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Item S4County of Monroe The Florida Keys Mayor David Rice 9400 Overseas Highway Suite 210 Marathon International Airport Terminal Marathon, FL 33050 305.289.6000 Boccdis4@monroecouniy-fl.gov monroecounty -fl.gov BOARD OF COUNTY COMMISSIONERS Mayor David Rice, District 4 1 2 ' Mayor Pro Tem Sylvia J. Murphy, District 5 Danny L. Kolhage, District 1 George Neugent, District 2 Heather Carruthers, District 3 Interoffice Memorandum Date: December 7, 2017 To: Kevin Madok, Clerk of the Court County Clerk's Office From: Commissioner David Rice, District 4 RE: NOTICE OF VOTING CONFLICT Per Florida Statute 1123143, I hereby disclose by written memorandum that I will abstain from the vote on certain issues brought before the Monroe County Board of Commissioners with entities with which I am involved. I will abstain from the vote on issues concerning the following entities: Guidance Care Center, Inc., a private, not - for - profit entity, which receives some of its operational funding from the County, as I currently sit on the Board of Directors of the Guidance Care Center. I am also a member of the Board of the Historic Florida Keys Foundation, Inc. At the December 13, 2017 BOCC meeting, I will abstain from the vote on item(s): #08, C21, C22, E8, & S4 Copy of agenda item listing from the Revised Agenda for each of the referenced item(s) is included for documentation. ATT. State Form 8B Memorandum of Voting Conflict for County, Municipal, and Other Local Elected Officers t FORM 813 MEMORANDUM OF VOTING CONFLICT FOR COUNTY, MUNICIPAL, AND OTHER LOCAL PUBLIC OFFICERS LAST NAME —FIRST NAME — MIDDLE NAME �1-CE D�} D PA — NAME OF BOARD, COUNCIL, C MMISSION, AUTHORI 0 COMMITTEE lYlorl�Ua�'oun C,oar-� o` �dmfy) �sro� MAILING ADDRESS - 6 b • THE BOARD, COUNCIL, COMMI - ION, AUTHORITY OR COMMITTEE ON WHICH -I -SERVE IS A -UN9a F.- -- ❑ CITY O ❑ UNTY Y OTHER LOCALAGENCY CITY , COUNTY (MD In � I ► + NAME of POLITICAL SUBDIVISI N: mo n rroa 6u n DATE ON WHICH VOTE OCCURRED MY POSITION IS: ELECTIVE ❑ APPOINTIVE WHO MUST FILE FORM 86 This form is for use by any person serving at the county, city, or other local level of government on an appointed or elected board, council, commission, authority, or committee. It applies to members of advisory and non - advisory bodies who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes. Your responsibilities under the law when faced with voting on a measure in which you have a conflict of interest will vary greatly depending on whether you hold an elective or appointive position. For this reason, please pay close attention to the instructions on this form before completing and filing the form. INSTRUCTIONS FOR COMPLIANCE WITH SECTION 112.3143, FLORIDA STATUTES A person holding elective or appointive county, municipal, or other local public office MUST ABSTAIN from voting on a measure which would inure to his or her special private gain or loss. Each elected or appointed local officer also MUST ABSTAIN from knowingly voting on a measure which would-inure to the special gain or loss of a principal (other than a government agency) by whom he or she is retained (including the parent, subsidiary, or sibling organization of a principal by which he or she is retained); to the special private gain or loss of a relative; or to the special private gain loss of a business associate. Commissioners of community redevelopment agencies (CRAB) under Sec. 163.356 or 163.357, F.S., and officers of independent special tax districts elected on a one -acre, one -vote basis are not prohibited from voting in that capacity. For purposes of this law, a "relative" includes only the officer's father, mother, son, daughter, husband, wife, brother, sister, father -in -law, mother -in -law, son -in -law, and daughter- in-I'aw. A "business associate" means any person of entity engaged in or carrying on a business enterprise with the officer as a partner, joint venturer, coowner of property, or corporate shareholder (where the shares of the corporation are not listed on any national or regional stock exchange). ELECTED OFFICERS: In addition to abstaining from voting in the situations described above, you must disclose the conflict: PRIOR TO THE VOTE BEING TAKEN by publicly stating to the assembly the nature of your interest in the measure on which you are abstaining from voting; and WITHIN 15 DAYS AFTER THE VOTE OCCURS by completing and filing this form with the person responsible for recording the minutes of the meeting, who should incorporate the form in the minutes. APPOINTED OFFICERS: Although you must abstain from voting in the situations described above, you are not prohibited by Section 112.3143 from otherwise participating in these matters. However, you must disclose the nature of the conflict before making any attempt to influence the decision, whether orally or in writing and whether made by you or at your direction. TAKEN: • You must complete and file this form (before making any attempt to influence the decision) with the person responsible for recording the minutes of the meeting, who will incorporate the form in the minutes. (Continued on page 2) CE FORM 8B - EFF. 11/2013 PAGE 1 Adopted by reference in Rule 34- 7.010(1)(f), F.A.C. APPOINTED OFFICERS (continued) • A copy of the form must be provided immediately to the other members of the agency. • The form must - be read publicly at the next meeting after the form is filed. IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING: • You must disclose orally the nature of your conflict in the measure before participating. • You must complete the form and file it.within 15 days after the vote occurs with the person responsible for recording the minutes of #lie meeting, who must incorporate the form in the minutes. A copy of the form must be provided immediately to the other members of the agency, and the form must be read publicly at the next meeting after the form is filed. � I I DISCLOSURE OF LOCAL OFFICER'S INTEREST I, .Da V; Q 1 y 1( 0.C-- , hereby disclose that on 4 3e- c qS L Q , 20 (a) A measure came or will come before my agency which (check one or more) Af li - inured to my special private gain or loss; inured to the special gain or loss of my business associate, inured to the special gain or loss of my relative, ; inured to the special gain or loss of by whom I am retained; or inured to the special gain or loss of which is the parent subsidiary, or sibling organization or subsidiary of a principal which has retained me. 9(b) he measure before my agency and the nature of my conflicting interest in the measure is as follows: I currently sit on the Board of Directors of the Guidance Care Center, Inc. I am also a member of the Board of the Historic Florida Keys Foundation, Inc. SEE ATTACHED AGENDA ITEM SUMMARY C Z i 0-2-2- Ste{ ' Cr - � j or e�a- t S If disclosure of specific information would violate confidentiality or privilege pursuant to law or rules governing attorneys, a public officer, who is also an attorney, may comply with the disclosure requirements of this section by disclosing the nature of the interest in such a way as to provide the public with notice of the conflict. r (� 2C Lm !fir 7 2c) 1 7 - - — - Date Filed f Signature - NOTIG €: -UND €R P-ROVISIONS-O€--FLORIDA-STAT-UT-ES-§1-1- 2:31 =7 - -A- FAILURE -TO- MAKE- AN- Y- REQU-I RED- DISC-L-O-SI-}RE -- CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING: IMPEACHMENT, REMOVAL OR SUSPENSION FROM OFFICE OR 'EMPLOYMENT, DEMOTION, REDUCTION IN SALARY, REPRIMAND, OR A CIVIL PENALTY NOT TO EXCEED $10,000. CE FORM 86 - EFF. 11/2013 PAGE 2 Adopted by reference in Rule 34- 7.010(1)(fl, F.A.C. C oun t y of Monr ELj » °o � i� G�, � BOARD OF COUNTY COMMISSIONERS � Mayor David Rice, District 4 The Florida Ke s lv ', y f i I w; \ Mayor Pro Tern Sylvia J. Murphy, District 5 ; ,= _ :' j Danny L. Kolhage, District 1 George Neugent, District 2 Heather Carruthers, District 3 County Commission Meeting December 13, 2017 Agenda Item Number: SA Agenda Item Summary #3587 BULK ITEM: Yes DEPARTMENT: Budget and Finance TIME APPROXIMATE: STAFF CONTACT: Laura DeLoach (305)292 -4482 No AGENDA ITEM WORDING: Approval of agreements with Guidance /Care Center (G /CC) for Substance Abuse Mental Health (SAMH) services, including services provided as the Designated Centralized Receiving Facility ($818,332) and the Jail In -House (JIP) Program ($171,374) for FY2018. The County funding for SAMH services are the local match required by Florida Statute. Copies of the agreements are provided. ITEM BACKGROUND: In FY17 the Substance Abuse Mental Health (SAMH) local matching funds were $690,000. For FYI the SAMH budget increases to $818,332, in part, due to additional funding for a new program required by 394.4573, F.S., the Monroe County Centralized Receiving Facility (Amendment #1, Contract No. ME225 -8 -27 dated 11/01/2017). Jail Programs (JIP): The G /CC total direct expenses originally budgeted was $237,227. Subsequently, Guidance Care Center had to modify the budget which now has total direct expense of $260,484. For Fiscal Year 2017, the Monroe County contract was $133,284, which was augmented by the county administered FDLE Byrne JAG grant of $37,331 and the RSAT funding of $66,667. FY2018, based on the revised request, the recommendation is to provide $171,374 in JIP funding. The County is still hopeful of receiving $43,380 in FDLE Byrne JAG funding for the women's program and RSAT funding the men's program, but these sources are not guaranteed for the FYI funding cycle. PREVIOUS RELEVANT BOCC ACTION: The requests for funding FY2018 SAMH and JIP programs were included in the County budget process; passed on September 27, 2017. The County, annually, funds the required local match for SAMH and also funds the JIP services. CONTRACT /AGREEMENT CHANGES: N/A STAFF RECOMMENDATION: Approval DOCUMENTATION: Agreement - GCC -SAMFI FYI Agreement - GCC - Jail Program FYI Jail Programs FYI Budget 03.3 0.17 Jail Programs FYI Budget 11. 16.17 FINANCIAL IMPACT: Effective Date: 10/01/2017 Expiration Date: 09/30/2017 Total Dollar Value of Contract: $989,706 SAMH, including Designated Receiving Facility = $818,332 JIP = $171,374 Total Cost to County: $989,706.00 Current Year Portion: $989,706.00 Budgeted: 989706.00 Source of Funds: 1 CPI: N/A Indirect Costs: N/A Estimated Ongoing Costs Not Included in above dollar amounts: N/A Revenue Producing: N/A Grant: N/A County Match: N/A Insurance Required: N/A Additional Details: N/A If yes, amount: 12/13/17 001 - 045905 • GCC SAMH FS 394.76 12/13/17 001 - 045906 • GCC JIP $171,374.00 Total: $818,332.00 $989,706.00 REVIEWED BY: Tina Boan Christine Limbert Maria Slavik Kathy Peters Board of County Commissioners Completed 12/04/2017 3:39 PM Completed 12/04/2017 4:24 PM Completed 12/05/2017 7:19 AM Completed 12/05/2017 9:19 AM Pending 12/13/2017 9:00 AM AGREEMENT This Agreement is made and entered into this 13th day of December, 2017, 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 -8 -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 and including services as the Designated Receiving Facility. 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 co under applicable state and federal regulations and eligibility determination procedures, for substance abuse treatment. This cost shall not exceed a total reimbursement of EIGHT HUNDRED U. EIGHTEEN THOUSAND, THREE HUNDRED THIRTY -TWO AND NO /100 DOLLARS ($818,332.00) in fiscal year 2017 -2018. gr 3. TERM. This Agreement shall commence on October 1, 2017, and terminate September 30, 2018, unless earlier terminated pursuant to other provisions herein. 4. PAYMENT. Payment will be paid monthly as hereinafter set forth. Baker Act and SAMH Billing Summary Forms, certified monthly financial and service load reports will be made available to the Board to validate the delivery of services under this contract. The monthly financial report is due in the office of the Clerk of the Board no later than the 15th day of the following month. After the Clerk of the Board pre- audits the certified report, the Board shall reimburse the Provider for its monthly expenses. However, the total of said monthly payments in the aggregate sum shall not exceed the total amount shown in Article 2, above, during the term of this agreement. To preserve client confidentiality required by law, copies of individual client bills and records shall not be available to the Board for reimbursement purposes but shall be made available only under controlled conditions to qualified auditors for audit purposes. The organization's final invoice must be received within sixty days after the termination date of this contract shown in Article 3 above. Payment will be made periodically, but no more frequently than monthly, as hereinafter set forth. Reimbursement requests will be submitted to the Board via the Clerk's Finance Office. The County shall only reimburse, subject to the funded amounts below, those reimbursable expenses which are reviewed and approved as complying with Monroe County Code of Ordinances, State laws and regulations and Attachment A - Expense Reimbursement Requirements. Any funds Guidance Care Center -SAMH Contract FY18; page 1 expended in violation of this Agreement or in violation of appropriate Federal, State, and County requirements shall be refunded in full to the County. Evidence of payment by the PROVIDER shall be in the form of a letter, summarizing the expenses, with supporting documentation attached. The letter should contain a notarized certification statement. An example of a reimbursement request cover letter is included as Attachment B. The organization's final invoice must be received within thirty days after the termination date of this contract shown in Article 3 above. After the Clerk of the Board examines and approves the request for reimbursement, the Board shall reimburse the PROVIDER. However, the total of said reimbursement expense payments in the aggregate sum shall not exceed the total amount shown in Article 2, above, during the term of this agreement. 5. AVAILABILITY OF FUNDS. The County reserves the right to withhold /reduce the funds to the Provider in the event that the Department of Children and Families eliminates /reduces the State contract funding. If funds cannot be obtained or cannot be continued at a level sufficient to allow for continued reimbursement of expenditures for services specified herein, this agreement may be terminated immediately at the option of the Board by written notice of termination delivered to the PROVIDER. The Board shall not be obligated to pay for any services or goods provided by the PROVIDER after the PROVIDER has received written notice of termination, unless otherwise required by law. 6. 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 7. RECORDS. PROVIDER shall maintain all books, records, and documents directly go pertinent to performance under this Agreement in accordance with generally accepted accounting >- principles consistently applied. Each party to this Agreement or their authorized representatives co 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 U. 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 UP to Sec. 55.03, FS, running from the date the monies were paid to PROVIDER. 0 In addition, if PROVIDER is required to provide an audit as set forth in in Section 9(e) 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. S. 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. 9. COMPLIANCE WITH COUNTY GUIDELINES. The PROVIDER must furnish to the County the following (items A -L 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 Statute 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; Guidance Care Center -SAMH Contract FY18; page 2 (d) Evidence of annual election of Officers and Directors; (e) Unqualified audited financial statements 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; 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. If the PROVIDER receives $100,000 or more in grant funding from the County: a. The CPA that prepares the audit must also be a member of the American Institute of Certified Public Accountants (AICPA); b. The CPA must maintain malpractice insurance covering the audit services provided and c. 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 -8 -27 and PPG- 2 -03); (j) All legally required licenses; E (k) Any updates /amendments throughout the fiscal year to the South Florida Behavioral Network contract with Guidance /Care Center (ME225 -8 -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) co 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 U. contract year. 10. 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 2016 -2017 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, 2018. RESPONSIBILITIES 11. 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. 12. 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. Guidance Care Center -SAMH Contract FY18; page 3 13. 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. 14. 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. 15. 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. 16. 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 17. 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 CR 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 co this agreement and shall entitle the Board to terminate this contract immediately upon delivery of written notice of termination to the PROVIDER. U. 18. 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. 19. NON - DISCRIMINATION. County and PROVIDER agree that there will be no discrimination against any person, and it is expressly understood that upon a determination by a court of competent jurisdiction that discrimination has occurred, this Agreement automatically terminates without any further action on the part of any party, effective the date of the court order. County or PROVIDER agree to comply with all Federal and Florida statutes, and all local ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1) Title VI of the Civil Rights Act of 1964 (PL 88 -352) which prohibits discrimination on the basis of race, color or national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC ss. 1681 -1683, and 1685 - 1686), which prohibits discrimination on the basis of sex; 3) Section 504 of the Rehabilitation Act of 1973, as amended (20 USC s. 794), which prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended (42 USC ss. 6101 -6107) which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL 92 -255), as amended, relating to nondiscrimination on the basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91 -616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, ss. 523 and 527 (42 USC ss. 690dd -3 and 290ee -3), as amended, relating to confidentiality of alcohol and drug abuse patient records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC s. et seq.), as amended, Guidance Care Center -SAMH Contract FY18; page 4 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) Monroe County Code Chapter 13, Article VI, which prohibits discrimination on the basis of race, color, sex, religion, national origin, ancestry, sexual orientation, gender identity or expression, familial status or age; 11) 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 20. 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. 21. 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. The PROVIDER and County staff shall try to resolve the claim or dispute with meet and confer sessions to be commenced within 15 days of the dispute or claim. 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. Any claims or dispute that the parties cannot resolve shall be decided by the Circuit Court, 16 Judicial Circuit, Monroe County, Florida. 22. 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 23. 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. 24. 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. 25. NON - WAIVER OF IMMUNITY. Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the County and the PROVIDER in this Agreement and the acquisition of any commercial liability insurance coverage, self- insurance coverage, or local government liability insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall any contract entered into by the County be required to contain any provision for waiver. 26. 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. Guidance Care Center -SAMH Contract FY18; page 5 27. 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 28. 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. 29. 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. 30. 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. 31. 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. 32. 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 33. EXECUTION IN COUNTERPARTS. This Agreement may be executed in any number of counterparts, each of which shall be regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement by signing any such counterpart. 34. 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: Guidance Care Center -SAMH Contract FY18; page 6 For Board: Grants Administrator and Monroe County Attorney 1100 Simonton Street PO Box 1026 Key West, FL 33040 Key West, FL 33041 For PROVIDER Frank Rabbito, Senior Vice President Guidance /Care Center 1205 Fourth Street Key West, FL 33040 3S. 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. 36. 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. 37. 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. 38. 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 FY18; page 7 S.4.a IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as of the day and year first written above. (SEAL) ATTEST: KEVIN MADOK, CLERK BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA By Deputy Clerk Witness witiVess By Mayor/Chairman Guidance/Care Center (Federal ID No. -5q ^ I '"l 5�3'. By .... Director Guidance/Care Center co r LL a 0 U 0 C d a� L a E U a-� w a Guidance Care Center -SAMH Contract FY16: page 8 Racket Pg. 2726 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 Ic request needs to also contain the following notarized certified statement: 0 °I certify that the above checks have been submitted to the vendors as noted and that the a� 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. U) 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. co Payroll U. 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. UP 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. E 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. �E c� 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. Telefax, Fax, etc. Guidance Care Center -SAMH Contract FY18; page 9 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 Ic Monroe County Code of Ordinances and State laws and regulations. Credit card statements are 0 not acceptable documentation for reimbursement. If attending a conference or meeting, a copy of 5 the agenda is needed. Airfare reimbursement requires the original passenger receipt portion of a� 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 a related bed tax. Room service, movies, and personal telephone calls are not allowable expenses. E 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. N 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 co 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. U. Non - allowable Expenses The following expenses are not allowable for reimbursement: capital outlay expenditures (unless UP specifically included in the contract), contributions, depreciation expenses (unless specifically included in the contract), entertainment expenses, fundraising, non - sufficient check charges, penalties and fines. c E c� Guidance Care Center -SAMH Contract FY18; 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_ by who is personally known to me. Notary Public Notary Stamp Guidance Care Center -SAMH Contract FY18; page 11 ATTACHMENT C Services to be provided: Local match portion of State - Funded Substance Abuse Mental Health (SAMH) and Designated Centralized Receiving Facility services, inclusive of Baker Act services, per Florida Statutes, and contracts between Guidance Care Center and the South Florida Behavioral Health Network (ME 225 -8 -27 and Amendment #1; PPG- 2 -03). Guidance Care Center -SAMH Contract FY18; page 12 Contractual Agreement Guidance /Care Center and South Florida Behavioral Health Network Contract Numbers: ME225 -8 -27, Amendment #1, Contract ME225 -8 -27 and PPG -2 -03 ATTACHMENT D Guidance Care Center -SAMH Contract FY18; page 13 '' South Florida - ' 0 Behavioral Health Network, Inc. rev. 07/01/2017 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. c: 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 0 2 This contract shall begin on July 1, 2017 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 shal I have exclusive jurisdiction in any action regarding this contract and venue shall be the appropriate State court in Miami -Dade County, Florida. t 6. Federal Law If this contract contains federal funds, the terms in this section apply: a. The Network Provider shall comply with the provisions of Federal law and regulations including, but not limited to, 2 CFR, Part 200, and other U. applicable regulations. co b. 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 if applicable. c. 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 U.S.C. § 7401 at seq.), section 508 of the Federal Water Pollution Control Act, as amended (33 U.S.C. § 1251 at seq.), Executive Order 11738, as amended and where applicable, and Environmental Protection Agency regulations (2 CFR, Part 1500). The Network Provider shall report any violations of the above to the ME and the Department. d. 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 be obtained from the Contract Manager. All disclosure forms as required by the Certification Regarding Lobbying form must be completed and returned to the Contract Manager, prior to CM payment under this Contract. e. If this Contract 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 t.� 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 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. Standard Contract Guidance /Care Center, Inc. Page 1 of 11 Contract No. M Racket Fig. 2732 '' South Florida 0 Behavioral Health Network, Inc. rev. 07/01/2017 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 A=- 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 Department 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 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, V G� c� c� t� c� E U) U. co U. U) E IM t.9 Standard Contract Guidance /Care Center, Inc. Page 2 of 11 Contract No. M Racket Fig. 2733 '' South Florida 0 Behavioral Health Network, Inc. rev. 07/01/2017 liabilities, damages, judgments, 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. 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 any 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. 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 V G� c� t9 c� E U) C4 U. CO U. U) E 0 0I CM t.� Standard Contract Guidance /Care Center, Inc. Page 3 of 11 Contract No. M Racket Fig. 2734 '' South Florida 0 Behavioral Health Network, Inc. rev. 07/01/2017 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 or the Department 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 a II their subcontractors. 22. Gratuities The Network Provider agrees that it will not offer to give or give any gift to any ME or Department employee. As part of the consideration for this contract, the parties intend that this provision will survive the contract for a period of two years. In addition to any other remedies available to the ME and the Department, 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 al I of its officers, agents and subcontractors in relation to this contract, are works for hire for the benefit of the Department, fully compensated for by the contract amount, and that neither the 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 Department shall have exclusive rights to all data processing software falling within the terms of section 119.084, F.S., which arises or is developed in the course of or as a result of work or services performed under this contract, or in 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. V G� a� c� t9 M a� E U) C4 U. co U. U) E CM t.9 Standard Contract Guidance /Care Center, Inc. Page 4 of 11 Contract No. M Racket Fig. 2735 '' South Florida 0 Behavioral Health Network, Inc. rev. 07/01/2017 b. If the Network Provider uses or delivers to the Department for its use or the use of its employees, agents or contractors, any design, device, or materials covered by letters, patent, or copyright, it is mutually agreed and understood without exception that the compensation paid pursuant to this contract includes all royalties or costs arising from the use of such design, device, or materials in any way involved in the work contemplated by this contract. 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 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 HIPAA 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 501.171 (4)(a), 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 take appropriate steps to maintain its accreditation or become fully accredited by June 30, 2018. 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 Career Source Florida: The Network Provider understands that the DCF, the Department of Economic Opportunity, and Career Source 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 Career Source Florida. b. Transitioning Young Adults: The Network Provider understands DCF's Operation Full Employment initiative to assist young adults aging out of the dependency system. The ME encourages Network Provider participation with the local Community -Based Care Lead Agency Independent Living Program to offer gainful employment to youth in foster care and young adults transitioning from the foster care system. 28. Health Insurance Portability and Accountability Act The Network Provider shall, where applicable, comply with the Health Insurance Portability and Accountability Act (42 U. S. C. 1320d.) as well as V G� a� a� t9 M 0 E U) LL co LL U) E 0 2 CM t.9 Standard Contract Guidance /Care Center, Inc. Page 5 of 11 Contract No. M Racket Fig. 2736 '' South Florida 0 Behavioral Health Network, Inc. rev. 07/01/2017 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. V 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 0 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 E 0 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. C4 Any claim by Network Provider of proprietary or trade secret confidentiality for any information contained in Network Provider's documents U. (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. co b. The Network Provider must clearly label any portion of the documents, data or records submitted that it considers exempt from public L ° 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 E 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 qy the records sought without any redaction of proprietary or trade secret information. d. The Network Provider shall be responsible for defending its claim that each and every portion of the redactions of proprietary or trade secret information are exempt from inspection and copying under Florida's Public Records Law. 33. Support to the Deaf or Hard -of- Hearing a. The Network Provider and its subcontractors, where direct services are provided, shall comply with section 504 of the Rehabilitation Act of 1973, 29 U.S.C. 794, as implemented by 45 C.F.R. Part 84 (hereinafter referred to as Section 504), the Americans with Disabilities Act of 1990, 42 U.S.C. 12131, as implemented by 28 C.F.R. Part 35 (hereinafter referred to as ADA), and the Children and Families Operating Instruction (CFOP) 60 -10, Chapter 4, entitled "Auxiliary Aids and Services for the Deaf or Hard -of- Hearing." b. If the Network Provider or any of its subcontractors employs fifteen (15) or more employees, the Network Provider shall designate a Single - Point-of- Contact (one per firm) to ensure effective communication with deaf or hard -of- hearing customers or companions in accordance with Section 504, the ADA, and CFOP 60 -10, Chapter 4. The name and contact information for the Network Provider's Single- Point -of- Contact shall be furnished to the ME's Grant or Contract Manager within fourteen (14) calendar days of the effective date of this requirement. c. The Network Provider shall, within 30 days of the effective date of this requirement, contractually require that its subcontractors comply with section 504, the ADA, and CFOP 60 -10, Chapter 4. The Network Provider's Single Point of Contact and that of its subcontractors will process the compliance data into the Department of Children and Families HHS Compliance reporting database at Standard Contract Guidance /Care Center, Inc. Page 6 of 11 Contract No. M Racket Fig. 2737 '' South Florida ' 0 Behavioral - Health Network, Inc. rev. 07/01/2017 httfas: llfsl6.formsite.comlDCFTrainino !Monthly - Summary- Reoortlform Ioc�in.html by the 4t" 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: http:llw myflfamilies.comiservice- ro�rams /deaf- and - hard- hearinglproviders 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 $5,512,140.00 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 $4,593,450.00, subject to the delivery and billing for services. The remaining amount of $918,690.00, 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 M E 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 its 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 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 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. G� c� c� t9 a� E U) U. co U. U) E CM t.9 Standard Contract Guidance /Care Center, Inc. Page 7 of 11 Contract No. M Racket Fig. 2738 '' South Florida 0 Behavioral Health Network, Inc. rev. 07/01/2017 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 be 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 w.sfbhn.orc� 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 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 V G� c� c� t9 c� E U) C4 U. co U. U) E C0 t.9 Standard Contract Guidance /Care Center, Inc. Page 8 of 11 Contract No. M Racket Fig. 2739 '' South Florida 0 Behavioral Health Network, Inc. rev. 07/01/2017 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 I evel, 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. G� 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, a� 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. c: M ' 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. 0 E (ii) "Subcontract" means any contract entered into by a Network Provider 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. U) (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; C4 LL (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 CO 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 -Verity program enrollment. (i) The Department of Homeland Security (DHS) or the Social Security Administration (SSA) may terminate the Network Provider'stgrantee's enrollment and deny access to the E -Verity 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- Verity. 4) 2 (iii) Information on registration for and use of the E -Verify program can be obtained via the Internet at the Department of Homeland (���) 9 fY P 9 P Web site: CM httL: // u.dhs. %ov /E- Verify (iv) The Network Provider /grantee is not required by this clause to perform additional employment verification using E -Verity 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 -Verity 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. 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; Standard Contract Guidance /Care Center, Inc. Page 9 of 11 Contract No. M Racket Fig. 2740 '' South Florida 0 Behavioral Health Network, Inc. rev. 07/01/2017 (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 215 -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, at 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: Kristen Chafee, 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: kristen.chaffee @westcare.com b. The name, address, and telephone of the Contract Manager for the ME for this contract is: Elba Tavares 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: 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. 50. All Terms and Conditions Included This contract and it attachments, I, II, 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 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 BY SIGNING THIS CONTRACT, THE PARTIES AGREE THAT THEY HAVE READ AND AGREE TO THE ENTIRE CONTRACT, AS DESCRIBED IN SECTION 50. ABOVE. Signature Page Follows G� c� c� t9 c� U) C4 U. 00 LL U) E CM t.� Standard Contract Guidance /Care Center, Inc. Page 10 of 11 Contract No. M Racket Fig. 2741 South Florida Behavioral Health Network, Inc. rev. 07/01/2017 IN WITNESS THEREOF, the parties have caused this contract, attachments, exhibits, and any documents referenced herein, to be executed by their undersigned officials as duly authorized. PROVIDER: Guidance /Care Center, Inc. SOUTH FLORIDA BEHAVIORAL HEALTH NETWORK, INC. SIGNED 4 NAME: Maureen Dunleavv TITLE: Area Director DATE: Federal Tax ID# (or SSN) 59- 1458324 Guidance /Care Center, Inc. SIG BY: NAME: TITLE: President and CEO DATE. Network Provider Fiscal Year Ending Date 6/30 Standard Contract Page 11 of 11 Contract No. ME225 -8 -27 Racket Fig. 2742 '' South Florida ', Behavioral - Health Network, Inc. ATTACHMENT I A. Services to be Provided 1. Program /Service Specific Terms (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 (PBPS) 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- N occurring disorders that is designed to improve services capability on a statewide or regional U. basis to achieve: system level change; efficient use of resources; use of evidence -based and CO 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 2 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. (a) "Co- occurring Disorder Service Capability" is the ability of any program to organize every aspect of its program infrastructure (policies, procedures, practices, documentation, and staff competencies), within its existing resources, to provide appropriately matched, integrated services to the individuals and families with co- occurring disorders that are routinely Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 1 of 54 Contract No. M Packet Fig. 2743 '' South Florida ', Behavioral - Health Network, Inc. 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 0) 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 2016, version 11.1.3 , 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: ce- abuse/ amphiet- 155- 2 -v11 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 Practices (EBP) are programs, practices or strategies that are supported by research. EBP's are programs that have demonstrated effectiveness with established general izabi I ity through research. Option #1 The program or strategy is recognized by a national registry of evidence -based programs and strategies as one that is appropriate for the identified outcome. It is important to note that inclusion within a registry does not reflect a program's effectiveness. Programs need to be reviewed for the intended target population, demographics, setting, and the research results for each program outcome. Additionally, the rating provided to the program by the registry must be considered prior to selection. Programs deemed not effective or inconclusive should not be selected. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 2 of 54 Contract No. M Racket Fig. 2744 '' South Florida ', Behavioral - Health Network, Inc. For a list of registries that provide information and research outcomes for evidence -based programs and strategies please refer to the Department's Guidance Document 1, Evidence Based Guidelines available at the following link: http: // .m Ifamilies.com/service- roram s /substance - abuse /manain- entities /2017- contract -docs Or Option #2 The program or strategy is reported in peer- reviewed journals or has documented effectiveness which is supported by other sources of information and the consensus judgment of informed experts. When claiming this option, a provider must include: • A description of the theory of change and a logic model; and • A discussion of how the content and structure of this proposed program or strategy is similar to programs or strategies that appear in approved registry or in the peer- reviewed literature, or how it is based on sound scientific principles of community prevention or public health; and • Documentation that the program or strategy was effectively implemented in the past, with 0 results that show a consistent pattern of credible and positive effects, including: • the number of times it was implemented, • the fidelity with which it was implemented, and • the results of any outcome evaluations; and • Documentation of a review by, and consent of, a Panel of Informed Experts indicating that the implementation of this proposed program or strategy is appropriate for the community N and likely to have a positive effect on the identified outcome and what evidence their U. decision was based upon. co • Following the selection of an option, sufficient documentation to support the decision must >_ be maintained by the Network Provider. • The ME does not fund Prevention services for this category. (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, Consumer, 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 consumers 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 consumer - related data as required by this contract. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 3 of 54 Contract No. M Racket Fig. 2745 '' South Florida ', Behavioral - Health Network, Inc. (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. (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 consumers; 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. (28) "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. (29) "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. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 4 of 54 Contract No. M Racket Fig. 2746 '' South Florida ', Behavioral - Health Network, Inc. Programs designed to prevent the development of mental, emotional, and behavioral disorders are commonly categorized in the following manner: (a) Universal Direct Prevention Directly serve an identifiable group of participants who have not been identified on the basis of individual risk. This includes interventions involving interpersonal and ongoing or repeated contact such as curricula, programs, and classes. These services shall address the following specific prevention strategies, as defined in Rule 65D- 30.013, F.A.C.: information dissemination, education, alternatives or problem identification and referral services. (b) Universal Indirect Prevention Universal indirect services support population -based programs and policies implemented by coalitions. These services can also include meetings and events related to the design and implementation of components of the strategic prevention framework, including needs assessments, logic models and comprehensive community action plans. The services shall address the following specific prevention strategies, as defined in Rule 65D- 30.013, F.A.C.: information dissemination, community -based processes and environmental strategies. (c) 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. (d) Indicated Prevention U. Preventive interventions that are targeted to high -risk individuals who are identified as having CO minimal but detectable signs or symptoms that foreshadow mental, emotional, or behavioral >_ disorders, 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. (31) "Prime Contract" is the contract between the Department of Children and Families and the ME. (32) "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 consumer and target population to be served. (33) "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. (34) "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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 5 of 54 Contract No. M Racket Fig. 2747 '' South Florida ', Behavioral - Health Network, Inc. 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. (35) "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. (36) "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. (37) "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. (38) "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. (39) "SAMH" stands for the Substance Abuse and Mental Health Programs within the co Department. >_ (40) "SAVE/VIS Program" is the U.S. Department of Homeland Security (DHS) administers the Systematic Alien Verification for Entitlements (SAVE) program. This program verifies immigration status and eligibility of alien applicants for federal benefits. The alien status verification system under SAVE is entitled the Alien Status Verification Index (ASVI), as described at 60 Federal Register 52694, 52697 (1995) administered by the Computer Sciences Corporation (CSC) as the Verification Information System (VIS). The SAVE/VIS Program can and may provide assistance in verifying eligibility in cases where a consumer does not possess sufficient documentation. (41) "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. (42) "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. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 6 of 54 Contract No. M Racket Fig. 2748 '' South Florida ', Behavioral - Health Network, Inc. (43) "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) 19156 waiver for children under age 18 to provide diagnostic and active treatment services in a secure setting. (44) "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. (45) "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. (46) "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. (47) "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. (48) "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. (49) "Utilization Management" is a system to ensure maximum, cost - effective, and clinically iq appropriate utilization of behavioral health services. The goal of the program is to eliminate U. waitlists and maximize utilization as well as diverting individuals served to more clinically CO appropriate services when applicable. U. (50) "Verifiable Service" is a service provision that is documented in compliance with the requirements contained in Rule 65E -14, F.A.C. (51) "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. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 7 of 54 Contract No. M Racket Fig. 2749 '' South Florida ', Behavioral - Health Network, Inc. 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. c. Scope of Service CO The following scope of service applies to the contract period and any renewal or extension: U. (1) The Network Provider is responsible for the administration and provision of services to the target population(s) indicated in Exhibit A, Consumers /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. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 8 of 54 Contract No. M Packet Fig. 2750 '' South Florida ', Behavioral - Health Network, Inc. (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 www .sfbhn.ora 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 (d) Be dedicated to excellence and quality results. There is a commitment to improve access to care, promote service continuity, support efficient and effective delivery of services that utilize evidence -based practices, recovery- oriented and peer involved approaches in accordance with priorities established by the ME and the Department for substance abuse, mental health treatment and /or co- occurring disorders and, substance abuse prevention services. (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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 9 of 54 Contract No. M Packet Fig. 2751 '' South Florida ', Behavioral - Health Network, Inc. warranted; (f) Cultural and linguistic competence; (g) Gender responsive, (h) Sexual orientation, and (i) Recovery- oriented and recovery - supported as defined by the Substance Abuse and Mental Health Services Administration (SAMHSA). 3. Consumers to be Served See Exhibit A, Consumers /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 consumer 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. (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; III. Staff name and identification number iii. Service date; iv. Start time V. Duration; Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 10 of 54 Contract No. M Packet Fig. 2752 '' South Florida ', Behavioral - Health Network, Inc. Vi. Covered Service; Vii. Service (Brief description of type of group); Viii. Group Indicator; and ix. Program (AMH, ASA, CMH, CSA) II. 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; III. 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 bythe 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 08/01/2017 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 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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 11 of 54 Contract No. M Packet Fig. 2753 '' South Florida ', Behavioral - Health Network, Inc. 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 consumers 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 08/01/2017, 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 08/01/2017 the Network Provider shall submit to the ME's contract manager an updated Civil Rights Compliance Checklist (CF0946) (12)By 08/01/2017 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. (14) By 08/01/2017, the Network Provider shall submit to the ME's contract manager a Quality CO Assurance Plan that details how the Network Provider will ensure and document that quality services are being provided to the consumers served, which is herein incorporated by reference. LL 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. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 12 of 54 Contract No. M Racket Fig. 27M '' South Florida ', Behavioral - Health Network, Inc. (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.(20) 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 consumers 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/ecisc.htmi 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 consumer (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 medical facility. The MOU provides for integration of behavioral health services and primary N health care services to the medically underserved in order to meet the goals specified in Section U. B.1.a.(19)(a) of this Attachment I. The Network Provider also agrees to accept referrals from the co 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 consumer. 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) Supplemental Security Income /Social Security Disability Insurance (SSI /SSDI) Outreach, Access, and Recovery (SOAR) The Network Provider shall adhere to the requirements of Exhibit AN, Supplemental Security Income /Social Security Disability Insurance (SSI /SSDI) Outreach, Access, and Recovery (SOAR). The Network Providers assign SOAR Processor /Case Manager to participate in meetings and /or trainings as requested by ME staff and shall designate SOAR Trained Processor(s) who have been trained through the SOAR Online Course developed by Policy Research Associates and SAMHSA who will process SOAR applications for all consumers receiving services through funding provided by this contract that have been screened and determined to be eligible for Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 13 of 54 Contract No. M Racket Fig. 2755 '' South Florida ', Behavioral - Health Network, Inc. SOAR benefits. (18)Linkage and Referral Process (a) The Network Provider's policies and procedures must address the referral and linkage process of consumers 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. 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. (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. (19) 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. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 14 of 54 Contract No. M Packet Fig. 2756 '' South Florida ', Behavioral - Health Network, Inc. (b) The quality improvement program must include at minimum: Activities to ensure that fraud, waste and abuse do not occur. 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. vii. Establishment of a Seclusion and Restraint Oversight Committee per Chapter 65E- 5.180, F.A.C. for agencies utilizing seclusion and /or restraint. (20) Continuous Quality Improvement Initiatives -Providers must comply with all of the provisions co 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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 15 of 54 Contract No. M Packet Fig. 2757 '' South Florida ', Behavioral - Health Network, Inc. improvement plan that delineates participation in the Health Integration Initiative. As part of the plan or component of the plan must include the following: 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 08/31/2017, 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 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 03/01/2018, 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, 2018, 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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 16 of 54 Contract No. M Racket Fig. 2758 '' South Florida ', Behavioral - Health Network, Inc. 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. By 08/31/2017, 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. 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. vi. By 03/01/2018, unless otherwise directed by the ME, the Network Provider shall complete an annual agency -wide self- assessment using the Fallot Assessment Tool. CD The results of the self- assessment must be submitted by April 1, 2018, or other date >_ specified by the ME, to the individual(s) identified in Exhibit C, Required Reports. CO (c) Cultural and Linguistic Competence U. 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: i. 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 08/31/2017, 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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 17 of 54 Contract No. M Racket Fig. 2759 '' South Florida ', Behavioral - Health Network, Inc. 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 03/01/2018, 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 The Network Provider will ensure that behavioral health services are available to consumers 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 consumer 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. 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 consumers. 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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 18 of 54 Contract No. M Racket Fig. 2760 '' South Florida ', Behavioral - Health Network, Inc. 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, 2018 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. (21) By 8/31/2017 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. (22)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 LL action plan; CO (b) Trauma Informed Care, as described in the agency's action plan; LL (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; (f) Progress on steps taken toward meeting the requirement to become an accredited provider by June 30, 2018 (g) 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. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 19 of 54 Contract No. M Racket Fig. 2761 '' South Florida ', Behavioral - Health Network, Inc. (23) Care Coordination and Reporting Requirements If providing services to an individual identified as needing care coordination services, the Network Provider is required to implement Care Coordination as defined in section 394.4573(1)(a), F.S., is required to meet the requirements as set forth in the DCF Guidance Document 4, Care Coordination, and the ME's Care Coordination Policy and Protocol, all documents are incorporated herein by reference and available when requested to ME's Contract Manager. Section 394.4573(1)(a), F.S., defines Care Coordination to "mean the implementation of deliberate and planned organizational relationships and service procedures that improve the effectiveness and efficiency of the behavioral health system by engaging in purposeful interactions with individuals who are not yet effectively connected with services to ensure service linkage. The purpose of care coordination is to enhance the delivery of treatment services and recovery supports and to improve outcomes among priority populations." The priority populations are defined in the DCF Guidance Document 4, Care Coordination. Care Coordination serves to assist individuals who are not effectively connected with the services and supports they need to transition successfully from higher levels of care to effective community -based care. Care Coordination is not intended to replace case management. The ME Care Coordination Department is responsible for identifying individuals eligible for Care Coordination through data surveillance, refer individuals to the Network Provider, track the individuals served by the Network Provider through Care Coordination, ensure the linkages to services and monitor outcome metrics. Required Report: On a monthly basis, by the 15th calendar day following the month of service, the Network Provider shall submit a Care Coordination Report on the template provided in Exhibit AC, to the ME's Contract Manager. (24)Transitional Voucher Project Pursuant to the Department's Guidance Document 29 — Transitional Voucher and the ME's Care Coordination Policy and Protocols, the Transitional Voucher Project provides care coordination and vouchers to purchase treatment and support services for adults transitioning from Florida Assertive Community Treatment (FACT) teams, acute crisis services, and institutional settings to independent community living. All Network Providers who serve individuals meeting the criteria above may participate in the Transitional Voucher Project. Transitional vouchers provide a participant with a monthly budget to be spent on allowable services pursuant to Rule 65E- 14.021, F.A.C. This service is intended to support Care Coordination efforts outlined in the DCF Guidance Document 4 — Care Coordination. The Transitional Voucher project is a flexible, consumer - directed voucher system designed to bridge the gap for persons with behavioral health disorders as they transition from acute or more restrictive levels of care to lower levels of care. The intent of this project is to enable individuals to live independently in the community with treatment and support services based on need and choice and build a support system to sustain their independence, recovery, and overall well- being. The project aims to: Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 20 of 54 Contract No. M Packet Fig. 2762 '' South Florida ', Behavioral - Health Network, Inc. (a) Prevent recurrent hospitalization and incarceration; (b) Provide safe, affordable, and stable housing opportunities; (c) Increase participant choice and self- determination in their treatment and support service selection; and (d) Improve community involvement and overall quality of life for program participants. To access these funds, the Network Provider must follow the ME's Care Coordination Policy and Protocols, available upon request to the ME's Contract Manager. The expenses may be authorized by the ME only to the extent that they are reasonable, allowable and necessary as determined through the assessment process; are clearly identified in the care plan; and only when no other funds are available to meet the expense. The Network Provider may be asked by the ME to provide a monthly and /or or a quarterly reports and /or data that documents transitional voucher services, in a template provided by the ME. (25)Financial Audit Reports (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 co 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. U. (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: / /r.m�flfamilies.com /service- roctrams /substance - abuse /managing_ entities /2017- contract -docs (26)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. (27) 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 consumers /stakeholders if applicable and appropriate. (28) The Network Provider shall comply with Children and Families Operating Procedure 215 -8, Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 21 of 54 Contract No. M Racket Fig. 2763 '' South Florida ', Behavioral - Health Network, Inc. OVERSIGHT OF HUMAN SUBJECT RESEARCH AND INSTITUTIONAL REVIEW BOARD DESIGNATION. The policy and guidance can be found at: h :ll naa. yflorida,comlappslvbsladocll 2551 I 09H13CxC1Addendu 10 CFOP215R 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. (29) 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. (30) The Network Provider shall meet with the ME's staff at regularly scheduled or specially called meetings when notified by the ME. (31)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. (32)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. (33)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. (34) The Network Provider shall ensure provision of services to consumers 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 consumers. The ME reserves the right to modify this list as the needs of the consumers change. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 22 of 54 Contract No. M Packet Fig. 27" '' South Florida ', Behavioral - Health Network, Inc. (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. (35) 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). (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 Iicensure. AHCA licenses can be verified at the following website: htt�:ll �ar, floridahealthfinder. elovlfacilitotlocatorfFacilit�learch .as�ax (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 co Exhibit L, Assisted Living Facilities with a Limited Mental Health License, if services U. 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 Consumer Report the required format as shown in Table 1, of Exhibit L, Assisted Living Facilities with a Limited Mental Health License. The ALF -LMHL Consumer Report shall be submitted in a secured, password protected, or encrypted format. (36)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. (37) Work and Social Opportunities for Peer Specialists Nationwide, health systems have accepted peers as a valuable part of the workforce. A shift to a more person- centered approach, a focus on integrated health, and a demand for more workers have increased the role peer specialists play in Florida's mental health and substance abuse systems . In keeping with Florida's goal of increasing the number of peer specialists, Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 23 of 54 Contract No. M Packet Fig. 2765 '' South Florida ', Behavioral - Health Network, Inc. the Network Provider shall provide employment and social opportunities to individuals who have lived experience of mental health and /or substance use conditions and /or lived experience of trauma. The Network Provider shall meet with the ME's staff at regularly scheduled or specially called meetings when notified by the ME. (38) 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. (39) 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. (40) Consumer Satisfaction Survey The Network Provider shall conduct satisfaction surveys of individuals served pursuant to DCF CO 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. UP (41) 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; Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 24 of 54 Contract No. M Packet Fig. 2766 '' South Florida ', Behavioral - Health Network, Inc. (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. (42) Consumer Trust Funds (CTF) (a) The Network Provider shall submit a letter to the contract manager certifying that they either are or are not the representative payee for Supplemental Security Income, Social Security Administration, Veterans Administration, Food Stamps, or other federal benefits on behalf of a consumer by August 1, 2017. (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 consumer, the Network Provider shall comply with the applicable federal laws including the establishment and management of individual consumer trust accounts >- (20 CFR 416 and 31 CFR 240). CO (c) Any Network Provider assuming responsibility for administration of the personal property U. and /or funds of consumers 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 consumer funds that are attributable to the Network Provider shall be repaid, plus applicable interest, within one (1) week of the determination. c (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 consumers 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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 25 of 54 Contract No. M Racket Fig. 2767 '' South Florida ', Behavioral - Health Network, Inc. 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, SAMH Programmatic 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 consumers served. The ME, at its sole discretion may request documentation evidencing recruitment efforts. b. Professional Qualifications (1) The Network Provider shall comply with applicable rules, statutes, requirements, and standards with regard to professional qualifications. See Exhibit F, SAMH Programmatic 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 U. contact with individuals held for examination or admitted for mental health treatment. CO (3) Additionally, the Network Provider shall provide employment screening for substance abuse U. U. 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 U) 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 c 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." Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 26 of 54 Contract No. M Packet Fig. 2768 '' South Florida ', Behavioral - Health Network, Inc. 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 co outside of one's own company to do work as part of a larger project. LL (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)]. '' South Florida ', Behavioral - Health Network, Inc. (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 N contemplated under this contract shall be available upon request by ME staff and at the time U. of monitoring. CO (8) The Network Provider shall implement and maintain procedures for subcontract procurement, U. 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. UP (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; 46 (d) had a contract terminated by the department or ME for failure to satisfactorily perform or for cause; or, Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 28 of 54 Contract No. M Packet Fig. 2770 '' South Florida ', Behavioral - Health Network, Inc. (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 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 CO this contract. U. (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. 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. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 29 of 54 Contract No. M Racket Fig. 2771 '' South Florida ', Behavioral - Health Network, Inc. 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 consumer 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. 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 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 CO regarding the amount and number of services paid for by the Substance Abuse Prevention and Treatment Block Grant. LL (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) Service data shall be submitted electronically, weekly, by 12:00 Noon every Wednesday. Final monthly service data will be submitted electronically to the ME no later than the 4th of each month following the month of service into KIS, PBPS maintained by Collaborative Planning Group Systems, Inc., or other data reporting system designated by the ME and /or the Department. If the Network Provider is funded to provide substance abuse prevention services, the Network Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 30 of 54 Contract No. M Racket Fig. 2772 '' South Florida ', Behavioral - Health Network, Inc. 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) To establish a unique client identifier for all individuals served, the Network Provider shall submit the Demographic Data Set required by PAM 155 -2, Chapter 4 within five (5) business days after the initial intake or admission. (b) Ensure that the data submitted clearly documents all consumer 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; (c) 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 consumers' 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 data maintained in the Network Provider service documentation and /or consumer files, if applicable; (d) 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; (e) 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 (f) 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) The Network Provider must subtract all units which are billable to Medicaid, and all units for SAMH consumer services paid from other sources, including Social Security, Medicare payments, and funds eligible for local matching which include patient fees from first, second, and third -party payers, from each monthly request for payment. Should an overpayment be detected upon reconciliation of payments, the Network Provider shall immediately refund any overpayment to the ME, 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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 31 of 54 Contract No. M Packet Fig. 2773 '' South Florida ', Behavioral - Health Network, Inc. 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. For Prevention services providers the individualized performance measure standards are specified in Attachment IV, Scope of Work. (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 consumers 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 E Provider's performance, and contains policies and procedures for submitting the required data. Collaborative Planning Group Systems, Inc. , 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 U) C. Performance Evaluation Methodology C4 (1) The Network Provider shall collect information and submit performance data and individual >_ consumer outcomes, to the ME data system in compliance with DCF PAM 155 -2 requirements, or co the latest revisions thereof. The specific methodologies for each performance measure may be found at the following website: U. htt: //w m�rflfamilies.com /service- rograms /substance - abuse/ am�hlet- 155- 2 -v11 (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. (5) Performance data information may be found on the department's web -based performance Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 32 of 54 Contract No. M Packet Fig. 2774 '' South Florida ', Behavioral - Health Network, Inc. Dashboard at: tqp://www.dcf.state.fl.us/performance/dashboard/. Additional substance abuse prevention data information may be obtained from the ME's Director of Prevention Services. 6. Network Provider Responsibilities a. Network Provider Unique Activities (1) In the event of a dispute as to the ME's determination regarding consumer 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 consumer, 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 N recipient utilization, cost, claims, billing, and collections for the ME. The Network Provider must U. maximize all potential sources of revenue to increase services, and institute efficiencies that will co consolidate infrastructure and management functions in order to maximize funding. U. (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 consumer 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 CFR 54a. (9) A Network Provider that receives block grant funding shall monitor its compliance with block grant requirements and activities. (10) A Network Provider that receives block grant funding shall comply with state or federal requests Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 33 of 54 Contract No. M Packet Fig. 2775 '' South Florida ', Behavioral - Health Network, Inc. for information related to block grant. (11) A Network Provider that receive CMH block grant funding, and have been designated as a prevention provider forthe purposes of H.R. Res. 3547, 113th Cong. (2014) (enacted), compliance with federal requirements. (12)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. (13) 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. (14)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, consumer records, and such documents determined to assure accountability of service provision and /or the expenditure of state and federal funds. (15) The Network Provider shall assist the ME and the Department in developing legislative budget requests based upon identified needs of the community. (16) 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 N the corrective action plan(s) within ten (10) calendar days of receipt by the Network Provider from the U. reviewing entity. CO (17) The Network Provider shall cooperate with the ME and the Department when investigations are U. 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. UP (18)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. (19) The Network Provider shall maintain in one place for easy accessibility and review by ME and /or Department staff all policies, procedures, tools, and plans adopted by the Network Provider. The Network Provider's policies, procedures, and plans, must conform to state and federal laws, the Florida Administrative Code, state and federal regulations, state and federal rules, and minimally meet expectations/ requirements contained in applicable Department of Children and Families and ME operating procedures. (20) The Network Provider shall maintain a mechanism for monitoring, updating, and disseminating policies and procedures regarding compliance with current government laws, rules, practices, regulations, and the ME's policies and procedures. (21)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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 34 of 54 Contract No. M Packet Fig. 2776 '' South Florida ', Behavioral - Health Network, Inc. Outcomes and Outputs, for the types of services provided under this contract. (22)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, SAMH Programmatic State and Federal Laws, Rules, and Regulations, and ME policies and procedures. (23)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, SAMH Programmatic State and Federal Laws, Rules, and Regulations. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 35 of 54 Contract No. M Packet Fig. 2777 '' South Florida ', Behavioral - Health Network, Inc. 7. Managing Entity Responsibilities a. Managing Entity Obligations (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 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. (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 N Counties. U. (g) The ME shall monitor and take action when necessary so that services which meet the co standards defined herein will be provided throughout the contract period. U. (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. UP (i) 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. (2) Network Providers with electronic health record (EHR) or electronic medical record systems (EMR) shall provide access to ME funded service and consumer data contained in these systems Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 36 of 54 Contract No. M Racket Fig. 2778 '' South Florida ', Behavioral - Health Network, Inc. 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 consumer 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 consumers, 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 consumers, 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 N maintenance and reporting of data on the performance standards that are specified in Exhibit D, U. Substance Abuse and Mental Health Required Performance Outcomes /Outputs. co (4) The ME implements a training program for its staff and the Network Provider staff. The LL trainings assure that staff receives externally mandated and internal training. The ME may coordinate training or directly provide training to Network Provider staff. gr (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 consumers is appropriate. The ME will take corrective action to resolve situations in which the subcontracted Network Provider is not following the guidelines or working to help the system meet its utilization goals. (2) Authorization of Services (a) The ME shall conduct authorization and reauthorizations for applicable levels of care as described in the approved Coordination of Care Plan Manual — FY 2017 -18, or the latest revision thereof , 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 timeline standards Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 37 of 54 Contract No. M Packet Fig. 2779 '' South Florida ', Behavioral - Health Network, Inc. referenced in the approved Coordination of Care Plan Manual — FY 2017 -18 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 consumer 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. co Substantive amendments to submitted policies, procedures and plans shall be provided to the ME. LL (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 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 consumers who are served by the ME either directly or through any one of its contracted Network Providers. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 38 of 54 Contract No. M Racket Fig. 2780 '' South Florida ', Behavioral - Health Network, Inc. (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 2017 -2018 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. Acute Care Service Utilization Reporting for Public Receiving Facilities, Detoxification and Addiction Receiving Facilities: Instructional Manual for Reporting Acute Care Services Utilization (ACSU) Data 3.Real -time Data Entry: When required bythe Prime Contract, state and /orfederal rules, regulations, orthe ME's policies and procedures, 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(s) when notified and as directed by the ME. 4. Purchase Firearms by Mentally III Persons pursuant to Chapter 790, Florida Statute, Weapons and Firearms — Applicable to Receiving and /or Treatment Facilities as defined in s. 394.455, Florida Statute Current law prohibits dealers from selling firearms to persons who have been adjudicated mentally defective or has been committed to a mental institution by a court or as provided in subsection 790.065 (2)(a)4.b.(II), F.S., and as a result is prohibited by state or federal law from purchasing a firearm. Subsection 790.065, F.S., provides conditions under which an individual who has been allowed to transfer to voluntary status in lieu of court- ordered involuntary commitment after being admitted for Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 39 of 54 Contract No. M Packet Fig. 2781 '' South Florida ', Behavioral - Health Network, Inc. involuntary examination at a Baker Act receiving facility and is certified by an examining physician to be of imminent danger to himself of herself or others, may be prohibited from purchasing a firearm, and may not be eligible to apply for or retain a concealed weapon or firearms license. Within 24 hours after the person's agreement to voluntary admission, a record of the finding, certification, notice, and written acknowledgement ( "petition ") must be filed by the administrator of the receiving or treatment facility, as defined in s. 394.455, F.S, with the clerk of the court for the county in which the involuntary examination occurred (790.065, (2) (a).4.c.(II) F.S). No fee may be charged for such filing. On a monthly basis, the Network Provider shall submit a report on the template provided in Exhibit O, Weapons and Firearms Court Petitions Monthly Report, with information from the preceding month that includes the number of petitions filed, the names of the individuals that the petitions were filed for, and the dates that the petitions were filed. The report shall be submitted electronically in a secured, password protected or encrypted format by the dates and to the individuals specified in Exhibit C, Required Reports. 5. 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 and /or Invitation to Negotiate #008 - Prevention of Substance Abuse, Promotion of Positive Mental Health and Related Consequences released on December 16, 2017 (collectively referred to as "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 U. (positive mental health) services as part of the continuum of behavioral health care for co 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 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) Data Submission in PBPS: Upon submission of the monthly data, the Network Provider's Director of Prevention /Supervisor, shall send an e-mail to the ME's Director of Prevention Services attesting that the data submitted has been reviewed and approved. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 40 of 54 Contract No. M Packet Fig. 2782 '' South Florida ', Behavioral - Health Network, Inc. (c) The Network Provider will accurately report the performance measures specified in Attachment IV, Scope of Work. (d) Based on consumer 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. (e) Renewal: If this contract was awarded to the Network Provider as a result of a successful response to the ME's ITN, this contract may be renewed annually with a projected end date of June 30, 2018, subject to the availability of funds. Renewals shall be made by mutual agreement and shall be contingent upon satisfactory performance, monitoring and evaluations as determined by the ME, subject to the availability of funds. Any renewal shall be in writing. 6. 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 provider 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. CO (b) An intern registration is valid for five (5) years. U. (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. 7. Utilization Management Program: If the Network Provider contracts for services that are utilization managed by the ME, 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. The Network Provider agrees to submit real -time data until an automated system is implemented. a. The Network Provider agrees to adhere to the utilization management protocols pursuant to the South Florida Behavioral Health Network Coordination of Care Plan Manual — FY 2017- 18 or the latest revision thereof, 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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 41 of 54 Contract No. M Packet Fig. 2783 '' South Florida ', Behavioral - Health Network, Inc. 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 utilization management system to include additional treatment services authorization and to automate the pre- authorization and billing process. The Network Provider agrees to implement the changes to the utilization management program as directed and when directed by the ME. d. The Network Provider will offer consumers 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 of Care Plan Manual — FY 2017- 18,. e. The Network Provider shall obtain written authorization from the ME prior to providing the services as specified in the Coordination of Care Plan Manual — FY 2017 -18. A written authorization will also be required, prior to the expiration of the initial length of stay, in order N to extend services. The request for an extension must be justified in accordance with the U. ME approved consumer assessment and placement tool and in accordance with the co Coordination of Care Plan Manual — FY 2017 -18. U. f. When a consumer has been provided residential services as a non -ME funded consumer (e.g. paid by insurance), that stay is subtracted from the prescribed length of stay should the consumer 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 consumers requiring admission into a substance abuse and /or mental health service as specified in the Coordination of Care Plan Manual prior to the consumer being admitted to the program for treatment. (3) Complete all required assessment components outlined in the Coordination of Care Plan 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 of Care Plan Manual. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 42 of 54 Contract No. M Packet Fig. 2784 '' South Florida ', Behavioral - Health Network, Inc. h. Pre - Authorization Utilization Management Roster and Payment for Services Specified in the Coordination of Care Plan Manual — FY 2017 -18, or the latest revision thereof. 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 consumers served including, consumer name, consumer 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. 8. 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, Consumer /Participants to be Served, however persons in categories (i) and (ii) 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 CO 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 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. 8.b. above may result in a request for corrective Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 43 of 54 Contract No. M Packet Fig. 2785 '' South Florida ', Behavioral - Health Network, Inc. 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. c. 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. 9. Incident Reports a. The Network Provider shall submit incident reports into the Incident Reporting and Analysis System (IRAS) on all reportable incidents per CFOP 215 -6, within 24 hours of receiving notification of a reportable incident. In the event an incident has an immediate impact on the health or safety of a consumer, has potential media impact, or involves employee - related incidents of criminal activity, the Network Provider must notify the ME Risk and Compliance Coordinator 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. 10. 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 consumer 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. 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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 44 of 54 Contract No. M Racket Fig. 2786 '' South Florida ', Behavioral - Health Network, Inc. contract manager. b. 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. 12. 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 il. contradicted for residents, staff shall explain to the resident the conditions under which the articles CO 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 U. actions shall be reviewed weekly for effectiveness and continued need. 13. Involuntary Commitment, Placements, Services, Treatment 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, to the individuals specified in Exhibit C, Required Reports, 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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 45 of 54 Contract No. M Packet Fig. 2787 '' South Florida ', Behavioral - Health Network, Inc. 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. 14. 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. 15. 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. A Network Provider that receives SAPT block grant funding for the purpose of primary prevention, shall comply with 45 C.F.R. s. 96.125. d. Behavioral health services shall be provided to persons pursuant to s. 394.674, F.S., including N those individuals who have been identified as requiring priority by state or federal law. The identified U. priority populations are found in Exhibit A, Consumer /Participants to be Served, however CO 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 U. 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 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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 46 of 54 Contract No. M Packet Fig. 2788 '' South Florida ', Behavioral - Health Network, Inc. hours after such request. e. 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. f. As required by 45 C.F.R. ss. 96.17, the Network Provider maybe requested to provide information to the ME for the purposes of reporting on SAPTBG activities to the Department g. The Network Provider shall ensure compliance with 45 C.F.R. Subpart C —Financial Management. h. The Network Provider agrees to comply with the data submission requirements outlined in DCF PAM 155 -2 and by the dates specified in Exhibit C, Required Reports. 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. j. 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 may require additional reports from the Network Provider. co k. 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. I. 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. c 0 m. The Network Provider shall use SAPTBG funds provided under this contract to support both E 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. n. 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. o. 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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 47 of 54 Contract No. M Packet Fig. 2789 '' South Florida ', Behavioral - Health Network, Inc. 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)]. htt : / /sfbhn.or /word rasa /w - content/u loads/SAMHSA- Guidance- on -SAPT- and- CMHSBG- Reouirements.ndf 16. 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. 17. Option for Increased Services The Network Provider acknowledges and agrees that the contract may be amended to include additional, negotiated, services as deemed necessarybythe 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. 18. 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. 19. Transportation Disadvantaged co The Network Provider agrees to comply with the provisions of chapter 427, F.S., Part I, Transportation LL 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 consumers. The Network Provider agrees to comply with the provisions of Children and Families Operating Procedures 40 -50 (CFOP 40 -5) Acquisition of Vehicles For Transporting Disadvantaged Consumers if public funds provided under this contract will be used to purchase vehicles which will be used to transport consumers. C9 20. 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. 21. National Provider Identifier (NPI) a. All Network Providers shall obtain and use an NPI, a HIPAA standard unique health identifier for health care providers. '' South Florida ', Behavioral - Health Network, Inc. 22. 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 0 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 U. governing the conduct of entities engaged in the business of providing services with government funds. co 23. Information Technology Resources U. 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. 24. 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. 25. 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 (a) Guidance /Care Center, Inc. Page 49 of 54 Contract No. M Packet Fig. 2791 '' 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. 26. 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. 27. 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 N general public, the value or cost of which is $250 or more. Hardback books with a value or cost of U. $100 or more should be classified as nonexpendable property only if they are circulated to students co 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 U. 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 Network 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 Network Provider, the department shall pay for the title transfer. The Network 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 Network 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 Network Provider solely responsible for the use and condition of said property. Network 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 Network 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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 50 of 54 Contract No. M Packet Fig. 2792 '' South Florida ', Behavioral - Health Network, Inc. 