hard w+Supervisiat Ltx•d lU Utut 244s day 39. Saari -tmn Residaaial'1YcMtrtcni . Udt Red -Day I r+aa . "'A Guidance /Care Center, Inc. Page 96 of 121 Contract # PPG -1 -06 07/01/2012 EXHIBIT G 2013 -2014 FEceal Yew 30/13014 Nrwidtr Near: �Cvuidattce Caro C "attr; Lx. t "tnhad #. I'Fti•1•uit'' Revuicatk� Activity ? Cwt Caner TANF S I TANF 5 Unk X' • Ye. Ralo X. Ycs RtM! t z J 6 9 11 .lu ttaaal HtaMh ch"w x $mricei Unit (btbinsar - Aalrhmv 1 . Inte endm - t'frimp Unit. catatrce hoer •13. Aflercam - Cxoup Umv em taet hest' %eery & Rc%Ulmcy- FACT Ttsm t{. FAC`rTextw lNo'GUvt) Unit. >isnfhom .wry & Resillmcy Ccsr 44. i'.'i'ST dtaividuW UnIL SUSHmr v,w & rtsMtncy CCSr FACE& .M. COST- htdividusi unac StaHlimr �osery @ Rrsgienry- C'aahneagx PormAr 19 Residettlisl txtei R Unit? ? - hr dy +v Stem -tam Raidmlatl'rtxatatati VWL Ncd -Uny awry & RmAlmry - turid P, - +mmi za ]ncederdal txptasaw_ Cimp'sl 111rtt each $50 spat W6dadal rxpatxs; C('$T- F. A.e,F S. unit each S50 spat 71. lncidettai Fxpaars: Fnnttsic Unit each $50 spat Na t.TANF - Toad Nat 1<ILNF TatsIT4*�F... .. - ..-. 'iWd 1WmWi lresiih Ftatds- S6 NotrrA.NF TANF _.......... 'rata) Formd, Servkw = : pt rrar rr�� ltnrompaasata4 UMRt - p :total Noe :r:lNF - Tam TAMP Tatal hittt d iivaMh Pmds - SO Guidance /Care Center, Inc. Page 97 of 121 Contract # PPG -1 -06 07/01/2012 EXHIBIT G 2013 -2014 Ctilielt (i: S'IAT C FUNDING RY PR(R,RAM &. AV[ IV] IN t7aeal Yew 2013.2014 P—Ader None: t ance ( arc Center, Inc. i'nntraa t<: PFCf 1 -06 It_irim 0: AdutI SbAnrnee AMase 4tillrlma s S}Ihsavnm Alntse Adhityi COat Ctater 'rANFS UUM TANFS Unit X .- Yes Rde X - Yes Rate 1 2 3 4 t 6 ' DdoAntaf ort _ 24, StlManre Ahome Detoxitlrwim (No TANF) Unit bed-day €; JA _._ . , i 3: Oatpwiran DeioxiIWiat (NO T AN Unit: 44v dry . ............. Rau= L.. ._._........3 Total Nm- TANF:. Total NwTANF .. fetol Dr(OWICallod ::. SO Taut Detw llrttbn - s0 UntoaprmsstM UnRa -a G>tcdnpeas.lyd L'nin z Itevenfian 14 Pm'etnim Unit, nm•dir+ect osff lwtp _r 17. Pmrntinridaventim - Day tlydt 4•hr day mom :,,,, ..................m. .ill In ornndi n ardlkd al (No TANF) , t7ttit: tlalTfa,rr a_ ; J y. ToU1Non -TXNF TohdKo6TANF° _ „$1�44A47 _ ,...:SIi "Tdrl Prnadlm ° ......, .,5 Total Presrdim -1,44 Vn0oomettswed Vona c Uncompensated Unite SO 'll'edsomi acid Aaermwo 01. Aswvmmt Unit_ contact hour '��„___� ir2 CM MoreYM-11 .. ....... ......_.. Un de-i dalPtrsn f. R( t:'rm, suppnrUFYnetttawy title statTharr �. „ _. _. 0 . Day Car ...... .............m---- .._._. ......- m.__..._,. t7nA:4 -hrday tki. Dayalalr ._.... .. __,...., Unit: 44r day I.. ._.....,! �,,.,,_ .............. .___.. I.... _........ Oa In -Halle & un site Unit: dimsstafflxxw -: 10 tdoleiw Case Ataupnmm Unit diea ,aaff hntr l 1. htavatwn - hldsNld w{ Unit: dred staff tiotr t^ ' 12. Medical Smi— (No TANF) Unity cadaa hnor is. (NOTANIY) Unit: demme 14. (ndpatictd - lndisidual thfa: ccraart Was 15. rh resch IR Reatdeotial Lereli - Unit 21 day 19 RaidnrialLevel trade: 24-1r day' .0. ReAdaaial Level lit Unit : - 24 - today 24. RteidentLd Level IV Unit 244r day ... ... ..._..i 22 Regde Serrirex ______� UniCcmuthar 25. S,a�pated Fanpk>)7rrstt Unit died aalThdr [ _ _. ... 24. Sitppatisr Hotisino'l lying _. _. -. .. Unit direct5ndThar (: .. ... ..... ...... ........._ 34. 'rAs(, _ Un& direct waff taxr J _ ..,.... , 20. Aftercare Unit diet Oaffhrns [ ....... „.... r .._ . ...� .._ _...._,,.,. ,..,.,_,..; Guidance /Care Center, Inc. Page 98 of 121 Contract # PPG -1 -06 07/01/2012 EXHIBIT G 2013 -2014 F,%hlAtt Gi STAY E FLl11'UING BY E' OGRAM & ACIlvh IY Ftscal Year 20112014 Mmida'.Ysae: Uui+faticc Care C'aRtr. lnt. Cmtmc1#. li'C; -1-W I � - � Reeisim Jf; Atarb Subslmte Abuu t.'hWtren's SnMtwrtt Abuse Adhity i Cast Ceeaer T ANF S Unit TANF S Unit X _• Yr. Rate X„ Yes Itde I 2 3 4 s 4 9 3A Oavatkm -Group _ ttilll: Cdthd Hcvr ,_.,... -..... -- W .. ..- X Roan and rwea wAllpen l,Ava Urlik 24hr day 37 Rax,m aM Tiux ue4epeyiahxr Ixwel n _.. ...... Vnit 244w +day $$ Rl n and Hoard w5atpemmo txvtl M tFnit: : 44r da y.__ ....... . , ,._._ 'M Gdaradim O np . _._.,..�.._..,.'..... „ _.. .._. Ibtilcluitdt lrnr — ------------ _. - ...' �13. Atlacare - Clrwp UnC canact hour _ RMOYey Sllppd2 • IndlYldlgl titrR: dievxt 17, Ramay Swpat - Grmp ................. Olit: mlact hotw I .,__ i 'IR Oncal SUpemisim for EvidearccHaSw lVactica �. ........ ..__: lJ4if: cprlad laxq TWa1Nu TANF TdW Now TANF... T'dal "[AMFF •_ I "dW T:LVF y` �. .... .. Trial Treatment & .Afterme .:, ........................... TdW Treatment & Aderme ,. .... ...... ....__........_...._.._.. Unm Wenoded Vults - vocdnpemted UaRs Treatment & After - CC'Sf -44 Ci.1tT4ndiviitbW Clb' 3pliNdr ... .....: . _ .,... ..s ..,. ..................... x _.. . ° ... ... Nat -TxNF tioa- `ANF• TAYN < 'tANF -! TWW CS.'ST SrrNeea•� CdOI (:CST Sen7tea =so Un eaaWeneWed UMta - t4tcanpemated Uldts - Ind4mold F.xptetu 2R ttMiilgaAl ..gtebtbl Unit each 450 spad �.... ........_.E ,_.._.._._....�..� }....._..._.. _.........�! _._.__......._...._...! �_.. _. ._._.__._.. L.__ _. Tdal;NewTANF _� .............. TdW:SOe -TA. Tdal TANY law 1."F = .._.�.....___.. ....„„ CdW IneMrntal Li4wMe ... 'I Ml InMaentat 8apdtW _ so "I - dal NOn'tANY � - IOw NOa TANF - Sl -I 4,+V 'I'dat'fAVN ��j 'I dal IANF�c.........._._.... -..._ Tdal Subsfnue Umse fimfh so Trial Suhd —et Abtue Funds - ISJ, Guidance /Care Center, Inc. Page 99 of 121 Contract # PPG -1 -06 07/01/2012 EXHIBIT G 2014 -2015 Guidance /Care Center, Inc. Page 100 of 121 Contract # PPG -1 -06 Exhibit G: STATE FUNDING BY PROGRAM & AC - nVfPY Fiscal Year 2014 -2015 Provider Name: uidance Care Center In __G________________...... Contract >«: PP( I Revision #:[ Adult Mental Health Children Mental Health Activity /Cost Center TANFS Unit TANFS Unit X =Yes Rate X =Yes Rate 1 2 3 4 5 6 7 1 Emergency Stabilization° 03. Crisis Stabilization (No TANF) . ............................... 33 ... .. Unit: bed-day - ! i I L._.._�.__ - 04. Crisis Support/Emergency ---- Unit: staffhour I I L........ .......1 09. Inpatient (No TANF) 3 I Unit: 24-h r day i I Non -TANF- I Nom-TANF I Total Emergency Stabilization= s0 I Total Emergency Stabilization= s0 ' Uncompensated Wits= I i Uncompensated Units= Recovery & Resiliency I "" -= 01. Assessment Unit: contact hour 1 ' 02. Case Management ... ............................... . .... 1 Unit: direct staffhour I L ............................... :. ......................_......., I ................ 05. Day Can: i 7 Unit: 4-hr day 06. Day/Night ._ ............................. ..__......__.._...._ I ._.._................. �.. Unit: 4-hr day -.-- OT Drop- In /SeflHelp Centers (No-TANF) ' Unit facility day O8. In -Hone and On Site ' I Unit: direct staffhour , ! I 10.. Intensive Case Management Unit: direct staffhour 11. Intervention - Individual Unit: direct staffhour I.....,� I i 12. Medical Services (No TANF) I Unit : contact hour i 14. Outpatient - Individual i . ............................... i Unit: contact hour 15. Outreach i Unit: non-direct staffhour 16. Prevention '• I Unit: non-direct staffhour ' i I_.__......_.._......._, 17. Prevention/Intervention - Day, Unit: 4-hr day ` 1 �.._..._j 18. Residential Level - Unit24 -hrdaY _.. ...