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FY2017 10/19/2016AGREEMENT This Agreement is made and entered into this 19th day of October, 2016, 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 (ME225-7-27 and PPG-2-03) 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 AND NINTY THOUSAND AND NO/100 DOLLARS ($690,000.00) in fiscal year 2016-2017. 3. TERM. This Agreement shall commence on October 1, 2016, and terminate September 30, 2017, 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 expended in violation of this Agreement or in violation of appropriate Federal, State, and County Guidance Care Center-SAMH Contract FYI 7, page 1 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. S. 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. In addition, if PROVIDER is required to provide an audit as set forth in in Section 9(d) below, the audit shall be prepared by an independent certified public accountant (CPA) with a current license, in good standing with the Florida State Board of Accountancy, and maintain malpractice insurance covering the audit services provided. If the PROVIDER receives $100,000 or more in grant funding from the County, the CPA must also be a member of the American Institute of Certified Public Accountant (AICPA). The County shall be considered an "intended recipient" of said audit. 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. Guidance Care Center-SAMH Contract FYI 7; page 2 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) Proof of registration with the Florida Department of Agriculture as required by Florida Statute 496.405 and the Florida Department of State as require by Florida Statute 617.01201 or proof of exemption from registration as per Florida Stature 496.406. (c) 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; (d) Evidence of annual election of Officers and Directors; (e) 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; 1. If the PROVIDER receives $100,000 or more in grant funding from the County an audit shall be prepared by an independent certified public accountant (CPA): a. The CPA must have a current license, in good standing with the Florida State Board of Accountancy; b. The CPA must be a member of the American Institute of Certified Public Accountant (AICPA); c. The CPA must maintain malpractice insurance covering the audit services provided and d. The County shall be considered an 'intended recipient" of said audit." (f) Copy of a filed IRS Form 990 from most recent fiscal year with all attached schedules; (g) Organization's Corporate Bylaws, which must include the organization's mission, board and membership composition, and process for election of officers; (h) 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; (i) Specific description or list of services to be provided under this contract with this grant (see Attachment C, per contract ME225-7-27 and PPG-2-03); (j) All legally required licenses; (k) 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 (ME225-7-27 and PPG-2-03); (1) 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; (m) Cooperation with County monitoring visits that the County may request during the contract year; and (n) 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 2015-2016 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, 2017. 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. Guidance Care Center-SAMH Contract FY17; page 3 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. IS. 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. 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 Guidance Care Center-SAMH Contract FY17; page 4 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 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 Guidance Care Center-SAMH Contract FY17; page 5 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 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 Guidance Care Center-SAMH Contract FY17; page 6 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 For PROVIDER Frank Rabbito, Senior Vice President Guidance/Care Center 1205 Fourth Street Key West, FL 33040 Monroe County Attorney PO Box 1026 Key West, FL 33041 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 FYI 7; page 7 IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as of the day and year first written above. HEAVILIN, CLERK F'Deputy W i ss Q 0 .s a .c� ccl � Guidance Care Center-SAMH Contract FYI7; page 8 BOARD OF COUNTY COMMISSIONERS OF MONROE CO NTY LORIDA By M r/Chairman Guidance/Care Center (Federal ID No.5q-45� �32LI ) By Director Guidance/Care Center MONROE COUNTY ATTORNEY PPROVED AS TO FORM: cL� - : nL . , ._ _ _ CHRISTINE M. LIMBEkT-BARROWS ASSIST T COUNTY ATTORNEY Date 11�i� :��) 11Q 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 FYI 7; 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 FYI 7; 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. Executive Director Attachments (supporting documentation) Sworn to and subscribed before me this day of 20 who is personally known to me. Notary Public Notary Stamp Guidance Care Center-SAMH Contract FY17; page 11 by 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 (ME 225-7-27 and PPG-2-03. Guidance Care Center-SAMH Contract FYI 7; page 12 ATTACHMENT D Contractual Agreement Guidance/Care Center and South Florida Behavioral Health Network (Contract Nos. ME225-7-27 and PPG-2-03) Guidance Care Center-SAMH Contract FYI 7, page 13 �/ �o South Florida Behavioral Health Network, Inc. rev. 07/01 /2016 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, 2016. It shall end at midnight, local time in Miami -Dade County, Florida on June 30, 2017. 5. State of Florida Law This contract is executed and entered into in the State of Florida, and shall be construed, performed and enforced in all respects in accordance with Florida law, without regard to Florida provisions for conflict of laws. Courts of competent jurisdiction in Florida shall have exclusive jurisdiction in any action regarding this contract and venue shall be the appropriate State court in Miami -Dade County, Florida. 6. Federal Law a. If this contract contains federal funds, the Network Provider shall comply with the provisions of federal law and regulations including but not limited to, 45 Code of Federal Regulations (CFR), Part 74, 45 CFR, Part 92, and other applicable regulations. b. If this contract contains over $100,000 of federal funds, the Network Provider shall comply with all applicable standards, orders, or regulations issued under section 306 of the Clean Air Act, as amended (42 United States Code (U.S.C.) 7401 et seq.), section 508 of the Federal Water Pollution Control Act, as amended (33 U.S.C. 1251 et seq.), Executive Order 11738, as amended and where applicable, and Environmental Protection Agency regulations (40 CFR, Part 30). The Network Provider shall report any violations of the above to the ME. c. No federal funds received in connection with this contract may be used by the Network Provider, or agent acting for the Network Provider, or subcontractor to influence legislation or appropriations pending before the Congress or any State legislature. If this contract contains federal funding in excess of $100,000, the Network Provider must, prior to contract execution, complete 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 applicable, 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. b. Retention of all client records, financial records, supporting documents, statistical records, and any other documents (including electronic Standard Contract Guidance/Care Center, Inc. Page 1 of 11 Contract No. ME225-7-27 South Florida Behavioral Health Network, Inc. rev. 07/01/2016 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 seven (7) 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. Financial and Compliance AU.M. 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 and the DCF 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 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. The Network Provider's inability to evaluate liability or its evaluation of liability shall not excuse its duty to defend and indemnify after receipt of notice. Only an adjudication or judgment after the highest appeal is exhausted finding the 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 a. 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) thereof 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 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 Standard Contract Guidance/Care Center, Inc. Page 2 of 11 Contract No. ME225-7-27 South Florida .Behavioral Health Network, Inc. include but not limited to, cancellation or modification to policy limits. rev. 07/01 /2016 b. To the fullest extent permitted by law, and not withstanding any other provision of this Contract, the Network Provider by signing this contract acknowledges the value of obtaining Cyber Liability insurance, has considered all of the risks, and assumes all of the risks and liability associated with not obtaining such insurance. The Network Provider will indemnify, defend, and hold the ME harmless from any and all claims, losses, liabilities, damages, judgements, fees, expenses, awards, civil monetary penalties, and costs (including reasonable attorneys' and court fees and expenses) arising out of or related to any Breach or alleged Breach of Unsecured PHI created, received, maintained, transmitted, or otherwise used by the Network Provider and arising from the Network Provider's breach, or failure to perform pursuant to this Contract (collectively, a "Claim") up to and including the Appellate Court level and until the case is resolved. 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 waving the limits of sovereign immunity. 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 or to a provider of the Department's selection, 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 the Network Provider, the ME and the Department. 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 s. 215.97, s. 215.971, F.S. Should repayment not be promptly made upon discovery by the Network Provider or its auditor or upon written notice by the ME, the Network Provider will be charged interest at the lawful rate of interest on the outstanding balance until returned. b. Payments made for services subsequently determined by the ME to not be in full compliance with contract requirements shall be deemed overpayments. The ME shall have the right at an time to offset or deduct from any amount due to the ME from the Network Provider under this or any other contract or agreement.. c. 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 a. 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. Standard Contract Guidance/Care Center, Inc. Page 3 of 11 Contract No. ME225-7-27 �O South Florida .Behavioral Health Network, Inc. rev. 07/01 /2016 b. The ME monitors timely submissions of incident reports and may impose financial penalties as described in Section 39. Financial Penalties for Failure to Comply with Requirement for Corrective Action of this Standard Contract, paragraphs b., c., and d. 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 Certificate, CF Form 707 and the Civil Rights Compliance Checklist, CF Form 946 in accordance with CFOP 60-16 and 45 CFR 80. 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 twenty (20) 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 Standard Contract Guidance/Care Center, Inc. Page 4 of 11 Contract No. ME225-7-27 South Florida Behavioral Health Network, Inc. rev. 07ro1/2016 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 this contract. For the purposes of this provision, the term "use' shall include use by the Network Provider during the term of this contract and use by the ME, agents, or contractors and the Department during the term of this contract and perpetually thereafter. 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 Department and 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 Department'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 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 or immediately upon hire and annually thereafter. The Network Provider shall maintain a copy of the signed DCF Security Agreement form CF 0114 in the personnel file. The Network Provider agrees to submit copies of each signed DCF Security Agreement form CF 0114 to the ME's Contract Manager and the ME's Director of Information Technology upon request. 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 four (4) 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 thirty (30) 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 willtake appropriate steps to maintain its accreditation or become fully accredited by June 30, 2017. Should the ME seek accreditation the Network Provider shall collaborate with the ME in the application process. 27. Network Provider Employment Opportunities a. Agency for Workforce Innovation and Workforce Florida: The Network Provider understands that the DCF, the Department of Economic Opportunity, 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 Department of Economic Opportunity and Workforce Florida. Standard Contract Guidance/Care Center, Inc. Page 5 of 11 Contract No. ME225-7-27 �� South Florida Behavioral Health Network, Inc. rev. 07/01/2016 b. Transitioning Young Adults: The Network Provider understands DCF's Operation Full Employment initiative to assist young adults aging out of the dependency system. The ME encourages Network Provider participation with the local Community -Based Care Lead Agency Independent Living Program to offer gainful employment to youth in foster care and young adults transitioning from the foster care system. 28. Health Insurance Portability and Accountability Act The Network Provider shall, where applicable, comply with the Health Insurance Portability and Accountability Act (42 U. S. C. 1320d.) as well as all regulations promulgated thereunder (45 CFR Parts 160, 162, and 164). 29. Emergency Preparedness a. If the tasks to be performed pursuant to this contract include the physical care or supervision of clients, the Network Provider shall, within thirty (30) days of the execution of this contract, submit to the contract manager an emergency preparedness plan which shall include provisions for records protection, alternative accommodations for clients in substitute care, alternate facilities for the 24 hour facilities in case those facilities are incapacitated by the disaster and the expectation for returning exceeds emergency sheltering capabilities and time allowances supplies, and a recovery plan that will allow the Network Provider to continue functioning in compliance with the executed contract in the event of an actual emergency. For the purpose of disaster planning, the term supervision includes the responsibility of the ME, or its contracted agents to ensure the safety, permanency and well-being of a child who is under the jurisdiction of a dependency court. Children may remain in their homes, be placed in a non -licensed relative/non-relative home, or be placed in a licensed foster care setting. b. The ME agrees to respond in writing within thirty (30) days of receipt of the plan accepting, rejecting, or requesting modifications. In the event of an emergency, the ME may exercise oversight authority over such Network Provider in order to assure implementation of agreed emergency relief provisions. c. An updated emergency preparedness plan shall be submitted by the Network Provider no later than 12 months following the acceptance of an original plan or acceptance of an updated plan. The ME agrees to respond in writing within 30 days of receipt of the updated plan, accepting, rejecting, or requesting modification to the plan. 30. Notification of Legal Action The Network Provider shall notify the ME of legal actions taken against them or potential actions such as lawsuits, related to services provided through this contract or that may impact the Network Provider's ability to deliver the contractual services, or adversely impact the ME. The ME's contract manager will be notified within ten (10) days of Network Provider becoming aware of such actions or from the day of the legal filing, whichever comes first. 31. Whistleblower's Act Requirements In accordance with subsection 112.3187(2), F.S., the Network Provider and its subcontractors shall not retaliate against an employee for reporting violations of law, rule, or regulation that creates substantial and specific danger to the public's health, safety, or welfare to an appropriate agency. Furthermore, agencies or independent contractors shall not retaliate against any person who discloses information to an appropriate agency alleging improper use of governmental office, gross waste of funds, or any other abuse or gross neglect of duty on the part of an agency, public officer, or employee. The Network Provider and any subcontractor shall inform its employees that they and other persons may file a complaint with the Office of Chief Inspector General, Agency Inspector General, the Florida Commission on Human Relations or the Whistle -blower's Hotline number at 1-800-543-5353. 32. Proprietary or Trade Secret Information a. Unless exempted by law, all public records are subject to public inspection and copying under Florida's Public Records Law, Chapter 119, F.S. Any claim by Network Provider of proprietary or trade secret confidentiality for any information contained in Network Provider's documents (reports, deliverables or work papers, etc., in paper or electronic form) submitted in connection with this contract will be waived, unless the claimed confidential information is submitted in accordance with Section 32. b. below. b. The Network Provider must clearly label any portion of the documents, data or records submitted that it considers exempt from public inspection or disclosure pursuant to Florida's Public Records Law as proprietary or trade secret. The labeling will include a justification citing specific statutes and facts that authorize exemption of the information from public disclosure. If different exemptions are claimed to be applicable to different portions of the protected information, the Network Provider shall include information correlating the nature of the claims to the particular protected information. c. The ME, when required to comply with a public records request including documents submitted by the Network Provider, may require the Network Provider to expeditiously submit redacted copies of documents marked as confidential or trade secret in accordance with Section 32. b. above. Accompanying the submission shall be an updated version of the justification under Section 32. b., correlated specifically to redacted information, either confirming that the statutory and factual basis originally asserted remain unchanged or indicating any changes affecting the basis from the asserted exemption from public inspection or 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 - Standard Contract Guidance/Care Center, Inc. Page 6 of 11 Contract No. ME225-7-27 South Florida Behavioral Health Network, Inc. rev. 07/01/2016 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 httos://fs16.formsite.com/DCFTraining/Monthly-Summary-Report/form login.html 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 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: htta://www.myflfamilies.com/service-programs/deaf-and-hard-hearing/providers 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 $5,502,409.00, 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 $4,585,341.00, subject to the delivery and billing for services. The remaining amount of $917,068.00, 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 B, Method of Payment and in Exhibit H, Funding Detail, will automatically change, utilizing the 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 eight (8) 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 eight (8) 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. The MEs failure to pay the Network Provider within the ten (10) working days will result in a penalties as referenced in the Prime Contract. 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 Standard Contract Guidance/Care Center, Inc. Page 7 of 11 Contract No. ME225-7-27 �� South Florida Behavioral Health Network, Inc. rev. 07/01 /2016 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.S., corrective action plans may be required for noncompliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed for failure to implement or to make acceptable progress on such corrective action plans. The ME, at its sole discretion, will determine the findings identified in the corrective plan that will require a financial penalty. 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 notice 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 Contractfor 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 through the date of termination. 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 Contractshall 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 of 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.oro. 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) The parties agree to cooperate in resolving any differences in interpreting the contract, including but not limited to, client eligibility and/or placement into the appropriate level of care, a general dispute arising out of, or relating to this contract, or contesting a financial penalty for failure to comply with requirements of a corrective action plan. Within five (5) working days of the execution of this contract, each party shall designate a Standard Contract Guidance/Care Center, Inc. Page 8 of 11 Contract No. ME225-7-27 South Florida Behavioral Health Network, Inc. rev. 07/01/2016 Dispute Resolution Officer with the requisite authority to act as its representative for dispute resolution purposes, and provide that information to the other party. (b) Within five (5) working days from delivery to the Dispute Resolution Officer 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 parties are not able to meet within the five (5) working days due to scheduling difficulties, the meeting shall occur as mutually agreed to by the parties, but no later than ten (10) working days from the date of receipt of the written request for dispute resolution. If the representatives are unable to reach a mutually satisfactory resolution at the face-to-face meeting, the dispute resolution process in Section 42.(c) shall be followed. In the event of a dispute regarding client eligibility and/or placement into the appropriate level of care, the dispute shall not preclude the Network Provider from providing the provision of services to eligible individuals until the dispute is resolved. (c) 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 next step, the President/Chief Executive Officer of the parties shall confer in an attempt to amicably resolve the issue. If the President/Chief Executive Officer of the parties cannot resolve the issue, the issue shall be presented at the discretion of the ME either to the Board of Directors Executive Committee and/or the ME's Board of Directors. Should the dispute not be resolved at the Board of Directors Executive Committee and/or the ME's full Board of Directors level, 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. 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.215.473, F.S. Pursuant to section s.287.135(5), F.S., the ME shall 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. Employment Eligibility Verification (E-Verify) (a) Definitions as used in this clause: (i) "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/grantee to perform work pursuant to the contract/grant with the ME. (ii) "Subcontract" means any contract entered into by a Network Provide 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. (iii) "Subcontractor" means any supplier, distributor, vendor, or firm that furnishes supplies or services to or for the Network Provider or subcontractor. (b) Enrollment and verification requirements. (1) The Network Provider/grantee shall: (i) Enroll as a provider/grantee in the E-Verify program within 30 calendar days of contract award or amendment (ii) 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 Network Provider/grantee/subcontractor to perform work pursuant to the contract with the ME shall be verified as employment eligible within 3 business days after the date of hire. (2) The Network 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 Network 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 Network 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 Network 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 Network Provider/grantee, then the Network Provider/grantee must reenroll in E-Verify. (iii) 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: htto://www.dhs.gov/E-Verify (iv) The Network 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 Network Provider/grantee through the E-Verify program. (v) Evidence of the use of the E-Verify system will be maintained in the employee's personnel file. (vi) The Network provider/grantee shall include the requirements of this clause, including this paragraph (vi) (appropriately modified for identification of the parties), in each subcontract. (vii) The service provider at any tier level must comply with the E-Verify clause as subject to the same requirement as the Network Provider Standard Contract Guidance/Care Center, Inc. Page 9 of I 1 Contract No. ME225-7-27 �� South Florida Behavioral Health Network, Inc. rev. 07/01/2016 45. Employment Screening: The Network Provider shall ensure that all staff utilized that are required by Florida law to be screened in accordance with chapter 435 F.S., are of good moral character and meet the Level 2 Employment Screening standards specified sections 435.04, 110.1127, and subsection 39.001(2), F.S. as a condition of initial and continued employment that shall include but not limited to: (a) Employment history checks; (b) Fingerprinting for all criminal records checks; (c) Statewide criminal and juvenile delinquency records checks through the Florida Department of Law Enforcement (FDLE) (d) Federal criminal records check for the Federal Bureau of Investigation via the Florida Department of Law Enforcement and (e) Security background investigation, which may include local criminal record checks through local law enforcement agencies. (f) Attestation by each employee, subject to penalty of perjury, to meeting the requirements for qualifying for employment pursuant to chapter 435 F.S. and agreeing to inform the employer immediately if arrested for any of the disqualifying offenses while employed by the employer. 46. The Department requires, as applicable, the use of the Office of Inspector General's Request for Reference Check Form (CF 774), which states "As part of the screening of an applicant being considered for appointment to a career service, select exempt service, senior management, or OPS position with the Department of Children and Families or a Contract Provider Agency, a check with the Office of Inspector General (IG) is required to determine if the individual that is being recommended to be hired for the position if that individual has previously worked for the Department or a Contract Provider, or if that individual is being promoted, transferred or demoted within the Department or Agency'. 47. Human Subject Research: The Network Provider shall comply with the requirements of CFOP 25-8 for any activity under this contract involving human subject research within the scope of 45 CFR, Part 46, and 42 U.S.C. section 289, et seq., and may not commence such activity until review and approval by the Department of Children and Families Human Protections Review Committee and a duly constituted Institutional Review Board. 48. Survival of Terms: The parties agree that, unless a provision of this Contract, its Exhibits, Attachments, or incorporated documents expressly states otherwise as to itself or a named provision, all provisions of this Contract concerning obligations of the Network Provider and remedies available to the ME and/or the Department are intended to survive the ending date or an earlier termination of this Contract. The Network Provider's performance pursuant to such surviving provisions shall be without further payment, as the contract payments received during the term of this Contract are consideration for such performance. 49. 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 Benvenuti, CFO 3000 41 st Street, Ocean Marathon, FL 33050 Office number: 305-434-7660 Mobile number: 305-731-3343 Fax number: 305-434-9040 E-Mail: marianne.benvenuti@westcare.com b. The name, address, and telephone of the Contract Manager for the ME for this contract is: Elba Taveras South Florida Behavioral Health Network, Inc. 7205 Corporate Center Drive, Suite 200 Miami, FL 33126 Tel. (786) 507-7462 E-Mail: Etaveras@sfbhn.org d. The name, address, and telephone number of the representative of the Provider responsible for the administration of the program under this contract is: Frank C. Rabbito Deputy Chief Operational Officer 169 E. Flagler Street, Suite 1300 Miami, FL 33131 Office number: (305) 573-3784 Mobile number: (305) 799-1286 Fax number: (305) 381-7733 E-Mail: frabbitoftwestcare.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. 50. All Terms and Conditions Included This contract and it attachments, I. II. Ill. & 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://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, the Business Associate Agreement, and other attachments, if any; b. Any documents incorporated into any Exhibit or Attachment by reference; c. The Standard Contract; d. Any documents incorporated herein by reference Standard Contract Guidance/Care Center, Inc. Page 10 of 11 Contract No. ME225-7-27 �� South Florida Behavioral Health Network, Inc. rev. 07/01/2016 BY SIGNING THIS CONTRACT, THE PARTIES AGREE THAT THEY HAVE READ AND AGREE TO THE ENTIRE CONTRACT, AS DESCRIBED IN SECTION 50. 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. Center, Inc. SOUTH FLORIDA BWP� X IORAL HEALTH NETWORK, INC. N4SIGNED NAME: Frank Rabbi o NA E: hn W. Dow TITLE: Deoul'<y Chief OperatiaAal Officer TITLE: President andE DATE: DATE: /G Federal Tax ID# (or SSN) 59-145024 Network Provider Fiscal Year Ending Date 630 Standard Contract Guidance/Care Center, Inc. Page 11 of 1 i Contract No. ME225-7-27 :'1;:OAOOO ' South Florida Behavioral Health Network, Inc. ATTACHMENT I A. Services to be Provided 1. Program/Service Specific Terms 07/01/2016 (rev. 6.22.16) 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: http://sfbhn.org/wordr)ress/wp-content/ui)loads/Program Service-Specific-Terms.pdf (1) "Behavioral Health Services" are mental health services and substance abuse prevention and treatment services as defined by s. 394.9082(2)(a), F.S., and in Chapter 397. F.S. (2) "Block Grants": The Community Mental Health Block Grant (CMHBG), pursuant to 42 U.S.C. s. 300x, et. seq., and the Substance Abuse Prevention and Treatment Block Grant (SAPTBG), pursuant to 42 U.S.C. s. 300x-21, et. seq. (3) Collaborative Planning Group Systems, Inc. is the entity contracted with the Department of Children and Families that maintains the database called Performance Based Prevention System (PEPS) that Network Providers contracted to provide substance abuse prevention services must utilize to upload substance abuse prevention data required by this contract. (4) "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. (5) "Continuous Quality Improvement" is an ongoing, systematic process of internal and external improvements in service provision and administrative functions, taking into account both in process and end of process indicators, in order to meet the valid requirements of Individuals Served. (6) "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. (7) "Co-occurring Disorder" is any combination of mental health and substance abuse in any individual, whether or not they have been already diagnosed. (8) "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, Attachment I HCO2 (a) Guidance/Care Center, Inc. Page I of 53 Contract No. ME225-7-27 ��►o South Florida Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) 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. (9) "Coordinated System of Care" is the array of mental health and substance abuse services described in section 394.4573, F.S. The essential elements of a coordinated system of care include but are not limited to: (a) Prevention and early intervention; (b) Emergency care; (c) Acute care; (d) Residential treatment; (e) Outpatient treatment; (f) Rehabilitation; (g) Supportive services; (h) Recovery support; (i) Consumer support services, and U) Diversion programs. Services provided within the System of Care must be accessible and responsive to the needs of individuals, their families, and community Stakeholders. (10) "Cost Analysis" is the review of the proposed cost elements to determine if they are necessary, allowable, appropriate and reasonable. (11)"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. (12) "DCF PAM 155-2" is the Department of Children & Families, Pamphlet 155-2 - Mental Health and Substance Abuse Measurement and Data, effective July 2010 (10th edition, version 1), or the latest revised edition thereof, means a document promulgated by the department that contains required data -reporting elements for substance abuse and mental health services, and which can be found at: http://www.dcf.state.fl.us/programs/samh/pubs reports.shtml, and is incorporated herein by reference. (13) "Department" means the State of Florida Department of Children and Families. (14) "Electronic Health Record (EHR)" is defined by s. 408.051(2)(a), F.S. (15) "Evidenced -Based Practice (EBP) are practices that are based on accepted practices in the profession and are supported by research, field recognition, or published practice guidelines. Category #1: The intervention is included in Federal registries of evidence -based interventions; Or Category #2: The proposed program or strategy is reported in one or more peer -reviewed journals as having a positive effect on an outcome that is relevant to the identified outcome Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 2 of 53 Contract No. ME225-7-27 !F� South Florida Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) in the service or treatment plan of individuals receiving the specified intervention. To justify Option Two, a provider would also include a detailed description of the evidence of a positive effect on the selected outcome(s) and how the relevance was determined in a literature review. In addition, a population of interest in the study must match the intended recipients or individuals of the EBP. The ME does not fund Prevention services for this category. Recognized agencies that review and rate the quality of program research evidence include, but are not limited to: • Blueprints for Healthy Youth Development; • California Evidence -Based Clearinghouse for Child Welfare; • U.S. Substance Abuse and Mental Health Services Administration's (SAMHSA) National Registry of Evidence -based Programs and Practices; • The US Department of Health and Human Services. (16) "Forensic Mental Health Services" are services provided to individuals with mental illness pursuant to Chapter 916, Florida Statutes. (17) "HIPAX is the acronym for Health Insurance Portability and Accountability Act (42 U.S.C. 1320d, and 45 CFR Parts 160, 162, and 164). (18) "Individual(s) Served" (synonymous with Consumer, Client, Participant) is an individual who receives substance abuse or mental health services, the cost of which is paid, either in part or whole, by Department appropriated funds or local match (matching). (19) "Knight Information Software (KIS)", (synonymous with Care Coordination, Utilization Management and Financial Reporting System) 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, local match, Temporary Assistance for Needy Families (TANF), Purchase of Therapeutic Services (PTS) and Title 21 . 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 394.74, F.S. F.S. and 65E- 14.005, F.A.C. (21) "Managing Entity (ME)" as defined in section 394.9082(2)(d), F.S., is 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) "Mental Health Services" is defined pursuant to Chapter 394, F.S. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 3 of 53 Contract No. ME225-7-27 i� South Florida Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) (23) "Motivational Support Program" 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. (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) "Payer class" Medicare, Medicare HMO, Medicaid, Medicaid HMO, private -pay health insurance, private -pay health maintenance organization, private preferred provider organization, the Department of Children and Family Services, other government programs, self -pay patients, charity care and any other payer class other than the Department. (27) "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. "PBPS" is the Department's Performance Based Prevention System that collects data related to community assessments and plans and substance abuse prevention programs and activities. (28) "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. (29) "Prevention" refers to the proactive approach to preclude, forestall, or impede the development of substance abuse or mental health related problems. These strategies focus on increasing public awareness and education, community -based processes, and incorporating evidence -based practices. Programs designed to prevent the development of mental, emotional, and behavioral disorders are commonly categorized in the following manner: Universal Prevention Preventive interventions that are targeted to the general public or a whole population group that has not been identified on the basis of individual risk. The intervention is desirable for everyone in that group. Selective Prevention Preventive interventions that are targeted to individuals or to a subgroup of the population whose risk of developing mental, emotional, or behavioral disorders is significantly higher than average. The risk may be imminent or it may be a lifetime risk. Risk groups may be identified on the basis of biological, psychological, or social risk factors that are known to be associated with the onset of a disorder. Examples include programs offered to children exposed to risk factors, such as parental divorce, parental mental illness, death of a close relative, or abuse, to reduce risk for adverse mental, emotional, and behavioral outcomes. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 4 of 53 Contract No. ME225-7-27 South Florida .Behavioral Health Network, Inc. 07/01/2016 (re-. 6.22.16) Indicated Prevention: Preventive interventions that are targeted to high -risk individuals who are identified as having minimal but detectable signs or symptoms that foreshadow mental, emotional, or behavioral disorder, as well as biological markers that indicate a predisposition in a person for such a disorder but who does not meet diagnostic criteria at the time of the intervention. (30) "Prime Contract" is the contract between the Department of Children and Families and the ME. (31) "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, F.A.C. It includes but is not limited to the Network Provider's organizational profile, the service activity description, a detailed description of each program and covered service funded in the contract, the geographic service area, service capacity, staffing information, and client and target population to be served. (32) "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. (33) "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. (34) "Provider Network" (subcontractor or Network Provider) refers to the group of direct service providers, facilities, and organizations under contract with a ME to provide a comprehensive array of emergency, acute care, residential, outpatient, recovery support, and consumer support services including prevention services and any other services purchased by this contract. See section 394.9082, F.S. (35) "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. (36) "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. (37) "Representative Payee" refers to an entity/individual that is legally authorized to receive Supplemental Security Income, Social Security Income, Veterans Administration benefits, or other federal benefits on behalf of an individual served. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 5 of 53 Contract No. ME225-7-27 �� South Florida 10000 Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) (38) "SAMH" stands for the Substance Abuse and Mental Health Programs within the Department. (39) "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. (40) "SOAR" stands for Supplemental Security Income/Social Security Disability Insurance (SSI/SSDI) Outreach, Access and Recovery and is a Substance Abuse and Mental Health Services Administration (SAMHSA) technical assistance initiative designed to help individuals increase earlier access to SSI and SSDI through improved approval rates on initial Social Security applications by providing training, technical assistance, and strategic planning to Network Service Providers. (41) "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, , F.S. (42) "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. (43) "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. (44) "Substance Abuse and Mental Health Information System (SAMHIS)" is the Department's web -based data system for reporting substance abuse and mental health services, including the Substance Abuse and Mental Health Information System (SAMHIS) or any replacement system identified by the Department for the reporting of data by the Managing Entity and all Network Service Providers in accordance with this contract. (45) "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. (46) "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 as defined in under 42 U.S.C. ss. 601, et. seq., and ch. 414, F.S. (47) "Unit Measurement" synonymous with "measurement standard" is used in billing the ME for services. The definition of each unit of measure can be found in Rule 65E-14, F.A.C. (48) "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 Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 6 of 53 Contract No. ME225-7-27 %i� South Florida / Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) waitlists and maximize utilization as well as diverting individuals served to more clinically appropriate services when applicable. (49) "Verifiable Service" is a service provision that is documented in compliance with the requirements contained in Rule 65E-14, F.A.C. (50) "Wait List" is a master list for the Network, maintained by a Managing Entity that shows: (a) The number of individuals waiting for access to the recommended service or program; (b) The length of time each individual has been on the waiting list; and (c) The interim services provided to the individual. 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 children, adolescents, adults, and elders, as applicable, 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), and with the Substance Abuse and Mental Health Services Plan 2014- 2016, , 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 and expand its array of services to provide trauma informed care, as appropriate. 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. 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, trauma informed care services and ensure the integration of behavioral health services and primary care services to all the consumers in care in coordination with a Federally Qualified Health Center or other medical facility as required by this Contract. 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; (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. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 7 of 53 Contract No. ME225-7-27 U� South Florida //Behavioral Health Network, Inc. c. Scope of Service 07/01/2016 (rev. 6.22.16) 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, 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 of the ME to improve co-occurring capability, trauma informed care, ensure the integration of behavioral health and primary health care services 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 strategically applying substance abuse prevention programs, and environmental strategies that are relevant to community needs as defined in a ME approved Comprehensive Community Action Plan. Once approved, the plan can be obtained at: www.sfbhn.orq 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 responsive; and Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 8 of 53 Contract No. ME225-7-27 �� South Florida Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) (d) Be dedicated to excellence and quality results. There is a commitment to expand clinical treatment to include the behavioral health Transformation Initiative, evidence -based practices and recovery support services in accordance with priorities established by the 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; (g) Gender responsive, and (h) Sexual orientation. 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, Covered Service Funding by OCA and the description of such services specified in the Program Description as required by Rule 65E-14, 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. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 9 of 53 Contract No. ME225-7-27 �/ ' r� South Florida Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) (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, Covered Service Funding by OCA. Failure to meet the minimum numbers served may result in a corrective action and an imposed financial penalty as described in the Standard Contract. (3) The Network Provider shall adhere to treatment group size limitations not to exceed fifteen (15) individuals per group for any clinical therapy service provided, with the exception of Outpatient Group services. For Outpatient Group services funded under this contract, the Network Provider shall adhere to the group size limitations outlined in the current Medicaid Handbook. In addition to other programmatic documentation requirements, service documentation to evidence group activities shall include the following: (a) Data Elements I. Service Documentation -Group Sign in Sheet 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. Start time V. Duration; vi. Covered Service; vii. Service (Brief description of type of group); vill. Group Indicator; and ix. 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. Clinical diagnosis; V. Start time; vi. Duration; and vii. Services (Group progress note) (4) 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 08/01/2016, an attestation that all applicable Network Provider employees and subcontractors who have access to ME and Department information systems have completed the Security Agreement form as required in Paragraph 25. Information Security Obligations, of the Standard Contract. (5) For licensable services purchased by this Contract, the Network Provider shall have and maintain correct and current Department of Children and Families, as required by Rule 65D- 30, F.A.C., Licensure Standards for Substance Abuse Services and Agency for Health Care Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 10 of 53 Contract No. ME225-7-27 �o South Florida Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) Administration (AHCA) licenses and only bill for services under those licenses. In the event any of the Network Provider's license(s) is 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) is reinstated. (6) The Network Provider shall maintain and implement 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. Prior to the execution of this contract the Network Provider submitted a copy of its grievance procedures both applicants for, and recipients of, services and provider staff, however, should any updates to the grievance procedures occur during the term of this contract, the Network Provider must submit the amended procedures to the Contract Manager within thirty (30) calendar days of the amendment. The Network Provider shall post and provide copies of the grievance procedures to all consumers receiving services with funds provided for in this contract. (7) The Network Provider shall use the approved standardized assessment tool designated by the ME. Standardized tools and assessments approved by the ME must be used to determine placement and level of care and entered into KIS. Consumers partially treated by grants or other funding sources may be exempt from this requirement if the funding source required a different tool. Such exemption must be granted in writing by the ME. (8) 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. (9) By 08/01/2016, the Network Provider shall submit to the ME's contract manager an updated disaster plan consistent with Paragraph 29., Emergency Preparedness, of the Standard Contract. (10) 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. (11) By 08/01/2016, the Network Provider shall submit to the ME's contract manager an updated Civil Rights Compliance Checklist (CF0946) (12) By 08/01/2016, the Network Provider shall submit to the ME's contract manager an updated Civil Rights Certificate (CF707), signed a dated by the Network Provider's contract signer. (13) The Network Provider shall assure the delivery of services is based on Evidence -Based Practices implemented with fidelity and in accordance with the approved Program Description. Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 11 of 53 Contract No. ME225-7-27 �� South Florida Behavioral Health Network, Inc. 07/01 /2016 (rev. 6.22.16) (14) By 08/01/2016, the Network Provider shall submit to the ME's contract manager 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 thirty (30) days of adoption. The Quality Assurance Plan should address 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, trauma informed services, and cultural and linguistic competence. (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. (i) The Continuous Quality Improvement Initiatives identified in Section B.1.a.(19) below. (15) The Network Provider shall implement a "no wrong door" model as defined in s. 394.4573, F.S, 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 entry point to the behavioral health system. 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. A copy of the Network Provider's "No Wrong Door" policy is maintained in the Network Provider contract file. Should any updates to the to the "No Wrong Door" policy and procedure occur during the term of this contract, the Network Provider must submit the amended procedures to the Contract Manager within thirty (30) calendar days of the adoption. (16) The Network Provider shall execute and/or maintain if executed a Memorandum of Understanding (MOU) or contract with the appropriate Federally Qualified Health Center or other Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 12 of 53 Contract No. ME225-7-27 Wp'� South Florida Behavioral Health Network, Inc. 117/01/2016 (re-.. 6.22.16) medical facility. The MOU provides for integration of behavioral health services and primary health care services to the medically underserved in order to meet the goals specified in Section B.1.a.(19)(a) of this Attachment I. The Network Provider also agrees to accept referrals from the primary health care provider for eligible consumers who are in need of behavioral health services. 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. The MOU shall be submitted within ninety (90) days of the effective date of this contract 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) calendar days of execution. (17) Linkage and Referral Process (a) The Network Provider's policies and procedures must address the referral and linkage process of clients and coordination of care to local community providers for services not offered by the Network Provider. Such services include, but are not limited to, detoxification services, linkages with community programs such as housing, employment and parenting supports, and primary health care. The Network Provider is responsible for tracking and ensuring that the proper linkages are made and documented in accordance with the requirements in the Coordination Care Plan & Utilization Management Manual. Network Providers are required to submit all required documentation for the initiated referral. (b) The Network Provider may only refer a consumer to a provider that offers the service for which the Network Provider created the referral. The receiving provider is responsible for follow up and linkage including proper care coordination and discharge planning back to the referring provider. The referring provider is responsible for the communication and follow up with the receiving provider. The Network Provider is expected to adhere to the Department's Care Coordination Guidance Document which provides guidance for the implementation, administration and management of Care Coordination activities and adhere to any other ME directives and/or policies and procedures. The Department's Care Coordination Guidance Document can be accessed by visiting the Department's website or by clicking on the link below: http://www myflfamilies com/service-programs/substance-abuse/managing-entities/2016- contract-docs (c) 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. (d) 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 Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 13 of 53 Contract No. ME225-7-27 PA,I South Florida Behavioral Health Network, Inc. applicable state, federal rules and/or statues. 07/01/2016 (rev. 6.22.16) (e) If the Network Provider is the receiving provider, and if upon assessing a referred consumer on in -take, 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. (18) Continuous Quality Improvement Programs (a) The Network Provider must maintain a continuous quality improvement program and report on the continuous quality improvement activities. The program is the responsibility of the Director and is subject to review and approval by the governing board of the service Network Provider. Each director shall designate a Quality Assurance Officer/Compliance Officer who will be responsible for the continuous quality improvement program. The continuous quality Improvement program should objectively and systematically monitor and evaluate the appropriateness and quality of care to ensure that services are rendered consistent with prevailing professional standards, and identify and resolve problems. (b) The quality improvement program must include at minimum: i. Activities to ensure that fraud, waste and abuse do not occur. ii. 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. iii. A framework for evaluating outcomes, including: 1. Output measures, such as capacities, technologies, and infrastructure that make up the system of care. 2. Process measures, such as administrative and clinical components of treatment. 3. Outcome measures pertaining to the outcomes of services; iv. A system of analyzing those factors which have an effect on performance; V. A system of reporting the results of continuous quality improvement reviews; and, vi. Best practice models for use in improving performance in those areas which are deficient. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 14 of 53 Contract No. ME225-7-27 vr�' South Florida Behavioral Health Network, Inc. 07/01/2016 (re-*. 6.22.16) vii. Establishment of a Seclusion and Restraint Oversight Committee per Chapter 65E-5.180, F.A.C. for agencies utilizing seclusion and/or restraint. (19) Continuous Quality Improvement Initiatives - Providers must comply with all of the provisions for the initiatives outlined below: (a) Integration of Behavioral Health Services and Primary Health Care It is the goal of the ME to ensure the integration of behavioral health services and primary care services to all the consumers in care. The integration will be ensured through linkage of the behavioral health provider with the primary health care provider of the consumer through an electronic health record or other means of contact (phone, in person, etc). Referral and linkage processes will be necessary for all consumers who do not have a primary health care provider at entry into the system of care. Follow up and coordination of services are essential to meeting consumer health and behavioral health needs. Many individuals with behavioral health issues have chronic health conditions and may have neglected their primary health needs for some time. The ME and the Southern Region are committed to developing an integrated system of care that incorporates comprehensive screening and monitoring tools that identify those affected by chronic health conditions and a system of care that meets their needs. Network Providers will be implementing Integrated Primary and Behavioral Health techniques and initiatives to meet this need. This initiative will be addressed through a continuous quality improvement plan or component in the existing agency wide continuous quality improvement plan that delineates participation in the Health Integration Initiative. As part of the plan or component of the plan must include the following: I. Identification of the Federally Qualified Health Center or other medical facility where consumers who have been identified as needing primary health care services are referred to or the process established by the Network Provider to coordinate services with consumers' private primary health care provider should such exist. ii. A process to track and report outcomes of successful referrals and linkages of consumers of behavioral health services to primary health care services. In addition to tracking and reporting outcomes of consumers referred for behavioral health services by a primary health care provider to the Network Provider. The outcomes must be reported in the semi-annual Continuous Quality Improvement Updates. iii. Identification of at least two Integrated Healthcare Champions at the beginning of the contract term and submit the names of the individuals when requested by ME staff. iv. By 08/31/2016, unless otherwise directed by the ME, the Network Provider shall submit an action plan on the template provided by the ME. The action Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 15 of 53 Contract No. ME225-7-27 P?�o, South Florida 'Behavioral Health Network, Inc. 07/01/2016 (reN. 6.22.16) plan must be developed based on the results of the most recently completed Site Self -Assessment Evaluation Tool for the Maine Health Access Foundation Integration Initiative (MeHAF). The action plan will outline tasks and objectives that the Network Provider must address during the fiscal year that were identified in the self -assessment as needing improvement. V. Participation in the regional Healthcare Integration Committee meetings to develop the processes and training germane to this initiative. vi. Attendance of appropriate staff at the regional trainings regarding Integrated Healthcare, as requested by the ME staff. Participation in the trainings will be documented in the Continuous Quality Improvement Updates. vii. By 03/01/2017, unless otherwise directed by the ME, the Network Provider shall complete an annual agency -wide self -assessment using the Site Self - Assessment Evaluation Tool for the Maine Health Access Foundation Integration Initiative (MeHAF). The results of the self -assessment must be submitted by April 1, 2017, or other date specified by the ME, to the individual(s) identified in Exhibit C, Required Reports. (b) Trauma Informed Care 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 (TIC) initiative through 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: Identification of at least two TIC Champions at the beginning of the contract term and submit the names of the individuals when requested by ME staff. ii. By 08/31/2016, unless otherwise directed by the ME, the Network Provider shall submit an action plan on the template provided by the ME. The action plan must be developed based on the results of the most recently completed Fallot Tool. The action plan will outline tasks and objectives that the Network Provider must address during the fiscal year that were identified in the self -assessment as needing improvement. The ME will monitor the Network Provider on its execution of the tasks and objectives identified in the action plan. iii. Participation in the regional TIC meetings to develop the process for identifying and responding to those affected by trauma. IV. Attendance at the regional trainings regarding TIC as applicable. Applicable trainings will be documented in the Continuous Quality Improvement Updates. V. Participation in all TIC related activities to ensure staff and agency become competent in all areas of trauma informed care. Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 16 of 53 Contract No. ME225-7-27 V� South Florida /Behavioral ' Health Network, Inc. 07/01/2016 (rev. 6.22.16) A. By 03/01/2017, unless otherwise directed by the ME, the Network Provider shall complete an annual agency -wide self -assessment using the Fallot Assessment Tool. The results of the self -assessment must be submitted by April 1, 2017, or other date specified by the ME, to the individual(s) identified in Exhibit C, Required Reports. (c) Cultural and Linguistic Competence It is the goal of the ME to become a culturally and linguistically proficient network, through the full implementation of The National Standards for Cultural and Linguistically Appropriate Services (the National CLAS Standards). The National Culturally and Linguistically Appropriate Services (CLAS) Standards in Health and Health Care are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health and behavioral health care. In order to accomplish this task the Network Provider: Identification of at least two CLC Champions at the beginning of the contract term and submit the names of the individuals when requested by ME staff. ii. Participation in the regional CLC meetings. iii. By 08/3112016, unless otherwise directed by the ME, the Network Provider shall submit an action plan on the template provided by the ME. The action plan must be developed based on the results of the most recently completed Cultural and Linguistic Competence survey. The action plan will outline tasks and objectives that the Network Provider must address during the fiscal year that were identified in the self -assessment as needing improvement. iv. Collaborate with the ME to identify and utilize the Network Provider's data to (1) identify sub -populations (i.e., racial, ethnic, Lesbian, Gay, Bisexual, Transgender, Questioning, Intersex, or Two -Spirited (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; V. Agrees to implement effective language access services to meet the needs of their limited -English -proficient consumers and/or deaf or hard -of -hearing consumers, and increase their access to behavioral health care by providing sign language, translation, and interpretive services required to meet the communication needs of consumers as required by state and federal laws, including English, Spanish and Creole. Services will meet the cultural needs and preferences of the populations served. vi. By 03/01/2017, unless otherwise directed by the ME, the Network Provider shall complete an annual Cultural and Linguistic survey as directed by the ME. (d) Integration of Behavioral Health and the Child Welfare System L The Network Provider will ensure that behavioral health services are available to clients referred by the Community Based Care Organizations (CBC) or by the Department's Child Protective Investigators in cases where behavioral health indicators are present Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 17 of 53 Contract No. ME225-7-27 PAK ' South Florida Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) 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 behavioral health prevention or treatment services, as well as children in relative placements. For a detailed description of the client eligibility criteria please refer to the approved Motivational Support Program Protocols and Family Intensive Treatment Team Protocols, herein incorporated by reference, and available upon request to the MEs Contract Manager. ii. The coordination of efforts between the CBC, the ME and Network Providers is essential to the efficient service delivery for child -welfare involved families in behavioral health treatment. The ME and the Southern Region are committed to developing an integrated system of care that meets the needs of children and their families as there is significant overlap between clients. Network Providers will be implementing the Child Welfare Integration (CWI) initiative through a continuous quality improvement plan or component in the existing agency wide continuous quality improvement plan that delineates participation in the CWI initiative. As part of the plan or component of the plan must include the following: 1. Identification of at least two CWI Champions and submit the names of the individuals when requested by ME staff. 2. Participation in the CWI meetings to develop the process for identifying and responding to child -welfare involved families. 3. Attendance at trainings regarding CWI when notified by the ME. Attendance applicable trainings will be documented in the Continuous Quality Improvement Updates. 