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 Network Provider prior to the end of the contract period. The Network Provider cannot dispose of any property that reverts to the ME or department without the contract manager's approval. The Network 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 Network Provider. The Closeout Inventory Form shall contain, at a minimum, the same information required by the annual inventory. (6) The Network 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 Network 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 Network Provider pursuant L. to this contract shall be vested in the ME upon completion or termination of this contract. During the term of this contract, the Network Provider is responsible for insuring all property purchased by or transferred to the Network Provider is in good working order. The Network 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 Network 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 N termination of this contract. When property transfers from the Network Provider to the ME, U. the Network Provider shall be responsible for paying for the title transfer. CO (8) If the Network Provider replaces or disposes of property purchased by the Network Provider U. pursuant to this contract, the Network Provider is required to provide accurate and complete information pertaining to replacement or disposition of the property as required on the Network Provider's annual inventory. UP (9) The Network Provider hereby agrees to indemnify the ME and the department against any claim orloss arising out of the Network Provider's operations of any motor vehicle purchased by or transferred to the Network 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 Network 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 Network Provider. Subcontractors shall not be assigned or transferred title to these vehicles. The Network Provider hereby agrees to indemnifythe 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. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 51 of 54 Contract No. M Racket Fig. 2793 '' South Florida ', Behavioral - Health Network, Inc. 28. Health Insurance Portability and Accountability Act (HIPAA) a. In compliance with 45 CFR s. 1 64.504(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. 29. 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 CO 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., below. U. 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: htt�:B /dos. m�florida. com/ elections /for - voters /voter - registration /national- voter - registration -act/ 30. 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. c. The Network Provider shall obtain and provide proof to the ME's Contract Manager of Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 52 of 54 Contract No. M Packet Fig. 2794 '' South Florida ', Behavioral - Health Network, Inc. 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. 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 CO 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 U. 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. < 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. 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. j. 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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 53 of 54 Contract No. M Racket Fig. 2795 '' South Florida ', Behavioral - Health Network, Inc. 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 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 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 9. Exhibit I, Motivational Support (MSP) Provider Protocols 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, Weapons and Firearms Court Petitions 15. Exhibit Q, Missing Children 16. Exhibit R, Our Kids Miami - Dade /Monroe Child Welfare Quarterly Clinical Report 17. Exhibit V, Special Provisions for the Forensic Services Program 18. Exhibit X, Special Provisions for Projects for Assistance in Transition from Homelessness (PATH) Services 19. Exhibit AA, Motivational Support Specialist 20. Exhibit AC, Care Coordination Report Template 21. Exhibit Al, Family Intensive Treatment Team - Scope of Work 22. Exhibit AK, Outpatient Waitlist Report Form 23. Exhibit AM, Return on Investment - Special Appropriations Projects for Fiscal Year 2017 -18 24. Exhibit AN, Supplemental Security Income /Social Security Insurance (SSI /SSDI) Outreach, Access, and Recovery (SOAR) 25. Exhibit AP, Mental Health Case Management Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 54 of 54 Contract No. M Packet Fig. 2796 Exhibit A Consumers /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 I Illness Children's Substance Abuse 21 Adult Mental Health - Mental Health Problems Substance Abuse Community Coalition Adult Mental Health- Forensic Involvement ✓ hildren's Mental Health- Serious Emotional Disturbances Children's Mental Health- Emotional Disturbances Children's Mental Health -At Risk of Emotional Disturbances F y - , - Nult Substance Abuse Children's Substance Abuse B. Consumer /Participant Eligibility 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 s. 394.674(1)(c)3., F.S., based on the risk to the children due to a substance Exhibit A Guidance /Care Center, Inc. Page 1 of 3 Contract No. M Packet Fig. 2797 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.; If. 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. Consumer /Participant Determination 1. Determination of consumer eligibility is the responsibility of the network provider. The network Iq provider shall adhere to the eligibility requirements as specified in Exhibit F, SAMH Programmatic State and Federal Laws, Rules, and Regulations. The ME reserves the right to review the network provider's determination of consumer eligibility and override the >- determination of the network provider. When this occurs the network provider will immediately U. provide services to the consumer until such time the consumer completes his /her treatment, co 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 consumer 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 1. 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 Exhibit A Guidance /Care Center, Inc. Page 2 of 3 Contract No. M Packet Fig. 2798 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. M Racket Fig. 2799 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 $5,512,140.00 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 $4,593,450.00, subject to the delivery and billing for services. The remaining amount of $918,690.00 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 Network Provider agrees to provide local matching funds in the amount of $1,067,449.00 as indicated in Exhibit H, Funding Detail U. and Local Match Plan. co Should the Network Provider receive any funding from the "Uncompensated Units LL 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 ii. CMH Programs (100435 Category & 102780 (PRTS) Category) that are not grant funded. Exhibit B Page 1 of 5 Guidance /Care Center, Inc. Contract No. M Packet Fig. 2800 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. If. 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 Network 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 Network Provider closes or suspends the provision of services funded by this contract, the Network 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 Network 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 CO 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 LL funds are available and services have been provided. 3. Third Party Billing a. The Department is always the payer of last resort. The ME and the Network Provider specifically agree that the Department, through the ME, is never a liable third party. 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 Exhibit B Page 2 of 5 Guidance /Care Center, Inc. Contract No. M Racket Fig. 2801 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. 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. 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 Network 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 Network Provider agrees that co payments from a health maintenance organization, prepaid mental health plan, or provider U. 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 (TAN F) Billing 6. Invoice Requirements a. The rates negotiated with any Network Provider may not exceed the rate as specified in Exhibit B Page 3 of 5 Guidance /Care Center, Inc. Contract No. M Racket Fig. 2802 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: htto: / /sfbh n. orq /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 U. ME at sole discretion can reallocate funds. If the Network Provider fails to submit an CO invoice or written documentation for two (2) consecutive months within a twelve (12) >_ month period, the ME at sole discretion can terminate the contract. U. 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 Network Provider shall submit UP 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. 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 Network 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. M Packet Fig. 2803 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 Network 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: http: llv. m�floridacfo. comlaadirlreferenceuidelReference Guide For State Expenditures. df 9. Funding Sweeps co 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 Network 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. M Racket Fig. 2804 South Florida Behavioral Health Network Inc. Exhibit C Required Reports V c: C: M o :2 U) Q Cal U. co U. U) Guidance/Care Center, Inc. Exhibit C Contract No. MF- - -- Page 1 of 10 1 Packet Pg. 2805 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 via E-mail) Actions, as applicable Contract Manager 2. Director of Contract Accountability Memorandum of Understanding (MOU) with a Within 90 calendar days of the effective Federally Qualified Health Center (FQHC) date of the contract (for newly executed or 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 to primary care services to be submitted within 30 calendar days of the medically underserved behavioral health adoption client Sliding Fee Scale [reflecting the uniform 1 (Electronic Submission schedule of discounts referenced in 65E- Prior to contract execution via E-mail) ME Contract Manager 14.018(4)] Final FY 2017-2018 (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 (2) Budget Narrative, 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 via E-mail) (2) Service Activity Description amendment 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 via E-mail) b) Agency Staff implementation 2. VP of CQI Affidavit Regarding Debarment Annually prior to contract execution, or as 1 ME Contract Manager requested by the Contract Manager Local Match Calculation Form - Florida Annually prior to contract execution, or as 1 (Electronic Submission ME Contract Manager Department of Children and Families requested by the Contract Manager via E-mail) Submit updates within 30 calendar days of amendment or 1. ME Contract Manager "No Wrong Door" Policy and Procedures as requested by the contract manager and/or the QAIQI 1 Risk & Compliance Manager 2• QAIQI Risk & Compliance Manager V c: C: M o :2 U) Q Cal U. co U. U) Guidance/Care Center, Inc. Exhibit C Contract No. MF- - -- Page 1 of 10 1 Packet Pg. 2805 South Florida Behavioral Health Network Inc. Exhibit C Required Reports c: C: M o U) Q Cal U. 00 U. U) Guidance/Care Center, Inc. Exhibit C Contract No. MF- - -- Page 2 of 10 1 Packet Pg. 2806 Within 24 hours of occurrence, in accordance with CFOP 215-6 and Incident Report reportable incidents defined CFOP 180-4 Submission through IRAS Submission through IRAS Mandatory Reporting Requirements to the Office of the Inspector General Acute Care Service Utilization Reporting for Real-time data submission as mandated Public Receiving Facilities, Detoxification and by subsection 394.9082(l 0), Florida Electronically KIS Express Acute Care System Addiction Receiving Facilities. Statutes Service data shall be submitted electronically, weekly, by 12:00 Noon Monthly Data Required by DCF PAM 155-2 every Wednesday. Final monthly shall be Electronically KIS, PBPS, or other data system submitted electronically to the ME no later designated by the ME or the Department than the 4th of each month following the month of service ADA Client Communication Assessment jy-�Summar -Re �art form �Ioln.ht�ml Auxiliary Aid Service Record Monthly Summary By the 4th business day following the Report reporting month 1 (Electronic Submission (Applicable to agency's that employ fifteen (15) 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 Submitted with the monthly invoice, as Invoice Review Supporting Documentation appropriate, and/or as requested by 1 As requested by SFBHN staff SFBHN staff Exhibit K, Pre-Authorization Utilization Monthly, with the monity invoice by the 1. ME Sr. Accountant (Fiscal Department) Management Roster for Substane Abuse and eighth (8th) calendar day 1 Mentalt Health Residential Level 11 Services after the month of service 2. ME ASOC Manager Exhibit AC, Care Coordination Report Monthly by the 1 5th calendar day after the 1 ME Contract Manager month of service Transitional Voucher Monthly Report Monthly by the 1 0th calendar day after the (Reporting Template will be provided by the month of service 1 ME Housing Coordinator ME) TAN F SAM H Program Logs and Service Data, Asper the contract and/or as requested by 1 ME TANIF 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 8/1/2017 1 (Electronic Submission ME Contract Manager via E-mail) c: C: M o U) Q Cal U. 00 U. U) Guidance/Care Center, Inc. Exhibit C Contract No. MF- - -- Page 2 of 10 1 Packet Pg. 2806 South Florida Behavioral Health Network Inc. Exhibit C Required Reports V c: C o E U) CD Cal U. 00 U. U) E CM Guidance/Care Center, Inc. Exhibit C Contract No. MF- - -- Page 3 of 10 1 Packet Pg. 2807 Attestation of Network Providers Verification that all applicable employees and subcontractors with access to ME and/or DCF 8/1/2017 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 (Electronic Submission 1. ME Contract Manager Emergency Preparedness Plan 8/1/2017 via E-mail) 2. QAIQI Risk & Compliance Manager Civil Rights Compliance Checklist (CF0946) 8/1/2017 1 (Electronic Submission via E-mail) ME Contract Manager Civil Rights Certificate (CF707) 8/1/2017 1 (Electronic Submission via E-mail) ME Contract Manager Client Trust Fund Letter 8/1/2017 1 (Electronic Submission via E-mail) ME Contract Manager 1 (Electronic Submission 1. ME Contract Manager Quality Assurance/Quality Improvement Plan 8/1/2017 via E-mail) 2. QAIQI Risk & Compliance Manager Action Plan (Integration of Behavioral Health 8/31/2017 1 (Electronic Submission 1. ME Contract Manager Services and Primary Care, TIC, CLC) via E-mail) 2. QAIQI Risk & Compliance Manager July 5, 2017 (Period: 04/01/17 - 06/30/17) October 5, 2017 NVRA Voter Registration Agencies Quarterly (Period: 07/01/17 - 09/30/17) January 5, 2018 1 (Electronic Submission 1. ME Voter Registration Activities Activities Report Form (DS-DE1 31; effective (Period: 10/01/17 - 12/31/17) via E-mail) Coordinator 01/2012 or latest revision thereof, if applicable April 5, 2018 2. ME Contract Manager (Period: 01/01/18 - 03/31/18) July 5, 2018 (Period: 04/01/18- 06/30/18) October 31, 2017 (Period: 07/01/17 - 09/30/17) January 31, 2018 Quarterly Financial Statements (Balance Sheet (Period: 10/01/17 - 12/31/17) 1 (Electronic Submission 1. ME VP of Finance and Statement of Activity) April 30, 2018 (Period: 01/01/18 - 03/31/18) via E-mail) 2. ME Contract Manager July 31, 2018 (Period: 04/01/18 - 06/30/18) October 31, 2017 (Period: 07/01/17 - 09/30/17) January 31, 2018 Attestation indicating the filing of Form 941 and (Period: 10/01/17 - 12/31/17) 1 (Electronic Submission payment of any taxes due to the IRS have April 30, 2018 via E-mail) ME Contract Manager been paid. (Period: 01/01/18 - 03/31/18) July 31, 2018 (Period: 04/01/18 - 06/30/18) January 30, 2018 1. ME Contract Manager Continuous Quality Improvement Updates (Period: 07/01/17 - 12/31/17) 1 (Electronic Submission July 30, 2018 via E-mail) 2. QAIQI Risk & Compliance Manager (Period: 01/01/18 - 06/30/18) V c: C o E U) CD Cal U. 00 U. U) E CM Guidance/Care Center, Inc. Exhibit C Contract No. MF- - -- Page 3 of 10 1 Packet Pg. 2807 South Florida Behavioral Health Network Inc. Exhibit C Required Reports V c: C o U) Q Cal U. co U. U) Guidance/Care Center, Inc. Exhibit C Contract No. MF- - -- Page 4 of 10 1 Packet Pg. 2808 Completion of the annual self-assessment for the following initiatives: 1. Integration of Behavioral Health and Primary 1. ME Contract Manager Care (MeHAF) 3/1/2018 1 2. Trauma Informed Care (Fallot Assessment 2. QAIQI 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) 4/1/2018 1 2. Trauma Informed Care (Fallot Assessment 2. QAIQI Risk & Compliance Manager Tool) 3. Cultural and Linguistic Competence Survey as directed by the ME Motivational Support Program (MSP) Per Exhibit 1, 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) Year-End Financial Reports for Network Provider's Not Requiring Audits Per Attachment 11 Due 180 days after the end of the Network Providers 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. ME Contract Manager Awards for fiscal years beginning on or after Florida Statutes The schedule shall be 1 (Electronic Submission December 26, 2014) in State Awards during based on revenues and expenditures via E-mail) 2. VP of Finance the fiscal year recorded during the state's fiscal year. Due 180 days after the end of the Network Providers 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 Florida Statutes The schedule shall be 1 (Electronic Submission 1. ME Contract Manager based on revenues and expenditures via E-mail) 2. VP of Finance recorded during the state's fiscal year. Due 180 days after the end of the Network Providers fiscal year or within 30 days of the recipient's receipt of the audit report, whichever occurs first, directly to each of Projected Cost Center Operating and Capital the following unless otherwise required by 1. ME Contract Manager Budget Florida Statutes The schedule shall be 1 (Electronic Submission Actual Expenses & Revenues Schedule based on revenues and expenditures via E-mail) 2. VP of Finance recorded during the state's fiscal year. V c: C o U) Q Cal U. co U. U) Guidance/Care Center, Inc. Exhibit C Contract No. MF- - -- Page 4 of 10 1 Packet Pg. 2808 South Florida Behavioral Health Network Inc. Exhibit C Required Reports V o c: C: E U) Q Cal U. 00 U. U) E Oi CM Oi Guidance/Care Center, Inc. Exhibit C Contract No. MF- - -- Page 5 of 10 1 Packet Pg. 2809 Year-End Financial Reports for Network Provider's Not Requiring Audits Per Attachment 11 - Continued Due 180 days after the end of the Network Providers 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 Providers 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) based on revenues and expenditures 2. VP of Finance recorded during the state's fiscal year. ss Year-End Financial Reports for Network Provider's Requiring Audits Per Attachment 11 Due 180 days after the end of the Network Providers 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 the following unless otherwise required by 1 (Electronic Submission 1. ME Contract Manager necessary schedules per Attachment 11 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 Providers 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 Florida Statutes The schedule shall be 1 (Electronic Submission 1. ME Contract Manager based on revenues and expenditures via E-mail) 2. VP of Finance recorded during the state's fiscal year. Due 180 days after the end of the Network Providers 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) 2. VP of Finance based on revenues and expenditures recorded during the state's fiscal year. V o c: C: E U) Q Cal U. 00 U. U) E Oi CM Oi Guidance/Care Center, Inc. Exhibit C Contract No. MF- - -- Page 5 of 10 1 Packet Pg. 2809 South Florida Behavioral Health Network Inc. Exhibit C Required Reports V c: C M :2 U) Q Cal U. 00 U. U) Guidance/Care Center, Inc. Exhibit C Contract No. MF- - -- Page 6 of 10 1 Packet Pg. 2810 YeaM1End Financial Reports for Network Provider's Requiring Audits Per Attachment 11'= Continued Due 180 days after the end of the Network Providers 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) 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 Providers 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) 2. VP of Finance based on revenues and expenditures recorded during the state's fiscal year. Waitlist 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 Adult 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 1 1. Children's System of Care Department Per Exhibit AJ Manager/Expansion Grant Project Director 1. Peer Outreach Summary - Monthly by and Program Manager the 10th for BE Program Beyond Empowerment Program 2. Section K of the National Outcome Measures (See Exhibit AJ for intervals) 2. ME Evaluation Team 3. Pending Assessment - Monthly by the 10th 3. Program Manager for BE Program July 5, 2017 (Period: 04/01/17 - 06/30/17) October 5, 2017 (Period: 07/01/17 - 09/30/17) 1. ME Contract Manager Infant Mental Health-Narrative Milestones January 5, 2018 1 (Electronic Submission Report On Client Outcomes, if applicable (Period: 10/01/17 - 12/31/17) via E-mail) 2. VP of Behavioral Health April 5, 2018 (Period: 01/01/18 - 03/31/18) July 5, 2018 (Period: 04/01/18- 06/30/18) V c: C M :2 U) Q Cal U. 00 U. U) Guidance/Care Center, Inc. Exhibit C Contract No. MF- - -- Page 6 of 10 1 Packet Pg. 2810 South Florida Behavioral Health Network Inc. Exhibit C Required Reports V c: C o U) Q Cal U. 00 U. U) Guidance/Care Center, Inc. Exhibit C Contract No. MF- - -- Page 7 of 10 1 Packet Pg. 2811 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 ss Required Reports for Receiving Facilities and/or Treatment Facilities Weapons and Firearms Court Petitions Within 15 calendar days after end of 1 (Electronic Submission 1. ME Contract Manager Monthly Report, Exhibit 0 month for the preceding month's via E-mail) information 2. ME Director of Research and Evaluation 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 Housing Coordinator April or May of each fiscal year) 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 Housing Coordinator Other PATH data reports as requested by the As requested by the ME As requested by the ME ME Contract Manager & Requestor ME October 5, 2017 (Period: 07/01/17 - 09/30/17) January 5, 2018 Assisted Living Facility with a Limited Mental (Period: 10/01/17 - 12/31/17) 1 (Electronic Submission 1. ME Contract Manager Health License Client Quarterly Report, per April 5, 2018 via E-mail) Exhibit L (Period: 01/01/18 - 03/31/18) 2. ME Adult System of Care Manager July 5, 2018 (Period: 04/01/18 - 06/30/18) V c: C o U) Q Cal U. 00 U. U) Guidance/Care Center, Inc. Exhibit C Contract No. MF- - -- Page 7 of 10 1 Packet Pg. 2811 South Florida Behavioral Health Network Inc. Exhibit C Required Reports c: C o E U) Q Cal U. 00 U. U) E CM Guidance/Care Center, Inc. Exhibit C Contract No. MF- - -- Page 8 of 10 1 Packet Pg. 281 2 Reports Required for Adult Mental Health Providers, as applicable -Continued September 15, 2017 (Period: 07/01/17 - 08/31/17) November 15, 2017 (Period: 09/01/17 - 10/31/17) January 15, 2018 (Period: 11/01/17 - 12/31/17) 1 (Electronic Submission 1. ME Care Coordination Manager SOAR Bi-Monthly Report, per Exhibit AN March 15, 2018 via E-mail) (Period: 01/01/18 - 02/28/18) 2, ME Peer Services Manager May 15, 2018 (Period: 03/01/18 - 04/30/18) July 15, 2018 (Period: 05/01/18 - 06/30/18) Report Required for Florida Assertive Community Treatment (FACT) Providers October 5, 2017 (Period: 07/01/17 - 09/30/17) January 5, 2018 (Period: 10/01/17 - 12/31/17) 1 (Electronic Submission 1. ME Contract Manager FACT Enhancement Reconciliation Report April 5, 2018 via E-mail) (Period: 01/01/18 - 03/31/18) 2. ME Peer Services Manager July 5, 2018 (Period: 04/01/18 - 06/30/18) 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, 2017 (Period: 07/01/17 - 09/30/17) January 5, 2018 (Period: 10/01/17 - 12/31/17) 1 (Electronic Submission 1. ME Contract Manager Ad-Hoc Quarterly Report April 5, 2018 via E-mail) (Period: 01/01/18 - 03/31/18) 2. ME Peer Services Manager July 5, 2018 (Period: 04/01/18 - 06/30/18) L L _L Report Required for Miami-Dade Forensic Alternative (MDFAC) Provide. ss Daily Census Report Daily 1 (Electronic Submission via E-mail) Regional Forensic Coordinator 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, 2017 (Period: 07/01/17 - 09/30/17) January 5, 2018 (Period: 10/01/17 - 12/31/17) 1 (Electronic Submission Enrollment/Membership Report April 5, 2018 via E-mail) ME Contract Manager (Period: 01/01/18 - 03/31/18) July 5, 2018 (Period: 04/01/18 - 06/30/18) c: C o E U) Q Cal U. 00 U. U) E CM Guidance/Care Center, Inc. Exhibit C Contract No. MF- - -- Page 8 of 10 1 Packet Pg. 281 2 South Florida Behavioral Health Network Inc. Exhibit C Required Reports o U) Q Cal U. U. U) Guidance/Care Center, Inc. Exhibit C Contract No. MF- - -- Page 9 of 10 1 Packet Pg. 2813 Reports Required for Substance Abuse Services Providers January 5, 2018 Report for HIV Early Intervention Services, (Period: 07/01/17 - 12/31/17) SAPT Block Grant Set Aside Funded Services July 5, 2018 1 ME Contract Manager Only (Period: 01/01/18 - 06-30-18) 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 October 15, 2017 (Period: 07/01/17 - 09/30/17) Prevention Services Quarterly Reports (Fidelity January 15, 2018 (Period: 10/01/17 - 12/31/17) 1 (Electronic Submission (1) ME Director of Prevention Services to EBPs) April 15, 2018 via E-mail) (2) BSRl - ME Contracted Prevention (Period: 01/01/18 - 03/31/18) Services Evaluation Provider July 15, 2018 (Period: 04/01/18 - 06/30/18) . ... . ... .. 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-13 for the preceding month's services October 31, 2017 (Period: 07/01/17 - 09/30/17) January 31, 2018 Family Intensive Treatment Team Quarterly (Period: 10/01/17 - 12/31/17) 1 (Electronic Submission Expenditure Report (Network Provider May 1, 2018 via E-mail) ME Contract Manager Specific: Guidance/ Care Center, Inc.) (Period: 01/01/18 - 03/31/18) July 31, 2018 (Period: 04/01/18 - 06/30/18) 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 o U) Q Cal U. U. U) Guidance/Care Center, Inc. Exhibit C Contract No. MF- - -- Page 9 of 10 1 Packet Pg. 2813 South Florida Behavioral Health Network Inc. Exhibit C Required Reports Information and Referrals Provider's Network Jewish Community Services of South Florida, 1. ME Contract Mana er Inc.) Due monthly, by the 30th of every month 1 (Electronic Submission g Exhibit P -1, Information and Referral Monthly I following the month of service via E -mail) Progress Report Initial Projected Return on Investment I 7/10/2017 I 1 (Electronic Submission via E -mail) 1. ME Contract Manager October 10, 2017 (Period: 07/01/17 - 09/30/17) January 10, 2018 1. ME Contract Manager Quarterly Updates on Return on Investment (Period: 10/01/17 - 12/31/17) 1 (Electronic Submission Report - Per Exhibit AM April 10, 2018 via E -mail) (Period: 01/01/18 - 03/31/18) July 10, 2018 (Period: 04/01/18- 06/30/18) October 31, 2017 (Period: 07/01/17 - 09/30/17) January 31, 2018 (Period: 10/01/17 - 12/31/17) 1 (Electronic Submission Quartely Services Report May 1, 2018 via E -mail) ME Contract Manager (Period: 01/01/18 - 03/31/18) July 31, 2018 (Period: 04/01/18 - 06/30/18) October 31, 2017 (Period: 07/01/17 - 09/30/17) January 31, 2018 Navigate Program Quarterly Expenditure (Period: 10/01/17 - 12/31/17) 1 (Electronic Submission Report May 1, 2018 via E -mail) ME Contract Manager (Period: 01/01/18 - 03/31/18) July 31, 2018 (Period: 04/01/18 - 06/30/18) 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. M Page 10 of 10 Packet Fig. 2814 Exhibit D Substance Abuse & Mental Health Reauired Performance Outcomes & Outputs Provider Name: Guidance /Care Center, Inc. Contract #: ME225 -8 -27 Date: 7/1/2017' Revision #: Guidance /Care Center, Inc. Exhibit D Contract No. M Page 1 of 2 Packet Pg. 2815 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 illness 40 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 SAA73 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 30 days prior to discharge 15% 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 at the time of discharge 94% 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 functioning 64% 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 housing environment 93% MH780 f. Percent of children at risk of emotional disturbance (ED) who live in a stable housing environment 96% 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 versus 30 days prior to discharge 20% SA752 c. Percent of children with substance abuse who live in a stable housing environment at the time of discharge 93% Guidance /Care Center, Inc. Exhibit D Contract No. M Page 1 of 2 Packet Pg. 2815 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. M Page 2 of 2 Packet Pg. 2816 Table 2 Network Service Provider Output Measures — Persons Served For Fiscal Year FY17 -18 Service Category FY Target Residential Care 36 7i s Outpatient Care 1780 d o Crisis Care 350 X a State Hospital Discharges N/A Peer Support Services 0 C W Residential Care 0 L =' Outpatient Care 500 zs ii Crisis Care 12 Z c U SIPP Discharge N/A W Residential Care 0 Outpatient Care 286 a d v = M Detoxification 175 W Women's Specific Services 0 (A = Injecting Drug Users 0 3 a Peer Support Services 0 Residential Care 0 c N Outpatient Care 230 3 Detoxification 0 ua V) .Q c at' a, * *Refer to Attachment IV, Scope of Prevention Work for the numbers served. ** s 'u 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. M Page 2 of 2 Packet Pg. 2816 Exhibit E Monthly Payment Request 1. Exhibit E, Monthly Payment Request This exhibit is incorporated by reference and available upon request to the ME's Contract Manager Exhibit E Guidance /Care Center, Inc. 1 of 1 Contract No. M Packet Fig. 2817 Exhibit F SAMH PROGRAMMATIC 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: F -1 Federal Authority F -1.1 Block Grants Regarding Mental Health and Substance Abuse B -1.1.1 Block Grants for Community Mental Health Services 42 U.S.C. ss. 300x, et seq. B -1.1.2 Block Grants for Prevention and Treatment of Substance Abuse 42 U.S.C. ss. 300x -21 et seq. 45 C.F.R. Part 96, Subpart L F -1.2 Department of Health And Human Services, General Administration, Block Grants 45 C.F.R. Part. 96 F -1.3 Charitable Choice Regulations Applicable to Substance Abuse Block Grant and PATH Grant 42 C.F.R. Part 54 F -1.4 Confidentiality Of Substance Use Disorder Patient Records 42 C.F.R. Part 2 F -1.5 Security and Privacy 45 C.F.R. Part 164 F -1.6 Supplemental Security Income for the Aged, Blind and Disabled 20 C.F.R. Part 416 F -1.7 Temporary Assistance to Needy Families (TANF) 42 U.S.C. ss. 601 - 619 45 C.F.R., Part 260 F -1.8 Projects for Assistance in Transition from Homelessness (PATH) 42 U.S.C. ss. 290cc -21 — 290cc -35 F -1.9 Equal Opportunity for Individuals with Disabilities (Americans with Disabilities Act of 1990) 42 U.S.C. ss. 12101 -12213 F -1.10 Prevention of Trafficking (Trafficking Victims Protection Act of 2000) 22 U.S.C. s. 7104 2 C.F.R. Part 175 F -2 Florida Statutes F -2.1 Child Welfare and Community Based Care Ch. 39, F.S. Proceedings Relating to Children Exhibit F Page 1 of 4 Guidance /Care Center, Inc. Contract No. M Packet Fig. 2818 Ch. 402, F.S. Health and Human Services: Miscellaneous Provisions F -2.2 Substance Abuse and Mental Health Services Ch. 381, F.S. Public Health: General Provisions Ch. 386, F.S. Particular Conditions Affecting Public Health Ch. 394, F.S. Mental Health Ch. 395, F.S. Hospital Licensing and Regulation 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. 458, F.S. Medical Practice 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 F -2.3 Developmental Disabilities Ch. 393, F.S. Developmental Disabilities F -2.4 Adult Protective Services Ch. 415, F.S. Adult Protective Services F -2.5 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 -2.6 State Administrative Procedures and Services Ch. 119, F.S. Public Records Ch. 120, F.S. Administrative Procedures Act Ch. 287, F.S. Procurement of Personal Property and Services Ch. 435, F.S. Employment Screening 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. M Racket Fig. 2819 S. 112.061, F.S. authorized persons S. 112.3185, F.S. S. 215.422, F.S S. 216.181(16)(b), F.S. F -3 Florida Administrative Code Per diem and travel expenses of public officers, employees, and Additional standards for state agency employees Payments, warrants, and invoices; processing time limits; dispute resolution; agency or judicial branch compliance Advanced funds for program startup or contracted services F -3.1 Child Welfare and Community Based Care Ch. 65C -13, F.A.C. Foster Care Licensing Ch. 65C -14, F.A.C. Child- Caring Agency Licensing Ch. 65C -15, F.A.C. Child- Placing Agencies F -3.2 Substance Abuse and Mental Health Services Ch. 65D -30, F.A.C. Ch. 65E -4, F.A.C. Ch. 65E -5, F.A.C. Ch. 65E -10, F.A.C. Ch. 65E -11, F.A.C. Ch. 65E -12, F.A.C. Ch. 65E -14, F.A.C. Ch. 65E -20, F.A.C. Ch. 65E -26, F.A.C. F -3.3 Financial Penalties Ch. 65 -29, F.A.C. F -4 MISCELLANEOUS Substance Abuse Services Office Community Mental Health Regulation Mental Health Act Regulation Psychotic and Emotionally Disturbed Children - Purchase of Residential Services Rules Behavioral Health Services Public Mental Health Crisis Stabilization Units and Short Term Residential Treatment Programs Community Substance Abuse and Mental Health Services - Financial Rules Forensic Client Services Act Regulation Substance Abuse and Mental Health Priority Populations and Services Penalties on Service Providers F -4.1 Department of Children and Families Operating Procedures CFOP 155 -10 / 175-40 Services for Children with Mental Health and Any 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) F -4.2 Standards applicable to Cost Principles, Audits, Financial Assistance and Administrative Requirements S. 215.97, F.S. Florida Single Audit Act Exhibit F Page 3 of 4 Guidance /Care Center, Inc. Contract No. M Packet Fig. 2820 S. 215.971, F.S. Agreements funded with federal or state assistance Comptroller's Memorandum No. 03 (1999 -2000) F -4.3 <<< The remainder of this page is intentionally left blank. >>> Exhibit F Page 4 of 4 Guidance /Care Center, Inc. Contract No. M Racket Fig. 2821 Florida Single Audit Act Implementation CFO's Memorandum No. 03 (2014 - 2015) Compliance Requirements for Agreements 2 C.F.R., Part 200 Office of Management and Budget Guidance - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, available at https:/ /federalregister.gov /a/2013 -30465 2 C.F.R., Part 300 Department of Health and Human Services - Office of Management and Budget Guidance - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, Adoption of 2 C.F.R. Part 200 45 C.F.R., Part 75 Uniform Administration Requirements, Cost Principles, and Audit Requirements for HHS Awards Data Collection and Reporting Requirements S. 394.74(3)(e), F.S. Data Submission S. 394.9082, F.S. Behavioral health managing entities S. 394.77, F.S. Uniform management information, accounting, and reporting systems for providers S. 397.321(3)(c), F.S. Data collection and dissemination system DCF PAM 155 -2 Mental Health and Substance Abuse Measurement and Data <<< The remainder of this page is intentionally left blank. >>> Exhibit F Page 4 of 4 Guidance /Care Center, Inc. Contract No. M Racket Fig. 2821 EXHIBIT G: COVERED SERVICES FUNDING BY OCA Guidance/Care Center, Inc. NM225-8-27 MHO! MHM MIMS MIMIS MMM2 MI-1076 %AHON" %A110 1 11 MI-1026 WHOM MHOCN MHOCF TUVAL COVERED SERVICES FUNDING RATE 298,515 915,082 17,600 1,112,903 160,000 5,945 91,361 - $ 2,601,406 01 Assessment $ 89.00 139,167 12,600 19,500 $ 171,267 0) 02 Case Management $ 90.84 80,000 12,670 59,700 $ 152,370 03 Crisis Stabilization $ 352.97 1,077,903 $ 1 1 077,903 04 Crisis Support/Emergency $ 31.10 17,600 35,000 $ 52,600 Day/Night $ - 07 Drop-In/Self Help Centers $ 33.13 16,000 $ 16,000 08 In-Home/On-Site $ 93.34 50 $ 50 11 Intervention - Individual $ 65.68 126,344 9,900 $ 136,244 42 Intervention - Group $ 16.42 $ - 12 Medical Services $ 484.75 434,644 33,130 5,945 $ 473,719 13 Medication-Assisted Treatment $ 100.00 $ - 14 Outpatient - Individual $ 91.51 81,629 10,490 $ 92119 35 Outpatient - Group $ 22.88 1,000 1,610 $ 2,610 15 Outreach $ 49.04 980 60,300 2,550 $ 63,830 18 Residential Level 1 $ 298.72 58,515 $ 58,515 E Residential Level II $ - Residential Level Ill $ Residential Level IV $ cm 24 Substance Abuse Detox $ 290.00 $ Supported Employment $ 26 Supportive Housing $ 70.03 9,611 $ 9,611 27 TASC $ 82.29 $ - U) 28 Incidental Expenses $ 50.00 10,075 19,300 $ 29,375 Aftercare - Individual $ - Aftercare - Group $ IN 30 Information & Referral $ 32.61 12,164 $ 12,164 FACT Team $ - LL Room & Board Level I $ Room & Board Level 11 $ - 38 Room & Board Level III $ 112.17 240,000 $ 240,000 LL Short-term Residential Treatment - 40 Clubhouse Services $ 52.39 13,029 $ 13,029 CCST - Individual $ - CCST - Group $ U) Recovery Support - Individual Recovery Support - Group $ 48 Prevention - Indicated $ 67.49 $ 49 Prevention - Selective $ 70.20 $ 50 Prevention - Universal Direct $ 70.20 $ 51 Prevention - Universal Indirect $ 70.20 $ Special Proviso $ E $ 0) *Highlighted cells are eligible for fund allocation $ E! TOTAL FUNDING $ 4,593 $ 298,515 $ 915,082 $ 17,600 $ 1,112,903 $ 160,000 $ 5,945 $ 91,361 $ $ $ $ $ 2,601,406 TOTAL UNCOMPENSATED $ 918,690 $ 520,281 E Guidance/Care Center, Inc. Exhibit G Contract No. MP; - -- Pagel of4 I Packet Pg. 2822 EXHIBIT G: COVERED SERVICES FUNDING BY OCA Guidance/Care Center, Inc. NM225-8-27 M1601 M 16009 WH 01 F MHOIS-BA 11111-OBN Mliff", MEW! MITI RV WHOCN >1H 513 TOTAL COVERED SERVICES FUNDING RATE 470,000 15,677 $ 485,677 01 Assessment $ 89.00 48,000 15,677 $ 63,677 02 Case Management $ 90.84 46,000 $ 46,000 03 Crisis Stabilization $ 352.97 $ - 04 Crisis Support/Emergency $ 31.10 $ :v Day/Night $ 07 Drop-In/Self Help Centers $ 33.13 $ 08 In-Home/On-Site $ 93.34 213,665 $ 213,665 11 Intervention - Individual $ 65.68 47,000 $ 47,000 42 Intervention - Group $ 16.42 $ - 12 Medical Services $ 484.75 75,255 $ 75,255 13 Medication-Assisted Treatment $ 100.00 $ - 14 Outpatient - Individual $ 91.51 1,080 $ 1,080 35 Outpatient - Group $ 22.88 $ - 15 Outreach $ 49.04 31,000 $ 31,000 18 Residential Level 1 $ 298.72 $ - E Residential Level II $ Residential Level III $ Residential Level IV $ 24 Substance Abuse Detox $ 290.00 $ Supported Employment $ 26 Supportive Housing $ 70.03 $ 27 TASC $ 82.29 $ U) 28 Incidental Expenses $ 50.00 $ Aftercare - Individual $ Aftercare - Group IN 30 Information & Referral $ 32.61 8,000 $ 8,000 >_ FACT Team $ - LL Room & Board Level I $ Room & Board Level 11 $ 38 Room & Board Level III $ 112.17 $ LL Short-term Residential Treatment 40 Clubhouse Services $ 52.39 $ CCST - Individual $ CCST - Group $ U) Recovery Support - Individual Recovery Support - Group 48 Prevention - Indicated $ 67.49 $ 49 Prevention - Selective $ 70.20 $ 50 Prevention - Universal Direct $ 70.20 $ 51 Prevention - Universal Indirect $ 70.20 $ Special Proviso $ E $ *Highlighted cells are eligible for fund allocation $ TOTAL FUNDING $ 4,593,450 $ $ 470,000 $ 15,677 $ $ $ $ $ $ $ $ 485,677 TOTAL UNCOMPENSATED $ 918,690 $ 97,135 Guidance/Care Center, Inc. Exhibit G Contract No. MP; - -- Page 2 of 4 1 Packet Pg. 2823 EXHIBIT G: COVERED SERVICES FUNDING BY OCA Guidance/Care Center, Inc. NM225-8-27 MS003 MI MI MS921 MS021 MS "125 111117 M'S081 NISM "ISOTH W903 MURV %A S 9 C %ASOCT MMI'm Ryl, COVERED SERVICES FUNDING RATE 171,791 186,643 633,188 $ 95 I r 01 Assessment $ 89.00 17,000 $ 1 02 Case Management $ 90.84 30,000 $ 3 03 Crisis Stabilization $ 352.97 $ 04 Crisis Support/Emergency $ 31.10 3,000 $ :v Day/Night $ 07 Drop-In/Self Help Centers $ 33.13 $ 08 In-Home/On-Site $ 93.34 3,000 $ 11 Intervention - Individual $ 65.68 12,000 $ 1 42 Intervention - Group $ 16.42 $ 12 Medical Services $ 484.75 400 $ 13 Medication-Assisted Treatment $ 100.00 1,000 $ 14 Outpatient - Individual $ 91.51 10,000 $ 1 35 Outpatient - Group $ 22.88 58,241 $ 5 15 Outreach $ 49.04 12,000 $ 1 r 18 Residential Level 1 $ 298.72 $ E Residential Level 11 $ Residential Level III $ Residential Level IV $ cm 24 Substance Abuse Detox $ 290.00 183,643 $ 18 Supported Employment $ 26 Supportive Housing $ 70.03 $ 27 TASC $ 82.29 28,150 $ 2 U) 28 Incidental Expenses $ 50.00 $ Aftercare - Individual $ Aftercare - Group IN 30 Information & Referral $ 32.61 $ >_ FACT Team $ LL Room & Board Level I $ Room & Board Level 11 $ 38 Room & Board Level III $ 112.17 $ LL Short-term Residential Treatment 40 Clubhouse Services $ 52.39 $ CCST - Individual $ CCST - Group $ U) Recovery Support - Individual $ Recovery Support -Group $ 48 Prevention - Indicated $ 67.49 $ 49 Prevention - Selective $ 70.20 $ 50 Prevention - Universal Direct $ 70.20 $ 51 Prevention - Universal Indirect $ 70.20 $ Special Proviso $ E 633,188 $ 63 *Highlighted cells are eligible for fund allocation 1 $ TOTAL FUNDING $ 4,593 $ $ 171,791 $ 186,643 $ $ $ $ $ 633,188 $ $ $ $ $ $ 95 TOTAL UNCOMPENSATED $ 918,690 $ 1; E Guidance/Care Center, Inc. Exhibit G Contract No. MP; - -- Page 3 of 4 1 Packet Pg. 2824 EXHIBIT G: COVERED SERVICES FUNDING BY OCA Guidance/Care Center, Inc. NM225-8-27 MS001 Mse I M' 0 2 i MM MS025 SO PP %ASOTR MSTRV MCN SO MISOCT TOTAL FUNDING / COVERED SERVICES RATE 279,139 - 235,606 $ 514,745 01 Assessment $ 89.00 15,000 $ 15,000 02 Case Management $ 90.84 7,000 $ 7,000 03 Crisis Stabilization $ 352.97 $ - 04 Crisis Support/Emergency $ 31.10 $ :v Day/Night $ 07 Drop-In/Self Help Centers $ 33.13 $ 08 In-Home/On-Site $ 93.34 2,000 $ 2,000 11 Intervention - Individual $ 65.68 220,889 $ 220,889 42 Intervention - Group $ 16.42 600 $ 600 12 Medical Services $ 484.75 50 $ 50 13 Medication-Assisted Treatment $ 100.00 $ - 14 Outpatient - Individual $ 91.51 100 $ 100 35 Outpatient - Group $ 22.88 $ - 15 Outreach $ 49.04 22,000 $ 22,000 18 Residential Level 1 $ 298.72 $ - Residential Level 11 $ Residential Level III $ Residential Level IV $ 24 Substance Abuse Detox $ 290.00 $ Supported Employment $ 26 Supportive Housing $ 70.03 $ 27 TASC $ 82.29 8,500 $ 8,500 28 Incidental Expenses $ 50.00 $ - Aftercare - Individual $ Aftercare - Group 30 Information & Referral $ 32.61 3,000 $ 3,000 FACT Team $ - Room & Board Level I $ Room & Board Level 11 $ 38 Room & Board Level III $ 112.17 $ Short-term Residential Treatment 40 Clubhouse Services $ 52.39 $ CCST - Individual $ CCST - Group $ Recovery Support - Individual Recovery Support - Group 48 Prevention - Indicated $ 67.49 25,806 $ 25,806 49 Prevention - Selective $ 70.20 89,000 $ 89,000 50 Prevention - Universal Direct $ 70.20 117,700 $ 117,700 51 Prevention - Universal Indirect $ 70.20 3,100 $ 3,100 Special Proviso $ - *Highlighted cells are eligible for fund allocation $ - TOTAL FUNDING $ 4,593 $ $ 279,139 $ $ $ 235,606 $ $ $ $ $ $ $ 514,745 TOTAL UNCOMPENSATED $ 918,690 $ 102,949 Guidance/Care Center, Inc. Exhibit G Contract No. MP; - -- Page 4 of 4 1 Packet Pg. 2825 EDIT H - FUNDING DETAIL Provider: Guidance/Care Center, Inc. Contract #: ME225 -8 -27 Re $.4.a Amendment # OCA DESCRIPTION NEW OCA Residential Services MH001 Non - Residential Services MH009 Crisis Services MHO18 Crisis Services - Baker Act MH018.BA Community Forensic Program MHO 72 FACT Team MH073 Indigent Drug Program MH076 Proviso Allocation - Camillus MH093 Proviso Allocation - Citrus MH094 PATH Grant MHOPG TANF Services MHOTB Proviso Allocation - Homeless Trust MH010 Early Intervention - Psychotic Disorders MH026 Forensic Hospital Multidisciplinary Team MHOFH Transition Vouchers NIHTRV Care Coordination MHO Carry Forward MHOCF AMOUNT OCA DESCRIPTION NEW OCA AMOUNT Residential Services Nmool $ - Non- Residential Services Iv1H009 $ 470,000 Crisis Services MHO18 $ 15,677 Crisis Services - Baker Act MHOI 8 -BA $ Special Appropriation - ICFH M11OBN $ FACES Expansion Grant MHOFA $ Purchased Residential Treatment (PATS) 071 $ Transition Vouchers M1I � $ Care Coordination MHOCN $ Carry Forward NMOCF $ TOTAL ADULT MENTAL HEALTH = $ 2.601.406 1 TOTAL CHILDREN MENTAL HEALTH = $ 485.677 ADULT SUBSTANCE ABUSE $ 546,554 CHILDREN SUBSTANCE ABUSE $ 4,593,450 OCA DESCRIPTION NEW OCA AMOUNT OCA DESCRIPTION NEW OCA AMOUNT Residential Services MS003 $ - Residential Services MS003 $ - Non- Residential Services rVISO1 1 $ 171,791 Non- Residential Services M 1011 $ 279,139 Detox Services MS021 $ 186,643 Detox Services MS021 $ - HIV Services MS023 $ HIV Services MS023 $ Prevention Services MS025 $ Prevention Services MS025 $ 235,606 Women's Services MS027 $ Prevention Partnership Grant MSOPP $ Pregnant Women Project MS081 $ TANF Services MSO B $ Proviso Allocation - GCC MS091 $ 633,188 Proviso Allocation - Here's Help MS903 $ TANF Services MSO1'B $ - Transition Vouchers MS"1'R $ Proviso Allocation - Here's Help MS903 $ Care Coordination MSOCN $ Transition Vouchers MS a V $ Carry Forward MSOCF $ Care Coordination MSOCN $ Carry Forward MSOCF $ Opioid Crisis MAT MSOPM $ TOTAL ADULT SUBSTANCE ABUSE _ $ 991,622 TOTAL CHILDREN SUBSTANCE ABUSE _ $ 514,745 Drug Abuse Services $ 546,554 TOTAL ALL PROGRAMS = $ 4,593,450 Prevention $ 235,606 UNCOMPENSATED UNITS = $ 918,690 Deinstitutionalization Project $ 123,266 TOTAL = $ 5,512,140 CMH Program $ 485,677 MH Block Grant TOTAL FUNDS REQUIRING MATCH = $ 3,202,347 TOTAL FUNDS NOT REQUIRING MATCH $ 1,391,103 LOCAL MATCH REQUIRED = $ 1,067,449 NOTES 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 MHA18 to fund a Peer Specialist at the CSU. '2/28/17 $73,020 is added to MHA01 and reduced from MSAI l (swapped with Village). $8,111 is added to MHAPG to increase the PATH funding allocation, recurring. $59,000 is reduced from MSCI l due to projected lapse, 1 -time only. $124,716 is added to MSA03 and $220,120 to MSA21 to address the needs of the Opioid population, 1 -time only. FY 2017 -18 Adjustments: '3/15/17 $175,259 is added to MHA01 and reduced from MSAI l (swap with Village). 