� t _ I I..... _.. ...i 19. Residential Level ll Unit: 24-hr day 3 r, € ...........1 I 4...... .........1 20. Residential Level 111 Unit: 24-hr day 21. Residential Levelly Unit: 24-hr day t I 22. Res pite Services ? I Unit: contact hour 23. Sheltered Employment. (No TANF) I 1 Unit: 4 -hrday 25. Supported Employment ............. 1 Unit: direct staffhour - l____ 26. Supportive HousmgfLiving i Unit: direct staffhour 29. Aftercare - Individual Unit direct staffhour I ......_1 30. Information and Referral (No TANF) r Unit: staffhour N L 35. Outpatient - Caoup , Unit: contact hour ! ' 36. Room and Board w /Supervision Level I Unit: 24-hr day t = 1 37. Room and Board w /Supervision Level II ........... I Unit:24 -hrday .............__._...___...., 1 L= 38. Room and Board w /Supervision Level 111 3 1 Unit: 24 day _j 39, Short -tens Residential Treatment , — 1 Unit: Bed -Day - ! __.....` .I 1 Guidance /Care Center, Inc. Page 100 of 121 Contract # PPG -1 -06 07/01/2012 EXHIBIT G 2014 -2015 Activity / Cost Center 1 Adult Mental Health TANF S Unit X = Yes Rate 2 4 6 Children's Mental Health TANF $ Unit X = Yes Rate 7 9 11 40: Mental Heath Clubhouse Services I Unit: Clubhouse staffhour,� 42. Intervention - Grou Unit contact hour I 43. Aftercare - Croup Unit: contact hour Non -TANF= Non -TANF= TANF = I TANF= Total Recovery & Resiliency = $0 I Total Recovery & Resiliency= $0 Uncompensated Units = I Uncompensated Units = Recovery &Resiliency - FACT Team I I I 34. FACT Teams (No TANF) - Unit staff hour L........_ .......................... ............................... '............. ....._........_.__..........._� FACT= Total FACT= $0 I Uncompensated Units = I Recovery & Resiliency - CCST F 44. CCST - Individual Unit: Staff Hour 17 :.. 1 -^ W .. . N = 1 Nat -TANF= TANF =� I TANF= Total CCST Services = SO I Total CCST Services = SO Uncompensated Units I I ',.UncospensatedUnits- Recovery &resiliency - CCST - F.A.C.ES. 44. CCST - Individual Unit: Staff Hour I L� - - - - --� I Non -TANF = I TANF= Taal RA.C.ES. Services = so I Uncompensated Units = Recovery&Resiliency - Community Forensic 77 1 19. Residential Level R Unit: 24-hr day _ E________,3 i 39. Short-term Residential Treatment Unit: Bed -Day 77 t 7 Noe -TANF = TANF- Total Forensic Services = so Total Forensic Services = so Uncompensated Units = I UncoepensatedUnits = - Recovery& Resiliency - Incidental Expenses 28. Incidental Expenses: General Unit: each $50 spent 28. Incidental Expenses: CCST - F. A.C.@S. r Unit each $50 spent ll - .. ..............................1 .. ........- .....................j i........ .............._...._._......._. I '................. ............................... 28. Incidental Fxpenses: Forensic ................... 1 Unit: each $50 spent _____= � L= Li=LLi Non -TANF= I Non -TANF= .. TANF= ? I TANF= .................................... ....� Total Incidental Expenses = so I Total Incidental Expenses = s0 Uncompensated Units = I I Uncompensated Units = Total Non -TANF= I Total Non -TANF= . . . . . . . . . . . . . . . .... . .. . .. . . . . . . . . . . . . . . . . . . ..... . Taal TANF = I Total TANF= - Total Mental Health Funds = $0 Total Mental Health Funds = s0 Guidance /Care Center, Inc. Page 101 of 121 Contract # PPG - - 06 07/01/2012 EXHIBIT G 2014 -2015 Activity/ Cost Center 1 Adult Substance Abuse TANF$ Unit X = Yes Rate 2 3 4 Children's Substance Abuse TANF$ Unit X = Yes Rate 5 6 7 Detoxification I 24. Substance Abuse Detoxification (No TANF) Unit: bed-day 32. Outpatient Detoxification (No TANF) ` I Unit: 4-hr day { I I 1 Total Non -TANF= I Total Non -TANF= 3 Total Detoxification = $0 I Total Detoxification = $o Uncompensated Units = I Uncompensated Units = Prevention I 16. Prevention Unit: nondimct staffhour ' I 54320 I 17. Prevention/Intervention -Day _ .._ ............................ Unit: 4-hr day I 30. Infommtion and Referral (No TANF) I Unit: staffhour I ._._....- ...w...� I i Total Non -TANF= I Total Non -TANF= $144,447 Total Prevention= $0 Total Prevention= $144,447 Uncompensated Units = I I Uncompensated Units = $0 Treatment and Aftercare 01. Assessment ; tt Unit: contact hour 02. Case Management i Unit: direct staff hour ....._. ' . ........... t �...__: ........ i . 04. Crisis Support/Emergency Unit: staff hour 05.. Day Care Unit: 4 -hrday I. _ j -- 1 ..... L 06 Day/Night ...... ..._._ ..................... I t.. ........._..................... i Unit:4 -hrday ,,,_,_�� -�...,____..___._J 08. In- Home & On Site Unit: direct staffhour 10. Intensive Case Management Unit: direct staffhour 11. Intervention - Individual ��� -_ • Unit: direct staffhour I E=' 12. Medical Services (NoTANF) ....._...._�.._........._.... ..__ ........................._. Unit: contact hour ! i__.___.._.._..__.� I 3 I i ._ ............... ......_._....� 13. Methadone Maintenance (NoTANF) I. Unit: dosage I �..t 14, Outpatient - Individual Unit: contact hour €€ `` I (....._,.._....�............w i ............._. 15. Outreach Unit: non-direct staffhour 18, Residential Level l Unit: 24-hr day 19. Residential Level 11 Unit: 24-hr day i I W . . ............! 20. Residential Level tD Unit: 24-hr day f 21. Residential Level IV - Un it: 24hrday I 22. Respite Services Unit: contact hour 25. Supported Employment Unit: direct staffhour '• i.N..N ...............1 I (...... .. I 26. Supportive Housing /living I Unit: direct staffhour 27, TASC Unit: direct staffhour 29. Aftercare ............. Unit direct staffhour ' I Guidance /Care Center, Inc. Page 102 of 121 Contract # PPG -1 -06 07/01/2012 EXHIBIT G 2014 -2015 Activity / Cost Center Adult Substance Abuse TANF$ Unit X = Yes Rate Children's Substance Abuse TANF$ Unit X = Yes Rate 1 35. Outpatient - Group Unit: Contact Hour 36. Room and Board w /Supervision Level I Unit: 24-hr day 37. Room and Board w /Supervision Level H Unit: 24-hr day 38. Room and Board w /Supervision Level III Unit: 24-hr day 42. Intervention -Group Unit: Contact hour 43. Aftercare - Group Unit: contact hour 46. Recovery Support - Individual> Unit: direct staff hour 47. Recovery Support - Group Unit: contact hour 48. Clinical Supervision for Evidence -Based Practices Unit: contact hour Total Non -TANF= Total TANF 1 Total Incidental Expenses = $0 1 I I Total Non -TANF= Total TANF = Total Substance Abuse Funds = $0 I 5 6 7 Total Nan -TANF= Total TANF =' Total Incidental Expenses = $0 Total Non -TANF= $144,447 Total TANF = $o Total Substance Abuse Funds = $144,447 Guidance /Care Center, Inc. Page 103 of 121 Contract # PPG -1 -06 Total Non -TANF= Total TANF = Total Treatment & Aftercare = $0 Uncompensated Units = Treatment &After - COST 1 . 44, CCST- Individual — T ---� Unit: StaffHour Non- TANF = _ TANF =[._ _ _ Total CCST Services = $0 Uncompensated Units = 1 Incidental Expenses I ` 28. Incidental Expenses Unit: each $50 spent Total Non -TANF= Total TANF 1 Total Incidental Expenses = $0 1 I I Total Non -TANF= Total TANF = Total Substance Abuse Funds = $0 I 5 6 7 Total Nan -TANF= Total TANF =' Total Incidental Expenses = $0 Total Non -TANF= $144,447 Total TANF = $o Total Substance Abuse Funds = $144,447 Guidance /Care Center, Inc. Page 103 of 121 Contract # PPG -1 -06 07/01/2012 EXHIBIT H FUNDING DETAIL 2012 -2013 r "xt:. + .:vF. i f EY11TRiT R; E106DTN4: DETAU. .F ci01 I ^rh ( , 1 .F R. V.Fxii1Y 0 10. A6n0'6AMN4I{ -kb OVA AMOL T INdw Fl.itTT w9JMW C4iPlnw I A 1.n00 t7CA AA1011:. 