4. Participation in all CWI related activities to ensure staff and agency become knowledgeable of the Child Welfare system. (e) Accreditation The Network Provider shall take appropriate steps to maintain its accreditation or become fully accredited by June 30, 2017 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. (20) By 8/31/2016, the Network Provider shall submit a single agency action plan which outlines all of the components/activities identified in agency's annual self -assessments for each initiative. For example, the Integrated Healthcare Initiative (Behavioral Health and Primary Health Care) action plan should be developed based on the results of the most recently completed self - assessment, the Trauma Informed Care action plan shall be developed based on the results of the most recently completed Fallot Tool, and the Cultural and Linguistic Competence action plan shall be based on the results of the Cultural and Linguistic Competence survey. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 18 of 53 Contract No. ME225-7-27 ►� South Florida Behavioral 10000 Health Network, Inc. 07/01/2016 ('rev. 6.22.16) (21)Continuous Quality Improvement Updates The Network Provider shall submit semi-annual updates, by the dates specified in Exhibit C, Required Reports, on the implementation and progress of the following activities: (a) Integration of Behavioral Health Services and Primary Care as described in the agency's action plan; (b) Trauma Informed Care, as described in the agency's action plan; (c) Cultural and Linguistic Competence initiative, as described in the agency's action plan; (d) Identification of the evidence -based practices (EBPs) utilized by the agency and address how these EBPs are monitored to ensure fidelity to the model; (e) Participation in trainings and activities relating to the Integration of Behavioral Health and Child Welfare Systems; Progress on steps taken toward meeting the requirement to become an accredited provider by June 30, 2017. (f) Evidence of the implementation of the integration of behavioral health services and primary health care, evidence of tracking and ensuring the successful referrals and linkages of consumers of behavioral health services to primary health care services and consumers referred from the primary health care provider to the Network Provider for behavioral health services, and include progress on the implementation as described in the Network Provider's action plan to include the following: • The number of behavioral health consumers identified as needing primary care. • Number of successful linkages to primary care. (22) Care Coordination Performance Outcomes Beginning in FY 2016-17, the ME will begin to implement Care Coordination, as defined in s. 394.4573, F.S., throughout the system of care. The Network Provider is expected to work in collaboration with the ME to ensure that individuals with the highest level of need are being linked to community based care and provided the appropriate supports to ensure that their treatment needs are properly addressed. The ME will analyze the groupings of consumers and over time, develop a framework that identifies what are the expected service levels and frequency of services for a particular diagnosis and/or presenting combination of issues. The ME will analyze provider data to determine baseline and determine benchmark for future implementation. The Network Provider is expected to adhere to the Department's Care Coordination Guidance Document which provides guidance for the implementation, administration and management of Care Coordination activities, and adhere to any other ME directives and/or policies and procedures. The Department's Care Coordination Guidance Document can be accessed by visiting the Department's website or by clicking on the link below: http://www.mvflfamilies.com/service-programs/substance-abuse/managing-entities/2016- contract-does Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 19 of 53 Contract No. ME225-7-27 �� South Florida Behavioral Health Network, Inc. (23)Financial Audit Reports 07/01/2016 (rev. 6.22.16) (a) The Network Provider shall submit 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) Network Providers who withhold income taxes, social security tax, or Medicare tax from employee's paychecks or who must pay the employer's portion of social security or Medicare tax must use Form 941, Employer's Quarterly Federal Tax Return, to report those taxes. On a quarterly basis, and by the dates specified in Exhibit C, Required Reports, the Network Provider, shall submit an attestation that the 941 has been filed timely and any taxes due have been paid timely to IRS. (c) The Network Provider shall complete and submit the Department -approved Local Match Calculation Form, per the schedule and to the individual(s) identified in the Exhibit C, Required Reports. The Department -approved Local Match Calculation Form, Template 9 — Local Match Calculation Form is available at the following website: http://www.mvflfamilies.com/service-programs/substance-abuse/managing- entities/2016-contract-docs (24)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. (25) 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. (26) 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: http://www.dcf.state.fl.us/admin/publications/policies/215-8.pdf 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. (27) 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. (28) The Network Provider shall meet with the ME's staff at regularly scheduled or specially called meetings when notified by the ME. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 20 of 53 Contract No. ME225-7-27 �� South Florida //Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) (29)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 Coordination Care Plan & Utilization Management Manual, 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 the Standard Contract. (30)The Network Provider shall immediately upon discovery inform the ME of conditions related to performance that may interrupt the continuity of service delivery or involve media coverage. (31)The Network Provider will promote personal self-determination and choice by: (a) 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); (b) Engaging service recipients, family members, and advocates in the design, development, and evaluation of services; (c) Giving consumers a choice of provider and services, whenever possible; (d) Assessing and improving consumer satisfaction. (32) 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. (a) The Network Provider shall provide early diagnosis and treatment intervention to enhance recovery and prevent hospitalization. (b) 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. (33) Referrals and Case Management Services to Consumers Residing in Assisted Living Facilities with a Limited Mental Health License (a) It is unlawful to knowingly refer a person for residency to an unlicensed assisted living facility; to an assisted living facility the license of which is under denial or has been suspended or revoked; or to an assisted living facility that has a moratorium pursuant to part II of chapter 408. Referrals to unlicensed facilities are not lawful and subject to sanctions by the Agency of Health Care Administration (AHCA). Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 21 of 53 Contract No. ME225-7-27 �/ ►�' South Florida Behavioral Health Network, Inc. 07/01/2016 (ree, 6.22.16) (b) The Network Provider is directed to only refer consumers of mental health services to Assisted Living Facilities with a Limited Mental Health License. It is the referring Network Provider's responsibility to verify licensure. AHCA licenses can be verified at the following website: http://www.floridahealthfinder.gov/facilitylocator/FacilitySearch.aspx (c) In circumstances where the Network Provider determines that placement of particular individual in an Assisted Living Facilities with a Limited Mental Health License is unsuitable, the Network Provider shall request a meeting with the appropriate ME staff to discuss alternative options. The request shall be made in writing to the ME's Contract Manager. (d) The Network Provider agrees to comply with provisions and the reporting requirements of Exhibit L, Assisted Living Facilities with a Limited Mental Health License, if services to such residents are offered. (e) On a quarterly basis, by the dates, and to the individuals identified in Exhibit C, Required Reports, the Network Provider shall submit an ALF-LMHL Client Report the required format as shown in Table 1, of Exhibit L, Assisted Living Facilities with a Limited Mental Health License. To complete the ALF-LMHL Client Report, the Network Provider is directed to select a sample size of twenty (20%) percent of clients residing at Assisted Living Facilities with a Limited Mental Health License and receiving targeted case management services from the Network Provider. The ALF-LMHL Client Report shall be submitted in a secured, password protected, or encrypted format. (34)Develop and Disseminate Consumer Manual The Network Provider 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. (35) 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. (36) 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. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 22 of 53 Contract No. ME225-7-27 �o South Florida /�i Behavioral Health Network, Inc. 07/01J2016 (rep. 6.22.16) (37) 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. (38) Client Satisfaction Survey 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 as described in the Standard Contract. (39) The Network Provider agrees to assist in the development and implementation of the Care Coordination and Utilization Management (UM) System and shall maintain the capacity to perform or work towards obtaining the following functions including, but not limited to: (a) ME -approved automated, standardized, and 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 Q) Full compliance with federal and state laws, rules and regulations pertaining to security and privacy of protected health information. (40) Client Trust Funds (CTF) Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 23 of 53 Contract No. ME225-7-27 South Florida Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) (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, Food Stamps, or other federal benefits on behalf of a client by August 1, 2016. . (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 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, Food Stamps, 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, State and Federal Laws, Rules, and Regulations. (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 Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 24 of 53 Contract No. ME225-7-27 South Florida Behavioral Health Network, Inc. 07/01/2016 (rep. 6.22.16) (1) The Network Provider shall comply with applicable rules, statutes, requirements, and standards with regard to professional qualifications. See Exhibit F, State and Federal Laws, Rules, and Regulations and the requirements specified in Section 45. of the Standard Contract. (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)-(d), 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. (3) Additionally, the Network Provider shall provide employment screening for substance abuse personnel using the standards set forth in Chapter 397.451, F.S., Background Checks for Service Provider Personnel. "All owners, directors, and chief financial officers of service providers are subject to level 2 background screening as provided under chapter 435. All service provider personnel who have direct contact with children receiving services or with adults who are developmentally disabled receiving services are subject to level 2 background screening as provided under chapter 435. A volunteer who assists on an intermittent basis for fewer than 40 hours per month and is under direct and constant supervision by persons who meet all personnel requirements of this chapter is exempt from fingerprinting and background check requirements. " (4) Network Providers who have programs for children are required to meet the requirements of s. 39.001(2), (a) and (b) F.S which states the following: (a) If the department contracts with a provider for any program for children, all personnel, including owners, operators, employees, and volunteers, in the facility must be of good moral character. A volunteer who assists on an intermittent basis for less than 10 hours per month need not be screened if a person who meets the screening requirement of this section is always present and has the volunteer within his or her line of sight. (b) The department shall require employment screening, and rescreening no less frequently than once every 5 years, pursuant to chapter 435, using the level 2 standards set forth in that chapter for personnel in programs for children or youths. c. Staffing Changes The Network Provider shall notify the ME's contract manager, in writing within ten (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 services related to the performance required under this Contract, subject to the provisions relating to Assignments and Subcontracts in the Standard Contract and referenced therein. Written requests by the Network Provider to subcontract for the provision of services under this Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 25 of 53 Contract No. ME225-7-27 �� South Florida 'Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) contract will be routed through the ME's contract manager for approval. The ME is not obligated nor will it pay for any services delivered prior to its written approval of the act of subcontracting. The act of subcontracting shall not in any way relieve the Network Provider of any responsibility for the contractual obligations of this contract. The pre -approval process applies to Subcontractors and not Independent Contractors as defined below. (2) The ME has adopted the following definitions for vendors, subcontractors and/or independent contractors who are contracted by the Network Provider to do work contemplated under this contract: (a) Vendor: A person or company offering something for sale. (b) Subcontractor: A business to business relationship; contracting a business or person outside of one's own company to do work as part of a larger project. (c) Independent Contractor: a person who is in an independent trade, business, or profession in which they offer their services and/or expert advice to an individual or organization. The general rule is that an individual is an independent contractor if the payer has the right to control or direct only the result of the work and not what will be done and how it will be done. The earnings of a person who is working as an independent contractor are subject to Self -Employment Tax. (3) 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)]. http://sfbhn org/wordoress/wp-content/uploads/SAMHSA-Guidance-on-SAPT-and-CMHSBG- Requirements.pdf (4) Any vendor, subcontractor, or independent contractor the Network Provider contracts to do work contemplated under this contract, and who meets the definition of a Business Associate as defined in 45 CFR 160.103, must sign a legally binding document with the Network Provider that contains the same restrictions and conditions of the Business Associate Agreement between the Network Provider with the ME. The binding document must meet the requirements of 45 CFR s.164.504(e), Standard: Business Associate Contracts, the Privacy Rule, the Security Rule, the Breach Notification Rule, the Health Information Technology for Economic and Clinical Health ("HITECH") Act, the provisions included in the Network Provider's Business Associate Agreement with the ME, the ME's contractual requirements, and other laws and regulations pertaining to access, use, disclosure, and management of Protected Health Information ("PHI") without limitation, PHI in an electronic format (EPHI) created, received, maintained, or transmitted by the Network Provider or its subcontractors incidental to Network Provider's performance of this Contract. (5) All agreements, for services contemplated under this contract, shall adopt the applicable terms and conditions of the Network Provider's contract with the ME, including but not limited to, any Federal block grant requirements. In addition, all subcontract agreement's shall Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 26 of 53 Contract No. ME225-7-27 �� South Florida Behavioral 4000 Health Network, Inc. 07/01/2016 (rev. 6.22.16) contain the applicable terms and conditions, and any amendments thereto, found in the ME's contract with the Department (Prime Contract), which is incorporated herein by reference. Subcontract agreements shall include a detailed scope of work; term of the agreement, method of payment, clear and specific deliverables; and performance standards. (6) The Network Provider shall maintain individual subcontractor files for each subcontractor and provide a copy of all subcontracts agreements prior to the execution of those subcontracts and any amendments to the ME's contract manager. (7) All independent contractor agreements, and subcontractor agreement, vendor agreements, and business associate agreements, or other legally binding agreements, for work contemplated under this contract shall be available upon request by ME staff and at the time of monitoring. (8) 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. (9) 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. (10) 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 covered services, the Network Provider shall conduct a cost analysis for said subcontract, in accordance with Rule 65E-14. 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-14.19, F.A.C., Methods of Paying for Services, including but not limited to, covered services, measurement standard, 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. (11) The Network Provider shall monitor the performance of all subcontractors, and perform follow up actions as necessary. The Network Provider shall notify the ME immediately upon Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 27 of 53 Contract No. ME225-7-27 �o South Florida //Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) discovery 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, 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 and/or Attachment IV, Scope of Work if prevention services are purchased through this contract. (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, F.A.C. c. Changes in Location The Network Provider shall notify the ME's 65Econtract 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, 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 in accordance with Exhibit G, Covered Services Funding by OCA and in Attachment IV, Scope of Work if prevention services are purchased through this contract. 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(6), 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. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 28 of 53 Contract No. ME225-7-27 South Florida 'Behavioral Health Network, Inc. c. Reports 07/01/2016 (rev. 6.22.16) Where this contract requires the delivery of reports to the ME, mere receipt by the ME 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 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) 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. (3) 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. (4) The Network Provider shall ensure that its audit report will include the standard schedules that are outlined in Rule 65E-14, F.A.C. and submitted within the timeframes specified in Exhibit C, Required Reports. (5) The Network Provider shall submit treatment data, as set out in subsection 394.74(3) (e), F.S. and DCF PAM 155-2. (6) The Network Provider is instructed to report the modifiers to procedure codes in compliance with the DCF PAM 155-2, Appendix 2. (7) Data shall be submitted electronically, weekly, by 12:00 Noon every Wednesday. Final monthly data will be submitted electronically to the ME no later than the 4`h of each month following the month of service into KIS, PBPS maintained by KIT Solutions or other data reporting system designated by the ME and/or the Department. 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 as directed by the ME, electronically no later than the 4th 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 KIS, or other data reporting system designated by the ME is consistent with the data maintained in the Network Provider's clients' files/EMR-EHR systems. Ensure that substance abuse prevention services data entered into PBPS, or other data reporting system designated by the ME and/or the Department, is consistent with the Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 29 of 53 Contract No. ME225-7-27 pp� South Florida Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) data maintained in the Network Provider service documentation and/or client files, if applicable; (c) Review the ME's KIS error / download error reports to determine the number of records accepted and rejected. Based on this review, the Network Provider shall make sure that the rejected records are corrected and resubmitted in KIS, or other data reporting system designated by the ME. Only error -free data as processed by KIS will be accepted by the ME for monthly state reporting and payment validation; (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 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. (8) 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, or other designated data reporting system designated by the ME. 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. (9) The Network Provider shall obtain the format and directions for submitting Payer Class data from the ME. (10)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. (11) 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 Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 30 of 53 Contract No. ME225-7-27 W� South Florida Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) the ME, including but not limited to services provided to a Medicaid -eligible individual prior to becoming a Medicaid recipient when those services are subsequently covered under a retroactive Medicaid reimbursement determination 5. Performance Specifications 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 KIS 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. 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 ME to objectively measure a Network Provider's performance, and contains policies and procedures for submitting the required data. KIT Solutions, or any other data system designated by the ME and/or the Department, maintains the procedures for submitting the required prevention data into PBPS. The ME will also monitor the Network Provider for the performance measures 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, or the latest revisions thereof. The specific methodologies for each performance measure may be found at the following website: http://www myfifamilies com/service-programs/substance-abuse/pamphlet- 155-2 (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 Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 31 of 53 Contract No. ME225-7-27 South Florida Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) Mental Health Required Performance Outcomes/Outputs. (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, as described in the Standard Contract 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 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. (5) 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. (6) 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). (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. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 32 of 53 Contract No. ME225-7-27 �/ �� South Florida Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) (9) None of the funds provided under the following grants may be used to pay the salary of an individual at a rate in excess of Level II of the Executive Schedule: Block Grants for Community Mental Health Services, Substance Abuse Prevention and Treatment Block Grant, Projects for Assistance in Transition from Homelessness, Project Launch, Florida Youth Transition to Adulthood; and Florida Children's Mental Health System of Care Expansion Implementation Project. (10) Any compensation paid for an expenditure subsequently disallowed as a result of the Managing Entity's or any Network Service Providers' non-compliance with state or federal funding regulations shall be repaid to the Department upon discovery. (11)The Network Provider shall make available to the ME and the Department all records pertaining to service delivery. These records shall be made available at all reasonable times for inspection, review, copying, or audit. Service delivery records include but are not limited to, invoicing, fiscal management, data management, incident reporting, client records, and such documents determined to assure accountability of service provision and/or the expenditure of state and federal funds. (12) The Network Provider shall assist the ME and the Department in developing legislative budget requests based upon identified needs of the community. (13) The Network Provider shall provide to the ME, copies of, including but not limited to, evaluations, assessments, surveys, monitoring reports that pertain to licensure, accreditation, or other administrative or programmatic review, when those reports identify deficiencies that require corrective action. The Network Provider shall submit to the ME all of the applicable reports, including copies of the corrective action plan(s) within ten (10) calendar days of receipt by the Network Provider from the reviewing entity. (14) The Network Provider shall cooperate with the ME and the Department when investigations are conducted regarding a regulatory complaint of the Network Provider. When additional information or documentation is requested by the ME, the Network Provider will submit the information within twenty-four (24) hours of the request unless otherwise specified in the ME's 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 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. (17) 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. (18)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. (19)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, State and Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 33 of 53 Contract No. ME225-7-27 U000 South Florida Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) Federal Laws, Rules, and Regulations, and ME policies and procedures. (20)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(1) 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 (1) The Network Provider shall develop, maintain, and improve care coordination and integrated care systems as follows: (a) Develop Initial Service Agreements (i) 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. (ii) 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. (iii) The Network Provider may be required to develop and implement cooperative agreements with other external stakeholders. (2) 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. State and Federal Laws, Rules, and Regulations See Exhibit F, State and Federal Laws, Rules, and Regulations. 7. Managing Entity Responsibilities Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 34 of 53 Contract No. ME225-7-27 South Florida Behavioral Health Network, Inc. a. Managing Entity Obligations 07/01/2016 (rev. 6.22.16) (a) The ME shall only subcontract with entities that are fiscally sound, and that can adequately ensure the accountability of public funds. (b) 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 Department during the monthly reconciliation and performance review identified in the Prime Contract. (c) 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. (d) 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. (e) 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. (f) 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. (g) 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. (h) 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. (1) 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 monitor(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. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 35 of 53 Contract No. ME225-7-27 �/ . �'01 South Florida Behavioral Health Network, Inc. 07/01/2016 (re-*. 6.22.16) (2) Network Providers with electronic health record (EHR) or electronic medical record systems (EMR) shall provide access to ME funded service and client data contained in these systems to the ME's monitoring team and provide sufficient resources to facilitate the monitoring process of services provided under this contract. Resources is defined but is not limited to, personnel, terminals, guest read-only accounts, privileges for monitors to access client records, and/or remote access into the systems by the monitors. (3) The ME will monitor the Network Provider on its performance of all tasks and special provisions of the contract. (4) The ME will provide a written report to the Network Provider within thirty (30) calendar days of the exit conference. 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. 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. (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. (5)The ME may convene cross -organizational training and assistance to help non -accredited Network Providers become accredited. 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 Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 36 of 53 Contract No. ME225-7-27 i� South Florida Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) (a) The ME shall conduct authorization and reauthorizations for applicable levels of care as described in the approved Coordination Care Plan & Utilization Management Manual, 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 Coordination Care Plan & 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. (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. 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 Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 37 of 53 Contract No. ME225-7-27 �� South Florida Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) 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, Monthly Payment Request (Incorporated by reference and available from the MEs Contract Manager upon request) Exhibit G, Covered Service Funding by OCA Exhibit H, Funding Detail and Local Match D. Special Provisions 1. The Network Provider is expected to maintain its administration cost to 10.00% or less for Fiscal Year 2016-2017 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 SAMH Projected Operating and Capital Budget shall evidence the reduction and redistribution of the cost savings. 2. Prevention Services, if applicable: General Statement: If the Network Provider was awarded prevention services funding as a result of successful application to the ME's Invitation to Negotiate Solicitation #004 - Prevention of Substance Abuse, Promotion of Positive Mental Health and Related Consequences and Evaluation of the System released on March 4, 2015 ("ITN"), the following shall apply: (a) The prevention services provided under this contract are to fund rigorous, effective, evidence - based, substance abuse prevention programs and strategies and promotion of wellness (positive mental health) services as part of the continuum of behavioral health care for individuals and their families. The strategies, activities, and services must be consistent with the local community ME -approved local Needs Assessment Logic Model (NALM) and the Comprehensive Community Action Plan (CCAP). The Network Provider shall work in collaboration with the funded ME Evaluation Entity, by participating in meetings and providing service data vital for the completion of a system -wide evaluation of the prevention services within the Strategic Prevention Framework. The evaluation of the prevention system, as outlined in the ITN, is expected to be the systematic collection and analysis of information about program activities, characteristics, and outcomes to reduce uncertainty, improve effectiveness, and assist in decision -making. The information gathered from the evaluation process will help the ME, the State and communities become more skillful and exact in describing what they plan to do, monitor what they are doing, and improve the prevention system of care. Evaluation results can and should be used to determine what efforts should be sustained and to assist in sustainability planning efforts. The ME will provide substantial input, in collaboration with the Network Provider and Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 38 of 53 Contract No. ME225-7-27 i� South Florida Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) the Evaluation Entity, both in planning and implementation of the evaluation process and activities, and will make recommendations regarding the continuance of the activities. (b) Based on client needs, the Network Provider shall adhere to services as outlined in the approved Prevention Program Description, incorporated herein by reference and as set forth in Attachment IV, Scope of Work, in addition to providing services from the list of approved covered services listed in Exhibit G, Covered Service Funding by OCA. Any change in the array of services shall be justified in writing and submitted to the ME's contract manager for review and approval. (c) Renewal: If this contract was awarded to the Network Provider as a result of a successful response to the ME's Invitation to Negotiate Solicitation #004 - Prevention of Substance Abuse, Promotion of Positive Mental Health and Related Consequences and Evaluation of the System released on March 4, 2015, this contract may be renewed annually for period not to exceed three (3) years with a projected end date of June 30, 2018, 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. 3. Intern Registration Requirements pursuant to section 491.0045, F.S. (a) The Network Provider shall monitor and ensure that an individual who has not satisfied the postgraduate or post -master's level experience requirements, as specified in s. 491.005(1)(c), (3)(c), or (4)(c), F.S., register as an intern in the profession for which he or she is seeking licensure before commencing the post -master's experience requirement or for an individual who intends to satisfy part of the required graduate -level practicum, internship, or field experience, outside the academic arena for any profession, the network provide must monitor and ensure that the individual registers as an intern in the profession for which he or she is seeking licensure before commencing the practicum, internship, or field experience. (b) An intern registration is valid for five (5) years. (c) A registration issued on or before March 31, 2017, expires March 31, 2022, and may not be renewed or reissued. Any registration issued after March 31, 2017, expires 60 months after the date it is issued. A subsequent intern registration may not be issued unless the candidate has passed the theory and practice examination described in s. 491.005(1)(d), (3)(d), and (4)(d), F.S. (d) An individual who has held a provisional license issued by the board may not apply for an intern registration in the same profession. 4. Real-time Data Entry: When required by the Prime Contract, state and/or federal rules, regulations, or policies, the Network Provider shall submit to the ME real-time data in KIS Express, or other similar data structure, for services purchased by this contract. The Network Provider agrees to implement the new data reporting system when notified and as directed by the ME. 5. 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 applicable levels of care Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 39 of 53 Contract No. ME225-7-27 i� South Florida Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) a. The Network Provider agrees to adhere to the utilization management protocols pursuant to the South Florida Behavioral Health Network Coordination Care Plan & 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 Coordination Care Plan & 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 Coordination Care Plan & Utilization Management Manual. e. The Network Provider shall obtain written authorization from the ME prior to providing the services as specified in the Coordination Care Plan & 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 Coordination Care Plan & 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: (1) 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. (2) 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 Coordination Care Plan & Utilization Management Manual prior to the client being Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 40 of 53 Contract No. ME225-7-27 �� South Florida /� Behavioral Health Network, Inc. 07A)1/2016 (re-*. 6.22.16) admitted to the program for treatment. (3) Complete all required assessment components outlined in the Coordination Care Plan & 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. (4) Participate and cooperate in the centralized waiting list in accordance with the waiting list policies and procedures outlined in the Coordination Care Plan & Utilization Management Manual. 6.Pre-Authorization Utilization Management Roster and Payment for Services Specified in the Coordination Care Plan & Utilization Management Manual The Network Provider shall submit a request for reimbursement on the approved ME invoices incorporated herein by reference and available upon request from the ME's contract manager. . A listing of all prior -authorized clients served including, client name, client I.D. number, authorization number, covered service and service period must be provided to support the invoice. This information may be submitted on Exhibit K, SAMH Pre -Authorization Utilization Management Roster, of this contract, unless the Network Provider has an agency generated report that includes the required elements indicated above. This information must be attached to the approved ME's invoice, , 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. 7. 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. Behavioral health services shall be provided to persons pursuant to s. 394.674, F.S., including those individuals who have been identified as requiring priority by state or federal law. The identified priority populations are found in Exhibit A, Client/Participants to be Served, however persons in categories (1) and (2) below are specifically identified as persons to be given immediate priority over those in any other categories. These individuals may not be placed on a wait list without receiving interim services within the required timeframes. (i) Pursuant to 45 C.F.R. s. 96.131, priority admission to pregnant women and women with dependent children by Network Service Providers receiving SAPT Block Grant funding. If the clinically appropriate services cannot be provided for the pregnant woman, interim services, not later than forty (48) hours after the woman seeks treatment services, shall be provided pursuant to 45 CFR s. 96.123; (ii) Pursuant to 45 C.F.R. s. 96.126 (b), (1) and (2), adherence with the requirement to provide interim services for injection drug users by Network Service Providers receiving SAPT Block Grant funding. (iii) Priority for services to families with children that have been determined to require substance abuse and mental health services by child protective investigators and also meet the target populations in subsections (a) or (b), below. Such priority shall be limited Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 41 of 53 Contract No. ME225-7-27 South Florida Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) to individuals that are not enrolled in Medicaid or another insurance program, or require services that are not paid by another payor source: a. Parents or caregivers in need of adult mental health services pursuant to s. 394.674(1)(a)2., F.S., based upon the emotional crisis experienced from the potential removal of children; and b. Parents or caregivers in need of adult substance abuse services pursuant to s. 394.674(1)(c)3., F.S., based on the risk to the children due to a substance use disorder. Failure to adhere to the requirements in Section D. 7.b. above may result in a request for corrective action for non-performance, non-performance or unacceptable performance. Penalties may be imposed for failure to implement or to make acceptable progress on corrective action as described in Section 39, of the Standard Contract. In cases where consumers in need of residential treatment and a bed is not immediately available, the Network Provider shall provide non-residential services to the consumer to engage the consumer until a placement becomes available. Interim services may include peer support services such as drop in centers and/or linkages to recovery support services, and/or include a combination of services that meet the needs and desires of the individual while waiting for services. Failure to meet this requirement may result in a request for corrective action for non- performance, non-performance or unacceptable performance. Penalties may be imposed for failure to implement or to make acceptable progress on corrective action as described in Section 39., of the Standard Contract. 8. 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 immediately upon discovery. 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 otherwise specified in the request. 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. 9. Mandatory Reporting Requirements Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 42 of 53 Contract No. ME225-7-27 �'South Florida .Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) a. The Network Provider and any subcontractor must comply with and inform its employees of the following mandatory reporting requirements. Each employee of the Network Provider, and of any subcontractor, providing services in connection with this contract who has any knowledge of a reportable incident shall report such incident as follows: (1) Reportable incidents that may involve an immediate or impending impact on the health or safety of a client shall be immediately reported to the contract manager; and (2) Other reportable incidents shall be reported to the ME and Department's Office of Inspector General by completing a Notification/Investigation Request (form CF 1934) and emailing the request to the Office of Inspector General at IG.Complaints@myflfamilies.com. 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. c. In the event of a breach or potential breach of Protected Health Information, the Network Provider is directed to the reporting requirements delineated in the executed Business Associate Agreement, incorporated herein by reference. 10. 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: CFOP 155-47, Processing Referrals from the Department Of Corrections.pdf, and is incorporated herein by reference. 11. Health, Safety, and Physical Environment Requirements for Substance Abuse and Mental Health Levels 1, 2, and 3 Residential Treatment Facilities Unless abridged by a court of law, the rights of individuals who are admitted into a residential treatment facility shall be assured. Each residential treatment facility shall be operated in a manner that protects the individual's rights, life, and physical safety while under the evaluation and treatment. To avoid high risk situations such as suicide, death, serious injury, violence, and abuse of any individual the contracted residential treatment network provider shall ensure that its facilities are safe and secure, for example, exposed plumbing pipes are to be covered to prevent individual access. If for clinical reasons access to potentially dangerous grooming aids or other personal articles is contradicted for residents, staff shall explain to the resident the conditions under which the articles may be used and shall document the clinical rationale for these conditions in the resident's record. If clinically indicated, personal articles of residents may be kept under lock and key by staff. Such actions shall be reviewed weekly for effectiveness and continued need. 12. Involuntary Commitment, Placements, Services, Treatment Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 43 of 53 Contract No. ME225-7-27 ►o South Florida 'Behavioral Health Network, Inc. 07/01/2016 ('reN. 6.22.16) a. Mental Health Services Provider: The Network Provider agrees to provide services to persons who have been court ordered into involuntary outpatient services in accordance with section 394.4655, F.S., court ordered into involuntary inpatient placements as defined in section 394.467, F.S., and court ordered for involuntary examination under 394.463, F.S. b. Substance Abuse Services Provider: The Network Provider agrees to provide services to persons who have been court ordered into involuntary assessment and stabilization under section 397.6818, F.S., and/or court ordered into an involuntary substance abuse treatment under section 397.6957, F.S. It is the Network Provider's responsibility to be familiar with and ensure that the requirement's regarding involuntary admissions are followed pursuant to, including but not limited to, ss. 397.6751, F.S. c. Pursuant to s. 394.4655(3)-(4), and (7), F.S. and s. 397.697(4), F.S., if the court orders involuntary services, the Network Provider shall submit a copy of the order to the ME within one (1) working day after it is received from the court. Similarly, if the court orders a program or a service that is not available, Network Provider must notify the ME within one (1) working day after it is received from the court indicating that the requested program or service is not available. Documents may be electronically submitted as directed by the ME. Documents must be submitted in a secured, password protected, or encrypted format. 13. Motivational Support Program The Network Provider shall comply with the provisions of Exhibit I, Motivational Support Program Provider Protocols, (and Exhibit J, Motivational Support Program Treatment Summary Report. 14. Service Provision Requirements for Substance Abuse Prevention and Treatment Block Grants, if applicable. a. As applicable, the Network Provider shall comply with the requirements set forth in 45 C.F.R. Subpart L — Substance Abuse Prevention and Treatment Block Grant. b. In accordance with 45 C.F.R. s. 96.131(b), the Network Provider that receive Block Grant funds and that serve injection drug users shall publicize the following notice: "This program receives federal Substance Abuse Prevention and Treatment Block Grant funds and serves people who inject drugs. This program is therefore federally required to give preference in admitting people into treatment as follows: 1. Pregnant injecting drug users; 2. Pregnant drug users; 3. People who inject drugs; and 4. All others." c. Behavioral health services shall be provided to persons pursuant to s. 394.674, F.S., including those individuals who have been identified as requiring priority by state or federal law. The identified priority populations are found in Exhibit A, C I ient/Partici pants to be Served, however persons in categories (1) and (2) below are specifically identified as persons to be given immediate priority over those in any other categories. These individuals may not be placed on a wait list without receiving interim services within the required timeframes. (i) Pursuant to 45 C.F.R. s. 96.131, priority admission to pregnant women and women with dependent children by Network Service Providers receiving SAPT Block Grant funding. If the clinically appropriate services cannot be provided for the pregnant woman, interim services, not later than forty (48) hours after the woman seeks treatment services, shall be Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 44 of 53 Contract No. ME225-7-27 �� South Florida //Behavioral . Health Network, Inc. 07/01/2016 (rev. 6.22.16) provided pursuant to 45 CFR s. 96.123; (ii) Pursuant to 45 C.F.R. s. 96.126 (b), (1) and (2), adherence with the requirement to provide interim services for injection drug users by Network Service Providers receiving SAPT Block Grant funding and until the clinically appropriate level of treatment can be provided to the individual as follows: 45 C.F.R. s 96.126 (b) (1)- (2) Capacity of treatment for intravenous substance abusers and any other requirement. (1) 14 days after making the request for admission to such a program, or (2) 120 days after the date of such request, if no such program has the capacity to admit the individual on the date of such request and if interim services, including referral for prenatal care, are made available to the individual not later than 48 hours after such request. d. Outreach Services to Injection Drug Users: The Network Provider shall carry out outreach activities to encourage injection drug users in need of treatment to undergo such treatment pursuant to the requirements in 45 C.F.R. s. 96.126(e), The Network Provider shall document the services to demonstrate the provision of these services per the documentation requirements for Outreach services specified in Rule 65E-14, FAC. e. As required by 45 C.F.R. ss. 96.17, the Network Provider may be requested to provide information to the ME for the purposes of reporting on SAPTBG activities to the Department f. The Network Provider shall ensure compliance with 45 C.F.R. Subpart C — Financial Management. g. The Network Provider agrees to comply with the data submission requirements outlined in DCF PAM 155-2 and the by the dates specified in Exhibit C, Required Reports. h. 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 modifiers required for Block Grant funds, where applicable. The Network Provider also agrees to report to the ME and/or the Department, information regarding the amount and number of services paid for by the Community Mental Health Services Block Grant and/or the Substance Abuse Prevention and Treatment Block Grant. i. Only if such services are purchased through this contract is the Network Provider responsible for complying with the reporting requirements outlined in Exhibit AB, Substance Abuse Prevention and Treatment Block Grant (SAPTBG) Early Intervention Funded Services for Human Immunodeficiency Virus (HIV) by the dates and to the individual(s) listed in Exhibit C, Required Reports. Subject to other applicable state and/or federal requirements, the ME a may require additional reports from the Network Provider. j. Only if such services are purchased through this contract is the Network Provider responsible for complying with the for SAPTBG set -aside funded services for pregnant women and women with dependent children services, SAPTBG set -aside funded services for HIV Early Intervention Programs and the SAPTBG set -aside funds for Evidenced -based Outreach Services to Injection Drug Users as outlined in Exhibit C, Required Reports. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 45 of 53 Contract No. ME225-7-27 �o South Florida .Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) k. 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. I. 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, Covered Service Funding by OCA. m. 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. n. 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)]. http://sfbhn orq/wordpress/wp-content/uploads/SAMHSA-Guidance-on-SAPT-and-CMHSBG- Reguirements.Of 15. 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. 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. 17. Sliding Fee Scale The ME requires the Network Provider to comply with the provisions of Rule 65E-14.018, F.A.C. Prior to the execution of this contract the Network Provider submitted a copy of its sliding fee scale and policy that reflects the uniform schedule of discounts referenced in Rule 65E-14.018, F.A.C. 18. 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 Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 46 of 53 Contract No. ME225-7-27 %� �� South Florida Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) 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. 19. 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. 20. 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.shtml (2) The National Plan and Provider Enumeration System (NPPES) located at: https:Hnppes.cros.hhs.gov/NPPESNVelcome.do (3) The CMS NPI located at: http://www.cros.hhs.gov/NationalProvldentStand/ 21. 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 with government funds. 22. Information Technology Resources Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 47 of 53 Contract No. ME225-7-27 �� South Florida /� Behavioral Health Network, Inc. 07/01/2016 (res. 6.22.16) 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. 23. Programmatic, Fiscal & Contractual Contract File References All of the documentation submitted by the Network Provider which may include, but not be limited to the Network Provider's original proposal, Program Description, SAMH Projected Operating and Capital Budget, Agency Capacity Report, 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. 24. Employee Loans Funds provided by the ME to the Network Provider under this contract shall not be used by the Network Provider to make loans to their employees, officers, directors and/or subcontractors. Violation of this provision shall be considered a breach of contract and the termination of this contract shall be in accordance with the 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. 25. Travel The Network Provider's internal procedures will assure that: travel voucher Form DFS-AA-15, State of Florida Voucher for Reimbursement of Traveling Expenses, incorporated herein by reference, be utilized completed and maintained on file by the Network Provider. Original receipts for expenses incurred during officially authorized travel, items such as car rental and air transportation, parking and lodging, tolls and fares, must be maintained on file by the Network Provider. Section 287.058 (1) (b) F.S., requires that bills for any travel expense shall be maintained in accordance with Section 112.061, F.S. governing payments for traveling expenses. CFOP 40-1 (Official Travel of State Employees and Non -Employees) provides further explanation, clarification, and instruction regarding the reimbursement of traveling expenses necessarily incurred during the performance of business. The Network Provider must retain on file documentation of all travel expenses to include the following data elements: name of the traveler, dates of travel, travel destination, purpose of travel, hours of departure and return, per diem or meals allowance, map mileage, incidental expenses, signature of payee and payee's supervisor. 26. 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 Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 48 of 53 Contract No. ME225-7-27 �� South Florida '/ Behavioral Health Network, Inc. 07/01/2016 (re-.. 6.22.16) 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 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. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 49 of 53 Contract No. ME225-7-27 w� South Florida 'Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) (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. 27. Health Insurance Portability and Accountability Act (HIPAA) In compliance with 45 CFR s.164.504(e), the Network Provider shall comply with the provisions of the Business Associate Agreement, incorporated herein by reference to this Contract, governing the safeguarding, use and disclosure of Protected Health Information created, received, maintained, or transmitted by the Network Provider or its subcontractors incidental to Network Provider's performance of this Contract. b. A violation or breach of any of the assurances as stipulated in the Business Associate Agreement shall constitute a material breach of this Contract. 28. National Voter Registration Act (NVRA) of 1993 a. The Network Provider shall comply with the National Voter Registration Act (NVRA) of 1993, Pub. L. 103-31 (1993), sections 97.025, F.S. b. As a Voter Registration Agency, the Network Providers shall designate a Voting Registration Activities Coordinator and provide the contact information of the Coordinator by the date and to the individual(s) identified in Exhibit C, Required Reports. The Network Provider shall notify the ME's contract manager, in writing within (10) calendar days of staffing changes regarding this position. c. As a Voter Registration Agency, the Network Provider shall provide individuals seeking services and/or individuals served with an opportunity at admission or when they change an address, to either register or update their voter registration. The National Voter Registration Act Preference Form/Application are DS-DE77-ENG and DS-DE77-SPN, are available at the link provided in paragraph f., below d. The Network Provider shall submit a NVRA Voter Registration Agencies Quarterly Activities Report Form, DS-DE131, by the dates and to the individual(s) identified in Exhibit C, Required Reports. The Quarterly Activity Report Form is available at the link provided in paragraph f., Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 50 of 53 Contract No. ME225-7-27 U00000 �South Florida Behavioral Health Network, Inc. below. 07/01/2016 (re,.. 6.22.16) e. Any person aggrieved by a violation of either the National Voter Registration Act or a voter registration or removal procedure under the Florida Election Code may file a written complaint with the Department of State by completing and submitting the NVRA Complaint Form (DS-DE 18). f. The Department of State has published all form referenced herein, along with online training and additional guidance to implement NVRA at: http://dos mvflorida com/elections/for-voters/voter-registration/national-voter-registration-act/ 29. Special Insurance Provisions a. The Network Provider shall notify the ME Contract Manager within thirty (30) calendar days if there is a modification to the terms of insurance including but not limited to, cancellation or modification to policy limits. b. The Network Provider acknowledges that, as an independent contractor, the Network Providers, and its subcontractors, at all tiers are not covered by the State of Florida Risk Management Trust Fund for liability created by s. 284.30, F.S. The Network Provide shall obtain and provide proof to the ME's Contract Manager of comprehensive general liability insurance coverage (broad form coverage), specifically including premises, fire and legal liability to cover managing the Network Provider and all of its employees. The limits of Network Provider's coverage shall be no less than $300,000 per occurrence with a minimal annual aggregate of no less than $1,000,000. The Managing Entity shall cause all Network Service Providers, at all tiers, who the Managing Entity reasonably determines to present a risk of significant loss to the Managing Entity or the Department, to obtain and provide proof to Managing Entity and the Department of comprehensive general liability insurance coverage (broad form coverage), specifically including premises, fire and legal liability covering the Network Service Provider and all of its employees. The limits of coverage for the Managing Entity's Network Service Providers, at all tiers, shall be in such amounts as the Managing Entity reasonably determines to be sufficient to cover the risk of loss. e. If any officer, employee, or agent of the Managing Entity operates a motor vehicle in the course of the performance of its duties under this contract, the Managing Entity shall obtain and provide proof to the Department of comprehensive automobile liability insurance coverage. The limits of the Managing Entity's coverage shall be no less than $300,000 per occurrence with a minimal annual aggregate of no less than $1,000,000. f. If any officer, employee, or agent of any Network Service Provider, at all tiers, operates a motor vehicle in the course of the performance of the duties of the Network Service Provider, the Managing Entity shall cause the Network Service Provider to obtain and provide proof to the Managing Entity and the Department of comprehensive automobile liability insurance coverage with the same limits. g. The Managing Entity shall obtain and provide proof to the Department of professional liability insurance coverage, including errors and omissions coverage, to cover the Managing Entity and all of its employees. If any officer, employee, or agent of the Managing Entity administers any Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 51 of 53 Contract No. ME225-7-27 i� South Florida 'Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) prescription drug or medication or controlled substance in the course of the performance of the duties of the Managing Entity under this contract, the professional liability coverage shall include medical malpractice liability and errors and omissions coverage, to cover the Managing Entity and all of its employees. The limits of the coverage shall be no less than $300,000 per occurrence with a minimal annual aggregate of no less than $1,000,000. h. If any officer, employee, or agent of the Network Service Provider, at all tiers, provides any professional services or provides or administers any prescription drug or medication or controlled substance in the course of the performance of the duties of the Network Service Provider, the Managing Entity shall cause the Network Service Provider, at all tiers, to obtain and provide proof to the Managing Entity and the Department of professional liability insurance coverage, including medical malpractice liability and errors and omissions coverage, to cover all Network Service Provider employees with the same limits. i. The ME and the Department shall be exempt from, and in no way liable for, any sums of money that may represent a deductible or self -insured retention under any such insurance. The payment of any deductible on any policy shall be the sole responsibility of the Network Provider purchasing the insurance. All such insurance policies of the Network Providers, and its subcontractors at all tiers, shall be provided by insurers licensed or eligible to do and that are doing business in the State of Florida. Each insurer must have a minimum rating of "A" by A. M. Best or an equivalent rating by a similar insurance rating firm, and shall name the ME and the Department as an additional insured under the policy(ies). The Network Provider shall use its best good faith efforts to cause the insurers issuing all such general, automobile, and professional liability insurance to use a policy form with additional insured provisions naming the ME and the Department as an additional insured or a form of additional insured endorsement that is acceptable to the ME and the Department in the reasonable exercise of its judgment. k. All such insurance proposed by the Managing Entity shall be submitted to and confirmed by the Contract Manager annually by March 31. I. The requirements of this section shall be in addition to, and not in replacement of, the requirements of Section 10, of the Standard Contract to which this Attachment I is attached, but in the event of any inconsistency between the requirements of this section and the requirements of the Standard Contract, the provisions of this section shall prevail and control. 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 3. Exhibit C, Required Reports 4. Exhibit D, Substance Abuse and Mental Health Required Outputs 5. Exhibit E, Monthly Payment Request 6. Exhibit F, State and Federal Laws, Rules and Regulations 7. Exhibit G, Covered Service Funding by OCA 8. Exhibit H, Funding Detail & Local Match Plan 9. Exhibit I, Motivational Support (MSP) Provider Protocols Performance Outcomes and Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 52 of 53 Contract No. ME225-7-27 ?A;� ' South Florida Behavioral Health Network, Inc. 07/01/2016 (rev. 6.22.16) 10. Exhibit J, Motivational Support Specialist 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 N, Special Provisions for the Indigent Drug Program 14. Exhibit O, Crisis Stabilization Unit, Substance Abuse Detoxification, Addiction Receiving Facility Daily Tracker and Data Collection 15. Exhibit 0-1a-c, CSU Detox Addiction Daily Tracker 16. Exhibit 0-2a, CSU File Layout 17. Exhibit 0-2b-c, Substance Abuse Detoxification/Addition Receiving Facility Services Utilization Data Collection Tracker 18. Exhibit Q, Missing Children 19. Exhibit R, Our Kids Miami-Dade/Monroe Child Welfare Quarterly Clinical Report 20. Exhibit V, Special Provisions for the Forensic Services Program 21. Exhibit X, Special Provisions for Projects for Assistance in Transition from Homelessness (PATH) Services 22. Exhibit AA, Motivational Support Specialist 23. Exhibit Al, AI -A, Family Intensive Treatment Team, Scope of Work, and Monthly Progress Report 24. Exhibit AI-B, Monthly Discharge Report 25. Exhibit AK, Outpatient Waitlist Report Form 26. Exhibit AM, Return on Investment -Special Appropriations Projects for Fiscal Year 2016-17 27. Exhibit AN, Supplemental Security Income/Social Security Insurance (SSI/SSDI) Outreach, Access, and Recovery (SOAR) Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 53 of 53 Contract No. ME225-7-27 South Florida Behavioral I lealth Network,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: Non-Prevention Prevention ❑X Adult Mental Health-Severe& Persistent Mental Illness ❑ Adult Substance Abuse © Adult Mental Health-Serious&Acute Episodes of Mental © Children's Substance Abuse Illness ® Adult Mental Health-Mental Health Problems ❑ Substance Abuse Community Coalition ® Adult Mental Health-Forensic Involvement N Children's Mental Health-Serious Emotional Disturbances © Children's Mental Health-Emotional Disturbances © Children's Mental Health-At Risk of Emotional Disturbances © Adult Substance Abuse © 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.myflfamilies.com/service-proqrams/substance-abuse/publications) and is incorporated herein by reference. 