1 -time only adjustments shown above are reversed. Guidance /Care Center, Inc. Revised Exhibit H Contract No. M Page 1 of 1 Packet Fig. 2826 Guidance /Care Center, Inc. ME225 -8 -27 REQUIRED MATCH: $ 1,067,449 Guidance /Care Center, Inc LOCAL MATCH PLAN UNITS COST CENTERS 290.74 RATE 01 Assessment $ 89.00 02 Case Management $ 90.84 03 Crisis Stabilization $ 352.97 04 Crisis Support/Emergency $ 31.10 06 Day/Night $ - 07 Drop -In /Self Help Centers $ 33.13 08 In- Home /On -Site $ 93.34 11 Intervention - Individual $ 65.68 42 Intervention - Group $ 16.42 12 Medical Services $ 484.75 13 Medication- Assisted Treatment $ 100.00 14 Outpatient - Individual $ 91.51 35 Outpatient - Group $ 22.88 15 Outreach $ 49.04 18 Residential Level I $ 298.72 19 Residential Level II $ - 20 Residential Level III $ - 21 Residential Level IV $ - 24 Substance Abuse Detox $ 290.00 25 Supported Employment $ - 26 Supportive Housing $ 70.03 27 TASC $ 82.29 28 Incidental Expenses $ 50.00 29 Aftercare - Individual $ - 43 Aftercare - Grow $ - 30 Information & Referral $ 32.61 34 FACT Team $ - 36 Room & Board Level I $ - 37 Room & Board Level II $ - 38 Room & Board Level III $ 112.17 39 Short-term Residential Treatment $ - 40 Clubhouse Services $ 52.39 44 CCST - Individual $ - 45 CCST - Group $ - 46 Recovery Sunnort - Individual $ - 47 Recovery Sunnort - (iroun G - 48 Prevention - Indicated $ 67.49 49 Prevention - Selective $ 70.20 50 Prevention - Universal Direct $ 70.20 51 Prevention - Universal Indirect $ 70.20 99 Special Proviso $ - MATCH ALLOCATION: GRAND TOTAL: $ 1,067,449 Guidance /Care Center, Inc LOCAL MATCH PLAN UNITS MATCH 290.74 $ 25,876 440.33 $ 40,000 226.65 $ 80,000 - $ 8,000 - $ 50,000 350.70 $ 170,000 109.28 $ 10,000 - $ 8,000 334.76 $ 100,000 - $ 10,000 1,667.11 $ 187,000 76.35 $ 4,000 UNITS MATCH 110.08 $ 10,000 30.94 $ 15,000 $ 692,876 Local Match Plan Page 1 of 1 UNITS MATCH 56.18 $ 5,000 748.57 $ 68,000 513.61 $ 47,000 1,748.25 $ 40,000 610.34 $ 177,000 $ 25,000 $ 337,000 7/1 UNITS MATCH 256.38 $ 12,573 $ 12,573 Contract No. M Packet Pg. 2827 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.). N d. FLORIDA SAFE FAMILIES NETWORK (FSFN) — A Department of Children and Families >_ automated data system utilized to track child welfare cases. co e. FULL CASE MANAGEMENT AGENCIES - full case management agencies under contract U. 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. If. 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. c� 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. M Packet Fig. 2828 Rev. 05/11/2014 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, 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. 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. MSP Screening: a) The Motivational Support Specialist (MSS) conducts the ME approved screening tool for all co referrals received through the Department of Children and Families (DCF) Program Administrator (PA) or Our Kids of Miami Dade /Monroe, Inc. U. 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. M Packet Fig. 2829 Rev. 05/11/2014 L 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. L 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. M Racket Fig. 2830 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: tW. / / sfbh n.orq/providers /contracts/ Exhibit I Guidance /Care Center, Inc. Page 4 of 4 Contract No. M Packet Fig. 2831 Exhibit J Motivational Support Program Treatment Summary Form Initial ❑ Weekly ❑ Monthly ❑ Agency: Date: Client Name: Social Security Number: Axis I: Axis II: Axis III: Axis IV: Axis V: Progress in Treatment: Urinalysis Results: Therapist Signature and Title: Print Name: DOB: Exhibit J Guidance /Care Center, Inc. Page 1 of 1 Contract No. M Packet Fig. 2832 Exhibit K Pre - Authorization Utilization Management Roster for Substance Abuse & Mental Health Residential Level II Services Only (1) Provider Name and Address: (2) Contract No: (4) Invoice Period: (3) SAMH Program: (5) Page of ( Client Count ( Authorization Number ( Client Name (Last, First) ( Social Security Number (10) Placement Authorization No. ( Service Period (12) Cost Center (13)' Unit Rate s( ;' No. of Units of Services Rendered ( Total Service Cost (Cot 13 x 14) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Totals $ Provider's Authorized Representative I CERTIFY THAT THE ABOVE IS ACCURATE AND CORRECT Provider's Signature Date Name (Print or Type) Title c as c� as E co a� c� LL cc LL 0 e CO M 0 M Exhibit K Guidance /Care Center, Inc. Page 1 of 1 Contract No. M Packet Pg. 2833 Exhibit L Assisted Living Facilities with Limited Mental Health License Authority: s. 394.4574, F.S. I. 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 U. served by the Network Provider are offered mental health services needed, including but not limited CO 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 by contacting the ME's Contract Manager: 7) Ensure that the Cooperative Agreement is annually updated between the Network Provider and the ALF -LMHL Administrator. 8) Ensure that an annual community living support plan, as defined in s. 429.02 F.S., is prepared by the assigned case manager and the resident served, in consultation with the ALF -LMHL administrator of Exhibit L Guidance /Care Center, Inc. Page 1 of 3 Contract No. M Racket Fig. 2834 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 Consumer Report the required format as shown in Table 1. below. The ALF -LMHL Consumer 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. M Racket Fig. 2835 3.4.a Table 1. ALF -LMHL Consumer Report 0 t� t> �s E 0 I IM 4 Guidance /Care Center, Inc. Exhibit L Page 3 of 3 Contract No. M Packet Pg. 2836 7/1/2016 Exhibit N Special Provisions For Network Provider's Participating in the Indigent Drua 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 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. IDPIFSH 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 LL agencies that participate in the IDP. An inventory is also known as a formulary. co 4. Patient Assistance Program (PAP): Any program offered through private agencies or pharmaceutical U. 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. M Packet Fig. 2837 7/1/2016 Section III. IDP Network Providers will: 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: L 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 A. 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: L 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: L 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: L 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. M Racket Fig. 2838 7/1/2016 iii. Retain a copy of the Issue Document. 7. Ensure that IDP prescriptions meet the following conditions: L 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 : / /flmedicaidbh.fmhi.usf.edu /. 11. Review and validate the IDP /FSH Warehouse monthly statements. 12. Address emergency situations, including but not limited to: L 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: 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. M Packet Fig. 2839 Exhibit O Weapons and Firearms Court Petitions Monthly Report Template (1) Provider Name and Address: (2) Contract No: (4) Reporting Period: (3) Total Number of Petitions Filed for Reporting Period: (5) Page of (6) Client Count (7) Client's First Name (8) Client's Middle Name (9) Client's Last Name (10) Date Petition was filed 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. Provider's Authorized Representative I CERTIFY THAT THE ABOVE IS ACCURATE AND CORRECT Provider's Signature Name (Print or Type) Date Title Exhibit O Guidance /Care Center, Inc. Page 1 of 1 Contract No. M Packet Pg. 2840 Rev. 07/01/2011 Exhibit Q Missing Children The network provider agrees when services are for children who are adjudicated dependent where the care of the child is assigned to the department or network provider, to follow the procedures outlined in Rule 65C- 30.019, F.A.C. and Rule 65C- 29.013, F.A.C. and in Children and Families Operating Procedure (CFOP) 175 -85, entitled "Prevention, Reporting, and Services to Missing Children ". The network provider will perform the departmental functions as described in Rule 65C- 30.019, F.A.C. and CFOP 175 -85 which correspond to the functional role of this contract. The network provider also agrees when services for children are community based and the child involved is not adjudicated dependent, to comply with all licensing and contracting requirements. 1. Definitions a. Designee - a person, contractual network provider or other agency or entity named by the department. b. Exigent Circumstances - situations that require immediate actions, such as the child is under the age of thirteen, believed to be out of the zone of safety for their age and development, mentally incapacitated, in a life threatening situation, in the company of others who could endanger their welfare or is absent under circumstance inconsistent with established behaviors. c. FDLE -MCIC - Florida Department of Law Enforcement - Missing Children's Information Center d. Family Services Counselor - a professional position responsible for case management for children placements. The term includes Department of Children and Families staff and staff working for an agency named as a designee. e. Missing Child - a person who is under the age of 18 years; whose location has not been determined; is currently placed in an out -of -home care setting; court order in -home placement; or >_ is the subject of an active abuse investigation in which the child has been sheltered, would have co 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 U. 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. M Racket Fig. 2841 Rev. 07/01/2011 (1) Take a report of the missing child. (2) Assign a case number to the missing child report and provide the case number back to the caregiver or person who is reporting the child missing. (3) Provide local law enforcement with a recent high quality photo of the child, or provide local law enforcement with a recent high quality photo when one becomes available. (4) Request that a copy of the police report be provided to the family services counselor once a police report becomes available. (5) If the responding law enforcement officer refuses to take a missing child report, for any reason, the individual attempting to report the child as missing will document the officer's name and specific local law enforcement agency name and request to speak to the law enforcement agency Watch /Shift Commander. If the law enforcement agency Watch Commander refuses to take a missing child report and it is a caregiver that is attempting to report the child as missing, the caregiver will immediately contact the family services counselor or on -call staff and provide them with all information related to local law enforcement not issuing a missing child report. Once the family services counselor or on -call staff have learned that a local law enforcement agency will not issue a missing child report they will immediately seek assistance from the local area Community Based Care (CBC) Child Location Specialist or the Department of Children and Families Regional Criminal Justice Services Coordinator on resolving any issue related to reporting the child as missing to local law enforcement. (6) If it is a caregiver who has reported the child as missing to local law enforcement or attempted to report a child as missing to local law enforcement, they shall immediately notify the child's family services counselor or emergency on -call staff and provide them with the following information: (a) The law enforcement agency name that the child was reported as missing to or co attempted to be reported as missing to; U. (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; c (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. M Racket Fig. 2842 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. 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. h. All of the department's documentation related to the missing child episode shall be completed and entered into the department's approved missing child reporting system within one working day of the family services counselor, on -call staff, or Community Based Care (CBC) Child Location Specialist learning of a missing child episode regardless of whether local law enforcement has issued a missing child report number. This includes the uploading of a recent high quality photograph of the child into the department's approved missing child reporting system. If local law enforcement has refused to issue a missing child report a dummy local law enforcement case number of 00000 and the name of the local law agency that refused to issue the missing child report shall be used to complete and enter the missing child episode into the department's approved missing child reporting system. Exhibit Q Guidance /Care Center, Inc. Page 3 of 3 Contract No. M Racket Fig. 2843 Exhibit R Child Welfare Quarterly Clinical Report Oark0ds of hc' a oriwfar•r +.a, inc 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. II. CHILD WELFARE QUARTERLY CLINICAL REPORT Mental Health Agency Name: Name of Person Completing Report: Child's Name: School: School Performance: Full Case Management Agency: Full Case Manager's Name: Relevant Incidents: Date of Report: Title: DOB: DOA: Grade: School Placement: Phone #: Cell #: Type of Service(s): Frequency: Location: Presenting Problem(s): Treatment Plan Goals/ Progress: * *Attach copy of most current Treatment Plan or Treatment Plan Review DSM IV Diagnosis (Current): Axis I: Axis II: Axis III: Axis IV: CGAS: Psychotropic Medications: Y/N If yes: Name of Psychiatrist: Was Medication treatment Plan completed? Y/N If yes, date of court approval: Current medication and dosage: Previous medication, if applicable: Rational for current medication: Date that child started taking the medication: Child's Treatment Summary /Therapeutic Recommendations: Therapist Signature Supervisor Signature Exhibit R Guidance /Care Center, Inc. Page 1 of 1 Contract No. M Packet Fig. 28," 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. M Packet Fig. 2845 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. (1) 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. ii. The Network Provider will ensure the committing court is immediately notified by phone and in writing of any deviations from the conditional release order. The Network Provider will ensure the ME Forensic Coordinator is copied on written correspondence to the court. iii. The Network Provider will ensure the review of required monthly monitoring reports in order to intervene in problematic situations, to provide alternative treatment modalities when necessary, and to identify trends and issues that illustrate opportunities for improvement in service delivery. The Network Provider will bring the aforementioned situations, trends and issues to the immediate attention of the ME Forensic Coordinator. IV. The Network Provider will maintain current copies of conditional release orders. 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. M Packet Fig. 2846 (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 to 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 Provider shall 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. M Packet Fig. 2847 Exhibit X Special Provisions for Projects for Assistance in Transition from Homelessness (PATH) Services I. The Network Provider receives federal PATH funds to provide support services for individual who: a. Have serious mental illnesses or serious mental illnesses and co- occurring substance use issues, and b. Are homeless or at imminent risk of becoming homeless. II. The Network Provider shall: a. Implement an approved Intended Use Plan (IUPs) which establishes PATH - funded program priorities including, at a minimum: • Targeting persons who are experiencing homelessness as a priority population and maximizing services to vulnerable adults who are literally and chronically homeless; • Conducting street outreach and case management as priority services; and b. Submit an annual IUP for Managing Entity and Department review and approval no later than March 1St. The Department will provide a template. The IUP must cover needs and services during the next PATH Fiscal Year (9/1- 8/31). c. Establish a service plan for all PATH - enrolled individuals including: • Goals to obtain community mental health services for the individual; • Coordinating and obtaining needed services for the individual, including services relating to shelter, daily living activities, personal and benefits planning, transportation, habilitation and rehabilitation services, prevocational and employment services, and permanent housing; • Assistance to obtain income and income support services, including housing assistance, Supplemental Nutrition Assistance Program (SNAP) benefits, and Supplemental Security Income /Social Security Disability Insurance (SSI /SSDI); • Referrals to other appropriate services; and • Review of the plan not less than once every three months. d. Maintain individual client files containing an intake form, a determination of eligibility for PATH - funded services, a service plan, and progress notes for each person served with PATH funds. e. Enter quarterly summary information about PATH programs and services into the PATH Data Exchange (PDX) at no later than the 10th of the month following the quarter of services. f. Submit an annual report into PATH Data Exchange no later than November 17th via the PATH Data Exchange (PDX) at htts: // ath dx.or / . h. Implement individual SOAR training to case managers and agency leads using the SOAR Online Course, available at: https:Hsoarworks.prainc.com /course /ssissdi- outreach- access - and - recovery- soar - online- training i. Provide at least one dollar of local matching funds for every three dollars of PATH funds received and expend local matching funds to provide eligible services to PATH eligible persons. Match - funded expenditures must align with the services identified 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.). The Managing Entity will: a. Conduct annual monitoring site visits of the PATH - funded Network Service Providers. b. Assess the current year's IUPs to ensure the provider is meeting the targets that were set forth. c. Monitor the NSP's program toward annual targets in IUPs as reported in the quarterly and monthly PATH reports. d. Assist PATH providers in collaborating with local resources to link people with safe, affordable housing. The ME must use Section 4 and Appendix F in the most current State PATH Contact (SPC) Welcome Manual to conduct annual monitoring site visits. The manual will be provided by the Department. IV. 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. 1a Monthly Reporting Requirements: By the 5th 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. Revised Exhibit X Guidance /Care Center, Inc. Page 2 of 2 Contract No. M Racket Fig. 2849 Exhibit AA Motivational Support Specialists I. 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: httc: / /sfbh n. orb /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 contract for these services. Department provides the ME with the authority to 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 co of Children and Families' Family Safety Program Office. U. 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. M Packet Fig. 2850 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. 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 co Support Program Protocols, incorporated by reference herein. U. 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. M Packet Fig. 2851 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 co referred to an appropriate treatment provider. U. 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. M Racket Fig. 2852 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 co recommended treatment services when the screening identifies behavioral health U. indicators. E. For SFBHN Funded Consumers, the MSS will: i. Generate a referral in the SFBHN data system for consumers funded through the Department. III. 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. M Racket Fig. 2853 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: i. Generate a referral and submit directly to the Private /Medicaid provider. ii. 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 co (3) business days of the receipt of the referral. U. 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. M Packet Fig. 28M 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. i. 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: i. Monitoring client's condition and progress in treatment; ii. Linking clients to services as dictated by their needs; and iii. Facilitating client's participation in treatment by removing barriers. 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. M Packet Fig. 2855 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; III. 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; III. 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. M Packet Fig. 2856 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 co a. The incidental fund request must contain, at a minimum, the information below: U. Name of the MSS accessing funds; III. Funds spent on behalf of (client name); iii. Referral type (protective investigation /supervision); iv. Date of request; V. Description of Goods /Services requested; Vi. How the purchase is related directly to the 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. M Packet Fig. 2857 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 20. a. 1 — 5 above will be calculated as follows: 1. Numerator: Individuals identified in FSFN SAMH notes Denominator: Total number of individuals entered into the KIS data system and /or identified in the MSP Tracker 2. Numerator: Number of clients screened Denominator: Total number of screenings completed within the specified timeframe 3. Numerator: Number of clients with a completed case management assessment Denominator Total number of case management assessments completed within the specified timeframe Exhibit AA Guidance /Care Center, Inc. Page 9 of 10 Contract No. M Packet Fig. 2858 4 is Numerator: Number of clients with a completed service plan Denominator: Total number of services plans completed within the specified timeframe Numerator: Number of cases identified in FSFN SAMH notes Denominator: Total number of progress notes documented in FSFN SAMH Exhibit AA Guidance /Care Center, Inc. Page 10 of 10 Contract No. M Racket Fig. 2859 Soulth Plorhda BehaV'�� ral Heakh NOW rk, 1� c. M -I HE [ ', 1 '41 hp 75 Provider: Reporting Period: Priority Populations below are defined in Guidance 4 of the ME contract 3 or more acute care admissions within 180 day period 3 or more notes: admissions within 180 day period of 16 days or more within 16 days or a" Exhibit AC Care Coordination Report Guidance/Care Center, Inc. C. # of individuals discharged during reporting period (out of those that were enrolled) Exhibit AC Page 1 of 4 # of AX of individuals in B . # of individuals individuals the E. Total # of individuals # of end of enrolled at identified as referrals engagement beginning of newly enrolled process during served to date during received period (A + B — the the reporting reporting reporting E period (not period period in yet enrolled)* Guidance/Care Center, Inc. C. # of individuals discharged during reporting period (out of those that were enrolled) Exhibit AC Page 1 of 4 IN U. Contract No. MP; - -- I Packet Pg. 2860 D. Total # of individuals enrolled at the E. Total # of # of individuals # of individual end of individuals identified as involved in reporting served to date homeless Child Welfare period (A + B — C) E in IN U. Contract No. MP; - -- I Packet Pg. 2860 } h Plorhda B haV'�x r l Heck OW, r I� . HE '1 Exhibit AC Care Coordination Report * Individuals in the engagement process are those individuals that are identified as meeting Care Coordination criteria who have not yet received services under Care Coordination ** Individuals enrolled in Care Coordination are those individuals that are receiving services under Care Coordination If applicable, describe a success story: Care Coordination Practices Describe the evidence -based or innovative practices utilized: What are you using as a standardized level of care determination? c as c� as E a� U) CO c� U. cc U. Exhibit AC Guidance /Care Center, Inc. Page 2 of 4 Contract No. M Packet Pg. 2861 } h Plorhda B haV'ix r l Heck: NOW r l� . Exhibit AC H t '1 Care Coordination Report uescrine strategies usea to alvert inalvlaual rrom civil aamisslon to bmm I Fs: List any new partnerships established in the reporting period (i.e., Memoranda of Understandings, Referral Agreements, Data Sharing Agreements, common assessments, etc.): How many individuals who were court- ordered to a civil SMHTF did you divert from the CSU to a community -based program this reporting period? Describe any service gaps identified and how they are being resolved (i.e., redirection of resources, purchase of out of network services, etc.): Describe how you are implementing care coordination practices (if no changes from previous report, mark no change): Exhibit AC Guidance /Care Center, Inc. Page 3 of 4 Contract No. M Packet Pg. 2862 Exhibit AC Care Coordination Report uescriDe any barriers encounterea ana proposea |uz it applicable, list training neecls: Completed by: Guidance/Care Center, Inc. Exhibit AC Page 4 of 4 � IN U. cc � U. " I Parket Pg. 2863 Exhibit All 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: h 1lsfbhn, orlword�resslw�- contentluloadsl PDATED-Farnily-Intensive- Treatment- Team - Procurement - 8.1.14. df 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, 2017, or the latest revision thereof, which is incorporated by reference and may be found at: htt: llwww, myflfarnilies. comiservice - proramslsubstance - abuselmana2in- entities12017- contract-docs 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. Revised July 1, 2016 Guidance /Care Center, Inc. Exhibit Al Contract No. M Page 1 of 6 Packet Fig. 2864 II. 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. Revised July 1, 2016 Guidance /Care Center, Inc. Exhibit Al Contract No. M Page 2 of 6 Packet Pg. 2865 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 Revised July 1, 2016 Guidance /Care Center, Inc. Exhibit Al Contract No. M Page 3 of 6 Packet Pg. 2866 FIT - EXHIBIT AI -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 PERFORMANCE MEASURE FOR ACCEPTANCE OF DELIVERABLES PROGRAMMATIC PERFORMANCE MEASURES 85% 90% a� a� a� c� M a� U) C4 U. co U. c E CM c� Revised July 1, 2016 Guidance /Care Center, Inc. Exhibit Al Contract No. M Page 4 of 6 Packet Pg. 2867 FAMILY INTENSIVE TREATMENT SERVICES MONTHLY PROGRESS REPORT SUPPLEMENTAL DATA REPORTS Reporting Requirement ' This Period This Quarter to Date >� ' Year 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 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 a� a� c� M 0 U) U. co U. U) toa c 0 E 0 2 CM 0 M Revised July 1, 2016 Guidance /Care Center, Inc. Exhibit Al Contract No. M Page 5 of 6 Packet Pg. 2868 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 V a� a� a� c� M 0 E U) N U. co U. U) c�a c 0 E 0 2 a� E 0 M Revised July 1, 2016 Guidance /Care Center, Inc. Exhibit Al Contract No. M Page 6 of 6 Packet Pg. 2869 Signature and Date Exhibit AK Monthly Substance Abuse and Mental Health Provider Waiting List Report Form 11 or 16 CIRCUIT NUMBER: I AGENCY NAME: ADULT MEN ADULT WOMEN REPORTING MONTH & YEAR: JUVENILES I Ending ITOTAL Treatment Services Beginning Census Number Added Number Placed Number Terminated Ending Census Treatment Services Beginning Census Numbei Added Number Placed Number Terminated Ending Census Treatment Services Beginning Census Number Added Number Placed Number Terminated Census M I F Ending Census Outpatient (MH /SA) Day /Night Outpatient (MH /SA) Day /Night Outpatient (MH /SA) Detox 0 0 Day /Night 0 0 Detox 0 0 Day /Night 0 0 Methadone 1 01 0 Day /Night 0 0 Methadone 0 0 01 0 Detox 0 0 0 0 0 Detox 0 0 0 0 0 Detox 0 0 0 0 0 0 0 Methadone 0 0 0 0 0 Methadone 0 0 0 0 0 Methadone 0 0 0 0 0 0 0 Total I I I I 1 1 1 Total I I I I I Total Of the total reported above, how many were seeking IV drug treatment? =How many IV drug users waited 8 to 14 days? ❑ More than 14 days? On the average, was your agency operating at 90% capacity during the reporting month? Yes ❑ No ❑ PREGNANT JUVENILES PREGNANT WOMEN Treatment Services Beginning Census Number Added Number Placed Number Terminated Ending Census Treatment Services Beginning Census Numbe Added Number Placed Number Terminated Ending Census Outpatient (MH /SA) Outpatient (MH /SA) Day /Night Day /Night Detox 0 0 0 0 0 Detox 0 0 0 0 0 Methadone 1 01 0 0 0 0 Methadone 0 0 01 0 0 Total I I I I I Total POSTPARTUM JUVENILES POSTPARTUM WOMEN Treatment Services Beginning Census Number Added Number Placed Number Terminated Ending Census Treatment Services Beginning Census Numbe Added Number Placed Number Terminated Ending Census Outpatient (MH /SA) Outpatient (MH /SA) Day /Night Day /Night Detox 0 0 0 0 0 Detox 0 0 0 0 0 Methadone 1 01 0 0 0 0 Methadone 0 0 01 0 0 Total I I I I I Total Beginning Census + Number Added - Number Placed - Number Terminated = Ending Census Of the total number of women /juveniles reported above, how many were pregnant? Of the total number of women /juveniles Go reported above, how many were postpartum? DIRECTIONS: PROVIDERS SHOULD COMPLETE AND SUBMIT THIS FORM TO SFBHN. SFBHN MUST RECEIVE THIS FORM NO LATER THAN THE 5TH OF THE MONTH. DEFINITIONS: Beginning Census - Number of individual on the waiting list at the beginning of the reporting month. Number Added - Number of individuals added to the waiting list during the month. Number Placed - Number of individuals placed into treatment services. Number Terminated - Number of individuals terminated from the waiting list for reasons other than placement into treatment (unable to contact for follow -up, individual arrested, etc.). Ending Census - Number of individuals left on the waiting list at the end of the reporting month. Staff Person Completing This Form: Phone: Form updated 12/2/2015 Exhibit AK Page 1 of 1 Guidance /Care Center, Inc. Contract No. M Packet Pg. 2870 Exhibit AM Return on Investment — Special Project Return on Investments for FY 2017 -18 I. Pursuant to the FY 2017 -18 General Appropriations Act, Ch. 2017 -70, Laws of Florida, the Network Provider has been awarded funding to provide the following services: Provider: Guidance /Care Center, Inc. Specific Appropriation Line Item # 366 — Family Intensive Treatment Funding Amount: $633,188.00 Designated as follows: Miami -Dade County: $483,871.00 Monroe County: $149,317.00 II. From the funds in Specific Appropriation 366, 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 in the 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. III. The Network Provider shall: 1. By July 10 2017, 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. M Packet Pg. 2871 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 or co- occurring disorders who are homeless or at risk of homelessness. Access to SSI /SSDI is a major tool in recovery from mental illnesses, homelessness or co- occurring disorders to engage in treatment, to keep appointments, to maintain housing, and to meet other basic needs. I. Network Provider Responsibilities 2. Each Case Manager /SOAR Processor at the Network Provider is responsible for entering their information and data into the SOAR Online Application Tracking (OAT) system. The Network Provider is responsible for notifying the ME about information regarding their Case Manager /SOAR Processor. This includes their name, SOAR Training Completion status, and their registration in OAT. 3. Eligibility Screening Screening for SOAR eligibility shall be conducted during the intake or admissions process. 4. Timeframes for Completion of Applications SOAR applications must be completed within a maximum of sixty (60) days of the protective filing date. This may vary depending on the Social Security Administration (SSA) office and the SOAR Liaison at that office. The SOAR Processor is responsible for going to their local SSA office and forming an agreement between themselves and the SSA SOAR Liaison about specific timeframes and what form of communication is best. 5. Appeals If applicable the SOAR Processor shall complete the appeal process for those applications which may be denied upon initial review; 6. Data Requirement (OAT System) The SOAR Processor shall start entering information into the OAT system once the protective filing date is determined. They should not wait for the application decision to be made before they enter data into the OAT system. The SOAR Processor(s) shall input all of the 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. The OAT program is available at: https:Tlsoartrack.prainc.comllo in.php Exhibit AN Page 1 of 2 Guidance /Care Center, Inc. Contract No. M Packet Pg. 2872 7. Training New SOAR Processor(s) shall be trained within forty -five (45) days of hire. The SOAR Processor(s) is responsible for their own training in the SOAR Model through the SOAR Online Course developed by Policy Research Associates and SAMHSA available at:. https: / /soa orks.prainc.com /course /ssissdi- outreach - access- and - recovery- soar - online- training 8. The Network Provider is responsible for notifying the ME regarding the training status of their Case Manager /SOAR Processor. The Case Manager /SOAR Processor shall complete the SOAR Online Course even if they participated in an in- person SOAR Training in the past. 9. The SOAR Processor(s) shall attend the regularly scheduled or specially called meetings when notified by the ME. These include SOAR group technical assistance trainings SOAR fundamental refresher trainings. 10. Performance Outcomes & Outputs: The Network Provider shall meet the standards and required outcomes specified below: a. Maintain a minimum completion rate of 75% of applications are completed and submitted within 60 days of the initiation of case management services. b. At a minimum, the Network Provider shall have a sixty -five percent (65 %) SOAR application approval rating during each fiscal year. c. Maintain the minimum negotiated quarterly target of 4 for completed applications. 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. II. 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: hfitp: llww�re m�tflfamiliese comiservice pro�ramslsubstsnce abuselmsnsir entities1201?- rnnrr =rr_r4nrr 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. M Packet Fig. 2873 South Florida Behavioral Health Network, Inc, Exhibit AP Mental Health Case Management Standards A. Definitions: The definitions below are for the purposes of this Exhibit. Other definitions may exist in care coordination or other authorities. "Caseload" means those clients which are managed by a designated case manager. "Case management services consist of activities that identify the recipient's needs, plan services, link the service system with the person, coordinate the various system components, monitor service delivery, and evaluate the effect of the services received. This covered service shall include clinical supervision provided to a service provider's personnel by a professional qualified by degree, licensure, certification, or specialized training in the implementation of this service." Rule 65E- 14.021(4)(c)1. "Service Plan" is the part of the clinical record which outlines a comprehensive strategy for improving a client's quality of the services and resources necessary to achieve these goals and objectives. The service plan is designed to integrate the efforts and effects of multiple service and resource providers. The case manager and the client develop the service plan in conjunction with family members, service providers and other entities and individuals necessary to its implementation. Treatment Plan: is an individual document or identifiable section of the service plan developed by treatment staff and the client which depicts goals or objectives for the provision of services within specific treatment environments. Examples of treatment environments include, but are not limited to, day treatment, vocational, residential, outpatient and activities of daily living programs. B. Overall Goal of Case Management. The primary goal of care management is to optimize the functioning of individuals who have complex needs by coordinating the provision of quality treatment and support services in the most efficient and effective manner. The desired outcomes for persons using the service system are self- sufficiency and satisfaction in the living, learning, work and social environments of their choice. Case managers shall have at a minimum a bachelor's degree with major course work in a human services field or equivalent training and experience on a year for year basis in a related field. ( (1) Case management responsibilities include, but are not limited to, the following activities: (a) Development and implementation of a case management assessment: 1. A case management assessment is a holistic review of a client's living situation which includes a determination of the client's strengths and weaknesses, the client's needs and resources, and the strengths and weaknesses of the client's support system. The case managers shall be responsible for the overall completion of the assessment, but shall work with the client and consult with relevant professionals where specific expertise is needed. 2. The case management assessment shall consider information from the following sources: a. Client's assessment of his or her personal situation; b. Input from the family, friends or significant others. Such input shall be sought with the consent of the client; Exhibit AP Page 1 of 5 Guidance /Care Center, Inc. Contract No. M Packet Pg. 2874 South Florida Behavioral Health Network, Inc, c. Collateral information which may include records dealing with previous psychiatric hospitalizations, outpatient treatment and evaluations, summaries and progress notes from other involved human service individuals or agencies. If collateral information is not available, this shall be documented in the case record; d. Information from the referral source; e. Pertinent service agencies with whom the client is involved and an evaluation of the impact these services have on the client's life. 3. The case management assessment shall consider the following: a. The presenting problem; b. Client's current and potential strengths and deficits; c. The family's current and potential strengths and deficits; d. Client's relationship with family members and significant others; e. The impact of the currently provided services on the client's life; f. Client's involvement or need for involvement in client support groups or ancillary social support systems; g. Need for training in community living skills, medications, or activities of daily living; h. Need for education, vocational training or job- seeking skills; i. Need for housing, food, clothing, and transportation; j. Need for mental health, alcohol and drug abuse services; k. Need for medical and dental services, including current medications; I. Need for legal services; m. Need for backup support and consultation to family, friends, landlords, employers, community agencies and community members who come in contact with the client; and n. Need for and the establishment of financial resources such as Social Security, Supplemental Security Income, Veterans Administration or trust funds. 4. The case management assessment is to consist of a single identifiable, dated document, included in the clinical record. 5. The initial case management assessment must be completed within 30 days of the referral of the client for case management services. 6. A home visit is to be made prior to the completion of the Assessment, unless the case manager's supervisor deems such a visit unsafe to the case manager or such a visit is denied by the client. In such instances where a home visit does not occur: a. The reasons for the failure to make such a visit will be documented in the case record and signed by the case manager and the case manager supervisor. b. Subsequent visitations and the suitability of the housing shall be considerations addressed in the service plan. 7. Subsequent written case management assessments shall be completed and an updated Service Plan developed at a minimum of every 6 months, or when the client changes residence, enters or is discharged from a state treatment facility or at other times when the client's situation changes significantly. (b) Service Planning Exhibit AP Page 2 of 5 Guidance /Care Center, Inc. Contract No. M Packet Pg. 2875 South Florida Behavioral Health Network, Inc, 1. Service planning is the process of developing a general strategy to utilize strengths and address weaknesses identified through case monitoring and through assessments. The case manager, in conjunction with the client, shall be responsible for the development of the service plan. However, service planning is a collaborative effort which also involves family members, service providers, or others significant to the implementation of the resultant plan. The results of the service planning process shall be a service plan. 2. The Service Plan must be on a single identifiable and dated document, developed within 15 days of a completed Assessment and signed by the client, case manager, the case manager's supervisor, and other appropriate participants involved in the service plan development. The service plan is an individualized document which meets the comprehensive needs of the client. All service plans shall be included in the client's record. 3. In cases where immediate services are needed, service delivery shall not be delayed pending completion of either the assessment or service plan. 4. The Service Plan shall contain a description of the long -term desired outcome for the case 5. The Service Plan shall contain measurable goals and objectives derived from the assessment of client's strengths, deficits and resource needs. a. Each objective must have an identified time frame for achievement, and stated in terms of observable and measurable outcomes. b. Each objective shall state the name of the individual or agency responsible for the action to be achieved. 6. The client shall be provided a copy of the Service Plan, and this shall be documented in the record. With the approval of the client, others involved in its development or implementation shall be provided with a copy of the service plan. (c) Linkage and Brokerage The case manager shall ensure that the Service Plan is implemented through a variety of linkage and brokerage activities designed to procure specified services, treatment and resources for the client. 1. Such activities include verbal or written referrals, telephone calls, meetings, assistance with making appointments and completing applications, assistance at interviews and hearings, transportation and supportive counseling. 2. The case manager shall convene case staffing at major decision points during the client's involvement with the alcohol, drug abuse and mental health system. Such decision points shall include movements to a lesser or more restrictive environment in the community or transfers to and from state hospitals. Such conferences shall be attended, as appropriate, by the client, family members, service providers and significant others. (d) Monitoring Case Managers shall ensure that Service Plan goals and objectives are consistently pursued, assess the functioning level of the client, and assess progress toward the achievement of goals and objectives Exhibit AP Page 3 of 5 Guidance /Care Center, Inc. Contract No. M Packet Pg. 2876 South Florida Behavioral Health Network, Inc, through a range of monitoring activities including telephone calls, home visits, case and treatment reviews, interviews and site visits. 1. Where monitoring reveals that minor adjustments are necessary in order to better accomplish the goals and objectives of the service plan, the case manager shall update these portions of the plan and take action to implement these adjustments. 2. Where monitoring reveals that conditions have changed to the extent that the service plan is no longer valid, the case manager shall make a reassessment and ensure the development of a new service plan. (e) Advocacy 1. Case managers shall function in the best interest of the client and shall intercede on behalf of the client to assure that service and resources needs are met. 2. The case manager shall identify service and resource gaps and barriers which limit a client's access to existing services and resources to client managers. (2) The case manager shall make a minimum of a monthly face -to -face contact with all clients residing in the community. (3) Case managers may utilize contingency funds provided by the department in accordance with circuit procedures. These shall be used to provide for unmet resource needs of clients when other resources are not available or in combination with other resources. (4) For clients residing in the community, the case manager shall make a home visit or field visit within the client's natural environment at a minimum of every other month, unless the case manager's supervisor deems such visits unsafe to the case manager or the client declines such visitation during the planning process. In such instances where home visits are not to occur: (a) The reason for the failure to make such a visit will be documented in the case record signed by the case manager and case manager supervisor, (b) Subsequent visitations and the suitability of the housing shall be considerations in the service plan. (5) When a client misses an appointment related to the service plan or is absent from a treatment program without notification, the case manager shall attempt to contact the client either by telephone or face -to -face meeting within twenty -four hours. If initial attempts to contact the client are unsuccessful, the case manager shall make additional efforts by telephone, face -to -face meetings, or correspondence. Upon contacting the client, the case manager shall explore the reasons for the absence or the missed appointment and shall work with the client to resolve any issues inhibiting the effective implementation of the plan. Such efforts and their results shall be documented in the case record. (6) Case Management Record. 1. An individualized case record for each client shall be maintained. 