3M700tFMFRC �CY STA RYIATAT FOW 301001- EAik'RCFNI'.Y SIARIL1TA RtTN a A-A01,7.T COM3L.A11MME. HEAT TH (lOdllO) ... (1!A- fIRE:OBRi1'S LIRRTAL HEALTH Ato"331 _..... ,¢- r�AOAi T'tviFax[TP ri»'h�, ^ - .v. 6'rv•'.:! � W,.- _ >drAALR'Sne.t AM2 TF�uz:: : +s• '• _: ' q �rt�urY vraav S- J7i$j' $E31.S j ?..... .y. ... ceY �sv�ro .Rl.•a01 >.�i._ I ._ MN nA"lt AY T XSRV1VrS 1100611} C A el"i DR ER £0't RAW" ACT 11043 511 h cv xN::.un• t E..wXm.ry a .L04.d T. J Tmiriw r St..60(emtr. T.w 507018 RBCW VURY A URMISMC'Y 503013 RWOYEILY d. RBEEO.ISITCY O:bADLT.T CTIMM14 N{FNTAL.ltl sAt TEf rIQO6l0) 0- 1 MS MENTAL 10.1, Ti! I{OOiIAi Al .Ira 7 n F..% 7 -_ K d 'E ,•�. Y &,. rxw lilt AiAl ESI ', :. �t F ( ,_ .> 7 _ " c Af Mla. f J.t.' Y Y: r F T} 1S.e1941 L 1t E •'t I 1 V .. k.. "E .Ol'. .: t'^ 7' E * Aiwai Fa 3lyd ant F a ..,..,.YY..... y{ . 30 F,7 7.1 i w,r 1 • -.11=+01; O)A•P1,rRrTIARFORFVVrW LAI TRL1tx%m SERVir.ES 0107 lx rll. 17 34 A. P -� - * �' rtiansr T r <uA rF .1 ,9) tPA iNVlrtWF P%YCn SUPS t%ltr;RAM 110Ua0) T.x xl tt:r+.T 400E f '= a61? NIP ! R•r •*gT 6 R181t+.LY Tmd ft—Y At RM4e 1 T W = F ..:n:Pra•'.ast 17n:µ T. i nj.mz:M _ 1 TOTAL. ADM T'SABNT 47. HI.ALTR+ 3 TOTAL CHILDREN'S&.NTAL RFATIH. I Il�dBer r Kd 60PEa00i. AA4kY S4Afmw AOUS OCA AMC)UNT 1Ad0m E.ILL01'b0010606- CA6An0'.O k6 _AJA_ Or. AMOIFT T 6410" D10TOX11 603001- DkTK1;tiLF(t'ATfO:�.ARY MA COMM XURYTAAY"F ARUSF %%VS 11"618y r A Cknl EbAFNl{ %lVXTANCT ARVITi SYf S 4/006701 A.:.AM}37 t 17 J 7.:'. = "L' "• LAWl T 1TF nynu." "pC ... v_"r. _TvtA• Lkoii— i- T ar./ - Vvarp —W VANS uue.m ➢+rNid LTWNS , 6 %O" PRFMIMONSFRVICES 607001- I'MVIC1T111 StRVICFX '; COMM MMST A'A E ARUXF '&ti'r'e 11006181 A / LOT TJ AFWK 41 ReTAM F ARUTI; SVCS 1100A301 . ,7F .,. AL,Cr{ - nurfiun TPi «'tiV r }c••a f ...' M N*rxnn .._ .. W @ ewtmv t ............. Pr.wmmwn Ywrir Tmd: =. E 44.vmrdlmlXmir.sTmAl• t Jki yqs rttlrbl -7 RFAYMkRT A AFTRRCARF 60T11LVI RBATMENT At ARTERCARO L' - COMM SUMAME ARM WCS 4IM6181 U C'RIL7XADOL NUWRTAAC9 ABUSE SVCS 1/000901 _ E . .. . _ . ,- .. a.I. .roa.P 4 i�:IAExJ•�• �..••••.• 4.t'i! 4t & €, (ZF•• 'I `.li - i r ST'k J kp;� -• t .... .,.. .. . L Mut T w } x T} - =5 •••.• ,rv,.,•••,• of R- TTFTAT r +3i 01 ; ': i ... b T7A Ski ff 1rvn W %rmmn - —. bxrnl.Ma r, C1..L rc.9* :�[r. , A.k AMTf Thrn i m1 . r ......i - ^F •2A t i :iii.." ....... . - P T, . Nn— .. _....._.. ... w � "loan I 'SSrau 3i.yo;C1<.'sJP f 7rY.v...eA tRmrmeTmal �� Tr.mm.w <AI AFia...r. T.:.l . n..:x�:ymaaerd :1.un ^ny:naw:e.J 4rx4. TI)tAl ADULT' %5UD %TA51Ck AFn1Sk- S TU'CAL CtIfl.DldkR' %kt181T 4�Ck ARUM- I k6 TOTAL ALLFROOKANAW L AAAAAAA WJ" j AAA TOT AL ALL L'rWOMPBIOXTED UNITS- S ".�1'L•: k+9': r..L,1IMMIw J'.M1't+7i3. URA.`LD TOTAL OF FROCRA3f8 Al VMOA6RMATED WRTS- 3 IMAA7 ,.. S TM 1'TJTR ki '.i. Ir,. __ .... F.(.. a. r.1'i•' .a, .< •At. 1tAL•'.F ..�.. Y wLF rT- ;+2:.:rI ks. .ti.Q83 LAa _Fi- s +,UTZ ° w:.. GC2 JAt R,idf9u- s I6.TI3 �vleexa� �v�Ar ml Rmuw. lJwf.. .,egMe ••:+:.w..w ws7�. ... L`1ukr..n r:,.m..s. n we:ser_'cz'+In *wn'c'r Guidance /Care Center, Inc. Page 104 of 121 Contract # PPG -1 -06 07/01/2012 EXHIBIT H FUNDING DETAIL 2013 -2014 FY 2013 -2014 EXIWBIT H: Fl"M. DETAIL Pm.d<r Name: Gridance Cart Cenler.Inc. a Contract M:� -._, PPGI (16,,,____,__� Revuwn qt MENTAL IWAI:rll Bude'E,,Aty 611910506- Adult'. Mental lkaft, (ICA AMOI M HudgetFtity WM10506- Child,—'S Mental Health OCA AMOUNT 502 -4 -EJ ER( CY STABU,WATION 503M)1 -FMF CO , STABHXZAT1ON (JA -ADULT COMM1 MENTAL IIFALTH (10061(1) (JAClM.DRFN•S MENTAL. IWALLTH (1 )435) ADAMH Trust Fund TF (027-5)- AI it A DA MH Tm.l Fund TF lttZ W1)• 1F it 4neml Rer enue ((JW326)' AI5V1 _ G:nerol Revenue (U(1Oi26)• <f.Sl _ TSTF (122021)• .4h1s1 FGTF Titles XXI(261015) - 1 C<neral Revenue (W(ti26)• IMHA I _ General Revenue (-26)• ll", 1 v CJA -B AKFRACTSEFt"CFN (100611) (JACHEL MR 'S HAI"ACT (1()4257) General Rer enue (40326)• A! 1 O.nero1 Revenues (W0326)• C[ SS 1 TSTF (122M3)- A t 1 F —gency StaH11zs9m'1'otal- 5 Flrrrgency StaHllzanon Total- 5 Uncompensated Unites S - Uncorrrye...I.d Unit. E - 50201 R- RFY'OVERY& RESHJENC:Y 503013 - RECOVERY. RESH -t NCV CJA- ADt —COMM. MF]Yl'AL HEALTH (100610) CJA CI ULDREN'S MFWrA1, HW M (119)435) ADAMHTmat Fund TF(027W5) ARK NI _ ADAMH Trust Fund TF (021W5)• KK.iI O&MTF ((127W5) ARK 1 Gen eml Revenue(OWi26)• RRtiI C`71 Re. enue(00(1326) AKR .1 General Rer enue Children At Riak of ED (W)-326) RFO —AGAPE Fam M- 1,(OW326)• AF 1MIJ j FGTF- MIAMIDADEWrap Around Pro YR- 1(261015) 1Dt11 GR/Comm Fortnsic Bed. Adult Sac ((R9) ?26) <.! H t.v Federal Gant Trust Fund (261015) HRS I ADA M Tm.t Fund- FACT Adrmn(027W5) I F A 11 Rovenue(0 -326) SP \tA Ccnerol Revenue - FACT Admire (DW326) r 1 1 l GR -JV Reslor Incorrp To Pm(W0326)• :- N ry F71- FMGPMA Mcdicaid Ad. (261015) F TA 11 FGTF- Tile XXI(261015) Gcnerol Rer enue- FACT .—((M326) r'r';1�I _ F(TF- FGGGID- Jail Diversion Pm (261015) CJDII ; I CJA- PIBCI4V%FU RLN mFN'I'Nl. FGTF FOOGPT -Trans Fmm Homeles.....(261015) <% IR TREATMENT S EkVICFS (10279 ()) O&MTF (02745) MII IR OMCAID&Non -MCAID MOE (000326)• `RN'N R/ [snares( Re.cnue (000326) :+VIII A GR/Purch Rae T—tment Medicaid Sr - cs (04326) : PR 1'S WTTFTANF(4010()1) 11k� General Rer'enue ((N%1i26) IFF11t .. Tobacco Settlement Tm.t Fund (122023) 1-1 Federal Grant Tmet Fund (261015) A RRS 1 - -- CJA- fNDICAV'1'PSVCHMF])SPRO(:RAM (101350) Csneml Rer enue(t)(10326)• ea RRSI ... ............................... Total Non -TANF S - T tat Non -TANF S - Recorery6Re.1llency"total- S RecmerY Rea 111ency Tm i- s - unaorryen..ted Unit. S - uncompensated Unit. S - TOTALADtCV.% MFNTALIWiSl.'1'H- S TOTAL CHH,DRFN•S M%TTAL HW LTH- S SIBSTANCF.ABINF, BudgetF flly 60910604- Adult'a SUbtanne AW— OCA AMOUNT Budget ElrBty 60911M04- Chlldren•s SUlwtance AW— OCA AMOUNT 60345- DETOXHIC,ATION 602W1- DEl'OXMCATWON /ARF CJA -COMM S I BSTANCEABI S ES (l o061 A) (JACIm.WADOLSIBSTANC'E A11111-1 (19)420) ADAMHT— Fund TF(027W5)••• rirNNti ( ADAMHTmet Fund TF(027W5)•'• 1-* (;<neral Re. -enue (OW ?26)•• DIX S _ General Rerenue (04126)•• IJI Y:'1 TSTF (12202.3)•• DIh:S Detn.lne.11arr'r.dal s Ixro :lnea9mn'r.9al s uecompeneakd unit. E - Ilnenmpenaatea th.lb S - 60319)6- PREVINI'ION SERVICES 602 W2- PREVFJY11ON SERVICES CJA -COMM S I BSTANCEABISESVCS' (1110618) (JA- C'IBI.D/ADOI. %tBSTANCE ABlSF.6 V(:Y(1W420) General Rerenue((KK1326)•• PR�:AS ADAMHTmal Fund TF(027W5)••• Pp"'S S 89769 ADAMHTm.t FUnd TF(027W5)•••• PRVAS i General Revenue (04126)•. rR ,ti S 54,6]8 General Revenue (00()126)•• .F ..S ._ -� PrerentlnA s"--r-1 - S Pre. d— %erNCea Tmtal - S 144 44] Uncompensated unit S - uncompensated Una. S - 603W7- TRFA'TMFNI' B[ AVT CA 60243- 'I'RFA'ITNF]YI' & AFTERCARE CJA {'O MMSIBSTAEICF.ABISF.SVCS ADAMH Tmat Fund TF (027W5)... (10()618) TRTAC (YA- CHUM /AIK)L SIBSTANCEABtNESVCS(IM)420) A DA M H Trust Fund TF (027W5)... TRT.S „ Csnerol Revenue (WU326)•• 't Kr 1,i _ _ Cnneral Revenue (OW32G)•• O&MTF(516015) "IRIC TSTF(12202i)•• IRI(,S ADAMH Tmst Fund TF(027W5)••• _''%lily O&MTF (516015)•• IR11 :1 ADAMHTmal Fund TF(02]45)••• = A DA M H Trust Fund TF(021W5)••• 1 1 -111 General Resenue(MI326) :v' WTTF TANF(4OIW1) �•J'1'1'1 WTTFTANF( —MI) _ 'YI'C() GeneralR— ...