2. Behavioral Health services shall be provided to persons pursuant to s. 394.674, F.S., including those individuals who have been identified as requiring priority by state or federal law. These identified priorities include, but are not limited to, the categories in sections (a) through (j), below. Persons in categories (a) and (b) are specifically identified as persons to be given immediate priority over those in any other categories. a. Pursuant to 45 C.F.R. s. 96.131, priority admission to pregnant women and women with dependent children by Network Service Providers receiving SAPT Block Grant funding; b. Pursuant to 45 C.F.R. s. 96.126, compliance with interim services, for injection drug users, by Network Service Providers receiving SAPT Block Grant funding and treating injection drug users; c. Priority for services to families with children that have been determined to require substance abuse and mental health services by child protective investigators and also meet the target populations in subsections (a) or (b), below. Such priority shall be limited to individuals that are not enrolled in Medicaid or another insurance program, or require services that are not paid by another payor source: (1) Parents or caregivers in need of adult mental health services pursuant to s. 394.674(1)(a)2., F.S., based upon the emotional crisis experienced from the potential removal of children; and (2) Parents or caregivers in need of adult substance abuse services pursuant to Exhibit A Guidance/Care Center,Inc. Page 1 of 3 Contract No.ME225-7-27 South Florida Beha%ioral Health Nemork, Inc. s. 394.674(1)(c)3., F.S., based on the risk to the children due to a substance use disorder. d. Individuals who reside in civil and forensic state Mental Health Treatment Facilities and individuals who are at risk of being admitted into a civil or forensic state Mental Health Treatment Facility pursuant to s. 394.4573, F.S., Rules 65E-15.031 and 65E-15.071, F.A.C.; e. Individuals who are voluntarily admitted, involuntarily examined, or placed under Part I, Chapter 394, F.S.; f. Individuals who are involuntarily admitted under Part V, Chapter 397, F.S.; g. Residents of assisted living facilities as required in s. 394.4574 and 429.075, F.S.; h. Children referred for residential placement in compliance with Ch. 65E-9.008(4), F.A.C.; and i. Inmates approaching the End of Sentence pursuant to Children and Families Operating Procedure (CFOP) 155-47. j. In the event of a Presidential Major Disaster Declaration, Crisis Counseling Program (CCP) services shall be contracted for according to the terms and conditions of any CCP grant award approved by representatives of the Federal Emergency Management Agency (FEMA) and the Substance Abuse and Mental Health Services Administration (SAMHSA). 3. 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, State and Federal Laws, Rules, and Regulations. The ME reserves the right to review the network 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 no circumstances shall an individual's county of residence be a factor that denies access to service. Authorized services shall only be provided within the serviced area(s) outlined in Attachment 1, Section A.2.c.(2), subject to the availability of funds. 3. In the event of a dispute regarding client eligibility and/or placement into the appropriate level of care, the dispute shall not preclude the Network Provider from providing the provision of services to eligible individuals until the dispute is resolved. The dispute resolution process is described in Paragraph 42. of the Standard Contract. 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 The network provider is not authorized to bill the ME for more units than can be purchased with the amount of funds specified in Exhibit G, Covered Service Funding by OCA, 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. Exhibit A Guidance/Care Center, Inc. Page 2 of 3 Contract No. ME225-7-27 South Florida Behavioral Health Nct-.rork, Inc. 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. Exhibit A Guidance/Care Center, Inc. Page 3 of 3 Contract No. ME225-7-27 South Florida Behavioral Health Nework, (ne. Exhibit B Method of Payment Payment Clauses a. This is a fixed price (unit cost) contract. The unit prices are listed on Exhibit G, Covered Service Funding by OCA. 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 $5,602,409.00, 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 $4,585,341.00, subject to the delivery and billing for services. The remaining amount of $917,068.00 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 direct staff hour, at 25% of the contract's established rate for the individual services for the same covered service. Excluding Outpatient, total hourly reimbursement for group services shall not exceed the charges for fifteen individuals per group. Group size limitations outlined in the current Medicaid Handbook apply to Outpatient group services funded under this contract. c. Pursuant to s. 394.76(3), Florida Statutes (F.S.), the provider agrees to provide local matching funds in the amount of $987,516.00 as indicated in Exhibit H, Funding Detail and Local Match Plan. Should the Network Provider receive any funding from the "Uncompensated Units Reimbursement Funds", then the amount of Local Match Plan 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 the local match requirement i. Deinstitutionalization Projects Case Management Intensive Case Management Residential Services I -IV Supported Housing/Living Short Term Residential Treatment (not exempt if funded by Baker Act funds or operated by a public receiving facility) FACT Teams CMH Programs (100435 Category & 102780 (PRTS) Category) that are not grant funded. Exhibit B Page 1 of 5 Guidance/Care Center, Inc. Contract No. ME225-7-27 South Florida Beha%ioral Health -Network, Inc. d. In accordance with the provisions of s. 402.73(1), F.S., and Rule 65-29.001, Florida Administrative Code (F.A. C.), corrective action plans may be required for noncompliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed, to include contract termination in whole or in part, for failures to implement or to make acceptable progress on such corrective action plans. e. 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. f. 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. g. 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 covered service as given on Exhibit G, Covered Service Funding by OCA, or twenty-five percent (25%) of the prorated share of the amount of funding as specified on Exhibit G, Covered Service Funding by OCA. h. The ME in its sole discretion and subject to funding availability, may purchase from any Network 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. Third Party Billing 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. The Network Provider shall not bill the ME for services provided to: i. Individuals who have third party insurance coverage when the services provided are covered under the insurance plan; or ii. Medicaid enrollees or recipients of another publically funded health benefits assistance program, when the services provided are covered by said program. b. The Network Provider may bill the ME if services are provided to: i. Individuals who have lost coverage through Medicaid, or any other publically funded health benefits assistance program coverage for any reason during the period of non -coverage; or ii. Individuals who have a net family income at or above 150 percent of the Federal Poverty Income Guidelines, subject to the sliding fee scale requirements in Rule 65E-14.018 F.A.C. iii. The Network Provider shall ensure that Medicaid funds are accounted for separately from funds for this contract. Exhibit B Page 2 of 5 Guidance/Care Center, Inc. Contract No. ME225-7-27 South Florida Behavioral Health \emork, Inc. c. In no event shall Medicaid, any health insurance, another publically funded health benefits assistance program, or the ME be billed for the same service provided to the same individual on the same day. d. Medicaid earnings cannot be used as local match. e. The Network Provider shall ensure that Medicaid payments are accounted for in compliance with federal regulations. f. 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. g. 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. h. 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. i. 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,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 in accordance with Chapters 414, and 445, F.S. and the Department's State Plan for Temporary Assistance for Needy Families, renewal October 1, 2011 — September 30, 2014, or the latest revision thereof. Department's State Plan for Temporary Assistance for Needy Families can be obtained from the contract manager, or can be found at the following web site: hftp://www.dcf.state.fl.us/programs/access/docs/TANF-Plan.pdf b. The contract shall specify the unit cost rate for each covered service 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 covered services. 6. Invoice Requirements a. The rates negotiated with any Network Provider may not exceed the rate as specified in in Exhibit G, Covered Service Funding by OCA. Exhibit B Page 3 of 5 Guidance/Care Center, Inc. Contract No. ME225-7-27 South Florida Behavioral Health Nchvork, Inc. b. Network Providers are required to comply with Rule 65E-14.021, F.A.C., Schedule of Covered Services, including but not limited to, covered services, methods of payments, descriptions, program areas, data elements, , required fiscal reports, program description, rate setting process, payment for services including allowable and unallowable units and requests for payments. c. The Network Provider shall request payment monthly through submission of a properly completed invoice, Exhibit E, Monthly Payment Request, within eight (8) 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. Exhibit E, Monthly Payment Request, is incorporated herein by reference and available at the following website: hftp://sfbhn.org/providers/contracts/ 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 eight (8) calendar 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 eight (8) 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 eight (8) 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 twenty (20) days after the end of each state fiscal year in the contract period. g. The Network Provider shall ensure that the year-to-date number of units of service reported on a request for payment or any associated worksheet shall reconcile with the total number of units reported and accepted in KIS or other data system designated by the ME. h. Pursuant to 65E-14.021(7)(a)2., F.A.C., the Network Provider shall not invoice for any Covered Services paid for under any other contract or from any other source. 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, Food Stamps, and funds eligible for local matching which include patient fees from first, second, and third -party payers, from each monthly request for payment. For services provided based on bed -day availability, the provider must report any payments received from all other sources on the "Schedule of Bed -Day Availability" at the end of the fiscal year and refund any overpayment. i. Invoices shall be submitted in detail sufficient for a proper pre -audit and post -audit. Exhibit B Page 4 of 5 Guidance/Care Center, Inc. Contract No. ME225-7-27 South Florida Behavioral Health -Network, Inc. 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 covered service is outlined in Rule 65E-14.021, F.A.C., 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 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. The Network Provider's attention is directed to the Department of Financial Services Reference Guide For State Expenditures for guidance regarding the requirements applicable to the disbursement of funds from the State Treasury, regardless of payment methods. The Reference Guide For State Expenditures can be obtained at the following website: hftp://www.mvfloridacfo.com/aadir/reference -guide/Reference Guide For State Expenditures. Pdf 9. 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. Exhibit B Page 5 of 5 Guidance/Care Center, Inc. Contract No. ME225-7-27 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports Requi red Reports Due D. Response to Monitoring Reports and Within 10 calendar days from the day the 1 (Electronic Submission 1. ME Contract Manager Corrective Action Plans report is received via E-mail) 2, SFBHN staff member issuing CAP External Quality Assurance Reviews, Within 10 calendar days from the day the 1 (Electronic Submission 1. ME Contract Manager Monitoring Reports, Surveys and Corrective report is received, or as requested by the Actions, as applicable Contract Manager via E-mail) 2, Director of Contract Accountability Memorandum of Understanding (MOU) with a Federally Qualified Health Center (FQHC) Within 90 calendar days of the effective or date of the contract (for newly executed Federally Qualified Health Centers are MOU's); Within 30 calendar days for renewed 1 (Electronic Submission ME Contract Manager required to submit policies and procedures that MOU's; Updates to P&P for FQHC's shall via E-mail) explain the access primary care services to be submitted within 30 calendar days of the medically underserved behavioral health adoption client Sliding Fee Scale (reflecting the uniform schedule of discounts referenced in 65E- Prior to contract execution 1 (Electronic Submission ME Contract Manager 14.018(4)] via E-mail) Final FY 2016-2017 (1) Projected Cost Center Operating and Submitted annually prior to contract Capital Budget, execution. Submit updates within 30 1 (Electronic Submission 1. ME Contract Manager Budget Narrative, (2) Bud g calendar days of execution of an via E-mail) (3) Network Providers Agency Service amendment to the contract affecting the 2. VP of Finance Capacity Report, budget. (4) Cost Center Personnel Detail Report Program Description Annually, prior to contract execution. 1 (Electronic Submission 1. ME Contract Manager (1) Organizational Profile Submit updates within 30 calendar days of (2) Service Activity Description amendment via E-mail) 2. VP of Behavioral Health Grievance Procedures Annually, prior to contract execution. 1 (Electronic Submission 1. ME Contract Manager a) Clients (applicants or recipient of services) Submit updates within 30 calendar days of b) Agency Staff implementation via E-mail) 2, VP of CQI Affidavit Regarding Debarment Annually prior to contract execution, or as 1 ME Contract Manager requested by the Contract Manager Submit updates within 30 calendar days of "No amendment or as requested by 1. ME Contract Manager Wrong Door" Policy and Procedures the contract manager and/or the QA/QI 1 Risk & Compliance Manager 2. QA/QI Risk & Compliance Manager Guidance/Care Center, Inc. Exhibit C Contract No. ME225-7-27 Page 1 of 10 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports Date It of Copies Send to: Within 24 hours of occurrence, in accordance with CFOP 215-6 and Incident Report reportable incidents defined CFOP 180-4 Mandatory Submission through IRAS Submission through IRAS Reporting Requirements to the Office of the Inspector General 1. Ayana Roberts: Crisis Stabilization Unit, Substance Abuse E-mail: aroberts@sfbhn.org Detoxification, Addiction Receiving Facility Per Exhibit O, Section A., and Per Daily Tracker and Data Collection, as Exhibit W, 1 (Electronic Submission 2. Joanna Cardwell: applicable, until a new reporting system is via E-mail) E-mail: jardwell@sfbhn.org implemented By 11:00 A.M. [E.S.T.] based on the preceding days' midnight census 3. Betty Hernandez: E-mail: bhernandez@sfbhn.org 1. Ayana Roberts- E-mail: aroberts@sfbhn.org Baker Act Funding for Crisis Stabilization Per Exhibit W, by 11:00 A.M. [E.S.T.] 1 (Electronic Submission 2. Joanna Cardwell: Unit/Short Term Residential Facility Local based on the preceding days' midnight via E-mail) E-mail: jardwell@sfbhn.org Match Requirements, as applicable. census 3. Betty Hernandez: E-mail: bhernandez@sfbhn.org Per Exhibit O, Section B. Daily Reporting: By 11:00 A.M. [E.S.T.] Daily, Monthly, and Annual B. Data Reporting based on the preceding days' midnight for Public Receiving Facilities - Crisis census Stabilization Units, Substance Abuse Monthly Reporting: by the 4th of each 1 (Electronic Submission CSUData@sfbhn.org Detoxification and/or Addiction Receiving month following the month of service via E-mail) Facilities, as applicable, until a new data reporting system is implemented. Annual Reporting: by July 4, 2017, or the date as directed by the ME. Data shall be submitted electronically, weekly, by 12:00 Noon every Wednesday. Monthly Data Required by DCF PAM 155-2 Final monthly shall be submitted Electronically KIS, PBPS, or other data system electronically to the ME no later than the designated by the ME or the Department 4th of each month following the month of service ADA Client Communication Assessment https://fsl6.formsite.com/DCFTraining/Month Iv-Summary-Report/form loxin.html Auxiliary Aid Service Record Monthly Summary Report, By the 4th business day following the 1 (Electronic Submission (Applicable to agency's that employ fifteen (15) reporting month via E-mail) or more employees Confirmation E-mail to the ME Contract Manager Monthly, by the eighth (8th) calendar day Monthly Service Invoice after the month 1 ME Sr. Accountant (Fiscal Department) of service Guidance/Care Center, Inc. Exhibit C Contract No. ME225-7-27 Page 2 of 10 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports R equired Reports Due Date # of Copies Sendto Submitted with the monthly invoice, as Invoice Review Supporting Documentation appropriate, and/or as requested by 1 As requested by SFBHN staff SFBHN staff TANF SAMH Program Logs and Service Data, Asper the contract and/or as requested by 1 ME TANF Coordinator if applicable the contract manager By July 20 of each fiscal year and/or 20 Final Invoice days 1 ME Sr. Accountant (Fiscal Department) after contract end date Inventory Report 8/1/2016 1 (Electronic Submission ME Contract Manager via E-mail) Attestation of Network Provider's Verification that all applicable employees and subcontractors with access to ME and/or DCF 8/1/2016 1 (Electronic Submission ME Contract Manager information systems have signed a DCF via E-mail) Security Agreement form CF 0114 , per the Attachment I and Standard Contract 1. ME Contract Manager Emergency Preparedness Plan 8/1/2016 1 (Electronic Submission via E-mail) 2. QA/QI Risk & Compliance Manager Civil Rights Compliance Checklist (CF0946) 8/1/2016 1 (Electronic Submission via E-mail) ME Contract Manager Civil Rights Certificate (CF707) 8/1/2016 1 (Electronic Submission ME Contract Manager via E-mail) Client Trust Fund Letter 8/1/2016 1 (Electronic Submission ME Contract Manager via E-mail) 1 (Electronic Submission 1. ME Contract Manager Quality Assurance/Quality Improvement Plan 8/1l2016 via E-mail) 2. QA/QI Risk & Compliance Manager Action Plan (Integration of Behavioral Health 1 (Electronic Submission 1. ME Contract Manager Services and Primary Care, TIC, CLC, CWI 8/31/2016 via E-mail) Initiatives) 2. QA/QI Risk & Compliance Manager July 5, 2016 (Period: 04/01/16 - 06/30/16) October 5, 2016 NVRA Voter Registration Agencies Quarterly (Period: 07/01/16 - 09/30/16) 1. ME Voter Registration Activities Activities Report Form (DS-DE131; effective January 5, 2017 1 (Electronic Submission Coordinator 01/2012 or latest revision thereof, if applicable (Period: 10/01/16 - 12/31/16) via E-mail) 2. ME Contract Manager April 5, 2017 (Period: 01/01/17 - 03/31/17) July 5, 2017 (Period: 04/01 /17- 06/30/17) Guidance/Care Center, Inc. Exhibit C Contract No. ME225-7-27 Page 3 of 10 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports Required Reports Due Date # of Copies Send to: October 31, 2016 (Period: 07/01/16 - 09/30/16) January 31, 2017 Quarterly Financial Statements (Balance Sheet (Period: 10/01/16 - 12/31/16) 1 (Electronic Submission 1. ME VP of Finance and Statement of Activity) May 1, 2017 via E-mail) (Period: 01/01/17 - 03/31/17) 2. ME Contract Manager July 31, 2017 (Period: 04/01/17 - 06/30/17) October 31, 2016 (Period: 07/01/16 - 09/30/16) January31, 2017 Attestation indicating the filing of Form 941 and (Period: 10/01/16 - 12/31/16) 1 (Electronic Submission payment of any taxes due to the IRS have May 1, 2017 via E-mail) ME Contract Manager been paid. (Period: 01/01/17-03/31/17) July 31, 2017 (Period: 04/01/17 - 06/30/17) January 30, 2017 1. ME Contract Manager Continuous Quality Improvement Updates (Period: 07/01/16 - 12/31/16) 1 (Electronic Submission July 30, 2017 via E-mail) 2. QAIQI Risk &Compliance Manager (Period: 01/01/17 - 06/30/17) Completion of the annual self -assessment for the following initiatives: 1. Integration of Behavioral Health and Primary 1. ME Contract Manager Care (MeHAF) 3/1/2017 1 2. Trauma Informed Care (Fallot Assessment 2. QA/QI Risk & Compliance Manager Tool) 3. Cultural and Linguistic Competence Survey as directed by the ME Submission of the result of the following self - assessments 1. Integration of Behavioral Health and Primary 1. ME Contract Manager Care (MeHAF) 4l1/2017 1 2. Trauma Informed Care (Fallot Assessment 2. QA/QI Risk & Compliance Manager Tool) 3. Cultural and Linguistic Competence Survey as directed by the ME Payer Class Data, per the Attachment I, if November 1, 2016 (data for the previous 1 (Electronic Submission ME Contract Manager applicable fiscal year) via E-mail) Motivational Support Program (MSP) Per Exhibit I, Motivational Support 1 Per Exhibit 1, Motivational Support Program Treatment Summary Form, if applicable Program Provider Protocols Provider Protocols Designation of Dispute Resolution Officer Within 5 working days of contract 1 (Electronic Submission ME Contact Manager execution via E-mail) Local Match Calculation Form - Florida Upon Request 1 (Electronic Submission ME Contract Manager Department of Children and Families via E-mail) Guidance/Care Center, Inc. Exhibit C Contract No. ME225-7-27 Page 4 of 10 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports Required Repo rts Due .. Year -End Financial Reports for Network Provider's Not Requiring Audits Per Attachment 11 Due 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, Certification indicating that recipient expended whichever occurs first, directly to each of less than $500,000 ($750,000 in Federal the following unless otherwise required by 1 (Electronic Submission 1. ME Contract Manager Awards for fiscal years beginning on or after Florida Statutes The schedule shall be via E-mail) in State Awards during December 26, 2014 9 based on revenues and expenditures 2, VP of Finance the fiscal year recorded during the state's fiscal year. Year -End Financial Reports for Network Provider's Not Requiring Audits Per Attachment 11 - Continued Due 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 1 (Electronic Submission 1. ME Contract Manager Schedule of State Earnings Florida Statutes The schedule shall be via E-mail) 2. VP of Finance based on revenues and expenditures recorded during the state's fiscal year. Due 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, Projected Cost Center Operating and Capital whichever occurs first, directly to each of 1. ME Contract Manager Budget the following unless otherwise required by 1 (Electronic Submission Actual Expenses & Revenues Schedule Florida Statutes The schedule shall be via E-mail) based on revenues and expenditures 2. VP of Finance recorded during the state's fiscal year. Due 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 1 (Electronic Submission 1. ME Contract Manager Schedule of Bed -Day Availability Payments Florida Statutes The schedule shall be via E-mail) based on revenues and expenditures 2. VP of Finance recorded during the state's fiscal year. Due 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 Agency Prepared Financial Statements the following unless otherwise required by 1 (Electronic Submission 1. ME Contract Manager (Balance Sheet and Statement of Activity Florida Statutes The schedule shall be via E-mail) 2. VP Finance based on revenues and expenditures of recorded during the state's fiscal year. Guidance/Care Center, Inc. Exhibit C Contract No. ME225-7-27 Page 5 of 10 South Florida Behavioral Health Network, Inc. Exhibit C Required Reoorts .. Year -End Financial Report: for Network Provider's Requiring Audits Per Attachment 11 Due 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 Financial & Compliance Audit to include the p the following unless otherwise required by 1 (Electronic Submission 1. ME Contract Manager necessary schedules per Attachment II Florida Statutes The schedule shall be via E-mail) based on revenues and expenditures 2. VP of Finance recorded during the state's fiscal year. Year -End Financial Reports for Network Providets Requiring Audits Per Attachment 11- Continued Due 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 Schedule of State Earnings the following unless otherwise required by 1 (Electronic Submission 1. ME Contract Manager Florida Statutes The schedule shall be via E-mail) 2. VP of Finance based on revenues and expenditures recorded during the state's fiscal year. Due 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 1. ME Contract Manager Schedule of Related Party Transaction the following unless otherwise required by 1 (Electronic Submission Adjustments Florida Statutes The schedule shall be via E-mail) based on revenues and expenditures 2. VP of Finance recorded during the state's fiscal year. Due 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, Projected Cost Center Operating and Capital whichever occurs first, directly to each of 1. ME Contract Manager Budget the following unless otherwise required by 1 (Electronic Submission Actual Expenses & Revenues Schedule Florida Statutes The schedule shall be via E-mail) based on revenues and expenditures y, VP of Finance recorded during the state's fiscal year. Due 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 1. ME Contract Manager Schedule of Bed -Day Availability Payments the following unless otherwise required by 1 (Electronic Submission Florida Statutes The schedule shall be via E-mail) y, VP of Finance based on revenues and expenditures recorded during the state's fiscal year. Guidance/Care Center, Inc. Exhibit C Contract No. ME225-7-27 Page 6 of 10 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports Required Reports Due Date # of Copies Send to: Waltlist Reports Outpatient Wait List Report Form - Monthly by the 5th for the preceding 1 (Electronic Submission Exhibit AK month's services. via E-mail) ME System of Care Staff Reports Required for Children's Mental Health Providers, as applicable Children's Mental Health Quarterly clinical Per Exhibit R, Child Welfare Quarterly 1 Copy in client chart reports on all dependent children, if applicable Clinical Report Children's Mental Health Quarterly clinical Per Exhibit R, Child Welfare Quarterly 1 Copy in client chart reports on all community children, if applicable Clinical Report Reports Required for Children's Mental Health Providers, as applicable - Continued July 5, 2016 (Period: 04/01/16 - 06/30/16) October 5, 2016 (Period: 07/01 /16 - 09/30/16) 1. ME Contract Manager Infant Mental Health -Narrative Milestones January 5, 2017 1 (Electronic Submission Report On Client Outcomes, if applicable (Period: 10/01/16 - 12/31/16) via E-mail) 2. VP of Behavioral Health April 5, 2017 ( Period: 01 /01 /17 - 03/31 /17) July 5, 2017 (Period: 04/01/17- 06/30/17) Reports Required for Behavioral Health Network (BNet) Providers 1. ME Contract Manager One (1) hard copy, or one Alternative Services Provision Documentation Within 15 calendar days after end of (1) faxed copy, or one (1) 2. ME BNet Coordinator (Other than Pharmaceuticals) month encrypted attachment to an email to each recipient. 3. Children's Mental Health State Program Office 1. ME Contract Manager One (1) hard copy, or one Alternative Services Provision Documentation Within 15 calendar days after end of (1) faxed copy, or one (1) 2. ME BNet Coordinator (Pharmaceuticals only) month encrypted attachment to an email to each recipient. 3. Children's Mental Health State Program Office 1. ME Contract Manager One (1) hard copy, or one Statement of Program Cost September 1 following close of the (1) faxed copy, or one (1) 2. ME BNet Coordinator contract year (June 30) encrypted attachment to an email to each recipient. 3. Children's Mental Health State Program Office Reports Required for Adult Mental Health Providers, as applicable PATH Annual Data Report to SAMHSA, if Per PATH Grant Application Instructions 1 (Electronic Submission Per instruction on the PATH Grant applicable via E-mail) Application Drafts to be submitted to ME, Southern Region SAMH Program Office, and DCF 1 (Electronic Submission 1. ME Contract Manager PATH Annual Reports, if applicable Central Office in Tallahassee when via E-mail) requested (Generally drafts are due in 2, ME System of Care Staff April or May of each fiscal year) Guidance/Care Center, Inc. Exhibit C Contract No. ME225-7-27 Page 7 of 10 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports D. te # of Copies Send to: Reports Required for Adult Mental Health Providers, as applicable - Continued PATH Local Match Expenditure Report, if Monthly by the 8th of each month following 1 (Electronic Submission 1. ME Sr. Accountant (Fiscal Department) applicable the month of service via E-mail) 2. ME Contract Manager PATH Monthly Report (generated from the Monthly, by the 5th calendar day 1 (Electronic Submission 1. ME Contract Manager HMIS system) after the month via E-mail) of service 2. ME System of Care Staff Other PATH data reports as requested by the As requested by the ME As requested by the ME ME Contract Manager & Requestor ME Reports Required for Adult Mental Health Providers, as applicable - Continued October 5, 2016 (Period: 07/01/16 - 09/30/16) January 5, 2017 Assisted Living Facility with a Limited Mental (Period: 10/01/16 - 12/31/16) 1 (Electronic Submission 1. ME Contract Manager Health License Client Quarterly Report, per April 5, 2017 via E-mail) Exhibit L (Period: 01/01/17 - 03/31/17) 2. ME Adult System of Care Manager July 5, 2017 (Period: 04/01/17 - 06/30/17) September 15, 2016 (Period: 07/01/16 - 08/31/16) November 15, 2016 (Period: 09/01/16 - 10/31/16) January 16, 2017 (Period: 11/01/16 - 12/31/16) 1 (Electronic Submission 1. ME Adult System of Care Manager SOAR Bi-Monthly Report, per Exhibit AN March 15, 2017 via E-mail) (Period: 01/01/17 - 02/28/17) 2. ME Peer Services Manager May 15, 2017 (Period: 03/01/17 - 04/30/17) July 15, 2017 (Period: 05/01/17 - 06/30/17) Report Required for Florida Assertive Community Treatment (FACT) Providers October 5, 2016 (Period: 07/01/16 - 09/30/16) January 5, 2017 (Period: 10/01/16 - 12/31/16) 1 (Electronic Submission 1. ME Contract Manager FACT Enhancement Reconciliation Report April 5, 2017 via E-mail) (Period: 01/01/17 - 03/31/17) 2. ME Peer Services Manager July 5, 2017 (Period: 04/01/17 - 06/30/17) Vacant Position Report Monthly by the 7th of each month following 1 (Electronic Submission 1. ME Contract Manager the month of service via E-mail) 2, ME Peer Services Manager October 5, 2016 (Period: 07/01/16 - 09/30/16) January 5, 2017 (Period: 10/01/16 - 12/31/16) 1 (Electronic Submission 1. ME Contract Manager Ad -Hoc Quarterly Report April 5, 2017 via E-mail) (Period: 01/01/17 - 03/31/17) 2. ME Peer Services Manager July 5, 2017 (Period: 04/01/17 - 06/30/17) Report Required for Miami -Dade Forensic Alternative (MDFAC) Providers Daily Census Report 7- Daily 1 (Electronic Submissn iogional via E-mail) Re Forensic Coordinator Guidance/Care Center, Inc. Exhibit C Contract No. ME225-7-27 Page 8 of 10 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports Required Reports Due Da Report Required for Miami -Dade Forensic Alternative (MDFAC) Providers - Continued Monthly Program Quality Review Tracking By the 15th of each month following the 1 (Electronic Submission 1. ME Contract Manager Report month of services via E-mail) 2. Regional Forensic Coordinator Reports Required for Forensic Services Providers Monthly Report for Individuals on Conditional 1. ME Forensic Coordinator Release, if applicable By 15th of each month 1 2. Mental Health Administrator Office Statewide Forensic Bed Census Report, if Weekly (Every Thursday by 5:00 pm) 1 ME Forensic Coordinator applicable Reports Required for Consumer -Driven Agencies October 5, 2016 (Period: 07/01/16 - 09/30/16) January 5, 2017 (Period: 10/01/16 - 12/31/16) 1 (Electronic Submission Enrollment/Membership Report April 5, 2017 via E-mail) ME Contract Manager (Period: 01 /01 /17 - 03/31 /17) July 5, 2017 (Period: 04/01/17 - 06/30/17) Reports Required for Substance Abuse Services Providers January 5, 2017 Report for HIV Early Intervention Services, (Period: 07/01/16 - 12/31/16) SAPT Block Grant Set Aside Funded Services July 5, 2017 1 ME Contract Manager Only (Period: 01/01/17 - 06-30-17) Annual Report for Evidenced -based Injection Drug User Outreach Services, SAPT Block Upon Request 1 ME Contract Manager Grant Mandate, Designated Providers Only Annual Report for Pregnant Women and Women With Dependent Children SAPT Block Upon Request 1 ME Contract Manager Grant Set Aside Funded Services Only Monthly Outcomes for Women's Expansion Due monthly, by the 4th of every month 1 (Electronic Submission 1. ME IT Office Grant — Special Appropriation following the month of service via E-mail) 2. ME Contract Manager Reports Required for Substance Abuse Prevention Services Providers Prevention Data Collection Log (This log is the 1 (Electronic Submission of back up to the monthly prevention services Monthly no later than the 4th of each the Prevention Log to the ME Contract Manager invoice) until an alternate data system is month following the month of service Contract Manager) implemented October 15, 2016 (Period: 07/01/16 - 09/30/16) (1) ME Contract Manage Prevention Services Quarterly Reports (Fidelity January 15, 2017 (Period: 10/01/16 - 12/31/16) 1 (Electronic Submission (2) ME Director of Prevention Services to EBPs) April 15, 2017 via E-mail) (3) BSRI - ME Contracted Prevention (Period: 01/01/17 - 03/31/17) Services Evaluation Provider July 15, 2017 (Period: 04/01/17 - 06/30/17) Refer to Scope of Work attachment to the Contract for a complete list of required reports, if prevention services are contracted through this contract. Guidance/Care Center, Inc. Exhibit C Contract No. ME225-7-27 Page 9 of 10 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports Required Reports Due Date # of Copies Send to: Reports Required for Family Intensive Treatment Team Service Providers Family Intensive Treatment Team (1) Performance Measures: Monthly by the (1) Performance Measures as required by 4th for the preceding month's services, 2 (Electronic Submission Exhibit AI -A; via E-mail) ME Contract Manager (2) Utilization Report: Monthly by the 15th (2) Utilization Report - Exhibit AI-B for the preceding month's services Family Intensive Treatment Team Quarterly October 31, 2016 Expenditure Report (Network Provider (Period: 07/01/16 - 09/30/16) Specific: Guidance/ Care Center, Inc.) January 27, 2016 (Period: 10/01/16 - 12/31/16) 1 (Electronic Submission April 28, 2017 via E-mail) ME Contract Manager (Period: 01/01/17 - 03/31/17) July 28, 2017 (Period: 04/01/17 - 06/30/17) Reports Required for Motivational Support Program (MSP) Funded Services Providers 1. ME Contract Manager MSP Tracker By 10th of each month following the month 1 (Electronic Submission 2 ME QI Data Analyst of service via E-mail) 3. Child Welfare Integration Coordinator Reports Required for Provider's Funded for Special Projects by Florida Legislature - Return on Investment - Per Exhibit AM 1. ME Contract Manager Initial Projected Return on Investment 7/10/2016 1 (Electronic Submission via E-mail) October 10, 2016 (Period: 07/01/16 - 09/30/16) January 10, 2017 1. ME Contract Manager Quartlery Updates on Return on Investment (Period: 10/01/16 - 12/31/16) 1 (Electronic Submission Report - Per Exhibit AM April 10, 2017 via E-mail) (Period: 01 /01 /17 - 03/31 /17) July 10, 2017 (Period: 04/01/17- 06/30/17) Note: When a regular due date for a required report falls on a weekend or a legal holiday, the due date is extended to the next business day immediately following the weekend or holiday. Guidance/Care Center, Inc. Exhibit C Contract No. ME225-7-27 Page 10 of 10 South Florida 13eha'iorat Health Net )rk, Inc. Exhibit D Substance Abuse & Mental Health Required Performance Outcomes & Outputs Provider Name: Guidance/Care Center, Inc. Contract#: ME225-7-27 Date: July I,2016 Revision#: Table 1 Network Service Provider Measures Network Target Population and Measure Description Target Adults Community Mental Health MH003 a. Average annual days worked for pay for adults with severe and persistent mental 40 illness MH703 b. Percent of adults with serious mental illness who are competitively employed 24% MH742 c. Percent of adults with severe and persistent mental illnesses who live in stable housing environment 90% MH743 d. Percent of adults in forensic involvement who live in stable housing environment 67% MH744 e. Percent of adults in mental health crisis who live in stable housing environment 86% Adult Substance Abuse 5A058 a. Percentage change in clients who are employed from admission to discharge 10% SA754 b. Percent change in the number of adults arrested 30 days prior to admission versus 15% 30 days prior to discharge SA755 c. Percent of adults who successfully complete substance abuse treatment services 51% SA756 d. Percent of adults with substance abuse who live in a stable housing environment 94% at the time of discharge Children's Mental Health MH012 a. Percent of school days seriously emotionally disturbed (SED) children attended 86% MH377 b. Percent of children with emotional disturbances(ED) who improve their level of 64% functioning MH378 c. Percent of children with serious emotional disturbances(SED) who improve their level of functioning 65% MH778 d. Percent of children with emotional disturbance (ED)who live in a stable housing 95% environment MH779 e. Percent of children with serious emotional disturbance (SED)who live in a stable 93% housing environment MH780 f. Percent of children at risk of emotional disturbance (ED)who live in a stable 96% housing environment Children's Substance Abuse SA725 a. Percent of children who successfully complete substance abuse treatment services 48% SA751 b. Percent change in the number of children arrested 30 days prior to admission 20/ versus 30 days prior to discharge SA752 c. Percent of children with substance abuse who live in a stable housing 93% environment at the time of discharge Guidance/Care Center,Inc. Exhibit D Contract No.ME225-7-27 Page 1 of 2 South Florida Behavioral Health Network,Inc. Table 2 Network Service Provider Output Measures—Persons Served For Fiscal Year FY16-17 Service Category FY Target Residential Care 45 Outpatient Care 1700 0) 2 73 Crisis Care 304 «� v aState Hospital Discharges N/A Peer Support Services 0 Residential Care 0 N � • i Outpatient Care 535 CIJ .c Crisis Care 15 u a, 2 SIPP Discharge N/A Residential Care 0 co H Outpatient Care 635 N Q Detoxification 190 -3a Women's Specific Services N/A a Injecting Drug Users 50 Residential Care 0 c ram° Outpatient Care 174 N Detoxification 0 H .0 **Refer to Attachment IV, Scope -a Prevention of Work for the numbers served.** Network Provider Compliance: Failure to meet the applicable standards established in Tables 1 and 2 shall be considered nonperformance pursuant to Standard Contract, Paragraph 36. Financial Consequences for Network Provider's Failure to Perform. Guidance/Care Center,Inc. Exhibit D Contract No. ME225-7-27 Page 2 of 2 South Florida Behavioral Health ,Aehsork, Inc. Exhibit E Monthly Payment Request 1. Exhibit E, Monthly Payment Request This exhibit is incorporated by reference and available at following website: http://sfbhn.ory/prov iders/contracts/ Exhibit E Guidance/Care Center, Inc. 1 of 1 Contract No. ME225-7-27 South Florida Behavioral Health Net�iork, Inc. Rev. 7.01.2016 Exhibit F State and Federal Laws, Rules, and Regulations The network provider and its subcontractors shall 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. Federal Authority A. Mental Health 42 U.S. C. ss. 300x, et. seq. B. Substance Abuse Prevention and Treatment Block Grant (SAPTBG) 42 U.S.C. ss. 300x-21 et. seq. 45 C.F.R. pt. 96 C. Restrictions on expenditures of SAPTBG 45 C.F.R. s. 96.135 D. Substance Abuse -Confidentiality 42 C.F.R., pt. 2 E. Health Insurance Portability and Accountability Act (HIPAA) 45 C.F.R. pt. 164 F. Social Security Income for the Aged, Blind and Disabled 20 C.F.R. pt. 416 G. Endorsement and Payment of Checks Drawn on the United States Treasury 31 C.F.R. pt. 240 H. Temporary Assistance to Needy Families (TAN F) 42 U.S.C. ss. 601, et. seq. 45 C.F.R., pt. 260 I. Projects for Assistance in Transition from Homelessness (PATH) 42 U.S. C. s. 290cc-21 et. seq. 42 C.F.R., pt. 54 J. Americans with Disabilities Act of 1990 42 U.S. C. ss. 12101 et. seq. K. Trafficking Victims Protection Act of 200 22 U.S.C. 7104 2 CFR Part 175 Exhibit F Page 1 of 4 Guidance/Care Center, Inc. Contract No. ME225-7-27 II. FLORIDA STATUTES A. Child Welfare and Community Based Care Ch. 39, F.S. Proceedings Relating to Children Ch. 119, F.S. Public Records Ch. 402, F.S. Health and Human Services; Miscellaneous Provisions Ch. 435, F.S. Employment Screening Ch. 490, F.S. Psychological Services Ch. 491, F.S. Clinical, Counseling and Psychotherapy Services Ch. 1002, F.S. Student and Parental Rights and Educational Choices B. Substance Abuse and Mental Health Services Ch. 381, F.S. Public Health: General Provisions Ch. 386, F.S. Particular Conditions Affecting Public Health Ch. 395, F.S. Hospital Licensing and Regulation Ch. 394, F.S. Mental Health Ch. 397, F.S. Substance Abuse Services Ch. 400, F.S. Nursing Home and Related Health Care Facilities Ch. 414, F.S. Family Self Sufficiency Ch. 435, F.S. Employment Screening Ch. 458, F.S. Medical Practice Ch. 459, F.S. Osteopathic Medicine Ch. 464, F.S. Nursing Ch. 465, F.S. Pharmacy Ch. 490, F.S. Psychological Services Ch. 491, F.S. Clinical, Counseling and Psychotherapy Services Ch. 499, F.S. Florida Drug and Cosmetic Act Ch. 553, F.S. Building Construction Standards Ch. 893, F.S. Drug Abuse Prevention and Control S. 409.906(8), F.S. Optional Medicaid Services - Community Mental Health Services C. Developmental Disabilities Ch. 393, F.S. Developmental Disabilities D. Adult Protective Services Ch. 415, F.S. Adult Protective Services E. Forensics Ch. 916, F.S. Mentally Deficient and Mentally III Defendants Ch. 985, F.S. Juvenile Justice; Interstate Compact on Juveniles S. 985.19, F.S. Incompetency in Juvenile Delinquency Cases S. 985.24, F.S. Interstate Compact on Juveniles; Use of detention; prohibitions F. State Administrative Procedures and Services Ch. 120, F.S. Administrative Procedures Act Ch. 287, F.S. Procurement of Personal Property and Services Ch. 815, F.S. Computer - Related Crimes Exhibit F Page 2 of 4 Guidance/Care Center, Inc. Contract No. ME225-7-27 Ch. 817, F.S. Fraudulent Practices S. 112.061, F.S. Per diem and Travel Expenses of public officers, employees, and authorized persons S. 112.3185, F.S. Additional Standards for State Agency Employees S. 215.422, F.S. Payments, Warrants & Invoices; Processing Time Limits S. 216.181(16)(b), F.S. Advanced funds for Program Startup or Contracted Services III. FLORIDA ADMINISTRATIVE CODE (RULES) A. Child Welfare and Community Based Care Ch. 65C-12, F.A.C. Emergency Shelter Care Ch. 65C-13, F.A.C. Foster Care Licensing Ch. 65C-14, F.A.C. Group Care Ch. 65C-15, F.A.C. Child -Placing Agencies B. Substance Abuse and Mental Health Services Ch. 65D-30, F.A.C. Substance Abuse Services Office Ch. 65E-4, F.A.C. Community Mental Health Regulation Ch. 65E-5, F.A.C. Mental Health Act Regulation Ch. 65E-10, F.A.C. Psychotic and Emotionally Disturbed Children- Purchase of Residential Services Rules Ch. 65E-11, F.A.C. Behavioral Health Services Ch. 65E-12, F.A.C. Public Mental Health Crisis Stabilization Units and Short Term Residential Treatment Programs Ch. 65E-14, F.A.C. Community Substance Abuse and Mental Health Services - Financial Rules Ch. 65E-20, F.A.C. Forensic Client Services Act Regulation CH. 65E-26, F.A.C. Substance Abuse and Mental Health Priority Populations and Services C. Financial Penalties Ch. 65-29, F.A.C. Penalties on Service Providers IV. MISCELLANEOUS A. Department of Children and Families Operating Procedures CFOP 155-10/175-40 Services for Children with Mental Health and Any Other Co - Occurring Substance Abuse or Developmental Disability Treatment Needs in Out -of -Home Care Placements CFOP 155-11 Title XXI Behavioral Health Network CFOP 155-47 Processing Referrals From The Department Of Corrections CFOP 215-6 Incident Reporting and Analysis System (IRAS) B. Standards applicable to Cost Principles, Audits, Financial Assistance and Administrative Requirements S. 215.97, F.S. Florida Single Audit Act S. 215.971, F.S. Agreements funded with federal or state assistance Comptroller's Memorandum No. 03 (1999-2000) Florida Single Audit Act Implementation Exhibit F Page 3 of 4 Guidance/Care Center, Inc. Contract No. ME225-7-27 CFO's Memorandum No. 03 (2014 - 2015) Compliance Requirements for Agreements 2 CFR, Part 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, available at https://federalregister.gov/a/2013-30465 2 CFR, Part 300.1 Adoption of 2 CFR Part 200 45 C.F.R., pt. 75 Uniform Administration Requirements, Cost Principles, and Audit Requirements for HHS Awards C. Data Collection and Reporting Requirements S. 394.74(3)(e), F.S. Data Submission S. 394.9082, F.S. Behavioral health managing entities S. 397.321(3)(c), F.S. Data collection & dissemination system S. 394.77, F.S. Uniform management information, accounting, and reporting systems for providers DCF PAM 155-2 Mental Health and Substance Abuse Measurement and Data Exhibit F Page 4 of 4 Guidance/Care Center, Inc. Contract No. ME225-7-27 EXHIBIT G:COVERED SERVICES FUNDING BY OCA July 2016 Guidance/Care Center,Inc. ADULT MENi':\I.HEALTH ME225-7-27 MH001 M11009 MH018 N1H0I8 M11072 \111073 MH076 M11093 MH094 MHAPG MHO'IB MHOCF COVERED SERVICES FUNDING/ MHAO1 MHAO9 MHA18 MHA18 MHA72 MHA73 MHA76 MHA93 MHA94 MHAPG MHATB MHACF TOTAL RATE 123,266 915,082 17,600 1,112,903 160,000 - 5,945 - - 83,250 - - $ 2,418,046 01 Assessment $ 70.82 138,117 11,000 8,159 $ 157,276 02 Case Management $ 75.70 107,411 8,996 12,434 $ 128,841 03 Crisis Stabilization $ 325.29 1,041,903 $ 1,041,903 04 Crisis Support/Emergency $ 19.69 17,600 71,000 $ 88,600 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ 26.58 42,541 $ 42,541 08 In-Home/On-Site $ 77.48 100 $ 100 11 Intervention-Individual $ 58.47 116,844 19,928 - $ 136,772 42 Intervention-Group $ 14.62 - $ - 12 Medical Services $ 403.96 391,917 44,282 5,945 - $ 442,144 14 Outpatient-Individual $ 81.33 81,629 6,834 - $ 88,463 35 Outpatient-Group $ 20.33 2,000 1,660 - $ 3,660 15 Outreach $ 44.49 480 54,100 9,704 $ 64,284 18 Residential Level I $ 291.08 33,266 $ 33,266 19 Residential Level II $ - $ - 20 Residential Level III $ - $ _ 21 Residential Level IV $ - S - 24 Substance Abuse Detox $ 278.64 $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ 63.56 52,953 $ 52,953 27 TASC $ 69.78 $ - 28 Incidental Expenses $ 50.00 10,850 13,200 - $ 24,050 29 Aftercare-Individual $ 70.92 $ - 43 Aftercare-Group $ 17.73 $ - 30 Information&Referral $ 29.23 10,664 $ 10,664 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ 78.84 90,000 $ 90,000 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ 46.21 12,529 $ 12,529 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - 47 Recovery Support-Group $ - 48 Prevention-Indicated $ 53.56 $ - 49 Prevention-Selective $ 58.58 $ - 50 Prevention-Universal Direct $ 58.58 $ - 51 Prevention-Universal Indirect $ 58.58 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 4,585,341 $ 123,266 $ 915,082 $ 17,600 $ 1,112,903 $ 160,000 $ - $ 5,945 $ - $ - $ 83,250 $ - $ - $ 2,418,046 TOTAL UNCOMPENSATED $ 917,068 $ 483,609 Guidance/Care Center,Inc. Exhibit G Contract No. ME225-7-27 Page 1 of 4 EXHIBIT G:COVERED SERVICES FUNDING BY OCA July 2016 Guidance/Care Center,Inc. CHILDREN MENTAL HEALTH ME225-7-27 M11001 MH009 MH009-CR MH018 M11018 MHORN MIIOFA M11UFA-CR MHOMD MHOMD-CR MHOCF COVERED SERVICES FUNDING/ MHCO1 MHCO9 MHC09-CR MHCIS MHC18 MHCBN MHCFA MHCFA-CR MHCMD MHCMD-CR MHCCF TOTAL RATE - 470,000 - 15,677 - - - - - - - $ 485,677 01 Assessment $ 70.82 25,066 $ 25,066 02 Case Management $ 75.70 19,871 $ 19,871 03 Crisis Stabilization $ 325.29 $ - 04 Crisis Support/Emergency $ 19.69 15,677 $ 15,677 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ 26.58 $ - 08 In-Home/On-Site $ 77.48 313,092 $ 313,092 11 Intervention-Individual $ 58.47 62,714 $ 62,714 42 Intervention-Group $ 14.62 - $ - 12 Medical Services $ 403.96 33,645 $ 33,645 14 Outpatient-Individual $ 81.33 186 $ 186 35 Outpatient-Group $ 20.33 30 $ 30 15 Outreach $ 44.49 12,796 $ 12,796 18 Residential Level I $ 291.08 $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ 278.64 $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ 63.56 $ - 27 TASC $ 69.78 $ - 28 Incidental Expenses $ 50.00 $ - 29 Aftercare-Individual $ 70.92 $ - 43 Aftercare-Group $ 17.73 $ - 30 Information&Referral $ 29.23 2,600 $ 2,600 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ 78.84 $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ 46.21 $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 53.56 $ - 49 Prevention-Selective $ 58.58 $ - 50 Prevention-Universal Direct $ 58.58 $ - 51 Prevention-Universal Indirect $ 58.58 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 4,585,341 $ - $ 470,000 $ - $ 15,677 $ - $ - $ - $ - S - S - S - $ 485,677 TOTAL UNCOMPENSATED $ 917,068 $ 97,135 Guidance/Care Center,Inc. Exhibit G Contract No. ME225-7-27 Page 2 of 4 EXHIBIT G:COVERED SERVICES FUNDING BY OCA July 2016 Guidance/Care Center,Inc. \I l l LT SUBSTANCE A I1I I ME225-7-27 MS003 MS01I MS021 MS023 MS025 MS027 MS081 MS091 MSOTB MS903 MSOCF COVERED SERVICES FUNDING/ MSA03 MSAI l MSA21 MSA23 MSA25 MSA27 MSA81 MSA91 MSATB MSACF TOTAL RATE - 347,040 186,643 - - - - 633,190 - - - $ 1,166,873 01 Assessment $ 70.82 52,709 $ 52,709 02 Case Management $ 75.70 63,889 $ 63,889 03 Crisis Stabilization $ 325.29 $ - 04 Crisis Support/Emergency $ 19.69 3,000 $ 3,000 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ 26.58 $ - 08 In-Home/On-Site $ 77.48 283 $ 283 11 Intervention-Individual $ 58.47 43,411 $ 43,411 42 Intervention-Group $ 14.62 $ - 12 Medical Services $ 403.96 632 $ 632 14 Outpatient-Individual $ 81.33 35,074 $ 35,074 35 Outpatient-Group $ 20.33 64,777 $ 64,777 15 Outreach S 44.49 38,970 $ 38,970 18 Residential Level I $ 291.08 $ - 19 Residential Level II $ $ - 20 Residential Level III S - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ 278.64 183,643 $ 183,643 25 Supported Employment $ - $ - 26 Supportive Housing $ 63.56 $ - 27 TASC $ 69.78 47,095 $ 47,095 28 Incidental Expenses $ 50.00 $ - 29 Aftercare-Individual $ 70.92 200 $ 200 43 Aftercare-Group $ 17.73 $ - 30 Information&Referral $ 29.23 $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ 78.84 $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ 46.21 $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - 633,190 $ 633,190 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 53.56 $ - 49 Prevention-Selective $ 58.58 $ - 50 Prevention-Universal Direct $ 58.58 $ - 51 Prevention-Universal Indirect S 58.58 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 4,585,341 $ - $ 347,040 $ 186,643 $ - $ - $ - $ - $ 633,190 $ - $ - $ - $ 1,166,873 TOTAL UNCOMPENSATED $ 917,068 $ 233,375 Guidance/Care Center, Inc. Exhibit G Contract No.ME225-7-27 Page 3 of 4 EXHIBIT G:COVERED SERVICES FUNDING BY OCA July 2016 Guidance/Care Center,Inc. CHILDREN 't'BSTANCE ABUSE ME225-7-27 MS003 MSOII NIS021 MS023 MS025 MS02S-CR MISOPP \ISOTB MS903 MSOCF COVERED SERVICES FUNDING/ MSCO3 MSC11 MSC21 MSC23 MSC25 MSC25-CR MSCPP MSCTB MSCCF TOTAL RATE - 279,139 - - 235,606 - - - - - $ 514,745 01 Assessment $ 70.82 4,000 $ 4,000 02 Case Management $ 75.70 5,000 $ 5,000 03 Crisis Stabilization $ 325.29 $ - 04 Crisis Support/Emergency $ 19.69 $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ 26.58 $ - 08 In-Home/On-Site $ 77.48 300 $ 300 11 Intervention-Individual $ 58.47 234,339 $ 234,339 42 Intervention-Group $ 14.62 50 $ 50 12 Medical Services $ 403.96 100 $ 100 14 Outpatient-Individual $ 81.33 300 $ 300 35 Outpatient-Group S 20.33 50 $ 50 15 Outreach $ 44.49 33,000 $ 33,000 18 Residential Level I $ 291.08 $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV S - $ - 24 Substance Abuse Detox $ 278.64 $ - 25 Supported Employment S - $ - 26 Supportive Housing $ 63.56 $ - 27 TASC $ 69.78 2,000 $ 2,000 28 Incidental Expenses $ 50.00 - $ - 29 Aftercare-Individual $ 70.92 $ - 43 Aftercare-Group $ 17.73 $ - 30 Information&Referral $ 29.23 $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ 78.84 $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ 46.21 $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 53.56 39,006 $ 39,006 49 Prevention-Selective $ 58.58 59,100 $ 59,100 50 Prevention-Universal Direct $ 58.58 106,100 $ 106,100 51 Prevention-Universal Indirect $ 58.58 31,400 $ 31,400 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 4,585,341 $ - $ 279,139 $ - S - $ 235,606 $ - $ - $ - $ - $ - $ 514,745 TOTAL UNCOMPENSATED $ 917,068 $ 102,949 Guidance/Care Center. Inc. Exhibit G Contract No. ME225-7-27 Page 4 of 4 EXHIBIT H - FUNDING DETAIL July 2016 Provider: Guidance/Care Center, Inc. ADULT MENTAL HEALTH OCA DESCRIPTION NEW' OCA OLD OCA AMOUNT Residential Services MI1001 MHA01 $ 123,266 Non -Residential Services M14009 MHA09 $ 915,082 Crisis Services MH018 MHA18 $ 17,600 Crisis Services - Baker Act MHO 18 MHA18 $ 1,112,903 Community Forensic Program MH072 MHA72 $ 160,000 FACT Team MH073 MHA73 $ - Indigent Drug Program MH076 MHA76 $ 5,945 Proviso Allocation - Camillus MH093 MHA93 $ - Proviso Allocation - Citrus MH094 MHA94 $ - PATH Grant MHOPG MHAPG $ 83,250 TANF MHOTB MHATB $ - Carry Forward MHOCF MHACF $ TOTAL ADULT MENTAL HEALTH = $ 2,418,046 ADULT SUBSTANCE ABUSE OCA DESCRIPTION NEW OCA OLD OCA AMOUNT Residential Services MS003 MSA03 $ - Non -Residential Services MS01 I MSAI I $ 347,040 Detox Services MS021 MSA21 $ 186,643 HIV Services MS023 MSA23 $ - Prevention Services MS025 MSA25 $ Women's Services MS027 MSA27 $ - Pregnant Women Project MS081 MSA81 $ - Proviso Allocation - GCC MS091 MSA91 $ 633,190 TANF MSOTB MSATB $ - Proviso Allocation - Here's Help MS903 $ - Carry Forward MSCCF MSACF $ TOTAL ADULT SUBSTANCE ABUSE_ $ 1,166,873 ING MATCH: Drug Abuse Services $ 778,244 Prevention �i $ 235,606 De institutionalization Project $ 123,266 CMH Program $ 485,677 MH Block Grant TOTAL FUNDS NOT REQUIRING MATCH S 1,622,793 Contract #: ME225-7-27 Amendment # CHILDREN MENTAL HEALTH OCA DESCRIPTION NEW OCA OLD OCA AMOUNT Residential Services MHOOI MHC01 $ - Non -Residential Services MH009 MHC09 $ 470,000 Non -Residential Services - CR MH009 MHC09 $ - Crisis Services MH018 MHC18 $ 15,677 Crisis Services - Baker Act MH018 MHC 18 $ - Special Appropriation - ICFH MHOBN MHCBN $ Beyond Empowerment Grant MHOFA MHCFA $ Beyond Empowerment Grant MHOFA MHCFA $ FACES Wraparound Grant MHCMD MHCMD $ FACES Wraparound Grant - CR MHCMD MHCMD $ Carry Forward MHOCF MHCCF $ TOTAL CHILDREN MENTAL HEALTH = $ 485,677 CHILDREN SUBSTANCE ABUSE OCA DESCRIPTION NEW OCA OLD OCA AMOUNT Residential Services MS003 MSC03 $ - Non -Residential Services MS01I MSCH $ 279,139 Detox Services MS021 MSC21 $ - HIV Services MS023 MSC23 $ - Prevention Services MS025 MSC25 $ 235,606 Prevention Services - CR MS025 MSC25 $ - Prevention Partnership Grant MSOPP MSCPP $ TANF Services MSOTB MSCTB $ Proviso Allocation - Here's Help MS903 $ Carry Forward MSOCF MSCCF $ TOTAL CHILDREN SUBSTANCE ABUSE _ $ 514,745 TOTAL ALL PROGRAMS = $ 4,585,341 UNCOMPENSATED UNITS = $ 917,068 TOTAL = $ 5,502,409 TOTAL FUNDS REQUIRING MATCH = $ 2,962,548 LOCAL MATCH REQUIRED = $ 987,516 NOTES 9/1/15 $235,606 is added to CSA-MSC25 to allcocate the Prevention funding based on the ITN. $6,409 is reduced from AMH-MHAPG due to AOB reduction. 11/23/15 $17,600 is added to MHACF to fund a Peer position to work at the CSU. '2/16/16 $43,746 is added to MSAI 1 for additional services, $16,639 is reduced from MSC l 1 and $34,445 from MSC25 due to projected lapsing of funds. FY 2016-17 Adjustments: 3/2/16 $17,600 allocation in the MHACF OCA is withdrawn, due to 1-time only allocation. 1-timeonly allocations on 2/16/16 are revered. $17,600 is added to MHA 18 to fund a Peer Specialist at the CSU. Guidance/Care Center, Inc. Exhibit H Contract No. ME225-7-27 Page 1 of 1 LOCAL MATCH PLAN July 2016 Guidance/Care Center,Inc. ME225-7-27 REQUIRED MATCH: $ 987,516 k\III ( \III ks\ ( S k COST CENTERS RATE UNITS MATCH UNITS MATCH UNITS MATCH UNITS MATCH 01 Assessment $ 70.82 668.17 $ 47,320 - - $ - - $ - 02 Case Management $ 75.70 554.82 $ 42,000 - 606.45 $ 45,908 - $ - 03 Crisis Stabilization $ 325.29 797.54 $ 259,431 - - - 04 Crisis Support/Emergency $ 19.69 - $ - - - $ - - $ - 06 Day/Night $ - 07 Drop-In/Self Help Centers $ 26.58 - $ - - - - 08 In-Home/On-Site $ 77.48 - $ - - - - 11 Intervention-Individual $ 58.47 - $ - - - $ - - $ - 42 Intervention-Group $ 14.62 - - - - 12 Medical Services $ 403.96 205.35 $ 82,952 - - - 14 Outpatient-Individual $ 81.33 425.08 $ 34,572 - 419.33 $ 34,104 - 35 Outpatient-Group $ 20.33 - - 3,300.63 $ 67,110 - 15 Outreach $ 44.49 - $ - - 93.66 $ 4,167 1,322.25 $ 58,827 18 Residential Level I $ 291.08 251.95 $ 73,337 - - - 19 Residential Level II $ - 20 Residential Level III $ - 21 Residential Level IV $ - 24 Substance Abuse Detox $ 278.64 - - 547.60 $ 152,582 - 25 Supported Employment $ - 26 Supportive Housing $ 63.56 - $ - - - - 27 TASC $ 69.78 - - - $ - - 28 Incidental Expenses $ 50.00 - - - - 29 Aftercare-Individual $ 70.92 - - - - 43 Aftercare-Group $ 17.73 - - - - 30 Information&Referral $ 29.23 - $ - - - - 34 FACT Team $ - 36 Room&Board Level I $ - 37 Room&Board Level II $ - 38 Room&Board Level III $ 78.84 1,080.75 $ 85,206 - - - 39 Short-term Residential Treatment $ - 40 Clubhouse Services $ 46.21 - - - - 44 CCST-Individual $ - 45 CCST-Grotto $ - 46 Recovery Support-Individual $ - 47 Recovery Support-Group $ - 48 Prevention-Indicated $ 53.56 49 Prevention-Selective $ 58.58 50 Prevention-Universal Direct $ 58.58 51 Prevention-Universal Indirect $ 58.58 99 Special Proviso $ - MATCH ALLOCATION: $ 624,818 $ - $ 303,871 $ 58,827 GRAND TOTAL: $ 987,516 Local Match Plan Guidance/Care Center,Inc. Page 1 of 1 Contract No. ME225-7-27 South Florida Behavioral Health Network, Ine. Rev. 05/11 /2014 Exhibit I Motivational Support Program (MSP) 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 MSP 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 MSP referral and has been referred to an SFBHN treatment provider. SFBHN will be notified by the MSP if a provider is not complying within these established protocols. 1. PROGRAM SPECIFIC TERMS a. CASE MANAGEMENT - Case management services consist of activities aimed at identifying the recipient's needs, planning services, linking the service system with the person, coordinating the various system components, monitoring service delivery, and evaluating the effect of the services received. b. CHILD WELFARE - Services provided directly or under contract with the Florida Department of Children and Families' Family Safety Program Office. c. DEPARTMENT - The Department of Children and Family Services, created pursuant to Section 20.19, Florida Statues (F.S.). d. FLORIDA SAFE FAMILIES NETWORK (FSFN) — A Department of Children and Families automated data system utilized to track child welfare cases. e. FULL CASE MANAGEMENT AGENCIES - full case management agencies under contract with Our Kids of Miami-Dade/Monroe, Inc., that provide support to children and families to help ensure the best possible outcomes for children and families who are involved in the child welfare system in Miami -Dade County. f. INCIDENTAL EXPENSES - This cost center provides for incidental expenses, such as clothing, medical care, educational needs, developmental services, FACT Team housing subsidies and pharmaceuticals (if not required by the RFP to be reimbursed through a separate cost reimbursement contract), and other approved costs. All incidental expenses must have prior written authorization by the ME's authorized staff member or be authorized in the contract. g. INTENSIVE FAMILY PRESERVATION SERVICES: Agencies under contract with Our Kids of Miami-Dade/Monroe, Inc. to provide intensive in home services intended to prevent high and imminent risk families from entering the Dependency Court system while increasing the families' level of functionality. h. MOTIVATIONAL SUPPORT SPECIALISTS (MSS) — Are staff positions (Case Manager) that provide ancillary support to the CBC Case Manager, perform linkage to the child welfare system to engage and support involved child welfare families in appropriate behavioral health treatment and recovery with a goal of improving both behavioral health treatment and child welfare outcomes. i. MOTIVATIONAL SUPPORT SPECIALISTS SUPERVISOR —A master's level supervisor who manages and oversees the Motivational Support Specialists. Exhibit I Guidance/Care Center, Inc. Page 1 of 4 Contract No. ME225-7-27 Rev. 05/11/2014 South Florida Behavioral Health Network, Inc. j. OUR KIDS OF MIAMI-DADE/MONROE, INC. ("Our Kids") — The Department of Children and Family Services Child Welfare Community Based Care (CBC) Lead Agency for the Southern Region. k. OUTREACH - Outreach services are provided through a formal program to both individuals and the community. Community services include education, identification, and linkage with high - risk groups. Outreach services for individuals are designed to: encourage, educate, and engage prospective consumers who show an indication of behavioral health needs. Client enrollment is not included in Outreach services. 1. QUALIFIED PROFESSIONAL - A physician or physician assistant licensed under Chapter 458 or 459, F.S., a professional licensed under Chapter 490 or 491, F.S., notwithstanding any other provision of law, or a person who is certified through a department -recognized certification process as provided for in ss. 397.311(33), 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. m. SCREENING — A process involving a brief review to determine the person's appropriateness and eligibility for behavioral health services and the possible level of service. In. 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 to include the results of a urinalysis, when applicable, as specified in the Motivational Support Program Protocols, incorporated by reference herein. MSP Screening: a) The Motivational Support Specialist (MSS) conducts the ME approved screening tool for all referrals received through the Department of Children and Families (DCF) Program Administrator (PA) or Our Kids of Miami Dade/Monroe, Inc. b) Should the initial screening determine that the consumer is in need of behavioral health services, the MSS will make a referral to a treatment provider for a full assessment and linkage to services as specified below. Referrals: a) The MSS will contact the treatment provider to request an appointment for an individual that has been identified by the MSS as being in need of behavioral health services. The MSS will submit the SFBHN Consent to Release Information and the MSP Referral form as part of the referral packet. b) The Provider must provide the MSS an appointment for intake within seven (7) business 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. Exhibit I Guidance/Care Center, Inc. Page 2 of 4 Contract No. ME225-7-27 South Florida Behavioral licalth Network, Inc. Rev. 05/11/2014 i. Should the consumer be a no-show at the appointment, the provider will notify the MSS 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 MSS case manager. Substance Abuse: a) Assessment: Prior to the referral to the treatment provider, the MSS will complete the ME approved screening tool and a copy will be provided to the treatment provider at the time of referral. The MSP consumer must have an ME approved assessment completed within 20 days of admission into Outpatient SA Treatment. The completed assessment must be provided to the MSS within this timeframe. If the consumer is placed in Residential SA Treatment, the ME approved assessment is due within 5 days of admission. Upon completion of the ME approved assessment tool provider will provide a copy to the MSS. b) Drug Testing: The initial drug test is conducted by the DCF Protective Investigator (PI) prior to the referral to the MSP. Subsequent weekly random drug testing will be conducted by the treatment provider commencing the date of admission. All testing will be observed by the same gender staff as the client. At minimum, all MSP 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 MSS 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 MSP, subsequent random drug screenings will be conducted as specified in the consumer's individualized treatment plan. Mental Health: a) Assessment: The MSP 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 MSS 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 MSP consumers. Documentation: a) Monthly treatment summaries will be submitted until such time as the case is closed with MSP. b) The standardize MSP 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. Exhibit I Guidance/Care Center, Inc. Page 3 of 4 Contract No. ME225-7-27 South Florida Behavioral Health Network, Inc. Rev. 05/11/2014 c) The Provider will coordinate with the MSS, and/or the DCF Protective Investigators (PI), and/or the Our Kids, Intensive Family Preservation Services (IFPS), Full Case Management Agencies (FCMA) Providers to participate in staffing's as required. Direct Referrals from Protective Investigators (Pis): Refer to the Motivational Support Program Protocol (Miami Dade County and Monroe County) which are available by clicking at the following link: hftp://sfbhn.org/providers/contracts/ Exhibit I Guidance/Care Center, Inc. Page 4 of 4 Contract No. ME225-7-27 South Florida Behavioral Health Nehcork, Inc. Exhibit J Motivational Support Program Treatment Summary Form 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: Exhibit J Guidance/Care Center, Inc. Page 1 of 1 Contract No. ME225-7-27 M .l It r. V ran w O y .