2. A clearly identifiable portion of the agency's record shall be devoted to case management. This portion shall contain the demographic information and items specified in subsection 65E- 4.014(3)b., F.A.C. 3. The case record shall be maintained in accordance with Rule 65E- 4.014, F.A.C. 4. In addition to items specified in Rule 65E- 4.014, F.A.C., the record shall contain: (a) The name of the current assigned case manager Exhibit AP Page 4 of 5 Guidance /Care Center, Inc. Contract No. M Racket Fig. 2877 South Florida Behavioral Health Network, Inc, (b) Any copies of a consent to give information relevant to the case. (c) Assessment information as stated above. (d) Service Plan as stated above. (e) Progress Notes, documenting all of the case manager's activities, contacts and communications on behalf of the client, including the following: 1. Date 2. Type of contact; for example, home visit, telephone, office visit 3. Contacting person 4. Person or agency contacted 5. Brief account of contact 6. Relevance to the Service Plan 7. Documentation of missed appointments, follow -up, and an explanation of why the appointments were missed 8. Documentation for the need and lack of availability of any goods or services for which contingency funds are requested (f) Advocacy efforts as specified above. (7) Case load. The mental health case manager's caseload shall not exceed 40 consumers at any given time. (8) Case managers shall a minimum of a bachelor's degree with major course work in a human services field or equivalent training and experience on a year for year basis in a related field. Exhibit AP Page 5 of 5 Guidance /Care Center, Inc. Contract No. M Packet Pg. 2878 t 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 U. or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil >_ penalty of not less than $10,000 and not more than $100,000 for each such failure. Signatures Date Name of Authorized Individual t Application or Contract Number ., Name of Organization Address of Organization CF 1123, PDF 03/96 Attachment III Guidance /Care Center, Inc. Page 1 of I Contract No. ME225 Packet Pg. 2879 South Florida - Behavioral 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 TYPE OF FUNDING: "Regular" Prevention Services Prevention Partnership Grant PPG X COST ALLOCATED TO: (check both if approved for both covered services) Children's Substance Abuse Adult Substance Abuse 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, grief 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 comprehensive programming, and the partners and coordination efforts): 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 always. 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 Evaluation). 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 old 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 a� a� a� c� C M C 0 U) U. co U. U) c E a� c� Guidance /Care Center, Inc. Scope of Work Contract No. M Page 1 of 12 Pocket Pg. 2880 acute mental health crises (i.e., suicidal thoughts and /or behavior, acute stress reaction, panic attacks, 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 Selective - — Alcohol Literacy Challenge 348* Indicated —Teen Intervene 40 Selective — PRIME for Life 250 Universal Direct — Health Fairs 300 Universal Direct — Information Dissemination Capacity Building with parents, 25 school personnel, community key stakeholders *Participants may be duplicated across voorams 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 (110 miles) to include all 3 high schools, 3 middle schools, youth residing at the Florida Keys Children's Shelter, Treasure Village Montessori, Island Christian School, 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 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 Guidance /Care Center, Inc. Scope of Work Contract No. M Page 2 of 12 Packet Fig. 2881 Community values — children /youth Section III. SITE LOCATIONS AND INFORMATION* *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 ` Monroe County Schools - teachers, school counselors DJJ Self- referral Social Service Agencies Community Centers a� a� c� 0 U) U. co U. U) c.a c 0 a� E 0 M Guidance /Care Center, Inc. Scope of Work Contract No. M Page 3 of 12 Packet Fig. 2882 � Site Name Street Address City Zip Cod Ch it dre il Parent # of Others Youth s Key West High School 2100 Fla ler Avenue Key West 33040 Coral Shores High School 89901 Old Highway Tavernier 33070 Marathon Middle /High 350 Sombrero Road Marathon 33050 School Key West Collegiate High 5901 College Road Key West 33040 School Island Christian School 83400 Overseas Islamorada 33036 Highwa Plantation Key Middle 100 Lake Road Tavernier 33070 School Key Largo Middle School 104801 Overseas Key Largo 33037 Highwa Horace O'Bryant Middle 1105 Leon Street Key West 33040 School Sugarloaf Middle School 255 Crane Blvd Sugarloaf 33042 Treasure Village 86731 Overseas Islamorada 33036 Montessori H 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 Community Partners Sites Monroe 33040 County 33050 33037 TOTAL NUMBER OF TO BE SERVED 638 *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 ` Monroe County Schools - teachers, school counselors DJJ Self- referral Social Service Agencies Community Centers a� a� c� 0 U) U. co U. U) c.a c 0 a� E 0 M Guidance /Care Center, Inc. Scope of Work Contract No. M Page 3 of 12 Packet Fig. 2882 Section V. PERFORMANCE MEASURES wyantity erTormance measures Activities/Service Name & Description (Include Activity frequency, intensity, & duration # # Level of sessions, as well as the Children/ # # Required % To Meet Sellectiv number of cycles/cohorts Youth Parents Others Sessions Required e — 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 Alcohol Literacy Challenge 0 0 1 ALC 100%of348 will Selective 348 Session receive services, for each 85% will complete of 190 ALC and 85% of participan completers or 296 is will improve on the ALC PRIME for Life 0 0 Minimum PRIME for Life — Selective 250 4.5 hours 100% of 250 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 or 213 will improve based on the outcome measures Teen Intervene 40 0 0 3 Teen Intervene — Indicate sessions 100% of 40 will d receive services, 85% will complete the program and 85% of completers or 34 participants will improve from pre- to post test in the minimum of 3 sessions (3 sessions are one cohort) Health Fairs 100 200 0 5 100% of 300 Health participants will Fairs receive V c: C: M :2 C: 0 E U) Q N U. U. U) E E Guidance/Care Center, Inc. Scope of Work Contract No. MF- - -- Page 4 of 12 1 Packet Pg. 2883 Quality Performance Measures (Including fidelity measures, satisfaction survey information, supervision, training, staffing, and other required information pertaining to quality) Quality Measure Measurement Reporting Tool Timin Average number of sessions Participant sign -in sheets collected information at the attended (Participant at session session Retention) Pre -and Post - surveys from each . At the end of each of the Health Fairs, 85% participant services improved Participant Satisfaction Survey Alcohol Literacy Challenge - or 255 100% of 348 and 85% 296 will improve based on the participants be pre /post outcome as measured by the approved provided Challenge minimum of 1 session prevention Average number of sessions Participant sign -in sheet collected at attended (Participant each session framework Retention) Alcohol Timeline Followback (TLFB) session Number of participants completed at baseline and exit from . At the end of each of the information while treatment services Teen Intervene — 100% of 40 Participant Satisfaction Surveys will receive services and 85% attending the or 34 will complete the program. 85 % of completers fairs. will improve from pre -to post Quality Performance Measures (Including fidelity measures, satisfaction survey information, supervision, training, staffing, and other required information pertaining to quality) Quality Measure Measurement Reporting Tool Timin 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 348 and 85% 296 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 40 Participant Satisfaction Surveys will receive services and 85% or 34 will complete the program. 85 % of completers will improve from pre -to post test in the minimum of 3 sessions (3 sessions are 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 250 and exit by each participant will receive services, 85% of 250 or 213 will complete the program in a minimum of 4.5 sessions V a� a� c� M a� U) CD N U. U. U) c�a c E CO c� Guidance /Care Center, Inc. Scope of Work Contract No. M Page 5 of 12 Pocket Fig. 2884 and 85% of completers will improve based on the outcome measures # and % of participant satisfied with services provided Observation of service delivery/ Fidelity checklist Documentation of structured supervision # and % of staff with necessary training / certification (as required by all entities and EBP) # and % of staff working toward achieving certification in the State of Florida in Prevention Certification 85% of participants who completed program will complete the satisfaction survey and 80% will be satisfied based on the Satisfaction Survey Curriculum fidelity checklist Supervisor /Observer report Supervisory Tool /Checklist and Notes 100% of staff with necessary training /certification 100% of staff working towards achieving certification by attending SFBHN and other training consistent with FCB's criteria • At the end of each cohort • At the end of the services Three times per year in coordination with the Evaluation Team, one time in Quarter 2, one time in Quarter 3, and one time in Quarter 4 unless the EBP indicates otherwise with identified needs and changes to be reported to SFBHN in the Quarterly Report During regular supervisory sessions for each staff and not less than one time per month. (Per the Rule, "Supervisor Instructions ") Attendance at prevention training every quarter. Every prevention staff member must participate in at a minimum, 8 hours of training per By October 2016 or one month after hire of one new staff, all staff not certified, will be working co towards State of Florida U. Prevention Certification M Guidance /Care Center, Inc. Scope of Work Contract No. M Page 6 of 12 Packet Fig. 2885 Section VI. Participant Outcomes Outcome: 85% of youth who complete ALC will decrease favorable attitudes towards alcohol Outcome: 85% of youth who complete PRIME and Teen Intervene will decrease favorable attitudes towards alcohol, tobacco, and other drugs. Outcome 85% of youth who complete Teen Intervene will increase their healthy behaviors and decrease their use of ATOD or delay the age of onset for marijuana use. Outcome 85% of youth who complete PRIME will increase their healthy behaviors and skills associated with healthy behaviors. Pre /post tests Satisfaction surveys Pre /post tests Satisfaction surveys Pre /post tests Satisfaction surveys Pre /post tests Satisfaction surveys At the end of each cohort session At the end of each of the services At the end of each cohort session At the end of each of the services At the end of each cohort session At the end of each of the services At the end of each cohort session At the end of each of the services Cohorts Section VII. TASK LIST • Meet and communicate with school personnel • /partner agencies • Prepare program materials • Administer Participant Registration Form and pre -post tests • Administer Satisfaction Survey • Travel to /from session • Data Entry V a� a� a� c� a� U) N U. CO U. U) c 0) E 0 0 M Guidance /Care Center, Inc. Scope of Work Contract No. M Page 7 of 12 Packet Fig. 2886 V a� a� a� c� a� U) U. co U. U) c E c� Guidance /Care Center, Inc. Scope of Work Contract No. M Page 8 of 12 Pocket Fig. 2887 Type of d Sessions or Participant Hours s 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 agencies based on • Prepare program materials the Quality • Administer Participant Registration Form Outcome • Administer Satisfaction Survey Measure • 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) 250 youth 4.5 to 20 100% of Activity Description: Participants will be recruited from ages 13- hours per the 250 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 • Data Entry based on Frequency: once weekly session the Quality Intensity: 4.5 to 20 hours (per the EBP) Outcome Duration: 1 50 -60- minute session, # of Cycle: 6 Cohorts @5 Measures y outh each Activity Title: Teen Intervene 40 youth 3 sessions 100% of Activity Description: Participants required to attend (3) 90 ages 13- 40 youth minute session, 1- 30- minute registration, 1- 30- minute 1 8 will 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 V a� a� a� c� a� U) U. co U. U) c E c� Guidance /Care Center, Inc. Scope of Work Contract No. M Page 8 of 12 Pocket Fig. 2887 Duration: one 90- minute session Designating enc Alcohol Literacy Challenge sessions Prime for Life SAMHSA approved, NREPP Teen Intervene and 85% of completers will show improveme nt based on the Quality Outcome measures Activity Title: EVALUATION — Curriculum evaluation tools. 638 2 85% These assessment tools match the services provided for ALC, PFL & Teen Intervene. Activity Description: Instrument used to identify substance abuse and other needs. Frequency: 2 sessions Intensity: 30 minutes /session Duration: 1 survey per youth completed at baseline and at exit Section VIII. EVIDENCE BASED PROGRAMS (EBP) Evidence Based Program Designating enc Alcohol Literacy Challenge SAMHSA approved, NREPP Prime for Life SAMHSA approved, NREPP Teen Intervene SAMHSA approved, NREPP Section IX. EVALUATION 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. a� a� c� C M c� U) N U. co U. U) c E 0 2 0 M Guidance /Care Center, Inc. Scope of Work Contract No. M Page 9 of 12 Packet Fig. 2888 -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 re larly, attend meetings, and submit the required documentation. Additional Prevention Requirements 1. Site Schedule A final site schedule, on the Site Schedule form, with dates, times, and location of services shall be submitted no later than August 31 of the fiscal year or when requested by the Contract Manager. Sites schedules must be approved by SFBHN, in writing, and will be based on county need and distribution of services to avoid duplication in any geographical area or school to maximize SFBHN funding. Any change shall be justified in writing and submitted to the Managing Entity in writing and submitted to the Contract Manager for review and approval by the Prevention Director. The Contract Manager will reply with approval. Two (2) site schedule changes may be made in the contract year. The site schedules shall be submitted on the SFBHN Prevention Site Schedule format. 2. Memorandum Of Understanding (MOU) With The Community Coalition To address local community substance abuse prevention needs and wellness promotion strategies, prevention providers and the community coalition shall execute and /or maintain a memorandum of understanding (MOU) delineating the specific responsibilities of each. This MOU >_ will be consistent with the strategies of the State of Florida Department of Children and Families' CO and the Managing Entity's (ME's) prevention strategy. The provider shall submit an executed copy of the MOU to the ME's Contract Manager within 30 days of the effective date of the contract (for U. newly executed MOUs) or within thirty (30) calendar days for renewed MOUs. SFBHN Contract Attachment — Guidance Document 10 3. Memorandum Of Understanding (MOU) With Sites To facilitate the coordination and delivery of services, all providers shall have executed Memoranda of Understanding (MOU) with the sites where services are being provided. All MOUs with the sites shall be current and up to date, outlining the terms of the agreement. 4. Participant Satisfaction Survey All providers shall collect and submit participant satisfaction surveys as noted in the Scope of Work. 5. Meetings All providers shall attend scheduled Prevention meetings as required by the ME and the evaluation team, BSRI, at regularly scheduled or specially called meetings when notified by the ME. The ME will make every attempt possible to schedule meetings with advanced notice; Guidance /Care Center, Inc. Scope of Work Contract No. M Page 10 of 12 Packet Fig. 2889 however, there may be meetings that may be called on short notice. These include, but are not limited to, Prevention provider meetings, meetings with Behavioral Science Research Institute, individual provider quarterly meetings with BSRI and /or SFBHN, Evidence Based Practice workgroup meetings to comply with the Block Grant requirements, and other meetings as noticed by SFBHN. The contract notes the other meetings where representatives of the provider organization are required to attend. 6. Reports / Assignments and Special Reports / Assignments Providers are expected to submit reports as outlined in the contract. Prevention Partnership Grant (PPG) reporting is specifically described in the contract with dates for submission. Other reports will be requested by SFBHN. Special reports and assignments are requested from time to time to meet State /Local Department of Children and Families, State Block Grant, SFBHN, and other requirements and needs. Prevention providers are required to submit the reports in the format requested and by the timeline requested. These reports may be requested from different sources for different reasons. Requests generally come from SFBHN staff, including the Prevention Director, and may be requested verbally or in writing. There may be times when other collaborative partners request information and SFBHN will support these requests. 7. Training The Scope of Work outlines the requirements for training to support the State Block Grant reporting requirements for workforce development as well as for strengthening the Prevention workforce. All staff of provider organizations funded by this contract, whether full -time, part-time, contractual, or consultant, who report units in the Performance Based Prevention System (not those paid by cost reimbursement or that are vendors), is required to attend eight (8) hours of training per quarter. All providers shall attend scheduled training as required by the ME, meet the >_ ME and the evaluation team, BSRI, for technical assistance and /or training, at regularly scheduled U. or specially called meetings when notified by the ME. co U. 8. Report Cards Providers are required to comply with the measures on the Prevention Report Card. Grading for the measures will be according to compliance or lack thereof. 9. Data All providers are required to submit the program data monthly in the Performance Based Prevention System (PBPS) as required by the contract. The provider shall also: ■ Ensure that the data submitted clearly documents all program participants, programs, and strategies which occurred under this contract and consistent with the Scope of Work in the contract; ■ Ensure that all data submitted to PBPS is consistent with the data maintained in the provider's file and consistent with the Scope of Work in the contract; ■ Review the data submitted with the evaluation team, Behavioral Science Research Institute (BSRI), monthly to determine any discrepancies in the numbers related the evaluation and the Scope of Work and make corrections prior to submission for approval by the SFBHN Prevention Director; Guidance /Care Center, Inc. Scope of Work Contract No. M Page 11 of 12 Packet Fig. 2890 ■ Submit an email to the SFBHN Prevention Director and the designated SFBHN Data Analyst verifying that the data in the PBPS system has been checked and is correct and complete and may be used for Block Grant reporting and payment. There shall be a designated individual and one back up individual at the provider organization responsible for verifying the data and submitting the email. This will imply that the data has been reviewed and is ready for submission. o The email subject line shall read: PBPS Data Submission Verification o The body of the email shall read: (name of organization) is submitting the PPG Prevention data for the month of (name of the month) in PBPS and we assure that the data is complete and correct. Our organization's data may be used to report to the State for the Block Grant report. Our organization's data may be used to reconcile with the payments for this month. ■ Failure to submit any data, or correct any errors in the data which results in a rejection rate of ten percent (10 %) or higher of the monthly data submitted, will require the provider to submit a corrective action plan describing how and when the missing data will be submitted or how and when the rejected will be corrected and resubmitted; and ■ In accordance with the provisions of s. 402.73(1), F. S., and Rule 65- 29.001 F.A.C., corrective action plans may be required for non - compliance, 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. Evaluation Prevention providers shall work in collaboration with the evaluation team, Behavioral Science Research Institute (BSRI) by participating in meetings, training, and providing service data and other necessary identified data vital to the completion of the system -wide evaluation of the prevention services within the Strategic Prevention Framework. Data will be provided to BSRI in the BSRI data system, DOES, and in any other requested format. The data includes the numbers for outcome data and process data required that contributes to the evaluation of the Prevention System of Care. Prevention providers are required to participate in fidelity checks, meetings, training, and other fidelity activities related to the outcomes in the Scope of Work and for the larger Prevention System of Care evaluation. BSRI will report compliance and collaboration to SFBHN per the BSRI Scope of Work requirements. Guidance /Care Center, Inc. Scope of Work Contract No. M Page 12 of 12 Packet Fig. 2891 S.4.a Amendment #1 Contract No. ME225-8 -27 11/01/2017 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. ME225 -8 -27 PREAMBLE: This amendment adds and annual amount of $200,000.00 (two hundred thousand) to fund a Monroe County Centralized Receiving Facility as required by 394.4573, F.S. To serve an additional 54 clients. Funding for the Monroe County Centralized Receiving Facility shall start January 1, 2018. This amendment also reflects Approved Operating Budget alignment reductions, and updates language in the Standard Contract and to the Attachment I, and revised the Scope of Work as follows: This amendment revises the Standard Contract; Attachment 1, Exhibit B, Method of Payment; Exhibit C, Required Reports; Exhibit G, Covered Services Funding by OCA; Exhibit H, Funding Detail; changes the due date far Exhibit AC, Care Coordination report; revises the Standard Contract's Paragraph 3, Provision of the Prime Contract, and Paragraph 9.c. Indemnification; updates website fink to CFOP 155 -47; adds language to the contract, and revises the Attachment IV, Scope of Work. 1. Page 1 of 11, Standard Contract, Paragraph 3., Provisions of the Prime Contract, is hereby amended to read: 3. Provisions of the Prime Contract co r All provisions, terms and conditions, or amendments, addendum, changes or revisions applicable to 0 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 co 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, x terms and conditions of The Prime Contract and this Contract, the provisions, terms and conditions g of this Contract will prevail. In the event of a conflict between the provisions of the documents of N this contract, the documents shall be interpreted in the order of precedence listed in Paragraph 5_0, of this Standard Contract. fri 2. Page 2 of 11, Standard Contract, Paragraph 9.c., Indemnification, is hereby amended to read: 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 32. 3. Page 7 of 11, Standard Contract, Paragraph 34, Contract Amount is hereby amended to read: 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 $5,650,610.00 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 $4,708,842.00, subject to the delivery and billing for services. The remaining amount of $941,768.40.04 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, Page 1 of 4 1 Packet Pg. 2892 S.4.a Amendment 41 Contract No. ME225 -8 -27 11/01/2017 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. 4. Page 20 of 54, Attachment I, Section B. 1.a., Manner of Service Provision, subparagraph (23), Care Coordination and Reporting Requirements, is hereby amended to change the date that the monthly Care Coordination Report is due from the 15th to the 5th calendar day following the month of service. S. Page 26 of 54, Attachment 1, Section B. Manner of Service Provision, Paragraph 2.b.(3), is hereby amended to read: (3) Additionaliy, the Network Provider shall provide employment screening for substance abuse L personnel using the standards set forth in Chapter 397.4073, F.S., Background Checks for Service Q Provider Personnel. "All owners, directors, chief financial officers, and clinical supervisors of ar service providers are subject to level 2 background screening as provided under chapter 435. Ali a service provider personnel who have direct contact with children receiving services or with co adults who are developmentally disabled receiving services are subject to level 2 background 0 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 co meet all personnel requirements of this chapter is exempt from fingerprinting and background check requirements." U _ 6. Page 45 of 54, Attachment 1, Section ❑., Special Provisions, Paragraph 11, website link to the CFOP 155 -47, is amended to read: Fittp://www.dcf-state-fl-us/admin/PLiblication.5/Rolicies.asj2 7. Page 54 of 54, Attachment I, Special Provisions, is hereby amended to add: 31, Centralized Receiving Facility Guidance Care/Center, Inc. ( "Network Provider") is the designated centralized receiving facility ( "CRF ") that serves as the coordinated system of entry in Monroe County for individuals with mental health or substance use disorders, or ca- occurring disorders. The designation as the CRF and the services to be provided are established in accordance with Florida Statute 394, Florida Mental Health Act, Florida Statute 397, Hal S. Marchman Alcohol and Other Drug Services Act, and in accordance with the Monroe County Designated Receiving System Plan, dated 2017 -2020, MDC- Plan, or latest revision thereof, herein incorporated by reference. S. Page 54 of 54, Attachment I, Section E. List of Exhibits, is hereby amended to add: 26. Exhibit AS, Monroe County Centralized Receiving Facility 9. Page 1 of 5, Exhibit B, Method of Payment, Payment Clause, Paragraph a., is hereby amended to read: 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 Racket Page 2 of 4 F+g. 2893 S.4.a Amendment #1 Contract No. ME225 -8 -27 11/01/2017 units provided in accordance with the terms and conditions of this contract for a total dollar amount not to exceed $5,650,610.00 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 $4,708,842.00, subject to the delivery and billing for services. The remaining amount of 1941,768.00.00 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. 10. Page 2 of 10, Exhibit C, Required Reports, is hereby amended to change the due date of Exhibit AC, Care Coordination Report, as follows: EWWAC, Care Coordination Report Monthly hythe Stn calendar day after ME Contract Manager the month ofserv;7,e 11. Pages 1 - 4, Exhibit G, Covered Services Funding by OCA, are hereby deleted in their entirety and Pages 1— 4, Revised Exhibit G, Covered Services Funding by OCA, are inserted in lieu thereof and attached hereto. 12. Page 1 of 1, Exhibit H, Funding Detail is hereby deleted in its entirety and Page 1 of 1, Revised Exhibit H, Funding Detail, is inserted in lieu thereof and attached hereto. 13. Page 1 of 1, Local Match Plan, is hereby deleted in its entirety and Page 1 of 1, Revised Local Match Plan, is inserted in lieu thereof and attached hereto. co r 14. Pages 3 — 7, Exhibit AS, Monroe County Centralized Receiving Facility, are hereby inserted and attached hereto. 15. Pages 1 -12, Attachment IV, Scope of Work are hereby deleted in their entirety and Revised Pages 1 -12, Attachment IV, Scope of Work are inserted in lieu thereof and attached hereto. This amendment shall begin on November 1, 2017 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. Page 3 of 4 1 Packet Pg. 2894 S.4.a Amendment 41 Contract No. ME225 -8 -27 11/01/2017 IN WITNESS THEREOF, the parties hereto have caused this thirty one 31 page amendment to be executed by their officials` thereunto duly authorized. GUIDANCE/CARE CENTER, INC. SIGNE BY: 0q NAME: Ffe**46 Poul& ULA 1 43q SOUTH FLORIDA BEHAVIORAL HEALTH NETWORK, INC. SIGNED/` I r J NAME: John W. Dow TITLE: r - D'tCCW TITLE: President and CEO DATE: DATE: FEDERAL Tax ID # (or SSN): 59- 1458324 co r U- Page 4 flC d Racket Pg. 2$95 S.4.a f'lF3r'idl i 1 :il i{li ' {: II. t: Exhibit D Substance Abuse & Mental Health Required Performance Outcomes & Outputs Provider Marne: Guidance /Care Center, Inc. Contract #: ME225 -8 -27 Date: 09/28/2017 Revision #: 1 Guidance/Care Center. Inc. ME225 -8 -27 l l U2017 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 illness 40 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 SAA73 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 30 days prior to discharge 15% SA755 c. Percent of adults who successfully complete substance abuse treatment services 51% 5A756 d. Percent of adults with substance abuse who live in a stable housing environment at the time of discharge 94% Children's Mental Health MH012 I 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 functioning 64% 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 environment 9s% MH779 e. Percent of children with serious emotional disturbance (SED) who live in a stable housing environment 93% MH780 f. Percent of children at risk of emotional disturbance (ED) who live in a stable housing environment 964 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 versus 30 days prior to discharge 20% SA752 c. Percent of children with substance abuse who live in a stable housing environment at the time of discharge 934 co U- GuidancelCare Center, Inc. Revised Exhibit D Contract No. M£ Racket Pg. 2896 Page I of 2 S.4.a 4!.,.111 "1or i:f:i F I;: " ;1 if1 ' \' .rf.;.�.. -I c. 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. co r U- Guidance /Care Center Inc. Revised Exhibit D Contract No. ME Racket Pg. 2897 Page 2 of 2 Table 2 Network Service Provider Output Measures — Persons Served For Fiscal Year FY17 -18 Service Category FY Target Residential Care 26 ca Outpatient Care 2780 Qy L @ Crisis Care 350 z State Hospital Discharges N/A Peer Support Services 0 Residential Care 0 w N @ Outpatient Care 500 '—° ro Crisis Care 12 C U ar SIPP Discharge N/A °J Residential Care 0 Outpatient Care 316 Q n.1 ro Detoxification 195 Women's Specific Services 0 ±� Injecting Drug Users 0 ¢ Peer Support Services 0 Residential Care 0 U c N Outpatient Care 2015 3 Detoxification 0 v1 N C Q * *Refer to Attachment IV, Scope of Prevention Work for the numbers served. ** Q 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. co r U- Guidance /Care Center Inc. Revised Exhibit D Contract No. ME Racket Pg. 2897 Page 2 of 2 S.4.a A m er r mcal u I 1•,11 i - 51 I ill 71. Guidnnce.+Cnre Cer0er, Inc. sf I n '.In I I Ile 1'1 1111 1i 1'I I'.s. M E22<_ -9 -27 '11 .1x2 1')45 91I.0 !: - _ _ {}' FUNDINCI COVERED SERVICES l i'?.I hi RATE l}1 AssessmeW 5 89.90 02 Care M1lannp,emtnl S 90,144 03 C'l'isl9 Snilrili[Alierl S 352,97 04 C1151S Slippa UEnwram- S 31,111 S n.. 117 i11np•]nrScif ilrlp Centers 5 33,13 [18 In -11ork +On -Site 5 9314 11 tld- 111ion • IRLIMduet S 65,6a 42 Iufe- errrinu - Group 5 145A2 12 NI cd it II Services 5 494.75 13 NI rd it Arian -.A ssis l ed'I're8 l nl cn r S 100.011 15 Ourpnlicrrr- Irrdirid,10 S "",I 35 Ourpndcru- G1Q11p S 22.98 IS Our1 S 49.04 IS ReAdentud Level ] 5 298,72 • ' Residmw Level :[ ti . ' X&dcnllol (,eve[ HI - "_ I Res: denlial Level IV 5 24 Srr bs 1111re Abuse 17aror S 290.90 . S1pplRed Emp luvmcw 26 Supporrive Houelu>!, S 79.03 27 TASC 5 82.27 29 111rlderlrnl Expenses S 1.00 2 Atlercorc • lrth tdua' L i Ar..enunre • Gruup . 3n InrormHliorl & Refer'r:l] S 32,61 FACT I'cp n .,. Rsrn & r3 ^AiJ Level I 3.4 R1n.rr 1I3DHIO I.evc1 ill S 112,17 0 's;�wR :ern'. 1lesi deiihol free'ntem I - 40 Cluhlrnuse Serviee5 5 52.39 • C:CST- :.1d:vidu:Ll COST - Grn••p , 1;. Rc-covcry Suppurl - Q•.dividual - •: RecoN e: v S upporl - G:oup 414 Pr'evemioit • Indireled S 67.49 49 I're rt nl i nl - Sel ee rive S 70,20 59 Prc veu l i 13 - I 1iVe rsal Di I u 5 7 0,20 51 1 I I • LIILivel'sal Indima S 70.20 ..• S;t.rin] f'rao-lanrC. ^c' Hlimbursem:.r1 S " l!irldlg4 a1h ■n vi1g141r for fund >tllora16 E'CH11311'G: COVERED SERVICES FUNDING 13V OCA X1111101 1•,11 i - 51 I ill 71. '•I iII Ili • 11111 11S r1! "ir -1 '•111 5111.1. 11 1111 1l sf I n '.In I I Ile 1'1 1111 1i 1'I I'.s. ?[N !•27 '11 .1x2 1')45 91I.0 !: - _ _ {}' LS'!y l i'?.I hi I 51C S - 71 :x.13•. S n.. 4t: 5 I' S .-I S SL S s 5 X 1, (-29 S )2 2 t S S " S I �1.'t73 5 -• 5 S I S x S 1 71,1 1: S ?'.. 1 7 1 S S d S S S 1 A 1 ( s S - 5 - S 5 }: L K.' 1 x y 2. 1 TOTAL FONDING 5 4.7014 Y32 y .2Y ,:.•, 5 '11 sps2 S ? s � e1..; c TOTAL U NCOMP13 NS Al 1 1) 5 94!.7G5 Guidance CarelCenter. Inc. Rrviwd Exhillr G 1 1 of a Co r LL a r� c� U 0 C 41 a3 L a s= Q1 E t U fp a-� w a 515 C Racket Pg. 2898 S.4.a E.XHI BIT G: COV EH VD SERVICES FUN 171 N(: BY OCA A mel'.d`Ile n: 111 Gllld an rMCare Cru ler, Inc. ME225.8 -17 C'OVERE1)SERVIC'ES 5111161 FUNDING 511 hif- %lI[I -1 l' MIi1,14 b5 �11r�13 5 11141 V., 5[HI)'I '•111'11(5 .1 If !IH ",r '1[1'1'.51 RATE d7:1.u:lu ...i�.. - - L 4Y5677 01 Assessntrttr S 89,00 3X.:1•: S •In ri�rti 1}; Case.ManR gem oil l S 9[1,85 4 i•. cm 113 C1'i ris Srabilix Rtion 5 3 Y IF7 Cii s is Su p por rlE9ic rec n cy S 31.10 ;?.h" S .5p77 iii Day /Niphl S 07 ❑ro p- 6u5elf 11 elp Ce 111 ctv S 33,13 S OR In- lionlel015 -Sire 5 93-34 ' 1 :,,•;,s 5 7; S,r I 1 Iute men L ion - Ind ivid uRl 5 65.68 7. iii) S J' A Inretvvenlion - Group S 16,42 S - 12 Medical Semi res S 485.75 7S _5 =. S :?, ?•5 13 Medlcmlon -Assis to Lt Tivatnl etl S 10.00 S - 14 00pahenl- Llrtividual S 91.51 ri?l1i S t:•k[: 3S Uulpnlienl - Group 5 22.88 5 - I$ 011ovach S 49.04 IA Residelllial Level I S 293,72 S I RcFidersciol Level It ) S ...' Residential Level IN i - S - - Residential Level N + $ 24 Suhslnrtce Abuse Deto% S MAO S tiulipcilec Emp.7 -11; 5 ?h Suppurli- 1111 —ng 5 70.13 S - _? 1'.ASC 5 82.19 S 2b lucldenrnl Ex4in cs 3 SAO 7 AF•.eruure • hidmdun1 S 30 In f., to nt 9u1 A Bcfrs oal S 32.61 a nan S b uua FA 'I lean, ± s .• Itrc in R I Oaro Love: J s S • Rn,irt & Tf—d 1.cvri II ail Rou to & I30 it1•d Ixvrl III S 112,17 S •'• Sh1:I I - re 1111 Reside -hil Trta 1111 enI 41) CIIIb1i —A Se rvJ res S 52,39 S 1 ] C.'C:5'f - lIIdividual S -• C(:SI.6wuI) 5 s .. Rr. 'e1y S II, PO :' - hidividual - • Rccavcrr Suppu'- Group } - J.y 1 • Indi,fed S 67,49 S 49 I'lTmIlion- SrIcri4v S 70.20 S 511 Pivwentlari - llniversxl Riivci S 70.20 S SI I'my entlalt- I lniveml Indlrel•t S 70,28 S - • Sj:ee:nl Provi io'Com Relllilmrse.zmr L L "Nletdighled MU arm eliyihie for crud allaralion S 1 01Al,FUNDING $ 4,10,A42 8 t 57 5 .5.677 S - 5 - fi F L L 5 05 .677 70 LAL UN C 0.h1 p LNSATE❑ S 94t S 77.115 Guidance Care /Center. Inc. H:: +ieuJ Exhibx Cr Page 2 0 -0 CO r LL a c� U 0 C 03 tit a3 L a m E U [p a-� w a Racket Pg. 2899 S.4.a FXHIBIT GI COVERED SERVICES FUNDING BY UCA 115•ir�J •1��111 Il.��r :l '•]tii�'i 11�•l;M1 Vii. i, ?1�i•�i .Iri:i �I If ti�il ll .', �')f�x �I'i[[[i' S1ti i['1 51�1i['r .'•1 "11•}1 Itlli 17 i:.n ii1 IP III s[i.i1� :i1 :� II•: iii ijji11 ICII ,fig :ll 01 ryrli 5x 1d1 :,I�lill ii ISE 1 4 l:I. "!1 [ ? c - F - S - I y .. .1.11ti 5 T s S $ 1 t j 7 'I FUNDING S 4,7B8,842 $ O1'AL UNCON1FrN5ATED 5 941 768 Guidance Care /Center. Inc. Revised Exhibil C' 1'ago 3 of a CID r LL a r� c� U 0 C d a� L a s= m E t U ru a-� w a Racket Pg. 2900 An1e1'dm. -m Oil G 11 l J ni I l'eiCH re Cc Il her. Ine. ME225-14.27 FUND[N(; 1 COVERED SERVICES RATE 111 Assessrtrellt S 89.00 0 Cnce Mnn RRenl Col S 90,86 03 Crisis 5labili7.0 l i a 11 S 352.97 04 Crisis Su p por r1Enle raeucy 5 31,10 DeyNiglli 07 Drop•1nl5elf Help Cen[em 5 33,13 0s In- llolllelokl -Sire S 93,34 11 rulriwillioll • Indis'iduul 5 65,68 42 Inlelvelllion- G1'oup S 16,62 12 Medienl Sarvires S 484.75 13 MMirIII ion -A,;5 i s to d en l rile III S MIMIC 14 011(pnrienl - IIId Iyldugl 5 91,51 3S Ontpxlienl - Group S 22.88 I5 (Jn[i'eHLh S 49,04 18 ResideilriA Lcvel I 5 298.72 1" R :sicc-l:1:J Leye`.11 ..r Resic filial Lever 1[I _ Rosidonlid ].ever 1V 1 24 Sub$Uilce Abuse NO% S 290.90 ! . Supported Er•lplu}rme1:1 26 SIIp110111" Ifaurillr 5 7u,u) 27 TASC S 82,29 28 laddenr'll Expenses S 1.01) 11 � Atlercire - lndiv.dual ti 15 At10rcure • Grouo S 30 Informa & Referral 5 32.61 1 FAC T T�anl It uu in & Beard Le eII ' RY:ir. & Board Leycl 11 ti 38 Room & floRrd Le.yal III S 112.17 : Silo n - rerll Resi Jenlial Tree: ill 11: 40 Clubhouse Services S 52.14 .; C•C•S - f - [Mividual 5 CCS - GIonp . (• Recave ry S•jppnn- [I mi vidual •" kccuwr Sappurt- Group h - 48 Pl - ladll'aled 5 67,J9 49 Pmcenrimi- 9der[ive S 70.20 50 ?revel I l ioll - UIliversI Direct S 70,20 51 Pirr en lion - Un it rel al lodireel 5 70.20 I •. Speclnl I'icvisc+Casr Rehlhur -mvnt 'I iRI1Ilgist d MIA arc rliriWv for fluid o0o[hlion 115•ir�J •1��111 Il.��r :l '•]tii�'i 11�•l;M1 Vii. i, ?1�i•�i .Iri:i �I If ti�il ll .', �')f�x �I'i[[[i' S1ti i['1 51�1i['r .'•1 "11•}1 Itlli 17 i:.n ii1 IP III s[i.i1� :i1 :� II•: iii ijji11 ICII ,fig :ll 01 ryrli 5x 1d1 :,I�lill ii ISE 1 4 l:I. "!1 [ ? c - F - S - I y .. .1.11ti 5 T s S $ 1 t j 7 'I FUNDING S 4,7B8,842 $ O1'AL UNCON1FrN5ATED 5 941 768 Guidance Care /Center. Inc. Revised Exhibil C' 1'ago 3 of a CID r LL a r� c� U 0 C d a� L a s= m E t U ru a-� w a Racket Pg. 2900 S.4.a EXHIBIT C: COVERED SERVICES FUNDING BY OCA Amendn -ent 0i CuiJnner.Care Cen l er, Inc. �S F:225 -8 -17 COVERED SERV ICES FUNDING �III I 1: := ?1 Y'n'I S1ti i.'I'fl L'a!i ii! }f.tillt}' %1 N.i ['I ,irvii['I I41 L. I. RATE [Il Assessmen[ 5 89.00 150:1, S 15,11[:6 1)2 Cnse Managenlepl S 90.53 7Sm. S L1n:1i 03 Crisis SrahllixaTioll 5 351.97 S - U3 Crisis Sir 1) po fl +Kill a ngea c7 S ,3iJU S Cc D1y' 4g $ o7 Ilfop- IolSelrvelp C'enrer's S 33.13 1 n8 In- Flon,elOit -Site S 9333 Intrn'en[ion - InJividunl S 59.65 42 I r,l er}.'en l i oil - Ci 1'aup S 16A2 i 0 S 6•:a 12 All edicxl ti Nices S 454.75 ,, s 5n 13 M ed i cal imi- As si s red Trear wrir 5 SUII,Uo S - 14 Oil 41 Rl i enl - Indivi Junl 5 91.51 I S L'11 35 Onrpoliem- C;ruup 5 22.88 S Is Onrreneh S 39.04 .,, , S ::. i11n IB ResiJentlnl Level I S 298.71 S Rrsidnt.A [, -1 11 + S ..• Rvside:u,al Lccl III s - S . _. Rcsider•.[nl Leval IV i T - 24 Suhslnnee Mills, Detox 5 290.110 S ... S,ipp�ned Empleyn,em 5 S - 2G Su pp vt II%e Ilnusi ng S 70.03 S 27 I,ISi 5 8219 x. `1.•.1 S ti.5!rti 28 1r1ii[Ienlgl 1 5 l.00 S .. Atlere:rr - TIOMduu: - S li Arlcrcure - Ciraap - S 3t1 6161, marina & IWOVI ill S 32.G1 , 1:f1 -. S i:. 1 1 FAC I' Inair, - S • . Ke-11 & liodid Level I e s RCr1:11 A: board Level 11 - S 38 Rauirl & Rnni J Level Ill S 112,17 S �" Sl0r[•Ie:.1i R—der:tiul r- eumienl I i - 4l1 Clubhmrsu Selvices S 52.39 5 •• ('( "- 111dI S L '. :i eu.. rIy Su 11; M1 • 11tdl ViLInil: ) - i7 Ei u u cu' y 3 u p;wr r - CiruLp 48 Pievtntinn • IndicareA S 67.37 49 Pr even r i n u - S elect l i Ve S 70.211 50 PI'el'err t i yn - LI I I'N H I INITCI S 70,20 NI,117 ) hl,I`' 51 Piv%onliarl - l l rnivn rs x l In dl ref[ S'2eC 101 f °.0V150fCn51 Re n I da. rs ue,ei Lr b s 'Will[iighlA sMIJ arc allylidt for fund nllvrallan S TOTAL FI.NDI N 5 4,708,842 % S 113.773 S S $ 19 161 5 01AL � I NL: O,YIYE hSATFD 5 , -,768 c 9f,5l,7 Guidance CarelGenter, Inc. itrV ..r. I:�'1.1 t; 4 M i Racket Pg. 2901 1:\EIIBIT II - FUND1NG DE :I'A11, Provider: Guidancv /Care Center, Inc. Contract #: ME225.8 -27 A:nenilment # 1 S.4.a RL Novtnll:er 2L AD11UY N1 E N TA L I I EA LTH CHILDREN 'MENTAL IIEAI.I'lI OCA DESCRIVI'ION NEW O[';1 AMOUNT OCA DESCRIPTION NEAV OCA ANFOUNf itesidcuta: Scrvttes h.`. Rr1iS $ 323,02`) 1 Rcsideatial Sun ice; M 11001 w moll- Residential SQr%i;:es :\41:011!1 5 15 p Non-ltcmdcnlmi Services N111()1 S •170, {110 Crisis 5en•iL :es Ik l!1I8 — 17,11111) I Crisis Services N•1110 S S 15,677 C,66; cnrce+- BukcrA:t NIH!ii8 -B _$ _ 3 I.lI :.1(1.3 CrisisScrk;u - BilkerAet N•TFrl:R - BA _ S -.... Con 1111 L:1133v FcirC Pro gi ; 1 n MI 1072 S 1 60,000 Special Apjuopr :arion - :CP] I N'II ORN S FACT Team V. 1. 5 - - -- FACES Expansion Grant M It;f A S Indigent Drag Progranl y;f 071: Purchased Residential'] rL:mrncclt (PRTS) K11!071 $ _ S 1,945 ]'ruL isu Ailaoador - Citrus ily4 l; f i S Tr11nSltivin Vouencrs [BAH ] R V S — i PATiI Cram Nil ir11'i; S 0 0 . 000 Cal: CuordiiinIiu.l M HOC: N S 5 TANFServices N1110iI3 Carry Forty :ird \1IIIKI S Proviso Allocation - Homeless 1 NIH0!0 5 ]iar'sv tr i - Psvc :Y Dmor(ic+ ;s N •rHfl2 :± S - Fonntiic ifolSPna1 Muitidiscsplinary [vain N1 "(4 II 5 \Liar!!( -Dade CUUMV C'SU Fund DC R� S For Prnfi�' Stlh- ]tc.ipJw - Kkcv West I IMA M11.tiE 1' S - Transition Vouchers V FIT itV S Cafe Cnnrdinatsn3l N•il rili :N S Carry Forv,lyd N-1'1:;['S 5 48,548 ADULT MENTAL 11F,11.T1E = S 2,578,707 TOTAL CHILDREN MENTAL HEALTH = g 485,677 ADULT SUBSTANCE ABUSE CHILDREN SUBSTANCE ABUSE: OCA DESCRIPTION NFAN' OCA ANIOUNT OCA DE:SCRIP I'1ON 1 1;1. 1 1V M 1 AX101:NT Res :delxial Serb' es MSO:: 3 S - 1 ?widen :ial Services MSrJl :i y — -- Nor- Rcsldcnilal Scnlccs ti15n1 l S 2 1 1,791 N(rl- Residential Scn:UZS NIS01 I S 253,773 Do'ox ServicYs 1•;ti11? S 336.643 Dctux Services M'5021 3 HIV Scr�i S — 111V Scraices '1502± S ]'f�L•etil3rlrl )Crl'1CYti N•Ttil)3� S ServioC MS1125 199 ,061 V'ronle:is Services N1tiG2? R Prcccnlinri Partnership Gran[ S _ -- r'regnan; Va'omm ProlQct N•1tii111 $ 'IANF Servicu Nltir17 Fi 5 _ 1 -GCC NiS119I ) i6 3.lfiR Piov:SoAIucuran- I ] arCsHclp hl 111± S I.AN7 Services 1.1�r11 N $ — — Tra.isit1U11 Votltllcrs 1 I R S Proviso .Allotuation - I ]Cre's f Ielp �iti9: 3 X — — Care Coordin Lit on htSOC'N 5 1'ra,lsiti to Vut;clrcrs NIS _ tV S Ci:rry Por%V Lrd MiSoC F S Cure Courdiialloll N•rSl;C $ C°.rry Forward Opso:c J Crisis MAT ;VISr'Tm $ -_ M:a 1111 - 11ade COLL11[V• CSU F13 Lid Targeted Response - UproldCris is N95C'•PII % TOTA1,ADtlLTStIBSTANCVAR11SE= $ 1,191,622 TOTAL (CHILDRL•NSUBSTANCE.ABUSE= S 452,836 FUNDS NOT REQUIRING MATCH: Di ug AlHwmY Scivnx:s S 021,664 TOTAL. ALL PROGRAMS = S 4,7'8,842 Pfc%cmian S 199.0163 i :NCONIP -NSA t E 1) L'NITS 5 941.768 DeinstUutiunr.lizatmr.Prolcct S t23.266 TOTAL= S 5,650,610 t :-- ,,H Program S 4Si.677 N!H RIo;a. G ran I TOTAL. FINDS REQI IIRING MA ^t'] t S 3,27 7 TOTAL. FUNDS NOT ItPQUIRiN`0'dA]CH $ 1.329.67() LOCAL N7ATCII REQUIRE1) 55 [iii NOTES FY 2' }16 -17 AcyuslnlentS. 312116 517,600 a locatttm. in lllc MH.AC'F OCA is %vkhLirtwri, [iuc to •. -t :rtY wily allc;ctoli 111 - ]- Iiueonly allucations an 2i Ifi :6 arc revered - S 17,600 is added to N.11A l8 to fund a Peer Sneclalisl at d:e C.tiU. '2:22.'17 $73,020 LS idded 10 MI1A0I and reduced 'ranl'%9SAI I (swapped with ViIhige). 58, I I I is addcL to UIHAPCI to increase the PATE I .`undmg allocation, recurring 559.001) Is reduced hang MSC1 I dUe tO PI01"Ied lapse• 1 - 11 M7 0111% S124,7 16 is added I MSA {13 and $220,1 ^_0 to MSA21 to address i5. r :ends uf';h: 0PIOld Population, l - [i :rle 0ely. FY 2017 -15 AdivaVUCnt" 1 !l5i17 S[75.259 is added to MHA01 and reduced tfrnn NItiA1 ] (ti [i :ti [vtth Vi1 :age[ !-dine a:i1V adfustn:enrs shown iihovc arc rL r cd. 012.•'] 7 56 is rL:duc.�d fi IvtHAOI du-, to AC)B ad; usInlenIS, FCC uLILn 525.36( is re[Iured tram N1 SC I I duC to ILips Lr and A0B reductions, rep erring 538,543 is led Ucd 1'roIn MSC25 due to AO L3 adjusfineius, recurring 10.'311]7 SA8.54N is added to MIiACF(calry foiu•ard towds) to p.irtially uffsct the M rcducliprts• I -time only S 1,301 is reduced 1'ruin N1 IAPG d.le io AOI3 11(hUsinle:1 is 1 I i2T +17 $50,000 1i added in M5AI I and 5150.0 in N1SA21 to forLd sire CeniraI Reccivir :g Facaitp c`:ectivc Janua 2018 co r LL Guidance Care /Center, Inc. Contract No. ME Racket Pg. 2942 Exh Page I of I S.4.a Guidance /Care Center, Inc. ME225 -8 -27 Ain endinent 91 REQUIRED MATCH: $ 1,093,057 Guidance CarelCenter, Inc LOCAL MATCH PLAN UNITS COST CENTERS UNITS MATCH UNITS RATE 01 Assessment $ 89.00 02 Case Management $ 90.84 03 Crisis Stabilization $ 352.97 04 Crisis Support/Emergency $ 3I.10 06 Day/Night S - 07 Drop -1n /Self Help Centers $ 33.13 08 In $ 93.34 11 Intervention - Individual 3 65.68 42 Intervention - Group $ I6.42 12 Medical Services S 484.75 13 Medication- Assisted Treatment $ 100.00 14 Outpatient - Individual $ 91.51 35 Outpatient - Group $ 22.88 15 Outreach $ 49.04 I8 Residential Level I $ 298.72 19 Residential Level II $ - 20 Residential Level III $ - 21 Residential Level IV $ - 24 Substance Abuse Detox $ 290.00 25 Supported Employment S - 26 Supportive Housing S 70.03 27 TASC $ 82,29 28 Incidental Expenses $ 1.00 29 Aftercare - Individual $ - 43 Aftercare - Group S - 30 Information & Referral 5 32.6I 34 FACT Team $ - 36 Room & Hoard Level 1 $ - 37 Roam & Hoard Level If $ - 38 Room & Board Level III $ 1I2.17 39 Short -term Residential Treatment $ - 40 Clubhouse Services S 52.39 44 COST- Individual $ - 45 CCST - Groun S - 46 Recoveiv ,5unnort - Individual �i mnnrf $ - 47 48 Recnveiv - (ironn Prevention - Indicated S S 67.49 49 - S .20 7 ( 0 ] (] �1 p Prevention [ Selective rrPVPnilnn f In 711.2 - .MPrca� 99 Special Proviso $ - MATCH ALLOCATION: GRAND TOTAL: S 1,093,057 Guidance CarelCenter, Inc LOCAL MATCH PLAN UNITS MA'T'CH UNITS MATCH UNITS 290.74 $ 25,876 - 56.18 $ 440.33 $ 40,000 110,08 S 10,000 748.57 $ 334.29 S 117,993 - - i - $ 8,000 - - - $ 50,000 366.41 S 177,615 30.94 $ 15,400 - ; 109.28 S 10,000 - 513.61 $ - - 1,748.25 $ - S 8,000 - - S c 334.76 $ 100.000 - - i - - 541.38 I S ; - S 10,000 - - co 1,667.11 $ 187,000 - - LL T 76.35 S 4,000 N 0 U 0 C d a� S 738,484 S 25,000 S a Revised Local Match Plan Page 1 of 1 m E t U C9 a- w a Racket Pg. 2903 S.4.a 'mIIII Vloriit,1 kefii1�kwal Itrv0ltII iti[mok d -. I;:�% Y. t1 .1E:; ;201ri Exhibit AS Monroe County Centralized Receiving Facility I. Overview Guidance /Care Center, Inc. ("'Network Provider ") is the designated centralized receiving facility ( "CRF ") that serves as the coordinated system of entry in the central region of Monroe County for individuals with mental health or substance use disorders, or co- occurring disorders. The designation as the CRF and the services to be provided are established in accordance with Florida Statute 394, Florida Mental Health Act, Florida Statute 397, Hal S. Marchman Alcohol and Other Drug Services Act, and in accordance with the Monroe County Designated Receiving System Plan, dated 2017 -2020, (MC -Plan, or latest revision thereof), herein incorporated by reference. The CRF is responsible for assessment and evaluation, both voluntary and involuntary, and treatment or triage and/or stabilization of persons with mental health or substance use disorder, or co- occurring disorders. The CRF shall function as a no- wrong -door model that responds to individual needs and integrates services among various providers. The Network Provider shall participate in a coordinated system that is linked by a method to share data, formal referral agreements, and cooperative arrangements for care coordination. The Network Provider shall provide or arrange for necessary services following an initial assessment or screening and evaluation. [I. Provisions of the Prime Contracts The CRF is funded with Department of Children and Families and Monroe County funding. 