(04326)•• SPJ<'S GR- Indigent PVg Pm MOE(W0326)•• —1— ADAMH Trust Fund TF(027(U5)••• FGTF - FL Access to Rcv (261015) F 11 H•. SSBG TF (639 K1 ) FGTF- Medicaid Adm(261015) %I A C'04 w.r FGTF - Sc— Into— Treat Pro (261015) I'AV11 y � Gcnerol Ret'cnue ((1(10326)•• F 10 ADAMHTmal Fund TF(02'1W5)••• fJA" Total Non -TANF E - Total Non -TANF S - Treatment & ABercare'ratal - 5 Treatment 6 Aner — Tdal - S Uncompensoted Unite $ - Uncompensated Units S - TOTAL ADIR.'1'S SIBSTANCEAHISE- S 'TOTAL CIBI.DREV•S SIBSTANCE ABIfiE- S 144.447 ' rOTAL ALL PROGRAMS - S 144,447 TOTAL ALL l INCOMPFNSA'rFD IINHS - 5 FUNDSNOTREQV H— GMATCH. (:RAND TOTAL OF PROGRAM.%& t NCOMPENSATE tWN . S 144,447 lgvg Ab Sen S - -- TOTALFUNDS REQUIRTNGMATCH- 5 144,447 De alv Protect $ LOCAL MATCH REQUIRE- S 36112 I CM S S ADDITION ALI.00AL MATCH -�� (MH BI kG nt S TOTAL FUNDS NOT REQUIRING MATCH= S GRAND TOTAL LOCAL MATCH- S 36.1]2 Tel Health Block m m 1x aLham.ce AFU+e Prevem:nn end •tiuh. m Prevent ionand'I' mHlock (:rant- Tr.- arment Hlock (:rxn eliyiFle 4lmding ARreemrnt -Rt - (I(1NRAPPLY Guidance /Care Center, Inc. Page 105 of 121 Contract # PPG -1 -06 07/01/2012 EXHIBIT H FUNDING DETAIL 20142015 FY 2014-2015 FXIIBrF Ik FINDING DETAIL Provider Nattn'� :dance Cam Center, Inc .:..................................................._.................... ..... ............................... ............._..._............_ ................._ Contract a PP J Raviz ion s ��..._ ...................... .............� �.... ............................... MENTAL I I'AL'HI Bndget Entity 60910506- Adult's MentJl kl1th OC'A AMOUNT Budyt.t Entity 60910506- C'hild'en'S Mental IIWft (K'A AMOUNT 50200 ERGFN('Y STABILFIA'IION 50311(11- FTTFR(:EJVCYSTABILIZATION CJA ADIB.T C. MIA MENTAL II (1111M 111) CJA- C'FBI.DRFN'S MENTAL IIFALTH (100435) 00 ADAMHTmst Fund5)• 4 LSS1 00 ADAMH Tmet FUnd5)' C 1 TF Gl Revenue (0-326)326)` - en.m 1 C5S 1 � � Ga oral R.—u. (0-326)326)• ' C' TGSI TSTF(122023)` I'SSI FGTF- Till. XXI(261015) %""1 General Raven ue(OIX)326)" S'MHA.1 1 General Revanua(000326)` S'NH01 »� (JA -B AKFRACTSFRVICES (11111611) (JA-CIm.DRE2V'S BAKERACT (104257) (IDneml Revenue (OW326)• Rovenua (0(9)326)` CTSSI -_ TSTF(122023)• A ISSI Fmergency StntlllznHUn 'TMaI— S Finergency St,mHl Hd9 Tuhd— $ - U.— V.ns.tad Undz S - U... ....tad Unds S - 502019 -RDC VEIIY& RESII.INC'Y 5113013 - RECOVERY& RESIAN('Y (JA- ADIR.T(OMM. MENTAL HEA 711 (1[0)11610) CJA- ClM.DREN'S MENTAL II]EALTH (108 ADAMH Trust Fund TF (027 -5) ARRSI ADAMH Tmst Fund TF (027W5)` C:RR 1 , O &MTF (027W5) ARTIST n j Rev :nue (U -326)" C'RRS1 R' ft, : At Risk oCm C�i R(� (n Revenue (IX9Y326) GAGAPEFam Minizt r5(000326)• ARRSI AFAIMU �.., i (lanaml (-0326) ,,.. FGTF- MIAMI- DADEWmp Arou nd Pm YR- 1(261015) CINIDtit1 . GR/Comm Forensic Beds Adult SVC(000326) CFB \S Fdml Chnnt Tmst Fund (261015) CRRSI ADAMH Tmst Fund -FACT Ad Wn (027-5) 1' I . I.' G....1 Revenue ( -0326) SV M A General Ravenna - FACT Admu ( -0326) F T' 11 v .. GR J V Rostov Incodtp To Pro( - 0326)• 32N i., FGTF FMGPMA Modto.id Admire (261015) F7 4 1 <� , , 1 FGTF - Title XXI (261015) % I Clonaml Revenue FACT sues (000326) FTSl9 _ FGTF- FGGGID J.11Dive (261015) C:II'l TI. _ FSFD RESME14 - HAL (JA- PI92CIA zPro FGTF FGGGF`T -T. n. Fmm Ho— W.sness (261015) C"I" E 'TREATMENT SERVICES (1(12780) O &MTF (027W5) 'v11151x t 9 GR/MCAID &Non -M CA ID MOE (0 -326)• vVHt�M C Revenue (000326) SMFIA2 -. GR/Pumh Res Tm.I—n Medlc.ld Svcs (0IX)326) u1[ RIS i W TTF TANF (401 W I) 'A i x C naml Revenue (000326) Tobacco S.ttbm T Fund (122023) 4 KKSl Fedaml Grant Tmst Fund (261015) A RRS 1 .... CJA -IN DICE T PS VCII MEDS PROGRAM (101 3'0) General Revenue (0(9)326)• ARTIST �.___ Toml N-TANF S - Totnl Non -TANF S - Recovery & Reslllency T—I — S - Recovery & Res111eney Tutd — S - Un— V.nsatod Units S - Unc n,,.nsated Units S - TOTAL ADULTS MENTAL IFE1LT11— S TOTAL CIRLDREN'S MENTAL H ALT11— S SURSTANCF,ABISE Budget F.Hty6 (19106114 - Adult's SUbt.nee AW.e (WA AMOUNT Iludget EntCy609106114- Chlld'en'.SUbetn.ee AWS OC'A AMOUNT 6113005- DErOXIFK7A'IlON 602001- DFTO)CIICATION /ARF G/A-COMMSI /BSTANCEABVBESVCS (11 '0618) CJAC 'III.MAM)LSIMSTANCEAIIIKFSVC:S (11111420) ...... „,, ADAMHTmst Fund TF (027W5)-- DTXAS A DA MH Tm s t Fund TF (027W5) "`• D11C General Revenue (0- 326)•" DTXAS C<neml Rovenue (000326)`• DTXCS TSTF (122023)• ` DT\ S__ Ikto9lncaHdm'TMnI— S Detu,dnc "ti TMnI— s - Uncumpen.eredUnits $ - Unaompe ... Wd Unlb $ - 603006- PREVFNTION SERVICES 602002- PRFVFNTION SElVIC'FS CJA- C.OMMSIBSTANCEABIRESVCS (1[1[1[()619) CYA- CIILWADOL SUDSTAN ClEABUS- ESVC-S (IW420) Csneml Ravenna ((99)326)•• PRI'AS ADAMH Tmst Fund TF (027005) " "" PRvCS A DAM H Tmst Fund TF(027CO5)• "" PRVAS ( -- __ ; General Revenue (000326)•” PP\CS $_ 54678 (leneml Rovanue (000326)" SPIC, , Prevendun S ... I— TM.1 — S Prevention S—rN TMd — S 144,447 Uncompens.led Units $ - Unconq .... ted Units S - 6n31R17 -TREATMENT & AFTERCARE 6112003 -' R FN4NT& AFCERCARE (JA- COMMS1 USTANCF ABIISESVCS (100619) (JA- Cl S IAlSTANCEABINE SVC'S(100420) ..... ............................... ADAMH Tmst FUnd TF (027 -5)'•' r..._ TRTAS AD MHTmst FUnd TF(027W5)— TRTC'S General Revenue(OW326) "" '112 T'. \S . ............. General Revenue (()00326) "` 'T RTC,., 0 &MTF(51W 5) I'RIAS TSTF(122023)r• 'iRit1 i ADAMH Tmst Fund TF(027W5) "• "HIV I O &MTF (51 6()I1) "• 'i KiCS ADAMHTmst Fund TF(027005) "` 2 ADAMH Tmst Fund TF (027C)(6)... 2 Ci" General Rev ....(001[.:26) 3JTCA ............._I WTTF TANF(401 -1) ?`iTri WTTF TANI (zlool) 'IT Cl J (bnoml Revenue (00)0326)•• SP.IC'S GR- Indigent Dmg Pm MOE(UW326) "• DP(;'r% - . .......... ..� Fd TF(CC27W5)rrr y CS ADAMHTm l un FO TF FL A... z to Rov(261015) - i-h'TRt, .�....� SSBG TF (639Z2) TRTC:S ,........ ........... FGTF- Medicaid Ad. (261015) MAC ')1 r„ 4 FGTF -SCmen in me Trent Pm (261015) SBA %u - - - - (b ml (00() 26)- SVIAS ADAMH Tmst Fund TF (027W5)•`• "AS _..._ .. Total NOn -TANF S - Total NOn -TANF S - "rre.tment & ACrere.re TM.1 — S Tre.tment & Anerc.re TMnI — S Vncor�....tad Units S - UnconVensated Units $ - TOTAL ADULTS SURSTANCEABtSE— S TOTAL C'/W,DREN'S SUBSTANC'EABENE— S 144,447 'TOTAL ALL PROC:RAMS — S 144947 "IXITAL ALL INC'OMPFNSATM INrIS — S FUNDS NOT REQUIRING MATCH: C: ND TOTAL CIF PROC:RAMS & INCOMPFNSA'IED tNITS — S 144,447 S S TOTAL FUNDS REQUIRING MATCH= S 144,447 LOCAL MAT CH REQUI R® - - 113-g ADDITIONAL LOC A ATCTi MH BI Cie t ....... ... ... S .. ... . .. TOO TAL FUNDS S NOT REQUIRING MATCH S GRAND TOTAL LOCAL MATCH -- 5 36 txl Healdh 131oek C d ad 6e v e AMds 1'revendian end •Nlwnn ntxxe P Trentm rnt R man eligible finding Aigeement - KhvT RICT I(>NV APPLY Guidance /Care Center, Inc. Page 106 of 121 Contract # PPG -1 -06 07/01/2012 EXHIBIT H LOCAL MATCH PLAN 2012 -2013 PART LU NEW LOCAL. A—M L'U PY«-L.