� o d 0 L ++ V ^ O C �U d U V .Q ^ � O c 0 •� d o � •L o 0. 3 d yd v L C 0 •N L .0 o = s z _ d •-- N M 4 tn \O n 00 C, •--� Old N L6 N N w m O Z U C O U t N x rn wa South Florida Bchmioral Health Nch►ork, Inc. 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 License (ALF-LMHL) that are also responsible for providing case management services to mental health residents in the ALF-LMHL shall: 1) Ensure that the ALF-LMHL where the consumer is residing at, or referred to, maintains a current Agency for Health Care Administration (AHCA) license for ALF-LMHL facilities. The Network Provider shall maintain a copy of the AHCA ALF-LMHL facility license in each consumer file. Referrals to unlicensed ALF-LMHL 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 other mental health professional I who is supervised by one of these professionals, to establish that all residents are appropriate to reside in the ALF-LMHL. 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-LMHL 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-LMHL. 4) Ensure that individuals living in ALF-LMHL 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-LMHL. 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 24/7 emergency access information; transportation provision; and services and activities available at the ALF-LMHL. The ALF-LMHL administrators must also be given contact information for the managing entity, as appropriate. The cooperative agreement must contain a provision requiring the provider to maintain a file for each ALF-LMHL client with copies of all required documentation. All ALF-LMHL client records must be available for production by the Network Provider for monitoring purposes. A sample of the ME ALF Client Record monitoring tool can be obtained at the following website: http://sfbhn.org/wordpress/wp-content/uploads/ALF-Client-Record-Tool. xlsx 7) Ensure that the Cooperative Agreement is annually updated between the Network Provider and the ALF-LMHL Administrator. Exhibit L Guidance/Care Center, Inc. Page 1 of 3 Contract No. ME225-7-27 South Florida Behavioral Ilealth Net«ork, Inc. 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-LMHL administrator of the facility in face-to-face meetings. At a minimum, meetings will be held for initial plan development and annual updates to the plan. More frequent meetings shall be held as necessary to resolve concerns expressed by the resident, case manager, or ALF-LMHL Administrator. The plan should be individualized and should include information about support services and special needs. 9) The case manager shall assist the mental health resident in carrying out the activities identified in the individuals community living support plan. 10) Each case manager shall keep a record of the date and time of any face-to-face interaction with the resident and make the record available to the ME for inspection. The record must be retained for at least two (2) years after the date of the most recent interaction. 11) Adequate and consistent monitoring and enforcement of community living support plans and cooperative agreements are conducted by the resident's case manager. 12) 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. Required Report On a quarterly basis, by the dates and to the individuals identified in Exhibit C, Required Reports, the Network Provider shall submit an ALF-LMHL Client Report the required format as shown in Table 1. below. To complete the ALF-LMHL Client Report, the Network Provider is directed to select a sample size of twenty (20%) percent of clients residing at Assisted Living Facilities with a Limited Mental Health License and receiving targeted case management services from the Network Provider. The ALF-LMHL Client Report shall be submitted in a secured, password protected, or encrypted format. Left blank intentionally Exhibit L Guidance/Care Center, Inc. Page 2 of 3 Contract No. ME225-7-27 South Florida Behavioral health Network,Inc. Rer.12.28.2015 Table 1.ALF-LMHL Client Report ALF-LMHL Name ALF-LMHL Address Zip Client's Last Client's First Client's Agency Name Cooperative Annual Support Plan Case Manager Name SFBHN Funded Code Name Name D.O.B. Agreement present in Present in ALF chart with all Services ALF chart with all required signatures(Client, (Yes/No) required signatures CM,&ALF-LMHL (Client,CM&ALF- Administrator) LMHL Administrator) (Yes/No) • • *Sample size of 20%of all clients receiving targeted case management services Exhibit L Guidance/Care Center,Inc. Page 3 of 3 Contract No.ME225-7-27 South Florida Behavioral Health Nethrork, Inc. 7/1/2016 Exhibit N Special Provisions For Network Provider's Participating in the Indigent Drug Program The Network Provider shall follow the guidelines established by the Florida Department of Children and Families defined in Incorporated Document 13, Indigent Drug Program, dated July 1, 2016, or the latest revision thereof, and 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 eligible individuals. Section I: Purpose 1. Establish IDP administration procedures; 2. Provide written guidelines to the Managing Entities (ME) and IDP Providers; and 3. Establish Florida State Hospital's (IDP/FSH Warehouse) medication order guidelines and processes for receiving, storing, and shipping IDP medications. Section II. Definitions 1. DP Dispensing Unit: A pharmacy holding a current permit from the Florida Board of Pharmacy that dispenses medication for the IDP. 2. IDP/FSH Warehouse: A physical space located on the campus of Florida State Hospital (FSH) at Chattahoochee, Florida. This space is reserved for receiving, storing, and shipping IDP medications. 3. Inventory: A listing of medications available through the IDP/FSH Warehouse that can be ordered by agencies that participate in the IDP. An inventory is also known as a formulary. 4. Patient Assistance Program (PAP): Any program offered through private agencies or pharmaceutical manufacturers designed to provide medication at low or no cost to uninsured individuals, 5. Psychiatric or Psychotropic Medication: Any drug prescribed with the primary intent to stabilize or improve mood, mental status, behavioral symptomatology, or mental illness. The medications include but are not limited to the following major categories: a. Antipsychotics; b. Antidepressants; c. Anxiolytics; d. Mood stabilizers; and e. Cerebral or psychomotor stimulants. f. Other medications commonly used may include, but are not limited to, beta blockers, anticonvulsants, cognition enhancers, and opiate blockers. 6. Side Effect and Adverse Drug Reaction: Any effect other than the primary intended effect resulting from medication treatment. Side effects may be negative, neutral, or positive for the patient. An adverse drug reaction is an undesired or unexpected side effect, allergy, or toxicity that occurs with the administration of medication. Adverse drug reactions can range from mild side effects to very severe reactions, including death. Onset may be sudden, or it may take days to develop undesired or toxic reactions to medications. Exhibit N Guidance/Care Center, Inc. Page 1 of 3 Contract No. ME225-7-27 South Florida Behavioral health Nemork, Inc. Section III. IDP Network Providers will: 7/1/2016 1. Assess and enroll individuals in the IDP who meet the clinical and financial criteria established in ch.394, F.S. a. To meet the clinical criteria individuals: I. Must be a member of at least one of the Department's priority populations; and ii. Must not reside in a state mental health treatment facility or an inpatient community unit. iii. To meet the financial eligibility criteria individuals: iv. Must have a net family income that is at or below 150 percent of the Federal Poverty Income Guidelines, as published annually in the Federal Register; V. Must lack third -party insurance or other psychotropic medications funding sources; and vi. Must not participate in a program where other funding sources pay for psychotropic medications. If individuals have third party insurance for psychotropic medications but were temporarily denied benefits for these medications, they may receive IDP medications until such time as eligibility is reestablished. 2. Provide information to individuals regarding adverse effects, side effects, possible allergic reactions, co- occurring disorders, and instructions on what to do in case of an emergency; 3. Submit updated information to the IDP/FSH Warehouse and to the ME with the first medication order, and ensure that the following information is updated as needed: I. The providers' IDP contact information including name, e-mail, and phone number; ii. The authorized person's name who approves the Supply Requisition (See Appendix 1); and iii. A copy of the pharmacy license(s). Keep a copy of the license and the permit issued in accordance with the requirements specified in s. 499.012(1)(d), F.S. 4. Use the Supply Requisition (See Appendix 2) obtained via email from the IDP/FSH Warehouse to place orders, and select medications from the Mental Health Treatment Facilities Inventory found in the Department's CFOP 155-1, Appendix G: Submit orders only as needed; ii. Order no more than 12 different medications in each requisition; If ordering more than 12 different medications in one order, use an additional Supply Requisition; iii. Fax or e-mail the completed, signed, and approved Supply Requisition directly to the IDP/FSH Warehouse; and iv. Pay line of credit surpluses to IDP/FSH Warehouse before the Warehouse processes new orders. 5. Submit the last order and payment before May 15 of the fiscal year; 6. Review all orders for accuracy: I. Review the medication with the Issue Document (See Appendix 3) to ensure accuracy; If discrepancies are found, call the IDP/FSH Warehouse within 24 hours or email the Issue Document with corrections; and Exhibit N Guidance/Care Center, Inc. Page 2 of 3 Contract No. ME225-7-27 South Florida Behavioral Ilealth `ct%sork, Inc. 7/1/2016 iii. Retain a copy of the Issue Document. 7. Ensure that IDP prescriptions meet the following conditions: i. There cannot be more than two refills, and one prescription cannot cover more than a 90 day supply; ii. Must be listed on the IDP Inventory; and iii. Must be filled at an IDP pharmacy. 8. Actively participate in Patient Assistance Programs (PAP) that provide psychiatric medications without cost; 9. Provide training in: recognizing, reporting, and documenting adverse effects, side effects, possible allergic reactions, and co-occurring disorders to staff working with individuals under the IDP. 10. Review updated video presentations for medication guidelines or read the adult medication guidelines available through the Florida Mental Health Institute (FMHI) of the University of South Florida's Medicaid Drug Therapy Management Program for Behavioral Health, found at http://fimedicaidbh.fmhi.usf.edu/. 11. Review and validate the IDP/FSH Warehouse monthly statements. 12. Address emergency situations, including but not limited to: i. Order additional psychiatric medications from either the IDP/FSH Warehouse or a pharmacy of their choice (for urgent needs); and ii. Pay dispensing fees to IDP Dispensing Unit for individuals who cannot afford them. 13. Implement medication receiving, storage, and administrative procedures that meet the current State approved prescribing instructions pursuant to s. 465.035, F.S.; and 14. Contact via telephone or e-mail the IDP/FSH Warehouse to cancel backorders or portions of backorders; provide the Supply Requisition number. Section IV: IDP Providers may: 1. Return outdated medications: i. For inventory management purposes include a packaging slip that contains an itemized medication list; and ii. Clearly mark the package as outdated. 2. Return overstocked medications: I. Complete the Supply Requisition. Under the remarks section of the requisition state that overstocked medications are returned for credit and explain the reason for returning the medications; ii. Mail medications in package(s) clearly marked as overstocked; and iii. Only return unopened medications. 3. Submit a check to the IDP/FSH Warehouse accounting office to prepay orders to extend the line of credit. The remaining line of credit cannot be carried over into the next fiscal year. Exhibit N Guidance/Care Center, Inc. Page 3 of 3 Contract No. ME225-7-27 South Florida Behavioral I lealth Net-*rork, Ine. Exhibit O Crisis Stabilization Unit, Substance Abuse Detoxification, Addiction Receiving Facility Daily Tracker and Data Collection A. The Crisis Stabilization Unit, Substance Abuse Detoxification services, Addiction Receiving Facility Network Provider shall: (1) Submit a daily Crisis Stabilization Unit (CSU) and Substance Abuse Detoxification/Addiction Receiving Facility (Detox) census log to the individual(s) identified in Exhibit C, Required Reports. (2) The daily census log shall be submitted electronically by 11:00 A.M. [E.S.T.] based on the preceding days' midnight census. The Daily CSU and/or Detox Tracker, as applicable, must be submitted in the template created by the ME as found in Exhibit 0-1a, Daily CSU Tracker ("Tracker") and in Exhibit 0-1b, Daily SA Detox/Addiction Receiving Facility Tracker ("Tracker"). The tracker must be submitted in a secured, password protected, or encrypted format. (3) The Network Provider is not authorized to alter Exhibits 0-1a nor Exhibit 0-1b.. Any changes to templates will render the report unusable and will subject the Network Provider to financial consequences/penalties. B. Data Reporting for Public Receiving Facilities - Crisis Stabilization Units, Substance Abuse Detoxification and/or Addiction Receiving Facilities To meet the requirements of s. 394.9082 (10), F.S., the Network Provider shall adhere to the following CSU data reporting requirements: (1) Report on a daily basis, by 11:00 A.M. [E.S.T.] based on the preceding day's midnight census, the following: (a) All admissions and discharges of clients receiving public receiving facility services who qualify as indigent, as defined in s. 394.4787, F.S.; and (b) Current active census of total licensed beds, the number of beds purchased by the department, the number of clients qualifying as indigent occupying those beds, the number of match beds, and the total number of unoccupied licensed beds regardless of funding. (2) Utilize the template provided in Exhibit 0-2b Crisis Stabilization Services Utilization Data Collection Tracker and/or Exhibit 0-2c, Substance Abuse Detoxification/Addiction Receiving Facility Services Utilization Data Collection Tracker to report the daily census information required in section B. 1 (a) and (b) above. The report shall be submitted to the individuals listed in Exhibit C, Required Reports. The Network Provider shall submit Exhibit 0 Page 1 of 2 Guidance/Care Center, Inc. Contract No. ME225-7-27 South Florida Behavioral Health Net%�ork, Inc. the manual reports until notified in writing by the ME that the daily census information is to be submitted into KIS. The Network Provider is not authorized to alter Exhibit 0-2b nor Exhibit 0-2c. Any changes to the template will render the report unusable and will subject the Network Provider to financial consequences/penalties pursuant to Section 39., Financial Penalties for Failure to Comply with Requirement for Corrective Action, of the Standard Contract. (3) Submit data on a monthly basis, by the 4th of each month following; the month of service into KIS, or other data reporting system designated by the ME, which aggregates and reconciles the daily data submitted under section B. (1) (a) and (b) above (4) Submit data, on an annual basis by July 4th or other date as directed by the ME, into KIS, or other data reporting system designated by the ME, which aggregates and reconciles the monthly data as referenced in section B. (3) above. (5) If the monthly or annual aggregate data submitted by the Network Provider are inconsistent with the daily or annual data submitted under paragraph the Network Provider shall make the necessary corrections to ensure accurate data. C. Real-time Data Entry: When required by the Prime Contract, state and/or federal rules, regulations, or policies, the Network Provider shall submit to the ME real-time data in KIS Express, or other similar data structure, for services purchased by this contract. The Network Provider shall submit the manual data logs required by this Exhibit until such time that a new data system is implement. The Network Provider agrees to implement the new data reporting system when notified and as directed by the ME. Exhibit 0 Page 2 of 2 Guidance/Care Center, Inc. Contract No. ME225-7-27 South Florida Behavioral Health Network, Inc. Exhibit 0-la 7/01/2016 Daily Crisis Stabilization Unit Tracker DAILY CSU TRACKER (PROVIDER NAME) 6ATE. TIMt"OP DATE OF FINANCIAL SSN LAST NAME FIRST NAME ADMISSION ADMISSION DISCHARGE STATUS Exhibit 0-1a Guidance/Care Center, Inc. Page 1 of 1 Contract No.ME225-7-27 South Florida Behavioral Health Network, Inc. Exhibit 0-lb 07/01/2016 Daily SA Detox/Addiciton Receiving Facility Tracker DAILY SA DETOX/ADDICTION RECEIVING FACILITY TRACKER (PROVIDER NAME) FINANCIAL ADMISSION ADMISSION DISCHARGE SSN LAST NAME FIRST NAME STATUS Exhibit 0-lb Guidance/Care Center, Inc. Page 1 of 1 Contract No.ME225-7-27 O N 0 n 0 3 y C 3 � Y L1 C of O E L E 3 L Y C y c a) p a) p a a)a) c p v- CU 10 + o 3 v v 3 v L m cu -0C `� +' L C `� �"' Z O y a) H V) '� Y O m E a) p _0ai '^ .F m E p a �n v E u v + c O m s C Y m E Y m t c Y m Y O N a) } a) a) } a1 a) Z O Z Y } Y Y } Y y O t Y O\ U L O m L m N\ L L Q m L m L L O 0 L H G a) CL O a) L) H N LJ yl ? Q v3i ^y ^ in of 3 Q 3 C a) N Y O a) W N y O m C a) c a) a) u O v — m m L LD E D L L E o r s O m Y o Lp m 0 0 a E c y C N\ WO C S O C N 4- \ O 00 �O C 2 O C .+ O O X —_ O Oa m p 3 m, o m 3o c v E v v m o c c p 3 tD > 0 , _j a° > ,0 > 0 O " m o > ,� m m > a) � m Q 00 � a m @ 'a m O O �n '� L N m to vi C m Q)o of L N 0a �f C of m a "O p O •- O O \ Q) - a, 3 - o \ .Q) .1 a) .3 Lr) a) s v — m m> m -0 a° aL) o v ) v° L v m > a) v L m a) I� H "O L O L p H L m Q) r- H -O L O L p H w L C N H O -4 O Z O Z L L H y CO O I coo Yt a) L Z p_ v •v O. 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Exhibit O-2a 'Mr ATTA Crisis Stabilization Service Utilization—CSSU—File Layout Field Name Field Field Edits and Validations Position Type/Size CONTRACTORID 1 CHAR(10) The format for contractor ID must be XX-XXXXXXX (key) Note:Contractor ID of the managing entity must be registered in ME contract look-up table PROVIDERID 11 CHAR(10) The format for provider ID must be XX-XXXXXXX (key) Note: Provider ID of the must be registered in ME contract look-up table PROGTYPE 21 CHAR(1) The code for program type must be 1 for Adult Mental Health(AMH) (key) or 3 for Children Mental Health (CMH) Note:the code validation edits may change in the future to reflect other program type codes,e.g.,2 for Adult Substance Abuse(ASA) and 4 for Children Substance Abuse(CSA) COVRDSVCS 22 CHAR(2) The code for covered service must be 03 for Crisis Stabilization (key) Services The code for covered service must be 24 for Substance Abuse Detoxification/Addiction Receiving Facility Services Note:the validation edits may change in the future to reflect other bed day covered services, e.g., Residential, Inpatient, Detox, etc. FUND 24 CHAR(1) The code for DCF funded CSU beds is 2 for SAMH. (key) The code for DCF funded Substance Abuse Detoxification/Addiction Receiving Facility beds is 24 for SAMH Note: The validation edits may change in the future to reflect other funding sources, e.g., Local Match Medicaid, Medicare, Private Pay, Health Insurance, etc. CENSUSDATE 25 CHAR(8) The format for census date is YYYYMMDD (key) Note:the daily census date covers the time period between 12:00 am and 11:59 pm. LICENSEBED 33 CHAR(6) The format is six numeric digits(e.g.,999999). Must be right justified (mandatory) and padded with 0 as needed,e.g.,000500 Note:this is the total count of state licensed beds for this contractor, provider, program type,and covered service regardless of the funding source. DCFBEDS 39 CHAR(6) The format is six numeric digits(e.g.,999999). Must be right justified (mandatory) and padded with 0 as needed,e.g.,000300 Guidance/Care Center, Inc. Exhibit O-2a Contract No. ME225-7-27 Page 1 of 2 South Florida Behavioral Health Nehrork, Inc. Exhibit O-2 a Crisis Stabilization Service Utilization—CSSU—File Layout Field Name Field Field Edits and Validations Position Type/Size Note:this is the total count of DCF funded beds for this contractor, provider, program type,covered service,and fund source. DCFOCCUPIED 45 CHAR(6) The format is six numeric digits(e.g.,999999). Must be right justified (mandatory) and padded with 0 as needed,e.g.,000250 Note:this is the total count of DCF funded beds that are occupied for this contractor, provider, program type, covered service, and funding source. NONDCFOCCUPIED 51 CHAR(6) The format is six numeric digits(e.g.,999999). Must be right justified and padded with 0 as needed,e.g.,000100 Note:this is total count of non-DCF-funded beds that are occupied for this contractor, provider, program type,covered service, regardless of the funding source. BEGCENSUS 57 CHAR(6) The format is six numeric digits(e.g.,999999). Must be right justified (mandatory) and padded with 0 as needed,e.g.,000200 Note:this is the distinct count of indigent clients,who were currently active and were admitted prior to the date of the census for this contractor, provider, program type,covered service, and funding source. NEWADMIS 63 CHAR(6) The format is six numeric digits(e.g.,999999). Must be right justified (mandatory) and padded with 0 as needed,e.g.,000100 Note:this is the distinct count of indigent clients,who were currently active and were admitted on the date of the census for this contractor, provider, program type,covered service, and funding source. DISCHARGES 69 CHAR(6) The format is six numeric digits(e.g.,999999). Must be right justified (mandatory) and padded with 0 as needed,e.g.,000050 Note:this is the distinct count of indigent clients,who were discharged on the date of the census for this contractor, provider, program type,covered service,and funding source. TRANSTYPE 75 CHAR(1) This field specify the transaction type with the following code values: A=Add New Record;C=Change or Replace Existing Record; and D= Delete Existing Record. Guidance/Care Center,Inc. Exhibit O-2a Contract No.ME225-7-27 Page 2 of 2 South Florida Behavioral Health Network,Inc. Exhibit 0-2b 07/01/2016 CSU Services Utilization Data Collection Trakcer a:RDSVCS FUND CENSUSDATE UCENSEBED DCFBEDS DCFOCCUPIED NONDCFOCCUPIED BEGCENSUS NEWADMIS DISCHARGES TRANSTYPE Guidance/Care Center, Inc. Exhibit O-2b-c Contract No. ME225-7-27 Page 1 of 2 South Florida Behavioral Health Network.Inc. Exhibit 0-2c Or/01/2016 SA Detox/Addiction Receiving Facility Utlitatian Data Collection Tracker • ..J �. -.;. .,•• BRED DCFBEDS DCFOCCUFIED NONDCFOCCUPIED REGCENSUS NEWADMIS DISOIARGES TRANSTVPE Guidance/Care Center, Inc. Exhibit O-2b-c Contract No.ME225-7-27 Page 2 of 2 South Florida Behavioral Health Nchvork, Inc. 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: Exhibit Q Guidance/Care Center, Inc. Page 1 of 3 Contract No. ME225-7-27 South Florida Behavioral Flealth \ehvork, Inc. Rev. 07101 /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, Exhibit Q Guidance/Care Center, Inc. Page 2 of 3 Contract No. ME225-7-27 South Florida Behavioral Health Nemork, Inc. 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. 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. 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. Exhibit Q Guidance/Care Center, Inc. Page 3 of 3 Contract No. ME225-7-27 South Florida Behavioral Health Nehvork, Inc. Exhibit R Child Welfare Quarterly Clinical Report I. The network provider shall complete a quarterly progress report, as shown in Section II. below, and shall file it in the medical record of the child. 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. r.M r% cvrcoi v rri 1KIVre1 RFPC PT 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: Type of Service(s): Presenting Problem(s): Date of Report: Title: DOB: DOA: Grade: School Placement: Phone#: Cell#: Frequency: Location: Treatment Plan Goals/ Progress: "Attach copy of most current Treatment Plan or Treatment Plan Review DSM IV Diagnosis (Current): Axis I: Axis II: Axis III: Axis IV: CGAS: Psychotropic Medications: Y/N If yes: Name of Psychiatrist: Was Medication treatment Plan completed? Y/N If yes, date of court approval: Current medication and dosage: Previous medication, if applicable: Rational for current medication: Date that child started taking the medication: Child's Treatment Summary/Therapeutic Recommendations: Therapist Signature Supervisor Signature Exhibit R Guidance/Care Center, Inc. Page 1 of 1 Contract No. ME225 7-27 South Florida Behavioral Health Nctvwrk, Inc. 7.1.2016 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 that have been committed or may be at risk of commitment to the Department of Children and Families ("Department"), 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, this Forensic Services Exhibit, Children and Families Operating Procedure No. 155-18, Guidelines for Conditional Release Planning for Individual's Found Not Guilty by Reason of Insanity or Incompetent to Proceed due to Mental Illness, any other applicable state and/federal rules, regulations, operating procedures established forensic performance measures. (a) All individuals referred for admission to a 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, for individuals residing within Miami -Dade, Monroe, or Broward Counties. 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. (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, Exhibit V Guidance/Care Center, Inc. Page 1 of 3 Contract No. ME225-7-27 South Florida Behavioral Health _Aemork, Inc. 7.1.2016 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. 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 network provider's facility(ies). iii. The Network Provider will ensure attendance at court hearings, obtain conditional release orders 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. i. 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. i. The Network Provider will ensure that individuals on conditional release order are monitored in accordance with the court order to ensure compliance with the order and department rules. H. 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. Q) 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. Exhibit V Guidance/Care Center, Inc. Page 2 of 3 Contract No. ME225-7-27 South Florida Behavioral Health \et vork, Inc. 7.1.2016 (k) Statewide Community Forensic Residential Services i. Citrus Health Network, Inc.: The Network Provider agrees to make available eight (8) residential beds in the Safe Transition and Access to Recovery (STAR) Program, for eligible consumers on conditional release from other circuits in need of forensic mental health services placed by the ME pursuant to FRCrP 3.219(b), 3.217(b) and F.S. 916.17. The STAR Program provides intensive, short-term treatment to individuals who are temporarily in need of a structured therapeutic setting in a less restrictive but longer -stay alternative to acute hospitalization. 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. Passageway Residence of Dade County, Inc.: The Network Provider agrees make available fourteen (14) residential level 2 beds for eligible consumers on conditional release from other circuits in need of forensic mental health services placed by the ME. Statewide admission to Passageway Residence of Dade County, Inc. is for individuals committed to the Florida Department of Children and Families, in accordance with the provisions of Florida Statutes Chapter 916, Forensic Services Act and released pursuant to FRCrP 3.219(b), 3.217(b) and F.S. 916.17. 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 Providers hall submit weekly census reports by the dates and times specified in Exhibit C, Required Reports, and to the individuals identified. iii. Psychosocial Rehabilitation Center Inc d/b/a Fellowship House: The Network Provider agrees to make available four (4) residential level 2 beds for eligible consumers on conditional release from other circuits in need of forensic mental health services placed by the ME pursuant to FRCrP 3.219(b), 3.217(b) and F.S. 916.17. 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. Exhibit V Guidance/Care Center, Inc. Page 3 of 3 Contract No. ME225-7-27 South Florida Behavioral Health -Netnork, Ine. 7.1.2016 Exhibit X Special Provisions for Projects 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 data reports to the ME upon request; (e) Submit Annual Data Report to SAMHSA; (f) Submit the Annual reapplication for the PATH Grant. (g) Assure that there is a process in place which allows for information to be provided to ME upon request and multiple staff can access all PATH related information and data as requested. (h) Identify, at a minimum, two (2) staff responsible for the PATH Program. (i) The Network Provider shall notify the ME's contract manager, in writing within (10) calendar days of staffing changes regarding the positions II. Local match requirements: (a) Eligible PATH local match 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 Title V, Part C, Section 524 of the Public Health Services Act (42 U.S.C. 290cc-21 et. seq). (b) The Network Provider will submit a monthly local match expenditure report demonstrating how the agency is meeting its PATH local match obligations. The expenditure report shall be submitted along with the monthly invoice which is due by the 8th of each month following the month of services. The expenditure report shall identify, by funding source, the expenditures incurred on PATH eligible services. III. Monthly Reporting Requirements: By the 5'h of each month following the month of services, the Network Provider will submit to the individuals identified in Exhibit C, Required Reports, a monthly report containing the information submitted into the Homeless Management Information System (HMIS), and any other report(s) requested by the ME staff. Exhibit X Guidance/Care Center, Inc. Page 1 of 1 Contract No. ME225-7-27 South Florida Behmioral Health Network, Ine. Re,.. 7/1/16 Exhibit AA Motivational Support Specialists The Network Provider agrees to comply with the provisions of this exhibit, agrees to adhere to the requirements set forth in the approved Motivational Support Program Protocols ("Protocols"), incorporated by reference herein. The protocols for each circuit in the Southern Region (Miami Dade County and Monroe County) are available on the ME's website under "Other Contracting Resources" and can be obtained by clicking on the following link: hftp://sfbhn.org/providers/contracts/ The Network Provider also agrees to 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 Motivational Support Specialist (MSS) are intended to reduce the incidence of child abuse and neglect resulting from parent(s)' or caregiver(s)' behavioral health condition and to improve outcomes for the families involved in the child welfare system. 2. AUTHORITY The Prime Contract between the ME and the Department provides the ME with the authority to contract for these services. 3. PROGRAM SPECIFIC TERMS a. CASE MANAGEMENT - Case management services consist of activities aimed at identifying the recipient's needs, planning services, linking the service system with the person, coordinating the various system components, monitoring service delivery, and evaluating the effect of the services received. b. CHILD WELFARE - Services provided directly or under contract with the Florida Department of Children and Families' Family Safety Program Office. c. DEPARTMENT - The Department of Children and Family Services, created pursuant to Section 20.19, Florida Statues (F.S.). d. FLORIDA SAFE FAMILIES NETWORK (FSFN) — A Department of Children and Families automated data system utilized to track child welfare cases. e. FULL CASE MANAGEMENT AGENCIES - full case management agencies under contract with Our Kids of Miami-Dade/Monroe, Inc., that provide support to children and families to help ensure the best possible outcomes for children and families who are involved in the child welfare system in Miami -Dade County. f. INCIDENTAL EXPENSES - This cost center provides for incidental expenses, such as clothing, medical care, educational needs, developmental services, FACT Team housing subsidies and pharmaceuticals (if not required by the RFP to be reimbursed through a separate cost reimbursement contract), and other approved costs. All incidental expenses must have prior written authorization by the ME's authorized staff member or be authorized in the contract. g. INTENSIVE FAMILY PRESERVATION SERVICES: Agencies under contract with Our Kids of Miami-Dade/Monroe, Inc. to provide intensive in home services intended to prevent high and imminent risk families from entering the Dependency Court system while increasing the families' level of functionality. Exhibit AA Guidance/Care Center, Inc. Page 1 of 10 Contract No. ME225-7-27 South Florida Beha-vioral Health \etm ork, Inc. Re%. 7/t/I6 h. MOTIVATIONAL SUPPORT SPECIALISTS (MSS) — Are staff positions (Case Manager) that provide ancillary support to the CBC Case Manager, perform linkage to the child welfare system to engage and support involved child welfare families in appropriate behavioral health treatment and recovery with a goal of improving both behavioral health treatment and child welfare outcomes. L MOTIVATIONAL SUPPORT SPECIALISTS SUPERVISOR —A master's level supervisor who manages and oversees the Motivational Support Specialists. j. OUR KIDS OF MIAMI-DADE/MONROE, INC. ("Our Kids") — The Department of Children and Family Services Child Welfare Community Based Care (CBC) Lead Agency for the Southern Region. k. OUTREACH - Outreach services are provided through a formal program to both individuals and the community. Community services include education, identification, and linkage with high - risk groups. Outreach services for individuals are designed to: encourage, educate, and engage prospective consumers who show an indication of behavioral health needs. Client enrollment is not included in Outreach services. I. QUALIFIED PROFESSIONAL - A physician or physician assistant licensed under Chapter 458 or 459, F.S., a professional licensed under Chapter 490 or 491, F.S., notwithstanding any other provision of law, a person who is certified through a department -recognized certification process as provided for in ss. 397.311(33), 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. m. SCREENING — A process involving a brief review to determine the person's appropriateness and eligibility for behavioral health services and the possible level of service. n. 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 to include the results of a urinalysis, when applicable, as specified in the Motivational Support Program Protocols, incorporated by reference herein. 4. GEOGRAPHIC AREA & LOCATION a. Services will be provided in Monroe County at the Network Provider's site and/or, or in the field (i.e. client's home, community service center, etc.) b. MSS services should be located in a place where they will be easily available and accessible to child welfare personnel. MSS locations, where client records are maintained, must be licensed for Intervention: General Intervention and Intervention: Case Management as required by Rule 65D-30, F.A.C. 5. SERVICES & TIMES MSS's do not provide direct treatment service but shall provide behavioral health assessment (screening), case management, outreach, and utilize incidental expenses as appropriate and negotiated with the ME. 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 staff, as per the approved operating budget, herein incorporated by reference. b. Changes to the staffing pattern must be prior approved by the ME. Exhibit AA Guidance/Care Center, Inc. Page 2 of 10 Contract No. ME225-7-27 South Florida Behavioral Ilealth Network, Inc. Re%. 7/ 1 / 1 G c. Staff shall preferably hold the appropriate clinical license or certification. The minimum qualifications for a MSS 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 behavioral health needs and child abuse/neglect knowledge and experience. All MSS 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) or children referred by the CBC or by the Department Child Protective Investigators (CPI) in which behavioral health indicators are present 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 as defined in the Motivational Support Program Protocols, incorporated by reference herein. Services may also be provided for the enrolled parent(s)'/caregiver(s)' family members, household residents, or significant others in need of behavioral health prevention or treatment services, as well as children in relative placements. For a detailed description of the client eligibility criteria please refer to the approved Motivational Support Program Protocols, incorporated by reference herein. 8. CASELOAD Each MSS shall maintain a caseload with a maximum of forty (40) families. A family includes all members of the family who are in need of behavioral health services. Caseload size shall be based on the severity, case management needs, and resources available to support the MSS. Once the MSS case load has reached capacity, the referrals shall continue to be screened and referred to an appropriate treatment provider. 9. SCREENING AND REFERRAL OF CLIENT TO SERVICES a. Each MSS shall maintain a directory of treatment resources, eligibility criteria, and referral procedures for available prevention and treatment resources in each community. The MSS will establish and maintain a working relationship with Our Kids of Miami-Dade/Monroe. Inc., (Community Based Care Lead Agency or "CBC"), within the community and Community Based Care Intensive Family Preservation Provider. b. The MSS will maintain an open line of communication with all relevant stakeholders (CPI, CBC Lead Agency, CBC Full Case Management Agency, CBC Intensive Family Preservation Provider, and the ME Child Welfare Integration Coordinator) in order to coordinate care, identify and resolve all systematic and programmatic barriers to client engagement and retention in treatment in a process of continuous quality improvement. c. Referrals to the MSP may be submitted through two sources: the CBC and the DCF CPI Program Administrators. For a detailed description of the referral process criteria please refer to the approved Motivational Support Program Protocols, incorporated by reference herein. d. The Motivational Support Supervisor (MS Supervisor), who is responsible for the day to day operations of the MSP, will receive referrals via an e-mail from the CBC with a FSFN case number and intake number. The MS Supervisor will assign an MSS to the referred case. The assignment of the MSS will be documented in FSFN where the referral source can access the Exhibit AA Guidance/Care Center, Inc. Page 3 of 10 Contract No. ME225-7-27 Rev. 7/ 1 / 16 South Florida Behavioral Health Nehvork, Inc. information. The MSS will need to respond to and administer a urinalysis to all "urgent" cases within 24 hours of receipt of referral from the CPI Program Administrator. The MSS will also administer a urinalysis to all unsafe and conditionally safe cases within the time frame detailed in the Motivational Support Program Protocol. The Department is in the process of updating and renaming the "Safety Methodology' protocol and will be renamed the Florida's "Practice Model". Once the Practice Model is fully implemented, there will be no "Conditional Safe' cases and MSS will only serve "Unsafe cases". It is the Network Provider's responsibility to be aware of the changes and follow the guidelines as directed by the Department and/or the ME. e. The MSS will ensure that screening and linkage to behavioral health services are completed within the required time frames as described in the approved Motivational Support Program Protocols, incorporated by reference herein. f. A brief description of the duties of the MSP Screening processes are below, however, the Network Provider is referred to the approved Motivational Support Program Protocols, incorporated by reference herein, for a detailed description of the screening and referral process. A. The MSS, upon receipt of referral, will secure an SFBHN Consent to Release Information from the consumer and will attach this consent as part of the referral packet to the behavioral health provider. If the consumer refuses to sign the Consent to Release Information to MSS, then FSFN will be updated to indicate such. B. If the case is found not to have any behavioral indicators, MSS will enter a SAMH note in FSFN indicating the result of the assessment and upload the ME approved screening tool. The progress should be rated as "adequate". C. The MSS will utilize the ME approved screening tool as the screening tool which will determine the need for behavioral health services for all referrals. The MSS will determine if there has been an ME approved screening tool completed within the previous 90 days and ascertain if another ME approved screening tool is necessary. D. The MSS will ensure that an intake appointment is made within seven (7) business days to a behavioral health treatment provider for a full assessment and linkage to recommended treatment services when the screening identifies behavioral health indicators. E. For SFBHN Funded Consumers, the MSS will: Generate a referral in the SFBHN data system for consumers funded through the Department. Upload the ME approved screening tool into FSFN and to the data system within three (3) business days of its completion. iii. Document the recommendations in FSFN that are captured in the ME approved screening tool. iv. Submit a referral to a behavioral health treatment provider for assessment and linkage to treatment services, through the SFBHN data system. V. Ensure that an initial appointment for intake takes place within seven (7) business days of the receipt of referral from MSS, regardless of the consumer's ability to pay. vi. Ensure that the consumer was financially assessed utilizing the sliding fee scale in accordance with the provisions of Rule 65E-14.018, F.A.C. Exhibit AA Guidance/Care Center, Inc. Page 4 of 10 Contract No. ME225-7-27 South Florida Behavioral Ilealth Net«ork, Inc. Re%. 7/1/16 vii. Use reports received by the network behavioral health treatment provider to update FSFN monthly using the indicated categories noted above. The referenced progress report form to be used by the behavioral health treatment provider to report the consumer's progress to the MSS is herein incorporated by reference and available upon request from the ME's contract manager. F. For Privately/Medicaid Funded Consumers, the MSS will: Upon receipt of referral, the MSS will secure Consent to Release Information from the consumer and will attach this consent as part of the referral packet to the behavioral health provider. If the consumer refuses to sign the Consent to Release Information to MSS, then FSFN will be updated to indicate such. The MSS will: Generate a referral and submit directly to the Private/Medicaid provider. Document the recommendations that are captured in the ME approved screening tool into FSFN. iii. Submit a referral to a behavioral health treatment provider for assessment and linkage to treatment services. The MSS will use reports received by the behavioral health treatment provider to update FSFN monthly using the indicated categories noted above. The referenced progress report form to be used by the behavioral health treatment provider to report the consumer's progress to the MSS is incorporated by reference and available upon request from the ME's contract manager. 10. TREATMENT AND FOLLOW-UP a. Upon contact with the consumer, the assessment by the MSS will be completed within three (3) business days of the receipt of the referral. b. For those consumers who did not respond and/or comply to contact attempts, the MSS will enter a note into FSFN and identify the appropriate category, based upon the response by the consumer, by COB on the third business day. c. This entry into FSFN will result in an alert notifying the Primary Worker (CPI or CBC subcontracted providers), who will follow up with the family and take action, as appropriate. d. The MSS will utilize the FSFN to regularly update the consumer's progress. The MSS shall input all direct contact information into FSFN within forty-eight (48) hours following contact with the consumer and will select one of the definitions of progress in treatment categories to identify the consumer's progress. The definitions of progress in the treatment categories are found in the approved Motivational Support Program Protocols, incorporated by reference herein. e. Upon notification from a behavioral health provider that a consumer has missed their scheduled initial intake appointment, the MSS shall update FSFN to document the lack of participation and shall attempt to re-engage the consumer in behavioral health services. f. The MSS will resubmit the referral for recommended treatment services, as appropriate, and document in FSFN. g. Should a behavioral health provider not be able to meet a consumers clinical needs, the behavioral health provider shall link the consumer to an appropriate behavioral health provider. Exhibit AA Guidance/Care Center, Inc. Page 5 of 10 Contract No. ME225-7-27 South Florida Behavioral health Nethvork, Inc. Rev. 7/ 1 / 16 The referring behavioral health provider shall notify the MSP within one (1) business day of this occurrence. The MSS will engage the SFBHN Child Welfare Integration Coordinator for assistance with the referral, if necessary. h. The MSS will contact the new behavioral health treatment provider within 24 hours of the notification to ensure that an initial intake appointment is scheduled within the required seven (7) business day timeframe. L The MSS will notify all stakeholders of the change in behavioral health treatment provider and the new date of intake, and update FSFN within forty-eight (48) hours of occurrence. 11. CASE RECORD AND PLANNING a. The MSS are responsible for developing a case management assessment and service plan for each consumer/family receiving services from MSP.. The MSS is directed to follow and adopt, at a minimum, the requirements set forth in Rule 65E-15.051, the Florida Administrative Code for Case Management The MSS are required to provide a copy of the service plan to the child welfare worker for incorporation into the child welfare case plan. b. The MSS are responsible for reviewing and updating the case management assessment and service plan as required by Rule 65E-15.051. An updated service plan is also required when there is a major change of status regarding the client's participation in behavioral health treatment. The MSS are required to provide a copy of the updated service plan to the child welfare worker for incorporation into the child welfare case plan. c. The MSS shall perform continued case management related to the behavioral health services needs portion of the plan. Case management activities shall be provided for a period up to ninety (90) days from the date that the case has been accepted by MSP. MSS 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: L Monitoring client's condition and progress in treatment; ii. Linking clients to services as dictated by their needs; and iii. Facilitating client's participation in treatment by removing barriers. 12. PROGRESS REPORT & STAFFING a. The MSS shall provide a monthly written status report, reported through FSFN as described in the Motivational Support Program Protocols, incorporated by reference herein, throughout the duration of the open behavioral health case to the child welfare worker and/or the CBC/IFPS/FCMA Provider, indicating treatment progress and alerting the child welfare worker to any barriers or other concerns. A written report is also required when there is a major change of status regarding the client's participation, and at the close of the case. b. The MSS shall participate in staffing of the family's progress as requested by the child welfare worker, the CBC/IFPS/FCMA Provider, or the behavioral health treatment provider. The MSS will facilitate a staffing of the family's progress when there is a major change of status regarding the client's participation in behavioral health treatment. Although face-to-face staffing is preferred, interested parties may participate through telephone conferencing. c. The MSS are required to remain informed regarding the status of the child welfare case plan. 13. DEPENDENCY COURT LIAISON Exhibit AA Guidance/Care Center, Inc. Page 6 of 10 Contract No. ME225-7-27 South Florida Behavioral Ilealth Nehrork, Inc. Rev.7/1/16 a. The MSS shall provide liaison services to the dependency court and inter -agency communication regarding the status and progress of clients in the MSS caseload who are in behavioral health treatment. In accordance with 42CFR 2.61, The MSS will aid the behavioral health treatment provider and the court through coordination of care. The behavioral treatment provider in collaboration with the child welfare staff will make recommendations to the court regarding family reunification. b. The MSS shall appear in court under any of the following circumstances: i. Clinical case staffing of the client indicates the need for the MSS; ii. The court issues a subpoena to the MSS; iii. The department or a child welfare agency provides a request to the MSS 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 MSS shall provide said report to the department's Legal Counsel for filing with the court. Client/family requests for an MSS to appear on their behalf will be taken into consideration. 14. LENGTH OF SERVICE & DISCHARGE a. MSS services shall be provided to an eligible client receiving behavioral health treatment to ensure linkage with and support for the child welfare case plan. The MSS may continue to provide MSS services to clients in active behavioral health treatment after the child welfare case is closed. b. The client may be discharged from MSS services upon any of the following: i. Behavioral health treatment is completed; ii. The client refuses to participate in the program; or iii. The client is incarcerated, or moves to another geographic area. iv. The case has been open with MSP for 90 days. c. Decisions about when to close a case or keep it open should be made by the MSS in consultation with the behavioral health provider, child welfare worker, CBC/IFPS/FCMA Provider, and/or the court. 15. DATA REPORTING REQUIREMENTS Data shall be submitted electronically to the ME by the 4th of each month following the month of service into the Knight Information Software database or other data reporting system designated by the ME. MSS shall enter data using an MSS Staff ID as defined in PAM 155-2 and by the dates specified in Exhibit C, Required Reports. The MSS shall also utilize FSFN to regularly update the consumers' progress within the timeframes specified in the Motivational Support Program Protocols, incorporated by reference herein. 16. TRAINING The Network Provider agrees to ensure that MSS's participate in the MSS statewide meetings when they occur, any training provided by the Department specifically for MSS, and/or to attend a work related conference. 17. INCIDENTAL EXPENSE FUNDS Exhibit AA Guidance/Care Center, Inc. Page 7 of 10 Contract No. ME225-7-27 South Florida Behavioral Health Nehrork, Inc. Rev. 7/ 1 / 1( 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 MSS, 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 MSS incidental funds, along with the corresponding incidental fund request form(s). The expenditure of MSS 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 MSS funding for this contract is $100,000.00. This includes $0.00 that the Network Provider agrees to make available for Incidentals Expense funds. 18. INCIDENTAL FUND REQUEST FORM a. The incidental fund request must contain, at a minimum, the information below: Name of the MSS accessing funds; ii. Funds spent on behalf of (client name); Ill. Referral type (protective investigation/supervision); iv. Date of request; V. Description of Goods/Services requested; vi. How the purchase is related directly to the intervention plan; vii. Goal/Reason for purchase amount requested; and viii. MSS and approving authority signature with date. 19. REQUIRED REPORTS a. The MSP Tracker, incorporated herein by reference, is due monthly by the 10th of each month following the month of service to the individuals identified in Exhibit C, Required Reports. Failure to submit the MSP Tracker by the due may result in a corrective action and Exhibit AA Guidance/Care Center, Inc. Page 8 of 10 Contract No. ME225-7-27 South Florida Behavioral Health Netivork, Inc. Re,.. 7/1/16 the imposition of financial penalties as stated in the Standard Contract. The MSP Tracker must contain the names of each individual(s) engaged by the MSP. In addition, the list shall contain the names of those individuals who the MSS have been unsuccessful in engaging in to the MSP. 20. PERFORMANCE SPECIFICATIONS a. Performance Measures 1. One hundred percent (100%) of individuals identified in the FSFN SAMH notes can be reconciled with the information entered in the KIS data system (or any other data system designated by the ME) and/or in the MSP Tracker log. 2. The ME -approved screening tool is completed for all consumers receiving services from MSP. At a minimum, ninety percent (90%) of the screenings shall be completed within the timeframes specified in the approved Motivational Support Program Protocol. 3. A Case management assessment is completed for all consumers receiving services from MSP. At a minimum, ninety percent (90%) of the case management assessments shall be completed within the timeframes specified in the approved Motivational Support Program Protocol. 4. A service plan is completed for all consumers receiving services from MSP. At a minimum, ninety percent (90%) of the service plans shall be completed within the timeframes specified in the approved Motivational Support Program Protocol. 5. Monthly progress notes shall be documented in FSFN SAMH by the MSS for one hundred percent (100%) of the cases. b. Performance Evaluation Methodology i. The outcome measurement contained in paragraph 19. a. 1 — 5 above will be calculated as follows: 1. Numerator: Denominator: 2. Numerator: Denominator: 3. Numerator: Denominator Individuals identified in FSFN SAMH notes Total number of individuals entered into the KIS data system and/or identified in the MSP Tracker Number of clients screened Total number of screenings completed within the specified timeframe Number of clients with a completed case management assessment Total number of case management assessments completed within the specified timeframe Exhibit AA Guidance/Care Center, Inc. Page 9 of 10 Contract No. ME225-7-27 South Florida Behavioral Health Nemork, Inc. Re%.7/t/1G 4. Numerator: Denominator: 5. Numerator: Denominator Number of clients with a completed service plan Total number of services plans completed within the specified timeframe Number of cases identified in FSFN SAMH notes Total number of progress notes documented in FSFN SAMH Exhibit AA Guidance/Care Center, Inc. Page 10 of 10 Contract No. ME225-7-27 South Florida Beha-6oral Health Nethork, Inc. Revised July 1, 2016 Exhibit Al Family Intensive Treatment Team Scope of Work I. General Description From the funds in Specific Appropriation, the recurring sum of $633,188.00 ($10,000 per family served) is provided to implement the Family Intensive Treatment (FIT) team model that is designed to provide intensive team -based, family -focused, comprehensive services to families in the child welfare system with parental substance abuse. Treatment shall be available and provided in accordance with the indicated level of care and program specifications in accordance with the following incorporated documents: a. The Network Provider hereby agrees to adhere to the requirements specified in the abbreviated bid which is incorporated by reference and may be found at: http://sfbhn.org/wordpress/wp-content/uploads/UPDATED-Family-Intensive- Treatment-Team-Procurement-8.1.14.pdf. b. The Network Provider's response to the ME's abbreviated bid, which is incorporated by reference and may be requested from the ME's Contract Manager. c. The Network Provider hereby agrees to adhere to the requirements specified in the Program Guidance for Contract Deliverables- Incorporated Document 18, Family Intensive Treatment (FIT) Model Guidelines and Requirements, dated July 1, 2016, or the latest revision thereof, which is incorporated by reference and may be found at: http://www.mvflfamilies.com/service-programs/substance-abuse/managing- entities/2016-contract-dots d. Guidance/Care Center, Inc. (GCC) will provide the services to clients in Monroe County and subcontract with The Village South, Inc. to service clients in Miami - Dade County. GCC and The Village South, Inc. are sister companies under the WestCare Foundation. The Network Provider is directed to the Standard Contract and Attachment I of this contract for the guidelines that govern subcontracting for services contemplated under this contract. Guidance/Care Center, Inc. Exhibit AI Contract No. ME225-7-27 Page 1 of 6 Revised July 1, 2016 South Florida Behmioral Health Netrork, Inc. Ill. Performance Measures The Network Provider shall submit a Monthly Progress Report using the template provided in Exhibit AI -A, that details the services for the reporting period. III. Discharge Reporting The Network Provider shall submit a monthly discharge report using the template provided in Exhibit AI-B, that details the number of families discharged during the reporting period. IV. Method of Payment a) As a recipient of state financial assistance, the Network Provider and its subcontractor(s) must comply with s. 215.971 (1), F.S., and with the Chief Financial Officer's Memorandum (CFOM) No. 03(2014-2015), hereby incorporated by reference. b) The Network Provide shall serve 64 families and shall be paid based on an estimated cost of $10,000 per family served. Should the Network Provider exceed the estimated cost per family and number of families to be served and the ME identifies lapse funding, based on the MEs sole discretion, the Network Provider may be compensated for excess services provided, subject to the availability of funds. c) Refer to Exhibit B, Method of Payment for general payment clauses. The ME shall reimburse the Network Provider based on a fixed price payment methodology and for the allowable expenditures incurred during the term of this Contract. d) Quarterly Expenditure Report: The Network Provider shall submit a quarterly expenditure report to the ME. Any funds paid to the Network Provider in excess of the amount to which the Network Provider is entitled under the terms and conditions of this Contract must be refunded to the ME unexpended funds shall be refunded to the ME. V. Financial Consequences In the event that the Network Provider fails to achieve the minimum performance measures as specified in Exhibit AI -A, the ME shall apply financial consequences in accordance with the provisions of Section 36, Financial Consequences for Network Provider's Failure to Perform. Guidance/Care Center, Inc. Exhibit Al Contract No. ME225-7-27 Page 2 of 6 South Florida Behavioral Health Net"ork, Inc. Revised July 1, 2016 In addition, should the Network Provider not meet the minimum number of families to be served by the end of the fiscal year, the ME shall impose a financial penalty of the estimated cost of $10,000 per family. VI. Required Reports: The reporting requirements may be found in Exhibit C, Required Reports. Remainder of the page left blank intentionally Guidance/Care Center, Inc. Exhibit Al Page 3 of 6 Contract No. ME225-7-27 Revised July 1,2016 South Florida Beha.ioral Health Network,Inc. FIT- EXHIBIT Al-A FAMILY INTENSIVE TREATMENT SERVICES MONTHLY PROGRESS REPORT Provider Name Contract Number Reporting Period From To Reporting Requirement Annual Target This Period This Quarter Year to Date to Date 1 PERFORMANCE MEASURE FOR ACCEPTANCE OF DELIVERABLES Number of families served 64 PROGRAMMATIC PERFORMANCE MEASURES Percentage of parents served living in a stable 90% housing environment. Percentage of parents served who improve their level of functioning as measured by the Functional 80% Assessment of Mental Health and Addiction (FAMHA) Percentage of Discharge Summaries completed within 85% 7 days of discharge. Percentage of initial assessments (ASI and 85% ASAM) completed within five 5 days of enrollment. Percentage of parents receiving treatment services within 48 business hours of 90% completing the initial assessments(ASI and ASAM). Guidance/Care Center, Inc. Exhibit Al Contract No.ME225-7-27 Page 4 of 6 Revised July 1, 2016 South Florida Behavioral Health Network,Inc. FAMILY INTENSIVE TREATMENT SERVICES MONTHLY PROGRESS REPORT SUPPLEMENTAL DATA REPORTS Reporting Requirement j This Period This Quarter Year to Date to Date Number of Child Welfare Cases Closed Number of Family Reunifications Number of Parents Receiving an Individualized Treatment plan Number of Individuals Receiving Child Welfare Services ,j Number of Parents Receiving Intensive In-Home Treatment and Services Number of Parents Receiving Detoxification Treatment Number of Parents Receiving Crisis Stabilization Services Number of Parents Receiving Inpatient Psychiatric Services Number of Parents Receiving Residential Treatment Number of Parents Receiving Individual Therapy Number of Parents Receiving Group Therapy Number of Parents Receiving Family Therapy Number of Parents Receiving Medication Services • Guidance/Care Center. Inc. Exhibit Al Contract No. ME225-7-27 Page 5 of 6 Revised July 1,2016 South Florida Behavioral Health Network,Inc. FAMILY INTENSIVE TREATMENT SERVICES MONTHLY PROGRESS REPORT Number of Parents Receiving Therapeutic Training or Psycho-education Number of Parents Receiving Transportation Support Number of Parents Receiving Supportive Housing Number of Parents Receiving Supported Employment Number of Parents Receiving Aftercare Services ATTESTATION I hereby attest the information provided herein is accurate, reflects services provided in accordance with the terms and conditions of this contract, and is supported by client documentation records maintained by this agency. Signature and Date Authorized Name,Title, and Agency Name (please print) Guidance/Care Center,Inc. Exhibit Al Contract No.ME225-7-27 Page 6 of 6 South Florida Behavioral Health Network,Inc. Exhibit AI-B i/I/2016 NOTES: 1.Report data on the number discharged during the reporting period 2.Fields highlighted in blue are autocalculated Discharge-Instructions for Completion Enter the total number of individuals in each column(F through M)who were discharged during the reporting period to indicate the reason for discharge Total "As of Date" #Serving on Reason for Discharge Discharge # Target#to /of Target Monthly Families Month Served YTD (mmlddlyy) "As o/Date" #Pending Total Re-engaged be Served Served Waitlist Rolled Completed TX Moved Jail/Prison Disengage Transfer Died Goal Change Court Closed Over July 0 #DIVIO! August 0 0 #DIVIO! September 0 0 #DIVIO! October 0 0 #DIVl0! November 0 0 #DIVIO! December 0 0 #DIVIO! January 0 0 #DIV/o! February 0 0 #DIVIO! March 0 0 #DIV/0! April 0 0 #DIVID! May 0 0 #DIVIO! June 0 0 #DIVID! Totals 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Reason for Discharge-Legend Column F-Completed Treatment Column G-Moved Column H-Went to Jail/prison Column I-Disengagement Column J-Transfer to another FIT program Column K-Died Column L-Child Welfare Goal Change(TPR) Column M-Judge/court closed the child welfare case Guidance/Care Center,Inc. mit nl-B Contract No.ME225-7-27 Page 1 of 1 @f§ 00 )2/ 00 Cl. \ °° LU0� 00LU / K mE j z = g IL o ■z kk! § � cm o 0 � � .