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, tthe contract entered into between the Department of Children and Families and the ME, not in conflict with this Contract, shall be binding upon the Network Provider and the Network Provider Guidance CarelCenter, Inc. Exhibit AS Page 1 of 7 Inserted 11/27/2017 Contract No. ME Racket Pg. 2944 S.4.a `. ;otIt.'1 I' InriIIa HoII:I) ii,r:il I Ie'cIliI! 'cil5 ui iC, I Hr. �. 01:ri1 l,' —'il l,, agrees to comply with same. The Prime Contract is incorporated by reference in this Contract. Ill. Monroe County Designated Receiving System Plan The Network Provider agrees to adhere to and implement the CRF in Monroe County as described in the Monroe County Designated Receiving System Plan, dated 2017 -2020 (or the latest revision thereof), herein incorporated by reference. IV. Obiectives The primary objectives of the CRF are to: 1. Provide a central receiving system serving the target populations; Z. Provide initial screenings, assessments for consumers that meet criteria for acute care services, triage, care coordination, and related services and linkage to appropriate level of care; 3. Provide opportunities for jail diversion, offering a more suitable and less costly alternative to incarceration; 4. Reduce the inappropriate utilization of emergency rooms; S. Increase the quality and quantity of services through coordination of care and recovery support services; 6. Implement standardized screening tools and procedures for services; and, 7. Improve access and reduce processing time for law enforcement offic transporting individuals needing behavioral health services. V. Scope of the Activities and Services A. Target Population 1. Individuals needing evaluation or stabilization under s. 394.463, F.S., the Baker Act; Guidance Care /Center, Inc. Exhibit AS Page 2 of 7 Inserted 11/27/2017 CO r U- a 0 U 0 d L a E U a-� w a Contract No. ME Racket Pg. 2905 S.4.a t: od i I oriiis Beb!n for ;d 11k rt�tinrk, ]rsr. .t.V,'0112iri8 2. Individuals needing evaluation or stabilization under s. 397.675, F.S., the Marchman Act; and, 3. Individuals needing crisis services as defined in ss. 394,67(17) -(18), F.S. 4. Individuals needing screening for non -acute mental health and/or substance abuse treatment services and that meet the target population descriptions contained in s. 394.674, F.S. and described in the OCF Pamphlet 155 -2. B. Client Services 1. The Network Provider shall provide crisis stabilization, substance abuse detoxification services, crisis support emergency services, screenings, assessments for consumers that meet criteria for acute care services, and Medication Assisted Treatment, and care coordination for clients referred to other providers. 2. Screening services for individuals needing acute and non -acute mental CO Cq health and/or substance abuse treatment services must be avaiiable through the CRF seven days per week, 365 days per year. CO r LL 3. Screening Tools The Network Provider shall utilize the AST, and the a GAIN SS, or any other screening tool(s) agreed to between the ME and I? c� the Network Provider. 0 r d 4. The Network Provider must have a protocol to screen and triage all individuals to determine an individual's immediacy of needs and a establish a plan for further assessment and treatment. The screening must at a minimum include: U a- w a Reason for referral • Medical needs • Current medications • Current substance use, and Exhibit AS Page 3 of 7 Inserted 11/27/2017 Packet Pg. 2946 Guidance Care/Center, Inc. Contract No. ME S.4.a 0nifh F'I mil;; f;rh;I%i0 r;d IIe -IIIf 1 1 v, fII if) 4,.'•.01N • Risk of harm to self and others C. The Network Provider's ability to accept consumers under the CRF system is to be executed according to its capabilities and limitations as described in the table below and as described in the Monroe County Transportation Plan for Involuntary Examinations (Baker Act) and Involuntary Admissions (Marchman Act), herein incorporated by reference. CRF Service Capabilities/]Limitations Voluntary Assessment and Crisis Stabilization Unit (Adults Only), Evaluation Detoxification (Adults Only), Screening and Assessment Involuntary Assessment and Crisis Stabilization Unit (Adults Only), Evaluation Detoxification (Adults Only), Screening and Assessment Triage for Mental Health Services Crisis Stabilization Unit (Adults Only), Screening and Assessment Triage for Substance Use Disorder Detoxification (Adults Only), Services Screening and Assessment Involuntary Treatment for Mental Crisis Stabilization Unit (Adults Only) Health Disorders Involuntary Treatment for Detoxification (Adults Only) Substance Use Disorders D. Performance Measures 1. 85% of persons who walk into the CRF requesting screening tnon- acute) services shall be screened on the same day. Exhibit AS Page 4 of 7 Inserted 11/27/2017 Packet Pg. 2947 Guidance Care/Center, Inc. Contract No. ME S.4.a •,airir i lc�rir {a i3elra� i�rr:�i :�;•;i!i!r 'art��i�E':;, lur, �.01161iM1 {ft; 2. 100% of persons brought in involuntarily by law enforcement under Baker Act will be admitted for evaluation. Appropriate transfer to other CSU's/lnpatient will be secured by the Network Provider staff upon evaluation and determination that continued admission is medically required. Transportation to the referral facility will be arranged by the Network Provider. 3. 85% of persons determined by the screening process to need outpatient services shall be linked to an appropriate provider. The CRF will secure an outpatient appointment within ten (10) business days of the date of the initial screening. 4. 85% of persons referred to outpatient services will receive a follow - up within seventy -two (72) hours of scheduled appointment to determine linkage. S. 85% of persons determined not to have a successful linkage will receive an alternate referral for outpatient services within ten (10) business days. 6. No more than 14.81% CSU readmissions within thirty X303 calendar days for consumers referred internally for post -CSU discharge services. 7. No more than TBD% Detoxification readmissions within thirty (30) calendar days for consumers referred internally for post - detoxification discharge services. E. Service Site Address and Telephone Numbers: 3000 41 Street Ocean Marathon, FL 33050 (305) 434 -7660 F. Funding: The Network Provider's allocation to operate the CRF is found in Exhibit H, Funding Detail. Guidance CarelCenter, Inc. Exhibit AS Page 5 of 7 Inserted 11/27/2017 co r U_ a rn 0 U c� d L a E U CC a-• w a Racket Pg. 2908 Contract Na. M� S.4.a 5ourh Florir{a Betel r�,icoral IIt�rlIli :`:nirrrl. Inv. V. () 1AI1001Is G. Method of Payment: The CRF shall be paid on a fee - for - service (Unit Rate) method of payment, in accordance with the payment methodology provided for in Rule 65E- 14.019 (2), F.A.C. for the covered services listed in Exhibit G, Covered Service by OCA. H. Collaborations and Partnerships: 1. ME's Care Coordination Department The Network Provider shall work with the ME's Care Coordination Department if an individual entering the CRF is identified as needing care coordination services. Refer to Attachment I, Section B. 1. a. (23), Care Coordination and Reporting Requirements, for a more detailed description of Care Coordination services. 2. The Network Provider, in collaboration with the ME and Monroe ZZ County, shall review and update, as necessary, the designated receiving CO system at least once every three (3) years, or earlier if deemed necessary. CO r U- 3. The Network Provider is expected to develop partnerships and a agreements with community partners (i.e., other SFBHN contracted I? U Network Providers, managed care organizations, criminal and juvenile justice systems, community based care organizations, housing providers, federally qualified health centers, etc,) for the coordination of care to L individuals referred from the CRF, to leverage resources and share data a as allowed by federal and state laws. E U I. Reporting Requirements: a 1. Service Data: Service Data into K1S or any data system designated by the ME and shall be submitted per the requirements described in Attachment I, Section B. 4. Deliverables, and in Attachment 1, Section D. Exhibit AS Page 6 of 7 Inserted 11/27/2017 Packet Pg. 2949 Guidance CarelCenter, Inc. Contract No. ME S.4.a Srs kit 11 Flo 1 Reh;lN I14 Nrt%�ovk, Iru. 2., Acute Care Service Utilization Reporting for Public Receiving Facilities, Detoxification and Addiction Receiving Facilities. 2. Performance Measures Report: By the 30" of every month following the reporting month for the measures listed above in Section Vt., paragraph D., Performance Measures. 3. Ad Hoc Reports: The Network Provider agrees to submit any ad -hoc and/or additional reports as determined necessary by the ME, Department of Children and Families. J. Staffing: Any changes in staffing plan greater than 25% of either the total FTE or total salary costs, as per the approved budget, is subject to ME approval. K. Meetings/Trainings 1. The Network Provider will ensure that its staff is properly trained on CRF model, goals and objectives, evidence based practices and Screening and Level of Care Placement Tools. 2. The Network Provider shall meet with the ME's staff at regularly scheduled or specially called meetings and/or trainings when notified by the ME. CO r U_ a 0 U c� d L a E U a-� w a Guidance Care /Center. Inc. Exhibit AS Page 7 of 7 Inserted 11/27/2017 Racket Pg. 291 Q Contract No. ME S.4.a K� South Florlda � � Behavloral - Health Network, Inc. REVISED ATTACHMENT IV PREVENTION SCOPE OF WORK NAME OF PROVIDER: Guidance /Care Center NAME OF PREVENTION PROGRAM: Power of Prevention AMOUNT OF CONTRACT AWARD: $199,063.00 TYPE OF FUNDING: "Regular" Prevention Services Prevention Partnership Grant PPG X COST ALLOCATED TO: (check both if approved for both covered services) Children's Substance Abuse Adult Substance Abuse 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 descript ari ;af program abt vii s; target populatiari tv l,e serri haw the services address cultural competency ' the name (s) of the EBP (s) :and haw it (the will be implemented, describe comp r ehensive prog ram ming, and the `art and coordination efforts The GuidancelCare 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 ESP's; implement sessions based on these ESP'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 always. The POP program staff will seek to coordinate all prevention activities with referrals from other agencies to collaborate and maximize resources when indicated and 2ossible. 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 Evaluation).. 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 old 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, co U_ Guidance/Care Center, Inc. Revised Attachment IV Contract fro. ME Packet Pg. 2911 Scope of Work S.4.a 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 ll. TARGET POPULATION -- RISK AND PROTECTIVE FACTORS TARGET POPULATION OR PARTICIPANTS (Include numbers in tables and a narrative description of p articipant characteristics below):' Universal — Direct or Indirect, Selective, Indicated Number of Unduplicated Participants (if duplicated note) Selective - — Alcohol Literacy Challenge 348* Indicated —Teen Intervene 40 Selective — PRIME for Life 250 Universal Direct — Health Fairs 340 Universal Direct — Information Dissemination Capacity Building with parents, 25 school personnel, community key stakeholders *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, FI. Services will be provided county -wide (110 miles) to include all 3 high schools, 3 middle schools, youth residing at the Florida Keys Children's Shelter, Treasure Village Montessori, island Christian School, 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 co r U_ Packet Pg. 2912 Guidance /Care Center, Inc. Revised Attachment IV Contract No. ME2 Scope of Work S.4.a Section 111. SITE LOCATIONS AND INFORMATION* '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 DJJ Self - referral Social Service Agencies Community Centers co U- GuidancelCare Center, Inc. Revised Attachment IV Contract No. ME Racket Pg. 2913 Scope of Work # Site: Name '= ;. -: Street Address City Zip Cad C#tlldre Parent # of n! - Others 'Youth Key West High School 2100 FI ag ler Avenue Key West 33040 Coral Shores High School 89901 Old Highway Tavernier 33070 Marathon Middle /High 350 Sombrero Roar! Marathon 33050 School Key West Collegiate High 5901 College Road Key West 33040 School Island Christian School 83400 Overseas Islamorada 33036 Highwa Plantation Key Middle 100 Lake Road Tavernier 33070 School Key Largo Middle School 104801 Overseas Key Largo 33037 Highwa Horace O'Bryant Middle 1105 Leon Street Key West 33040 School Su ar #oaf Middle School 255 Crane Blvd Sugarloaf 33642 Treasure Village 86731 Overseas Islamorada 33036 Montessori Hw Florida Keys Children's 73 High Point Road Tavernier 33670 Shelter DJJ 5563 College Road Key West 33440 Suite 209 Southernmost Boys and 1400 United Street Key West 33040 Girls Club YMCA of Greater Miami at 5010 St. Croix Place Key Largo 33437 Key Largo Community Park Community Partners Sites Monroe 33440 County 33050 33037 TOTAL NUMBER OF TO BE SERVED 638 '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 DJJ Self - referral Social Service Agencies Community Centers co U- GuidancelCare Center, Inc. Revised Attachment IV Contract No. ME Racket Pg. 2913 Scope of Work S.4.a Section V. PERFORMANCE MEASURES Quantity Performance Measures A ct ivit les /Service Name ,& Descr>p fon'(Iriclu e;' , Activity frequency,, intensity; & d4ratior� ` # a Level of..sessions,, 'as:well as the" : - I - Childrenl Parents Dtiters Reyulred, Io To Meet Required . Selectiv e -- n�ambe� i?f c' `Youth sessions indicate expected to be offered.`arfd.. d tentative schedulettimin Youth/Chlldren At -Risk of,Substance'Abuse Problems —include individual measures that rivlll result in achieving the Substance' Abuse & Mental, Health Required Performance: Outcomes & 0t tputs + Par At -Risk of Substance.Abus 'Problerns — Include individual measures that will result in achieving theSubstarice Abuse & Mental Health Required Performance Outcomes & Outputs Alcohol Literacy Challenge 0 0 1 ALC 100% of 348 will Selective 348 Session receive services, for each 85% will complete of 190 ALC and 85% of participan completers or 298 is will improve on the ALC PRIME for Life 0 0 Minimum PRIME for Life — Selective 250 4.5 hours 100% of 250 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 or 213 will improve based on the outcome measures Teen Intervene 40 0 0 3 Teen Intervene — Indicate sessions 100% of 40 will d receive services, 85% will complete the program and 85% of completers or 34 participants will improve from Pre- to post test in the minimum of 3 sessions (3 sessions are one cohort Health Fairs 100 200 0 5 100% of 300 Health participants will Fairs receive co U_ Guidance /Care Center, Inc. Revised Attachment 1V Contract No. ME Packet Pg. 2914 Scope of Work S.4.a Quality Performance Measures (Including fidelity measures, satisfaction survey information, supervision, training, staffing, and other required information pertaining to quality) Quali . Measure Measurement Reporting Tool Timin Average number of sessions Participant sign -in sheets collected information at the attended (Participant at session session Retention) Pre -and Post- surveys from each is At the end of each of the Health Fairs, 85% participant services improved Participant Satisfaction Survey Alcohol Literacy Challenge - or 255 100% of 348 and 85% 296 will improve based on the participants be pre /post outcome as measured by the approved provided Challenge minimum of 1 session prevention Average number of sessions Participant sign -in sheet collected at attended (Participant each session framework Retention) Alcohol Timeline Followback (TLFB) session Number of participants completed at baseline and exit from a At the end of each of the information while treatment services Teen Intervene —100% of 40 Participant Satisfaction Surveys will receive services and 85% attending the or 34 will complete the program. 85 % of completers fairs. will improve from pre -to post Quality Performance Measures (Including fidelity measures, satisfaction survey information, supervision, training, staffing, and other required information pertaining to quality) Quali . Measure Measurement Reporting Tool Timin 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 is At the end of each of the Number of participants participant services improved Participant Satisfaction Survey Alcohol Literacy Challenge - 100% of 348 and 85% 296 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 a At the end of each of the improved treatment services Teen Intervene —100% of 40 Participant Satisfaction Surveys will receive services and 85% or 34 will complete the program. 85 % of completers will improve from pre -to post test in the minimum of 3 sessions (3 sessions are 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 a At the end of each of the Number of participants Evaluation — curriculum services improved assessment— completed at baseline PRIME for Life — 100% of 250 and exit by each participant will receive services, 85% of 250 or 213 will complete the p rogram in a minimum of 4.5 CO r U_ x a c� U 0 d I` n� a� a m E U a Guidance /Care center, Inc. Revised Attachment kV Contract No. Md Racket Pg. 2915 Scope of Work S.4.a sessions Goal I : By June 30, Goal I : By ,tune 30, and 85% of completers will 2018 reduce the rate of improve based on the 2018 reduce the rate of outcome measures past 30 -day alcohol use past 30 -day alcohol use # and % of participant 85% of participants who completed . At the end of each cohort satisfied with services program wilt complete the . At the end of the services provided satisfaction survey and 80% will be underage young adults satisfied Based on the Satisfaction underage young adults Surve and youth in Monroe Observation of service Curriculum fidelity checklist Three times per year in delivery/ Fidelity checklist Supervisor /Observer report coordination with the Evaluation Long. Goal II: Expand Long. Goal II: Expand Team, one time in Quarter 2, one the community time in Quarter 3, and one time in the community Quarter 4 unless the EBP indicates messaging and messaging and otherwise with identified needs and communication strategy communication strategy changes to be reported to SFBHN to build community in the Quarterly Report Documentation of structured Supervisory Tool /Checklist and During regutar 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 carter. # and % of staff working 100 %o 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} I Prevention Certification Section VI. Participant Outcomes CCAP Goal Goal I : By June 30, Goal I : By ,tune 30, Goal i s 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 H: Expand the community the community the community messaging and messaging and messaging and communication strategy communication strategy communication strategy to build community to build community to build community ownership of the ownership of the ownership of the co U- Racket Pg. 2916 Guidance /Care Center, Inc. Revised Attachment W Contract No. ME Scope of Work S.4.a SFBHN Goal(s) underage drinking problems in Monroe County more effectively through formalizing of new relationships with key community and business leaders using the Strategic Prevention Framework. SFBHN Prevention Goal #1 : Decrease norms and acceptance of alcohol, marijuana, and other drug use (inclusive of peer and parent attitudes). outcomes Data Source/ Measurement Outcome: 85% of youth Pre/post tests who complete ALC will decrease favorable Satisfaction surveys attitudes towards alcohol Outcome: 85% of youth who complete PRIME and Teen Intervene will decrease favorable attitudes towards alcohol, tobacco, and other drugs_ Outcome 85% of youth who complete Teen Intervene will increase their healthy behaviors and decrease their use of ATOD or delay the age of onset for marijuana use. Outcome 85% of youth who complete PRIME will increase their healthy behaviors and skills associated with healthy behaviors. Pre/post tests Satisfaction surveys Pre/post tests Satisfaction surveys Pre/post tests Satisfaction surveys underage drinking problems in Monroe County more effectively through formalizing of new relationships with key community and business leaders using the Strategic Prevention Framework. SFBHN Prevention Goal #1: Decrease norms and acceptance of alcohol, marijuana, and other drug use (inclusive of peer and parent attitudes). SFBHN Prevention Goal #3: increase age of onset for marijuana use Timing when each data sourceimeasure will be' collected • At the end of each cohort session • At the end of each of the services • At the end of each cohort session • At the end of each of the services • At the end of each cohort session • At the end of each of the services At the end of each cohort session ■ At the end of each of the services underage drinking problems in Monroe County more effectively through formalizing of new relationships with key community and business leaders using the Strategic Prevention Framework. SFBHN Prevention Goal #2 : Increase education and awareness regarding alcohol, marijuana use SFBHN Prevention Goal #4: Increase healthy behaviors and self esteem Outputs - Associated Activity- 0 Meet and communicate with school personnel • /partner agencies • Prepare program materials ■ Administer Participant Registration Form and pre -post tests • Administer Satisfaction Survey • Travel to /from session • Data Entry CO U_ Guidance /Care Center, Inc. Revised Attachment IV Contract Flo. NEE Racket Pg. 2917 Scope of Work S.4.a Cohorts Section Vli. TASK LIST U_ Guidance /Care Cente inc. Revised Attachment IV Contract No. ME Racket Pg. 2918 Scope of Work #i 8� Type. EBP . Recommehde °lo t[� meet ._ o f - ` •Actiuilfies/5errilc e:Name & Descriptive Parti d. Sessions or: this s Hours' putcbme 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 partnerstagencies 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 agencies based on • Prepare program materials the Quality • Administer Participant Registration Form Outcome ■ Administer Satisfaction Survey Measure • Travel to /from session ■ Data Entry Frequency: 1 or 2 sessions intensity: 90 minutesxl session or 45 minutesx2 sessions Duration: 1 session, # of Cohorts @ 8 youth each Activity Title: PRIME for Life (PFL) 250 youth 4.5 to 20 100% of Activity Description: Participants will be recruited from ages 13- hours per the 250 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 sessi o n. 1 -30- complete minute registration, 1 -30- minute screening, 1 -30 minute prelpost the surveys, 1 30- minute referral. program ■ Meet & communicate with school personnel /partner and 86% of agencies compieters ■ Prepare program materials will show ■ Administer Participant Registration Form improveme • Administer Mentai Health First Aid screening tool nt on the • Administer Satisfaction Survey prelpost ■ Travel to/ from session surveys ■ Data Entry based on Frequency: once weekly session the Quality Outcome Intensity: 4.5 to 20 hours (per the EBP) Measures Duration: 1 50 -80- minute session, # of Cycle: 6 Cohorts @5 y outh each Activity Title: Teen Intervene 40 youth 3 sessions 100% of Activity Description: Participants required to attend (3) 90 ages 13- 40 youth minute session, 1- 30- minute registration, 1- 30- minute 1 8 witl receive screening, 1- 30 minute pre/ post survey, and 1- 30- minute services, U_ Guidance /Care Cente inc. Revised Attachment IV Contract No. ME Racket Pg. 2918 Scope of Work S.4.a referral. The staff will employ the Mental Health First Aid skill Designating Agenc Alcohol Literacy Challenge 85% will sets during the sessions. SAMHSA approved, NREPP Teen Intervene 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. 538 2 85% These assessment tools match the services provided for ALC, PFL & Teen Intervene. Activity Description: Instrument used to identify substance abuse and other needs. Frequency: 2 sessions intensity: 30 minutes /session Duration: 1 survey per youth completed at baseline and at exit Section VIII. EVIDENCE BASED PROGRAMS (EBP) Evidence Based Program" Designating Agenc 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 .E5D- 34,4'1;3(2 ) F,A.C.,-in collaboration with the Evaulation Team identified oji SFBHN each year. The m SFBHN .Evtidatiod - Tea shall - review. the results of providers' program evaluation 'and al techpical materials 'mdd by providers annually to ensure corisistendy 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. co r LL Guidance /Care Center, Inc. Revised Attachment IV Contract No. ME Racket Pg. 2919 Scope of Work S.4.a -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 Additional Prevention Requirements Site Schedule A final site schedule, on the Site Schedule form, with dates, times, and location of services shall be submitted no later than August 31 of the fiscal year or when requested by the Contract Manager. Sites schedules must be approved by SFBHN, in writing, and will be based on county need and distribution of services to avoid duplication in any geographical area or school to maximize SFBHN fending. Any change shall be justified in writing and submitted to the Managing Entity in writing and submitted to the Contract Manager for review and approval by the Prevention Director. The Contract Manager will reply with approval. Two (2) site schedule changes may be made in the contract year. The site schedules shall be submitted on the SFBHN Prevention Site Schedule format. 2. Memorandum Of Understanding MOU With The Community Coalition To address local community substance abuse prevention needs and wellness promotion strategies, prevention providers and the community coalition shall execute and for maintain a memorandum of understanding (MOU) delineating the specific responsibilities of each. This MOU will be consistent with the strategies of the State of Florida Department of Children and Families' and the Managing Entity's (ME's) prevention strategy. The provider shall submit an executed copy of the MOU to the ME's Contract Manager within 30 days of the effective date of the contract (for newly executed MOUs) or within thirty (30) calendar days for renewed MOUs. SFBHN Contract Attachment — Guidance Document 90 3. Memorandum Of Understanding (MOU) With Sites To facilitate the coordination and delivery of services, all providers shall have executed Memoranda of Understanding (MOU) with the sites where services are being provided. Ali MOUs with the sites shall be current and up to date, outlining the terms of the agreement. 4. Participant Satisfaction Survey All providers shall collect and submit participant satisfaction surveys as noted in the Scope of Work. Co U_ GuidanoelCare Center, Inc. Revised Attachment iV Contract No, MI Racket Pg. 2920 Scope of Work S.4.a 5. Meetings All providers shall attend scheduled Prevention meetings as required by the ME and the evaluation team, BSRI, at regularly scheduled or specially called meetings when notified by the ME. The ME will make every attempt possible to schedule meetings with advanced notice; however, there may be meetings that may be called on short notice. These include, but are not limited to, Prevention provider meetings, meetings with Behavioral Science Research Institute, individual provider quarterly meetings with BSRI and/or SFBHN, Evidence Based Practice workgroup meetings to comply with the Block Grant requirements, and other meetings as noticed by SFBHN. The contract notes the other meetings where representatives of the provider organization are required to attend. 6. Reports /Assignments and Special Reports /Assignments Providers are expected to submit reports as outlined in the contract. Prevention Partnership Grant (PPG) reporting is specifically described in the contract with dates for submission. Other reports will be requested by SFBHN. Special reports and assignments are requested from time to time to meet State /Local Department of Children and Families, State Block Grant, SFBHN, and other requirements and needs. Prevention providers are required to submit the reports in the format requested and by the timeline requested. These reports may be requested from different sources for different reasons. Requests generally come from SFBHN staff, including the Prevention Director, and may be requested verbally or in writing. There may be times when other collaborative partners request information and SFBHN will support these requests. 7. Training The Scope of Work outlines the requirements for training to support the State Block Grant co reporting requirements for workforce development as well as for strengthening the Prevention workforce. All staff of provider organizations funded by this contract, whether full -time, part -time, U_ contractual, or consultant, who report units in the Performance Based Prevention System (not those paid by cost reimbursement or that are vendors), is required to attend eight (8) hours of N training per quarter. All providers shall attend scheduled training as required by the ME, meet the ME and the evaluation team, BSRI, for technical assistance and /or training, at regularly U scheduled or specially called meetings when notified by the ME. 0 8. Report Cards Providers are required to comply with the measures on the Prevention Report Card. Grading for the measures will be according to compliance or lack thereof. 9. Data All providers are required to submit the program data monthly in the Performance Based Prevention System (PBPS) as required by the contract. The provider shalt also: ■ Ensure that the data submitted clearly documents all program participants, programs, and strategies which occurred under this contract and consistent with the Scope of Work in the contract; ■ Ensure that all data submitted to PBPS is consistent with the data maintained in the provider's file and consistent with the Scope of Work in the contract; Racket Pg. 2921 Guidance/Care Center, Inc. Revised Attachment 1V Contract No. M� Scope of Work S.4.a ■ Review the data submitted with the evaluation team, Behavioral Science Research Institute (BSRI), monthly to determine any discrepancies in the numbers related the evaluation and the Scope of Work and make corrections prior to submission for approval by the SFBHN Prevention Director; ■ Submit an email to the SFBHN Prevention Director and the designated SFBHN Data Analyst verifying that the data in the PBPS system has been checked and is correct and complete and may be used for Block Grant reporting and payment. There shall be a designated individual and one back up individual at the provider organization responsible for verifying the data and submitting the email. This will imply that the data has been reviewed and is ready for submission. o The email subject line shall read: PEPS Data Submission Verification c The body of the email shall read: (name of organization) is submitting the PPG Prevention data for the month of (name of the month) in PEPS and we assure that the data is complete and correct. Our organization's data may be used to report to the State for the Block Grant report. Our organization's data may be used to reconcile with the payments for this month. ■ Failure to submit any data, or correct any errors in the data which results in a rejection rate of ten percent (10 %) or higher of the monthly data submitted, will require the provider to submit a corrective action plan describing how and when the missing data will be submitted or how and when the rejected will be corrected and resubmitted; and ■ In accordance with the provisions of s. 402,73(1), F. S., and Rule 65- 29.001 F.A.C., i corrective action plans may be required for non - compliance, nonperformance, or co r unacceptable performance under this contract. Penalties may be imposed for failures to >_ implement or to make acceptable progress on such corrective action plans. x Evaluation Prevention providers shall work in collaboration with the evaluation team, Behavioral Science Research Institute (BSRI) by participating in meetings, training, and providing service data and other necessary identified data vital to the completion of the system -wide evaluation of the prevention services within the Strategic Prevention Framework. Data will be provided to BSRI in the BSRI data system, DOES, and in any other requested format. The data includes the numbers for outcome data and process data required that contributes to the evaluation of the Prevention System of Care. Prevention providers are required to participate in fidelity checks, meetings, training, and other fidelity activities related to the outcomes in the Scope of Work and for the larger Prevention System of Care evaluation. BSRI will report compliance and collaboration to SFBHN per the 8SR1 Scope of Work requirements, Racket Pg. 2922 Guidance /Care Center, Inc. Revised Attachment IV Contract No. ME Scope of Work Florida U A South 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 0 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. t 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. U. b. If this contract contains over $100,000 of federal funds, the Network Provider shall comply with all applicable standards, orders, or regulations CO issued under section 306 of the Clean Air Act, as amended (42 United States Code (U.S.C.) 7401 at seq.), section 508 of the Federal Water >_ Pollution Control Act, as amended (33 U.S.C. 1251 at 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. 0 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. Racket Pg. 2923 U A 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 ALLl . 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 V G� c� c� t9 a� U) C4 U. co U. U) E I0 t.9 Standard Contract Guidance Care Center, Inc. Page 2 of 10 Contract No. Racket Pg. 2924 U A 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. wMwfflwE,sfbhnoM 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. V G� a� t9 M a� E U) C4 U. CO U. U) E 0 2 CO t.9 Standard Contract Guidance Care Center, Inc. Page 3 of 10 Contract No. Racket Pg. 2925 U A 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 Providers 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 V G� c� t� C M t c� E U) C4 U. co U. U) E C0 t.� Standard Contract Guidance Care Center, Inc. Page 4 of 10 Contract No. Racket Pg. 2926 U A 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. V G� a� a� t� C M a� E U) U. co U. U) E C0 t.9 Standard Contract Guidance Care Center, Inc. Page 5 of 10 Contract No. Racket Pg. 2927 U A 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 Hand -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 V G� c� a� t� C t a� U) U. co U. U) E C0 t.� Standard Contract Guidance Care Center, Inc. Page 6 of 10 Contract No. Racket Pg. 2928 U A 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 httlas:// fsl6. formsite. com/ DCFTraininolMonthl�- Summary- C�eoork/form Iooin.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: htt:/ 1. myflfamilies .comisenrice- �rorams /deaf- and - hard- hearingleroviders 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 Jq&J 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, V G� c� a� t9 C t a� E U) r C4 U. co U. U) E C0 E t.� Standard Contract Guidance Care Center, Inc. Page 7 of 10 Contract No. Racket Pg. 2929 U A South Florida Behavioral Health Network, Inc. rev. 07/01/2015 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 W noncompliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed for failure to implement or to make 0 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 0 E! 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 U. 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 CO herein. >_ LL 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. UP 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 0 twenty -four (24) hours (excluding Saturday, Sunday, and Holidays) notice in writing to the Network Provider after Network Provider's failure to fully 0 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 4) do not limit the ME's right to remedies at law or in equity. 2 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. co 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 co 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. Racket Pg. 2930 Florida U A South 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 C 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 S and /or placement into the appropriate level of care, the dispute shall not preclude the Network Provider from providing the provision of services to C: 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 M 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. t 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, C 0 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 E submitted a false certification or if the Network Provider is placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized E! 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: U) (i) "Employee assigned to the contract' means all persons employed during the contract term by the Network Provider /grantee to perform work pursuant r 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. N U. (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. co (III) Subcontractor means an supplier, distributor, vendor, or firm that furnishes supplies (���) ' " Y PP � or services to or for the Network Provider or subcontractor. L ° (b) Enrollment and verification requirements. (1) The Network Provider /grantee shall: UP (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 0) E! enrollment. 4 (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. E (ii) During the period between termination of the enrollment and a decision by the suspension or debarment official whether to suspend or debar, the 0 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: httL: // a.dhs.gov /E- Verifip (iv) The Network Provider /grantee is not required by this clause to perform additional employment verification using E -Verity for any employee whose employment eligibility was previously verified by the Network Provider /grantee through the E -Verity program. (v) Evidence of the use of the E -Verity system will be maintained in the employee's personnel file Standard Contract Guidance Care Center, Inc. Page 9 of 10 Contract No. Racket Pg. 2931 South Florida Behavioral Health Netvrork, Inc. rev 07ro112ol5 (vi) The Network providertgrantee 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 -9044 E -Mail: marianne.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 Health 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. Hagler 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, I, It, III. & IV and any exhibits referenced in said attachments, together with any documents incorporaled by � reference, including the ME prime contract (which can be found at http:llwww.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 r 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. LL 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 documents incorporated herein by reference BY SIGNING THIS CONTRACT', "I'HE PARTIES AGREE; THAT THEY HAVE READ AND AGREE TO THE ENTIRE CONTRACT, AS DESCRIBED IN SECTION 46. ABOVE. IN WFINESS THEREOF, the parties have caused this contract, attachments, exhibits, and any documents referenced herein, to be executed by their undersigned officials as duly authorized. PROVIDER: a elCare Center, Inc. SOUTH FLORIDA BEHAVIORAL HEALTH NETWORK, INC. i . SIG SIGNED /� NAME: Drank abbito NAME: / John W. Dow TITLE: Senior Vice President TITLE: President and CEO DATE: DATE: Federal Tax ID#f (or SSN) 59- 1458324 Network Provider Fiscal Year Ending Date 6130 Standard Contract Guidance Care Center, Inc. Page 1 0 of 10 Contract No. PPG -2 -03 South Florida &1 0000 Behavioral Health Network, Inc. ATTACHMENT (1) "Application" is the proposal submitted by an organization to the Department of Children a and Families Office of Substance Abuse and Mental Health in response to Request for E 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. >_ U. (4) "Comprehensive Community Action Plan (CCAP) ". A document that describes and depicts co 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. UP (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. E (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. E c� (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. Attachment I HCO2 (d) Guidance Care Center, Inc. Page I of 40 Contract No. Racket Fig. 2933 South Florida &1 0000 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: htt:llw dcf.state.fl.usf rorams�samhf ubs reorts.shtml 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. (1 1) "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 co 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. Racket Fig. 294 South Florida &1 0000 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 c 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. co U. (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). 0 (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, a 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. Racket Fig. 2935 South Florida &1 0000 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). co (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. Racket Fig. 2936 South Florida &1 0000 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) "SAVE/VIS Program" is the U.S. Department of Homeland Security (DHS) administers the Systematic Alien Verification for Entitlements (SAVE) program. This program verifies immigration status and eligibility of alien applicants for federal benefits. The alien status verification system under SAVE is entitled the Alien Status Verification Index (ASVI), as described at 60 Federal Register 52694, 52697 (1995) administered by the Computer Sciences Corporation (CSC) as the Verification Information System (VIS). The SAVE/VIS Program can and may provide assistance in verifying eligibility in cases where a client does not possess sufficient documentation. (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. Racket Pg. 2937 South Florida &1 0000 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: L Prevention and early intervention; ii. Emergency care; iii. Acute care; iv. Residential treatment; V. Outpatient treatment; A. 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 co individuals' substance, their families, and community Stakeholders. >_ LL (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. Racket Fig. 2938 South Florida &1 0000 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 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 CO U. Section 394.9082, F.S., Prevention Partnership Grant Request for Applications #LHZ03, and the Prime Contract provides the M E 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. Packet Fig. 2939 South Florida &1 0000 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. Packet Fig. 2940 South Florida &1 0000 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. Packet Fig. 2941 South Florida &1 0000 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. Racket Fig. 2942 South Florida &1 0000 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. Packet Fig. 2943 South Florida &1 0000 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: 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. Packet Fig. 2944 South Florida &1 0000 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. Racket Fig. 2945 South Florida &1 0000 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. 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. A. 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: i. 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 I HCO2 (d) Guidance Care Center, Inc. Page 14 of 40 Contract No. Packet Fig. 2946 South Florida &1 0000 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 U. during the initial child abuse /neglect investigation or at any point during child protective co 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. 2 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. Racket Fig. 2947 South Florida &1 0000 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 iq Assurance Plan that details how the Network Provider will ensure and document that quality U. services are being provided to the clients served, which is herein incorporated by reference. CO This requirement may be waived if the Network Provider has submitted a Quality Assurance U. 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. Racket Fig. 2948 South Florida &1 0000 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: 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. Packet Fig. 2949 South Florida &1 0000 Behavioral Health Network, Inc. ii. Networking capacities with local providers in the community for persons with trauma; iii. Strategies and activities to develop or improve TIC service capability; iv. Scope of services and programs to be included in the process; and V. Timeframes for reviewing TIC capability within each Network Provider program. (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 co statements /documentation. U. (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 U 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. Packet Fig. 2950 South Florida &1 0000 Behavioral Health Network, Inc. http: / /sfbhn.or /word resslwp- contentluploads /Incorporated- Document- 30- Local- Match- Calculation- Form- AuOust- 18- 2014.x1sx (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: hftp q olicies1215 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 co Department staff all policies, procedures, tools, and plans adopted by the Network Provider. U. 