+� sifim kith', .1r - nsv Maus. *7alapt l "se%'sNa,i�. rt awYWl <Illf'CMY ➢ftl /'x 1 if.te. 11(ulAlii I A— I Arwalwt 1 Awrspt e _ ). Aaewtr 3 Rae D Ras b I.St fb )lnrhsa± xats ParRxs:t rata r. Imrcr e.nrh + ^aC ?a7lxfv:.baid .,,...,.. .. __. '-d Stash, rrvI a T-.1 m1 t, i i f xz ikaEen E ].19 M6tdi - E R Ras D Ras 'a Ralr = t r tdak prvL� K -. Ifit:!a W:fmed r =fiz: Pnsr u:d •, flnita Por(hm+d t kYW IaYE�o4 : t'rW ToWltad� a tTW SuAY4ds ......,�.._.,,.__ „_.......,_.. K. CM. bbYM.lt . m. ..•,,,,,,,,,,,,,,,,,,,,,,,,,,,, x i as )Aads __,. ,_,. - ,,..,,,,...�,m�.,,,mw...�., e tNa �d>r: ♦ Tatd McD;h + Yala tdslrb b Rte t xRU'+ Rae h. R.m a i�,.,, w.a,�a - n� w•t.�d i ,..,may � +_naxs £ t =c - moo ,?ql MMdt , 1 a Yy.,bR N>rch a 1 ati IA,r )I a ; mi 73xESA E Lu+E Pb3+ased Lba:l PtJ:x! 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M a fatal Match ': - a Told Melch To1el Mehh Tohl Match rT - M1. Rote $ h. Pale : S b . Rate f b. Rate f c. tlnits Wn:hasM c. tlnits WnhexM c. Units WrthaxM c. Units Wrth_' 2. ('-e hbn.g<Ite.1 2. C., hbe.getlent 2 C-r Ske.gettent _,__...... 2. C.. hbnage-W _ ......_ ...._._...... a. Total Match > $ .......... I Total Match �S a. TohI Match e. Total Mahh > S h. Pate S b. Rate S b. Rate S b. Rate f - <, Units WrthaxM c. Ilnitx Wrchaxcd c. Unite Wn:hased c. Ilnils Wrth..W n/e 3. ('rlab S.Ullaatlm 1 CHab SkNIUMIm 3. CHO. SbNlb.tlm 1. Cda1, S Ullutlm e. 1'oNl Mehh S e. total Match � E a. 1'ulal Match Mtch 5 I, Rate Rate E b. Pte S b. Wte 5 c. Ilnitx P-h-W c. llnils WrchesM c. Units WrchesM c. Units Wmh-W 4. Crlala Su[por✓D,krR<m'y J. (Hal. SulportlHnrg-e J. (1W S.1iYFkrrgmcy J. (A,N Salp lilk sedey a. Total Match __ _ �S e. ""o Match e. Total Match S e. Total Match : S b. Rate S b. Rate M ds S b. Rate S b. c. Units Wrehaxed c. Wech.,W c. Unit. Wrche d c. ILiits Wrchaxed 5. Dry Ct< 5. my C.. 5. My C ..... 5, D.y C.I. a. Total Match ..... : S a. Tuhl Match S ..... a. Total Mt,:h b a. Total Mels.h S b. Rate : S b. Rate S b. Rate S b. Rate $ - c. Units Wrtha,M e. Unit, Wrth.,W c. Units Wrthased c. Unds Wmh.aed 6. It. Ighl 6. Dq' Vlght 6. D.y -Mt h 1,01 e. "fugal Match fatal Mich _ S a. Total Meleh S - e. Tolnl Match �S h. Rate S h. Rat< S b. Rate S b. Role 5 c. Ifidlx Wrch -e,l W. c. Units Wn:h e. tlnits Wmhe.se,I e. lJnits PurthaeM 7. Ihc1.WSW -Iklp Cenhn 7. IhopWSelf -Iklp Cenhn _.._ 7. ik""h/ldr.tklp Crnhn .. ... _.._. ___,,,, 7. M""htSH(dklp Crnhn ........... .. _. a. 'foal Match ................ .,. ,._ S a. Told Me¢h ....... ! E ,,., e. 'total Mahh S e. 'Pohl Mehh 1 T h. Rate T b. Rate S b. Rah E b. Wta ! S - c. Unit. Wn:h,xW c. Unilx Wrth-d c. Units WrchexM c. Units WrthaxM 8.b- FWr., -d Qa.Slh Senitt. B. WfFme nd (ln Slh SerNCea _. _, B d QsSlh SeMm -..... a. 'I'ntal Melch _.... _. l'otal Melch ..... $ - e. land Match$ - a. I'nhl Match E - b. Rate S b. IGh S b. Rate WIe S c. U.." U.." p-besed Il ils c n Wichased c. I/ntt, Wmhaaed c. Ilnils N eh-m ma e. I'otel Match S e. Tu1.1 Match S e. Total Match S e ['oral Match b. Rte f b. Mt. S b. Rte ! 5 - b. Rate ' S c. tlnits W,ehaxM i c. Units Wnhas<d 4 c. Units Wtchased c. Ilnitx Wrthesed 10 Fhm1,<C -e binagemenl 10. Fkmiw C'ne hbnage t ............ . 10. Fkmlx<C., hbnagemrnl . Fhtulw C.ar hbnagemrnt ...... e. Tidal Match ...... ....... ...._____,.._......,.... i E a. Total Mehh S a. "rotaI Match S - a. 'fatal Match is - . Rte E b. Rate S b. Rah T - b. Mt e - s c. llnils ILSehaxM c. tlnits Wrth..M c. tlnits Ihlrth.sM n/e c. Units p-h-ed II. Fhraentlm 11. le-dad It Fknentlm 11. le-dad e. Total Match _ $ - e. ToNl Match i S - a. "Pohl Match ............................. S - a. Total Match is 4491. b. Rte S b. Pate i S b. Rate S b. Wte I S 61.95 c. Ilnitx Wrthas e. Units Wn:hasM c. Units Wmhased c. tlnits I'urthesM 56.45 12. hkdcA SrMCn 12. hk ll .a S. "'. .._............................ 12. hkder S,M, - ............... _......................... 12, hkder SeM<n ................. .... a. Total M-1, ............. S a. Turd Match _..__.... $ a. Total Match (E a. 'Pohl Mehh S - h. Rare : S b. Mt. E b. Mt. I E - b. M, : S - c. tlnits W,chesM c. tlnits WrchesM c. Moils [".h -w e. tlnits WRh-W 13. NI d, ale NYnten.nee I). hkd,a NbintenaMe IJ. hktlusbrh NUliel n[e _ _ 13 hkth.mlle hYnl -.tic< a. I'o Match S e. Told Mahh S _ _ _.,.._._ a. Total M-1, S _ e. 'fohl Match f - b. Rte S b. Rte S b. Rate E b. Rte i S c. tlnits WschasM W, c. tlnits P-hasM <. toots W,eh.,W e. tlnits W,eh -ed 14.(,e"d- I -FdNdW 14. Uat dtl .bdiAdd 14 (latptl <nl ---dl 14.(Ftp.tl<nt- FANdrr _ e. fatal Match S - e. Told Match ... S - e. Total Match E - to a. 'I'otd Mahh S - b. Wle $ b. Rate s b. Pale � S b. ! 5 c. llnils W rchaxM c. Ilnils W reh,, W c. Ilnitx N,eh.sM We e. Ilnils W lchasM 15. Uuherh 15. Uutttach 15. 1l --h 15. CIe-h e. 'total Mtch S - a. Total Match 5 - a. Total Match 'total Match : S 100011.00 h. Rate S b. Rah S b. Rte Rah T 4.120 c. Units WrthasM W. c. Unds WnhaxM c. llnils WrthasM c. lJnitx WrthesM 231 J8 16 P-d- 16. I'n,entl- 16. Pre d- ..... 16. P -ded e. Tul al M-1, .......... ............................... S a. Total Mahh ........... ..........................._... S a. Total Match 1 S e. To1el Match S 2262100 b. Rte b b. Rah S b. Nate S b. Wte : 5 1320 e. (lnits Wmhesed c. tlnits Wn:h ... d c. Unds Wn:hased e. Units WmhasM 529.6) 17. Ptt deelFk dee -Uay I7.P _flW mle-fl- -D.y I7. Prr d- /Fh dad- thy 17. Pnsrntledlb dee -Iky ___..... a. 'Pohl M-1, ' S a. Total Match S e. Tool Mahh t S a. Total Match S h. Wte S b. Mt. ': S b. MI. ! E - h. Rate � S . Ilnitx Wrch -ed c. U,its Wrthascd c. Units Wrthascd c. Units Wn:hascd 18. W. &.do U< l I 19 Ikalskntld Uwl I ......._ ..............._....... 18. 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Units N.h..d 44 WST 41 ( o- pM..Iw C.-dty (C(SI) :1 (apml�.iw C-lly S-k, T ... (M'8 a. I-] M-1, r. ."la s r-, m-h r.w.%I-h b Rate s i b R... b R.. s h R- $ c. j P..h-d P-h..,ed 1, U.,u N.1-d W, .. U.,f., N,h ... d 1"11 To A s s - i I \ .. s - 11A 14d., s 36,112.00 Guidance/Care Center, Inc. Page 110 of 121 Contract # PPG-1-06 07/01/2012 EXHIBIT H LOCAL MATCH PLAN 2014 -2015 n 2014 -2015 Agency Notre: r (kidenae Care (corer, kc. Contact Number. PP61-06 UHa: 711 12014 AMHT el S CMHT al ASA T-I E 1S. T-1 5 (k.nd Td S -. NA - 3b,113.00 16.112.00 I \ m.nt 1 Van meat I. T, nt I. U .men y T a Intel MetcM1 �S e. tarot Match S e Toml Match IE a Total Match - b. S b. Rata S c. lJnilr 1'utchaxed c. Unito s Pumhesed e. Un P. Pomhesed c. Unit+PuteM1Saed 2, 1ne 5kmgerrenl ......... ............................... 2. Cre \ Wr. t y..... ............................... ...... z. Cnr nknagetneN y. .._..._......_. .._ ................ 2. Cue nYr ag<ment a........._. ... _._ .. e. Taal Match �S Taal b. Rate : S a. '1'otel Math b. Rate S S - a. otel Match b. Rare : S - e. Total Match b. Rate S : S c. Units Wtcha.ed c. Units Purchased c. U.R. purchased c. llnita MicM1ased t, CrDlr SnHllntlm 3 . CH.1. SnUllaatlm }. (lisle SHbfllaatlm ............_......_........... 1. cd.l. s,mlle.tlm ._.................. y ...._ ..... .................. a. Total Match : E ............. Tagil M e. atch ..................... �S a. atch Torel M r.......... S a. Total Match y T b. Rate i S b. Rate : 5 b. Pare i b. Rote S c. Ilnita Purchaxed n1a c. Units Purchased c. llnita M-h. -d c. Unit. ..h... J. (}Isle Sup Vhltsrg - y ...._......... ......,,., J. Crlala SupprV F3nerg c y........._ _ ........... 4. ( Suppor11 3 N-sy , , J.