■ E § [ \ % k E m� $\ kk C k 3$ c \E \E �k kk \maj jk }k ) 0 ( \ \P E 2 E / ƒ § LU � \ { z 0SD � ) LU \ \ ] t E 6 § { «§ OR Ic `. k 00 mE § 2 \�7k a;r;« k m 0. § �!7E 0 k \ 0- LU � /\\\\ k o )� u zEE,E §� EI\a! LU ES±t\ § IL*\\\§ § k k § 6 » / e 0 § § \ / ca k \ § / South Florida Behavioral Health Nemork, Inc. Exhibit AM Return on Investment — Special Project Return on Investments for FY 2016-17 Pursuant to the FY 2016-17 General Appropriations Act, Ch. 2016-66, Laws of Florida, the Network Provider has been awarded funding to provide the following services: Provider: Guidance/Care Center, Inc. Specific Appropriation Line Item # 385 — Family Intensive Treatment Funding Amount: $633,188.00 Designated as follows: Miami -Dade County: $483,871.00 Monroe County: $149,317.00 Project: Family Intensive Treatment - From the funds in Specific Appropriation 38S, General Revenue to implement the Family Intensive Treatment (FIT) team model that is designed to provide intensive team - based, family -focused, comprehensive services to families inthe child welfare system with parental substance abuse. These subcontracts shall be executed and managed in accordance with Guidance 18 - Family Intensive Treatment (FIT) Model Guidelines and Requirements. Treatment shall be available and provided in accordance with the indicated level of care required and providers shall meet program specifications. Funds shall be targeted to select communities with high rates of child abuse cases. II. The Network Provider shall: 1. By July 10, 2016, provides an initial projected estimate of positive return on investment the state may receive by providing the funding, and, 2. No later than 10 days after the completion of each fiscal quarter, provide a report documenting the actual return on investment the state has received as a result of this funded project. The Network Provider shall describe the methodology by which the return of investment was determined. A return on investment can vary and can include increased jobs and revenue to the state; reduced recidivism or involvement in the juvenile justice system; improved health care costs, quality, and access; or improvements to water quality. Actual returns by fiscal year should be included if state funding was previously received, as well as projected positive returns based on current fiscal year funding. The Network Provider shall submit the reports to the ME's Contract Manager by the dates specified in Exhibit C, Required Reports. Exhibit AM Page 1 of 1 Guidance/Care Center, Inc. Contract No. ME225-7-27 South Florida Behavioral Health Network, Inc. EXHIBIT AN Supplemental Security Income/Social Security Disability Insurance (SSI/SSDI) Outreach, Access, and Recovery (SOAR) SOAR is a national project funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) that is designed to increase access to SSI/SSDI for eligible adults with mental illnesses who are homeless or at risk of homelessness. Access to SSI/SSDI is a major tool in recovery from mental illness and homelessness to engage in treatment, to keep appointments, to maintain housing, and to meet other basic needs. Network Provider Responsibilities 1. Designation of a SOAR Processor: The Network Provider shall have a designated SOAR trained Processor(s) who will process SOAR applications for all consumers receiving adult mental health case management services under this contract that have been screened and determined to be eligible for SOAR benefits. 2. Eligibility Screening: Screening for SOAR eligibility shall be conducted during the intake or admissions process. 3. Timeframes for Completion of Applications: SOAR applications must be completed within two (2) weeks of the protective filing date. For additional information regarding the processing of applications, please refer to the SFBHN SOAR Basics Guide ("Guide"). The Guide is hereby incorporated by reference and can be obtained by contacting the ME's Adult System of Care Manager or the ME's Peer Services Manager. 4. Data Requirement (OAT System): The SOAR Processor(s) shall input data into the OAT System, at a minimum monthly, for processed applications during the reporting period. The SOAR Processor(s) shall be responsible for ensuring that the information in the OAT System is updated regularly as necessary. 5. Training: The SOAR Processor(s) shall be retrained every two (2) years. New SOAR Processor(s) shall be trained within forty-five (45) days of hire and every two years thereafter. 6. Meetings: The SOAR Processor(s) shall attend the regularly scheduled or specially called meetings when notified by the ME. 7. Required Reports: The Network Provider shall submit to the ME's Adult System of Care Manager or the ME'S Peer Services Manager a bi-monthly report by the dates specified in Exhibit C, Required Reports, containing the following elements: a. Number of screenings completed for the reporting period b. Number of eligible SOAR consumers c. Number of applications submitted 8. Performance Outcomes & Outputs: The Network Provider shall meet the standards and required outcomes specified below: a. At a minimum, seventy percent (70%) or a total of fifty (50) screened consumers, whichever is greater, determined to be eligible for SOAR shall have a SOAR application submitted. b. At a minimum, the Network Provider shall have a sixty-five percent (65%) SOAR application approval rating during each fiscal year. Exhibit AN Page 1 of 2 Guidance/Care Center. Inc. Contract No. ME225-7-27 South Florida Behavioral Health Network, Inc. Network Provider Compliance: Failure to meet the applicable standards established in Tables 1 and 2 shall be considered nonperformance pursuant to Standard Contract, Paragraph 36. Financial Consequences for Network Provider's Failure to Perform. 11. Managing Entity Responsibilities 1. The ME shall adhere to the requirements identified in the Department's Supplemental Security Income/Social Security Disability Insurance (SSI/SSDI) Outreach, Access, and Recovery (SOAR) Guidance Document — Incorporated Document 9. The Department's Incorporated Document 9 can be accessed by visiting the Department's website or by clicking on the link below: hftp://www. myflfam iiies.com/service-programs/substance-abuse/managing-entities/2016-contract- docs 2. The ME shall ensure that the Network Provider implements the SOAR process. 3. The ME shall monitor the Network Provider's performance on all tasks identified in this Exhibit and issue corrective actions if deemed necessary. 4. The ME shall provide training and technical assistance when requested by the Network Provider Exhibit AN Page 2 of 2 Guidance/Care Center, Inc. Contract No. ME225-7-27 �� South Florida // Behavioral Health Network, Inc. Rev. 5/4/2015 ATTACHMENT II Financial and Audit Compliance The administration of resources awarded by the Managing Entity (ME) 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 Uniform Guidance: Cost Principles, Audit, and Administrative Requirements for Federal Awards (also known as the OMB Uniform Guidance), Section 200.500- 200.521 and Section 215.97, F.S., as revised, the ME 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 ME staff, limited scope audits as defined by OMB Uniform Guidance, Section 200.331, 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 ME. In the event the ME determines that a limited scope audit of the recipient is appropriate, the recipient agrees to comply with any additional instructions provided by the ME regarding such audit. The recipient further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the ME, Department of Children and Families 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 Uniform Guidance, Section 200.500-200.521, as revised. In the event the recipient expends $500,000 ($750,000 for fiscal years beginning on or after December 26, 2014) 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 133 Uniform Guidance, Section 200.500-200.521, as revised. The recipient agrees to provide a copy of the single audit to the ME Contract Manager. In the event the recipient expends less than $500,000 in Federal awards during its fiscal year, the recipient agrees to provide certification to the ME's Contract Manager that a single audit was not required. In determining the Federal awards expended during its fiscal year, the recipient shall consider all sources of Federal awards, including Federal resources received from the Department of Children & Families through the ME, Federal government (direct), other state agencies, and other non -state entities. The determination of amounts of Federal awards expended should be in accordance with guidelines Attachment II Page 1 of 4 Guidance/Care Center, Inc. Contract No. ME225-7-27 �� South Florida /Behavioral Health Network, Inc. Rev. 5/4/2015 established by OMB Uniform Guidance, Section 200.500-200.521, as revised. An audit of the recipient conducted by the Auditor General in accordance with the provisions of OMB Uniform Guidance, Section 200.500-200.521, 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 Section 200.508 of OMB Uniform Guidance, as revised. The schedule of expenditures should disclose the expenditures by contract number for each contract with the ME in effect during the audit period. The financial statements should disclose whether or not the matching requirement was met for each applicable contract. All questioned costs and liabilities due the Department (through the contract with the ME) shall be fully disclosed in the audit report package with reference to the specific contract number. 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. The recipient agrees to provide a copy of the single audit to the ME's Contract Manager. In the event the recipient expends less than $500,000 in State financial assistance during its fiscal year, the recipient agrees to provide certification to the ME's Contract Manager that a single audit was not required. In determining the state financial assistance expended during its fiscal year, the recipient shall consider all sources of state financial assistance, including state financial assistance received from the Department of Children & Families through its contract with the ME, 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 ME in effect during the audit period. The financial statements should disclose whether or not the matching requirement was met for each applicable contract. All questioned costs and liabilities due the Department (through the contract Attachment II Page 2 of 4 Guidance/Care Center, Inc. Contract No. ME225-7-27 �� South Florida Behavioral Health Network, Inc. Rev. 5/4/2015 with the ME) 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 ME 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. Contract manager for this contract (1 copy) B. Department of Children & Families ( 1 electronic copy and management letter, if issued ) Office of the Inspector General Single Audit Unit Building 5, Room 237 1317 W inewood Boulevard Tallahassee, FL 32399-0700 Email address: single.auditLxmyflfamilies.coin C. Reporting packages for audits conducted in accordance with Uniform Guidance, Section 200.500-200.521, as revised, and required by Part I of this agreement shall be submitted, when required by Section 200.512 (d), OMB Uniform Guidance, 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.html and other Federal agencies and pass -through entities in accordance with Section 200.512 (e), OMB Uniform Guidance, as revised. D. Copies of reporting packages required by Part II of this agreement shall be submitted by or on behalf of the recipient directly to the following address: Auditor General Local Government Audits/342 Claude Pepper Building, Room 401 111 West Madison Street Tallahassee, Florida 32399-1450 Email address: HQW.IG.Single.Audit(a�myflfamilies.com Attachment II Page 3 of 4 Guidance/Care Center, Inc. Contract No. ME225-7-27 �P4 South Florida / Behavioral Health Network, Inc. Rev. 5/4/20 15 Network Providers, when submitting audit report packages to the ME and the Department for audits done in accordance with OMB Uniform Guidance, Section 200.500-200.521, or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit or for -profit organizations), Rules of the Auditor General, should include, when available, correspondence from the auditor indicating the date the audit report package was delivered to them. When such correspondence is not available, the date that the audit report package was delivered by the auditor to the provider must be indicated in correspondence submitted to the Department in accordance with Chapter 10.558(3) or Chapter 10.657(2), Rules of the Auditor General. PART IV: RECORD RETENTION The recipient shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six years from the date the audit report is issued and shall allow the ME, the Department or its designee, Chief Financial Officer or Auditor General access to such records upon request. The recipient shall ensure that audit working papers are made available to the ME, the Department or its designee, Chief Financial Officer or Auditor General upon request for a period of three years from the date the audit report is issued, unless extended in writing by the ME and/or the Department. Attachment II Page 4 of 4 Guidance/Care Center, Inc. Contract No. ME225-7-27 �� 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 dvil penalty of e"an $10,000 and not more than $100,000 for each such failure. (<-- Signature r Y`- � r Date e of Authorized Individual b Application or Contract Number Name of Organization (-lf( CF 1123, PDF 03/96 Attachment III Guidance/Care Center, Inc. Page I of I Contract No. ME225-7-27 �� South vioral Florida Beha Health Network,Inc. Attachment IV SCOPE OF WORK NAME OF PROVIDER: Guidance/Care Center NAME OF PREVENTION PROGRAM: Power of Prevention AMOUNT OF CONTRACT AWARD: $235,606.00 "Regular" Prevention Services Prevention Partnership Grant TYPE OF FUNDING: (PPG) X COST ALLOCATED TO: (check both Children's Substance Abuse Adult Substance Abuse if approved for both covered services) X X Section I. DESCRIPTION OF SERVICES AND STRATEGIES FOR SERVICE DELIVERY DESCRIPTION OF SERVICES SUMMARY (Include overall intention/purpose of program and service flow, brief description of program activities. target population to be served. how the services address cultural competency, the name (s) of the EBP (s) and how it (they) will be implemented, describe compreheniy?prpgrmrnfning, and the partners and coor•in The Guidance/Care Center's Prevention program, POP for Power of Prevention, consists of four evidence-based practices: Alcohol Literacy Challenge, PRIME for Life; and Teen Intervene, all of which address the specific long-term outcomes identified in the CCAP for Monroe County. The overall intention of implementing these practices is to reduce the rate of past 30-day alcohol use amongst youth ages 13- 18, and to reduce the rate of binge drinking amongst underage youth in Monroe County. Monroe County rates remain higher than Florida rates according to the 2014 Florida Youth Survey. These practices also address common goals and outcomes listed in the Monroe County CCAP 2015-2018, while integrating linkages to primary care for those participants currently lacking resources to maintain overall health and wellness. Services will build upon identified protective factors while considering identified risk factors to align with SAMHSA's CSAP Strategic Prevention Framework, the National Drug Control Strategy, and the National Underage Drinking Prevention Strategy. Using the Strategic Prevention Strategy's 5 steps, POP staff will ASSESS the needs of youth; build participant's capacity considering risk and protective factors; plan the best Prevention approaches with participants using EBP's; implement sessions based on these EBP's; and work closely with the SFBHN and Behavioral Science Research Institute (BSRI) evaluation entity to conduct evaluation of the program's outcomes and effectiveness. The Mental Health First Aid strategy will support the processes. These five steps assist youth while considering sustainability of the program and a framework of cultural competency at all times. The POP program staff will seek to coordinate all prevention activities with referrals from other agencies to collaborate and maximize resources when indicated and possible. Specific primary prevention programs, practices, and strategies in each of the six prevention , strategies: Education, Alternatives, Problem Identification and Referral, Information Dissemination, Community-Based Processes (Coalitions and Evaluation), Environmental ' Strategies (Coalitions and Evaluati. , , .W. EDUCATION —Alcohol Literacy Challenge is a brief classroom-based program designed to alter alcohol expectancies and reduce the quantity and frequency of alcohol use among middle and high school students. PRIME for Life is a motivational intervention used in group settings to prevent alcohol and other drug problems (Marijuana, Prescription, and Over-the-Counter Drugs), and/or provide early interventions. Teen Intervene is a brief, early intervention for 12-19 year olds who display early stages of alcohol or drug involvement. The program staff will be trained in Mental Health First Aid, an NREPP designated Evidence Based Practice, which is an adult public education program that can be adapted to adolescents and designed to improve participants' knowledge and modify their attitudes and perceptions about mental health and related issues, including how to respond to individuals who are experiencing one or more acute mental health crises (i.e., suicidal thoughts and/or behavior, acute stress reaction, panic attacks, Attachment IV Guidance/Care Center,Inc. Page 1 of 9 Contract No.ME225-7-27 South Florida IBeha Health Network,Inc. and/or acute psychotic behavior) or are in the early stages of one or more chronic mental health problems (i.e., depressive, anxiety, and/or psychotic disorders, which may occur with substance abuse). This will assist the staff in increased skills to implement the screening, assessment, and accuracy of the DCI tool and other services for enhanced participant improvements. ALTERNATIVES —each program provides activities for youth to consider excluding substance use and increasing pro-social behavior. PROBLEM IDENTIFICATION AND REFERRAL—Teen Intervene and PRIME for Life identifies youth who have experimented with substances and assesses further services and referrals to those services. INFORMATION DISSEMINATION -through the Prevention programs offered, and the collaboration of Agencies, youth in the community and community members will become more aware of the risks of underage drinking and drug use. Section II. TARGET POPULATION — RISK AND PROTECTIVE FACTORS TARGET POPULATION OR PARTICIPANTS (Include numbers in tables and a narrative description of participant characteristics below): Universal — Direct or Indirect, Selective, Indicated Number of Unduplicated Participants (if duplicated note) Universal Direct—Alcohol Literacy Challenge 348* Indicated —Teen Intervene 48* Selective— PRIME for Life 190* Universal Direct— Health Fairs 300 *Participants may be duplicated across programs Description of participants to be served (describe criteria for program enrollment eligibility, geographic areas / Neighborhoods (list zip codes), risk factors of the neighborhoods, description of the sites (school, church, park, etc.), as well as any other significant demographic information), specific cultural characteristics, and describe according to the Comprehensive Community Action Plan priorities. Participants to be served include male and female at-risk youth ages 13-18 residing in Monroe County, FL Services will be provided county-wide (100 miles) to include all 3 high schools, 3 middle schools, youth residing at the Florida Keys Children's Shelter, and youth attending various community programs as well as youth involved in the Juvenile Justice System. Educational priorities in accordance with the Monroe County CCAP are Youth Alcohol Use/Abuse, Youth Drug Use/Abuse. Participants to be served include Health Fairs throughout Monroe County. Including handing out materials concerning the prevention programs and meeting with participants face to face. Universal Indirect will only be used for meetings and strategizing with the Monroe County Coalition per the financial rule. Risk and Protective Factors to be addressed: Risk Factors: Protective Factors: Favorable attitudes towards ATOD Prosocial opportunities/activities Perceptions of harm Positive peer influence Community norms Skill/competency Self-regulation Healthy behaviors Increased knowledge/awareness Self-esteem Community values children Positive family communication Community values— children/youth Attachment IV Guidance/Care Center, Inc. Page 2 of 9 Contract No.ME225-7-27 �� South Flori vioral da %/ Beha Health Network,Inc. Section III. SITE LOCATIONS AND INFORMATION* Childre # of Site Name Street Address City Zip Cod n/ Parent Others Youth Key West High School 2100 Flagler Avenue Key West 33040 Coral Shores High School 89901 Old Highway Tavernier 33070 Marathon Middle/High 350 Sombrero Road Marathon 33050 School Plantation Key Middle 100 Lake Road Tavernier 33070 School Key Largo Middle School 104801 Overseas Key Largo 33037 Highway Horace O'Bryant Middle 1105 Leon Street Key West 33040 School Florida Keys Children's 73 High Point Road Tavernier 33070 Shelter DJJ 5503 College Road Key West 33040 Suite 209 Southernmost Boys and 1400 United Street Key West 33040 Girls Club YMCA of Greater Miami at 500 St. Croix Place Key Largo 33037 Key Largo Community Park TOTAL NUMBER OF TO 586 BE SERVED *Sites/locations of services cannot be changed without prior authorized approval of the SFBHN Contact Manager. Section IV. MAJOR REFERRAL SOURCES Monroe County Schools—teachers, school counselors DJJ Self-referral Social Service Agencies Community Centers Section V. PERFORMANCE MEASURES Quantity Performance Measures Activities/Service Name & Description (Include Activity frequency. intensity; & duration to# # o Level # # To Meet Selectiv of sessions, as well as the Children! Parents Others Required Required e— number of cycles/cohorts Youth Sessions Indicate expected to be offered and d tentative schedule/timing) • Youth/Children At-Risk of Substance Abuse Problems —include individual measures that will result in achieving the Substance Abuse & Mental Health Required Performance Outcomes & Outputs • Parent/Families At-Risk of Substance Abuse Problems — include individual measures that will result in achieving the Substance Abuse & Mental Health Required Performance Outcomes & Outputs L Attachment IV Guidance/Care Center,Inc. Page 3 of 9 Contract No.ME225-7-27 South Florida Behavioral Health Network, Inc. Alcohol Literacy Challenge 190 0 0 1 ALC 100% of 190 will Universal Session receive services, - Direct for each 85% will complete of 190 ALC and 85% of participan completers or 162 is will improve on the ALC PRIME for Life 348 0 0 Minimum PRIME for Life — Selective 4.5 hours 100% of 348 will and up to receive services, a 85% will complete maximum the program in a of 20 minimum of 4.5 hours sessions per the and 85% of EBP completers will improve based on the outcome measures Teen Intervene 48 0 0 3 Teen Intervene — Indicate sessions 100% of 48 will d receive services, 85% will complete the program and 85% of completers or 41 participants will improve from pre to post test in the minimum of 3 sessions (3 sessions is one cohort Health Fairs 100 200 0 5 100% of 300 Health participants will Fairs receive information at the Health Fairs, 85% or 255 participants be provided prevention framework information while attending the fairs. Attachment IV Guidance/Care Center, Inc. Page 4 of 9 Contract No. ME225-7-27 South Florida Beha Health Network,Inc. Quality Performance Measures (Including fidelity measures, satisfaction survey information, supervision, training, staffing, and other required information pertaining to quality) Average number of sessions Participant sign-in sheets collected • At the end of each cohort attended (Participant at session session Retention) Pre and Post surveys from each • At the end of each of the Number of participants participant services improved Participant Satisfaction Survey Alcohol Literacy Challenge- 100% of 190 and 85% 162 will improve based on the pre/post outcome as measured by the approved SFBHN tool Alcohol Literacy Challenge minimum of 1 session Average number of sessions Participant sign-in sheet collected at attended (Participant each session • At the end of each cohort Retention) Alcohol Timeline Followback (TLFB) session Number of participants completed at baseline and exit from • At the end of each of the improved treatment services Teen Intervene— 100% of 48 Participant Satisfaction Surveys will receive services and 85% will complete the program. 85 % of completers will improve from pre to post test in the minimum of 3 sessions(3 sessions is one cohort) Participant Sign-in sheets collected Average number of sessions at each session • At the end of each cohort attended (Participant Survey from each participant at start session Retention) and exit • At the end of each of the Number of participants Evaluation —curriculum services improved assessment— completed at baseline PRIME for Life— 100% of 348 and exit by each participant will receive services, 85% of 348 or 296 will complete the program in a minimum of 4.5 sessions and 85% of completers will improve based on the outcome measures # and % of participant 85% of participants who completed • At the end of each cohort satisfied with services program will complete the • At the end of the services provided satisfaction survey and 80% will be satisfied based on the Satisfaction Attachment IV Guidance/Care Center,Inc. Page 5 of 9 Contract No.ME225-7-27 op South Florida // Beha Health Network,Inc. Survey Observation of service Curriculum fidelity checklist Four times per year in coordination delivery/ Fidelity checklist Supervisor/Observer report with the Evaluation Team —One time in FY Quarter 1, one time in FY Quarter 2, on time in FY Quarter 3, and one time in FY Quarter 4 with identified needs and changes to be reported to SFBHN in the Quarterly Report Documentation of structured Supervisory Tool/Checklist and During regular supervisory supervision Notes sessions for each staff and not less than one time per month. (Per the Rule, "Supervisor Instructions") # and % of staff with 100% of staff with necessary Attendance at prevention training necessary training training/certification every quarter. Every prevention / certification (as required by staff member must participate in at all entities and EBP) a minimum, 8 hours of training per quarter. # and % of staff working 100% of staff working towards By October 2016 or one month toward achieving certification achieving certification by attending after hire of one new staff, all staff in the State of Florida in SFBHN and other training consistent not certified, will be working Prevention Certification with FCB's criteria towards State of Florida (FCB) Prevention Certification Section VI. Participant Outcomes CCAP Goal Goal I: By June 30, Goal I: By June 30, Goal I: By June 30, 2018 reduce the rate of 2018 reduce the rate of 2018 reduce the rate of past 30 day alcohol use past 30 day alcohol use past 30 day alcohol use and the rate of Binge and the rate of Binge and the rate of Binge Drinking among Drinking among Drinking among underage young adults underage young adults underage young adults and youth in Monroe and youth in Monroe and youth in Monroe County. County. County. Long. Goal II: Expand Long. Goal II: Expand Long. Goal II: Expand the community the community the community messaging and messaging and messaging and communication strategy communication strategy communication strategy to more effectively build to more effectively build to more effectively build community ownership of community ownership of community ownership of the underage drinking the underage drinking the underage drinking problems in Monroe problems in Monroe problems in Monroe County through County through County through formalizing of new formalizing of new formalizing of new relationships with key relationships with key relationships with key community and community and community and business leaders using business leaders using business leaders using the Strategic Prevention the Strategic Prevention the Strategic Prevention Framework. Framework. Framework. SFBHN Goal(s) SFBHN Prevention Goal SFBHN Prevention Goal SFBHN Prevention Goal #1: Decrease norms and #1: Decrease norms and #2: Increase education acceptance of alcohol, acceptance of alcohol, and awareness marijuana, and other marijuana, and other regarding alcohol, Attachment IV Guidance/Care Center,Inc. Page 6 of 9 Contract No. ME225-7-27 �� BeSouthavioral Florida / h Health Network,Inc. drug use (inclusive of drug use (inclusive of marijuana use peer and parent peer and parent attitudes). attitudes). SFBHN Prevention Goal #4: Increase healthy SFBHN Prevention Goal behaviors and self #3: Increase age of esteem onset for marijuana use Timing when each Outcomes Data Source/ data source/measure Outputs & Associated Measurement will be collected Activity Outcome: 85% of youth Pre/post tests • At the end of each • Meet and who complete ALC will cohort session communicate with decrease favorable Satisfaction surveys • At the end of each of school personnel attitudes towards alcohol the services • /partner agencies • Prepare program Outcome: 85% of youth Pre/post tests • At the end of each materials who complete PRIME and cohort session • Administer Teen Intervene will Satisfaction surveys • At the end of each of Participant decrease favorable the services Registration Form attitudes towards alcohol, and prepost tests tobacco, and other drugs. • Administer Outcome: 85% of youth Pre/post tests • At the end of each Satisfaction Survey who complete Teen cohort session • Travel to/from Intervene will increase Satisfaction surveys • At the end of each of session their healthy behaviors the services • Data Entry and decrease their use of ATOD or delay the age of onset for marijuana use. Outcome: 85% of youth Pre/post tests • At the end of each who complete PRIME will cohort session increase their healthy Satisfaction surveys • At the end of each of behaviors and skills the services associated with healthy behaviors. Cohorts Section VII. TASK LIST EB'P.. . / #& I 1' % toMeet Activities/Service Name & Description Type of ! Rec this Participant d Sessionsscions or Outcome s Hours - Activity Title: ALCOHOL LITERACY CHALLENGE (ALC) 348 youth 1 session per 100% of Activity Description: Participants will be recruited from ages 13- participant youth will partners/agencies and will receive a 1-15 minute pre-survey of 18 and 2 receive their risk and protective factors. The curriculum will be sessions per services, administered a minimum of 1x, and 1-15 minute post-survey will participant 85% will be administered at end of session. The staff will employ the needing complete Mental Health First Aid skill sets during the session. If referral to ALC and participant's post-survey indicates high risk factors, participant additional 85% of to have 1 other-30 minute referral to another Prevention services completers program. 1-30 minute registration, 1-30 minute screening. will • Meet & communicate with school personnel/partner improve based on Attachment IV Guidance/Care Center,Inc. Page 7 of 9 Contract No.ME225-7-27 �/ �� South Florida 'Behavioral Health Network, Inc. agencies the Quality • Prepare program materials Outcome • Administer Participant Registration Form Measure • Administer Satisfaction Survey • Travel to/from session • Data Entry Frequency: 1 or 2 sessions Intensity: 90 minutesxl session or 45 minutesx2 sessions Duration: 1 session, # of Cohorts @ 6 youth each Activity Title: PRIME for Life (PFL) 348 youth 4.5 to 20 100% of Activity Description: Participants will be recruited from ages 13- hours per the 348 partners/agencies and will be guided in self -assessing their level 18 EBP for each participants of progression toward or into dependence or addiction to alcohol participant, in PFL will or other drugs. Participants will be assisted in developing a documenting receive detailed plan for successfully following through with behavior the need services, change in addition to workbook activities. The staff will employ 85% will the Mental Health First Aid skill sets during the session. 1-30 complete minute registration, 1-30 minute screening, 1-30 minute pre/post the surveys, 1 30 minute referral. program • Meet & communicate with school personnel/partner and 85% of agencies completers • Prepare program materials will show • Administer Participant Registration Form improveme • Administer Mental Health First Aid screening tool nt on the • Administer Satisfaction Survey pre/post • Travel to/ from session surveys based on • Data Entry the Quality Frequency: once weekly session Outcome Intensity: 4.5 to 20 hours (per the EBP) Measures Duration: 1 50-60 minute session, # of Cycle: 6 Cohorts @5 youth each Activity Title: Teen Intervene 48 youth 3 sessions 100% of 48 Activity Description: Participants required to attend (3) 90 ages 13- youth will minute session, 1- 30 minute registration, 1- 30 minute 18 receive screening, 1- 30 minute pre/post survey, and 1- 30 minute services, referral. The staff will employ the Mental Health First Aid skill 85% will sets during the sessions. complete Frequency: once weekly session the Teen Intensity. Three sessions Intervene Duration: one 90 minute session sessions and 85% of completers will show improveme nt based on the Quality Outcome measures Activity Title: EVALUATION —Curriculum evaluation tools. 190* 2 85% These assessment tools match the services provided. Activity Description: Instrument used to identify substance abuse and other needs. Attachment IV Guidance/Care Center, Inc. Page 8 of 9 Contract No. ME225-7-27 Soutavioralh Florida / Beh Health Network,Inc. Frequency: 2 sessions Intensity: 30 minutes/session Duration: 1 survey per youth completed at baseline and at exit for PRIME for Life, # of Cycles: 10 cycles © 10 youth *duplication OF 190 PRIME FOR LIFE# Section VIII. EVIDENCE BASED PROGRAMS (EBP) Evden e B sed Pro lam .. .., A ency Alcohol Literacy Challenge SAMHSA approved, NREPP Prime For Life SAMHSA approved, NREPP Teen Intervene SAMHSA approved, NREPP Section IX. EVALUATION Describe how the program will evaluate the effectiveness of all prevention services to be implemented consistent with 650-30.013(2), F.A.C., in collaboration with the Evaulation Team identified by SFBHN each year. The SFBHN Evauation Team shall review the results of providers' program evaluation and all technical materials used by providers annually to ensure consistency with current research in the prevention field Evaluation of the effectiveness of all Prevention services described shall take place with BSRI. GCC/POP will do the following: -Address the underage drinking goal from the Monroe County CCAP and common outcomes related to substance and other alcohol use and will measure them using the Monroe County FYSAS, and Alcohol Time Line Follow Back. POP will use results from previous years' FYSAS as the baseline and utilize more results by 2017 during course of this project to define meaningful improvement and gauge POP participant outcomes as they relate to the overall goals of the CCAP. -Adhere to the Fidelity requirements of each program. -Any problem areas in the classrooms or in the groups, will be discussed and addressed at weekly Supervision meetings. -The effectiveness of all 4 programs will be evaluated through the pre and post surveys and client satisfaction surveys. -Random observations will be done by Prevention Coordinator and Research Assistant. -All activities for Prevention will be consistent with the agency's Quality Assurance/Quality Improvement Plan. -Activity Logs will be maintained for all Prevention activities and client charts will be maintained for Indicated Prevention Activities. -Coordinate with the Evaluation Team regularly, attend meetings, and submit the required documentation. Attachment IV Guidance/Care Center,Inc. Page 9 of 9 Contract No.ME225-7-27 �� South Florida .Behavioral Health Network, Inc. rev. 07/01 /2015 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 September 1, 2015. It shall end at midnight, local time in Miami -Dade County, Florida on June 30, 2018. 5. State of Florida Law This contract is executed and entered into in the State of Florida, and shall be construed, performed and enforced in all respects in accordance with Florida law, without regard to Florida provisions for conflict of laws. Courts of competent jurisdiction in Florida shall have exclusive jurisdiction in any action regarding this contract and venue shall be the appropriate state court in Miami -Dade County, Florida. 6. Federal Law a. If this contract contains federal funds, the Network Provider shall comply with the provisions of federal law and regulations including but not limited to, 45 Code of Federal Regulations (CFR), Part 74, 45 CFR, Part 92, and other applicable regulations. b. If this contract contains over $100,000 of federal funds, the Network Provider shall comply with all applicable standards, orders, or regulations issued under section 306 of the Clean Air Act, as amended (42 United States Code (U.S.C.) 7401 et seq.), section 508 of the Federal Water Pollution Control Act, as amended (33 U.S.C. 1251 et seq.), Executive Order 11738, as amended and where applicable, and Environmental Protection Agency regulations (40 CFR, Part 30). The Network Provider shall report any violations of the above to the ME. c. No federal funds received in connection with this contract may be used by the Network Provider, or agent acting for the Network Provider, or subcontractor to influence legislation or appropriations pending before the Congress or any State legislature. If this contract contains federal funding in excess of $100,000, the Network Provider must, prior to contract execution, complete 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 applicable, 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. b. Retention of all client records, financial records, supporting documents, statistical records, and any other documents (including electronic Standard Contract Guidance Care Center, Inc. Page 1 of 10 Contract No. PPG-2-03 WA South Florida Behavioral Health Network, Inc. rev. 07/01/2015 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 seven (7) 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. Financial and Compliance Aluo. 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 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 evaluate liability or its evaluation of liability shall not excuse its duty to defend and indemnify after receipt of notice. Only an adjudication or judgment after the highest appeal is exhausted finding the 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 a. 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 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 Standard Contract Guidance Care Center, Inc. Page 2 of 10 Contract No. PPG-2-03 F2� South Florida Behavioral Health Network, Inc. rev. 07/01 /2015 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. b. To the fullest extent permitted by law, and not withstanding any other provision of this Contract, the Network Provider by signing this contract acknowledges the value of obtaining Cyber Liability insurance, has considered all of the risks, and assumes all of the risks and liability associated with not obtaining such insurance. The Network Provider will indemnify, defend, and hold the ME harmless from any and all claims, losses, liabilities, damages, judgements, fees, expenses, awards, civil monetary penalties, and costs (including reasonable attorneys' and court fees and expenses) arising out of or related to any Breach or alleged Breach of Unsecured PHI created, received, maintained, transmitted, or otherwise used by the Network Provider and arising from the Network Provider's breach, or failure to perform pursuant to this Contract (collectively, a "Claim") up to and including the Appellate Court level and until the case is resolved. 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 waving the limits of sovereign immunity. 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 s. 215.97, s. 215.971, F.S. Should repayment not be promptly made upon discovery by the Network Provider or its auditor or upon written notice by the ME, the Network Provider will be charged interest at the lawful rate of interest on the outstanding balance until returned. b. Payments made for services subsequently determined by the ME to not be in full compliance with contract requirements shall be deemed overpayments. The ME shall have the right at an time to offset or deduct from any amount due to the ME from the Network Provider under this or any other contract or agreement and payment otherwise due under this Contract will be deemed received regardless of such offset. c. 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 a. 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. Standard Contract Guidance Care Center, Inc. Page 3 of 10 Contract No. PPG-2-03 P� South Florida �/ Behavioral ' Health Network, Inc. rev. 07/01/2015 b. The ME monitors timely submissions of incident reports and may impose financial penalties as described in Section 39. Financial Penalties for Failure to Comply with Requirement for Corrective Action of this Standard Contract, paragraphs b., c., and d. 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 Certificate, CF Form 707 and the Civil Rights Compliance Checklist, CF Form 946 in accordance with CFOP 60-16 and 45 CFR 80. 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 twenty (20) 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 Standard Contract Guidance Care Center, Inc. Page 4 of 10 Contract No. PPG-2-03 �� South Florida Behavioral Health Network, Inc. rev. 07/01 /2015 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 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 Otsuka Digital Health (ODH), 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 or immediately upon hire and annually thereafter. The Network Provider shall maintain a copy of the signed DCF Security Agreement form CF 0114 in the personnel file. The Network Provider agrees to submit copies of each signed DCF Security Agreement form CF 0114 to the ME's Contract Manager and the ME's Director of Information Technology upon request. 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 four (4) 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 thirty (30) 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. Should the ME seek accreditation the Network Provider shall collaborate with the ME in the application process. 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. Standard Contract Guidance Care Center, Inc. Page 5 of 10 Contract No. PPG-2-03 �� South Florida // Behavioral Health Network, Inc. rev. 07/01/2015 b. Transitioning Young Adults: The Network Provider understands DCF's Operation Full Employment initiative to assist young adults aging out of the dependency system. The ME encourages Network Provider participation with the local Community -Based Care Lead Agency Independent Living Program to offer gainful employment to youth in foster care and young adults transitioning from the foster care system. 28. Health Insurance Portability and Accountability Act The Network Provider shall, where applicable, comply with the Health Insurance Portability and Accountability Act (42 U. S. C. 1320d.) as well as all regulations promulgated thereunder (45 CFR Parts 160, 162, and 164). 29. Emergency Preparedness a. If the tasks to be performed pursuant to this contract include the physical care or supervision of clients, the Network Provider shall, within thirty (30) days of the execution of this contract, submit to the contract manager an emergency preparedness plan which shall include provisions for records protection, alternative accommodations for clients in substitute care, alternate facilities for the 24 hour facilities in case those facilities are incapacitated by the disaster and the expectation for returning exceeds emergency sheltering capabilities and time allowances supplies, and a recovery plan that will allow the Network Provider to continue functioning in compliance with the executed contract in the event of an actual emergency. For the purpose of disaster planning, the term supervision includes the responsibility of the ME, or its contracted agents to ensure the safety, permanency and well-being of a child who is under the jurisdiction of a dependency court. Children may remain in their homes, be placed in a non -licensed relative/non-relative home, or be placed in a licensed foster care setting. b. The ME agrees to respond in writing within thirty (30) days of receipt of the plan accepting, rejecting, or requesting modifications. In the event of an emergency, the ME may exercise oversight authority over such Network Provider in order to assure implementation of agreed emergency relief provisions. c. An updated emergency preparedness plan shall be submitted by the Network Provider no later than 12 months following the acceptance of an original plan or acceptance of an updated plan. The ME agrees to respond in writing within 30 days of receipt of the updated plan, accepting, rejecting, or requesting modification to the plan. 30. Notification of Legal Action The Network Provider shall notify the ME of legal actions taken against them or potential actions such as lawsuits, related to services provided through this contract or that may impact the Network Provider's ability to deliver the contractual services, or adversely impact the ME. The ME's contract manager will be notified within ten (10) days of Network Provider becoming aware of such actions or from the day of the legal filing, whichever comes first. 31. Whistleblower's Act Requirements In accordance with subsection 112.3187(2), F.S., the Network Provider and its subcontractors shall not retaliate against an employee for reporting violations of law, rule, or regulation that creates substantial and specific danger to the public's health, safety, or welfare to an appropriate agency. Furthermore, agencies or independent contractors shall not retaliate against any person who discloses information to an appropriate agency alleging improper use of governmental office, gross waste of funds, or any other abuse or gross neglect of duty on the part of an agency, public officer, or employee. The Network Provider and any subcontractor shall inform its employees that they and other persons may file a complaint with the Office of Chief Inspector General, Agency Inspector General, the Florida Commission on Human Relations or the Whistle -blower's Hotline number at 1-800-543-5353. 32. Proprietary or Trade Secret Information a. Unless exempted by law, all public records are subject to public inspection and copying under Florida's Public Records Law, Chapter 119, F.S. Any claim by Network Provider of proprietary or trade secret confidentiality for any information contained in Network Provider's documents (reports, deliverables or work papers, etc., in paper or electronic form) submitted in connection with this contract will be waived, unless the claimed confidential information is submitted in accordance with Section 32. b. below. b. The Network Provider must clearly label any portion of the documents, data or records submitted that it considers exempt from public inspection or disclosure pursuant to Florida's Public Records Law as proprietary or trade secret. The labeling will include a justification citing specific statutes and facts that authorize exemption of the information from public disclosure. If different exemptions are claimed to be applicable to different portions of the protected information, the Network Provider shall include information correlating the nature of the claims to the particular protected information. c. The ME, when required to comply with a public records request including documents submitted by the Network Provider, may require the Network Provider to expeditiously submit redacted copies of documents marked as confidential or trade secret in accordance with Section 32. b. above. Accompanying the submission shall be an updated version of the justification under Section 32. b., correlated specifically to redacted information, either confirming that the statutory and factual basis originally asserted remain unchanged or indicating any changes affecting the basis from the asserted exemption from public inspection or 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 Standard Contract Guidance Care Center, Inc. Page 6 of 10 Contract No. PPG-2-03 %/�K5 South Florida .Behavioral Health Network, Inc. rev. 07/01/2015 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/DCFTraining/Monthly-Summary-Report/form login.html 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 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: htti)://www mvflfamilies com/service-programs/deaf-and-hard-hearing/providers 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 $450,000.00, 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 $450,000.00, 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. 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 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 eight (8) 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 eight (8) 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, Standard Contract Guidance Care Center, Inc. Page 7 of 10 Contract No. PPG-2-03 �� South Florida .Behavioral Health Network, Inc. rev. 07/01l2015 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, 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.S., corrective action plans may be required for noncompliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed for failure to implement or to make acceptable progress on such corrective action plans. The ME, at its sole discretion, will determine the findings identified in the corrective plan that will require a financial penalty. 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 notice 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 of 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. Standard Contract Guidance Care Center, Inc. Page 8 of 10 Contract No. PPG-2-03 U200 South Florida Behavioral Health Network, Inc. rev. 07/01 /2015 42. Dispute Resolution (a) The parties agree to cooperate in resolving any differences in interpreting the contract, including but not limited to, client eligibility and/or placement into the appropriate level of care, a general dispute arising out of, or relating to this contract, or contesting a financial penalty for failure to comply with requirements of a corrective action plan. Within five (5) working days of the execution of this contract, each party shall designate a Dispute Resolution Officer with the requisite authority to act as its representative for dispute resolution purposes, and provide that information to the other party. (b) Within five (5) working days from delivery to the Dispute Resolution Officer 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 parties are not able to meet within the five (5) working days due to scheduling difficulties, the meeting shall occur as mutually agreed to by the parties, but no later than ten (10) working days from the date of receipt of the written request for dispute resolution. If the representatives are unable to reach a mutually satisfactory resolution at the face-to-face meeting, the dispute resolution process in Section 42.(c) shall be followed. In the event of a dispute regarding client eligibility and/or placement into the appropriate level of care, the dispute shall not preclude the Network Provider from providing the provision of services to eligible individuals until the dispute is resolved. (c) 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 next step, the President/Chief Executive Officer of the parties shall confer in an attempt to amicably resolve the issue. If the President/Chief Executive Officer of the parties cannot resolve the issue, the issue shall be presented at the discretion of the ME either to the Board of Directors Executive Committee and/or the ME's Board of Directors. Should the dispute not be resolved at the Board of Directors Executive Committee and/or the ME's full Board of Directors level, 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. 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. Employment Eligibility Verification (E-Verify) (a) Definitions as used in this clause: (i) "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/grantee to perform work pursuant to the contract/grant with the ME. (ii) "Subcontract" means any contract entered into by a Network Provide 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. (iii) "Subcontractor" means any supplier, distributor, vendor, or firm that furnishes supplies or services to or for the Network Provider or subcontractor. (b) Enrollment and verification requirements. (1) The Network Provider/grantee shall: (i) Enroll as a provider/grantee in the E-Verify program within 30 calendar days of contract award or amendment; (ii) 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 Network Provider/grantee/subcontractor to perform work pursuant to the contract with the ME shall be verified as employment eligible within 3 business days after the date of hire. (2) The Network 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 Network 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 Network 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 Network 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 Network Provider/grantee, then the Network Provider/grantee must reenroll in E-Verify. (iii) Information on registration for and use of the E-Verify program can be obtained via the Internet at the Department of Homeland Security Web site: http://www.dhs.gov/E-Verify (iv) The Network 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 Network Provider/grantee through the E-Verify program. (v) Evidence of the use of the E-Verify system will be maintained in the employee's personnel file. Standard Contract Guidance Care Center, Inc. Page 9 of 10 Contract No. PPG-2-03 wm 01., South Florida &10000 Behavioral Health Network, Inc. rev. 07/01 /2015 (vQ The Network provider/grantee shall include the requirements of this clause, including this paragraph (vi) (appropriately modified for identification of the parties), in each subcontract. (vii) The service provider at any tier level must comply with the E Verify clause as subject to the same requirement as the Network Provider. 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 41st 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 Benvenuti, CFO 3000 41 st Street, Ocean Marathon, FL 33050 Office number. 305-434-7660 Mobile number: 305-731-3343 Fax number. 305-434-9040 E-Mail: madanne.benvenuti@westcare.com b. The name, address, and telephone of the Contract Manager for the ME for this contract is: Anny Cartagena South Florida Behavioral Heafth Network, Inc. 7205 Corporate Center Drive, Suite 200 Miami, FL 33126 Tel. (786) 507-7474 E-Mail: ACartagena@sfbhn.org d. The name, address, and telephone number of the representative of the Provider responsible for the administration of the program under this contract is: Frank C. Rabbito, Sr. VP 169 E. Flagler Street, Suite 1300 Miami, FL 33131 Office number. (305) 573-3784 Mobile number. (305) 799-1286 Fax number. (305) 381-7733 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, 1, 11, III. & 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://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 tens 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, the Business Associate Agreement, and other attachments, if any; b. Any documents incorporated into any attachment by reference; c. The Standard Contract; d. Any documerts 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. TITLE: Senior Vice President DATE: Federal Tax ID# (or SSN) 59-1458324 SOUTH FLORIDA BE4AVIORAL HEALTH NETWORK, INC. SIGNED NV4"//� NAMEAohn W. Dow TITLE: President and EO^-- DATE: z � �✓ Network Provider Fiscal Year Ending Date 6/30 Standard Contract Guidance Care Center, Inc. Page 10 of 10 Contract No. PPG-2-03 ;� South Florida �, Behavioral I Health Network, Inc. ATTACHMENT A. SERVICES TO BE PROVIDED 1. Prevention Services and other Program/Service Specific Terms Contract and program/service specific terms used in this document can be found in the Florida Department of Children and Families Prevention Partnership Grant (Fiscal Year 2015-2018) Request for Applications (RFA) #LHZ03, herein incorporated by reference. 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: http://sfbhn.org/wordPress/wp-content/uploads/Program Service -Specific -Terms pdf. (1) "Application" is the proposal submitted by an organization to the Department of Children and Families Office of Substance Abuse and Mental Health in response to Request for Applications (RFA) #LHZ03. (2) "Behavioral Health Services" are mental health services and substance abuse prevention and treatment services as defined in chapters 394, 397 and 916, F.S. which are provided using state and federal funds. (3) "Capacity Building": Efforts that increase or improve the resources available to establish or maintain prevention activities. (4) "Comprehensive Community Action Plan (CCAP)". A document that describes and depicts goals and objectives related to the state consumption priorities and the proposed programs and strategies. It also describes and depicts intermediate changes to risk and protective factors and process -based objectives. Applications must include at least one objective that addresses sustainability and at least one objective that addresses capacity building. Goals and objectives are subject to modification during the negotiation process. (5) "Continuous Quality Improvement" is a 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. (6) "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. (7) "Cost Analysis" means the review of the proposed cost elements to determine if they are necessary, allowable, appropriate and reasonable. (8) "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. 11 Attachment I HCO2 (d) Guidance Care Center, Inc. Page 1 of 40 Contract No. PPG-2-03 v// South Florida /Behavioral . Health Network, Inc. (9) "DCF PAM 155-2" is the Department of Children & Families, Pamphlet 155-2 - Mental Health and Substance Abuse Measurement and Data, effective July 2010 (10th edition, version 1),or the latest revised edition thereof, means a document promulgated by the Department that contains required data -reporting elements for substance abuse and mental health services, and which can be found at: http://www dcf state fl us/programs/samh/pubs reports.shtmi, and is incorporated herein by reference. (10) "Cultural Competency" An organization's ability to work effectively in cross-cultural settings. Culturally competent prevention practitioners understand the cultural context of the communities they serve and have the willingness and skills to effectively interact within this context. Cultural competence entails drawing upon community -based values, traditions and customs while working with knowledge representatives from the community to plan, implement, and evaluate prevention activities. (11) "Department" means the State of Florida Department of Children and Families. (12) "Evaluation Plan" A document that explains and describes program assessment, improvement, and strategic management.1 The evaluation plan explains and describes program assessment, improvement, and strategic management. The assessment portion should address the process for verification and documentation as well as how program activities and their effects will be quantified. Additionally, areas that can be improved or enhanced need to be identified to address areas of weakness. The final piece of strategic management will provide information that can help an agency or organization make decisions about how resources should be applied in the future to better serve its mission or goals. (13) "Evidence -Based" Prevention programs, practices, or strategies in the substance abuse profession are those that are supported by research. Based on the evidence -based practices, Center for Substance Abuse Prevention (CSAP) Options of the Strength of Evidence include: 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 but are not limited to the 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; Blueprints for Healthy Youth Development; California evidence -based Clearinghouse for Child Welfare; U.S. Substance Abuse and Mental Health Services Administration's (SAMHSA) National Registry of evidence -based Programs and Practices; or The US Department of Health and Human Services. Option 2) this proposed program or strategy is reported in two or more peer -reviewed journals as having positive effects 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. (14) "Evaluation Plan" A document that explains and describes program assessment, improvement, and strategic management. The evaluation plan explains and describes program assessment, improvement, and strategic management. The assessment portion Attachment I HCO2 (d) Guidance Care Center, Inc. Page 2 of 40 Contract No. PPG-2-03 �/ South Florida Behavioral Health Network, Inc. should address the process for verification and documentation as well as how program activities and their effects will be quantified. Additionally, areas that can be improved or enhanced need to be identified to address areas of weakness. The final piece of strategic management will provide information that can help an agency or organization make decisions about how resources should be applied in the future to better serve its mission or goals. (15) "Evidence -Based. Prevention programs, practices, or strategies in the substance abuse profession are those that are supported by research. Based on the evidence -based practices, Center for Substance Abuse Prevention (CSAP) Options of the Strength of Evidence include: 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 but are not limited to the 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; Blueprints for Healthy Youth Development; California evidence -based Clearinghouse for Child Welfare; U.S. Substance Abuse and Mental Health Services Administration's (SAMHSA) National Registry of evidence -based Programs and Practices; or The US Department of Health and Human Services. • Option 2) this proposed program or strategy is reported in two or more peer -reviewed journals as having positive effects 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. (16) "Fidelity" is the degree to which the evidence -based practice implemented adheres to the practice's implementation design. (17) "Harmful Consequences" Negative effects caused by drug use, such as diseases, fatalities, academic failures, and criminal behavior. (18) "HIPAX is the acronym for Health Insurance Portability and Accountability Act (42 U.S.C. 1320d, and 45 CFR Parts 160, 162, and 164). (19) "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. (20) "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. (21) "Needs Assessment Logic Model (NALM)" A visual depiction of the relationships between risk and protective factors, drug consumption, and harmful consequences. A logic model Attachment I HCO2 (d) Guidance Care Center, Inc. Page 3 of 40 Contract No. PPG-2-03 South Florida .100000 / Behavioral Health Network, Inc. visually demonstrates the causal mechanisms and interconnections between variables using arrows to show the direction of influence. (22) "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. (23) "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. (24) "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. (25) "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. (26) "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. (27) Prevention. 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 as defined in Rule 65E-14.021(4) (v) — (y). (28) "Prime Contract" is the contract between the Department of Children and Families and the ME. (29) "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. (30) "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. (31)"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. (32) "Provider Network" (subcontractor or Network Provider) is the direct service agencies that are under contract with a ME and that together constitute a comprehensive array of Attachment I HCO2 (d) Guidance Care Center, Inc. Page 4 of 40 Contract No. PPG-2-03 South Florida Behavioral Health Network, Inc. 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. (33) "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. (34) "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. (35) "SAMH" means the Substance Abuse and Mental Health Programs within the Department (36)"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. (37) "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. (38) "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. (39) Strategic Prevention Framework (SPF)" A planning process that guides the selection, implementation, and evaluation of evidence -based, culturally appropriate, sustainable prevention activities. The SPF's effectiveness begins with a clear understanding of community needs and depends on the involvement of community members in all stages of the planning process. The SFP uses the 5-step process known to promote youth development, reduce risk -taking behaviors, build assets and resilience, and prevent problem behaviors. The SPF is built on a community -based risk and protective factors approach to prevention and a series of guiding principles that can be adapted and utilized at the federal, state, tribal, and community levels. The idea behind SPF is to use the findings from public health research along with evidence -based prevention programs to build capacity within states territories, tribes and the prevention filed. This framework will promote resilience and decrease risk factors in individuals, families, and communities. Attachment I HCO2 (d) Guidance Care Center, Inc. Page 5 of 40 Contract No. PPG-2-03 �� South Florida �/ Behavioral Health Network, Inc. The SPF is comprised of the following elements: 1) assesses the conditions that underlie the onset and progression of substance abuse, including childhood and underage drinking; 2) builds prevention capacity and infrastructure to sustain achievements; 3) selects evidence -based practices to change those conditions and reduce substance - abuse related problems in the communities; 4) implements the identified strategies with fidelity; and 5) evaluates the strategies implemented to determine what efforts should be sustained and to assist in sustainability planning efforts. (40) "Strategies" is a plan of action or policy designed to achieve a major goal. (41)"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: i. Prevention and early intervention; ii. Emergency care; iii. Acute care; iv. Residential treatment; V. Outpatient treatment; vi. Rehabilitation; vii. Supportive intervention; viii. Recovery support; and ix. Consumer support services. Services provided as the SOC must be assessable and responsive to the needs of individuals' substance, their families, and community Stakeholders. (42) Target Population. The PPG target population is students ages 0 to 20. Parents, teachers and other school staff, coaches, social workers, case managers, and other prevention stakeholders may also be the target of proposed activities because of their ability to influence students ages 0 to 20. Activities that target the behavior of these stakeholders for change can be considered process measures. Approved performance measures, on the other hand, must measure improvements in the attitudes and behaviors of students ages 0 to 20. (43) "Verifiable Service" is a service provision that is documented in compliance with the requirements contained in Rule 65E-14.021, F.A.C. 2. General Description a. General Statement i. The Prevention Partnership Grants (PPG) program, created by s. 397.99, F.S., is designed to encourage school and community substance abuse prevention partnerships. The PPG program is funded through the federal Substance Abuse Prevention and Treatment Block Grant (Block Grant), administered by the Florida Department of Children and Families (Department) and contracted through this contract with the ME. Attachment I HCO2 (d) Guidance Care Center, Inc. Page 6 of 40 Contract No. PPG-2-03 r� South Florida /� Behavioral Health Network, Inc. 