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. Racket Fig. 2951 South Florida &1 0000 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. Packet Fig. 2952 South Florida &1 0000 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 (j) 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 CO the ethnic and racial composition of the clients /participants served. >- LL (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. Packet Fig. 2953 South Florida &1 0000 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 U. requests by the Network Provider to subcontract for the provision of services under this co 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. Racket Fig. 29M South Florida &1 0000 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)]. htto: / /sfbhn.or /word ress /w3- content/u loads/SAMHSA- Guidance- on -SAPT- and- CMHSBG- Re uirements. df (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 co contain the applicable terms and conditions, and any amendments thereto, found in the ME's U. 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. Packet Fig. 2955 South Florida &1 0000 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; a� (c) is currently involved, or has been involved within the last 5 years, with any litigation, C: 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 c for cause; or, c: M (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 a 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. N (11) The Network Provider shall monitor the performance of all subcontractors, and perform U. follow up actions as necessary. The Network Provider shall notify the ME immediately upon CO 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. Racket Fig. 2956 South Florida &1 0000 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 CO State, and Federal laws, rules, and regulations. U. 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 M E 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 I HCO2 (d) Guidance Care Center, Inc. Page 25 of 40 Contract No. Packet Fig. 2957 South Florida &1 0000 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 : / /.m�flfamilies.comiservice- rw o ramslsubstance- abusel amphiet -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 a designated by the ME. The data shall be submitted electronically no later than the 4th of each month E 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. U) (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. >_ co (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 LL 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 UP 0 (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. Packet Fig. 2958 South Florida &1 0000 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: htt: /1.m�flfamilies,com /service- rorams /substance - abuse/ amphlet -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: httg:/ /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. Packet Fig. 2959 South Florida &1 0000 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. co (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. fn (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. Racket Fig. 2960 South Florida &1 0000 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. Packet Fig. 2961 South Florida &1 0000 Behavioral 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- cublicationslforms/ (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: htt: lidos. m�tflorida.comlelectionslforms- 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. Packet Fig. 2962 South Florida &1 0000 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 N arising under this contract are to be brought solely and directly to the ME for consideration and U. resolution between the Network Provider and the ME. In any event, the ME's decision on all co issues is final and solely subject to the ME's appeal process and legal rights of the Network >_ Provider. U. (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. Racket Fig. 2963 South Florida &1 0000 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 co 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. 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. Packet Fig. 2964 South Florida &1 0000 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: hftp://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 co SAMH Projected Operating and Capital Budget (CF -MH 1042, July 2014, Rule 65E- 14.021(5), F.A.C.) U. 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 a. The Network Provider shall submit incident reports into the Incident Reporting and Analysis System (IRAS) on all reportable incidents per CFOP 215 -6, within 24 hours of receiving notification of a reportable incident. In the event an incident has an immediate impact on the health or safety of a consumer, has potential media impact, or involves employee - related incidents of criminal activity, the Network Provider must notify the ME Risk and Compliance Coordinator 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. Packet Fig. 2965 South Florida &1 0000 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. Packet Fig. 2966 South Florida &1 0000 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:llv.myflfamilies.com/ service- proramslsubstance- abuselpamphlet -155 -2 f. 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)] htt�: / /sfbhn.or /word resslwp- content/u� loads /SAMHSA- Guidance- on -SAPT- and- CMHSBG- Re uirements.udf 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 N shall determine at what time and to which Network Provider and what amounts are to be given to U. Network Providers for additional services. co 7. Sliding Fee Scale U. 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 https: / /nppes .cros.hhs.gov /NPPES /StaticFo ard.do ?fo and static.npistart. c. Additional information can be obtained from one of the following websites: online at Attachment I HCO2 (d) Guidance Care Center, Inc. Page 35 of 40 Contract No. Packet Fig. 2967 South Florida &1 0000 Behavioral Health Network, Inc. (1) The Florida Medicaid HIPAA located at: btR://www.fdhc.state.fl.us/hipaalindex.shtmi (2) The National Plan and Provider Enumeration System (NPPES) located at: hftps (3) The CMS NPI located at: http 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 4 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 co the conduct of entities engaged in the business of providing services to government. U. 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. Packet Fig. 2968 South Florida &1 0000 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 U. $100 or more should be classified as nonexpendable property only if they are circulated to students or co 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. Packet Fig. 2969 South Florida &1 0000 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 C: 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 E 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 N >- 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. CO LL (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 c 0 E (1) Title (ownership) to, and possession of, all vehicles acquired with funds from this contract shall 0 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. Packet Fig. 2970 South Florida &1 0000 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. 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 CO 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. LL 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. Racket Pg. 2971 South Florida &1 0000 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. 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 co U. 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. Packet Fig. 2972 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: B. Client/Participant Eligibility 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 Q), 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. Packet Fig. 2973 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. Client/Participant Eligibility 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 Q), 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. Packet Fig. 2973 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. C I ient/Partici pant 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. Packet Fig. 2974 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. Racket Fig. 2975 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 $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 co Services X 16.67% + Uncompensated Mental Health Services that is not exempt from local >_ match requirements X 33.33 %.* U. *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 fl. 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. Packet Fig. 2976 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 CO 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: 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. Packet Pg. 2977 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 co 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: hftR-I/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. Packet Fig. 2978 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. co i. Invoices shall be submitted in detail sufficient for a proper pre -audit and post- audit. >_ LL 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. Packet Pg. 2979 htt�: llv. myfloridacfo. com�aadirlreferenceuide�Reference Guide For State Expenditures. df 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. Racket Fig. 2980 South Florida Behavioral Health Network, Inc. Exhibit C -1 Required Reports for PPG For Fiscal Year 2015 -16 V G� C C! C! C9 C! E U C4 U. co U. U C E 0I CM 0I E C9 Exhibit C -1 Guidance Care Center, Inc. Page 1 of 5 Contract No. Racket Pg. 2981 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 MOD'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 amendment to the contract affecting cting 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 Anually 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 1 & the contract manager and /or the 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 submission through IRAS & 4 Mandatory QA/QI Risk & Compliance Reporting Requirements to the Office Manager of the Inspector General V G� C C! C! C9 C! E U C4 U. co U. U C E 0I CM 0I E C9 Exhibit C -1 Guidance Care Center, Inc. Page 1 of 5 Contract No. Racket Pg. 2981 South Florida Behavioral Health Network, Inc. V G� C C1 C1 C9 C1 E U) C4 U. 00 U. U) C E 0I iM 0I C9 Exhibit C -1 Guidance Care Center, Inc. Page 2 of 5 Contract No. Racket Pg. 2982 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 submitted electronically to the ME no Electronically system designated by the ME or later than the 4th of each month the Department 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) ADA Client Communication Assessment httos lfsl6.formsite.COm1DCFFraln ing MonthlvSummary Auxiliary Aid Service Record Monthly Summary Report, By the 4th business day following the 1 (Electronic Submission Re ort(form to ;in.html (Applicable to agencys 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 Monthly Service Invoice day 1 ME Sr. Accountant (Fiscal after the month 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 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 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 Emergency Preparedness Plan 11/13/2015 1 (Electronic Submission & via E -mail) QA/QI Risk & Compliance Manager Civil Rights Compliance Checklist (CF0946) 11/13/2015 1 (Electronic Submission ME Contract Manager via E -mail) Civil Rights Certificate (CF707) 11/13/2015 1 (Electronic Submission ME Contract Manager via E -mail) ME Contract Manager Quality Assurance /Quality Improvement Plan 11/2/2015 1 (Electronic Submission & via E -mail) QA/QI Risk & Compliance Manager Action Plan (Integration of Behavioral Health ME Contract Manager Services and Primary Care, TIC, CLC, CWI 11/30/2015 1 (Electronic Submission & Initiatives) via E -mail) QA/QI Risk & Compliance Manager V G� C C1 C1 C9 C1 E U) C4 U. 00 U. U) C E 0I iM 0I C9 Exhibit C -1 Guidance Care Center, Inc. Page 2 of 5 Contract No. Racket Pg. 2982 South Florida Behavioral Health Network, Inc. V G� C 01 C1 C9 C C1 U U. / U. U C E Oi CM Oi E C9 Exhibit C -1 Guidance Care Center, Inc. Page 3 of 5 Contract No. Racket Pg. 2983 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 8, Quarterly Program Status Report April 30, 2016 via E -mail) ME Director of Prevention (Period: 01/01/16 - 03/31/16) rvices Services Se July 31, 2016 (Period: 04/01/16 - 06/30/16) October 31, 2015 (Period: 07/01/15 - 09/30/15) 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 via E -mail) & (Period: 01/01/16 - 03/31/16) ME Contract Manager July 31, 2016 (Period: 04101/16 - 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 - 12/31/15) ME VP of Finance requirements in Attachment I, Section B. 1. a. April 30 2016 , 1 (Electronic Submission 8, (21) (Period: 01/01/16 - 03/31/16) via E -mail) ME Contract Manager July 31, 2016 (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. V G� C 01 C1 C9 C C1 U U. / U. U C E Oi CM Oi E C9 Exhibit C -1 Guidance Care Center, Inc. Page 3 of 5 Contract No. Racket Pg. 2983 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, Budget directly to each of the following unless 1 (Electronic Submission ME Contract Manager 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 -Day Availability Payments 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. V G� C C! C! C9 M C! E U C4 U. co U. U C E CM Oi E C9 Exhibit C -1 Guidance Care Center, Inc. Page 4 of 5 Contract No. Racket Pg. 2984 South Florida Behavioral Health Network, Inc. Year -End Financial Reports 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, Financial Compliance Audit to include the directly to each of the following unless 1 (Electronic Submission ME Contract Manager necessary schedules per Attachment II otherwise required by Florida Statutes via E -mail) The schedule shall be based on V 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, direct to each of the following unless directly g 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 ecroc u sson ME Contract Manager g, 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 & The schedule shall be based on via E -mail) VP of Finance revenues and expenditures recorded during the state's fiscal year. V G� C1 C9 C1 U U. co U. U C E CM 0I C9 Exhibit C -1 Guidance Care Center, Inc. Page 5 of 5 Contract No. Racket Pg. 2985 Exhibit D Substance Abuse & Mental Health Reauired Performance Outcomes & Outputs Provider Name: Guidance /Care Center, Inc. Contract #: PPG -2 -03' Date: September 1, 2015 -June 30, 2018 Revision #: Guidance Care Center, Inc. Exhibit D Contract No. Page 1 of 2 Packet Pg. 2986 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 illness 40 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 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 30 days prior to discharge 15% 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 at the time of discharge 94% 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 functioning 64% 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 housing environment 93% MH780 f. Percent of children at risk of emotional disturbance (ED) who live in a stable housing environment 96% 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 versus 30 days prior to discharge 20% SA752 c. Percent of children with substance abuse who live in a stable housing environment at the time of discharge 93% Guidance Care Center, Inc. Exhibit D Contract No. Page 1 of 2 Packet Pg. 2986 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. Page 2 of 2 Packet Pg. 2987 Table '2 Network Service Provider Output Measures — Persons Served For Fiscal Year FYIS -16 Service Category FY Target Residential Care 0 7i s Outpatient Care 0 d o Crisis Care 0 = _ a State Hospital Discharges N/A Peer Support Services 0 Residential Care N/A L Outpatient Care N/A Crisis' Care N/A Z =' SIPP Discharge N/A a, Residential Care 0 c Outpatient Care 0 N a Detoxification 0 Women's Specific Services 0 a Injecting Drug Users 0 Residential Care N/A c M Outpatient Care N/A 3 Detoxification N/A a "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. Page 2 of 2 Packet Pg. 2987 Exhibit E Monthly Payment Request 1. Exhibit E, Monthly Payment Request This exhibit is incorporated by reference and available at following website: h :1 /sfbh�. r /� �rovid s /contracts/ Exhibit E Guidance Care Center, Inc. 1 of 1 Contract No. Packet Fig. 2988 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. Racket Fig. 2989 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. Racket Fig. 2990 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 FLORIDA ADMINISTRATIVE CODE (RULES) A. Child Welfare and Community Based Care a� Ch. 65C -12, F.A.C. Emergency Shelter Care Ch. 65C -13, F.A.C. Foster Care Licensing a� Ch. 65C -14, F.A.C. Group Care Ch. 65C -15, F.A.C. Child- Placing Agencies c� 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 Residentia E 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 Resider Treatment Programs U) Ch. 65E -14, F.A.C. Community Substance Abuse and Mental Health Services- Financial Rt Ch. 65E -15, F.A.C. Continuity of Care Case Management Ch. 65E -20, F.A.C. Forensic Client Services Act Regulation U. CH. 65E -26, F.A.C. Substance Abuse and Mental Health Priority Populations and co Services >_ LL 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 Cost Principles for Educational Institutions OMB Circular A -87 Cost Principles for State, Local and Indian Tribal Governments Exhibit F Page 3 of 4 Guidance Care Center, Inc. Contract No. Packet Fig. 2991 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 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. Racket Fig. 2992 September 1, 2015 - June 30, 2016 EXMBIT G: COVERED SERVICES BY OCA Septemb Guidance/Care Center, Inc. - PPG PPG -2 -03 "H010 N11 M110 MWIR MKI0721 N111073 N11'0 M"1093 N H01'G MHe :M)CF Exhibit G Guidance Care Center, Inc. Page 1 of 4 Contract No. P -- ' I Packet Pg. 2993 COVERED SERVICES FUNDING MIRA01 MRA09 M]EIA18 M]EIA18 M]EIA72 M]EIA73 M]EIA76 MIEIA93 MIEIA94 MRAPG MRATB MIE[ACF TOTAL RATE $ Assessment Case Management $ Crisis Stabilization $ Crisis Support/Emergency $ Day/Night Drop-In/Self He 1p Centers $ In-Home/On-Site $ Intervention Individual $ Intervention Group Medical Services $ Outpatient - Individual $ Outpatient - Group $ Outreach Residential Level I $ Residential Level 11 $ Residential Level III $ .Y1 Residential Level IV $ Substance Abuse Detox $ Supported Employment Supportive Housing TASC Incidental Expenses I:. Aftercare - Individual A: Aftercare - Group Information & Referral $ FACT Team Room & Board Level I Room & Board Level 11 $ Room & Board Level III Short-term Residential Treatment Clubhouse Services $ CCST - Individual CCST - Group $ Recovery Support - Individual .7 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 $ Special Proviso $ *Highlighted cells are eligible for fund allocation $ TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ $ $ TOTAL UNCOMPENSATED $ Exhibit G Guidance Care Center, Inc. Page 1 of 4 Contract No. P -- ' I Packet Pg. 2993 September 1, 2015 - June 30, 2016 EXHIBIT G: COVERED SERVICES BY OCA Septembe Guidance/Care Center, Inc. - PPG PPG-2-03 MKI001 M1009 M11009_0 018 W1018 M1 MINN A MHUFA-CR N111"Al"D MHUMD-CR M IWIF Exhibit G Guidance Care Center, Inc. Page 2 of 4 Contract No. P -- ' I Packet Pg. 2994 COVERED SERVICES FUNDING MIRC01 MHC09 %IHC09-Cl MHC18 MHC18 M]EICBN MHCFA MHCFA-CR MHCNM MIE[CMD-CR MHCCF TOTAL RATE Assessment Case Management Crisis Stabilization Crisis Support/Emergency Day/Night Drop-In/Self Help Centers In-Home/On-Site Intervention Individual Intervention Group Medical Services Outpatient - Individual Outpatient - Group Outreach E Residential Level I Residential Level 11 Residential Level III .Y1 Residential Level IV 2, Substance Abuse Detox Supported Employment U) Supportive Housing TASC co Incidental Expenses I Aftercare - Individual LL Aftercare - Group Information & Referral FACT Team LL Room & Board Level I Room & Board Level 11 Room & Board Level III U) Short-term Residential Treatment Clubhouse Services CCST - Individual CCST - Group Recovery Support - Individual .7 Recovery Support - Group E 48 Prevention - Indicated $ 43.12 0) 49 Prevention - Selective $ 48.68 50 Prevention - Universal Direct $ 48.68 51 Prevention - Universal Indirect $ 48.68 Special Proviso E *Highlighted cells are eligible for fund allocation TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ $ TOTAL UNCOMPENSATED $ Exhibit G Guidance Care Center, Inc. Page 2 of 4 Contract No. P -- ' I Packet Pg. 2994 September 1, 2015 - June 30, 2016 EXHIBIT G: COVERED SERVICES BY OCA Septembe Guidance/Care Center, Inc. - PPG PPG-2-03 MN003 VIMM MS021 N`IS023 MN25 S XIS081 M NIS01B XIS903 "WSKY Exhibit G Guidance Care Center, Inc. Page 3 of 4 Contract No. P -- ' I Packet Pg. 2995 COVERED SERVICES FUNDING MSA03 MSAII MSA21 MSA23 MSA25 MSA27 MSA81 MSA91 MSATB MSACF TOTAL RATE $ Assessment Case Management $ Crisis Stabilization $ Crisis Support/Emergency $ Day/Night Drop- In/Self Help Centers $ In-Home/On-Site $ Intervention Individual $ Intervention Group $ Medical Services $ Outpatient - Individual $ Outpatient - Group $ Outreach Residential Level I $ Residential Level 11 Residential Level III $ .Y1 Residential Level IV $ Substance Abuse Detox $ Supported Employment Supportive Housing $ TASC Incidental Expenses Aftercare - Individual $ Aftercare - Group Information & Referral $ FACT Team $ Room & Board Level I $ Room & Board Level 11 $ Room & Board Level III Short-term Residential Treatment Clubhouse Services $ CCST - Individual CCST - Group $ Recovery Support - Individual .7 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 $ Special Proviso $ *Highlighted cells are eligible for fund allocation $ TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ $ $ $ $ TOTAL UNCOMPENSATED Exhibit G Guidance Care Center, Inc. Page 3 of 4 Contract No. P -- ' I Packet Pg. 2995 September 1, 2015 - June 30, 2016 EXHIBIT G: COVERED SERVICES BY OCA Septembe Guidance/Care Center, Inc. - PPG PPG-2-03 MIR MNW I NIN21 MN23 M Rs' 0 2 5 2 919P "K F MSUPP MM)TH NIN 13 TOTAL UNCOMPENSATED I Exhibit G Guidance Care Center, Inc. Page 4 of 4 Contract No. P ' I Packet Pg. 2996 COVERED SERVICES FUNDING MSCO3 MSCII MSC21 MSC23 MSC25 MSC25-CR MSCPP MSCTB MSCCF TOTAL RATE 150,000 150,000 Assessment Case Management Crisis Stabilization Crisis Support/Emergency Day/Night Drop-In/Self Help Centers In-Home/On-Site Intervention Individual Intervention Group Medical Services Outpatient - Individual Outpatient - Group Outreach Residential Level I Residential Level 11 Residential Level III .Y1 Residential Level IV Substance Abuse Detox Supported Employment Supportive Housing TASC Incidental Expenses Aftercare - Individual Aftercare - Group Information & Referral FACT Team Room & Board Level I Room & Board Level 11 Room & Board Level III Short-term Residential Treatment Clubhouse Services CCST - Individual CCST - Group Recovery Support - Individual .7 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 Special Proviso *Highlighted cells are eligible for fund allocation TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ 150,000 $ $ $ 150,000 TOTAL UNCOMPENSATED I Exhibit G Guidance Care Center, Inc. Page 4 of 4 Contract No. P ' I Packet Pg. 2996 July 1, 2016 - June 30, 2017 EXMBIT G: COVERED SERVICES BY OCA Septembe Guidance/Care Center, Inc. - PPG PPG -2 -03 "H010 N11 M110 MWIR MKI0721 N111073 N11'0 M"1093 N H01'G MM :M)CF Exhibit G Guidance Care Center, Inc. Page 1 of 4 Contract No. P -- ' I Packet Pg. 2997 COVERED SERVICES FUNDING MIRA01 MRA09 M]EIA18 M]EIA18 M]EIA72 M]EIA73 M]EIA76 MIEIA93 MIEIA94 MRAPG MRATB MIE[ACF TOTAL RATE $ Assessment Case Management $ Crisis Stabilization $ Crisis Support/Emergency $ Day/Night Drop-In/Self He 1p Centers $ In-Home/On-Site $ Intervention Individual $ Intervention Group Medical Services $ Outpatient - Individual $ Outpatient - Group $ Outreach Residential Level I $ Residential Level 11 $ Residential Level III $ .Y1 Residential Level IV $ Substance Abuse Detox $ Supported Employment Supportive Housing TASC Incidental Expenses I:. Aftercare - Individual A: Aftercare - Group Information & Referral $ FACT Team Room & Board Level I Room & Board Level 11 $ Room & Board Level III Short-term Residential Treatment Clubhouse Services $ CCST - Individual CCST - Group $ Recovery Support - Individual .7 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 $ Special Proviso $ *Highlighted cells are eligible for fund allocation $ TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ $ $ TOTAL UNCOMPENSATED $ Exhibit G Guidance Care Center, Inc. Page 1 of 4 Contract No. P -- ' I Packet Pg. 2997 July 1, 2016 - June 30, 2017 EXHIBIT G: COVERED SERVICES BY OCA Septembe Guidance/Care Center, Inc. - PPG PPG-2-03 MKI001 M1009 M11009_0 018 W1018 M1 MINN A MHUFA-CR N111"Al"D MHUMD-CR M IWIF Exhibit G Guidance Care Center, Inc. Page 2 of 4 Contract No. P -- ' I Packet Pg. 2998 COVERED SERVICES FUNDING MIRC01 MHC09 %IHC09-Cl MHC18 MHC18 M]EICBN MHCFA MHCFA-CR MHCNM MIE[CMD-CR MHCCF TOTAL RATE Assessment Case Management Crisis Stabilization Crisis Support/Emergency Day/Night Drop-In/Self Help Centers In-Home/On-Site Intervention Individual Intervention Group Medical Services Outpatient - Individual Outpatient - Group Outreach E Residential Level I Residential Level 11 Residential Level III .Y1 Residential Level IV 2, Substance Abuse Detox Supported Employment U) Supportive Housing TASC co Incidental Expenses I Aftercare - Individual LL Aftercare - Group Information & Referral FACT Team LL Room & Board Level I Room & Board Level 11 Room & Board Level III U) Short-term Residential Treatment Clubhouse Services CCST - Individual CCST - Group Recovery Support - Individual .7 Recovery Support - Group E 48 Prevention - Indicated $ 43.12 0) 49 Prevention - Selective $ 48.68 50 Prevention - Universal Direct $ 48.68 51 Prevention - Universal Indirect $ 48.68 Special Proviso E *Highlighted cells are eligible for fund allocation TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ $ TOTAL UNCOMPENSATED $ Exhibit G Guidance Care Center, Inc. Page 2 of 4 Contract No. P -- ' I Packet Pg. 2998 July 1, 2016 - June 30, 2017 EXMBIT G: COVERED SERVICES BY OCA Septemb Guidance/Care Center, Inc. - PPG PPG-2-03 MN003 VIMM MS021 N`IS023 MN25 S XIS081 M NIS01B XIS903 "WSKY Exhibit G Guidance Care Center, Inc. Page 3 of 4 Contract No. P -- ' I Packet Pg. 2999 COVERED SERVICES FUNDING MSA03 MSAII MSA21 MSA23 MSA25 MSA27 MSA81 MSA91 MSATB MSACF TOTAL RATE $ Assessment Case Management $ Crisis Stabilization $ Crisis Support/Emergency $ Day/Night Drop- In/Self Help Centers $ In-Home/On-Site $ Intervention Individual $ Intervention Group $ Medical Services $ Outpatient - Individual $ Outpatient - Group $ Outreach Residential Level I $ Residential Level 11 Residential Level III $ .Y1 Residential Level IV $ Substance Abuse Detox $ Supported Employment Supportive Housing $ TASC Incidental Expenses Aftercare - Individual $ Aftercare - Group Information & Referral $ FACT Team $ Room & Board Level I $ Room & Board Level 11 $ Room & Board Level III Short-term Residential Treatment Clubhouse Services $ CCST - Individual CCST - Group $ Recovery Support - Individual .7 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 $ Special Proviso $ *Highlighted cells are eligible for fund allocation $ TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ $ $ $ $ TOTAL UNCOMPENSATED Exhibit G Guidance Care Center, Inc. Page 3 of 4 Contract No. P -- ' I Packet Pg. 2999 July 1, 2016 - June 30, 2017 EXMBIT G: COVERED SERVICES BY OCA Septembe Guidance/Care Center, Inc. - PPG PPG-2-03 MIR MNW I NIN21 MN23 M Rs' 0 2 5 2 919P "K F MSUPP MM)TH NIN 13 TOTAL UNCOMPENSATED I Exhibit G Guidance Care Center, Inc. Page 4 of 4 Contract No. P ' I Packet Pg. 3000 COVERED SERVICES FUNDING MSCO3 MSCII MSC21 MSC23 MSC25 MSC25-CR MSCPP MSCTB MSCCF TOTAL RATE 150,000 150,000 Assessment Case Management Crisis Stabilization Crisis Support/Emergency Day/Night Drop-In/Self Help Centers In-Home/On-Site Intervention Individual Intervention Group Medical Services Outpatient - Individual Outpatient - Group Outreach Residential Level I Residential Level 11 Residential Level III .Y1 Residential Level IV Substance Abuse Detox Supported Employment Supportive Housing TASC Incidental Expenses Aftercare - Individual Aftercare - Group Information & Referral FACT Team Room & Board Level I Room & Board Level 11 Room & Board Level III Short-term Residential Treatment Clubhouse Services CCST - Individual CCST - Group Recovery Support - Individual .7 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 Special Proviso *Highlighted cells are eligible for fund allocation TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ 150,000 $ $ $ 150,000 TOTAL UNCOMPENSATED I Exhibit G Guidance Care Center, Inc. Page 4 of 4 Contract No. P ' I Packet Pg. 3000 July 1, 2017 - June 30, 2018 EXMBIT G: COVERED SERVICES BY OCA Septembe Guidance/Care Center, Inc. - PPG PPG -2 -03 "H010 N11 M110 MWIR MKI0721 N111073 N11'0 M"1093 N H01'G MM :M)CF Exhibit G Guidance Care Center, Inc. Page 1 of 4 Contract No. P -- ' I Packet Pg. 3001 COVERED SERVICES FUNDING MIRA01 MRA09 M]EIA18 M]EIA18 M]EIA72 M]EIA73 M]EIA76 MIEIA93 MIEIA94 MRAPG MRATB MIE[ACF TOTAL RATE $ Assessment Case Management $ Crisis Stabilization $ Crisis Support/Emergency $ Day/Night Drop-In/Self He 1p Centers $ In-Home/On-Site $ Intervention Individual $ Intervention Group Medical Services $ Outpatient - Individual $ Outpatient - Group $ Outreach Residential Level I $ Residential Level 11 $ Residential Level III $ .Y1 Residential Level IV $ Substance Abuse Detox $ Supported Employment Supportive Housing TASC Incidental Expenses I:. Aftercare - Individual A: Aftercare - Group Information & Referral $ FACT Team Room & Board Level I Room & Board Level 11 $ Room & Board Level III Short-term Residential Treatment Clubhouse Services $ CCST - Individual CCST - Group $ Recovery Support - Individual .7 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 $ Special Proviso $ *Highlighted cells are eligible for fund allocation $ TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ $ $ TOTAL UNCOMPENSATED $ Exhibit G Guidance Care Center, Inc. Page 1 of 4 Contract No. P -- ' I Packet Pg. 3001 July 1, 2017 - June 30, 2018 EXHIBIT G: COVERED SERVICES BY OCA Septembe Guidance/Care Center, Inc. - PPG PPG-2-03 MKI001 M1009 M11009_0 018 W1018 M1101M MINN A MHUFA-CR N111"Al"D MHUMD-CR M IWIF Exhibit G Guidance Care Center, Inc. Page 2 of 4 Contract No. P -- ' I Packet Pg. 3002 COVERED SERVICES FUNDING MIRC01 MHC09 %IHC09-Cl MHC18 MHC18 M]EICBN MHCFA MHCFA-CR MHCNM MIE[CMD-CR MHCCF TOTAL RATE Assessment Case Management Crisis Stabilization Crisis Support/Emergency Day/Night Drop-In/Self Help Centers In-Home/On-Site Intervention Individual Intervention Group Medical Services Outpatient - Individual Outpatient - Group Outreach E Residential Level I Residential Level 11 Residential Level III .Y1 Residential Level IV 2, Substance Abuse Detox Supported Employment U) Supportive Housing TASC co Incidental Expenses I Aftercare - Individual LL Aftercare - Group Information & Referral FACT Team LL Room & Board Level I Room & Board Level 11 Room & Board Level III U) Short-term Residential Treatment Clubhouse Services CCST - Individual CCST - Group Recovery Support - Individual .7 Recovery Support - Group E 48 Prevention - Indicated $ 43.12 0) 49 Prevention - Selective $ 48.68 50 Prevention - Universal Direct $ 48.68 51 Prevention - Universal Indirect $ 48.68 Special Proviso E *Highlighted cells are eligible for fund allocation TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ $ TOTAL UNCOMPENSATED $ Exhibit G Guidance Care Center, Inc. Page 2 of 4 Contract No. P -- ' I Packet Pg. 3002 July 1, 2017 - June 30, 2018 EXMBIT G: COVERED SERVICES BY OCA Septembe Guidance/Care Center, Inc. - PPG PPG-2-03 MN003 VIMM MS021 N`IS023 MN25 S XIS081 M NIS01B XIS903 "WSKY Exhibit G Guidance Care Center, Inc. Page 3 of 4 Contract No. P -- ' I Packet Pg. 3003 COVERED SERVICES FUNDING MSA03 MSAII MSA21 MSA23 MSA25 MSA27 MSA81 MSA91 MSATB MSACF TOTAL RATE $ Assessment Case Management $ Crisis Stabilization $ Crisis Support/Emergency $ Day/Night Drop- In/Self Help Centers $ In-Home/On-Site $ Intervention Individual $ Intervention Group $ Medical Services $ Outpatient - Individual $ Outpatient - Group $ Outreach Residential Level I $ Residential Level 11 Residential Level III $ .Y1 Residential Level IV $ Substance Abuse Detox $ Supported Employment Supportive Housing $ TASC Incidental Expenses Aftercare - Individual $ Aftercare - Group Information & Referral $ FACT Team $ Room & Board Level I $ Room & Board Level 11 $ Room & Board Level III Short-term Residential Treatment Clubhouse Services $ CCST - Individual CCST - Group $ Recovery Support - Individual .7 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 $ Special Proviso $ *Highlighted cells are eligible for fund allocation $ TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ $ $ $ $ TOTAL UNCOMPENSATED Exhibit G Guidance Care Center, Inc. Page 3 of 4 Contract No. P -- ' I Packet Pg. 3003 July 1, 2017 - June 30, 2018 EXMBIT G: COVERED SERVICES BY OCA Septembe Guidance/Care Center, Inc. - PPG PPG-2-03 MIR MNW I NIN21 MN23 M Rs' 0 2 5 2 919P "K F MSUPP MM)TH NIN 13 TOTAL UNCOMPENSATED I Exhibit G Guidance Care Center, Inc. Page 4 of 4 Contract No. P ' I Packet Pg. 3004 COVERED SERVICES FUNDING MSCO3 MSCII MSC21 MSC23 MSC25 MSC25-CR MSCPP MSCTB MSCCF TOTAL RATE 150,000 150,000 Assessment Case Management Crisis Stabilization Crisis Support/Emergency Day/Night Drop-In/Self Help Centers In-Home/On-Site Intervention Individual Intervention Group Medical Services Outpatient - Individual Outpatient - Group Outreach Residential Level I Residential Level 11 Residential Level III .Y1 Residential Level IV Substance Abuse Detox Supported Employment Supportive Housing TASC Incidental Expenses Aftercare - Individual Aftercare - Group Information & Referral FACT Team Room & Board Level I Room & Board Level 11 Room & Board Level III Short-term Residential Treatment Clubhouse Services CCST - Individual CCST - Group Recovery Support - Individual .7 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 Special Proviso *Highlighted cells are eligible for fund allocation TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ 150,000 $ $ $ 150,000 TOTAL UNCOMPENSATED I Exhibit G Guidance Care Center, Inc. Page 4 of 4 Contract No. P ' I Packet Pg. 3004 September 1, 2015 -June 30, 2016 Provider: Guidance /Care Center, Inc. - PPG Contract #: PPG -2 -03 Amendment # ADULT MENTAL HEALTH NEW OCA OLD OCA OCA DESCRIPTION NEW C3CA OLD OCA AMOUNT Residential Services MHO01 MHA01 $ Non- Residential Services MH009 MHA09 $ Crisis Services MHO18 MHA18 $ Crisis Services - Baker Act MHO18 MHA18 $ Community Forensic Program MH072 MHA72 $ FACT Team MH073 MHA73 $ Indigent Drug Program MH076 MHA76 $ Proviso Allocation - Camillus M11093 MHA93 $ Proviso Allocation - Citrus MH094 MHA94 $ PATH Grant MHOPCI MHAPG $ TANF MHOTB MHATB $ Carry Forward M110CF MHACF $ TOTAL ADULT MENTAL HEALTH = $ OCA DESCRIPTION NEW OCA OLD OCA AMOUNT Residential Services MS003 MSA03 $ Non- Residential Services MS011 MSAI l $ Detox Services MS021 MSA21 $ HIV Services MS023 MSA23 $ Prevention Services MS025 MSA25 $ Women's Services 15027 MSA27 $ Pregnant Women Project MS081 MSA81 $ Proviso Allocation - GCC MS091 MSA91 $ TANF MSOTR MSATB $ Proviso Allocation - Here's Help MS903 FACES Wraparound Grant - CR $ Carry Forward MSOC'F MSACF $ TOTAL ADULT SUBSTANCE ABUSE _ $ FUNDS NOT REQUIRING MATCH: NEW OCA OLD OCA Drug Abuse Services NEW OCA OLD OCA Prevention $ Deinstitutionalization Project $ CMH Program $ MH Block Grant MFIC09 TOTAL FUNDS NOT REQUIRING MATCH $ TOTAL CHILDREN SUBSTANCE ABUSE _ $ 150,000 TOTAL ALL PROGRAMS = $ 150,000 UNCOMPENSATED UNITS = TOTAL= $ 150,000 TOTAL FUNDS REQUIRING MATCH = $ 150,000 LOCAL MATCH REQUIRED = $ 37,500 NOTES 10/1/2015 $150,000 is allocated for the PPG Grant funded prevention services per the RFA EDIT H - FUNDING DETAIL CHILDREN MENTAL HEALTH NEW OCA OLD OCA OCA DESCRIPTION NEW OCA OLD OCA AMOUNT Residential Services M11001 MFICO1 $ Non- Residential Services MH009 MFIC09 $ Non- Residential Services - CR MH009 MFIC09 $ - Crisis Services MH018 MFIC18 $ - Crisis Services - Baker Act MHO 18 MFIC18 $ Special Appropriation - ICFH MHOBN MHCBN $ FACES Expansion Grant MHOFA MHCFA $ FACES Expansion Grant - CR M170FA MHCFA $ FACES Wraparound Grant MHCMD MHCMD $ FACES Wraparound Grant - CR MHCMD MHCMD $ Carry Forward MHCFF MHCCF $ TOTAL CHILDREN MENTAL HEALTH = $ OCA DESCRIPTION NEW OCA OLD OCA AMOUNT Residential Services MS003 MSCO3 $ Non-Residential Services MS011 MSCI l $ Detox Services MS021 MSC21 $ HIV Services MS023 MSC23 $ Prevention Services MS025 MSC25 $ - Prevention Services - CR MS025 MSC25 $ - Prevention Partnership Grant MSOPP MSCPP $ 150,000 TANF Services MSCTB MSCTB $ - Proviso Allocation - Here's Help MS903 $ Carry Forward MSOC-F MSCCF $ Guidance Care Center, Inc. Exhibit H Contract No. Page 1 of 1 Packet Fig. 3005 July 1, 2016 -June 30, 2017 Provider: Guidance /Care Center, Inc. - PPG Contract #: PPG -2 -03 Amendment # ADULT MENTAL HEALTH NEW OCA OLD OCA OCA DESCRIPTION NEW C3CA OLD OCA AMOUNT Residential Services MHO01 MHA01 $ Non- Residential Services MH009 MHA09 $ Crisis Services MHO18 MHA18 $ Crisis Services - Baker Act MHO18 MHA18 $ Community Forensic Program MH072 MHA72 $ FACT Team MH073 MHA73 $ Indigent Drug Program MH076 MHA76 $ Proviso Allocation - Camillus M11093 MHA93 $ Proviso Allocation - Citrus MH094 MHA94 $ PATH Grant MHOPCI MHAPG $ TANF MHOTB MHATB $ Carry Forward M110CF MHACF $ TOTAL ADULT MENTAL HEALTH = $ OCA DESCRIPTION NEW OCA OLD OCA AMOUNT Residential Services MS003 MSA03 $ Non- Residential Services MS011 MSAI l $ Detox Services MS021 MSA21 $ HIV Services MS023 MSA23 $ Prevention Services MS025 MSA25 $ Women's Services 15027 MSA27 $ Pregnant Women Project MS081 MSA81 $ Proviso Allocation - GCC MS091 MSA91 $ TANF MSOTR MSATB $ Proviso Allocation - Here's Help MS903 FACES Wraparound Grant - CR $ Carry Forward MSOC'F MSACF $ TOTAL ADULT SUBSTANCE ABUSE _ $ FUNDS NOT REQUIRING MATCH: NEW OCA OLD OCA Drug Abuse Services NEW OCA OLD OCA Prevention $ Deinstitutionalization Project $ CMH Program $ MH Block Grant MFIC09 TOTAL FUNDS NOT REQUIRING MATCH $ TOTAL CHILDREN SUBSTANCE ABUSE _ $ 150,000 TOTAL ALL PROGRAMS = $ 150,000 UNCOMPENSATED UNITS = TOTAL= $ 150,000 TOTAL FUNDS REQUIRING MATCH = $ 150,000 LOCAL MATCH REQUIRED = $ 37,500 NOTES 10/1/2015 $150,000 is allocated for the PPG Grant funded prevention services per the RFA EDIT H - FUNDING DETAIL CHILDREN MENTAL HEALTH NEW OCA OLD OCA OCA DESCRIPTION NEW OCA OLD OCA AMOUNT Residential Services M11001 MFICO1 $ Non- Residential Services MH009 MFIC09 $ Non- Residential Services - CR MH009 MFIC09 $ - Crisis Services MH018 MFIC18 $ - Crisis Services - Baker Act MHO 18 MFIC18 $ Special Appropriation - ICFH MHOBN MHCBN $ FACES Expansion Grant MHOFA MHCFA $ FACES Expansion Grant - CR M170FA MHCFA $ FACES Wraparound Grant MHCMD MHCMD $ FACES Wraparound Grant - CR MHCMD MHCMD $ Carry Forward MHCFF MHCCF $ TOTAL CHILDREN MENTAL HEALTH = $ OCA DESCRIPTION NEW OCA OLD OCA AMOUNT Residential Services MS003 MSCO3 $ Non-Residential Services MS011 MSCI l $ Detox Services MS021 MSC21 $ HIV Services MS023 MSC23 $ Prevention Services MS025 MSC25 $ - Prevention Services - CR MS025 MSC25 $ - Prevention Partnership Grant MSOPP MSCPP $ 150,000 TANF Services MSCTB MSCTB $ - Proviso Allocation - Here's Help MS903 $ Carry Forward MSOC-F MSCCF $ Guidance Care Center, Inc. Exhibit H Contract No. Page 1 of 1 Racket Fig. 3006 July 1, 2017 -June 30, 2018 Provider: Guidance /Care Center, Inc. - PPG Contract #: PPG -2 -03 Amendment # ADULT MENTAL HEALTH NEW OCA OLD OCA OCA DESCRIPTION NEW C3CA OLD OCA AMOUNT Residential Services MHO01 MHA01 $ Non- Residential Services MH009 MHA09 $ Crisis Services MHO18 MHA18 $ Crisis Services - Baker Act MHO18 MHA18 $ Community Forensic Program MH072 MHA72 $ FACT Team MH073 MHA73 $ Indigent Drug Program MH076 MHA76 $ Proviso Allocation - Camillus M11093 MHA93 $ Proviso Allocation - Citrus MH094 MHA94 $ PATH Grant MHOPCI MHAPG $ TANF MHOTB MHATB $ Carry Forward M110CF MHACF $ TOTAL ADULT MENTAL HEALTH = $ OCA DESCRIPTION NEW OCA OLD OCA AMOUNT Residential Services MS003 MSA03 $ Non- Residential Services MS011 MSAI l $ Detox Services MS021 MSA21 $ HIV Services MS023 MSA23 $ Prevention Services MS025 MSA25 $ Women's Services 15027 MSA27 $ Pregnant Women Project MS081 MSA81 $ Proviso Allocation - GCC MS091 MSA91 $ TANF MSOTR MSATB $ Proviso Allocation - Here's Help MS903 FACES Wraparound Grant - CR $ Carry Forward MSOC'F MSACF $ TOTAL ADULT SUBSTANCE ABUSE _ $ FUNDS NOT REQUIRING MATCH: NEW OCA OLD OCA Drug Abuse Services NEW OCA OLD OCA Prevention $ Deinstitutionalization Project $ CMH Program $ MH Block Grant MFIC09 TOTAL FUNDS NOT REQUIRING MATCH $ TOTAL CHILDREN SUBSTANCE ABUSE _ $ 150,000 TOTAL ALL PROGRAMS = $ 150,000 UNCOMPENSATED UNITS = TOTAL= $ 150,000 TOTAL FUNDS REQUIRING MATCH = $ 150,000 LOCAL MATCH REQUIRED = $ 37,500 NOTES 10/1/2015 $150,000 is allocated for the PPG Grant funded prevention services per the RFA EDIT H - FUNDING DETAIL CHILDREN MENTAL HEALTH NEW OCA OLD OCA OCA DESCRIPTION NEW OCA OLD OCA AMOUNT Residential Services M11001 MFICO1 $ Non- Residential Services MH009 MFIC09 $ Non- Residential Services - CR MH009 MFIC09 $ - Crisis Services MH018 MFIC18 $ - Crisis Services - Baker Act MHO 18 MFIC18 $ Special Appropriation - ICFH MHOBN MHCBN $ FACES Expansion Grant MHOFA MHCFA $ FACES Expansion Grant - CR M170FA MHCFA $ FACES Wraparound Grant MHCMD MHCMD $ FACES Wraparound Grant - CR MHCMD MHCMD $ Carry Forward MHCFF MHCCF $ TOTAL CHILDREN MENTAL HEALTH = $ OCA DESCRIPTION NEW OCA OLD OCA AMOUNT Residential Services MS003 MSCO3 $ Non-Residential Services MS011 MSCI l $ Detox Services MS021 MSC21 $ HIV Services MS023 MSC23 $ Prevention Services MS025 MSC25 $ - Prevention Services - CR MS025 MSC25 $ - Prevention Partnership Grant MSOPP MSCPP $ 150,000 TANF Services MSCTB MSCTB $ - Proviso Allocation - Here's Help MS903 $ Carry Forward MSOC-F MSCCF $ Guidance Care Center, Inc. Exhibit H Contract No. Page 1 of 1 Racket Fig. 3007 September 1, 2015- June 30, 2016 Guidance /Care Center, Inc. - PPG PPG -2 -03 REQUIRED MATCH: $ 37,500 Guidance Care Center, Inc. LOCAL MATCH PLAN Se 'S.4.a UNITS MATCH UNITS MATCH UNITS MATCH UNITS MATCH 869.67 $ 37,500 $ - $ - $ - $ 37,500 Local Match Plan Page 1 of 1 Contract No. Packet Pg. 3008 COST CENTERS 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 $ - 50 Prevention - Universal Direct $ - 51 Prevention - Universal Indirect $ - 99 Special Proviso $ - MATCH ALLOCATION: GRAND TOTAL: $ 37,500 Guidance Care Center, Inc. LOCAL MATCH PLAN Se 'S.4.a UNITS MATCH UNITS MATCH UNITS MATCH UNITS MATCH 869.67 $ 37,500 $ - $ - $ - $ 37,500 Local Match Plan Page 1 of 1 Contract No. Packet Pg. 3008 July 1, 2016- June 30, 2017 Guidance /Care Center, Inc. - PPG PPG -2 -03 REQUIRED MATCH: $ 37,500 Guidance Care Center, Inc. LOCAL MATCH PLAN Se 'S.4.a UNITS MATCH UNITS MATCH UNITS MATCH UNITS MATCH 869.67 $ 37,500 $ - $ - $ - $ 37,500 Local Match Plan Page 1 of 1 Contract No. Packet Pg. 3009 COST CENTERS 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 $ - 50 Prevention - Universal Direct $ - 51 Prevention - Universal Indirect $ - 99 Special Proviso $ - MATCH ALLOCATION: GRAND TOTAL: $ 37,500 Guidance Care Center, Inc. LOCAL MATCH PLAN Se 'S.4.a UNITS MATCH UNITS MATCH UNITS MATCH UNITS MATCH 869.67 $ 37,500 $ - $ - $ - $ 37,500 Local Match Plan Page 1 of 1 Contract No. Packet Pg. 3009 July 1, 2017- June 30, 2018 Guidance /Care Center, Inc. - PPG PPG -2 -03 REQUIRED MATCH: $ 37,500 Guidance Care Center, Inc. LOCAL MATCH PLAN Se 'S.4.a UNITS MATCH UNITS MATCH UNITS MATCH UNITS MATCH 869.67 $ 37,500 $ - $ - $ - $ 37,500 Local Match Plan Page 1 of 1 Contract No. Packet Pg. 3010 COST CENTERS 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 $ - 50 Prevention - Universal Direct $ - 51 Prevention - Universal Indirect $ - 99 Special Proviso $ - MATCH ALLOCATION: GRAND TOTAL: $ 37,500 Guidance Care Center, Inc. LOCAL MATCH PLAN Se 'S.4.a UNITS MATCH UNITS MATCH UNITS MATCH UNITS MATCH 869.67 $ 37,500 $ - $ - $ - $ 37,500 Local Match Plan Page 1 of 1 Contract No. Packet Pg. 3010 P 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 L• 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. Racket Pg. 3011 P 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. Racket Fig. 3012 P 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 Winewood Boulevard Tallahassee, FL 32399 -0700 Email address: single. audit@, yflfa ilies.co C. Reporting packages for audits conducted in accordance with Uniform Guidance, co Section 200.500- 200.521, as revised, and required by Part I of this agreement shall be U. 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: 111iarvester, censos ,govlfac1co11ect1ddeinde.h 1 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: BO SIn e. i m t fe o le . o Attachment II Page 3 of 4 Guidance Care Center, Inc. Contract No. Racket Pg. 3013 P 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. Racket Pg. 3014 South FIori(Aa 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 fede4 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 shaft be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Signature !