-1e SupporVFlrsrgenq . ............ �I ... . ........ e. Taal Match S b. Rare : S e. Total Match b. Rate S S e. Tarlel Match b. Pare �S � S a. Total Match b. Rena � S c. llnita -ha +ed c. Unite Wmha+ed c. Units Wrchesed c. Unit. Wtchned n/a 5. 1 .r ('ne ..... 5. D.Y Care ....__. ............ 5 Hay Care - ._- ....... 5. Do Care y ...... -. a. Total Match b. Rate S fatal Match b. Wle �S : S - e. Total March b. Rata rE 5 e. Total Match b. Rana S S - c. lJnits Wichaaed c. Unite purchased c. Unit. purchased c. Units Push - 6. MY-Nlghl 6, Dry Night 6. IMy -Nigh) 6.Dry -Night 'Total . ......... _ e. 'I'ael Match �5 b. Nate : S - e. Total Match b. Rate �S S - e. Total March b. Rate �S 5 a. Match D. Rate E : S - c. Iln its Wsha.ed c. Unit. -ha.ed i Units Wrchased c, ll.d. -h-W ]. IhapWSelf -FkIP Center. ]. h✓SW- Mp('entera .......... __..__. ]. DropWSelf- Iklp(snten ]. Dra Sdf- He1PCenten ..... ...................__......._.. a. Total March ! S a. teal Match S a. Total Match 5 - e. T-1 Match i S h. Nate S D. Rate S b. Rate S b. Rate S . Units Furthered c. llnita N'hnal c. Units Pun:h ... d u. unitw purchased e.k -lions nd Dmtilte SerNC- g. Wlfame and (MSik SerNtn B. Wfbne and(In Site SerNtts _ 8. ht -lima rW OmSlk SerNrn a. Tagil Match S e. Tntai Match ___ ! S e. Total Match S o. I-I Match i 5 b. Rate S b. Rote S - b. Bete S b. Rate S c. U.o. Purchased c. Units Iurchased c. llnita purchased c. llnita Purchasd 'J. kptlent 9. wmd..t _ .... _ 9. hptlent 9. NpN1eM _ e Total March _. Total Match S - a. Tonal Match "total Match S - b. Pete S b. Wte S b. Rare 5 - b. Rota S c. Unit, purchased c. Units Pumha.ed c. Units Fushased c. Units Purchased 10. Weroi,e ('ne nknag<ment 10. ksmis Cre \snag 10. kknal,e C.. nknage.. _ ....... ., 10. htkni.e Cne nWngettte „ , ....,.,, e. Total Match r S ,..,._ a. Tarsal Match ..___.... ! S - e. feel Match S e. Total March S b. Rate S b. Rate ! S b. Rare S b. Wre 5 c. Units lL mh-a c. Ilnita Furchaxed q a c. Units PUmha.ed c. Units Pumheaed W. e. Total Match S - e. Total Match Total Match S - a. Total Match 3,J9100 b. Rata S b. Nate i S - b. Nate S - b. Rene E 6195 c. Ilnita Purchased c. llnita Wmhned c. Units Pumhewd c. Units Purchased Sb33 12. nkdcd SerNtn 12. nkdcN -Ace. 12. nkdcY SerNn. ............. .......... 12. N",A SnNm a. Total Match S a. Tarsal Match S e. Total Match 5 e. Total Match 5 - b. Nate, S b. Pate i S b. Rata E b. Role E - c. units wmh.,ed c. units wmhnad c. Unit. Pu mhased c. Unit, Poahuad 13. nktlradus Skintenrs< 13 . nkthaJne nYnsnrrtt ............................... 13. nklharMe AM1elntennt. ........... ._............_................ 13, nktltskne %Wntenrse r ,.,...__... ............................... ....._ ....... ............................... a. Total Match S e. Taal Match ,..,,,,,.,. S e. Taal Match S e. Total Match S - I, Rote E b. Rena b. Rote S c. hail. -hased c. Units Furthered c. llnita Wrchesed c. Unite Wrvha +ed 1J.(Mtpetlent- kdNdul IJ.(Ml dtl - k A." .__ IJ.- "dent- hrdNJrY 14. (SUtptlent- hWNdul ,,,,,,, a. Total Match $ e. Teel Match S a. Total March S e. Total Match E M1. Wte S b. Pate Rate E c. unit. purchased n +purchased c. unit. Punhned c. Units Pun:h ... d I5. (MSc -h I5. (MSenh I5. (MSc -h ................ ....... 15. OuM1ta,T .... a. 'total Match S ... ......... - a- Total Match ............ .... Tarsal Match e. T-1 Match S 100W.00 b. Rate S b. Nate S - b. Rate 5 b. Rate S 4320 t. Unitw purchased c. Units Nu heed c. Unit, Nu haeed c. llnita Purchased 211. I6. Preaentlm I6. --d- 16. PrerenHm ....__..._.. 16, Pre,entlm ......._ ...... a. Taal Match : S ....... ..._ - e. Total Match .... Taal Match 'total Match " s 22621ro b. Rate 5 b. Rate 5 b. Rate S b. Wte S J.i 20 Unite Wmhescd c. llnita Pusha.ed c. Unit. Purchased c. llnita Purchased 5236) 17. PrercntlWFhrarntlm -U.y 17. PreaentlaVkrcr,entlm- Day _ 17. Pre . entlmlkkr,entlm -Dry 17 . Ple,entlodkkr.entlm -Dry a. Total Match S - e. Total Match i S - a. Total Match S - e. fatal Match b. Rare E b. Rate S - b. Rote S b. Rate S c. Units purchased c. knits Punhued c. Unit+Punhawed c. llnita Wmhesed [8 1 den" Le,e11 Ig. pnlMrtlal la,el l 18. N lt`l U-1 l 18. Rnldentld tarot l _ e. 1'ntal Match S e. Total MetcM1 S - a. 1'otel Match �S - e. Total Match S b. Rare S b. Rate S - b. Rate 5 b . Rate E c. Ilnita -hared c. Unit. Pumhned c. Unit Purchased c. llnir. Pumhaxed 1, Re 1.... 1-1 H 19 w.1- uR l H 19. Raaldentlal l<.el H ..... I S .. 19. -&.d4 U< l H a. Total Match ......... S o. 'fatal Match S b. Rote S - a. Total Match b. Rate s S a. Taal Match b. Pale 1 5 - b. Rate S - c. llnhr PumM1UCd n c. llnita Pumheacd c. IJ,o. Purchased I c. Units Purchased 20. IteaI -A heel IR 20. Rex, -.A 1a,e1 m 20. Resldentl.l [ <, M ...... _ 20. Rnidentl.l heel lH _.... _ ._. _........... e. fatal Match S - a. Total Match ...... S - a. Total Match S - a. total Match 5 - D. Rate S b. Wte S b. Wt< Units Puchased S b. Rata c. Units Purchased S c. llnita I'umheaW c. hails 1Lmhased c. Guidance /Care Center, Inc. Page 111 of 121 Contract # PPG -1-06 07/01/2012 EXHIBIT H LOCAL MATCH PLAN 2014 -2015 i 'rural Match Rate :. Units Wrchased !2. Re.p. Sersices i. Total Match Rate ;. Units Wrchased 23. Shelhrcd Emp r. Total Match � Rate . Umti Wrchased 24. Sub...re AN- Dr..ifll s. Total Match R.te ;. Units Wrchased 25. Su pprhd F plo evt s. 'focal Memh Rate c. Units Wrchased 26. SupprhJFbwi.g/Lhi.g a- TntalMmch b. Rate c. Unds Wwhascd 27. TASC e. Total Mmch h. Rate c. Units Wrchased 28, I.cirketd E.p.ses e. Total Mmch h. Gate c. hints Wrchased 29. Af. e a. "r 1 M lch b. R. c. U-L Wrchased 30. l. - fl.. ..dWk-1 e. Total Mmch h. Rate Unds Wwh.sed 31. Resened 32. 00p-d .t De W.iflllfi . a. 'Total Match b. Rate c. llnits Wrchased 33, Resersed 34. FACTTevm a. fora[ M.tch b. Rate Unite Nmh.sed 35. Outpde.t -Gaup . Total Mamh b. Rate c. Units Wrchased 36. Rmm &Bwrd with S.p TOtul Match b. Smte Rate . I Ioun or UniLr Wrchased 37. Rmm & Bwrd with S.w fatal Mmch b. smm Isere U.it. Purchased 38. Rmm &Bwrd Mth S.pe a. fora[ Match b. State R.. . . [lours or Units Wrchased 39. short -hem Reaidesndl a. Total Match b. Rum llnits Wrchased 40. M -1 IkAth Cl.hhome a. T,, .1 Match b. Retc c. llnits Wrchased 4. CCST a. 1,, A Match h. Rate llnits Wrchased Total Match Rate I loos Wrchased W.ph S-i- Total Match Rate 1 Units Wch.sed Shelhrcd Empq me.t Total Match Rate linos Wrchased Sub.- Abuse Debsifl-1 F,, Match I Rate � Ilnils Wrchased , S.pprhd Fmpo>nc.t Totes Mulch Rate Units Puwha.cd S.p -d Ho.. l.g/LINog rom1M ch Rate Ilan. Wrchased TASC To.l Match Rate Units Wrchased t bride..[ E.peue. Total Mulch R.te llnits Wrchased Alb-c Total Match Rate llnits Wrchased I. -fio...d Rek-1 F. I Match Rate U.Ns Wrchased I. Rr.er.ed 2. Oulpnwt Deb.iflevtim 'ro.l Match R.. Units Wrchased 3. Resened 4. FACr Te.m . 'rota[ Match Rate Unite Purchased 5. 0,fmfl .t -Group . I..I Match Rate llnits Wrchased 6. Rmm& Bard with Supeni . 'r..1 Match State R.te H.- or Units Wrch.sed 7. Rmm & Bwrd Mth S.WN Total Match St- Rate Houn or Units Wrchased 9. Rmm &Bwrd Mth Suwm i. Total Mmch ,. State Rate 11- ,,Units Wrchased i9. Short -hem Re id -fl.l Tm i. Total Match , R.tc . llnits Wrchased 10. Me..l Fkalth CluMome S, i. F -IM emh ' Rate . llnits Purchased 11. Comprche..i.e Commuaiy r. 