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, ages 0-20, according to the state priorities, to be addressed through this agreement: ®Underage Drinking; ®Marijuana Use; and ®Non -Medical Prescription Drug Use ii. The Network Provider, when requested by the ME, 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: (a) System of Care Development and Management; (b) Utilization Management; (c) Quality Improvement; (d) Data Collection, Reporting, and Analysis; (e) Financial Management; (f) Disaster Planning and Responsiveness a. Authority Section 394.9082, F.S., Prevention Partnership Grant Request for Applications #LHZ03, and the Prime Contract provides the ME with the authority to contract for these services. b. 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 Section B.1.a., of this contract. Services shall also be delivered at the locations specified in, and in accordance with the Program Description, as required by Rule 65E-14.021, F.A.C. which is herein incorporated by reference, and maintained in the ME's contract manager's file. (2) Services are to be delivered in the following county(ies): —Miami-Dade County X Monroe County Attachment I HCO2 (d) Guidance Care Center, Inc. Page 7 of 40 Contract No. PPG-2-03 South Florida Behavioral Health Network, Inc. c. Major Program Goals (1) The overall goals of the PPG program are to: (a) Develop effective substance abuse prevention and early intervention strategies for target populations; and (b) Conduct prevention activities serving students who are not involved in substance use, intervention activities serving students who are experimenting with substance use, or both prevention and intervention activities, if a comprehensive approach is indicated as a result of a needs assessment; and (c) Meet the specific objectives and tasks as defined in and as indicated by the NALM and ME approved CCAP, incorporated herein by reference. d. 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; (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, Attachment I HCO2 (d) Guidance Care Center, Inc. Page 8 of 40 Contract No. PPG-2-03 �� South Florida ��Behavioral Health Network, Inc. (g) Gender responsive, and (h) Sexual orientation 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 shall adhere to services as outlined in the approved Prevention Program Description, incorporated herein by reference and as set forth in in addition to providing services from the list of approved covered services listed in Exhibit G, Covered Service Funding by OCA. 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 ensure that all staff is properly trained as required by the substance abuse licensing Rule 65D-30, F.A.C. (3) The Network Provider shall serve the number of persons indicated in Exhibit D, Substance Abuse and Mental Health Required Outcomes/Outputs within the covered services listed in Exhibit G, Covered Service Funding by OCA. (4) Quarterly Program Status Report: The Network Provider shall submit a quarterly Program Status Report by the dates and to the individual(s) identified in Exhibit C-1, Required Reports for PPG. The report shall provide sufficient detail documenting the progress of the services and activities of the program towards meeting the performance measures, goals, objectives and the tasks outlined in . (5) The Network Provider shall ensure the fidelity of each EBP the agency is utilizing. (6) Annually, when notified by the ME, the Network Provider shall complete an Evidence -based Fidelity Self -Assessment Survey. If warranted, the Network Provider shall complete a Fidelity Improvement Plan as directed by the ME. (7) 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 11/02/2015, 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. (8) For licensable services purchased by this Contract, such as substance abuse prevention 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 Attachment I HCO2 (d) Guidance Care Center, Inc. Page 9 of 40 Contract No. PPG-2-03 '� South Florida �/ Behavioral Health Network, Inc. of the Network Provider's license(s) are suspended, revoked, expired or terminated, the ME 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. (9) By 11/13/2015, 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. This requirement may be waived if the Network Provider has submitted its grievance procedures as a requirement of any other contract held between the Network Provider and the ME for the current fiscal year. (10)By 11/13/2015, the Network Provider shall submit to the ME's contract manager a disaster plan consistent with Paragraph 29., Emergency Preparedness, of the Standard Contract. This requirement may be waived if the Network Provider has submitted its Emergency Preparedness Plan as requirement of any other contract held between the Network Provider and the ME for the current fiscal year. (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 11/13/2015, the Network Provider shall submit to the ME's contract manager a completed Civil Rights Compliance Questionnaire. This requirement may be waived if the Network Provider has submitted a completed Civil Rights Compliance Questionnaire as a requirement of any other contract held between the Network Provider and the ME for the current fiscal year. (13)The Network Provider shall execute or maintain if executed, a Memorandum of Understanding (MOU) or contract with the appropriate Federally Qualified Health Center or other medical facility. The MOU provides for the integration of behavioral health services and primary health care services for all participants and consumers in care. Referral and linkage processes will be necessary for all participants/consumers who do not have a primary care provider at entry into the services in the system of care. Follow up and coordination of services are essential to meeting participant/consumer health and behavioral health needs which result in: • Improved access to primary care services; • Improved prevention, early identification, and intervention to reduce the incidence of serious physical illnesses, including chronic disease; • Increased availability of integrated, holistic care for physical and behavioral disorders; and • Improved overall health status of clients The relationships should be cooperative and reciprocal; that is, the partnership adds value to the program strategies and outcomes and achieves a level of systems improvement beyond the current standards. Programs and coalitions are required, based on the Strategic Prevention Framework (SPF) and all of the Prevention philosophy, to work together to achieve larger system outcomes based on the planning process and following the principles of integrated care. Attachment I HCO2 (d) Guidance Care Center, Inc. Page 10 of 40 Contract No. PPG-2-03 �� South Florida �/ Behavioral Health Network, Inc. In addition, all funded providers will be contractually required to work comprehensively with the funded Evaluation entity. The MOU shall be submitted within ninety (90) days of the effective date of this contract to the ME's contract manager on or before the due date(s) as specified in Exhibit C-1, Required Reports for PPG. The Network Provider shall submit copies of any amendment to the MOU, to the ME's contract manager, within thirty (30) calendar days of execution. 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. This requirement may be waived if the Network Provider has submitted an MOU or policies and procedures as a requirement of any other contract held between the Network Provider and the ME for the current fiscal year. (14)Linkage and Referral Process (a) The Network Providers 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, and primary health care. The Network Provider is responsible for tracking and ensuring that the proper linkages are made and documented in accordance with the requirements in the Coordination Care Plan & Utilization Management Manual. Network Providers are required to submit all required documentation for the initiated referral. (b) The Network Provider may only refer a consumer to a provider that offers the service for which the Network Provider created the referral. (c) 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. (d) 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. (e) If the Network Provider is the receiving provider, and if upon assessing a referred consumer on in -take, 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. (15)Continuous Quality Improvement Programs for Substance Abuse Prevention Services Network Providers (a) The Network Provider must maintain a continuous quality improvement program and Attachment I HCO2 (d) Guidance Care Center, Inc. Page 11 of 40 Contract No. PPG-2-03 '� South Florida ��Behavioral Health Network, Inc. report on the continuous quality improvement activities as required in Section B.1.a. (17) and (19) respectively. The program is the responsibility of the Director and is subject to review and approval by the governing board of the service Network Provider. Each director shall designate a Quality Assurance Officer/Compliance Officer who will be responsible for the continuous quality improvement program. The continuous quality Improvement program should objectively and systematically monitor and evaluate the appropriateness and quality of care to ensure that services are rendered consistent with prevailing professional standards, and identify and resolve problems. (b) The quality improvement program must include at minimum: i. Activities to ensure that fraud, waste and abuse do not occur. ii. 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. iii. A framework for evaluating outcomes, including: 1. Output measures, such as capacities, technologies, and infrastructure that make up the system of care. 2. Process measures, such as administrative and components of the services. 3. Outcome measures pertaining to the outcomes of services; iv. A system of analyzing those factors which have an effect on performance; V. A system of reporting the results of continuous quality improvement reviews; and, A. Best practice models for use in improving performance in those areas which are deficient. vii. Establishment of a Seclusion and Restraint Oversight Committee per Chapter 65E-5.180, F.A.C. for agencies utilizing seclusion and/or restraint. (16) Continuous Quality Improvement Initiatives — Network Providers must comply with all of the provisions for the initiatives outlined below: (a) Integration of Behavioral Health Services and Primary Health Care It is the goal of the ME to ensure the integration of behavioral health services and primary care services to all the consumers in care. The integration will be ensured through linkage of the behavioral health provider with the primary health care provider of the consumer through an electronic health record or other means of contact (phone, in person, etc). Referral and linkage processes will be necessary for all consumers who do not have a primary health care provider at entry into the system of care. Follow Attachment I HCO2 (d) Guidance Care Center, Inc. Page 12 of 40 Contract No. PPG-2-03 South Florida /140000 Behavioral Health Network, Inc. up and coordination of services are essential to meeting consumer health and behavioral health needs. Many individuals with behavioral health issues have chronic health conditions and may have neglected their primary health needs for some time. The ME and the Southern Region are committed to developing an integrated system of care that incorporates comprehensive screening and monitoring tools that identify those affected by chronic health conditions and a system of care that meets their needs. Network Providers will be implementing Integrated Primary and Behavioral Health techniques and initiatives to meet this need. This initiative will be addressed through a continuous quality improvement plan or component in the existing agency wide continuous quality improvement plan that delineates participation in the Health Integration Initiative. As part of the plan or component of the plan must include the following: I. Identification of the Federally Qualified Health Center or other medical facility where consumers who have been identified as needing primary health care services are referred to or the process established by the Network Provider to coordinate services with consumers' private primary health care provider should such exist. ii. A process to track and report outcomes of successful referrals and linkages of consumers of behavioral health services to primary health care services. In addition to tracking and reporting outcomes of consumers referred for behavioral health services by a primary health care provider to the Network Provider. The outcomes must be reported in the semi-annual Continuous Quality Improvement Updates. III. Identification of at least two Integrated Healthcare Champions at the beginning of the contract term and submit the names of the individuals when requested by ME staff. IV. Provide an annual action plan by November 30, 2015, as outlined Section B. 1.a. (18) below, which outlines all of the components/activities identified in your agency's most recently completed Behavioral Health and Primary Health Integrated Care Initiative self -assessment. V. Participation in the regional Healthcare Integration Committee meetings to develop the processes and training germane to this initiative. vi. Attendance of appropriate staff at the regional trainings regarding Integrated Healthcare, as requested by the ME staff. Participation in the trainings will be documented in the Continuous Quality Improvement Updates. (b) Trauma Informed Care 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 Attachment I HCO2 (d) Guidance Care Center, Inc. Page 13 of 40 Contract No. PPG-2-03 South Florida .Behavioral Health Network, Inc. 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 (TIC) initiative through 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: Identification of at least two TIC Champions at the beginning of the contract term and submit the names of the individuals when requested by ME staff. ii. By 03/01/2016 Completion of an annual agency -wide self -assessment using the Fallot Assessment Tool. The results of the self -assessment must be submitted by April 1, 2016, to the individual(s) identified in Exhibit C-1, Required Reports for PPG. iii. Provide an annual action plan which outlines all of the components/activities identified in agency's annual self -assessments for the TIC initiative. iv. Participation in the regional TIC meetings to develop the process for identifying and responding to those affected by trauma. V. Attendance at the regional trainings regarding TIC as applicable. Applicable trainings will be documented in the Continuous Quality Improvement Updates. vi. Participation in all TIC related activities to ensure staff and agency become competent in all areas of trauma informed care. (c) Cultural and Linguistic Competence It is the goal of the ME to become a culturally and linguistically proficient network, through the full implementation of The National Standards for Cultural and Linguistically Appropriate Services (the National CLAS Standards). The National Culturally and Linguistically Appropriate Services (CLAS) Standards in Health and Health Care are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health and behavioral health care. In order to accomplish this task the Network Provider: Identification of at least two CLC Champions at the beginning of the contract term and submit the names of the individuals when requested by ME staff. ii. Participation in the regional CLC meetings. iii. Agrees to complete an annual Cultural and Linguistic survey when directed by the ME. The survey must be completed by multiple staff at various levels of the agency; iv. Agrees to update the annual Cultural and Linguistic Competence Action Plan by November 30, 2015, as outlined Section B. 1.a. (18) below; V. Shall submit the final agency specific Cultural and Linguistic Competence Action Plan based on the National Standards for Culturally and Linguistically Appropriate Services Attachment 1 HCO2 (d) Guidance Care Center, Inc. Page 14 of 40 Contract No. PPG-2-03 South Florida ��Behavioral . Health Network, Inc. (the National CLAS Standards). The plan will outline tasks and objectives that the provider must address during the fiscal year. The action plan must focus on the implementation the CLAS standards and 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; vi. 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; vii. Agrees to implement effective language access services to meet the needs of their limited -English -proficient consumers, and increase their access to behavioral health care by providing sign language, translation, and interpretive services required to meet the communication needs of consumers, including English, Spanish and Creole. Services will meet the cultural needs and preferences of the populations served. (d) Integration of Behavioral Health and the Child Welfare System The Network Provider will ensure that behavioral health services are available to clients referred by the Community Based Care Organizations (CBC) or by the Department's Child Protective Investigators in cases where behavioral health indicators are present 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 behavioral health prevention or treatment services, as well as children in relative placements. For a detailed description of the client eligibility criteria please refer to the approved Motivational Support Program Protocols and Family Intensive Treatment Team Protocols, herein incorporated by reference. ii. The coordination of efforts between the CBC, the ME and Network Providers is essential to the efficient service delivery for child -welfare involved families in behavioral health treatment. The ME and the Southern Region are committed to developing an integrated system of care that meets the needs of children and their families as there is significant overlap between clients. Network Providers will be implementing the Child Welfare Integration (CWI) initiative through a continuous quality improvement plan or component in the existing agency wide continuous quality improvement plan that delineates participation in the CWI initiative. As part of the plan or component of the plan the following must be included: 1. Identification of at least two CWI Champions and submit the names of the Attachment I HCO2 (d) Guidance Care Center, Inc. Page 15 of 40 Contract No. PPG-2-03 '� South Florida /� Behavioral . Health Network, Inc. individuals when requested by ME staff. 2. Participation in the CWI meetings to develop the process for identifying and responding to child -welfare involved families. 3. Attendance at trainings regarding CWI when notified by the ME. Attendance applicable trainings will be documented in the Continuous Quality Improvement Updates. 4. Participation in all CWI related activities to ensure staff and agency become knowledgeable of the Child Welfare system. (e) Accreditation The Network Provider shall take appropriate steps to obtain or maintain national accreditation during state fiscal year 2015-2016 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. The Network Provider that is currently pursuing, intends to pursue, or is required to comply with the CARF Standards for Unaccredited Providers, shall report in the annual Quality Assurance Plan, Quality Improvement Plan and in the semi-annual updates, the steps to be taken towards meeting the requirement to become an accredited provider or meet the CARF Standards for Unaccredited Providers. (17)By 11/02/2015, the Network Provider shall submit to the ME's contract manager 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. This requirement may be waived if the Network Provider has submitted a Quality Assurance Plan as a requirement of any other contract held between the Network Provider and the ME for the current fiscal year. The Network Provider shall submit updates as amended of the Quality Assurance Plan within thirty (30) days of adoption. The Quality Assurance Plan should address 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, trauma informed services, and cultural and linguistic competence. (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. Attachment I HCO2 (d) Guidance Care Center, Inc. Page 16 of 40 Contract No. PPG-2-03 `� South Florida �/ Behavioral Health Network, Inc. (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. (i) The Continuous Quality Improvement Initiatives identified in Section B.1.a. (15) above. (18) By 11/02/2015 the Network Provider shall establish a Quality Improvement Plan, herein incorporated by reference, which includes the quality improvement activities for fiscal year 2015-2016 to improve performance. The Quality Improvement Plan may be submitted with the Quality Assurance Plan as one document or separately. The Quality Improvement Plan must include, at minimum, the CQI activities associated with the integration of Behavioral Health and Primary Health Care, integration of behavioral health and child welfare, Trauma Informed Care, Cultural and Linguistic Competence, evidence -based practices, referral and linkage to primary care for consumers of behavioral health services, and accreditation. (19)By 11/02/2015, the Network Provider shall submit a single agency action plan which outlines all of the components/activities identified in agency's annual self -assessments for each initiative. For example, the Integrated Healthcare Initiative (Behavioral Health and Primary Health Care) action plan should be developed based on the results of the most recently completed self - assessment, the Trauma Informed Care action plan shall be developed based on the results of the most recently completed Fallot Tool, and the Cultural and Linguistic Competence action plan shall be based on the results of the Cultural and Linguistic Competence survey. (20) Continuous Quality Improvement Updates The Network Provider shall submit semi-annual updates on the implementation of the performance measures and activities included in the annual Quality Improvement Plan and progress on the implementation of the agency's action plan to the ME's contract manager by the dates specified in Exhibit C-1, Required Reports for PPG. Each update shall include, at minimum, the following: (a) Evidence -based practices (EBPs) utilized by the agency and how these EBPs are monitored to ensure fidelity to the model. (b) Evidence of the implementation of the integration of behavioral health services and primary health care, evidence of tracking and ensuring the successful referrals and linkages of consumers of behavioral health services to primary health care services and consumers referred from the primary health care provider to the Network Provider for behavioral health services, and include progress on the implementation as described in the Network Provider's action plan. (c) Evidence of the implementation of the TIC initiative throughout the agency, including progress on the implementation of a TIC action plan that shall include incorporated results of the agency -wide self -assessment tool and the activities listed below: i. An overview of the Network Provider's TIC capabilities with regard to service structure (assessment, stabilization, treatment, support, and other services); Attachment I HCO2 (d) Guidance Care Center, Inc. Page 17 of 40 Contract No. PPG-2-03 �J South Florida �/ Behavioral ' Health Network, Inc. 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. (d) Evidence of the implementation of Cultural and Linguistic Competence, including progress on the implementation of the Cultural and Linguistic Competence Action Plan. (e) Evidence of the progress on steps to taken towards meeting the requirement to become an accredited provider or meet the CARF Standards for Unaccredited Providers. (f) Document participation in trainings and activities relating to the Child Welfare Integration Initiative. (21)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-1, Required Reports for PPG. The Network Provider agrees to provide the ME with any requests for additional financial statements/documentation. (b) Network Providers who withhold income taxes, social security tax, or Medicare tax from employee's paychecks or who must pay the employer's portion of social security or Medicare tax must use Form 941, Employer's Quarterly Federal Tax Return, to report those taxes. On a quarterly basis, and by the dates specified in Exhibit C-1, Required Reports, the Network Provider, shall submit an attestation that the 941 has been filed timely and any taxes due have been paid timely to IRS. (c) Quarterly and Final Expenditure Report: The Network Provider shall submit a quarterly expenditure report to by the dates and to the individuals identified in Exhibit C- 1, Required Reports for PPG. The expenditure report will track program expenses that are associated with the grant and reconciles these expenditures with the payments made to the Network Provider. The expenditure report will track both grant award - funded and match -funded expenses. The Network Provider shall return to the ME any unused PPG funds and unmatched grant funds no later than sixty (60) days following the end of each fiscal year. (d) The Network Provider shall complete and submit the Department -approved Local Match Calculation Form, per the schedule and to the individual(s) identified in the Exhibit C-1 Required Reports for PPG. The Department -approved Local Match Calculation Form is available at the following website: Attachment I HCO2 (d) Guidance Care Center, Inc. Page 18 of 40 Contract No. PPG-2-03 �� South Florida //Behavioral Health Network, Inc. http://sfbhn.org/wordpress/wp-content/uploads/Incorporated-Document-30-Local- Match-Calculation-Form-August-18-2014.xlsx (22)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. (23)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: http://www.dcf.state.fl.us/admin/publications/policies/215-8.Pdf 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. (24)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. (25)The Network Provider shall attend required trainings and/or meetings as required by the ME, meet with the ME's staff at regularly scheduled or specially called meetings when notified by the ME. (26)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. (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) 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. (29) 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. Attachment I HCO2 (d) Guidance Care Center, Inc. Page 19 of 40 Contract No. PPG-2-03 South Florida 'Behavioral Health Network, Inc. (30) 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. (31) Develop, Maintain and Improve Reporting The Network Provider shall submit reports included in Exhibit C-1, Required Reports for PPG. 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. (32) Client Satisfaction Survey 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. (33)lf requested by the ME, the Network Provider agrees to assist in the development and implementation of a the Care Coordination and Utilization Management (UM) System and shall maintain the capacity to perform the following functions including, but not limited to: (a) ME -approved automated, standardized, and 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; Attachment I HCO2 (d) Guidance Care Center, Inc. Page 20 of 40 Contract No. PPG-2-03 &14000 South Florida Behavioral Health Network, Inc. (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 0) Full compliance with federal and state laws, rules and regulations pertaining to security and privacy of protected health information. 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 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 (1) The Network Provider shall maintain staffing levels in compliance with applicable rules, statutes, and licensing standards. See Exhibit F, State and Federal Laws, Rules and Regulations. (2) The Network Provider shall engage in recruitment to maintain as much as possible staff with the ethnic and racial composition of the clients/participants served. (b) Professional Qualifications (1) The Network Provider shall comply with applicable rules, statutes, requirements, and standards with regard to professional qualifications. See Exhibit F, State and Federal Laws, Rules and Regulations. (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. (3) 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. (4) Network Providers who have programs for children are required to meet the requirements of Attachment I HCO2 (d) Guidance Care Center, Inc. Page 21 of 40 Contract No. PPG-2-03 /� South Florida �/ Behavioral . Health Network, Inc. s. 39.001(2), (a) and (b) F.S which states the following: a. If the department contracts with a provider for any program for children, all personnel, including owners, operators, employees, and volunteers, in the facility must be of good moral character. A volunteer who assists on an intermittent basis for less than 10 hours per month need not be screened if a person who meets the screening requirement of this section is always present and has the volunteer within his or her line of sight. b. The department shall require employment screening, and rescreening no less frequently than once every 5 years, pursuant to chapter 435, using the level 2 standards set forth in that chapter for personnel in programs for children or youths. (c) Staffing Changes The Network Provider shall notify the ME's contract manager, in writing within ten (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 services related to the performance required under this Contract, subject to the provisions relating to Assignments and Subcontracts in the Standard Contract and referenced therein. Written requests by the Network Provider to subcontract for the provision of services under this contract will be routed through the ME's contract manager for approval. The ME is not obligated nor will it pay for any services delivered prior to its written approval of the act of subcontracting. The act of subcontracting shall not in any way relieve the Network Provider of any responsibility for the contractual obligations of this contract. The pre -approval process applies to Subcontractors and not Independent Contractors as defined below. (2) The ME has adopted the following definitions for vendors, subcontractors and/or independent contractors who are contracted by the Network Provider to do work contemplated under this contract: (a) Vendor: A person or company offering something for sale. (b) Subcontractor: A business to business relationship; contracting a business or person outside of one's own company to do work as part of a larger project. (c) Independent Contractor: a person who is in an independent trade, business, or profession in which they offer their services and/or expert advice to an individual or organization. The general rule is that an individual is an independent contractor if the payer has the right to control or direct only the result of the work and not what will be done and how it will be done. The earnings of a person who is working as an independent contractor are subject to Self -Employment Tax. (3) 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 Attachment I HCO2 (d) Guidance Care Center, Inc. Page 22 of 40 Contract No. PPG-2-03 ��► South Florida /� Behavioral . Health Network, Inc. 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)]. http://sfbhn.orglwordpress/wp-content/uploadsISAMHSA-Guidance-on-SAPT-and-CMHSBG- Reguirements.Of (4) Any vendor, subcontractor, or independent contractor the Network Provider contracts to do work contemplated under this contract, and who meets the definition of a Business Associate as defined in 45 CFR 160.103, must sign a legally binding document with the Network Provider that contains the same restrictions and conditions of the Business Associate Agreement between the Network Provider with the ME. The binding document must meet the requirements of 45 CFR s.164.504(e), Standard: Business Associate Contracts, the Privacy Rule, the Security Rule, the Breach Notification Rule, the Health Information Technology for Economic and Clinical Health ("HITECH") Act, the provisions included in the Network Provider's Business Associate Agreement with the ME, the ME's contractual requirements, and other laws and regulations pertaining to access, use, disclosure, and management of Protected Health Information ("PHI") without limitation, PHI in an electronic format (EPHI) created, received, maintained, or transmitted by the Network Provider or its subcontractors incidental to Network Provider's performance of this Contract. (5) All agreements, for services contemplated under this contract, shall adopt the applicable terms and conditions of the Network Provider's contract with the ME, including but not limited to, any Federal block grant requirements. In addition, all subcontract agreement's shall contain the applicable terms and conditions, and any amendments thereto, found in the ME's contract with the Department (Prime Contract), which is incorporated herein by reference. Subcontract agreements shall include a detailed scope of work; term of the agreement, method of payment, clear and specific deliverables; and performance standards. (6) The Network Provider shall maintain individual subcontractor files for each subcontractor and provide a copy of all subcontracts agreements prior to the execution of those subcontracts and any amendments to the ME's contract manager. (7) All independent contractor agreements, and subcontractor agreement, vendor agreements, and business associate agreements, or other legally binding agreements, for work contemplated under this contract shall be available upon request by ME staff and at the time of monitoring. (8) 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. (9) 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 Attachment I HCO2 (d) Guidance Care Center, Inc. Page 23 of 40 Contract No. PPG-2-03 South Florida ��Behavioral . Health Network, Inc. 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. (10) 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 covered services, the Network Provider shall conduct a cost analysis for said subcontract, in accordance with Rule 65E-14. 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-14.19, F.A.C., Methods of Paying for Services, including but not limited to, covered services, measurement standard, 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. (11) The Network Provider shall monitor the performance of all subcontractors, and perform follow up actions as necessary. The Network Provider shall notify the ME immediately upon discovery 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 Prevention Program Description required by Rule 65E-14, F.A.C. and/or as specified in .. 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. (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, 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, F.A.C. Attachment I HCO2 (d) Guidance Care Center, Inc. Page 24 of 40 Contract No. PPG-2-03 �� South Florida //Behavioral Health Network, Inc. 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-1, 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 approved Prevention Program Description submitted by the Network Provider in accordance with Exhibit G, Covered service Funding by OCA and in. b. Records and Documentation The Network Provider shall protect confidential records from disclosure and protect client/participant 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 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 ME financial and programmatic reports specified in Exhibit C-1, Required Reports for Prevention Partnership Grant„ by the dates specified or as requested by ME staff. (2) 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. (3) 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 Attachment 1 HCO2 (d) Guidance Care Center, Inc. Page 25 of 40 Contract No. PPG-2-03 ��/ South Florida //Behavioral Health Network, Inc. mutually viable work plan. (4) The Network Provider shall ensure that its audit report will include the standard schedules that are outlined in Rule 65E-14, F.A.C. and submitted within the timeframes specified in Exhibit C-1, Required Reports for Prevention Partnership Grant, (5) In addition to the modifiers to procedure codes that are currently required to be utilized as per DCF PAM 155-2, Appendix 2, the Network Provider is directed to utilize the modifiers required for the services funded by the Other Cost Accumulators (OCAs) listed on the following website: http://www myflfamilies.com/service-programs/substance-abuse/pamphlet-155-2 (6) In addition to utilizing the modifiers to procedure codes for block grant funds identified in Section B. 4. (5) 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, if such funding is received. (7) The Network Provider shall submit prevention services data to PBPS or other data/reporting system designated by the ME. The data shall be submitted electronically no later than the 4th of each month following the month of service. 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, or other designated reporting system, is consistent with the data maintained in the Network Providers service documentation and or/ client files. (c) 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 when the rejected records will be corrected and resubmitted; and (d) 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. (8) Upon request, the Network Provider shall submit to the ME and/or the Department, information regarding the amount and number of services paid for by 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 I HCO2 (d) Guidance Care Center, Inc. Page 26 of 40 Contract No. PPG-2-03 �/ �� South Florida Behavioral Health Network, Inc. (2) The Network Provider agrees that the ODH, 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. 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. 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 ME to objectively measure a Network Provider's performance, and contain policies and procedures for submitting the required data. c. Performance Evaluation Methodology (1) The Network Provider shall collect information and submit performance data and individual client/participant 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: http://www.myflfamilies.com/service-programs/substance-abuse/pamphlet-155-2 (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 , during the contract period, to determine if the Network Provider is achieving the levels that are specified (5) Performance data information may be found on the department's web -based performance Dashboard at: http://dcfdashboard.dcf.state.fl.us/. Additional prevention data information may be found on the Exhibit D Substance Abuse and Mental Health Required Performance Outcomes/Outputs Report which is transmitted to the ME Director of Prevention Services, as requested. 6. Network Provider Responsibilities a. Network Provider Unique Activities (1) The Network Provider shall adhere to the deliverables as set forth in . Attachment I HCO2 (d) Guidance Care Center, Inc. Page 27 of 40 Contract No. PPG-2-03 �� South Florida //Behavioral Health Network, Inc. (2) In the event of a dispute as to the ME's determination regarding client/participant 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. (3) 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. (4) 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. (5) 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/participant, 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. (6) 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/participant information system and reconciled with ODH, PBPS, or other data reporting system designated by the ME. (7) 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). (8) The Network Provider receives federal block grant funds from the Substance Abuse Prevention and Treatment or Community Mental Health Block Grants and by signing this contract 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). (9) The Network Provider receives funding from the SAPTBG and by signing this contract 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. (10)The Network Provider shall make available to the ME and the Department all records pertaining to service delivery. These records shall be made available at all reasonable times for inspection, review, copying, or audit. Service delivery records include but are not limited to, invoicing, fiscal management, data management, incident reporting, client records, and such documents determined Attachment I HCO2 (d) Guidance Care Center, Inc. Page 28 of 40 Contract No. PPG-2-03 '� South Florida /� Behavioral Health Network, Inc. to assure accountability of service provision and/or the expenditure of state and federal funds. (11)The Network Provider shall assist the ME and the Department in developing legislative budget requests based upon identified needs of the community. (12)The Network Provider shall provide to the ME, copies of, including but not limited to, evaluations, assessments, surveys, monitoring reports that pertain to licensure, accreditation, or other administrative or programmatic review, when those reports identify deficiencies that require corrective action. The Network Provider shall submit to the ME all of the applicable reports, including copies of the corrective action plan(s) within ten (10) calendar days of receipt by the Network Provider from the reviewing entity. (13)The Network Provider shall cooperate with the ME and the Department when investigations are conducted regarding a regulatory complaint of the Network Provider. (14)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. (15)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. (16)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. (17)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. (18)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, State and Federal Laws, Rules, and Regulations and ME policies and procedures. (19)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(1) 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. Attachment I HCO2 (d) Guidance Care Center, Inc. Page 29 of 40 Contract No. PPG-2-03 ��/ South Florida IBehavioral Health Network, Inc. (20)Health Insurance Portability and Accountability Act (HIPAA) (a) In compliance with 45 CFR s.164.504(e), the Network Provider shall comply with the provisions of the Business Associate Agreement, incorporated herein by reference to this Contract, governing the safeguarding, use and disclosure of Protected Health Information created, received, maintained, or transmitted by the Network Provider or its subcontractors incidental to Network Provider's performance of this Contract. (b) A violation or breach of any of the assurances as stipulated in the Business Associate Agreement shall constitute a material breach of this contract. (21) National Voter Registration Act (NVRA) of 1993 (a) The Network Provider shall comply with the National Voter Registration Act (NVRA) of 1993, Pub. L. 103-31 (1993), sections 97.021 and 97.058, F.S., and ch. 2.048, F.A.C. (b) As a Voter Registration Agency, the Network Providers shall designate a Voting Registration Activities Coordinator and provide the contact information of the Coordinator by the date and to the individual(s) identified in Exhibit C-1, Required Reports for PPG. The Network Provider shall notify the ME's contract manager, in writing within (10) calendar days of staffing changes regarding this position. (c) As a Voter Registration Agency, the Network Provider shall provide individuals seeking services and/or individuals served with an opportunity at admission or when they change an address, to either register or update their voter registration. The National Voter Registration Act Preference Form/Application, DS-DE77-ENG and DS-DE77-SPN, are available at: http://dos.myflorida.com/elections/forms-publications/forms/ (d) The Network Provider shall submit a NVRA Voter Registration Agencies Quarterly Activities Report Form, DS-DE131, by the dates and to the individual(s) identified in Exhibit C-1, Required Reports for PPG. The Quarterly Activity Report Form is available at: http://dos.myflorida.com/elections/forms-publications/forms/ b. Coordination with other Providers/Entities (1) The Network Provider shall develop, maintain, and improve care coordination and integrated care systems as follows: (i) Collaboration with other ME funded prevention services Network Providers to include collaboration with the entity contracted by the ME to conduct an evaluation of the prevention system. (ii) 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. Attachment I HCO2 (d) Guidance Care Center, Inc. Page 30 of 40 Contract No. PPG-2-03 South Florida Behavioral Health Network, Inc. (2) 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. State and Federal Laws, Rules, and Regulations See Exhibit F, State and Federal Laws, Rules and Regulations. 7. ME Responsibilities a. ME 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 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 the Network Provider 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 inquiries 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 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 Attachment I HCO2 (d) Guidance Care Center, Inc. Page 31 of 40 Contract No. PPG-2-03 &100000 South Florida Behavioral Health Network, Inc. (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 monitor(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) Network Providers with electronic health record (EHR) or electronic medical record systems (EMR) shall provide access to ME funded service and client/participant data contained in these systems to the ME's monitoring team and provide sufficient resources to facilitate the monitoring process of services provided under this contract. Resources is defined but is not limited to, personnel, terminals, guest read-only accounts, privileges for monitors to access client/participant records, and/or remote access into the systems by the monitors. (3) The ME will monitor the Network Provider on its performance of all tasks and special provisions of the contract. (4) The ME will provide a written report to the Network Provider within thirty (30) calendar days of the exit conference. 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/participant, 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. 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/participants, 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. ME 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): Attachment I HCO2 (d) Guidance Care Center, Inc. Page 32 of 40 Contract No. PPG-2-03 /� South Florida /� Behavioral Health Network, Inc. (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/participants 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, Monthly Payment Request (Incorporated herein by reference and available at following website: http://sfbhn.org/providers/contracts/ Exhibit G, Covered Service Funding by OCA Exhibit H, Funding Detail and Local Match D. Special Provisions 1. The Network Provider is expected to reduce its administration cost to 10.00% or less for Fiscal Year 2015-2016 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 SAMH Projected Operating and Capital Budget (CF-MH 1042, July 2014, Rule 65E-14.021(5), F.A.C.) shall evidence the reduction and redistribution of the cost savings. 2. Renewal: This is a three (3) year contract, subject to the availability of funds, awarded to the Network Provider as a result of a successful response to the Florida Department of Children and Families Prevention Partnership Grant Fiscal Year 2015-2018 Request for Applications (RFA) #LHZ03. This contract may be renewed only as directed by the Florida Department of Children and Families. Funding in Years 2 and 3 are contingent upon compliance with the requirements of the PPG Program and demonstration of performance towards meeting the grant goals and objectives and the availability of funds. Any renewal shall be in writing. 3. 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 immediately upon discovery. 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 Attachment I HCO2 (d) Guidance Care Center, Inc. Page 33 of 40 Contract No. PPG-2-03 South Florida Behavioral Health Network, Inc. information or documentation is requested, the Network Provider will submit the information requested by the ME within 24 hours unless otherwise specified in the request. 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. 4. Mandatory Reporting Requirements a. The Network Provider and any subcontractor must comply with and inform its employees of the following mandatory reporting requirements. Each employee of the Network Provider, and of any subcontractor, providing services in connection with this contract who has any knowledge of a reportable incident shall report such incident as follows: (1) Reportable incidents that may involve an immediate or impending impact on the health or safety of a client/participant 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@myflfamilies.com. 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. c. In the event of a breach or potential breach of Protected Health Information, the Network Provider is directed to the reporting requirements delineated in the executed Business Associate Agreement, incorporated herein by reference. 5. Service Provision Requirements for Substance Abuse Prevention and Treatment Block Grants, only if applicable. a. As required by 45 C.F.R. ss. 96.17, the Network Provider may be requested to provide information to the ME for the purposes of reporting on SAPTBG activities to the Department. b. The Network Provider shall ensure compliance with 45 C.F.R. Subpart C — Financial Management. c. As applicable, the Network Provider shall comply with the requirements set forth in 45 C.F.R. Subpart L — Substance Abuser Prevention and Treatment Block Grant. d. The Network Provider agrees to comply with the data submission requirements outlined in DCF PAM 155-2. e. In addition to the modifiers to procedure codes that are currently required to be utilized as per Attachment I HCO2 (d) Guidance Care Center, Inc. Page 34 of 40 Contract No. PPG-2-03 &100000 South Florida Behavioral Health Network, Inc. DCF PAM 155-2, Appendix 2, the Network Provider is directed to utilize the modifiers required for Block Grant funds, where applicable. This list of modifiers with their corresponding Other Cost Accumulators (OCAs) are found at the following website: http://www.myflfamilies.com/service-programs/substance-abuse/pamphlet-155-2 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)] http://sfbhn org/wordpress/wp-contentluploadsISAMHSA-Guidance-on-SAPT-and-CMHSBG- Reguirements.Pdf 6. 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. 7. Sliding Fee Scale Prevention services are exempt from the Sliding Fee Scale requirements per Rule 65E-14.018, F.A.C. 8. Medicaid Enrollment 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. 9. 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: Attachment I HCO2 (d) Guidance Care Center, Inc. Page 35 of 40 Contract No. PPG-2-03 ��► South Florida 14000 Behavioral Health Network, Inc. (1) The Florida Medicaid HIPAA located at: http://www.fdhc.state.fl.us/hipaa/index.shtml (2) The National Plan and Provider Enumeration System (NPPES) located at: hftps://nppes.cms.hhs.gov/NPPES/Welcome.do (3) 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 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. 11. 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. 12. 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, SAMH Projected Operating and Capital Budget, Agency Capacity Report, 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. 13. 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 Attachment I HCO2 (d) Guidance Care Center, Inc. Page 36 of 40 Contract No. PPG-2-03 &100000 South Florida Behavioral Health Network, Inc. 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. 14. 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. 15. 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, Attachment I HCO2 (d) Guidance Care Center, Inc. Page 37 of 40 Contract No. PPG-2-03 '� South Florida /� Behavioral Health Network, Inc. record the number and description of the components making up the group, name, make, or manufacturer, serial number(s), if any, and if an automobile, the VIN and certificate number; acquisition date, original acquisition cost, funding source, information needed to calculate the federal and/or state share of its cost. (5) The ME's contract manager must provide disposition instructions to the provider prior to the end of the contract period. The provider cannot dispose of any property that reverts to the ME or department without the contract manager's approval. The provider shall furnish a Closeout Inventory Form no later than 30 days before the completion or termination of this contract. The Closeout Inventory Form shall include all nonexpendable property including all computers purchased by the provider. The Closeout Inventory Form shall contain, at a minimum, the same information required by the annual inventory. (6) The provider hereby agrees that all inventories required by this contract shall be current and accurate and reflect the date of the inventory. If the original acquisition cost of a property item is not available at the time of inventory, an estimated value shall be agreed upon by both the provider and the ME and shall be used in place of the original acquisition cost. (7) Title (ownership) to and possession of all property purchased by the provider pursuant to this contract shall be vested in the ME upon completion or termination of this contract. During the term of this contract, the provider is responsible for insuring all property purchased by or transferred to the provider is in good working order. The provider hereby agrees to pay the cost of transferring title to and possession of any property for which ownership is evidenced by a certificate of title. The provider shall be responsible for repaying to the ME the replacement cost of any property inventoried and not transferred to the ME upon completion or termination of this contract. When property transfers from the provider to the ME, the provider shall be responsible for paying for the title transfer. (8) If the provider replaces or disposes of property purchased by the provider pursuant to this contract, the provider is required to provide accurate and complete information pertaining to replacement or disposition of the property as required on the provider's annual inventory. (9) The provider hereby agrees to indemnify the ME and the department against any claim or loss arising out of the operations of any motor vehicle purchased by or transferred to the provider pursuant to this contract. (10) A formal contract amendment is required prior to the purchase of any property item not specifically listed in the approved contract budget. b. Title to Vehicles (1) Title (ownership) to, and possession of, all vehicles acquired with funds from this contract shall be vested in the ME upon completion or termination of the contract. The provider will retain custody and control during the contract period, including extensions and renewals. (2) During the term of this contract, title to vehicles furnished by the state or acquired at the direction of the state (using state or federal funds) shall not be vested in the provider. Subcontractors shall not be assigned or transferred title to these vehicles. The provider hereby agrees to indemnify the ME or the department against any claim or loss arising out of the operations of any motor vehicle purchased by or transferred to the provider pursuant to this contract. 16. Special Insurance Provisions a. The Network Provider shall notify the ME Contract Manager within thirty (30) calendar days if there is a modification to the terms of insurance including but not limited to, cancellation or Attachment I HCO2 (d) Guidance Care Center, Inc. Page 38 of 40 Contract No. PPG-2-03 South Florida .Behavioral Health Network, Inc. modification to policy limits b. The Network Provider acknowledges that, as an independent contractor, the Network Providers, and its subcontractors, at all tiers are not covered by the State of Florida Risk Management Trust Fund for liability created by s. 284.30, F.S. c. The Network Provide shall obtain and provide proof to the ME's Contract Manager of comprehensive general liability insurance coverage (broad form coverage), specifically including premises, fire and legal liability to cover managing the Network Provider and all of its employees. The limits of Network Provider's coverage shall be no less than $300,000 per occurrence with a minimal annual aggregate of no less than $1,000,000. d. The ME shall cause all Network Service Providers, at all tiers, who the ME reasonably determines to present a risk of significant loss to the ME or the Department, to obtain and provide proof to ME and the Department of comprehensive general liability insurance coverage (broad form coverage), specifically including premises, fire and legal liability covering the Network Service Provider and all of its employees. The limits of coverage for the ME's Network Service Providers, at all tiers, shall be in such amounts as the ME reasonably determines to be sufficient to cover the risk of loss. e. If any officer, employee, or agent of the ME operates a motor vehicle in the course of the performance of its duties under this contract, the ME shall obtain and provide proof to the Department of comprehensive automobile liability insurance coverage. The limits of the ME's coverage shall be no less than $300,000 per occurrence with a minimal annual aggregate of no less than $1,000,000. f. If any officer, employee, or agent of any Network Service Provider, at all tiers, operates a motor vehicle in the course of the performance of the duties of the Network Service Provider, the ME shall cause the Network Service Provider to obtain and provide proof to the ME and the Department of comprehensive automobile liability insurance coverage with the same limits. g. The ME shall obtain and provide proof to the Department of professional liability insurance coverage, including errors and omissions coverage, to cover the ME and all of its employees. If any officer, employee, or agent of the ME administers any prescription drug or medication or controlled substance in the course of the performance of the duties of the ME under this contract, the professional liability coverage shall include medical malpractice liability and errors and omissions coverage, to cover the ME and all of its employees. The limits of the coverage shall be no less than $300,000 per occurrence with a minimal annual aggregate of no less than $1,000,000. If any officer, employee, or agent of the Network Service Provider, at all tiers, provides any professional services or provides or administers any prescription drug or medication or controlled substance in the course of the performance of the duties of the Network Service Provider, the ME shall cause the Network Service Provider, at all tiers, to obtain and provide proof to the ME and the Department of professional liability insurance coverage, including medical malpractice liability and errors and omissions coverage, to cover all Network Service Provider employees with the same limits. The ME and the Department shall be exempt from, and in no way liable for, any sums of money that may represent a deductible or self -insured retention under any such insurance. The payment of any deductible on any policy shall be the sole responsibility of the Network Provider purchasing the insurance. Attachment I HCO2 (d) Guidance Care Center, Inc. Page 39 of 40 Contract No. PPG-2-03 �01 ', South Florida Behavioral Health Network, Inc. All such insurance policies of the Network Providers, and its subcontractors at all tiers, shall be provided by insurers licensed or eligible to do and that are doing business in the State of Florida. Each insurer must have a minimum rating of "A" by A. M. Best or an equivalent rating by a similar insurance rating firm, and shall name the ME and the Department as an additional insured under the policy(ies). The Network Provider shall use its best good faith efforts to cause the insurers issuing all such general, automobile, and professional liability insurance to use a policy form with additional insured provisions naming the ME and the Department as an additional insured or a form of additional insured endorsement that is acceptable to the ME and the Department in the reasonable exercise of its judgment. k. All such insurance proposed by the ME shall be submitted to and confirmed by the Contract Manager annually by March 31. I. The requirements of this section shall be in addition to, and not in replacement of, the requirements of Section 10, of the Standard Contract to which this Attachment I is attached, but in the event of any inconsistency between the requirements of this section and the requirements of the Standard Contract, the provisions of this section shall prevail and control. 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 3. Exhibit C-1, Required Reports for Prevention Partnership Grant 4. Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs 5. Exhibit E, Monthly Payment Request 6. Exhibit F, State and Federal Laws, Rules and Regulations 7. Exhibit G, Covered Service Funding by OCA 8. Exhibit H, Funding Detail & Local Match Plan Attachment I HCO2 (d) Guidance Care Center, Inc. Page 40 of 40 Contract No. PPG-2-03 South Florida Behavioral Health Nehsork, 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: Non -Prevention Prevention ❑ Adult Mental Health -Severe & Persistent Mental Illness ® Adult Substance Abuse ❑ Adult Mental Health -Serious & Acute Episodes of Mental Illness ® Children's Substance Abuse ❑ Adult Mental Health -Mental Health Problems ❑ Substance Abuse Community Coalition ❑ Adult Mental Health -Forensic Involvement ❑ Children's Mental Health -Serious Emotional Disturbances ❑ Children's Mental Health -Emotional Disturbances ❑ Children's Mental Health -At Risk of Emotional Disturbances ❑ Adult Substance Abuse ❑ Children's Substance Abuse B. C I ient/Partici pant 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 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.shtml) and is incorporated herein by reference. 2. Behavioral Health services shall be provided to persons pursuant to s. 394.674, F.S., including those individuals who have been identified as requiring priority by state or federal law. These identified priorities include, but are not limited to, the categories in sections (a) through 0), below. Persons in categories (a) and (b) are specifically identified as persons to be given immediate priority over those in any other categories. a. Pursuant to 45 C.F.R. s. 96.131, priority admission to pregnant women and women with dependent children by Network Service Providers receiving SAPT Block Grant funding; b. Pursuant to 45 C.F.R. s. 96.126, compliance with interim services, for injection drug users, by Network Service Providers receiving SAPT Block Grant funding and treating injection drug users; c. Priority for services to families with children that have been determined to require substance abuse and mental health services by child protective investigators and also meet the target populations in subsections (a) or (b), below. Such priority shall be limited to individuals that are not enrolled in Medicaid or another insurance program, or require services that are not paid by another payor source: (1) Parents or caregivers in need of adult mental health services pursuant to s. 394.674(1)(a)2., F.S., based upon the emotional crisis experienced from the potential removal of children; and (2) Parents or caregivers in need of adult substance abuse services pursuant to Exhibit A Guidance Care Center, Inc. Page 1 of 3 Contract No. PPG-2-03 South Florida Beha-,ioral Health NctN�ork, Inc. s. 394.674(1)(c)3., F.S., based on the risk to the children due to a substance use disorder. d. Individuals who reside in civil and forensic state Mental Health Treatment Facilities and individuals who are at risk of being admitted into a civil or forensic state Mental Health Treatment Facility pursuant to s. 394.4573, F.S., Rules 65E-15.031 and 65E-15.071, F.A.C.; e. Individuals who are voluntarily admitted, involuntarily examined, or placed under Part I, Chapter 394, F.S.; f. Individuals who are involuntarily admitted under Part V, Chapter 397, F.S.; g. Residents of assisted living facilities as required in s. 394.4574 and 429.075, F.S.; h. Children referred for residential placement in compliance with Ch. 65E-9.008(4), F.A.C.; and i. Inmates approaching the End of Sentence pursuant to Children and Families Operating Procedure (CFOP) 155-47. j. In the event of a Presidential Major Disaster Declaration, Crisis Counseling Program (CCP) services shall be contracted for according to the terms and conditions of any CCP grant award approved by representatives of the Federal Emergency Management Agency (FEMA) and the Substance Abuse and Mental Health Services Administration (SAMHSA). 