(� �R��� Date Name uthori � individual � Application or Contract Number Name of Organization ?c)cc) chS -5�, 530� Address of Organization CF 1123, PDF 03196 Attachment III Guidance Care Center, Inc. Page I of I Contract No. PPG -2 -03 F/ South Florida oe Behavioral 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 TYPE OF FUNDING: "Regular" Prevention Services Prevention Partnership Grant PPG X COST ALLOCATED TO: (check both if approved for both covered services) Children's Substance Abuse Adult Substance Abuse X X Section I. DESCRIPTION OF SERVICES AND STRATEGIES FOR SERVICE DELIVERY DESCRIPTION OF SERVICES SUMMARY (Include overall intention /purpose of program and service flaw, 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 comp rehensive p 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 g 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 strate UNIVERSAL— Indirect/Direct: Information Dissemination SELECTIVE: Education — Project SUCCESS and Alternatives INDICATED: Problem Identification and Referral and Alternatives Attachment IV Page 1 of 14 a� a� a� c� M a� U) C4 U. co U. U) c E CM c� Guidance Care Center, Inc. Contract No. Packet Fig. 3016 F/ South Florida oe Behavioral Health Network, Inc. EDUCATION — Project SUCCESS primarily involves the strategy of Education. The 9 "' 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 p articipant characteristics below): Universal — Direct or Indirect, Selective, Indicated Number of Unduplicated Participants if duplicated cote) 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 categ FYSAS 2010. A significantly reater percentag of Monroe County High School students 40.9% Attachment IV Page 2 of 14 co LL U) c 0 2 CM a� 0 W Guidance Care Center, Inc. Contract No. Packet Fig. 3017 F/ South Florida oe Behavioral 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 Zi C ©d # Children/ # Parent s Others Key West High School 2100 Fla ler Avenue Key West 33040 Level sessions, as well as the number of Childre Coral Shores High School 89901 Old Highway Tavernier 33070 Marathon Middle/High School 350 Sombrero Road Marathon 33050 Require e — tentative scheduleltimincg) Youth d Indicate "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, administrators DJJ Self- referral Social Service Agencies Wesley House and DCF Section V. PERFORMANCE MEASURES Quantitv Performance Measures Activities /Service Name & Description # Activity (Include frequency, intensity, & duration of # # # Require % To Level sessions, as well as the number of Childre Parent Other d Meet Selectiv cyclestcohorts expected to be offered and n/ s s Session Require e — tentative scheduleltimincg) Youth 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. Packet Fig. 3018 F/ South Florida oe Behavioral Health Network, Inc. Prevention Education Series 335 Timin 6to 8 85% Universal Project SUCCESS Measured at the end of each cohort attended (participant retention) Project SUCCESS pre /posts, Of attendance records and minimally 85% of scheduled sessions 85 % of youth will increase their scheduled Collected immediately prior to the 1 attitudes and beliefs related to session and immediately following the risk of harm associated with sessions underage drinking School Wide Activities 2500 9 90% Universal Small Groups 80 Project SUCCESS pre and post tests last session 2 85% Selective completion Newcomer 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 group alcohol and drug use 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) Quality Measure Measurement Reporting Tool Timin 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 1 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 a� e; a� a� c� a� U) C4 U. co U. U) c E CM c� Guidance Care Center, Inc. Contract No. Packet Fig. 3019 F/ South Florida oe Behavioral Health Network. Inc. # and % of youth /participants 90 % Satisfaction Survey Measured at the end of each program satisfied with services provided Activities /Service Name & Description cohort Observation of service Curriculum fidelity checklist Measured at the end of each program delivery/Fidelity checklist d Sessions or cohort Supervisor /Observer Report Hours 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 trainin # and % of staff working receive an initial screening of risk and protective factors Staff will show courses and documents toward Prevention from from the Florida Certification Board at certification with the Florida 50% time of contract monitoring. Certification Board Section VI. Participant Outcomes 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 drinkina amona the underage vouna adults and vouth of Monroe Countv. Cohorts Section VII. TASK LIST Attachment IV Page 5 of 14 LL U) c.a c E C0 c� Guidance Care Center, Inc. Contract No. Packet Fig. 3020 # & EBP % to Meet Activities /Service Name & Description Ty of Recommends this Participant d Sessions or Outcome s Hours Activity Title: Recruitment /Screening 545 N/A 85% 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 LL U) c.a c E C0 c� Guidance Care Center, Inc. Contract No. Packet Fig. 3020 F/ South Florida oe Behavioral Health Network, Inc. Duration: 60 mins. Designating enc Project SUCCESS SAMHSA approved, NREPP Activity Title: Project SUCCESS Prevention Education Series Curriculum 335 85% of 85% Activity Description: 91h 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 enc Project SUCCESS SAMHSA approved, NREPP Section IX. EVALUATION 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 a� a� c� a� U) U. U. Guidance Care Center, Inc. Contract No. Packet Fig. 3021 F/ South Florida Oe Behavioral 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. Racket Fig. 3022 �. South Florida ' � Behavioral - Health Network, Inc. Section X. EVALUATION PLAN Goal 1: By June 30, 2018, reduce the rate of past 34 -day alcohol use and the rate of Binge Drinking among underage young adults and youth in Monroe County. Future Survey annually) end of curriculum Assistant collects skills among minors. Data collection completion and enters data What measures Who/what is the Mow will the data be If survey data is When will Who is responsible instruments/ source of the data? collected? (e.g. archival needed, from 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 c as c� as U) c� U. U. U) 4) E c� Guidance Care Center, Inc. Contract No. Packet Pg. 3023 �. South Florida ' � Behavioral - Health Network, Inc. Intermediate Outcomes(s): Monitoring the Students Surveys 1,260 (420 Beginning and Research Reduce the number of Future Survey Data collection annually) end of curriculum Assistant collects underage alcohol drinkers Who /what is the How will the If survey data, What completion and enters data who report buying alcohol source of the data be from how many instruments/ will data be Evaluator in a store. data? collected? people will data questions will be collected? analyzes and be collected? used to collect 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 problems in Monroe County Framework. messaging and communication through formalizing strategy of new relationships to more effectively with key community build community ownership and business leaders of the underage using the Strategic drinking Prevention 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 c as c� as E a� U) c� U. U. U) 4) c� Guidance Care Center, Inc. Contract No. Packet Pg. 3024 �. South Florida ' � Behavioral - Health Network, Inc. Long term Outcome: By G /CC Hard copy singed 1 agency Coalition Annually Program Director 2018, MCC will have documents observations Involvement Assistant and signed Coalition quarterly Agreement Prevention involvement Agreements, Curriculum Supervisor which will create ownership among the G /CC and Monroe Surveys 10 Staff Perception Following Research community to change the County High Survey completion of Assistant collects community norms that are Schools each curriculum and enters data favorable to Underage cycle Evaluator drinking. analyzes and Objective 1 from CCAP: Increase capacity and funding of prevention resources in the community and for community stakeholders. Immediate Outcome(s): G /CC Observations Minimum of 3 Fidelity Measures Once (1) monthly Research Increase training, observations for Project Assistant and mentoring and technical quarterly SUCCESS Prevention assistance for community Curriculum Supervisor capacity building. Intermediate Outcomes(s): G /CC and Monroe Surveys 10 Staff Perception Following Research Increase capacity of County High Survey completion of Assistant collects prevention providers and Schools each curriculum and enters data community partners to cycle Evaluator collaborate effectively to analyzes and accomplish the Goals and reports data Objectives of the community related to underage drinking. Attachment IV Page 10 of 14 c as c� as E a� U) U. U. U) 0 c� Guidance Care Center, Inc. Contract No. Packet Pg. 3025 �. 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 c Oi C9 as E a� U) IN U. Go U. U) 4) E E tl Guidance Care Center, Inc. Contract No. Packet Pg. 3026 �. South Florida ' � Behavioral - Health Network, 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 12016 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 as as E a� a� U) IN U. Go U. U) 4) E E tt Guidance Care Center, Inc. Contract No. Packet Pg. 3027 �. South Florida ' � Behavioral - Health Network, Inc. Conduct Individual Assessments 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 12017 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 c as c� as E a� U) c� U. U. U) 4) E c� Guidance Care Center, Inc. Contract No. Packet Pg. 3028 �. South Florida ' � Behavioral - Health Network, Inc. Present program overview & update to Parent Advisory Councils at each school During Project SUCCESS counselors the months of Sept. and Feb. 2017 Counselors to conduct introductory classroom presentations Aug. Sept. Project SUCCESS counselors 2017 2017 Implement Prevention Series groups Sept. Apr. Project SUCCESS counselors 2017 2018 Conduct Individual Assessments Aug. May Project SUCCESS counselors 2017 2018 Test for program fidelity Oct. 2017 May Project SUCCESS counselors 2018 Conduct Pre and Post tests Aug. May Project SUCCESS counselors 2017 2018 School wide awareness activities During the Project SUCCESS counselors months of Sept., Oct. Nov., Dec. 2017 Feb. Mar. Apr May 2018 Conduct weekly clinical supervision with Counselors Jul. 2017 June Program Coordinator 2018 Conduct monthly PS staff meetings with all Program Staff Jul. 2017 June Program Coordinator 2018 Identify and refer students in need of services during the summer months Apr. 2017 June Project SUCCESS counselors 2018 Attachment IV Page 14 of 14 c as t� as E a� U) IN U. Go U. U) 4) E E t� Guidance Care Center, Inc. Contract No. Packet Pg. 3029 Amendment 41 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 -2015 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 1 -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. SOUTH FLORIDA BEHAVIORAL HEALTH NETWORK, INC. SIGNED / SIGNED / NAME: Frank Rabbito NA AME John W. Dow TITLE: Senior Vice President { , TITLE: President and CEO DATE: c) "`i /4n 4 DATE: E "` FEDERAL Tax ID # (or SSN): 59- 1458324 Guidance Care Center, Inc. Page 1 of 1 Contract No, PPG -2 -03 September 1, 2015- June 30, 2016 EXRIBIT G: COVERED SERVICES FUNDING BY OCA Guidance/Care Center, Inc. - PPG PPG3 MHOW ME009 1114018 MHOIS 1111072 MT1073 MR576 NIII093 NIH094 NIHOPG NU PUB Mq0C'F R Amendment #1 Guidance Care Center, Inc. Revised Exhibit G Contract No. P -- - -- Page 1 of 4 '1 Packet Pg. 3031 COVERED SERVICES FUNDING/ NtFIA01 MRA09 MHA18 MHAIS MRA72 MRA73 MRA76 MRA93 NtEIA94 MHAPG MHATB MHACF TOTAL RATE $ Assessment Case Management Crisis Stabilization J Crisis Support/Emergency Day/Night Drop-In/Self Help Centers In-Home/On-Site Intervention - Individual Intervention - Group Medical Services Outpatient - Individual Outpatient - Group Outreach 4 Residential Level I Residential Level 11 Residential Level M Residential Level IV Substance Abuse Detox Supported Employment Supportive Housing TASC Incidental Expenses Aftercare - Individual Aftercare - Group Information & Referral FACT Team Room & Board Level I Room & Board Level 11 Room & Board Level III Short-term Residential Treatment Clubhouse Services CCST - Individual CCST - Group Recovery Support Individual 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 Special Proviso *F[Ighlighted cells are eligible for fund allocation TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ $ $ $ $ $ $ TOTAL UNCOMPENSATED $ R Amendment #1 Guidance Care Center, Inc. Revised Exhibit G Contract No. P -- - -- Page 1 of 4 '1 Packet Pg. 3031 September 1, 2015- June 30, 2016 EXRIBIT G: COVERED SERVICES FUNDING BY OCA Guidance/Care Center, Inc. - PPG PPG3 W1 � MHO0 MT1009-CT- N114018 WIMS NUMBN %M1,'WA A HO -CR MT10 us x 10CF R Amendment #1 Guidance Care Center, Inc. Revised Exhibit G Contract No. P — -- Page 2 of 4 '1 Packet Pg. 3032 COVERED SERVICES FUNDING/ NMC01 NMC09 %IHC09-Cl NMC18 MHC18 MHCBN MHCFA r*MCFA-CR NMCMD r*MCMD-CR r*MCCF TOTAL RATE $ Assessment Case Management Crisis Stabilization Crisis Support/Emergency Day/Night Drop-In/Self Help Centers In-Home/On-Site Intervention - Individual Intervention - Group Medical Services Outpatient - Individual Outpatient - Group Outreach 4 Residential Level I Residential Level 11 Residential Level M Residential Level IV Substance Abuse Detox Supported Employment �j Supportive Housing TASC Incidental Expenses Aftercare - Individual Aftercare - Group Information & Referral FACT Team Room & Board Level I Room & Board Level 11 Room & Board Level III Short-term Residential Treatment Clubhouse Services CCST - Individual CCST - Group Recovery Support Individual 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 Special Proviso *Highlighted ''cells are eligible for fund allocation TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ $ $ $ $ $ TOTAL UNCOMPENSATED $ R Amendment #1 Guidance Care Center, Inc. Revised Exhibit G Contract No. P — -- Page 2 of 4 '1 Packet Pg. 3032 September 1, 2015- June 30, 2016 EXRIBIT G: COVERED SERVICES FUNDING BY OCA R Amendment #1 Guidance/Care Center, Inc. - PPG PPG3 "OS003 MS 01 � 11SO21 MS023 MSS 25 115,027 %iQ081 M959'. %iQ01 F MQ903 msocv Guidance Care Center, Inc. Revised Exhibit G Contract No. P - -- Page 3 of 4 '1 Packet Pg. 3033 COVERED SERVICES FUNDING/ MSA03 MSAII MSA21 MSA23 MSA25 MSA27 MSA81 MSA91 MSATB MSACF TOTAL RATE Assessment Case Management Crisis Stabilization Crisis Support/Emergency Day/Night Drop-In/Self Help Centers In-Home/On-Site Intervention - Individual Intervention - Group Medical Services Outpatient - Individual Outpatient - Group Outreach 4 Residential Level I Residential Level 11 Residential Level M Residential Level IV Substance Abuse Detox Supported Employment �j Supportive Housing TASC Incidental Expenses Aftercare - Individual Aftercare - Group Information & Referral FACT Team Room & Board Level I Room & Board Level 11 Room & Board Level III Short-term Residential Treatment Clubhouse Services CCST - Individual CCST - Group Recovery Support Individual 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 Special Proviso *F[Ighlighted cells are eligible for fund allocation TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ $ $ $ $ $ TOTAL UNCOMPENSATED $ Guidance Care Center, Inc. Revised Exhibit G Contract No. P - -- Page 3 of 4 '1 Packet Pg. 3033 September 1, 2015- June 30, 2016 EXRIBIT G: COVERED SERVICES FUNDING BY OCA Guidance/Care Center, Inc. - PPG PPG3 MS003 MS61 i MSOM . MS021 NV1025CR MSUPP MSOTH MQ903 ms"'Iff R Amendment #1 Guidance Care Center, Inc. Revised Exhibit G Contract No. P - -- Page 4 of 4 '1 Packet Pg. 3034 COVERED SERVICES FUNDING MSCO3 MSC11 MSC21 MSC23 MSC25 MSC25-CR MSCPP MSCTB MSCCF TOTAL RATE 150,000 150,000 A: Assessment Case Management Crisis Stabilization Crisis Support/Emergency Day/Night Drop-In/Self Help Centers In-Home/On-Site Intervention - Individual Intervention - Group Medical Services Outpatient - Individual Outpatient - Group Outreach 4 Residential Level I Residential Level 11 Residential Level III Residential Level IV Substance Abuse Detox Supported Employment �j Supportive Housing TASC Incidental Expenses Aftercare - Individual Aftercare - Group Information & Referral FACT Team Room & Board Level I Room & Board Level 11 Room & Board Level III Short-term Residential Treatment Clubhouse Services CCST - Individual CCST - Group Recovery Support Individual 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 Special Proviso *F[Ighlighted cells are eligible for fund allocation TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ 150,000 $ $ - $ 150,000 TOTAL UNCOMPENSATED R Amendment #1 Guidance Care Center, Inc. Revised Exhibit G Contract No. P - -- Page 4 of 4 '1 Packet Pg. 3034 July 1, 2016-June 30, 2017 EXRIBIT G: COVERED SERVICES FUNDING BY OCA Guidance/Care Center, Inc. - PPG PPG3 MHOW ME009 1114018 MHOIS 1111072 MT1073 MR576 NIII093 NIH094 NIHOPG NU PUB Mq0C'F R Amendment #1 Guidance Care Center, Inc. Revised Exhibit G Contract No. P - -- Page 1 of 4 '1 Packet Pg. 3035 COVERED SERVICES FUNDING/ NtFIA01 MRA09 MHA18 MHAIS MRA72 MRA73 MRA76 MRA93 NtEIA94 MHAPG MHATB MHACF TOTAL RATE $ Assessment Case Management Crisis Stabilization J Crisis Support/Emergency Day/Night Drop-In/Self Help Centers In-Home/On-Site Intervention - Individual Intervention - Group Medical Services Outpatient - Individual Outpatient - Group Outreach 4 Residential Level I Residential Level 11 Residential Level M Residential Level IV Substance Abuse Detox Supported Employment Supportive Housing TASC Incidental Expenses Aftercare - Individual Aftercare - Group Information & Referral FACT Team Room & Board Level I Room & Board Level 11 Room & Board Level III Short-term Residential Treatment Clubhouse Services CCST - Individual CCST - Group Recovery Support Individual 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 Special Proviso * Highlighted'' cells are eligible for fund allocation TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ $ $ $ $ $ $ TOTAL UNCOMPENSATED $ R Amendment #1 Guidance Care Center, Inc. Revised Exhibit G Contract No. P - -- Page 1 of 4 '1 Packet Pg. 3035 July 1, 2016-June 30, 2017 EXRIBIT G: COVERED SERVICES FUNDING BY OCA Guidance/Care Center, Inc. - PPG PPG3 W1 � MHO0 MT1009-CT- N114018 WIMS NUMBN %M1,'WA A HO -CR MT10 us x 10CF R Amendment #1 Guidance Care Center, Inc. Revised Exhibit G Contract No. P — -- Page 2 of 4 '1 Packet Pg. 3036 COVERED SERVICES FUNDING/ NMC01 NMC09 %IHC09-Cl NMC18 MHC18 MHCBN MHCFA r*MCFA-CR NMCMD r*MCMD-CR r*MCCF TOTAL RATE $ Assessment Case Management Crisis Stabilization Crisis Support/Emergency Day/Night Drop-In/Self Help Centers In-Home/On-Site Intervention - Individual Intervention - Group Medical Services Outpatient - Individual Outpatient - Group Outreach 4 Residential Level I Residential Level 11 Residential Level M Residential Level IV Substance Abuse Detox Supported Employment �j Supportive Housing TASC Incidental Expenses Aftercare - Individual Aftercare - Group Information & Referral FACT Team Room & Board Level I Room & Board Level 11 Room & Board Level III Short-term Residential Treatment Clubhouse Services CCST - Individual CCST - Group Recovery Support Individual 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 Special Proviso *Highlighted'' cells are eligible for fund allocation TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ $ $ $ $ $ TOTAL UNCOMPENSATED $ R Amendment #1 Guidance Care Center, Inc. Revised Exhibit G Contract No. P — -- Page 2 of 4 '1 Packet Pg. 3036 July 1, 2016-June 30, 2017 EXRIBIT G: COVERED SERVICES FUNDING BY OCA R Amendment #1 Guidance/Care Center, Inc. - PPG PPG3 "OS003 MS01 � 11SO21 MS023 MSS 25 115,027 %iQ081 M959'. %iQ01 F MQ903 msocy Guidance Care Center, Inc. Revised Exhibit G Contract No. P - -- Page 3 of 4 '1 Packet Pg. 3037 COVERED SERVICES FUNDING/ MSA03 MSAII MSA21 MSA23 MSA25 MSA27 MSA81 MSA91 MSATB MSACF TOTAL RATE Assessment Case Management Crisis Stabilization Crisis Support/Emergency Day/Night Drop-In/Self Help Centers In-Home/On-Site Intervention - Individual Intervention - Group Medical Services Outpatient - Individual Outpatient - Group Outreach 4 Residential Level I Residential Level 11 Residential Level M Residential Level IV Substance Abuse Detox Supported Employment �j Supportive Housing TASC Incidental Expenses Aftercare - Individual Aftercare - Group Information & Referral FACT Team Room & Board Level I Room & Board Level 11 Room & Board Level III Short-term Residential Treatment Clubhouse Services CCST - Individual CCST - Group Recovery Support Individual 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 Special Proviso *F[Ighlighted cells are eligible for fund allocation TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ $ $ $ $ $ TOTAL UNCOMPENSATED $ Guidance Care Center, Inc. Revised Exhibit G Contract No. P - -- Page 3 of 4 '1 Packet Pg. 3037 July 1, 2016-June 30, 2017 EXRIBIT G: COVERED SERVICES FUNDING BY OCA Guidance/Care Center, Inc. - PPG PPG3 MS003 MS61 i MSOM . MS021 NV1025CR MSUPP MSOTH MQ903 ms"'Iff R Amendment #1 Guidance Care Center, Inc. Revised Exhibit G Contract No. P - -- Page 4 of 4 '1 Packet Pg. 3038 COVERED SERVICES FUNDING MSCO3 MSCII MSC21 MSC23 MSC25 MSC25-CR MSCPP MSCTB MSCCF TOTAL RATE 150,000 150,000 A: Assessment Case Management Crisis Stabilization Crisis Support/Emergency Day/Night Drop-In/Self Help Centers In-Home/On-Site Intervention - Individual Intervention - Group Medical Services Outpatient - Individual Outpatient - Group Outreach 4 Residential Level I Residential Level 11 Residential Level III Residential Level IV Substance Abuse Detox Supported Employment �j Supportive Housing TASC Incidental Expenses Aftercare - Individual Aftercare - Group Information & Referral FACT Team Room & Board Level I Room & Board Level 11 Room & Board Level III Short-term Residential Treatment Clubhouse Services CCST - Individual CCST - Group Recovery Support Individual 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 Special Proviso *Highlighted cells are eligible for fund allocation TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ 150,000 $ $ - $ 150,000 TOTAL UNCOMPENSATED R Amendment #1 Guidance Care Center, Inc. Revised Exhibit G Contract No. P - -- Page 4 of 4 '1 Packet Pg. 3038 July 1, 2017-June 30, 2018 EXRIBIT G: COVERED SERVICES FUNDING BY OCA Guidance/Care Center, Inc. - PPG PPG3 MHOW ME009 1114018 MHOIS 1111072 MT1073 MR576 NIII093 NIH094 NIHOPG NH PUB Mq0C'F R Amendment #1 Guidance Care Center, Inc. Revised Exhibit G Contract No. P - -- Page 1 of 4 '1 Packet Pg. 3039 COVERED SERVICES FUNDING/ NtFIA01 MRA09 MHA18 MHAIS MRA72 MRA73 MRA76 MRA93 NtEIA94 MHAPG MHATB MHACF TOTAL RATE $ Assessment Case Management Crisis Stabilization J Crisis Support/Emergency Day/Night Drop-In/Self Help Centers In-Home/On-Site Intervention - Individual Intervention - Group Medical Services Outpatient - Individual Outpatient - Group Outreach 4 Residential Level I Residential Level 11 Residential Level M Residential Level IV Substance Abuse Detox Supported Employment Supportive Housing TASC Incidental Expenses Aftercare - Individual Aftercare - Group Information & Referral FACT Team Room & Board Level I Room & Board Level 11 Room & Board Level III Short-term Residential Treatment Clubhouse Services CCST - Individual CCST - Group Recovery Support Individual 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 Special Proviso * Highlighted'' cells are eligible for fund allocation TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ $ $ $ $ $ $ TOTAL UNCOMPENSATED $ R Amendment #1 Guidance Care Center, Inc. Revised Exhibit G Contract No. P - -- Page 1 of 4 '1 Packet Pg. 3039 July 1, 2017-June 30, 2018 EXRIBIT G: COVERED SERVICES FUNDING BY OCA Guidance/Care Center, Inc. - PPG PPG3 W1 � MHO0 MT1009-CT- N114018 WIMS NUMBN %M1,'WA A MHOU -CR MT10 MT10CF R Amendment #1 Guidance Care Center, Inc. Revised Exhibit G Contract No. P — -- Page 2 of 4 '1 Packet Pg. 3040 COVERED SERVICES FUNDING/ NMC01 NMC09 %IHC09-Cl NMC18 MHC18 MHCBN MHCFA r*MCFA-CR NMCMD r*MCMD-CR r*MCCF TOTAL RATE $ Assessment Case Management Crisis Stabilization Crisis Support/Emergency Day/Night Drop-In/Self Help Centers In-Home/On-Site Intervention - Individual Intervention - Group Medical Services Outpatient - Individual Outpatient - Group Outreach 4 Residential Level I Residential Level 11 Residential Level M Residential Level IV Substance Abuse Detox Supported Employment �j Supportive Housing TASC Incidental Expenses Aftercare - Individual Aftercare - Group Information & Referral FACT Team Room & Board Level I Room & Board Level 11 Room & Board Level III Short-term Residential Treatment Clubhouse Services CCST - Individual CCST - Group Recovery Support Individual 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 Special Proviso *Highlighted'' cells are eligible for fund allocation TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ $ $ $ $ $ TOTAL UNCOMPENSATED $ R Amendment #1 Guidance Care Center, Inc. Revised Exhibit G Contract No. P — -- Page 2 of 4 '1 Packet Pg. 3040 July 1, 2017-June 30, 2018 EXRIBIT G: COVERED SERVICES FUNDING BY OCA R Amendment #1 Guidance/Care Center, Inc. - PPG PPG3 "OS003 MS 01 � 11SO21 MS023 MSS 25 115,027 %iQ081 M959'. %iQ01 F MQ903 msocv Guidance Care Center, Inc. Revised Exhibit G Contract No. P - -- Page 3 of 4 '1 Packet Pg. 3041 COVERED SERVICES FUNDING/ MSA03 MSAII MSA21 MSA23 MSA25 MSA27 MSA81 MSA91 MSATB MSACF TOTAL RATE Assessment Case Management Crisis Stabilization Crisis Support/Emergency Day/Night Drop-In/Self Help Centers In-Home/On-Site Intervention - Individual Intervention - Group Medical Services Outpatient - Individual Outpatient - Group Outreach 4 Residential Level I Residential Level 11 Residential Level M Residential Level IV Substance Abuse Detox Supported Employment �j Supportive Housing TASC Incidental Expenses Aftercare - Individual Aftercare - Group Information & Referral FACT Team Room & Board Level I Room & Board Level 11 Room & Board Level III Short-term Residential Treatment Clubhouse Services CCST - Individual CCST - Group Recovery Support Individual 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 Special Proviso *F[Ighlighted cells are eligible for fund allocation TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ $ $ $ $ $ TOTAL UNCOMPENSATED $ Guidance Care Center, Inc. Revised Exhibit G Contract No. P - -- Page 3 of 4 '1 Packet Pg. 3041 July 1, 2017-June 30, 2018 EXRIBIT G: COVERED SERVICES FUNDING BY OCA Guidance/Care Center, Inc. - PPG PPG3 MS003 MS61 i MSOM . MS021 NV1025CR MSUPP MSOTH MQ903 ms"'Iff R Amendment #1 Guidance Care Center, Inc. Revised Exhibit G Contract No. P - -- Page 4 of 4 '1 Packet Pg. 3042 COVERED SERVICES FUNDING MSCO3 MSCII MSC21 MSC23 MSC25 MSC25-CR MSCPP MSCTB MSCCF TOTAL RATE 150,000 150,000 A: Assessment Case Management Crisis Stabilization Crisis Support/Emergency Day/Night Drop-In/Self Help Centers In-Home/On-Site Intervention - Individual Intervention - Group Medical Services Outpatient - Individual Outpatient - Group Outreach 4 Residential Level I Residential Level 11 Residential Level III Residential Level IV Substance Abuse Detox Supported Employment �j Supportive Housing TASC Incidental Expenses Aftercare - Individual Aftercare - Group Information & Referral FACT Team Room & Board Level I Room & Board Level 11 Room & Board Level III Short-term Residential Treatment Clubhouse Services CCST - Individual CCST - Group Recovery Support Individual 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 Special Proviso *Highlighted cells are eligible for fund allocation TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ 150,000 $ $ - $ 150,000 TOTAL UNCOMPENSATED R Amendment #1 Guidance Care Center, Inc. Revised Exhibit G Contract No. P - -- Page 4 of 4 '1 Packet Pg. 3042 S.4.a 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." I have read the above and state that neither Y-0� � name) nor any Affiliate has been placed on the convicted vendor list within the last 36 months. (Signature) Date: 14, rf STATE OF: � IV COUNTY OF: r u Pj co Subscribed and sworn to (or affirmed) before me on (date) by (name of affiant). He A g is personall known to me or has produced (type of identification) as N identification. U U 0 C &V zQ aV - A ) NOTARY PUBLIC My Commission Expires: CAROL A. 00CHOW Notary public - State of Florida My Comm. Expires Jun 7, 2018 COrMllSSIOn # FF 10;4268 Guidance Care Center- SAMH Contract FYI 8; page 14 Racket Pg. 3043 S.4.a ATTACHMENT F SWORN STATEMENT CINDER ORDINANCE NO. 010 -7990 MONROE COUNTY, FLORIDA ETHICS CLAUSE &LAI 6t&fIl-r— lc,�,V6 een4ew llve- (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. 0 10- 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." V (Signature) /� Date: . '7 COUNTY OF: �� Subscribed and sworn to (or affirmed) before me on cw 4� M I (date) by I 1 iU> ( W }du (name of affiant). HeQ is erson known to me or has produced identification) as identification. (type of C)gm 0 Im NOTARY PUBLIC My Commission Expires: co LL Guidance Care Canter -SAMN Contact FY98; page 95 Racket Pg. 3044 CAROL A. DOCHOW 11 Notary Public - SWe of Florida J•,= My Comm. Expires Jun 7. 2010 Commission # FF 104268 co LL Guidance Care Canter -SAMN Contact FY98; page 95 Racket Pg. 3044 S.4.a ATTACHMENT G DRUG -FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.987 hereby certifies that: C­kA I Ate. -,n > 1 (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: 4 b&i STATE CF: RD* COUNTY OF: %y W' Subscribed and sworn to (or affirmed) beforE 1� or has produced identification. me on — 7 (date) by (name of affiant). He h is personally known to me (type of identification) as NOTARY PUBLIC My Commission Expires: co r LL Racket Pg. 3045 CAROL _ A- C10CIioW Notary Public • sia,e 01 Fiorirla V,'- My Comm- Expires J,ir� 7, 20T8 ........ ,..• Cur"'TissiOn # FF 104268 Guidance Care Center -SRMH Contract FY18; page 16 me on — 7 (date) by (name of affiant). He h is personally known to me (type of identification) as NOTARY PUBLIC My Commission Expires: co r LL Racket Pg. 3045 ATTACHMENT H FY18 Annual Performance Report (For year October 1, 2017 — September 30, 2018) Agency Name POC Phone /Email Grant Amount Per Section 8 of your contract, it is required that you fill out the entire form and answer every question. Narrative on the FY18 Performance (i.e. successes, challenges, etc): Questions: 1. Please list services and client information below for the program/activities funded by the Monroe co County award. U. Services Target Population # of persons in target population Total # of clients served in FY18 Unduplicated Clients Served 2. What were the measurable outcomes (including numbers) accomplished in FY18? Please base these outcomes on the services you identified in Question #1. 3. What number and percentage of your clients /participants were at or below the federal poverty level in FY18; and /or 200 %; and /or another standard used by your organization? 4. Were all the awarded funds used in FY18? If not, please explain. 5. What is the number of FTEs working on the program(s) funded by the award in FY18? Guidance Care Center -SAMH Contract FY18; page 17 6. Were the awarded funds used as match in FY18? If so, please list matching sources. 7. What area of Monroe County did you serve in FY18? 8. How many total FTEs in your organization? 9. Volunteers: hours of program service were contributed by volunteers in FY18. 10. What was the CEO /Executive Director (or highest paid title) compensation in FY18? (Please breakdown between salary and benefits.) 11. What is your organization's fiscal year? For the following questions, please use the number as reported on your FY18 IRS Form 990. If your FY18 IRS Form 990 is not yet prepared, please provide an estimate for the following questions. 12. What were your organization's total expenses in FY18? 13. What was your organization's total revenue in FY18? 14. What was the organization's total in grants and contracts for FY18? co 15. What was the organization's total donations and in -kind (fundraising) in FY18? U. 16. What percentage of your expenses are program service expenses versus management and general expenses in FY18 as reported on your IRS Form 990? (Program service expenses are defined as expenses needed to run your programs. Management and general expenses encompass expenses such as fundraising, human resources, salaries of those not working directly with programs, legal services, accounting services, insurance expenses, office management, auditing, and other centralized services.) Guidance Care Center -SAMH Contract FY18; page 18 AGREEMENT This Agreement is made and entered into this 13th day of December, 2017, 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 PROVIDER is a not - for - profit corporation established for the provision of behavioral health services throughout the Florida Keys, and WHEREAS, it is a legitimate public purpose to provide behavioral health services including comprehensive substance abuse services for individuals in the Jail In -House Program at the Monroe County Detention Center, now, therefore, IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as follows: FUNDING 1. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially and satisfactorily performing and providing services to incarcerated persons in the Monroe County jail, shall reimburse the Provider for a portion of the Provider's expenditures for the Jail In -House Program (including substance abuse and mental health services, such as psychosocial assessment, individual counseling, group therapy and case management, to those incarcerated individuals that qualify for the program), as billed by the Provider. This cost shall not exceed a total reimbursement of ONE HUNDRED SEVENTY -ONE THOUSAND THREE HUNDRED SEVENTY -FOUR AND NO /100 DOLLARS ($171,374) during the fiscal year 2017 -2018. 2. TERM. This Agreement shall commence on October 1, 2017, and terminate September 30, 2018, unless earlier terminated pursuant to other provisions herein. 3. PAYMENT. 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. 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 2 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 1, above, during the term of this agreement. 4. AVAILABILITY OF FUNDS. 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. S. 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. Contract- Guidance Care Center -Jail Program -FY18; page 1 RECORDKEEPING 6. 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 8(e) 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. 7. 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. S. COMPLIANCE WITH COUNTY GUIDELINES. The PROVIDER must furnish to the County the following (items A -J 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 Statute 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 statements 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; 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. If the PROVIDER receives $100,000 or more in grant funding from the County: a. The CPA that prepares the audit must also be a member of the American Institute of Certified Public Accountants (AICPA); b. The CPA must maintain malpractice insurance covering the audit services provided and c. 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); (j) 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 Contract- Guidance Care Center -Jail Program -FY18; page 2 frequencies of services provided, a profile of clients (including residency) and numbers served, and outcomes achieved (see Attachment G); (k) Cooperation with County monitoring visits that the County may request during the contract year; and (1) 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. RESPONSIBILITIES 9. 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. 10. 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. 11. 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. 12. 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. 13. 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. 14. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the PROVIDER is an independent contractor and not an employee, agent or instrumentality 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 15. 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 Contract- Guidance Care Center -Jail Program -FY18; page 3 this agreement and shall entitle the Board to terminate this contract immediately upon delivery of written notice of termination to the PROVIDER. 16. 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. 17. NON - DISCRIMINATION. County and PROVIDER agree that there will be no discrimination against any person, and it is expressly understood that upon a determination by a court of competent jurisdiction that discrimination has occurred, this Agreement automatically terminates without any further action on the part of any party, effective the date of the court order. County or PROVIDER agree to comply with all Federal and Florida statutes, and all local ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1) Title VI of the Civil Rights Act of 1964 (PL 88 -352) which prohibits discrimination on the basis of race, color or national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC ss. 1681 -1683, and 1685 - 1686), which prohibits discrimination on the basis of sex; 3) Section 504 of the Rehabilitation Act of 1973, as amended (20 USC s. 794), which prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended (42 USC ss. 6101 -6107) which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL 92 -255), as amended, relating to nondiscrimination on the basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91 -616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, ss. 523 and 527 (42 USC ss. 690dd -3 and 290ee -3), as amended, relating to confidentiality of alcohol and drug abuse patient records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC s. et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC s. 1201 Note), as maybe amended from time to time, relating to nondiscrimination on the basis of disability; 10) Monroe County Code Chapter 13, Article VI, which prohibits discrimination on the basis of race, color, sex, religion, national origin, ancestry, sexual orientation, gender identity or expression, familial status or age; 11) 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 18. 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. 19. 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. The PROVIDER and County staff shall try to resolve the claim or dispute with meet and confer sessions to be commenced within 15 days of the dispute or claim. 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. Any claims or dispute that the parties cannot resolve shall be decided by the Circuit Court, 16 Judicial Circuit, Monroe County, Florida. 20. 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. Contract- Guidance Care Center -Jail Program -FY18; page 4 ASSURANCES 21. 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. 22. 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. 23. NON - WAIVER OF IMMUNITY. Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the County and the PROVIDER in this Agreement and the acquisition of any commercial liability insurance coverage, self- insurance coverage, or local government liability insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall any contract entered into by the County be required to contain any provision for waiver. 24. 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. 2S. 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 26. 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 and causes of action for medical malpractice, medical negligence, 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. 27. 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. 28. 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. Contract- Guidance Care Center -Jail Program -FY18; page 5 29. 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. 30. 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 31. EXECUTION IN COUNTERPARTS. This Agreement may be executed in any number of counterparts, each of which shall be regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement by signing any such counterpart. 32. NOTICE. Any notice required or permitted under this agreement shall be in writing and hand - delivered or mailed, postage pre -paid, by certified mail, return receipt requested, to the other party as follows: For Board: Grants Administrator and Monroe County Attorney 1100 Simonton Street PO Box 1026 Key West, FL 33040 Key West, FL 33041 For PROVIDER Frank Rabbito, Senior Vice President Guidance /Care Center 1205 Fourth Street Key West, FL 33040 33. 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. 34. 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 Contract- Guidance Care Center -Jail Program -FY18; page 6 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. 35. 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. 36. 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] Contract- Guidance Care Center -Jail Program -FY18; page 7 S.4.b IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as of the day and year first written above. (SEAL) ATTEST: KEVIN MADOK, CLERK By Deputy Clerk r f y � Witnes '�'. � 1.. W 6 ess BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA By- Mayor/Chairman Guidance/Care Center (Federal I❑ No, tq — 1 ` 1 - �3 a } Director, Outreach & acacy Guidance/Care Center Contract - Guidance Care Center -Jail Program -FY78; page 8 Racket Pg. 3055 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. Contract- Guidance Care Center -Jail Program -FY18; 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. Contract- Guidance Care Center -Jail Program -FY18; page 10 ATTACHMENT B Monroe County Board of County Commissioners Finance Department 500 Whitehead Street Key West, FL 33040 Date ORGANIZATION LETTERHEAD 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 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 (B) Total prior payments $ X (C) Total requested and paid (A + B) $ X (D) Total contract amount $ X Balance of contract (D -C) X I certify that the above checks have been submitted to the vendors as noted and that the expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this organization's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source. Chief Executive Officer Attachments (supporting documentation) Sworn to and subscribed before me this day of 20 who is personally known to me. Notary Public Notary Stamp by Contract- Guidance Care Center -Jail Program -FY18; page 11 ATTACHMENT C Services to be provided: Guidance /Care Center, Inc. will assessment, case management, and vocational workshops to ME provide substance abuse individual therapy, grou n and women in the Mor Center (also known as the Jail In -House Program) services including i therapy, drug testing roe County Detention Contract- Guidance Care Center -Jail Program -FY18; page 12 ATTACHMENT 0 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." I have read the above and state that neither �.CiL��11 (Respondent's name) nor any Affiliate has been placed on the convicted vendor list within the last 36 months. {Signature} Date: 1 7 4 4 11 - 7 STATE OF: COUNTY OF: Subscribed and sworn to (or affirmed) before me on (date) by m gm&zln D ide (name of affiant). H She i persona} known to me or has produced (type of identification) as identification. y , CAROL A. Of7CHOW Notary Public - State of Florida I q My Comm. Expires Jun 7, 2018 1, NOTARY PUB IC Commisslon # FF 104268 L My Commission Expires: Contract - Guidance Care Center -Jail Program -FY18; page 13 Racket Pg. 3060 S.4.b ATTACHMENT E SWORN STATEMENT UNDER ORDINANCE NO. 010 -1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE Crime Can 1 vL . (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. 0 10- 199 0 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: STATE 01=: ��I1 �� COUNTY OF: S'611VUY UU Subscribed and ' sworn to (or affirmed) before me on Gam& . + 2 (date) by i U PA01, M {name of affiant). Hel�is er known has produced (type of identification) as identification. NOTARY PUBLIC My Commission. Expires: - r,- :' CAROL A. 90CNOW =� 4 Rosary Public • S1,110 01 Florlsli ar �• \1 �y COMM_ ExPI e, Jun 7. 201 B Commission # FF 104268 Contract- Guidance Care Center- -Jai! Program -FY 16; page 14 Racket Pg. 3061 S.4.b ATTACHMENT F DRUG -FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: Cou I A.A,►.ce, I (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 prohlbition. 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 servlces 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. Vi (Signature) Date: STATE OF: gmf� COUNTY OF: fll f a& Subs 'bed and sworn to (or affirmed) before me on V or has produced identification, (name of NOTARY PUBLIC My Com mission Expires: (date) by affiant). e h is personally known to me (tyre identification) as Racket Pg. 3062 CAROL A. OOCHOW I Hofary Public • State of Florida -,� �`.. My Comm. Expires ,tun 7, 201a Comm15S1on # FF 104268 Contract- Guidance Care Center -Jer) Program- FY'18; page 95 NOTARY PUBLIC My Com mission Expires: (date) by affiant). e h is personally known to me (tyre identification) as Racket Pg. 3062 ATTACHMENT G FY18 Annual Performance Report (For year October 1, 2017 — September 30, 2018) Agency Name POC Phone /Email Grant Amount Per Section 8 of your contract, it is required that you fill out the entire form and answer every question. Narrative on the FY18 Performance (i.e. successes, challenges, etc.): Questions: 1. Please list services and client information below for the program/activities funded by the Monroe County award. Services Target Population # of persons in target population Total # of clients served in FY18 Unduplicated Clients Served 2. What were the measurable outcomes (including numbers) accomplished in FY18? Please base these outcomes on the services you identified in Question #1. 3. What number and percentage of your clients /participants were at or below the federal poverty level in FY18; and /or 200 %; and /or another standard used by your organization? 4. Were all the awarded funds used in FY18? If not, please explain. 5. What is the number of FTEs working on the program(s) funded by the award in FY18? Contract- Guidance Care Center -Jail Program -FY18, page 16 6. Were the awarded funds used as match in FY18? If so, please list matching sources. 7. What area of Monroe County did you serve in FY18? 8. How many total FTEs in your organization? 9. Volunteers: hours of program service were contributed by volunteers in FY18. 10. What was the CEO /Executive Director (or highest paid title) compensation in FY18? (Please breakdown between salary and benefits.) 11. What is your organization's fiscal year? For the following questions, please use the number as reported on your FY18 IRS Form 990. If your FY18 IRS Form 990 is not yet prepared, please provide an estimate for the following questions. 12. What were your organization's total expenses in FY18? 13. What was your organization's total revenue in FY18? 14. What was the organization's total in grants and contracts for FY18? 15. What was the organization's total donations and in -kind (fundraising) in FY18? 16. What percentage of your expenses are program service expenses versus management and general expenses in FY18 as reported on your IRS Form 990? (Program service expenses are defined as expenses needed to run your programs. Management and general expenses encompass expenses such as fundraising, human resources, salaries of those not working directly with programs, legal services, accounting services, insurance expenses, office management, auditing, and other centralized services.) 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