'I'o.1 Match Rine :. U.it. Pnwhased TF"dre N.l Letel ry . Total Match Rate . (lnts Wrchased 21. R..Id -fl.l Lesel N 2. R Senircs . Total Match Nate . Units 1Lrcha.ed ,,. Total Match rf ............ ........_.._ A Sub.eee Abase De.vflcvNae ............... . Total Match E Rate S .. Units Wrchased b. Relc I d. c. Units Wshesed /e 27. TASC �. Total Mamn Rate ;. Units Wrchased 21 R ph S'"- _ - r IM th S $ b. R. I N. c. llnits Wwhe.ed n/e 23. Sh II -d - - t - F Match e f - - b. Rat f Na Units Wrchased Na 24. Sublv.ee Abuse Dlm.ifi-dw - r .1 Match r f h. Rae I! <: Units Wrchased I me 25. S.pporfd Fmplww0 rota[ Match F f b. Rate f j! c. Units Wrchased /a pporhd Hou.l.g /LAW ,,...,..26.5 1111.1 Match I W h Ra f Ne c. Ilnils Wrchased i W. 27. TASC - e. 'I'olal Match b. R.te f Na c. llnits Wrchased Na 28, bcide.t.l b W,- . - .'f t IMntch f b. Rae Na c. Unds Nwhaved n/e 29. Afhrwre . 'f cal Mmch S b Rare I n/a Units wwh.sed j Ne 30.1 f Hou..d Ref e... I Match S b. Ra �- n/a c. Ilnils Wrchased 31. R--d 32. Ou1p Heut Dem fi-dll _ - a. Total Match f b. Rate f Ne c. Units Wrchased 33. Resened 34. FACT Te.m e- Tolel Mulch � f b. Rate { S W. c. Unite Wmh ... d 35. Oulpde.t -Group ....... e. 'rote[ Match .......... ......n 'f � b. Ram f .m e. UnJ.. Wwh.aed i /e 36. Rmm &Bo.rdM.SapeMSio. Lesell a. Tula[ Match i f b. St- R- f - .1. c. Hoar U- Purchased n/e 37. Ram& Bovrdwith S.pM.fo. Ua 111 �- a. Toml Mmch S b. Stine Rate Na c. Houn -U-. Wrchased j N. 38. Rmm &Bo.rdwi. S.pMsiw ID Total Match j I - b. Slam Nate .[loan or Ilnils 1L,haaed I Ne 39. Sbort -mein Reside. N.I Trealmeut e. Total Memh '> f - b. Rat. j s W. c. Units Wrchased Ne 40. Me.td Hevllb Cl.m -Se R- a. Total Match ` f b. Rate E Na c. Units Wrchased n/r 3Tj 41.C..W'h,"iw Comm..ity S< Mc< T e.m fCCST) a. Total Match ^S h. Nate f Units Wwhaacd nh TF"dre N.l Letel ry . Total Match Rate . (lnts Wrchased $ 2. R Senircs . Total Match Nate . Units 1Lrcha.ed S 3. ShrlWmdFmpi,) -t . '1'olal Match Rate Units Wrchased S A Sub.eee Abase De.vflcvNae ............... . Total Match E Rate S .. Units Wrchased 15. S.pporhd Fmpoyr.e.t i. l'o.l Mmch ! Rate Ilnils Wrchaud . b. S.ppwwdH".l.g /IANeg i. 'fo.l Match ,. Rate :. llnits Wrchased S 27. TASC �. Total Mamn Rate ;. Units Wrchased .................... ( s 28. (.rid -1 E.,.... r. R Match r. Nate ;. llnits 1L.hused $ 29. Afhrc.rc .. R oral Match b. Rate ;. Unes 1L.hesed $ 30. I.form.Nw ..d Rek-1 a. Total Match b. Rate c. Unit. Purchased 31. Resened 32. O-Hwt Demdfle.do. $ Rate S llnits Wrchased Reamed FACT T- Tnml Match j S R.te (�- Ilnits Wrchased O.tpne.t -Cro.p .......... Tole[ Match S Rate E U.it. Wwh ... d R. & Bwrd with S.pM.lou I 'total Match State Rate �. Houn or U- Wrchased ! '. Room& Bwrd Mth SapeMsio_._I Total Match $ Slate Rate Houn or llnits Wrchased I. Rmm &Bwrd MtY SUpM.ioul 'Total Mmch r S S.te Ram 11".. or Bait. Wrchased Sborl -hem Resld -i,l T-tme. Total Match L Rate S llnits Wrchased ,_ 1. W..l Had. CUM ... e S"- Total Match �f Rare S Units I'uwhesed � I. Comprc Yr7w Cnmm..iy Se M. C. Match S� R.te u.h. I'urchaa<a Guidance /Care Center, Inc. Page 112 of 121 Contract # PPG -1 -06 07/01/2012 ATTACHMENT II SCOPE OF WORK The Guidance/Care Center's (G /CC} will provide the Project Success program using the Substance Abuse and Mental Health and Services Administration (SAMHSA) Center for Substance Abuse Prevention (CSAP) Project SUCCESS program recognized in the National Registry of Evidence -based Programs and Practices (NREPP). The program will be available and accessible to high risk youth ages 12 -18 who have experimented with alcohol showing early danger signs and multiple risk factors for substance abuse and attend Monroe County High Schools. Goal 1 Reduce DUI crashes countywide amongst 18 -20 year olds by 10% in 2015 by meeting the following objectives: reducing alcohol use, increasing the perception of harm and risk in youth and enhancing positive, pro - social protective factors. Goal 2: Increase capacity by providing level 2 prevention programming for those at high risk; thereby eliminating service gaps for these students by providing the funding and resources necessary to ensure successful program implementation, continuity of care and partnership capacity countywide, TARGET POPULATION OR PARTICIPANTS (Include numbers in tables and a narrative description of participant characteristics below): Level I & Level ".. Ntmtb" of P,a"101"I is . Youth living in Monroe County (Level 1 & 2) Year 1 Level 1 = 330 ChIkiltat Youth . Year 2 and 3 Level 1= 410 Key West High School Year 1 Level 2 = 206 Key West Year 2 and 3 = 206 Parent Education Group (Level 1) Year 1= 23 Coral Shores High School Year 2 and 3 = 42 Youth participating in school wide activities (Level 1) Years 1, 2 and 3 = 2540 (2370 = youth & 170= adults) 12 so Description of participants to be served (describe criteria for program enrollment eligibility, geographic arras /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 12 -17 years who reside in Monroe County. Services will be provided at all three high schools and Marathon Middle School. The Project SUCCESS Program will be available to 9 -12 grade students attending any one of the three Monroe County High Schools 6 -12 graders at Marathon High /Middle. The comparison of percentage of Monroe County youth and Florida Statewide youth who reported having used a list of 14 various drugs in their lifetimes reveals that percentages for Monroe County youth exceed those for the state in every category (FYSAS 2010). A significantly greater percentage of Monroe County High School students (40.9° /6) than statewide students (33.6 %) witnessed gang members selling drugs. The ethnicity of these children breaks down as follows: 52.9% White, 33.8% Hispanic, 10.10% Black, 1.45% Asian and 2.88% Other. 51" Not" Stti llddr6ss City 110C94 . 1 1 33070 ChIkiltat Youth . PaferrCs O #W Key West High School 2100 Flagier Ave Key West 33040 1200 20 80 Coral Shores High School 89901 Old Highway Tavernier 740 12 so Marathon Middle High School 350 Sombrero Rd. Marathon 33050 1 600 10 40 Guidance /Care Center, Inc. Page 113 of 121 Contract # PPG -1 -06 07/01/2012 ATTACHMENT II SCOPE OF WORK PERFORMANCE MEASURES Quart tY Project SUCCESS: Total =410 served annually in Level 1 1 330 Year 1 0 206 served annually in Level 2 1 410 Years 2 Year 1: 330 served Level 1 and 206 in Level 2 & 3 (Parent Education Group prevention activities: 2540 23 Yearl and 42 Years 2 &3 0 9 sessions 35% 1 and 2 for participants to achieve results 85% 1 2 4 School wide )portuni es 1 Perrormance Goal k Reduce the Monroe County prevalence rate of past 30 -day alcohol use among youth. Goal L Increase youtI& attitudes and beliefs about the risk of harm of underage drinkin Project SUCESS 9 sessions 85% _ Year 1 Level 1 = 330 281Participants Year 2 and 3 Level 1= 410 349 Participants Year 1 Level 2 = 206 175 Participants Year 2 and 3 = 206 175 participants Parent Education Group 2 sessions for 1.5 hours 85 %= Year 1= 23 19 participants Year 2 and 3 = 42 35 participants School -wide prevention 2540 4 opportunities awareness activities Quality Description of the required program Quality measures. Guidance /Care Center, Inc. Page 114 of 121 Contract # PPG -1 -06 07/01/2012 ATTACHMENT II SCOPE OF WORK Q"I ty 1 mes"11% l loasumnitntt and Nips Toat Average number of sessions attended 85% of 330 participants or 281 will . At the end of each cohort of (Participant Retention) complete Project SUCCESS pre / post group sessions test, attendance records and a minimum of 9 sessions (Note. 410 will be served in yrs, 2 & 3) • Collected immediately prior 85% of 23 or 20 participants complete to the 1st session and the Parent Education Group —a immediately following the last minimum of 2 sessions session, Measure: (Student Survey of Risk and Protective Factors and logs) Note. 42 parents will be served in yrs. 2 &3 • 70% of youth will increase their • Monitoring the Future instrument; . Collected immediately prior attitudes and beliefs related to risk of pre /post tests to the l session and harem of underage drinking immediately following the last • 70% of the youth will have no or a • Monitoring the Future instrument; session decrease in past 30 -day alcohol use pre /post tests . Collected immediately prior by curriculum completion to the I" session and • 70% of youth will decrease favorable + Monitoring the Future instrument; immediately following the last attitudes toward alcohol and drug use pre /post tests session s 70% of parents will decrease • Collected immediately prior favorable attitudes toward alcohol • Student Survey of Risk and to the 1" session and and drug use. Protective Factors immediately following the last session • Collected immediately prior to the 1" session and immediately following the last session, P and %of youth satisfied with services 90% • At the end of each Program provided Satisfaction survey cohort for youth in Project SUCCESS • At the end of each Parent Education session Observation of service delivery/ Fidelity Curriculum fidelity checklist. At the end of each cohort for checklist youth 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 1WA At the time of contract training/certification monitoring 616 youth will receive the Guidance /Care Center, Inc. 1. Data entered into the I At admission into PBPSsystem &TheGCC program Page 115 of 121 Staff trained; Program Contract # PPG -1 -06 07/01/2012 ATTACHMENT II SCOPE OF WORK EVIDENCE BASED PROGRAMS (ESP) 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. Project SUCCESS SAMSHA approved, NREPP Option 1 Parent Education Group Part of Project SUCCESS - SAMSHA approved, Option 1 NREPP School -wide awareness activities Part of Project SUCCESS - SAMSHA approved, Option 1 NREPP TASK LIST Activities Year I Act vitier /%Mce Name &DesMption # &Typ*Of EBP %to Participants, Recommended Meet Sessions or this Hours Outcome'` Activity Title; Recruitment/ Orientation and Assessment 410 youth 40-60 minutes 85% Activity 0escriodon: Participants will be recruited from designated schools 330 in yr. 1 for 1 session and will receive a pretest assessment of their risk and protective factors. re ue c : One time upon program entry. Intensity. 1 sessions Duration 40-60 minutes per session. Activity Title: Project SUCCESS (Prevention Education Series) Curriculum 206 9 sessions Qa 85% ActivityDescrintion: Participants will be required to attend 9, minute 1.5 hour per sessions Level 2 session FreauencV• One time per week Inte nsity, 6 -12 sessions Duration: One 90 minute session Activity Title: Parents Education Group 23 in yr.1 1 session per 85% Activity Description: Participants will receive ATOD education information 42 in yrs. 2 & cohort for 60 Freauency: 3 minutes Intensity. I)V for each cohort Du Lion 60 Activity Title Project SUCCESS post testing 300 youth 60 -min. 8596 Activity Description: Participants will receive a post test assessment of their sessions risk and protective factors Freauencv: lx upon program completion Intensity. 1 session Duration: 60 minutes Additional Requiremeritsc Obtain MOU with county level coalition by November 30, 2012. Other reports as required by funder Guidance /Care Center, Inc. Page 116 of 121 Contract # PPG -1 -06 07/01/2012 ATTACHMENT II SCOPE OF WORK EVIDENCE BASED PROGRAMS (ESP) 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. Project SUCCESS ISAMS14A approved, NREPP Option I Parent Education Group 1part of Project SUCCESS - SAMSHA approved, 10ption I awareness activities IPart of Project SUCCESS - SAMSHA approved, Ioption 1 TASK L15T year T Acthifties /Service Name & Description # &Type of EBP %to Participants Recommended Meet Sessions or this Hours oune mo ActivityTitle: Recruitment/ Orientation and Assessment 410youth 40-60 minutes WA Activity Description: Participants will be recruited from designated schools 330 in yr. 1 for 1 session and will receive a pretest assessment of their risk and protective factors, Freauencu One time upon program entry. Intensity, I sessions D Mbo : 40-60 minutes per session. Activity Title: project SUCCESS (Prevention Education Series) Curriculum 206 9 sessions @ 85 0 /4 Activity Description. Participants will be required to attend 9, minute 1.5 hour per sessions Level 2 session Freauenr , One time per week Intensi 6 -12 sessions Duration: One 90 minute session ActivitvTitle: Parents Education Group 42 1 session per 8SOA Activity Description:. Participants will receive ATOD education. information 23 in yrs.. 2 & cohort for 60 Freouem .. Once 3 minutes Intensity: 1x1 for each cohort mt/on: Activity Title: Project SUCCESS post testing 300 youth 60-min. 8SIA Activity Description: Participants will receive a post test assessment of their sessions risk and protective factors Freauencv: Ix upon program completion Intensity: ] session Duration: 60 minutes Additional Kequtremerm Obtain MOU with county level coalition by November 30, 2012. Other reports as required by (under Guidance /Care Center, Inc. Page 117 of 121 Contract # PPG -1 -06 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 ertification shall be subject to a civil penalty of not less than $10,000 and not more than $100,0 fo at;WWch failure. lam Y K itt t o --- l t 1741 2- Signature tl Date 1 `+ Name of Authorized indiv' Fillaf Contract Number — Name of Organization 000 �l@�afll. Address of Organization Guidance /Care Center, Inc. Page 118 of 121 Contract # PPG -1 -06 07/01/2012 ATTACHMENT IV 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 /omb /circulars /al 02 /a102.html. (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 Awards (SEFA) and the Data Collection Form (SF —SAC) required by OMB Circular A -133. OMB Circular Guidance /Care Center, Inc. Page 119 of 121 Contract # PPG -1 -06 07/01/2012 A -133 is available at http: / /www.whitehouse.gov /omb /circulars /al33 /al33.htmi. 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 fo 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 ) 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 Guidance /Care Center, Inc. Page 120 of 121 Contract # PPG -1 -06 07/01/2012 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 gov /fac /collect /ddeindex htmI 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. Page 121 of 121 Contract # PPG -1 -06