3. 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 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, State and Federal Laws, Rules, and Regulations. The ME reserves the right to review the network 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 no circumstances shall an individual's county of residence be a factor that denies access to service. Authorized services shall only be provided within the serviced area(s) outlined in Attachment 1, Section A.2.c.(2), subject to the availability of funds. 3. In the event of a dispute regarding client eligibility and/or placement into the appropriate level of care, the dispute shall not preclude the Network Provider from providing the provision of services to eligible individuals until the dispute is resolved. The dispute resolution process is described in Paragraph 42. of the Standard Contract. 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 The network provider is not authorized to bill the ME for more units than can be purchased with the amount of funds specified in Exhibit G, Covered Service Funding by OCA, 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. Exhibit A Guidance Care Center, Inc. Page 2 of 3 Contract No. PPG-2-03 South Florida Behavioral Health ;NchFork, Inc. 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. Exhibit A Guidance Care Center, Inc. Page 3 of 3 Contract No. PPG-2-03 South Florida Behavioral Health Nemork, Inc. Exhibit B Method of Payment Payment Clauses This is a fixed price (unit cost) contract. The unit prices are listed on Exhibit G, Covered Service Funding by OCA. 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 $450 000.00 ($150,000.00 per fiscal year of this contract), 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 $450,000.00, 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. Pursuant to s. 394.76(3), Florida Statutes (F.S.), the provider agrees to provide local matching funds in the amount of $112,500.00 ($37,500.00 per fiscal year of this contract) as indicated in Exhibit H, Funding Detail and Local Match Plan. c. Should the Network Provider receive any funding from the "Uncompensated Units Reimbursement Funds", then the amount of Local Match Plan 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 the local match requirement i. Deinstitutionalization Proiects Case Management Intensive Case Management Residential Services I -IV Supported Housing/Living Short Term Residential Treatment (not exempt if funded by Baker Act funds or operated by a public receiving facility) FACT Teams CMH Programs (100435 Category & 102780 (PRTS) Category) that are not grant funded. d. In accordance with the provisions of s. 402.73(1), F.S., and Rule 65-29.001, Florida Administrative Code (F.A. C.), corrective action plans may be required for noncompliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed, to include contract termination in whole or in part, for failures to implement or to make acceptable progress on such corrective action plans. Exhibit B Page 1 of 5 Guidance Care Center, Inc. Contract No. PPG-2-03 South Florida Behavioral Health Netisork, Inc. e. 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-1, Required Reports. f. 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. g. 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 covered service as given on Exhibit G, Covered Service Funding by OCA, or twenty-five percent (25%) of the prorated share of the amount of funding as specified on Exhibit G, Covered Service Funding by OCA. h. The ME in its sole discretion and subject to funding availability, may purchase from any Network 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. Third Party Billing, if applicable. 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. The Network Provider shall not bill the ME for services provided to: i. Individuals who have third party insurance coverage when the services provided are covered under the insurance plan; or ii. Medicaid enrollees or recipients of another publically funded health benefits assistance program, when the services provided are covered by said program. b. The Network Provider may bill the ME if services are provided to: i. Individuals who have lost coverage through Medicaid, or any other publically funded health benefits assistance program coverage for any reason during the period of non -coverage; or ii. Individuals who have a net family income at or above 150 percent of the Federal Poverty Income Guidelines, subject to the sliding fee scale requirements in Rule 65E-14.018 F.A.C. iii. The Network Provider shall ensure that Medicaid funds are accounted for separately from funds for this contract. c. In no event shall Medicaid, any health insurance, another publically funded health benefits assistance program, or the ME be billed for the same service provided to the same individual on the same day. d. Medicaid earnings cannot be used as local match. Exhibit B Page 2 of 5 Guidance Care Center, Inc. Contract No. PPG-2-03 South Florida Behavioral llcalth Network, Inc. e. The Network Provider shall ensure that Medicaid payments are accounted for in compliance with federal regulations. f. 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. g. 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. h. 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. i. 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, as applicable. 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,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. Invoice Requirements a. The rates negotiated with any Network Provider may not exceed the rate as specified in in Exhibit G, Covered Service Funding by OCA. b. Network Providers are required to comply with Rule 65E-14.021, F.A.C., Schedule of Covered Services, including but not limited to, covered services, methods of payments, descriptions, program areas, data elements, , required fiscal reports, program description, rate setting process, payment for services including allowable and unallowable units and requests for payments. c. The Network Provider shall request payment monthly through submission of a properly completed invoice, Exhibit E, Monthly Payment Request, within eight (8) 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. Exhibit E, Monthly Payment Request, is incorporated herein by reference and available at the following website: hftp://sfbhn.org/providers/contracts/ 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 eight (8) calendar days following the end of the month. The Network Provider shall request payment monthly through submission of a properly completed invoice, per the Exhibit B Page 3 of 5 Guidance Care Center, Inc. Contract No. PPG-2-03 South Florida Behavioral Itealth \eh�ork, Fne. requirements of this contract, within eight (8) 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 eight (8) 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 twenty (20) days after the end of each state fiscal year in the contract period. g. The Network Provider shall ensure that the year-to-date number of units of service reported on a request for payment or any associated worksheet shall reconcile with the total number of units reported and accepted in ODH or other data system designated by the ME. h. Pursuant to 65E-14.021(7)(a)2., F.A.C., the Network Provider shall not invoice for any Covered Services paid for under any other contract or from any other source. 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, Food Stamps, 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. Invoices shall be submitted in detail sufficient for a proper pre -audit and post -audit 6. 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 covered service is outlined in Rule 65E-14.021, F.A.C. 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 ODH, 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. 7. The Network Provider's attention is directed to the Department of Financial Services Reference Guide For State Expenditures for guidance regarding the requirements applicable to the disbursement of funds from the State Treasury, regardless of payment methods. The Reference Guide For State Expenditures can be obtained at the following website: Exhibit B Page 4 of 5 Guidance Care Center, Inc. Contract No. PPG-2-03 South Florida Behavioral Ilealth Ncthrork, Inc. http://www.mvfloridacfo.com/aadir/reference guide/Reference Guide For State Expenditures. pdf 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. Exhibit B Page 5 of 5 Guidance Care Center, Inc. Contract No. PPG-2-03 South Florida Behavioral Health Network, Inc. Exhibit C-1 Required Reports for PPG For Fiscal Year 2015-16 Rect.1red Reports Due Date # of Copies Send to: ME Contract Manager Response to Monitoring Reports and Corrective Within 10 calendar days from the day 1 (Electronic Submission & Action Plans the report is received via E-mail) SFBHN staff member issuing CAP External Quality Assurance Reviews, Monitoring Within 10 calendar days from the day 1 (Electronic Submission ME Contract Manager & Reports, Surveys and Corrective Actions, as the report is received, or as requested via E-mail) Director of Contract applicable by the Contract Manager Accountability Memorandum of Understanding (MOU) with a Within 90 calendar days of the Federally Qualified Health Center (FQHC) effective date of the contract (for newly or executed MOU's); 1 (Electronic Submission Federally Qualified Health Centers are required Within 30 calendar days for renewed via E-mail) ME Contract Manager to submit policies and procedures that explain MOU's; Updates to P&P for FQHC's the access to primary care services to the shall be submitted within 30 calendar medically underserved behavioral health client days of adoption Final FY 2015-2016 (1) Projected Cost Center Operating and Submitted annually prior to contract Capital Budget, execution. Submit updates within 30 1 (Electronic Submission ME Contract Manager (2) Budget Narrative, calendar days of execution an via E-mail) & (3) Network Providers Agency Service Capacity a cting amendment to the contract affecting VP of Finance Report, the budget. (4) Cost Center Personnel Detail Report Program Description Annually, prior to contract execution. 1 (Electronic Submission ME Contract Manager (1) Organizational Profile Submit updates within 30 calendar via E-mail) & (2) Service Activity Description days of amendment VP of Behavioral Health Grievance Procedures, unless waived Annually, prior to contract execution. 1 (Electronic Submission ME Contract Manager a) Clients (applicants or recipient of services) Submit updates within 30 calendar via E-mail) & b) Agency Staff days of implementation VP of CQI Affidavit Regarding Debarment Anualy prior to contract execution, or 1 ME Contract Manager as requested by the Contract Manager Submit updates within 30 calendar days of amendment or ME Contract Manager "No Wrong Door' Policy and Procedures as requested by the contract manager and/or the 1 & QA/QI Risk & Compliance QA/QI Risk & Compliance Manager Manager Within 24 hours of occurrence, in accordance with CFOP 215-6 and ME Contract Manager Incident Report reportable incidents defined CFOP 160 4 Mandatory submission through IRAS & QA/QI Risk & Compliance Reporting Requirements to the Office Manager of the Inspector General Exhibit C-1 Page 1 of S Guidance Care Center, Inc. Contract No. PPG-2-03 South Florida Behavioral Health Network, Inc. Data shall be submitted electronically, weekly, by 12:00 Noon every ODH, PBPS, or other data Monthly Data Required by DCF PAM 155-2 Wednesday. Final monthly shall be Electronically system designated by the ME or submitted electronically to the ME no the Department later than the 4th of each month following the month of service Desgination of Dispute Resolution Officer Within 5 working days of contract 1 (Electronic Submission ME Contact Manager execution via E-mail) https://fsl6.formsite.com/DCFrrain inz/Monthly-Summary- ADA Client Communication Assessment Auxiliary Aid Service Record Monthly Summary Report, By the 4th business day following the 1 (Electronic Submission Report/form to in.html Confirmation E-mail to the ME (Applicable to agency's that employ fifteen (15) reporting month via E-mail) or more employees Contract Manager Monthly, by the eighth (8th) calendar day ME Sr. Accountant (Fiscal Monthly Service Invoice after the month 1 Department) of service Prevention Data Collection Log (This log is the 1 (Electronic Submission of back up to the monthly prevention services Monthly no later than the 4th of each the Prevention Log to the ME Contract Manager invoice) until an alternate data system is month following the month of service Contract Manager) implemented By July 20 of each fiscal year and/or ME Sr. Accountant (Fiscal Final Invoice 20 days 1 Department) after contract end date Inventory Report 11/2/2015 1 (Electronic Submission via E-mail) ME Contract Manager Attestation of Network Provider's Verification that all applicable employees and subcontractors with access to ME and/or DCF 11/2/2015 1 (Electronic Submission ME Contract Manager information systems have signed a DCF via E-mail) Security Agreement form CF 0114 , per the Attachment I and Standard Contract ME Contract Manager 1 (Electronic Submission & Emergency Preparedness Plan 11/13/2015 via E-mail) QA/QI Risk &Compliance Manager Civil Rights Compliance Checklist (CF0946) 11/13/2015 1 (Electronic Submission via E-mail) ME Contract Manager Civil Rights Certificate (CF707) 11/13/2015 1 (Electronic Submission via E-mail) ME Contract Manager g ME Contract Manager 1 (Electronic Submission & Quality Assurance/Quality Improvement Plan 11/2/2015 via E-mail) QAlQI Risk &Compliance Manager ME Contract Manager Action Plan (Integration of Behavioral Health 1 (Electronic Submission & Services and Primary Care, TIC, CLC, CWI 11/30/2015 via E-mail) QA/QI Risk & Compliance Initiatives) Manager Exhibit C-1 Page 2 of 5 Guidance Care Center, Inc. Contract No. PPG-2-03 South Florida Behavioral Health Network, Inc. January 30, 2016 ME Contract Manager Continuous Quality Improvement Updates (Period: 10/01/15 - 12/31/15) 1 (Electronic Submission & July 30, 2016 via E-mail) QA/QI Risk & Compliance (Period: 01/01/16 - 06/30/16) Manager October 31, 2015 (Period: 07/01/15 - 09/30/15) January 31, 2016 ME Contract Manager (Period: 10/01/15 - 12/31/15) 1 (Electronic Submission & Quarterly Program Status Report April 30, 2016 via E-mail) Director of Prevention (Period: 01/01/16 - 03/31/16) Se Services July 31, 2016 (Period: 04/01/16 - 06/30/16) October 31, 2015 (Period: 07/01/15 - 09130/15) January 31, 2016 Quarterly Financial Statements (Balance Sheet (Period: 10/01/15 - 12/31/15) 1 (Electronic Submission ME VP of Finance and Statement of Activity) April 30, 2016 (Period: 01/01/16 - 03/31/16) via E-mail) & ME Contract Manager July 31, 2016 (Period: 04/01/16 - 06/30/16) October 31, 2015 (Period: 07/01/15 - 09/30/15) January 31, 2016 Attestation indicating the filing of Form 941 and (Period: 10/01/15 - 12/31/15) 1 (Electronic Submission ME VP of Finance payment of any taxes due to the IRS have been April 30, 2016 via E-mail) & paid. (Period: 01/01/16 - 03/31/16) ME Contract Manager July 31, 2016 (Period: 04/01/16 - 06/30/16) October 31, 2015 (Period: 07/01/15 - 09/30/15) January 31, 2016 Quarterly and Final Expenditure Report per the (Period: 10/01/15 - 12/31115) April 30, 2016 1 (Electronic Submission ME VP of Finance requirements in Attachment I, Section B. 1. a. (Period: 01/01/16 - 03/31/16) via E-mail) & (21) July 31, 2016 ME Contract Manager (Final Expenditure Report) (Period: 04/01/16 - 06/30/16) Local Match Calculation Form - Florida Upon Request 1 (Electronic Submission ME Contract Manager Department of Children and Families via E-mail) Year -End Financial Reports for Network Provider's Not Requiring Audits Per Attachment 11 Due 180 days after the end of the Network Provider's fiscal year or within 30 days of the recipient's receipt of the Certification indicating that recipient expended audit report, whichever occurs first, Less than $500,000 ($750,000 in Federal directly to each of the following unless 1 (Electronic Submission ME Contract Manager Awards for fiscal years beginning on or after otherwise required by Florida Statutes via E-mail) & December 26, 2014) in State Awards during the The schedule shall be based on VP of Finance fiscal year revenues and expenditures recorded during the state's fiscal year. Exhibit C-1 Page 3 of 5 Guidance Care Center, Inc. Contract No. PPG-2-03 South Florida Behavioral Health Network, Inc. Year -End Financial Reports for Network Provider's Not Requiring Audits Per Attachment II Due 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 1 (Electronic Submission ME Contract Manager Schedule of State Earnings otherwise required by Florida Statutes via E-mail) & The schedule shall be based on VP of Finance revenues and expenditures recorded during the state's fiscal year. Due 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, Schedule of Related Party Transaction directly to each of the following unless otherwise required by Florida Statutes 1 (Electronic Submission ME Contract Manager & Adjustments The schedule shall be based on via E-mail) VP of Finance revenues and expenditures recorded during the state's fiscal year. Due 180 days after the end of the Network Provider's fiscal year or within 30 days of the recipient's receipt of the Projected Cost Center Operating and Capital audit report, whichever occurs first, directly to each of the following unless ME Contract Manager Budget 1 (Electronic Submission & Actual Expenses &Revenues Schedule otherwise required by Florida Statutes via E-mail) The schedule shall be based on VP of Finance revenues and expenditures recorded during the state's fiscal year. Due 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 1 (Electronic Submission ME Contract Manager Schedule of Bed -Da Availability Payments Y Y Y otherwise required by Florida Statutes via E-mail) & The schedule shall be based on VP of Finance revenues and expenditures recorded during the state's fiscal year. Due 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 Agency Prepared Financial Statements otherwise required by Florida Statutes 1 (Electronic Submission ME Contract Manager & (Balance Sheet and Statement of Activity The schedule shall be based on via E-mail) VP of Finance revenues and expenditures recorded during the state's fiscal year. Exhibit C-1 Page 4 of 5 Guidance Care Center, Inc. Contract No. PPG-2-03 South Florida Behavioral Health Network, Inc. Year -End Financial Reports for Network Provider's Requiring Audits Per Attachment II Due 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, Financial &Compliance Audit to include the directly to each of the following unless otherwise required by Florida Statutes 1 (Electronic Submission ME Contract Manager & necessary schedules per Attachment II The schedule shall be based on via E-mail) VP of Finance revenues and expenditures recorded during the state's fiscal year. Due 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 1 (Electronic Submission ME Contract Manager Schedule of State Earnings otherwise required by Florida Statutes via E-mail) & The schedule shall be based on VP of Finance revenues and expenditures recorded during the state's fiscal year. Due 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, Schedule of Related Party Transaction directly to each of the following unless otherwise required by Florida Statutes 1 ( Electronic Submission ME Contract Manager & Adjustments The schedule shall be based on via E-mail) VP of Finance revenues and expenditures recorded during the state's fiscal year. Due 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, Projected Cost Center Operating and Capital directly to each of the following unless ME Contract Manager Budget otherwise required by Florida Statutes 1 (Electronic Submission & Actual Expenses & Revenues Schedule The schedule shall be based on via E-mail) VP of Finance revenues and expenditures recorded during the state's fiscal year. Due 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 ME Contract Manager Schedule of Bed -Day Availability Payments otherwise required by Florida Statutes 1 (Electronic Submission via E-mail) & The schedule shall be based on VP of Finance revenues and expenditures recorded during the state's fiscal year. Exhibit C-1 Page S of 5 Guidance Care Center, Inc. Contract No. PPG-2-03 South Florida Behavioral Health Network, Inc. Exhibit D Substance Abuse & Mental Health Required Performance Outcomes& Outputs Provider Name: Guidance/Care Center, Inc. Contract#: PPG-2-03 Date: September 1,2015-June 30,2018 Revision#: Table 1 Network Service Provider Measures Target Population and Measure Description Network Target Adults Community Mental Health MH003 a. Average annual days worked for pay for adults with severe and persistent mental 40 illness MH703 b. Percent of adults with serious mental illness who are competitively employed 24% MH742 c. Percent of adults with severe and persistent mental illnesses who live in stable 90% housing environment MH743 d. Percent of adults in forensic involvement who live in stable housing environment 67% MH744 e. Percent of adults in mental health crisis who live in stable housing environment 86% Adult Substance Abuse SA058 a. Percentage change in clients who are employed from admission to discharge 10% SA754 b. Percent change in the number of adults arrested 30 days prior to admission versus 15% 30 days prior to discharge SA755 c. Percent of adults who successfully complete substance abuse treatment services 51% SA756 d. Percent of adults with substance abuse who live in a stable housing environment 94/ at the time of discharge Children's Mental Health MH012 a. Percent of school days seriously emotionally disturbed (SED) children attended 86% MH377 b. Percent of children with emotional disturbances (ED) who improve their level of 64% functioning MH378 c. Percent of children with serious emotional disturbances(SED) who improve their 65% level of functioning MH778 d. Percent of children with emotional disturbance (ED)who live in a stable housing environment 95% MH779 e. Percent of children with serious emotional disturbance (SED) who live in a stable 93% housing environment MH780 f. Percent of children at risk of emotional disturbance (ED)who live in a stable 96% housing environment Children's Substance Abuse SA725 a. Percent of children who successfully complete substance abuse treatment services 48% SA751 b. Percent change in the number of children arrested 30 days prior to admission 20% versus 30 days prior to discharge SA752 c. Percent of children with substance abuse who live in a stable housing 93% environment at the time of discharge Guidance Care Center,Inc. Exhibit D Contract No.PPG-2-03 Page 1 of 2 South Florida Behavioral Health Network,Inc. Table 2 Network Service Provider Output Measures—Persons Served For Fiscal Year FY15-16 Service Category FY Target Residential Care 0 Outpatient Care 0 a,• -5 2 To Crisis Care 0 a State Hospital Discharges N/A Peer Support Services 0 s Residential Care N/A u) aci Outpatient Care N/A v f0 Crisis Care N/A s c v a, SIPP Discharge N/A Residential Care 0 u fa Outpatient Care 0 4, a, N O Detoxification 0 3 Women's Specific Services 0 Injecting Drug Users 0 Residential Care N/A Outpatient Care N/A N o Detoxification N/A • .a • G **Refer to Attachment IV,Scope Prevention of Work for the numbers served.** Network Provider Compliance: Failure to meet the applicable standards established in Tables 1 and 2 shall be considered nonperformance pursuant to Standard Contract, Paragraph 36. Financial Consequences for Network Provider's Failure to Perform. Guidance Care Center,Inc. Exhibit D Contract No. PPG-2-03 Page 2 of 2 South Florida Behavioral health Neorork, Inc. Exhibit E Monthly Payment Request 1. Exhibit E, Monthly Payment Request This exhibit is incorporated by reference and available at following website: http://sfbhn.org/providers/contracts/ Exhibit E Guidance Care Center, Inc. 1 of 1 Contract No. PPG-2-03 South Florida Behavioral Health Net"ork. Inc. ReN. 2.23.201i Exhibit F State and Federal Laws, Rules, and Regulations The network provider and its subcontractors shall 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. Federal Authority A. Mental Health 42 U.S. C. ss. 300x, et. seq. B. Substance Abuse Prevention and Treatment Block Grant (SAPTBG) 42 U.S.C. ss. 300x-21 et. seq. 45 C.F.R. pt. 96 Restrictions on expenditures of SAPTBG 45 C.F.R. s. 96.135 C. Substance Abuse -Confidentiality 42 C.F.R., pt. 2 D. Health Insurance Portability and Accountability Act (HIPAA) 45 C.F.R. pt. 164 E. Social Security Income for the Aged, Blind and Disabled 20 C.F.R. pt. 416 F. Endorsement and Payment of Checks Drawn on the United States Treasury 31 C.F.R. pt. 240 G. Temporary Assistance to Needy Families (TANF) 42 U.S.C. ss. 601, et. seq. 45 C.F.R., pt. 260 H. Projects for Assistance in Transition from Homelessness (PATH) 42 U.S. C. s. 290cc-21 et. seq. 42 C.F.R., pt. 54 I. Americans with Disabilities Act of 1990 42 U.S. C. ss. 12101 et. seq. Exhibit F Page 1 of 4 Guidance Care Center. Inc. Contract No. PPG-2-03 II. FLORIDA STATUTES A. Child Welfare and Community Based Care Ch. 39, F.S. Proceedings Relating to Children Ch. 119, F.S. Public Records Ch. 402, F.S. Health and Human Services; Miscellaneous Provisions Ch. 435, F.S. Employment Screening Ch. 490, F.S. Psychological Services Ch. 491, F.S. Clinical, Counseling and Psychotherapy Services Ch. 1002, F.S. Student and Parental Rights and Educational Choices B. Substance Abuse and Mental Health Services Ch. 381, F.S. Public Health: General Provisions Ch. 386, F.S. Particular Conditions Affecting Public Health Ch. 395, F.S. Hospital Licensing and Regulation Ch. 394, F.S. Mental Health Ch. 397, F.S. Substance Abuse Services Ch. 400, F.S. Nursing Home and Related Health Care Facilities Ch. 414, F.S. Family Self Sufficiency Ch. 435, F.S. Employment Screening Ch. 458, F.S. Medical Practice Ch. 459, F.S. Osteopathic Medicine Ch. 464, F.S. Nursing Ch. 465, F.S. Pharmacy Ch. 490, F.S. Psychological Services Ch. 491, F.S. Clinical, Counseling and Psychotherapy Services Ch. 499, F.S. Florida Drug and Cosmetic Act Ch. 553, F.S. Building Construction Standards Ch. 893, F.S. Drug Abuse Prevention and Control S. 409.906(8), F.S. Optional Medicaid Services -Community Mental Health Services C. Developmental Disabilities Ch. 393, F.S. Developmental Disabilities D. Adult Protective Services Ch. 415, F.S. Adult Protective Services E. Forensics Ch. 916, F.S. Mentally Deficient and Mentally III Defendants Ch. 985, F.S. Juvenile Justice; Interstate Compact on Juveniles S. 985.19, F.S. Incompetency in Juvenile Delinquency Cases S. 985.24, F.S. Interstate Compact on Juveniles; Use of detention; prohibitions G. State Administrative Procedures and Services Ch. 120, F.S. Administrative Procedures Act Ch. 287, F.S. Procurement of Personal Property and Services Ch. 815, F.S. Computer - Related Crimes Ch. 817, F.S. Fraudulent Practices Exhibit F Page 2 of 4 Guidance Care Center, Inc. Contract No. PPG-2-03 S. 112.061, F.S. Per diem and Travel Expenses of public officers, employees, and authorized persons S. 112.3185, F.S. Additional Standards for State Agency Employees S. 215.422, F.S. Payments, Warrants & Invoices; Processing Time Limits S. 216.181(16)(b), F.S. Advanced funds for Program Startup or Contracted Services Ill. FLORIDA ADMINISTRATIVE CODE (RULES) A. Child Welfare and Community Based Care Ch. 65C-12, F.A.C. Emergency Shelter Care Ch. 65C-13, F.A.C. Foster Care Licensing Ch. 65C-14, F.A.C. Group Care Ch. 65C-15, F.A.C. Child -Placing Agencies B. Substance Abuse and Mental Health Services Ch. 65C-12, F.A.C. Emergency Shelter Care Ch. 65D-30, F.A.C. Substance Abuse Services Office Ch. 65E-4, F.A.C. Community Mental Health Regulation Ch. 65E-5, F.A.C. Mental Health Act Regulation Ch. 65E-10, F.A.C. Psychotic and Emotionally Disturbed Children- Purchase of Residential Services Rules Ch. 65E-11, F.A.C. Behavioral Health Services Ch. 65E-12, F.A.C. Public Mental Health Crisis Stabilization Units and Short Term Residential Treatment Programs Ch. 65E-14, F.A.C. Community Substance Abuse and Mental Health Services -Financial Rules Ch. 65E-15, F.A.C. Continuity of Care Case Management Ch. 65E-20, F.A.C. Forensic Client Services Act Regulation CH. 65E-26, F.A.C. Substance Abuse and Mental Health Priority Populations and Services C. Financial Penalties Ch. 65-29, F.A.C. Penalties on Service Providers Reduction or withholding of funds Ch. 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 and Any Other Co - Occurring Substance Abuse or Developmental Disability Treatment Needs in Out -of -Home Care Placements CFOP 155-11. The Title XXI Behavioral Health Network CFOP 215-6 Incident Reporting and Analysis System (IRAS) B. Federal Cost Principles OMB Circular A-21 OMB Circular A-87 Guidance Care Center, Inc. Cost Principles for Educational Institutions Cost Principles for State, Local and Indian Tribal Governments Exhibit F Page 3 of 4 Contract No. PPG-2-03 OMB Circular A-102 Grants and Cooperative Agreements with State and Local Governments OMB Circular A-122 Cost Principles for Non-profit Organizations C. Audits OMB Circular A-133 Audits of States, Local Governments and Non -Profit Organizations Ch. 215.97, F.S. Florida Single Audit Act Comptroller's Memorandum No. 03 (1999-2000): Florida Single Audit Act Implementation D. Administrative Requirements 45 C.F.R., pt. 74 Uniform Administration Requirements for Awards and Subawards to Institutions of Higher Education, Hospitals, other Non -Profit Organizations and Other Commercial Organizations 45 C.F.R., pt. 92 Uniform Administrative Requirements for Grants and Cooperative Agreements to State and Local Governments OMB Circular A110 Uniform Administrative Requirements for Grants and Agreements With Institutions of Higher Education, Hospitals, and Other Non -Profit Organizations E. Data Collection and Reporting Requirements S. 397.321(3)(c), F.S. Data collection & dissemination system S. 394.74(3)(e), F.S. Data Submission S. 394.77, F.S. Uniform management information, accounting, and reporting systems for providers S. 394,9082, F.S. Behavioral health managing entities PAM 155-2 Mental Health and Substance Abuse Data Measurement Handbook Exhibit F Page 4 of 4 Guidance Care Center, Inc. Contract No. PPG-2-03 September 1,2015-June 30,2016 EXHIBIT G:COVERED SERVICES BY OCA September 2015 Guidance/Care Center,Inc.-PPG ADULT MENTAL HEALTH PPG-2-03 MH00I MH009 MH018 N111018 MH072 MH073 N111076 MH093 MH094 MHOPG MHOTB MHOCF COVERED SERVICES FUNDING/ MHAO1 MHAO9 MHA18 MHA18 MHA72 MHA73 MHA76 MHA93 MHA94 MHAPG MHATB MHACF TOTAL RATE - - - - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - 11 Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - I5 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 $ - 49 Prevention-Selective $ 48.68 $ - 50 Prevention-Universal Direct $ 48.68 $ - 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED $ - Exhibit G Guidance Care Center, Inc. Page 1 of4 Contract No. PPG-2-03 September 1,2015-June 30,2016 EXHIBIT G:COVERED SERVICES BY OCA September 2015 Guidance/Care Center,Inc.-PPG ( lilt.DRFN MENTAL HEA1.1 II PPG-2-03 MH001 MH009 1I1OO9-CF MH018 MH018 MHOBN MHOFA Miflu '-c It NHlo\ID MHOMD-CR MHOCF COVERED SERVICES FUNDING/ MHCOI MHCO9 VIHC09-CI MHC18 MHC18 MHCBN MHCFA MHCFA-CR MHCMD MHCMD-CR MHCCF TOTAL RATE - - - - - - - - - - - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - 11 Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - l5 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 $ - 49 Prevention-Selective $ 48.68 $ - 50 Prevention-Universal Direct $ 48.68 $ - 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED $ - Exhibit G Guidance Care Center,Inc. Page 2 of 4 Contract No. PPG-2-03 September 1,2015-June 30,2016 EXHIBIT G:COVERED SERVICES BY OCA September 2015 Guidance/Care Center,Inc.-PPG N.1)1 LT SUBSTANCE ABUSE PPG-2-03 MS003 MS011 MS021 MS023 MS025 ,1•,..: NIS081 MS09I MSOTB MS903 MSOCF COVERED SERVICES FUNDING/ MSA03 MSAI1 MSA21 MSA23 MSA25 MSA27 MSA81 MSA91 MSATB MSACF TOTAL RATE - - - - - - - - - - - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - 11 Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 $ - 49 Prevention-Selective $ 48.68 $ - 50 Prevention-Universal Direct $ 48.68 $ - 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED $ - Exhibit G Guidance Care Center, Inc. Page 3 of 4 Contract No.PPG-2-03 September 1,2015-June 30,2016 EXHIBIT G:COVERED SERVICES B1'OCA September 2015 Guidance/Care Center,Inc.-PPG CHILDREN SUBSTANCE ABUSE PPG-2-03 MS003 MSOII MS021 MS023 MS025 \1S025-CR \I''i'r MSOTB MS903 MSOCF COVERED SERVICES FUNDING/ MSCO3 MSC11 MSC21 MSC23 MSC25 MSC25-CR MSCPP MSCTB MSCCF TOTAL RATE - - - - - - 150,000 - - - $ 150,000 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - 11 Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 10,469 $ 10,469 49 Prevention-Selective $ 48.68 13,486 $ 13,486 50 Prevention-Universal Direct $ 48.68 126,045 $ 126,045 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ 150,000 $ - $ - $ - $ 150,000 TOTAL UNCOMPENSATED Exhibit G Guidance Care Center, Inc. Page 4 of 4 Contract No.PPG-2-03 July 1,2016-June 30,2017 EXHIBIT G:COVERED SERVICES BY OCA September 2015 Guidance/Care Center,Inc.-PPG \I)l 1.I \II:\I kL HEALTH PPG-2-03 MH001 MH009 MH018 3IIIOI8 MH072 MH073 MH076 IH093 MH094 MHAPG MHOTB MHOCF COVERED SERVICES FUNDING/ MHAO1 MHAO9 MHAI8 MHA18 MHA72 MHA73 MHA76 MHA93 MHA94 MHAPG MHATB MHACF TOTAL RATE - - - - - - - - - - - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/blight $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - 11 Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 $ - 49 Prevention-Selective $ 48.68 $ - 50 Prevention-Universal Direct $ 48.68 $ - 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED $ - Exhibit G Guidance Care Center,Inc. Page 1 of4 Contract No. PPG-2-03 July 1,2016-June 30,2017 EXHIBIT G:COVERED SERVICES BY OCA September 2015 Guidance/Care Center,Inc.-PPG ( 1111.1)I{IN MENTAL HEALTH PPG-2-03 MH001 MH009 MH009-CF MHO18 MH018 MHOBN MHOFA M1IHOFA-CR MHOMD MHOMD-CR MHOCF COVERED SERVICES FUNDING/ MHCO1 MHCO9 1HC09-C1 MHC18 MHC18 MHCBN MHCFA MHCFA-CR MHCMD MHCMD-CR MHCCF TOTAL RATE - - - - - - - - - - - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 0 3 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - 11 Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ • $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group S - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 $ - 49 Prevention-Selective $ 48.68 $ - 50 Prevention-Universal Direct $ 48.68 $ - 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED $ - Exhibit G Guidance Care Center,Inc. Page 2 of4 Contract No. PPG-2-03 July 1,2016-June 30,2017 EXHIBIT G:COVERED SERVICES BY OCA September 2015 Guidance/Care Center,Inc.-PPG \I)t I,T SUBS] kNCE ABUSE PPG-2-03 MS003 N1S011 MS021 MS023 MS025 MS027 MSO81 MS091 MSOTB MS903 MSOCF COVERED SERVICES FUNDING/ MSA03 MSAII MSA21 MSA23 MSA25 MSA27 MSA81 MSA91 MSATB MSACF TOTAL RATE - - - - - - - - - - - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - 11 Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 $ - 49 Prevention-Selective $ 48.68 $ - 50 Prevention-Universal Direct $ 48.68 $ - 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED $ - Exhibit G Guidance Care Center,Inc. Page 3 of4 Contract No.PPG-2-03 July 1,2016-June 30,2017 EXHIBIT G:COVERED SERVICES BY OCA September 2015 Guidance/Care Center,Inc.-PPG CHILDREN SUBS I kNCE ABUSE PPG-2-03 MS003 MS011 MS021 MS023 \i"u25 \1S025-CR MSOPP \ISOTB Nts,+,,, USOCF COVERED SERVICES FUNDING/ MSCO3 MSCII MSC2I MSC23 MSC25 MSC25-CR MSCPP MSCTB MSCCF TOTAL RATE - - - - - - 150,000 - - - $ 150,000 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - 11 Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 3 5 Outpatient-Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 4 3 Aftercare-Group S - $ - 30 Information&Referral $ - $ - 34 FACT Team S - $ - 36 Room&Board Level I S - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 10,469 $ 10,469 49 Prevention-Selective $ 48.68 13,486 $ 13,486 50 Prevention-Universal Direct $ 48.68 126,045 $ 126,045 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ 150,000 $ - $ - $ - $ 150,000 TOTAL UNCOMPENSATED Exhibit G Guidance Care Center,Inc. Page 4 of 4 Contract No. PPG-2-03 July 1,2017-June 30,2018 EXHIBIT G:COVERED SERVICES BY OCA September 2015 Guidance/Care Center, Inc.- PPG ADULT MENTAL HEALTH PPC-2-03 nii iiiiii i111i009 MH018 MH018 MH072 MH073 MH076 MH093 MH094 \1HOPG \liiul13 MHOCF COVERED SERVICES FUNDING/ MHAO1 MHAO9 MHAI8 MHA18 MHA72 MHA73 MHA76 MHA93 MHA94 MHAPG MHATB MHACF TOTAL RATE - - - - - - - - - - - - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - 11 Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level IIl $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 $ - 49 Prevention-Selective $ 48.68 $ - 50 Prevention-Universal Direct $ 48.68 $ - 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - IIIIIIIIIIIIIIMIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED $ - Exhibit G Guidance Care Center,Inc. Page 1 of 4 Contract No.PPG-2-03 July 1,2017-June 30,2018 EXHIBIT G:COVERED SERVICES BY OCA September 2015 Guidance/Care Center,Inc.-PPG (l II I.I)R1;N MENTAL III: Ill I PPG-2-03 MH001 MH009 ‘1H009-CF MH018 MH018 MHOBN M1101 t MHOFA-CR MHOMD MHOMD-CR MHOCF COVERED SERVICES FUNDING/ MHCO1 MHCO9 11HC09-C1 MHC18 MHC18 MHCBN MHCFA MHCFA-CR MHCMD MHCMD-CR MHCCF TOTAL RATE - - - - - - - - - - - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - 1 I Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient•Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 4 3 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 $ - 49 Prevention-Selective $ 48.68 $ - 50 Prevention-Universal Direct $ 48.68 $ - 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED $ - Exhibit G Guidance Care Center,Inc. Page 2 of 4 Contract No. PPG-2-03 July 1,2017-June 30,2018 EXHIBIT G:COVERED SERVICES BY OCA September 2015 Guidance/Care Center, Inc.-I'PG ADULT SUBSTANCE ABl sl PPG-2-03 MS003 yISO11 NI`,u2i vIS023 MS025 v,"n_.- \IS081 MS091 MSOTB MS903 MSOCF COVERED SERVICES FUNDING/ MSA03 MSAII MSA21 MSA23 MSA25 MSA27 MSA81 MSA91 MSATB MSACF TOTAL RATE - - - - - - - - - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - 11 Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 $ - 49 Prevention-Selective $ 48.68 i $ - 50 Prevention-Universal Direct $ 48.68 $ - 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED $ - Exhibit G Guidance Care Center,Inc. Page 3 of4 Contract No.PPG-2-03 July 1,2017-June 30,2018 EXHIBIT G:COVERED SERVICES BY OCA September 2015 Guidance/Care Center,Inc.-PPG CHILDREN SUBSTANCE ABUSE PPG-2-03 MS003 MS011 MS021 MS023 MSu_> \IS025-CR MSOPP \ISOTB \L"903 MSOCF COVERED SERVICES FUNDING/ MSCO3 MSC11 MSC21 MSC23 MSC25 MSC25-CR MSCPP MSCTB MSCCF TOTAL RATE - - - - - - 150,000 - - - $ 150,000 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - 11 Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - I5 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 10,469 $ 10,469 49 Prevention-Selective $ 48.68 13,486 $ 13,486 50 Prevention-Universal Direct $ 48.68 126,045 $ 126,045 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - • $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ 150,000 $ - $ - $ - $ 150,000 TOTAL UNCOMPENSATED Exhibit G Guidance Care Center,Inc. Page 4 of4 Contract No. PPG-2-03 September 1, 2015-June 30, 2016 EXHIBIT H - FUNDING DETAIL September 2015 Provider: Guidance/Care Center, Inc. - PPG Contract #: PPG-2-03 Amendment # ADULT MENTAL HEALTH CHILDREN MENTAL HEALTH OCA DESCRIPTION NEW OCA OLD OCA AMOUNT OCA DESCRIPTION NEW OCA OLD OCA AMOUNT Residential Services MHOO1 MHA01 Residential Services MH001 MHC01 $ - $ Non -Residential Services MH009 MHA09 Non -Residential Services M11009 MHC09 $ $ Crisis Services MH018 MHA18 Non -Residential Services - CR MH009 MHC09 $ $ Crisis Services - Baker Act MHO 18 MHA18 Crisis Services MH018 MHC 18 $ $ Community Forensic Program MH072 FACT Team MH073 MHA72 MHA73 Crisis Services - Baker Act Special Appropriation - ICFH MHO 18 MHC 18 MHOBN MHCBN $ $ $ $ Indigent Drug Program MI-1076 Proviso Allocation - Camillus MH093 MHA76 MHA93 FACES Expansion Grant FACES Expansion Grant - CR MHCFA MHCFA MHCFA MHCFA $ $ $ $ Proviso Allocation - Citrus MH094 MHA94 FACES Wraparound Grant MHCMD MHCMD $ $ PATH Grant MHOPG MHAPG FACES Wraparound Grant - CR MHCMD MHCMD $ $ TANF MHOTB MHATB Carry Forward MHOCF MHCCF $ $ $ Carry Forward MHOCF MHACF TOTAL ADULT MENTAL HEALTH = S TOTAL CHILDREN MENTAL HEALTH = S ADULT SUBSTANCE ABUSE CHILDREN SUBSTANCE ABUSE OCA DESCRIPTION NEW OCA OLD OCA AMOUNT OCA DESCRIPTION NEW OCA OLD OCA AMOUNT Residential Services MS003 MSA03 $ Residential Services MS003 MSC03 $ Non -Residential Services MS01 I MSAI I $ Non -Residential Services MS01 I MSC11 $ Detox Services MS021 MSA21 $ Detox Services MS021 MSC21 $ - HIV Services MS023 MSA23 $ HIV Services MS023 MSC23 $ Prevention Services MS025 MSA25 $ Prevention Services MS025 MSC25 $ Women's Services MS027 MSA27 $ Prevention Services - CR MS025 MSC25 $ Pregnant Women Project MS081 Proviso Allocation - GCC MS091 MSA81 MSA91 $ $ Prevention Partnership Grant TANF Services MSOPP MSCPP MSCTB MSCTB $ $ 150,000 - TANF MSO"IB MSATI3 $ Proviso Allocation - Here's Help MS903 $ Proviso Allocation - Here's Help MS903 $ Carry Forward MSOCF MSCCF $ Carry Forward MSOCF MSACF $ TOTAL ADULT SUBSTANCE ABUSE _ $ TOTAL CHILDREN SUBSTANCE ABUSE FUNDS NOT REQUIRING MATCH: !Drug Abuse Services - revention TOTAL ALL PROGRAMS = UNCOMPENSATED UNITS = $ 150,000 FDeinstitutionaliz;aticmProject ^�* $ TOTAL = $ 150,000 CMH Program MH Block Grant $ TOTAL FUNDS REQUIRING MATCH = $ 150,000 TOTAL FUNDS NOT REQUIRING MATCH $ LOCAL MATCH REQUIRED = $ 37,500 NOTES 10/ l/2015 $150,000 is allocated for the PPG Grant funded prevention services per the RFA Guidance Care Center, Inc. Exhibit H Contract No. PPG-2-03 Page 1 of 1 July 1, 2016- June 30, 2017 EXHIBIT H - FUNDING DETAIL September 2015 Provider: Guidance/Care Center, Inc. - PPG Contract #: PPG-2-03 Amendment # ADULT MENTAL HEALTH CHILDREN MENTAL HEALTH OCA DESCRIPTION NEW OCA OLD OCA AMOUNT OCA DESCRIPTION NEW OCA OLD OCA AMOUNT Residential Services MHO01 MHA01 Residential Services MH001 MHC01 $ $ Non -Residential Services MH009 MHA09 Non -Residential Services MH009 MHC09 $ $ Crisis Services M11018 MHA18 Non -Residential Services - CR MH009 MHC09 $ $ Crisis Services - Baker Act MHO18 MHA18 Crisis Services MH018 MHC 18 $ - $ Community Forensic Program MH072 FACT Team MH073 MHA72 MHA73 Crisis Services - Baker Act Special Appropriation - ICFH MH018 MHC18 MHCBN MHCBN $ $ $ $ Indigent Drug Program MH076 Proviso Allocation - Camillus MH093 MHA76 MHA93 FACES Expansion Grant FACES Expansion Grant - CR MHOFA MHCFA MHOFA MHCFA $ $ $ $ Proviso Allocation - Citrus MH094 MHA94 FACES Wraparound Grant MHOMD MHCMD $ $ PATH Grant MFIOPG MHAPG FACES Wraparound Grant - CR MHOMD MHCMD $ $ TANF MHOTB MHAT13 Carry Forward MHOCF MHCCF $ $ $ Carry Forward MHOCF MHACF TOTAL ADULT MENTAL HEALTH = $ TOTAL CHILDREN MENTAL HEALTH = $ ADULT SUBSTANCE ABUSE CHILDREN SUBSTANCE ABUSE OCA DESCRIPTION NEW OCA OLD OCA AMOUNT OCA DESCRIPTION NEW OCA OLD OCA AMOUNT Residential Services MS003 MSA03 $ Residential Services MS003 MSC03 $ Non -Residential Services NiS01 I MSAI1 $ Non -Residential Services MSOI I MSCH $ Detox Services NIS021 MSA21 $ Detox Services MS021 MSC21 $ HIV Services MS023 MSA23 $ HIV Services MS023 MSC23 $ Prevention Services MS025 MSA25 $ Prevention Services MS025 MSC25 $ Women's Services MS027 MSA27 $ Prevention Services - CR MS025 MSC25 $ - Pregnant Women Project MS081 Proviso Allocation - GCC MS091 MSA81 MSA91 $ $ Prevention Partnership Grant TANF Services MSOPP MSCPP MSOTB MSCTB $ 150,000 $ - TANF MSOTB MSATB $ Proviso Allocation - Here's Help MS903 $ Proviso Allocation - Here's Help MS903 $ Carry Forward MHOCF MSCCF $ Carry Forward MHOCF MSACF $ TOTAL ADULT SUBSTANCE ABUSE _ $ TOTAL CHILDREN SUBSTANCE ABUSE FUNDS NOT REQUIRING MATCH: tDrug Abuse Services 1Prevention _.`.._ .___.. $ ' TOTAL ALL PROGRAMS = $ UNCOMPENSATED UNITS = 150,000 ID emstitutionalization Project $� : TOTAL = $ 150,000 CMH Program $ MH Block Grant L TOTAL FUNDS REQUIRING MATCH = $ 150,000 TOTAL FUNDS NOT REQUIRING MATCH $ LOCAL MATCH REQUIRED = $ 37,500 NOTES 10/1/2015 $150,000 is allocated for the PPG Grant funded prevention services per the RFA Guidance Care Center, Inc. Exhibit H Contract No. PPG-2-03 Page I of I July 1, 2017- June 30, 2018 EXHIBIT H - FUNDING DETAIL September 2015 Provider: Guidance/Care Center, Inc. - PPG Contract #: PPG-2-03 Amendment # ADULT MENTAL HEALTH CHILDREN MENTAL HEALTH OCA DESCRIPTION NEW OCA OLD OCA Residential Services MH001 MHA01 Non -Residential Services M11009 MHA09 Crisis Services MHO 18 MHA18 Crisis Services - Baker Act MII018 MHA18 Community Forensic Program MH072 MHA72 FACT Team MH073 MHA73 Indigent Drug Program MH076 MHA76 Proviso Allocation - Camillus MH093 MHA93 Proviso Allocation - Citrus MH094 MHA94 PATH Grant MHAPG MHAPG TANF MHOTB MHATB AMOUNT OCA DESCRIPTION Residential Services Non -Residential Services Non -Residential Services - CR Crisis Services Crisis Services - Baker Act Special Appropriation - ICFH FACES Expansion Grant FACES Expansion Grant - CR FACES Wraparound Grant FACES Wraparound Grant - CR Carry Forward NEW OCA OLD OCA MH001 MHC01 MH009 MHC09 MH009 MHC09 MHO18 MHC18 MI-1018 MHC 18 MHCBN MHCBN MHCFA MHCFA MHCFA MHCFA MHCMD MHCMD MHCMD MHCMD MHCFF MHCCF AMOUNT $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Carry Forward MHOCF MHACF TOTAL ADULT MENTAL HEALTH = $ TOTAL CHILDREN MENTAL HEALTH = $ ADULT SUBSTANCE ABUSE CHILDREN SUBSTANCE ABUSE OCA DESCRIPTION NEWOCA OLD OCA Residential Services MS003 MSA03 Non -Residential Services MS01 I MSA11 Detox Services MS021 MSA21 HIV Services MS023 MSA23 Prevention Services MS025 MSA25 Women's Services MS027 MSA27 Pregnant Women Project MS081 MSA81 Proviso Allocation - GCC MS091 MSA91 TANF MSOTB MSATB Proviso Allocation - Here's Help MS903 AMOUNT $ $ $ $ $ $ $ $ $ $ OCA DESCRIPTION Residential Services Non -Residential Services Detox Services HIV Services Prevention Services Prevention Services - CR Prevention Partnership Grant TANF Services Proviso Allocation - Here's Help Carry Forward NEW OCA OLD OCA MS003 MSC03 MS01 I MSCH MS021 MSC21 MS023 MSC23 MS025 MSC25 MS025 MSC25 MSOPP MSCPP MSOTB MSCTB MS903 MSOCF MHCCF AMOUNT $ - $ $ $ $ $ - $ 150,000 $ $ $ Cary Forward MSOCF MSACF $ TOTAL ADULT SUBSTANCE ABUSE _ $ TOTAL CHILDREN SUBSTANCE ABUSE FUNDS NOT REQUIRING MATCH: Drug Abuse Services Prevention Deinstitutionalization Project �1 ! $ _ - $ TOTAL ALL PROGRAMS = UNCOMPENSATED UNITS = TOTAL = $ $ 150,000 150,000 CMH Program MH Block Grant $ j { TOTAL FUNDS REQUIRING MATCH = $ 150,000 TOTAL FUNDS NOT REQUIRING MATCH $ LOCAL MATCH REQUIRED = $ 37,500 NOTES 10/I/2015 $150,000 is allocated for the PPG Grant funded prevention services per the RFA Guidance Care Center, Inc. Exhibit H Contract No. PPG-2-03 Page 1 of 1 September 1,2015-June 30,2016 LOCAL MATCH PLAN September 1,2015 Guidance/Care Center,Inc.-PPG PPG-2-03 REQUIRED MATCH: $ 37,500 \\III ( \III \ti\ ( ti\ COST CENTERS RATE UNITS MATCH UNITS MATCH UNITS MATCH UNITS MATCH 01 Assessment $ - 02 Case Management $ - 03 Crisis Stabilization $ - 04 Crisis Support/Emergency $ - 06 Day/Night $ - 07 Drop-In/Self Help Centers $ - 08 In-Home/On-Site $ - 11 Intervention-Individual $ - 42 Intervention-Group $ - 12 Medical Services $ - 14 Outpatient-Individual $ - 35 Outpatient-Group $ - 15 Outreach $ - 18 Residential Level I $ - 19 Residential Level II $ - 20 Residential Level III $ - 21 Residential Level IV $ - 24 Substance Abuse Detox $ - 25 Supported Employment $ - 26 Supportive Housing $ - 27 TASC $ - 28 Incidental Expenses $ - 29 Aftercare-Individual $ - 43 Aftercare-Group $ - 30 Information&Referral $ - 34 FACT Team $ - 36 Room&Board Level I $ - 37 Room&Board Level II $ - 38 Room&Board Level III $ - 39 Short-term Residential Treatment $ - 40 Clubhouse Services $ - 44 CCST-Individual $ - 45 CCST-Group $ - 46 Recovery Support-Individual $ - 47 Recovery Support-Group $ - 48 Prevention-Indicated $ 43.12 869.67 $ 37,500 49 Prevention-Selective $ - 50 Prevention-Universal Direct $ - 51 Prevention-Universal Indirect $ - 99 Special Proviso $ - MATCH ALLOCATION: $ - $ - S - $ 37,500 GRAND TOTAL: $ 37,500 Local Match Plan Guidance Care Center,Inc. Page 1 of 1 Contract No. PPG-2-03 July 1, 2016-June 30, 2017 LOCAL MATCH PLAN September 1,2015 Guidance/Care Center,Inc.-PPG PPG-2-03 REQUIRED MATCH: $ 37,500 1\III ( \III \ti\ ( "\ COST CENTERS RATE UNITS MATCH UNITS MATCH UNITS MATCH UNITS MATCH 01 Assessment $ - 02 Case Management $ - 03 Crisis Stabilization $ - 04 Crisis Support/Emergency $ - 06 Day/Night $ - 07 Drop-In/Self Help Centers $ - 08 In-Home/On-Site $ - 11 Intervention-Individual $ - 42 Intervention-Group $ - 12 Medical Services $ - 14 Outpatient-Individual $ - 35 Outpatient-Group $ - 15 Outreach $ - 18 Residential Level I $ - 19 Residential Level II $ - 20 Residential Level III $ - 21 Residential Level IV $ - 24 Substance Abuse Detox $ - 25 Supported Employment $ - 26 Supportive Housing $ - 27 TASC $ - 28 Incidental Expenses $ - 29 Aftercare-Individual $ - 43 Aftercare-Group $ - 30 Information&Referral $ - 34 FACT Team $ - 36 Room&Board Level I $ - 37 Room&Board Level II $ - 38 Room&Board Level III $ - 39 Short-term Residential Treatment $ - 40 Clubhouse Services $ - 44 CCST-Individual $ - 45 CCST-Group $ - 46 Recovery Support-Individual $ - 47 Recovery Support-Group $ - 48 Prevention-Indicated $ 43.12 869.67 $ 37,500 49 Prevention-Selective $ - 50 Prevention-Universal Direct $ - 51 Prevention-Universal Indirect $ - 99 Special Proviso $ - MATCH ALLOCATION: $ - $ - $ - $ 37,500 GRAND TOTAL: $ 37,500 Local Match Plan Guidance Care Center, Inc. Page 1 of 1 Contract No.PPG-2-03 July 1, 2017-June 30, 2018 LOCAL MATCH PLAN September 1,2015 Guidance/Care Center,Inc.-PPG PPG-2-03 REQUIRED MATCH: $ 37,500 \\III CMII \.\ ( ti COST CENTERS RATE UNITS MATCH UNITS MATCH UNITS MATCH UNITS MATCH 01 Assessment $ - 02 Case Management $ - 03 Crisis Stabilization $ - 04 Crisis Support/Emergency $ - 06 Day/Night $ - 07 Drop-In/Self Help Centers $ - 08 In-Home/On-Site $ - 11 Intervention-Individual $ - 42 Intervention-Group $ - 12 Medical Services $ - 14 Outpatient-Individual $ - 35 Outpatient-Group $ - 15 Outreach $ - 18 Residential Level I $ - 19 Residential Level II $ - 20 Residential Level III $ - 21 Residential Level IV $ - 24 Substance Abuse Detox $ - 25 Supported Employment $ - 26 Supportive Housing $ - 27 TASC $ - 28 Incidental Expenses $ - 29 Aftercare-Individual $ - 43 Aftercare-Group $ - 30 Information&Referral $ - 34 FACT Team $ - 36 Room&Board Level I $ - 37 Room&Board Level II $ - 38 Room&Board Level III $ - 39 Short-term Residential Treatment $ - 40 Clubhouse Services $ - 44 CCST-Individual $ - 45 CCST-Group $ - 46 Recovery Support-Individual $ - 47 Recovery Support-Group $ - 48 Prevention-Indicated $ 43.12 869.67 $ 37,500 49 Prevention-Selective $ - 50 Prevention-Universal Direct $ - 51 Prevention-Universal Indirect $ - 99 Special Proviso $ - MATCH ALLOCATION: $ - $ - $ - $ 37,500 GRAND TOTAL: $ 37,500 Local Match Plan Guidance Care Center, Inc. Page 1 of 1 Contract No. PPG-2-03 w� South Florida /Behavioral Health Network, Inc. ATTACHMENT II Financial and Audit Compliance Rev. 5/4/2015 The administration of resources awarded by the Managing Entity (ME) 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 Uniform Guidance: Cost Principles, Audit, and Administrative Requirements for Federal Awards (also known as the OMB Uniform Guidance), Section 200.500- 200.521 and Section 215.97, F.S., as revised, the ME 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 ME staff, limited scope audits as defined by OMB Uniform Guidance, Section 200.331, 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 ME. In the event the ME determines that a limited scope audit of the recipient is appropriate, the recipient agrees to comply with any additional instructions provided by the ME regarding such audit. The recipient further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the ME, Department of Children and Families 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 Uniform Guidance, Section 200.500-200.521, as revised. In the event the recipient expends $500,000 ($750,000 for fiscal years beginning on or after December 26, 2014) 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 133 Uniform Guidance, Section 200.500-200.521, as revised. The recipient agrees to provide a copy of the single audit to the ME Contract Manager. In the event the recipient expends less than $500,000 in Federal awards during its fiscal year, the recipient agrees to provide certification to the ME's Contract Manager that a single audit was not required. In determining the Federal awards expended during its fiscal year, the recipient shall consider all sources of Federal awards, including Federal resources received from the Department of Children & Families through the ME, Federal government (direct), other state agencies, and other non -state entities. The determination of amounts of Federal awards expended should be in accordance with guidelines Attachment 11 Page 1 of 4 Guidance Care Center, Inc. Contract No. PPG-2-03 V/ South Florida /Behavioral ' Health Network, Inc. Rev. 5/4/2015 established by OMB Uniform Guidance, Section 200.500-200.521, as revised. An audit of the recipient conducted by the Auditor General in accordance with the provisions of OMB Uniform Guidance, Section 200.500-200.521, 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 Section 200.508 of OMB Uniform Guidance, as revised. The schedule of expenditures should disclose the expenditures by contract number for each contract with the ME in effect during the audit period. The financial statements should disclose whether or not the matching requirement was met for each applicable contract. All questioned costs and liabilities due the Department (through the contract with the ME) shall be fully disclosed in the audit report package with reference to the specific contract number. 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. The recipient agrees to provide a copy of the single audit to the ME's Contract Manager. In the event the recipient expends less than $500,000 in State financial assistance during its fiscal year, the recipient agrees to provide certification to the ME's Contract Manager that a single audit was not required. In determining the state financial assistance expended during its fiscal year, the recipient shall consider all sources of state financial assistance, including state financial assistance received from the Department of Children & Families through its contract with the ME, 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 ME in effect during the audit period. The financial statements should disclose whether or not the matching requirement was met for each applicable contract. All questioned costs and liabilities due the Department (through the contract Attachment II Page 2 of 4 Guidance Care Center, Inc. Contract No. PPG-2-03 �� South Florida A/ Behavioral Health Network, Inc. Rev. 5/4/2015 with the ME) 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 ME 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. Contract manager for this contract (1 copy) B. Department of Children & Families ( 1 electronic copy and management letter, if issued ) Office of the Inspector General Single Audit Unit Building 5, Room 237 1317 Winewood Boulevard Tallahassee, FL 32399-0700 Email address: single.audit c myflfamilies.com C. Reporting packages for audits conducted in accordance with Uniform Guidance, Section 200.500-200.521, as revised, and required by Part I of this agreement shall be submitted, when required by Section 200.512 (d), OMB Uniform Guidance, 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/coIlect/ddeindex.htmI and other Federal agencies and pass -through entities in accordance with Section 200.512 (e), OMB Uniform Guidance, as revised. D. Copies of reporting packages required by Part II of this agreement shall be submitted by or on behalf of the recipient directly to the following address: Auditor General Local Government Audits/342 Claude Pepper Building, Room 401 111 West Madison Street Tallahassee, Florida 32399-1450 Email address: HQW.IG.Single.Audit@mvflfamilies.com Attachment II Page 3 of 4 Guidance Care Center, Inc. Contract No. PPG-2-03 South Florida Behavioral Health Network, Inc. Rev. 5/4/2015 Network Providers, when submitting audit report packages to the ME and the Department for audits done in accordance with OMB Uniform Guidance, Section 200.500-200.521, or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit or for -profit organizations), Rules of the Auditor General, should include, when available, correspondence from the auditor indicating the date the audit report package was delivered to them. When such correspondence is not available, the date that the audit report package was delivered by the auditor to the provider must be indicated in correspondence submitted to the Department in accordance with Chapter 10.558(3) or Chapter 10.657(2), Rules of the Auditor General. PART IV: RECORD RETENTION The recipient shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six years from the date the audit report is issued and shall allow the ME, the Department or its designee, Chief Financial Officer or Auditor General access to such records upon request. The recipient shall ensure that audit working papers are made available to the ME, the Department or its designee, Chief Financial Officer or Auditor General upon request for a period of three years from the date the audit report is issued, unless extended in writing by the ME and/or the Department. Attachment II Page 4 of 4 Guidance Care Center, Inc. Contract No. PPG-2-03 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 tq�q,$10,000 and not more than $100,000 for each such failure. Signature ` I ,�\ T-�c "1 ►U Name utho`ntzed Individual / Czu-t Cep Zg N f O t'on 10 101 Date Application or Contract Number ame o rgamza i �3o o o chs+- S+. Oce-ak, K-ar6�LA-_ F 5-300 Address of Organization CF 1123, PDF 03/96 Attachment III Guidance Care Center, Inc. Page I of 1 Contract No. PPG-2-03 SBehouthavio4ral Florida Health Network,Inc. Attachment IV PREVENTION SCOPE OF WORK NAME OF PROVIDER: Guidance/Care Center NAME OF PREVENTION PROGRAM: Project SUCCESS AMOUNT OF CONTRACT AWARD: $150,000.00 for each year of the contract "Regular" Prevention Services Prevention Partnership Grant TYPE OF FUNDING: (PPG) X COST ALLOCATED TO: (check both Children's Substance Abuse Adult Substance Abuse if approved for both covered services) X X Section I. DESCRIPTION OF SERVICES AND STRATEGIES FOR SERVICE DELIVERY DESCRIPTION OF SERVICES SUMMARY (Include overall intention/purpose of program and service flow, brief description of program activities, target population to be served, how the services address cultural competency. the name (s) of the EBP (s) and how it (they) will be implemented, describe com.rehensive programming, and the partners and coordination efforts): 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, are showing early danger signs and multiple risk factors for substance abuse and who attend Monroe County High Schools. Project SUCCESS relies primarily on Education as a strategy. Services include school wide activities targeting the entire school population and are designed to increase awareness of mental health and substance abuse issues, small groups targeting youth identified as being at risk, prevention education groups targeting all 9th graders, and individual counseling to those in need of additional supportive counseling. CCAP Goals: 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. GCC partners with the Monroe County School District and the Monroe County Coalition for the provision of these services. IOM Category (Universal — Direct or Indirect, Selective, Indicated) for each program, practice, and strategy: UNIVERSAL—Indirect/Direct.: Information Dissemination SELECTIVE: Education—Project SUCCESS and Alternatives INDICATED: Problem Identification and Referral and Alternatives Attachment IV Page 1 of 14 Guidance Care Center,Inc. Contract No.PPG-2-03 Southavioral Florida rill Beh .� Health Network,Inc. Specific primary prevention programs, practices, and strategies in each of the six prevention j strategies: Education, Alternatives, Problem Identification and Referral, Information Dissemination, Community-Based Processes (Coalitions and Evaluation), Environmental Strategies (Coalitions and Evaluation). EDUCATION—Project SUCCESS primarily involves the strategy of Education. The 9th grade Prevention Education Series includes a 4 topic educational series provided in from 4 to 8 sessions. The Series combines both didactic and experiential approaches to achieve its goals. The Series consists of the following 4 topics: Being an Adolescent, Alcohol, Tobacco and Other Drugs, Relationships: Friends and Family, and Skills for Coping. The Small Group Series helps students identify and resist social and situational pressures to use substances, correct misperceptions about the prevalence and acceptability of substance use, focus on the personal consequences of use, teach and provide opportunities to practice resistance and coping skills and identify barriers to using the skills or adopting healthy attitudes. ALTERNATIVES—each program provides activities for youth to consider excluding substance use and increasing pro-social behavior. PROBLEM IDENTIFICATION AND REFERRAL—Project SUCCESS screens all participants for needs related to substance abuse, mental health, education, health, and social issues. Students are referred as is appropriate. INFORMATION DISSEMINATION—School Wide Activities are provided monthly to bring awareness to substance use issues and consequences as well as other mental health and physical health issues. Examples of awareness topics covered in the past include Red Ribbon Week, Kick Butts Day, Children of Alcoholics Awareness, Children's Mental Health Awareness, and Safe Graduation and Prom activities. Section II. TARGET POPULATION — RISK AND PROTECTIVE FACTORS TARGET POPULATION OR PARTICIPANTS (Include numbers in tables and a narrative description of participant characteristics below): Universal — Direct or Indirect, Selective, Indicated Number of Unduplicated Participants (if duplicated note) Universal Indirect/Direct—School wide activities and Information Dissemination 2,500 Universal Direct/Selective—9`n Grade Prevention Educational Series 335 Selective—Small Groups 80 Indicated—One on one counseling 130 Description of participants to be served (describe criteria for program enrollment eligibility, geographic areas / Neighborhoods (list zip codes), risk factors of the neighborhoods. description of the sites (school, church. park, etc.), as well as any other significant demographic information), specific cultural characteristics, and describe according to the Comprehensive Community Action Plan priorities: Youth alcohol use - Abuse by "legal" age individuals Youth/Adult marijuana use Prescription drug misuse/abuse Over the counter drugs misuse/abuse Participants will be students at the 3 High Schools in Monroe County and Middle School students in Marathon. School wide activities and Prevention Education Groups are universal in nature while small groups and individual counseling are targeted at youth identified as at risk. At risk students might be identified by parents, teachers, other community agencies or by themselves. Project SUCCESS is designed to be implemented in school settings. Each counselor has been provided with adequate space and access to student populations to fully implement the program as designed. 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%) Attachment IV Page 2 of 14 Guidance Care Center,Inc. Contract No.PPG-2-03 South Flori oral da Behavi Health Network,Inc. 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. Risk Factors: include community laws and norms favorable to drug use (Monroe County is a tourist/vacation destination), firearms and crimes, favorable attitudes towards alcohol use, favorable attitudes towards problem behaviors, low neighborhood attachment, and community disorganization. Protective Factors: include community, family and school, all bonding opportunities. Skills and recognition and strong, positive family bonds; parental monitoring of children's activities and peers; clear rules of conduct that are consistently enforced within the family; involvement of parents in the lives of their children; success in school performance; strong bonds with institutions, such as schools, religious organizations; adoption of conventional norms about drug use. Section III. SITE LOCATIONS AND INFORMATION* Site Name Street Address City Code Children/ Parent Others Youth s Key West High School 2100 Flagler Avenue Key West 33040 Coral Shores High School 89901 Old Highway Tavernier 33070 Marathon Middle/High School 350 Sombrero Road Marathon 33050 "Sites/locations of services cannot be changed without prior authorized approval of the SFBHN Contact Manager. Section IV. MAJOR REFERRAL SOURCES List the major referral sources for the services provided: Monroe County Schools—teachers, school counselors, administrators DJJ Self-referral Social Service Agencies Wesley House and DCF Section V. PERFORMANCE MEASURES Quantity Performance Measures Activities/Service Name & Description Activity (Include frequency, intensity, & duration of # % To Level sessions, as well as the number of Childre # # Require Meet Selectiv Parent Other d cycles/cohorts expected to be offered and n/ Require e— tentative schedule/timing) Youth s s Session d Indicate d • Youth/Children At-Risk of Substance Abuse Problems — include individual measures that will result in achieving the Substance Abuse & Mental Health Required Performance Outcomes & Outputs • Parent/Families At-Risk of Substance Abuse Problems— include individual measures that will result in achieving the Substance Abuse& Mental Health Required Performance Outcomes & Outputs Attachment IV Page 3 of 14 Guidance Care Center,Inc. Contract No. PPG-2-03 Sohutavh ioral Florida Be Health Network,Inc. Prevention Education Series 335 6to 8 85% Universal Project SUCCESS Of scheduled sessions School Wide Activities 2500 9 90% Universal Small Groups 80 2 85% Selective Newcomer group sessions 85%of other scheduled small group sessions Individual Sessions 130 1-3 85% Indicated Sessions, with justificatio n if different Quality Performance Measures (Include fidelity measures, satisfaction survey information, supervision, training, staffing, and other required information pertaining to quality) Average number of sessions 85% of 545 participants will complete Measured at the end of each cohort attended (participant retention) Project SUCCESS pre/posts, attendance records and minimally 85% of scheduled sessions 85 % of youth will increase their Project SUCCESS pre and post tests Collected immediately prior to the 1st attitudes and beliefs related to session and immediately following the risk of harm associated with last session underage drinking Collected immediately prior to the 1st 85% of the youth will have no or session and immediately following the a decrease in past 30 day Project SUCCESS pre and post tests last session alcohol use by curriculum completion Collected immediately prior to the 1st 85% of youth will decrease Project SUCCESS pre and post tests session and immediately following the favorable attitudes toward last session alcohol and drug use Attachment IV Page 4 of 14 Guidance Care Center,Inc. Contract No.PPG-2-03 F, SoBehauthvioral Florida Health Network.Inc. #and % of youth/participants 90% Satisfaction Survey Measured at the end of each program satisfied with services provided cohort Observation of service Curriculum fidelity checklist Measured at the end of each program delivery/Fidelity checklist cohort Supervisor/Observer Report Documentation of structured Supervisory record, Supervisory Tool, or During regular supervisory sessions supervision Checklist and notes in staff file and not less than one time per month #and % of staff with necessary 100% At the time of contract monitoring training # and % of staff working Staff will show courses and documents toward Prevention from the Florida Certification Board at certification with the Florida 50% the time of contract monitoring. Certification Board Section VI. Participant Outcomes Will be completed with the Evaluation Team and SFBHN. Timing when each Outcomes Data Source/ data Outputs & Associated Measurement source/measure Activity will be collected CCAP Objective: By June 30, 2018, reduce the rate of past 30 day alcohol use and the rate of Binge Drinking among underage young adults and youth in Monroe County. CCAP Outcome: By June 30, 2018, there will be a 5% reduction of 30 day use of alcohol and a 2.5% reduction of binge drinking among the underage young adults and youth of Monroe County. Cohorts Section VII. TASK LIST # & EBP % toMeet Activities/Service Name & Description Type of Rec this Participant d Sessionsscions or Outcome s Hours r Activity Title: Recruitment/Screening 545 N/A 8%: Activity Description:.All students referred or presenting for service will receive an initial screening of risk and protective factors Frequency:One time upon program entry Intensity:one session Duration: 15 mins. Activity Title: Prevention Assessment 130 45-60 mins. 85% Activity Description: Participants who become enrolled in the program will complete a detailed prevention assessment of service needs Frequency:Once, upon enrollment in the program Intensity:One session Attachment IV Page 5 of 14 Guidance Care Center,Inc. Contract No.PPG-2-03 Southaviora Floridal Beh Health Network,Inc. Duration: 60 mins. Activity Title: Project SUCCESS Prevention Education Series Curriculum 335 85%of 85% Activity Description:.9th graders will participate in a 4 topic scheduled Prevention Education Curriculum sessions(6-8) Frequency.'one time per week For 45—60 Intensity:6—8 sessions, based on participant discussion of the topics mins. as some topics take 2 sessions to cover Duration:45 to 50 mins. Activity Title: Pre-and Post testing 545 45 to 60 min. 85% Activity Description:. All large and small group participants will be pre sessions and post tested for the knowledge, beliefs, attitudes and use of substances Frequency:Twice Intensity:once before first session,once at completion of last session Duration:45 to 50 mins. Activity Title: Small group activities 80 45 to 60 min. 85% Activity Description:. At risk students will participate in small group sessions sessions designed to mitigate risk factors and enhance protective factors Frequency:One session per week Intensity:6—12 sessions depending on the group subject and with the exception of New Comers groups which only meet 3 times. Duration:45 to 50 mins. Section VIII. EVIDENCE BASED PROGRAMS (EBP) Evidence Based Program Designating Agency Project SUCCESS SAMHSA approved, NREPP Section IX. EVALUATION Describe how the program will evaluate the effectiveness of all prevention services to be implemented consistent with 65D-30.013(2), F.A.C., in collaboration with the Evaulation Team identified by SFBHN each year. The SFBHN Evauation Team shall review the results of providers' program evaluation and all technical materials used by providers annually to ensure consistency with current research in the prevention field 1- Adhering to the Fidelity Implementation Plan,Project SUCCESS will utilize Fidelity checklists from the Project SUCCESS implementation manual at the end of each small and large group cohort as described above under Quality Performance Measures. This checklist assesses whether the facilitator appropriately addressed each major objective, activity, and primary point of the session. If a Prevention counselor falls below the 90% criterion on the Fidelity checklist at any time, the Program Supervisor will develop a plan to assist them in increasing necessary skills. Weekly Fidelity checks will then occur until a 90% criterion is achieved. 2- Supervision Meetings—Any problem areas in the small or large groups or in counseling sessions or other program activities will be discussed and addressed at weekly Supervision meetings. 3- Program effectiveness will be evaluated through results of the Pre and Post tests as well as results of the Satisfaction Surveys. Attachment IV Page 6 of 14 Guidance Care Center,Inc. Contract No. PPG-2-03 �� South Florida Behavkual %/ Health Network, Inc. 4- Activity Logs are maintained for all Universal and Selective activities. 5- Client charts are maintained for all Indicated Prevention activities and are included in the GCC Peer Review process. 6- All activities for Prevention will be consistent with the agency's Quality Assurance Quality Improvement Plan. GCC will coordinate with the Evaluation Team, Behavioral Science Research Institute (BSRI), for process and outcome data as required. The Data will support any processes from the Westcare Team. Attachment IV Page 7 of 14 Guidance Care Center, Inc. Contract No. PPG-2-03 South Florida Behavioral Health Network,Inc. Section X. EVALUATION PLAN Goal 1: By June 30,2018,reduce the rate of past 30-day alcohol use and the rate of Binge Drinking among underage young adults and youth in Monroe County. Data collection What measures Who/what is the Flow will the data be If survey data is When will Who is responsible instruments/ source of the data? collected?(e.g.archival needed,front how data be for collecting, Outcomes questions will be (e.g.police, measures,survey, many people will collected? analyzing and used to collect schools,retailers, observation,etc) data be collected? reporting data? data? parents, Community members,etc) Long term Outcome:By Monitoring the Students Surveys 1,260(420 Beginning Research June 30,2018,there will Future Survey annually) and end of Assistant collects be a 5%reduction of 30- curriculum and enters data day use of alcohol and a completion Evaluator 2.5%reduction of binge analyzes and drinking among the reports data underage young adults and youth of Monroe County. Objective 1 from CCAP:Reduce the number of underage young adult(18-20)and youth(12 to 17)who drink and report buying or someone else buying alcohol in a store Immediate Outcome(s): Monitoring the Students Surveys 1,260(420 Beginning and Research Increase knowledge and Future Survey annually) end of curriculum Assistant collects skills among minors. completion and enters data Evaluator analyzes and reports data Attachment IV Page 8 of 14 Guidance Care Center, Inc. Contract No. PPG-2-03 Fez."- SouthBehavioral Florida Health Network,Inc. • Intermediate Outcomes(s): Monitoring the Students Surveys 1,260(420 Beginning and Research Reduce the number of Future Survey annually) end of curriculum Assistant collects underage alcohol drinkers completion and enters data who report buying alcohol Evaluator in a store. analyzes and reports data Objective 2 from CCAP: Reduce the underage young adult(18-20)and youth(12 to 17)attitudes of the acceptance of alcohol use. Immediate Outcome(s): Fidelity Measures Prevention Observations Minimum of 3 Random Research Provide increased and for Project Counselor observations Assistant and consistent messaging SUCCESS quarterly Prevention about the consequences of Curriculum Supervisor alcohol abuse Intermediate Outcomes(s): Fidelity Measures Prevention Observations Minimum of 3 Random Research Consistency of Evidence for Project Counselor observations Assistant and Based Programs SUCCESS quarterly Prevention Curriculum Supervisor Goal 2:Expand the community messaging and communication strategy to more effectively build community ownership of the underage drinking problems in Monroe County through formalizing of new relationships with key community and business leaders using the Strategic Prevention Framework. Data collection Who/what is the How will the If survey data, What How frequently Who is source of the data be from how many instruments/ will data be responsible for Outcomes data? collected? people will data questions will be collected? collecting, be collected? used to collect analyzing and data? reporting data? Attachment IV Page 9 of 14 Guidance Care Center, Inc. Contract No. PPG-2-03 0 U N 0 E bq 0 N O _T c 7 o � _ QY T _ L ° > W p > bq = U�Q T _ E E O U T N � U _ = U m N N L � O N U L bA O _ T Y > n• = L ° � U a ° U b _ 42 _ T Cl. U c`ai U a� C7 a a� L U _ N U hi > E N N s on s ca U s 0 on ( N i a� o%=�..=�E� E E u�v to v U E E N 9.a .a U � U -o > a. F5 Q O.. V] W Q cO LU CC L T s E o ° � � U 3 6 o cu s o = o m > L = O O N a3 Y a •C L � � Y � Ln CA M O C O N cz r _ O > T L In In � .fl O � Ln N O L _ O •' O U U o 0 cj C7 U v7 V1 = Ri N eC E L f� 2E t o op L > O N p o G U = p= _'E c > t O •cz •E wo N aL+ OA U� eq U ° � cc E E a a° ° O C0 0 N 0 a a O U lc6 c O U South Florida Behavioral Health Network,Inc. Section XI. PROJECT MASTER SCHEDULE/TIMELINE YEAR 1 Activities Timeline Party Responsible Start Date End Date Prepare, organize educational materials Sept. May Project SUCCESS counselors 2015 2016 Conduct follow-up on previous yr.clients Sept. Oct. Project SUCCESS counselors 2015 2015 Coordinate&finalize program logistics w/targeted schools Sept. Oct. Project SUCCESS counselors 2015 2015 Present program overview&update to Admin.,teachers,&other school staff Sept. Oct. Project SUCCESS counselors 2015 2015 Present program update to Community Coalition Sept. June Program Coordinator 2015 2016 Present program overview&update to Parent Advisory Councils at each school During Project SUCCESS counselors the months of Sept. and Feb. 2015 Counselors to conduct introductory classroom presentations Sept. Oct. Project SUCCESS counselors 2015 2015 Implement Prevention Series groups Oct. Apr. Project SUCCESS counselors 2015 2016 Conduct Individual Assessments Sept. May Project SUCCESS counselors 2015 2016 Test for program fidelity Nov. May Project SUCCESS counselors 2015 2016 Conduct Pre and Post tests Sept. May Project SUCCESS counselors 2015 2016 Attachment IV Page 11 of 14 Guidance Care Center,Inc. Contract No. PPG-2-03 mpe;,.• South Florida Behavioral Heath Netwo►k,Inc. School wide awareness activities During the Project SUCCESS counselors months of Oct.Nov., Dec.2015 Feb.Mar. Apr May 2016 Conduct weekly clinical supervision with Counselors Sept. June Program Coordinator 2015 2016 Conduct monthly PS staff meetings with all Program Staff Sept. June Program Coordinator 2015 2016 Identify and refer students in need of services during the summer months Apr. June Project SUCCESS counselors 2016 2016 Timeline Party Responsible YEAR 2 Activities Start Date End Date Prepare, organize educational materials Jul.2016 May Project SUCCESS counselors 2017 Conduct follow-up on previous yr.clients Aug. Oct. Project SUCCESS counselors 2016 2017 Coordinate&finalize program logistics w/targeted schools Sept. Oct. Project SUCCESS counselors 2016 2016 Present program overview&update to Admin.,teachers,&other school staff Aug. Oct. Project SUCCESS counselors 2016 2016 Present program update to Community Coalition Aug. June Program Coordinator 2016 2017 Present program overview&update to Parent Advisory Councils at each school During Project SUCCESS counselors the months of Sept. and Feb. 2016 Counselors to conduct introductory classroom presentations Aug. Oct. Project SUCCESS counselors 2016 2016 Implement Prevention Series groups Sept. Apr. Project SUCCESS counselors 2016 2017 Attachment IV Page 12 of 14 Guidance Care Center,Inc. Contract No.PPG-2-03 South Florida / Behavioral Health Network,Inc. Conduct Individual Assessments I Aug. May Project SUCCESS counselors 2016 2017 Test for program fidelity Oct. 2016 May Project SUCCESS counselors 2017 Conduct Pre and Post tests Sept. May Project SUCCESS counselors 2016 2017 School wide awareness activities During the Project SUCCESS counselors months of Sept.,Oct. Nov.,Dec. 2016 Feb. Mar.Apr May 2017 Conduct weekly clinical supervision with Counselors Jul.2016 June Program Coordinator 2017 Conduct monthly PS staff meetings with all Program Staff Jul. 2016 June Program Coordinator 2017 Identify and refer students in need of services during the summer months Apr. June Project SUCCESS counselors 2016 2017 Timeline Party Responsible YEAR 3 Activities Start Date End Date Prepare,organize educational materials July May Project SUCCESS counselors 2017 2018 Conduct follow-up on previous yr.clients August Sept. Project SUCCESS counselors 2017 2017 Coordinate&finalize program logistics w/targeted schools Jul 2017 Sept. Project SUCCESS counselors 2017 Present program overview&update to Admin.,teachers,&other school staff Jul. 2017 Aug. Project SUCCESS counselors 2018 Present program update to Community Coalition Jul 2017 June Program Coordinator 2018 Attachment IV Page 13 of 14 Guidance Care Center,Inc. Contract No. PPG-2-03 VI L Vf L V1 L VI L V1 L V1 L VI L N L O O O 0 v V7 _O v U) _O v V1 a) 1A a) VI _O v V7 v 0 _O v o C c C c c c C L, t,• c 3 3 3 3 3 3 3 O 0 3 O O O O O O 0 0 V) V) V1 Vf Vf V7 V) C c VI V) V) V) VI VI VI Ln V) W W W W W W W L L O W U U U U U U U O U V) (A V1 V) V) V1 V) rA �•+ Y �••' ++ Y Y �•+ m m u aui au) aui au) au) au) au) 00 to v 0 L 0 L 0 L 0 L 0 L 0 L 0 L O L 0 L 0 L CL 0_ a CL 0. o. a a 0_ 0_ } r 00 T 00 T 00 T 00 v 00 v 00 v 00 O- r 4 O L rl CLO m -4 20 ra ' I 2 O ra rl 20 C rl O� C 'I O C rl Z) O (n � r-I Y 0 u U _a OD i Q al a u' I� -O n �+ n ^ ON ^ Y O p LL Q 0 C +� ^ N C >- C) O i L VI ri C 0 c 0 OA ri 3 C) v C) C) u O = O a1 0 CDm m^ Q O E 0 m rV Q N V) N Q N O Q N p E V) Z N Q O 0 L 5 t N t U r0 a-' C v E rd U E c E 3 O c 3 N U L ;0 }� Y a) Y O Q) V1 a I v C r0 Q CL _O a) L toc C C c N a1 0 3 d aJ a O 0 Uro _ m u u 0 m 0 O- 30 OL ^ c v °° c a 3 u 3 00, A > N aJ c y W 0 b a1 % L a) M. 0) •� 3 N .cu L a1 rn u r0 N c w 3 O IA IA .� -O N N U 'c N 0 ++ c _ m O d C v L a) 3 u :EL rE o uu O v L •> coo L 3 m L i C C L a CL "_O 3 E C a v rA E u 3 0 u 3 3 u 3 u 3 w Qj C N -O "O "C -0 3 Q C C C c 7 Q CL a) C CD U m U a) v c m 0 0 Amendment # I Contract No. PPG-2-03 THIS AMENDMENT, entered into between South Florida Behavioral Health Network, Inc. hereinafter referred to as the "ME" and Guidance/Care Center. Inc., hereinafter referred to as the "Network Provider," amends Contract No. PPG-2-03. PREAMBLE: This amendment is to revise Exhibit G, Covered Services Funding by OCA for Fiscal Years 2015-2016, 2016-2017 and 2017-2018 to reflect funding reallocations within the Children Substance Abuse Program, Other Cost Accumulator (OCA) MSCPP (MSOPP-new OCA) at the provider's request. 1. Pages 1- 4, Exhibit G, Covered Services Funding by OCA for September 1, 2015- June 30, 2016 are hereby deleted in their entirety and Pages 2-4, Revised Exhibit G, Covered Services Funding by OCA for September 1, 2015- June 30, 2016 are inserted in lieu thereof and attached hereto. 2. Pages 1- 4, Exhibit G, Covered Services Funding by OCA for July 1, 2016- June 30, 2017 are hereby deleted in their entirety and Pages 1-4, Revised Exhibit G, Covered Services Funding by OCA for July 1, 2016- June 30, 2017 are inserted in lieu thereof and attached hereto. 3. Pages 1- 4, Exhibit G, Covered Services Funding by OCA for July 1, 2017- June 30, 2018 are hereby deleted in their entirety and Pages 1-4, Revised Exhibit G, Covered Services Funding by OCA for July 1, 2017- June 30, 2018 are inserted in lieu thereof and attached hereto. This amendment shall begin on April 1. 2016. All provisions of the contract and any attachments thereto in conflict with this amendment shall be and are hereby changed to conform to this amendment. All provisions of the contract not in conflict with this amendment are still in effect and are to be performed at the level specified in the contract. This amendment is hereby made a part of the contract. IN WITNESS THEREOF, the parties hereto have caused this thirteen (13) page amendment to be executed by their officials' thereunto duly authorized. GUIDANCE/CARE CENTER, INC. SIGNED NAME: Frank Rabbito HdriaAnk,� SOUTH FLORIDA BEHAVIORAL HEALTH NETWORK, INC. SIGNED BY: N John W. Dow TITLE: Senior Vice President �( ol^ OA TITLE: President and CEO DATE: S t I 1 ti DATE: E �� FEDERAL Tax ID # (or SSN): 59-1458324 Guidance Care Center, Inc. Page l of 1 Contract No. PPG-2-03 September 1,2015-June 30,2016 EXHIBIT G:COVERED SERVICES FUNDING BY OCA Revised:April 2016 Amendment#1 Guidance/Care Center,Inc.-PPG \I)1 LT MENTAL HEALTH PPG3 M1111001 N111009 MH018 MH018 MH072 M11073 MH076 MH093 MH094 MHOPG MHOTB MHOCF COVERED SERVICES FUNDING/ M11IIA01 M11IIA09 MHA18 M11A18 MHA72 MHA73 MHA76 MHA93 MHA94 MHAPG MHATB MHACF TOTAL RATE - - - - - - - - - - - - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - I I Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - I5 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - S - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 $ - 49 Prevention-Selective $ 48.68 $ - 50 Prevention-Universal Direct $ 48.68 $ - 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - S - S - S - TOTAL UNCOMPENSATED $ - Revised Exhibit G Guidance Care Center,Inc. Page 1 of4 Contract No. PPG-2-03 September 1,2015-June 30,2016 EXHIBIT G:COVERED SERVICES FUNDING BY OCA Revised:April 2016 Amendment#1 Guidance/Care Center,Inc.-PPG CHILDREN \II:\I \I.HEALTH PPG3 M1111001 MH009 M11009-CF M11018 MH0I8 MHOBN MHOFA MHOFA-CR MHOMD MHOMD-CR MHOCF COVERED SERVICES FUNDING/ MHCO1 MHCO9 NHC09-CI MHC18 MHC18 MHCBN MHCFA MHCFA-CR MHCMD MHCMD-CR MHCCF TOTAL RATE - - - - - - - - - - - $ - 0I Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - 1 I Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 $ - 49 Prevention-Selective $ 48.68 $ - 50 Prevention-Universal Direct $ 48.68 $ - 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED $ - Guidance Care Center,Inc. Revised Exhibit G Contract No. PPG-2-03 Page 2 of 4 September 1,2015-June 30,2016 EXHIBIT G:COVERED SERVICES FUNDING BY OCA Revised:April 2016 Amendment#1 Guidance/Care Center,Inc.-PPG V 11 I I SUBSTANCE ABUSE PPG3 MS003 MS011 MS021 MS023 MS02S MS027 MS081 MS091 MSOTB MS903 MSOCF COVERED SERVICES FUNDING/ MSA03 MSA11 MSA21 MSA23 MSA25 MSA27 MSA81 MSA91 MSATB MSACF TOTAL RATE - - - - - - - - - - - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - 1 I Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $. - $ - 35 Outpatient-Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 $ - 49 Prevention-Selective $ 48.68 $ - 50 Prevention-Universal Direct $ 48.68 $ - 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED $ - Revised Exhibit G Guidance Care Center, Inc. Page 3 of4 Contract No. PPG-2-03 September 1,2015-June 30,2016 EXHIBIT G:COVERED SERVICES FUNDING BY OCA Revised:April 2016 Amendment#1 Guidance/Care Center,Inc.-PPG ( I I ILDREN SUBSTANCE AM sI PPG3 MS003 MS011 MS021 MS023 MS025 MS025-CR MSOPP MSOTB MS903 MSOCF COVERED SERVICES FUNDING/ MSCO3 MSC11 MSC21 MSC23 MSC25 MSC25-CR MSCPP MSCTB MSCCF TOTAL RATE - - - - - - 150,000 - - - $ 150,000 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - I I Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - S - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 22,469 $ 22,469 49 Prevention-Selective $ 48.68 53,486 $ 53,486 50 Prevention-Universal Direct $ 48.68 74,045 $ 74,045 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ 150,000 $ - $ - $ - $ 150,000 TOTAL UNCOMPENSATED Guidance Care Center,Inc. Revised Exhibit G Contract No.PPG-2-03 Page 4 of 4 July 1,2016-June 30,2017 EXHIBIT G:COVERED SERVICES FUNDING BY OCA Revised:April 2016 Amendment#1 Guidance/Care Center,Inc.-PPG '.I)I I I \I I.NTALHEAI III PPG3 MH001 MH009 MHO18 MH018 MH072 MH073 MH076 MH093 MH094 MHOPG MHOTB MHOCF COVERED SERVICES FUNDING/ MHAO1 MHAO9 MHA18 MHA1S MHA72 MHA73 MHA76 MHA93 MHA94 MHAPG MHATB MHACF TOTAL RATE - - - - - - - - - - - - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - 11 Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level❑ $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ $ - 46 Recovery Support-Individual $ $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 $ - 49 Prevention-Selective $ 48.68 $ - 50 Prevention-Universal Direct $ 48.68 $ - 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED $ - Guidance Care Center,Inc. Revised Exhibit G Contract No. PPG-2-03 Page 1 of 4 July 1,2016-June 30,2017 EXHIBIT G:COVERED SERVICES FUNDING BY OCA Revised:April 2016 Amendment#1 Guidance/Care Center,Inc.-PPG CI I11.DREN MENTAL HEM.I I I PPG3 MH001 MH009 MH009-CF MH018 MHOI8 MHOBN MHOFA MHOFA-CR MHOMD MHOMD-CR MHOCF COVERED SERVICES FUNDING/ MHCO1 MHCO9 11HC09-CI MHC18 MHC18 MHCBN MHCFA MHCFA-CR MHCMD MHCMD-CR MHCCF TOTAL RATE - - - - - - - - - - - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - I I Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 $ - 49 Prevention-Selective S 48.68 $ - 50 Prevention-Universal Direct S 48.68 $ - 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - S - S - S - $ - $ - $ - $ - TOTAL UNCOMPENSATED $ - Guidance Care Center,Inc. Revised Exhibit G Contract No. PPG-2-03 Page 2 of 4 July 1,2016-June 30,2017 EXHIBIT G:COVERED SERVICES FUNDING BY OCA Revised:April 2016 Amendment#1 Guidance/Care Center,Inc.-PPG ADULT SUBS"I \SCE ABUSE PPG3 MS003 MS011 MS021 MS023 MS025 MS027 MSO81 MS091 NISOTB MS903 MSOCF COVERED SERVICES FUNDING/ MSA03 MSA11 MSA2I MSA23 MSA25 MSA27 MSA81 MSA9I MSATB MSACF TOTAL RATE - - - - - - - - - - - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - I I Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - IS Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level 1 $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 $ - 49 Prevention-Selective $ 48.68 $ - 50 Prevention-Universal Direct $ 48.68 $ - 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED $ - Guidance Care Center, Inc. Revised Exhibit G Contract No.PPG-2-03 Page 3 of 4 July 1,2016-June 30,2017 EXHIBIT G:COVERED SERVICES FUNDING BY OCA Revised:April 2016 Amendment#1 Guidance/Care Center,Inc.-PPG CHILDREN til its! S.NCE ABI'SI PPG3 MS003 MS011 MS021 MS023 MS025 MS025-CR MSOPP MSOTB MS903 MSOCF COVERED SERVICES FUNDING/ MSCO3 MSCII MSC21 MSC23 MSC25 MSC25-CR MSCPP MSCTB MSCCF TOTAL RATE - - - - - - 150,000 - - - $ 150,000 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ I I Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - • 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 22,469 $ 22,469 49 Prevention-Selective $ 48.68 53,486 $ 53,486 50 Prevention-Universal Direct $ 48.68 74,045 $ 74,045 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ 150,000 $ - $ - $ - $ 150,000 TOTAL UNCOMPENSATED Revised Exhibit G Guidance Care Center,Inc. Page 4 of Contract No. PPG-2-03 July 1,2017-June 30,2018 EXHIBIT G:COVERED SERVICES FUNDING BY OCA Revised:April 2016 Amendment#1 Guidance/Care Center,Inc.-PPG ADULT MENTAL HEALTH PPG3 MH001 MH009 MH018 M11018 M11072 \IH073 MH076 MH093 \I I III`>t \IHOPG MHOTB MHOCF COVERED SERVICES FUNDING/ MHAOI MHAO9 MHA18 MHA18 MHA72 MHA73 MHA76 MHA93 MHA94 MHAPG MHATB MHACF TOTAL RATE - - - - - - - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - 11 Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 $ - 49 Prevention-Selective $ 48.68 $ - 50 Prevention-Universal Direct $ 48.68 $ - 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - S - $ - $ - TOTAL UNCOMPENSATED $ - Revised Exhibit G Guidance Care Center, Inc. Page 1 of4 Contract No.PPG-2-03 July 1,2017-June 30,2018 EXHIBIT G:COVERED SERVICES FUNDING BY OCA Revised:April 2016 Amendment#1 Guidance/Care Center,Inc.-PPG ( !HI.UKFN MENTAL HEALTH PPG3 MH001 M11009 M11009-CF MH018 MH018 MHOBN MHOFA MHOFA-CR .I11,1\II) MHOMD-CR MHCFF COVERED SERVICES FUNDING/ MHCOI MHCO9 NHC09-CI MHC18 MHC18 MHCBN MHCFA MHCFA-CR MHCMD MHCMD-CR MHCCF TOTAL RATE - - - - - - - - - - - $ - ()I Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - I I Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - S - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 COST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 $ - 49 Prevention-Selective S 48.68 $ - 50 Prevention-Universal Direct $ 48.68 $ - 51 Prevention-Universal Indirect S 48.68 $ - 99 Special Proviso $ - $ - $ - S - TOTAL FUNDING $ 150,000 S - S - s - S - $ - $ - $ - $ - $ - $ - $ - S - TOTAL UNCOMPENSATED $ - Guidance Care Center, Inc. Revised Exhibit G Contract No. PPG-2-03 Page 2 of 4 July 1,2017-June 30,2018 EXHIBIT G:COVERED SERVICES FUNDING BY OCA Revised:April 2016 Amendment#1 Guidance/Care Center,Inc.-PPG :ADULT SUBSTANCE ABE SI. PPG3 MS003 MS011 MS021 MS023 MS025 MS027 MSO81 MS091 MSOTB MS903 MSOCF COVERED SERVICES FUNDING/ MSA03 MSA11 MSA21 MSA23 MSA25 MSA27 MSA81 MSA91 MSATB MSACF TOTAL RATE - - - - -- - - - - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - 11 Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 $ - 49 Prevention-Selective $ 48.68 $ - 50 Prevention-Universal Direct $ 48.68 $ - 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - S - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED $ - • Guidance Care Center,Inc. Revised Exhibit G Contract No.PPG-2-03 Page 3 of 4 July 1,2017-June 30,2018 EXHIBIT G:COVERED SERVICES FUNDING BY OCA Revised:April 2016 Amendment#1 Guidance/Care Center,Inc.-PPG CHILDRI.\SUBSTANCE ABUSE PPG3 MS003 MS011 MS021 MS023 MS025 MS025-CR MSOPP MSOTB NI S903 't,OCF COVERED SERVICES FUNDING/ MSCO3 MSC11 MSC21 MSC23 MSC25 MSC25-CR MSCPP MSCTB MSCCF TOTAL RATE - - - - - - 150,000 - - - $ 150,000 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop-In/Self Help Centers $ - $ - 08 In-Home/On-Site $ - $ - I I Intervention-Individual $ - $ - 42 Intervention-Group $ - $ - 12 Medical Services $ - $ - 14 Outpatient-Individual $ - $ - 35 Outpatient-Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare-Individual $ - $ - 43 Aftercare-Group $ - $ - 30 Information&Referral $ - $ - 34 FACT Team $ - $ - 36 Room&Board Level I $ - $ - 37 Room&Board Level II $ - $ - 38 Room&Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST-Individual $ - $ - 45 CCST-Group $ - $ - 46 Recovery Support-Individual $ - $ - 47 Recovery Support-Group $ - $ - 48 Prevention-Indicated $ 43.12 22,469 $ 22,469 49 Prevention-Selective $ 48.68 53,486 $ 53,486 50 Prevention-Universal Direct $ 48.68 74,045 $ 74,045 51 Prevention-Universal Indirect $ 48.68 $ - 99 Special Proviso $ - $ - $ - $ - TOTAL FUNDING $ 150,000 $ - $ - $ - S - $ - S - $ 150,000 $ - $ - $ - $ 150,000 TOTAL UNCOMPENSATED Guidance Care Center,Inc. Revised Exhibit G Contract No. PPG-2-03 Page 4 of 4 Contractual Agreement between Florida Department of Children and Families and South Florida Behavioral Health Network KH-225 - Contract Amendment #0022 (September 15, 2015) September 15, 2015 Contract No. KH225 Amendment #0022 THIS AMENDMENT, entered into between the State of Florida, Department of Children and Families, hereinafter referred to as the "Department," and South Florida Behavioral Health Network, Inc., hereinafter referred to as the "Provider," amends Contract No. KH225. The purpose of Amendment #0022 is to: • Renew contract KH225 for an additional four (4) years and nine (9) months, through June 30, 2020, pursuant to Section D. Paragraph 3 of Attachment I. • Amend the Standard Contract to increase the total contract funding to align with the Approved Operating Budget for FY2015-2016 and also include estimated funding for the renewal period. This increases the total value of the contract by $395,137,582.25. • Amend Attachment I, section B.1.a.(5), to add the statutory requirements regarding the collection of Crisis Stabilization Utilization data due to changes in Chapter 397, F.S. • Amend Attachment I, Method of Payment, which updates Table 1. Contract Funding to align the funding for FY15-16 as outlined in the Schedule of Funds dated 08/19/2015 and include estimated funding for the renewal period. Also, to update Paragraph 2. to remove any reference to the 16.72% in regard to Advances. • Amend Exhibit E-3, with the Schedule of Funds dated 08/19/2015 for FY2015-2016. • Amend Exhibit F, Region Specific Exhibit, to include the addition of item C. which specifies reporting requirements, including requirements from the Office of the Governor which instructs those providers who receive special project funding in FY15-16 to report return on investment projections and quarterly updates directly to the Governor's Office. Also includes revisions to Table A: Program Specific Fund Summary, to include Appropriations for FY15- 16 and Prevention Partnership Grant (PPG) recipients; adds item E. which specifies PPG Requirements; and adds item F. which lists the Appropriations for FY15-16. As a result, the Standard Contract, Attachment I, Exhibit E-3, ME Schedule of Funds, and Exhibit F, Region -Specific Exhibit are hereby amended to read: 1. Page 1, Standard Contract (dated 05/2014), Section 2, Effective and Ending Dates, is hereby amended to read: 2. Effective and Ending Dates. This Contract shall be effective on October 1, 2010 or the last date executed by a party, whichever is later. The service performance period under this Contract shall commence on October 1, 2010 or the effective date of this Contract, whichever is later, and it shall end at midnight, Eastern Time, on June 30, 2020, subject to the survival of terms provisions of Section 33.j hereof. 2. Page 1, Standard Contract (dated 06/2014), Section 3, Payment for Services, as previously amended on Page 1 of Amendment #0021, is hereby amended to read: 3. Payment for Service. The Department shall pay for contracted services performed by the Provider during the service performance period of this Contract according to the terms and conditions of this contract of an amount not to exceed $770,836,059.00 or the rate schedule, subject to availability of funds and the Department's determination of satisfactory performance of all terms by the Provider. The State of Florida's performance and obligation to pay under this Contract is contingent upon an annual appropriation by the Legislature. Any costs or services paid for under any other contract or from any other source are not eligible for payment under this Contract. South Florida Behavioral Health Network, Inc. Page 1 Southern Region SAMH Managing Entity September 15, 2015 Contract No. KH225 Amendment #0022 3. Page 9, Standard Contract, Signature Block, second sentence, is hereby amended to read: IN WITNESS THEREOF, the parties hereto have caused this seventy-one (71) page Contract to be executed by their undersigned officials as duly authorized. 4. Page 20, Attachment I (dated 07/01/2015), Section B. Manner of Service Provision, Paragraph 1.a.(5), Function 5. Data Collection, Reporting, and Analysis, as previously amended on Page 1 of Amendment #0021, is hereby amended to read: (5) Function 5. Data Collection, Reporting, and Analysis (o) No later than August 1, 2015, the Managing Entity shall require public receiving facilities within its Network Service Providers, pursuant to s. 394.9082(10), F.S., to collect and submit the crisis stabilization service utilization data specified therein on a daily basis using a file transfer protocol process or a web portal developed by the Managing Entity. 5. Page 30, Attachment I (dated 07/01/2015), Section C. Method of Payment, Paragraph 1, as previously amended on Page 1 of Amendment #0021, is hereby amended to read: 1. Payment Clause a. This advance fixed price, fixed payment contract is comprised of federal and state funds, subject to reconciliation. Exhibit E, ME Schedule of Funds identifies the type and amount of funding provided. At the beginning of each fiscal year, the Exhibit E, ME Schedule of Funds will be amended into this contract, and the total contract amount will be adjusted accordingly. b. The Department will pay the Managing Entity an operational cost for the management of the Network in accordance with the terms and conditions of this contract. The direct service cost is defined as the annual value of the contract less the operational cost of the Managing Entity. c. The contract total dollar amount shall not exceed $770,836,059.00, subject to the availability of funds, as outlined below: Table 1: Contract Funding State Fiscal Year Managing Entity Operational Cost Direct Service Cost Total Value of Contract 2010-2011 (9 months) $3,399,627.00 $52,952,530.00 $56,352,157.00 2011-2012 $3,491,295.00 $72,420,596.00 $75,911,891.00 2012-2013 $3,465,665.00 $70,244,946.00 $73,710,611.00 2013-2014 $3,432,250.00 $72,178,646.00 $75,610,896.00 2014-2015 $3,481,522.37 $72,203,746.63 $75,685,269.00 2015-2016 (3 months) $866,416.00 $19,811,845.75 $20,678,261.75 2015-2016 (9 months) $2,599,248.00 $59,435,537.25 $62,034,785.25 2016-2017 $3,465,664.00 $79,247,383.00 $82,713,047.00 2017-2018 $3,465,664.00 $79,247,383.00 $82,713,047.00 2018-2019 $3,465,664.00 $79,247,383.00 $82,713,047.00 2019-2020 $3,465,664.00 $79,247,383.00 $82,713,047.00 Total $34,598,679.37 $736,237,379.63 $770,836,059.00 South Florida Behavioral Health Network, Inc. Page 2 Southern Region SAMH Managing Entity September 15, 2015 Contract No. KH225 Amendment #0022 6. Page 31, Attachment I (dated 07/01/2015), Section C. Method of Payment, Paragraph 2. Payment, as previously amended on Page 1 of Amendment #0021, is hereby amended to read: 2. Payment a. In accordance with s. 394.9082, F.S., at the beginning of each fiscal year the Managing Entity may request an advance payment equal to two months of the current fiscal year contract value. Thereafter, the Managing Entity shall request monthly fixed payments equal to the fiscal year contract balance divided by the number of months remaining in the fiscal year. The payment request may be subject to financial consequences, pursuant to Section 8.51 b. The Managing Entity shall temporarily invest surplus advance funds in an insured or interest bearing account, in accordance with s. 216.181(16)(b), F.S. The Managing Entity shall remit to the Department, on a quarterly basis, any interest earned on advance funds via check. The Managing Entity must submit documentation from the financial entity where said funds are invested, evidencing the Annual Percentage Rate and actual interest income for each month. c. The Managing Entity shall expend any advance in accordance with the General Appropriations Act. d. The Managing Entity shall request payment in accordance with Section C.3., below. e. The Department will pay the Managing Entity according to the following schedule: Table 2: Invoice and Expenditure Report Submission Schedule Date of Invoice and Date of Expenditure Month of Service Fixed Payment Amount Monthly Progress Reports Submission Report Submission Advance Two months of the State Fiscal July 1 N/A Year Contract Amount Fiscal year contract balance No later than the 20th No later than the 20th of July - May divided by the number of months of month following month following service remaining in the fiscal year service delivery delivery Final Fiscal Year Fiscal year contract balance divided by the number of months August 15 August 15 Invoice (June) remaining in the fiscal year 7. Page 55, Exhibit E-3, ME Schedule of Funds, as previously amended on Page 1 of Amendment #0021, is hereby deleted in its entirety and Page 56, Revised Exhibit E-3, ME Schedule of Funds (dated 08/19/2016) is inserted in lieu thereof and attached hereto. 8. Pages 56 - 69, Exhibit F, Region -Specific Provisions, as previously amended on Page 1 of Amendment #0021, are hereby deleted in their entirety and Pages 56 - 62, Revised Exhibit F, are inserted in lieu thereof and attached hereto. South Florida Behavioral Health Network, Inc. Page 3 Southern Region SAMH Managing Entity September 15, 2015 Contract No. KH225 Amendment #0022 9. Page 60, Attachment II (dated 12116/2010), Certification Regarding Lobbying, as previously amended on Page 1 of Amendment #0021, is hereby renumbered as Page 63. 10. Pages 61 — 63, Attachment III, Financial and Compliance Audit (dated 05104/2015), as previously amended on Page 1 of Amendment #0021, are hereby renumbered as Pages 64-66. 11. Pages 64 — 68, Attachment IV, Protected Health Information (dated 07101/2014), as previously amended on Page 1 of Amendment #0021, are hereby renumbered as Pages 67 — 71. The parties hereby mutually agree to renew the contract as amended for a period of four (4) years and nine (9) months. This amendment shall begin on September 15,_2015 or the date on which the amendment has been signed by both parties, whichever is later. All provisions in the contract and any attachments thereto in conflict with this amendment shall be and are hereby changed to conform with this amendment. All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the contract. This amendment and all its attachments are hereby made a part of the contract. IN WITNESS THEREOF, the parties hereto have caused this twelve (12) Page amendment to be executed by their officials thereunto duly authorized. PROVIDER STATE OF FLORIDA SOUTH FLORIDA BEH IORAL HEALTH DEPARTMENT OF CHILDREN AND FAAWILIES NETWORK, INC. � f SIGNED BY: SIGNED BY: NAME: ohn . Dow NAME: Bronwyn Stanford TITLE: sident and Chief Executive Officer TITLE: Regional Managing Director DATE: / DATE: 9 FEDERAL ID NUMBER: 59-3380599 South Florida Behavioral Health Network, Inc. Page 4 Southern Region SAMH Managing Entity Revised Exhibit E-3 ME Schedule of Funds South Florida Behavioral Health Network, Inc. -Contract#KH225 FY 2015-16 Use Designation -As of 8/19/2015 Other Cost Accumulators Title Other Cost Federal State Total Accumulators Administrative Costs Managing Entity Administrative Costs MHS00 232.199 3 233,465 3.465.664 Mental Health ME Services&Supports Provider Activity-Mental Health I MH000 4,233,170 29,703,175 33,936,345 ME Early Intervention Services for SMI&Pysch Disorder JI MH026 - - - Purchase of Residential Treatment Services for Emotionally Disturbed Children and MH071 - 342,970 342,970 Community Forensic Beds MH072 - 3,027,332 3,027,332 Florida Assertive Community Treatment(FACT) MH073 1,164,515 2,289,063 3,453,578 Indigent Psychiatric Medication Program MH076 - 113,991 113,991 Clay Behavioral Health Center MH089 - - - Camillus House Mental Health/Substance Abuse Treatment-Homeless MH093 - 200,000 200,000 Citrus Health Network MH094 - 455,000 455,000 Jerome Golden Center MH096 - - - Crisis Center of Tampa Bay MH097 - - - ME Saluscare Center MH098 - - - Gracepoint Center MH819 - - - Lifestream Center MHS50 - - - Meridian Behavioral Healthcare MHSMB - - - Renaissance Center MHRM5 - - - Circles of Care-Cedar Village MHS51 - - - Circles of Care-Crisis Stabilization MHS52 - - - Grants PATH MHOPG 467,611 - 467,611 Florida Youth Transition of Adulthood MHOTA - - - Temporary Assistance for Needy Families(TANF) MHOTB 797,249 - 797,249 Title XXI Children's Health Insurance Program(Behavioral Health Network) MHOBN 874,757 108,831 983,588 ME Crisis Stabilization Services MHOCS 21,429 - 21,429 Grant Miami-Dade County Wraparound FACES MHOFA 1,600,000 - 1,600,000 Grants Miami-Dade County Wraparound MHOMD 764,788 - 764,788 Grants Project Launch MHOPL - - Subtotal Mental Health 9,923,519 36,240,362 46,163,881 Substance Abuse ME Services&Supports Provider Activity-Substance Abuse MS000 12,377,077 12,063,156 24,440,233 HIV Services MS023 869,289 - 869,289 Prevention Services MS025 3,477,156 - 3,477,156 Projects Expansion of Substance Abuse Services for Pregnant Women and their affected families MS081 - 1,812,723 1,812,723 Family Intensive Treatment(FIT) MS091 - 633,190 633,190 ME Data Management Support MS092 - - - Temporary Assistance for Needy Families(TANF) MSOTB 830,123 - 830,123 Drug Abuse Comprehensive Coordinating Treatment(DACCO) MS095 _ - - - First Step of Sarasota MS902 - - - Here's Help MS903 _ - 200,000 200,000 Prevention Partnership Grant(PPG) MSOPP 820.788 - 820,788 Subtotal Substance Abuse 18,374,433 14,709,069 33,083,502 Total All Fund Sources 28,530,151 54,182,896 82,713,047 Revised Contract KH225 South Florida Behavioral Health Network,Inc. Page 55 Amendment#0022 Contract KH225 Revised Exhibit F FY15-16 Region-Specific Provisions A. Pursuant to the terms of Attachment I, Section B.3.b., the Managing Entity shall subcontract for the legislatively appropriated program-specific funds listed in Table A with each specified Network Service Provider. Each subcontract shall require the Network Service Provider to use these funds only for the legislatively specified service and to report the unique numbers of persons served or services provided with these funds as distinct reporting elements within the subcontract report requirements. B. The Managing Entity shall provide the Department with a copy of the executed subcontract document for each program-specific fund no later than 30 days after this exhibit is incorporated into the Managing Entity's contract. The subcontract document shall include: 1. A description of the service purchased with the specific appropriation; 2. The payment methodology and rate applied to the service; 3. Output and outcome performance measures applied to the service; and 4. The reporting requirements implemented to ensure regular and ad hoc status updates to the Department. C. At a minimum,the managing entity shall ensure each Network Service Provider: 1. Reports the following performance metrics in the format specified by the Department: a. Number of clients served, b. Number of adults served, c. Number of children served, d. Number of clients admitted in a residential treatment center, e. Type of services provided to the clients, and f. Number of clients discharged. 2. Beginning with Fiscal Year 2015-16, provide reports directly to the Executive Office of the Governor Office of Policy and Budget (EOG/OPB) documenting the return on investment for any specific appropriation identified with the acronym "EOG/OPB" in Table A. a. An initial report identifying the positive return the state will receive by providing the funding shall be submitted to EOG/OPB on or before July 31, 2015. b. The initial report shall include actual returns by fiscal year if the provider previously received state funding, and projected positive returns based on the Fiscal Year 2015-16 funding. c. Quarterly update reports shall be submitted to EOG/OPB within 30 days after the end of each fiscal year quarter thereafter. d. All reports shall be submitted to MaryBeth.Vickers@laspbs.state.fl.us and a copy submitted to the Managing Entity subcontract file. Table A—Program-Specific Fund Summary Year Specific Provider Amount Appropriation FY14-15 351 Citrus Health Network $ 455,000.00 351 Camillus House $ 25,000.00 351 Guidance Care Center of Key West $ 100,000.00 South Florida Behavioral Health Network, Inc. Revised KH225 Amendment#0022 Page 56 Contract KH225 Revised Exhibit F FY15-16 Table A—Program-Specific Fund Summary Year ( Specific Provider Amount Appropriation FY14-15 r 372 Pregnant and Post-Partum Women Funding $1,812,723.00 Allocated to the following providers and amounts 1. South Florida Jail Ministries, Inc.: $970,841.00 2. The Village South, Inc.: $841,882.00 372 Family Intensive Treatment (FIT)funding, allocated to the following amounts for services in the designated locations. The Managing Entity shall designate a service provider for each location in accordance with Section D.S. of this Exhibit. 1.Miami-Dade County—Liberty City, specifically $483,871.00 limited to address child welfare cases referred from zip codes 33147 and 33142 2. Monroe County $149,317.00 FY15-16 PPG Guidance Care Center, Inc. $150,000.00 through Solicitation Village South/WestCare Foundation $150,000.00 FY17-18 LHZ03 Miami Coalition for a Drug-Free Community $150,000.00 HOPE for Miami $150,000.00 Switchboard of Miami, Inc. $150,000.00 Gang Alternatives, Inc. $70,788.00 FY15-16 377H Citrus Health Network $455,000.00 EOG/OPB 377J Pregnant Women, Mothers, and Affected Families $1,812,723.00 Funding Amounts Allocated to the following providers providers for will 1. South Florida Jail Ministries, Inc. be specified in 2. The Village South, Inc. a report submitted with the Final Fiscal Year Invoice Family Intensive Treatment (FIT)funding, allocated to the following amounts for services in the designated locations. The Managing Entity shall designate a service provider for each location in accordance with Section F.3. of this Exhibit. EOG/OPB 1. Miami-Dade County—Liberty City, specifically $483,871.00 limited to address child welfare cases referred from zip codes 33147 and 33142 2. Monroe County $149,317.00 Here's Help, Inc. $200,000.00 EOG/OPB Camillus House $200,000.00 EOG/OPB South Florida Behavioral Health Network, Inc. Revised KH225 Amendment#0022 Page 57 Contract KH225 FY15-16 D. Fiscal Year 2014-15 Appropriations Revised Exhibit F Pursuant to the FY14-15 General Appropriations Act, Ch. 2014-51, Laws of Fla., the Managing Entity shall implement the following: 1. Specific Appropriation 351 — Citrus Health Network, Inc. During Fiscal Year 2014-2015, from the funds in Specific Appropriation 351, the recurring sum of $455,000.00 from the General Revenue Fund shall continue to be provided to the Citrus Health Network. 2. Specific Appropriation 351 — Camillus House During Fiscal Year 2014-2015, from the funds in Specific Appropriation 351, the nonrecurring sum of $25,000.00 from the General Revenue Fund is provided for Camillus House mental health and substance abuse treatment for the homeless. 3. Specific Appropriation 351— Guidance Care Center of Key West During Fiscal Year 2014-2015, from the funds in Specific Appropriation 351, the nonrecurring sum of $100,000.00 from the General Revenue Fund is provided to Guidance Care Center of Key West for mental health and substance abuse treatment services. 4. Specific Appropriation 372 — Pregnant and Post-Partum Women Funding From the funds in Specific Appropriation 372, the recurring sum of $1,812,723.00 from the General Revenue fund is provided for the expansion of substance abuse services for pregnant women and their affected families. These services shall include the expansion of residential treatment, outpatient treatment with housing support, outreach, detoxification, child care and post-partum case management supporting both the mother and child consistent with recommendations from the Statewide Task Force on Prescription Drug Abuse and Newborns. Priority for services shall be given to counties with greatest need and available treatment capacity. S. Specific Appropriation 372 — Family Intensive Treatment Funding From the funds in Specific Appropriation 372, the recurring sum of $633,188.00 from the General Revenue Fund is provided to implement the Family Intensive Treatment (FIT) team model that is designed to provide intensive team -based, family -focused, comprehensive services to families in the child welfare system with parental substance abuse. Treatment shall be available and provided in accordance with the indicated level of care required and providers shall meet program specifications. Funds shall be targeted to select communities with high rates of child abuse cases. a. The Managing Entity shall designate a Network Service Provider to deliver the FIT model for each location specified above and shall subcontract with the provider to implement this proviso appropriation by August 15, 2014. b. The Managing Entity shall subcontract with the Network Service Providers providing FIT model services for the full amount of funding specified in Table A and shall not reduce payment to these providers for any operational costs, including behavioral health fees, of the Managing Entity associated with the administration of the subcontracts. c. To ensure the implementation and administration of the FIT team model complies with the Department's programmatic standards, the Managing Entity shall require Network Service South Florida Behavioral Health Network, Inc. Revised KH225 Amendment #0022 Page 58 Contract KH225 FY15-16 Revised Exhibit F Providers providing FIT model services adhere to the staffing, service delivery and reporting requirements of Incorporated Document 32: FIT Model Guidelines and Requirements, which is hereby incorporated by reference. E. Prevention Partnership Grants Pursuant to the Notice of Award for the PPG procurement RFA #LHZ03, the Managing Entity shall execute 3 year subcontracts with Network Service Providers for the annual amounts detailed in Table A for the implementation of the PPG program. 1. The Managing Entity shall negotiate PPG services within the scope of work detailed in the Network Service Provider's application. 2. The Subcontract shall incorporate the specifications and elements detailed in the RFA, including but not limited to objectives, measures, and reporting. 3. The Subcontract shall incorporate funding as detailed in the Table A for reasonable, allowable, and necessary expenditures required to perform PPG services. 4. The Subcontract shall require the Network Service Provider to enter all prevention data into the Department's Performance Based Prevention System (PEPS). F. Fiscal Year 2015-16 Appropriations Pursuant to the FY15-16 General Appropriations Act, Ch. 2015-232, Laws of Fla., the Managing Entity shall implement the following: 1. Specific Appropriation 377H — Citrus Health Network From the funds in Specific Appropriation 377H, the sum of $455,000 from the General Revenue Fund shall continue to be provided to the Citrus Health Network for behavioral health services. 2. Specific Appropriation 377J — Pregnant Women, Mothers, and Affected Families Funding From the funds in Specific Appropriation 377J, the recurring sum of $1,812,723.00 from the General Revenue fund is provided for the expansion of substance abuse services for pregnant women and their affected families. These services shall include the expansion of residential treatment, outpatient treatment with housing support, outreach, detoxification, child care and post-partum case management supporting both the mother and child consistent with recommendations from the Statewide Task Force on Prescription Drug Abuse and Newborns. Priority for services shall be given to counties with greatest need and available treatment capacity. The Managing Entity shall subcontract with the Network Service Providers for this funding as listed in Table A. With the submission of the Final Fiscal Year Invoice, the Managing Entity will submit a report that details for each provider the sub contractual amount, actual amount paid, and total units purchased. This report shall also contain the total of any anticipated carry forward funds of Specific Appropriation 377J — Pregnant and Post-Partum Women Funding. These anticipated carry forward funds will also be included on Incorporated Document 27: Managing Entity Carry Forward Expenditure Report. 3. Specific Appropriation 377J — Family Intensive Treatment Funding From the funds in Specific Appropriation 377J, the recurring sum of $633,190.00 from the General Revenue Fund is provided to implement the Family Intensive Treatment (FIT) team model that is designed to provide intensive team -based, family -focused, comprehensive services to families in the child welfare system with parental substance abuse. Treatment shall be available and provided in South Florida Behavioral Health Network, Inc. Revised KH225 Amendment #0022 Page 59 Contract KH225 FY15-16 Revised Exhibit F accordance with the indicated level of care required and providers shall meet program specifications. Funds shall be targeted to select communities with high rates of child abuse cases. The Managing Entity shall designate Network Service Providers to deliver the FIT model for each location specified above and shall subcontract with the provider to implement this proviso appropriation by July 31, 2015. b. The Managing Entity shall subcontract with the Network Service Providers providing FIT model services for the full amount of funding specified in Table A and shall not reduce payment to these providers for any operational costs, including behavioral health fees, of the Managing Entity associated with the administration of the subcontracts. c. To ensure the implementation and administration of the FIT team model complies with the Department's programmatic standards, the Managing Entity shall require Network Service Providers providing FIT model services adhere to the staffing, service delivery and reporting requirements of Incorporated Document 32: FIT Model Guidelines and Requirements, which is hereby incorporated by reference. 4. Specific Appropriation 377J — Here's Help, Inc. From the funds in Specific Appropriation 377J, $200,000 from the General Revenue Fund shall continue to be provided to Here's Help, Inc. S. Specific Appropriation 377M — Camillus House From the funds in Specific Appropriation 377M, the nonrecurring sum of $200,000 from the General Revenue Fund is provided to Camillus House for behavioral health services. G. The Miami -Dade Wraparound Project Families and Communities Empowered for Success (FACES) The Miami Dade Wraparound Project, also known as Families and Communities Empowered for Success (FACES), was initially awarded to the Department of Children and Families, Substance Abuse and Mental Health by the Substance Abuse and Mental Health Services Administration (SAMHSA) on September 9, 2010. The "Miami -Dade Wraparound Project" is a collaborative effort to enhance, expand and strengthen the existing community -based family and youth mental health services in Miami -Dade County, in order to better serve children and youth who have serious emotional disturbances (SED) and their families or caretakers in Miami -Dade County, Florida. The Department assigns the funding, subcontracting, reporting, and monitoring responsibilities of this grant to the Provider. The Provider shall ensure compliance with the terms and conditions specified in the grant award, which is incorporated by reference, federal and state law, Department standards, and this contract. The Provider will be responsible for invoice documentation, verification of service delivery, and compliance monitoring. The Provider will manage all aspects of the grant under the direction of the Substance Abuse and Mental Health Program Office. H. The Miami -Dade County FACES Wraparound Project Expansion Effective July 1, 2013, the Substance Abuse and Mental Health Services Administration (SAMHSA) awarded the Miami -Dade County FACES Wraparound Project Expansion in support of expanding the current FACES initiative to include 225 transitioning youth ages 18-21 who entered the mental health system prior to the age of 18. The Department assigns the funding, subcontracting, reporting, monitoring, and evaluation responsibilities of this grant to the Provider. The Provider shall ensure compliance with the terms and South Florida Behavioral Health Network, Inc. Revised KH225 Amendment #0022 Page 60 Contract KH225 Revised Exhibit F FY15-16 conditions specified in the grant award, which is incorporated by reference, federal and state law, Department standards, and this contract. The Provider will be responsible for invoice documentation, verification of service delivery, and compliance monitoring. The Provider will manage all aspects of the award under the direction of the Substance Abuse and Mental Health Program Office. I. Motivational Support Program (MSP) In addition to the requirements in Attachment I and Incorporated Document 23, Integration with Child Welfare, the Provider agrees to contract with a community Network Service Provider to operationalize the current MSP protocol for the purpose of enhancing the integration across the behavioral health and child welfare systems. The Provider will ensure the implementation and efficiency of the MSP protocol and report monthly progress to the Regional SAMH Program Office. This protocol is agreed upon with the Department, the Provider, the Community -Based Care organization (CBC), and the contracted Network Service Provider. J. Community Action Team Program (CAT) The Provider agrees that, in collaboration with the Department, they will develop, and enter into a Memorandum of Understanding (MOU) with each of the Community Action Team (CAT) providers within sixty (60) calendar days of contract execution. The MOU will operationalize the referral process between the Provider and the CAT programs, (including but not limited to identifying youths that meet the specified criteria for referral to the program as stated below). It is the Department's intent to reserve the CAT program for community -based services to children ages 11 to 21 with a mental health diagnosis or co- occurring substance abuse diagnosis at -risk for out -of -home placement as demonstrated by repeated failures at less intensive levels of care; having two or more hospitalization or repeated failures; involvement with the Department of Juvenile Justice or multiple episodes involving law enforcement; or, poor academic performance and/or suspensions. K. Statewide Forensic Beds For the following programs, the Provider shall make services available to eligible consumers on conditional release from other Circuits through their Network Service Providers at: 1. Public Health Trust/Jackson Health System — Miami -Dade Forensic Alternative Center (MDFAC) — Up to six (6) beds shall be available to Broward residents who meet MDFAC's Eligibility Criteria, which is incorporated by reference. MDFAC is a locked and staff secured facility intended to serve adult forensic consumers charged with second or third degree felonies who are committed to the department under Sections 916.13 and 916.15, F.S. These consumers have been found by a circuit court to be incompetent to proceed due to a serious mental illness or not guilty by reason of insanity and who do not have a significant history of violence. 2. Citrus Health Network, Inc. -Eight (8) statewide residential beds in the Safe Transition and Access to Recovery (STAR) Program shall be available to eligible consumers on conditional release in need of forensic mental health services placed by the Managing Entity pursuant to FRCrP 3.219(b), 3.217(b) and F.S. 916.17. The STAR Program provides intensive, short-term treatment to individuals who are temporarily in need of a structured therapeutic setting in a less restrictive but longer -stay alternative to acute hospitalization. 3. Passageway Residence of Dade County, Inc. — Fourteen (14) statewide residential level 2 beds shall be available to eligible consumers on conditional release who are in need of forensic mental health services placed by the Managing Entity. Statewide admission to Passageway Residence of Dade County, Inc. is for individuals committed to the Florida Department of Children and Families, in South Florida Behavioral Health Network, Inc. Revised KH225 Amendment #0022 Page 61 Contract KH225 FY15-16 Revised Exhibit F accordance with the provisions of Florida Statutes Chapter 916, Forensic Services Act and released pursuant to FRCrP 3.219(b), 3.217(b) and F.S. 916.17. 4. Psychosocial Rehabilitation Center d.b.a Fellowship House - Four (4) statewide residential level 2 beds shall be available to eligible consumers on conditional release who are in need of forensic mental health services placed by the Managing Entity pursuant to FRCrP 3.219(b), 3.217(b) and F.S. 916.17. L. Regionally Necessary Services 1. The Managing Entity shall subcontract with the following Network Services Provider with locations in Broward County for the specified Regionally Necessary Services: a. Citrus Health Network, Inc. for Statewide Inpatient Psychiatric Programs (SIPP) and Short - Term Residential Treatment (SRT) services; and 2. The Managing Entity Forensic Team shall provide outreach services to individuals residing in the following State Hospitals and counties: a. Florida State Hospital, Gadsden County b. North Florida Evaluation and Treatment Center, Alachua County c. Northeast Florida State Hospital, Baker County d. Treasure Coast Forensic Treatment Center, Martin County e. South Florida State Hospital, Broward County f. South Florida Evaluation and Treatment Center, Miami -Dade County South Florida Behavioral Health Network, Inc. Revised KH225 Amendment #0022 Page 62 ATTACHMENT E 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 CONTRACTOR 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." �1�``` I have read the above and state that neither Is v'aw " T. (Respondent's name) nor any Affiliate has been placed on the convicted vendor list within the last P. months. -Y�lV (Signature) Date: -! 2�" 1 to STATE OF: �t%- N COUNTY OF: KWW Subscribed and sworn to (or affirmed) before me on (date) by nar•Ciw Lmm (name of affiant). H Sh is personally known to me or has produced (type of identification) as identification. 91 , f ...� �'1-Al My Commission Expires: A. DOCHOW - Notary Public -Stale of Florida My Comm. Expires Jun 7, 2018 ;:•'' Commission 0 ff 104268 CAROL a Guidance Care Center-SAMN Contract FYI 7; page 14 ATTACHMENT F SWORN STATEMENT UNDER ORDINANCE NO. 010-1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE 1{ Gut ►-)A N Cc /C E % i%1JTZ--� INC- (Company) "...warrants that he/it has not employed, retained or otherwise had act on his/her behalf any former County officer or employee in violation of Section 2 of Ordinance No. 010-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 010-1990. For breach or violation of this provision the County may, in its discretion, terminate this Agreement without liability and may also, in its discretion, deduct from the Agreement 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." (Signature) Date: `- 3 STATE OF: "/VI % COUNTY OF: fWw Subscribed and sworn to (or affirmed) before me on� (date) by �U IJ��r�C�! ' (name of affiant). He/)%4 is personal) known to me or has produced identification) as identification. NOTARY PUBLIC My Commission Expires: CAROL A. DOCHOW Notary Public State of Florida i _ �• My Comm. Expires Jun 7.2018 Commission #F FF 104268 1111111, Guidance Care Center-SAMH Contract FY17; page 15 (type of ATTACHMENT G DRUG -FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: G v, NEIOc f"- woe- zfhL (Name of Business) 1. Publish 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. Inform employees about the dangers of drug abuse in the workplace, the business' 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. Give 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), notify 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. Impose 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. Make 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. (Signature) Date: Qi �� STATE OF: 1�1�f 'r COUNTY OF: —T- Subscrib d and savor to (or ffirmed) before me 00 A (name or has produced identification. :01 0.r •4c�, CAROL A. DOCHOW . Notary Public - State of Florida My Comm. Expires Jun 1, 2018 o�'811.�d�A'� Commission # FF 104268 Guidance Care Center-SAMH Contract FYI 7; page 16 )n lb9 (date) by of affiant). He/ he s personally known to me type I entiTccation as NOTARY PUBLIC My Commission Expires: