Item C38County of Monroe
The Florida Keys
Commissioner David Rice
9400 Overseas Highway, Ste. 210
Marathon Airport Terminal Building
Marathon, FL 33050
PH.: 305-289-6000
EM: rice-david(a) moo roecounty-fl.eov
Office EM: bocedis4aa,monroecounty-fl.eov
BOARD OF COUNTY COMMISSIONERS
Mayor Heather Carruthers, District 3
Mayor Pro Tern George Neugent, District 2
Danny L. Kolhage, District 1
David Rice, District 4
Sylvia J. Murphy, District 5
Interoffice Memorandum
AMENDED
Date: October 19, 2016
To: Amy Heavilin, Clerk of the Court
County Clerk's Office //��,
From: Commissioner David Rice, District # N704
RE: AMENDED NOTICE OF VOTING CONFLICT
Per Florida Statute 112.3143, I hereby disclose by written memorandum that I
will abstain from the vote on certain issues that are brought before the Monroe County
Board of Commissioners with entities that I am involved with.
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
Care Center. I am also a member of the Board of the Historic Florida Keys
Foundation, Inc.
At the October 19, 2016 BOCC meeting, I will abstain from the vote on the
following item(s):
#C32, C3�(J), C38, C39
Copy of agenda item(s) attached for documentation.
County of Monroe
The Florida Keys
Commissioner David Rice
9400 Overseas Highway, Ste. 210
Marathon Airport Terminal Building
Marathon, FL 33050
PH.: 305-289-6000
EM: rice-david(i,monroecounty-fl.gov
Office EM: boccdis4(a,monroecounty-Meov
BOARD OF COUNTY COMMISSIONERS
Mayor Heather Carruthers, District 3
Mayor Pro fern George Neugent, District 2
Danny L. Kolhage, District l
David Rice, District 4
Sylvia J. Murphy, District 5
Interoffice Memorandum
Date: October 12, 2016
To: Amy Heavilin, Clerk of the Court
County Clerk's Office
From: Commissioner David Rice, District 4
RE: NOTICE OF VOTING CONFLICT
Per Florida Statute 112.3143, I hereby disclose by written memorandum that I
will abstain from the vote on certain issues that are brought before the Monroe County
Board of Commissioners with entities that I am involved with.
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
Care Center. I am also a member of the Board of the Historic Florida Keys
Foundation, Inc.
At the October 19, 2016 BOCC meeting, I will abstain from the vote on the
following item(s):
#C32, C38, C39
Copy of agenda item(s) attached for documentation.
County of Monroe BOARD OF COUNTY COMMISSIONERS
Mayor Heather Carruthers, District 3
The Florida Keys Mayor Pro TernGeorge Neugent, District 2
Danny L. Kolhage, District I
David Rice, District 4
Sylvia J. Murphy, District 5
County Commission Meeting
October 19, 2016
Agenda Item Number: C.32
Agenda Item Summary #2206
BULK ITEM: Yes . DEPARTMENT: Project Management / Facilities
TIME APPROXIMATE: STAFF CONTACT: Doug Sposito (305) 292-4416
None
AGENDA ITEM WORDING: Approval of the Eighth Renewal to Agreement with the
or use of the wastewater treatment plant by the Marathon Detention
Facility. Estimated amount 10,000.
ITEM BACKGROUND: The agreement with Guidance/Care Center, Inc. for use of the
wastewater treatment plant by the Marathon Detention Facility expired on March 6, 2016. In
accordance to Article 1 of the original Agreement dated March 7, 1990, the agreement may be
renewed for ten successive three year terms, after the initial five year term. This will be the eighth
renewal option leaving two additional successive three year terms available.
PREVIOUS RELEVANT BOCC ACTION: On March 7, 1990, the BOCC approved the original
five-year Agreement with the Guidance Clinic for use of their wastewater treatment plant by the
Marathon Detention Facility. On April 19, 1995, the BOCC approved an amended Agreement for an
additional three years, with renewal options. On February 11, 1998, the BOCC approved the second
three-year term, and on February 21, 2001, the BOCC approved the third three-year term. On
August 15, 2001, the BOCC approved an Amendment to Agreement increasing the reimbursement
for monthly routine maintenance charges from up to $300.00 per month to up to $500.00 per month.
On February 18, 2004, the BOCC approved the fourth three-year renewal term. On March 21, 2007,
the BOCC approved the fifth three-year renewal term. On April 18, 2007, the BOCC approved an
Amendment to Agreement increasing the reimbursement for monthly routine maintenance charges
from up to $500.00 per month to up to $580.00 per month. On March 17, 2010 the BOCC granted
approval of Consent to Assignment and Assumption and Assignment Agreement and approved the
sixth three-year renewal term. On March 20, 2013 the BOCC approved the seventh three-year
renewal term with considerations of being connected to the Marathon Central wastewater system.
CONTRACT/AGREEMENT CHANGES:
Renewal Agreement shall commence on March 7, 2016 and terminate on March 6, 2019.
STAFF RECOMMENDATION: Approval
Packei Pg. 523
County of Monroe BOARD OF COUNTY COMMISSIONERS '
Mayor Heather Carruthers, District 3
The Florida Keys Mayor Pro Tern George Neugent, District 2
Danny L. Kolhage, District l
David Rice, District 4
Sylvia J. Murphy, District 5
County Commission Meeting
October 19, 2016
Agenda Item Number: C.38
Agenda Item Summary #2231
BULK ITEM: Yes DEPARTMENT: Budget and Finance
TIME APPROXIMATE: STAFF CONTACT: Laura DeLoach (305)292-4482
N/A
AGENDA ITEM . ORDING: uidance/Care Center - Approval of agreements with
iuWaucziCare Cenor FY17 t AmwigWommunity Transportation for
the Disadvantaged, the Substance Abuse Mental Health local match funding and the Jail In -House
Program.
ITEM BACKGROUND:
The Baker Act Transportation funding is $145,000 for FY17, the same amount as in prior year. The
Community Transportation for Disadvantaged Program has a slight increase for FY17 required local
match in the amount of $47,355. The Substance Abuse Mental Health (SAM1) local matching funds
for FY17 remains the same at $690,000. A copy of the agreements requiring match are attached.
The Jail In -House Program (JIP) recommended funding for FY17 is $133,284, the same amount
awarded in the Drevious vear.
PREVIOUS RELEVANT BOCC ACTION:
The FY17 funded amounts were included in the County budget process. Annually the County has
provided the required local matching funds for SAMH and Baker Act Transportation services as well
as discretionary funding for JIP.
CONTRACT/AGREEMENT CHANGES:
N/A
STAFF RECOMMENDATION: Approval
DOCUMENTATION:
GCC_SAMH_FY17 SIGNED
GCC-Transportation FY17 SIGNED _2016-09-29
C'rC;C',-.TTP FY17 STC'rNFD 2016-09-29
FINANCIAL IMPACT:
Packet Pg. 1114
County of Monroe BOARD OF COUNTY COMMISSIONERS
Mayor Heather Carruthers, District 3
The Florida Keys Mayor Pro Tern George Neugent, District 2
Danny L. Kolhage, District I
David Rice, District 4
—' Sylvia J. Murphy, District 5
County Commission Meeting
October 19, 2016
Agenda Item Number: C.37
Agenda Item Summary #2227
BULK ITEM: Yes DEPARTMENT: Budget and Finance
TIME APPROXIMATE: STAFF CONTACT: Laura DeLoach (305)292-4482
N/A
AGENDA ITEM WORDING: HSO Agreements - Approval of Fiscal Year 2017 contracts with
non-profit organizations funded by the Board of County Commissioners through recommendations
of the Human Services Advisory Board (HSAB).
ITEM BACKGROUND:
The Human Services Advisory Board met on July 27, 2016 and made recommendations to the
BOCC. A listing of the funding recommendations is attached. The recommendations were
approved as part of the County budget process.
PREVIOUS RELEVANT BOCC ACTION:
Annually the BOCC accepts recommendations by the Human Services Advisory Board for funding
of non -profits providing needed services to the residents of Monroe County. For FY 16 the BOCC
approved $1,927,860 in human service funding. As a part of the budget process the BOCC approved
$2,000,000 in funding for the FYI funding cycle.
CONTRACT/AGREEMENT CHANGES:
N/A
STAFF RECOMMENDATION: Approval
DOCUMENTATION: -14afl 11, —j 4 ) &0 C - 4trr,,j
FY 17 Final HSAB Recommendations
Aids Help_FY17_SIGNED_2016-09-30
Anchors Aweigh_FY17_SIGNED _2016-09-30
Y
Boys & Girls Club _FY17_SIGNED_2016-09-29
Burton Memorial_F17 SIGNED 2016-09-27
Florida Keys AHEC_FY17_SIGNED_2016-09-27
Florida Keys Children's Shelter _FY 17_SIGNED_2016-09-27
Florida Keys Healthy Start_FY 17_SIGNED_2016-SIGNED-2016
Florida Keys Outreach Coalition_ SIGNED_2016-09-30
Csi GCC-Heron FY17 SIGNED 2016-09-29
Good Health Clinic _FY17_SIGNED _2016-09-26
Grace Jones _FY17_SIGNED _2016-09-28
Heart of the Keys_FY17_SIGNED _2016-09-30
Hospice _ FYI 7_SIGNED_2016-09-27
Independence Cay_FY17_SIGNED 2016-10-03
KAIR FY17 SIGNED 2016-10-03
Keys to be the Change_FY17_SIGNED_2016-10-03
Kids Come First_FYI7_SIGNED_2016-10-03
Literacy Volunteers_FY 17_SIGNED_2016-09-29
MARC _FY 17_SIGNED_2019-09-28
Rural Health Network_FY 17_SIGNED_2016-10-02
Samuel's House _FY17_SIGNED-2016-09-28
Star of the Sea FYI7_SIGNED_2016-09-29
Voices for Florida Keys Children_FYI7_SIGNED_2016-09-28
Wesley House_FY17_SIGNED_2019-09-30
Womankind FY17 SIGNED 2016-09-30
FINANCIAL IMPACT:
Effective Date: 10/01/2016
Expiration Date: 09/30/2017
Total Dollar Value of Contract: $1,970,000
Total Cost to County: $1,970,000
Current Year Portion: $1,970,000
Budgeted: Yes
Source of Funds: 001
CPI: N/A
Indirect Costs: N/A
Estimated Ongoing Costs Not Included in above dollar amounts: N/A
Revenue Producing: No
Grant: N/A
County Match: N/A
Insurance Required: N/A
Additional Details:
10/19/16
001-03202
10/19/16
001-03232
10/19/16
001-03235
10/19/16
001-03236
10/19/16
001-03215
10/19/16
001-03241
10/19/16
001-03214
If yes, amount:
HOSPICE OF FLORIDA KEYS
MARC $190,000.00
FL KEYS CHILDRENS SHELTE
WESLEY HOUSE
WOMANKIND $140,000.00
BOYS AND GIRLS
SAMUEL'S HOUSE
$190,000.00
$189,000.00
$169,000.00
$110,000.00
$100,000.00
10/19/16
001-03246 - STAR OF THE SEA FOUNDATI
$100,000.00
10/19/16
001-03206 - FL KEYS OUTREACH COALITI
$90,000.00
10/19/16
001-03226 • GOOD HEALTH
$90,000.00
10/19/16
001-03239 - FL KEYS AREA
$65,000.00
10/19/16
001-03240 . RURAL HEALTH
$62,000.00
10/19/16
001-03262 - KEYS TO BE THE CHANGE
$60,000.00
10/19/16
001-03224 - GRACE JONES $55,000.00
10/19/16
001-03225 - AIDS HELP $55,000.00
10/19/16
001-03259 . THE HERON $47,000.00
10/19/16
001-03205 • LITERACY VOLS OF AMERICA
$40,000.00
10/19/16
001-03242 • FL KEYS HEALTHY START
$40,000.00
10/19/16
001-03253 - HEART OF THE KEYS YTH CT
$40,000.00
10/19/16
001-03260 • KIDS COME FIRST -FL KEYS
$33,000.00
10/19/16
001-03243 - KEYS AREA INTERDENOMINAT
$30,000.00
10/19/16
001-03247 • INDEPENDENCE CAY
$30,000.00
10/19/16
001-03255 - ANCHORS AWEIGH
$20,000.00
10/19/16
001-03261 • VOICES FOR FL KEYS CHILD
$15,000.00
10/19/16
001-03256 • BURTON MEMORIAL UMC
$10,000.00
Total:
$1,970,000.00
REVIEWED BY:
Tina Boan
Skipped
10/04/2016 4:43 PM
Christine Limbert Completed
10/04/2016 5:26 PM
Maria Slavik Completed
10/05/2016 7:19 AM
Kathy Peters
Completed
10/05/2016 1:45 PM
Board of County Commissioners Pending
10/19/2016 9:00 AM
FY17 HSAB Recommendations
NO.
APPLICANTS
FY17 AMOUNT
RECOMMENDED
1
Kids Come First in the FL Keys
33,000
2
Monroe Association for ReMARCable Citizens
190,000
3
Florida Keys Area Health Education Center
65,000
4
Star of the Sea Foundation
100,000
5
Literacy Volunteers of America
40,000
6
Grace Jones Community Day Care Center
55,000
7
Florida Keys Outreach Coalition
90,000
8
Samuel's House
100,000
9
Burton Memorial United Methodist Church
10,000
10
Womankind
140,000
11
Heart of the Keys Recreation Assoc.
40,000
12
Keys to Be the Change
60,000
13
Keys Area Interdenominational Resources
30,000
14
Independence Cay
30,000
15
AIDS Help
55,000
16
Boys & Girls Club
110,000
17
GCC - The Heron
47,000
18
Autism Society of the Keys
0
19
Southernmost Homeless Assistance League
0
20
Anchors Aweigh Club
20,000
21
Hospice of the Florida Keys (VNA/Hospice)
190,000
22
Voices for Florida Keys Children
15,000
23
Florida Keys Children Shelter
189,000
24
Good Health Clinic
90,000
25
Wesley House
169,000
26
Domestic Abuse Shelter
30,000
27
Rural Health Network
62,000
28
A Positive Step of Monroe County
0
29
Florida Keys Healthy Start Coalition
40,000
TOTAL:
$ 2,000,000
AMOUNT AVAILABLE: $ 2,000,000
■
County of Monroe BOARD OF COUNTY COMMISSIONERS
Mayor Heather Carruthers, District 3
The Florida Keys Mayor Pro Tern George Neugent, District 2
Danny L. Kolhage, District 1
David Rice, District 4
Sylvia J. Murphy, District 5
County Commission Meeting
October 19, 2016
Agenda Item Number: C.39
Agenda Item Summary #2235
BULK ITEM: Yes DEPARTMENT: Budget and Finance
TIME APPROXIMATE: STAFF CONTACT: Laura DeLoach (305)292-4482
N/A
AGENDA ITEM WORDING: Direct Funded Agreements - Approval of Fiscal Year 2017
contracts with Monroe_ Council of the Arts Corporation d/b/a Florida Keys Council of the Arts and
the eys Foundation, AF for Board of County Commissioners direct line -item
funding.
ITEM BACKGROUND: The Florida Keys Council of the Arts and the Historic Florida Keys
Foundation, Inc. have historically been funded directly by the BOCC. The amount of FYI funding
remains the same as funding received in the prior year.
PREVIOUS RELEVANT BOCC ACTION: As a part of the County budget process, for FY17,
the BOCC approved funding in the amount of $69,300 to Florida Keys Council of the Arts and
$32,450 to the Historic Florida Keys Foundation, Inc.
CONTRACT/AGREEMENT CHANGES:
N/A
STAFF RECOMMENDATION: Approval
DOCUMENTATION:
Florida Keys Council of the Arts _FY17_SIGNED _2016-09-30
Historic Florida Keys Fndt_FY17_SIGNED_2016-09-SIGNED
FINANCIAL INIPACT:
Effective Date: 10/01/2016
Expiration Date: 09/30/2017
Total Dollar Value of Contract: $69,300 (Florida Keys Council of the Arts); $32,450 (Historic
Florida Keys Foundation)
Packet Pa. 1477
Cheryl Robertson
From: Lamarche -Tamara <lamarche-tamara@monroecounty-fl.gov>
Sent: Wednesday, October 19, 2016 10:39 AM
To: Amy Heavilin; Cheryl Robertson
Cc: Rice -David
Subject: AMENDED Notice of Voting Conflict Memo Oct 19 2016
Attachments: AMENDED NVC Rice Oct 19 2016a1.docx.pdf
Please find attached an amended Notice of Voting Conflict Memo for Comm. Rice regarding items on the October 19,
2016 BOCC agenda. Item C37(J) HSAB funding contract for Guidance Care Center— Heron House was held out from the
agenda and Comm. Rice abstained from the vote.
The packet is complete with amended memo and additional backup documentation, and the original memo packet
submitted for the record. Hard copy will be sent down in the courier.
Tamara Lamarche
Executive Assistant
4,
Commissioner David Rice
District 4 Commissioner
Monroe County Board of Commissioners
9400 Overseas Highway, Ste. 210
Marathon, FL 33050
Ph: 305 289-6000
Fx: 305 289-4610
"How wonderful it is that nobody need wait a single moment before starting to improve the world. " -- Anne Frank
Please note: Florida has a very broad public records law. Most written communications to or from the County regarding County business are public
record, available to the public and media upon request. Your e-mail communication may be subject to public disclosure.
BOARD OF COUNTY COMMISSIONERS
County of Monroe A
Mayor Heather Carruthers, District 3
( T$ne Florida Keys (, Mayor Pro Tem George Neugent, District 2
t� ) ��` ��
�' Danny L. Kolhage, District 1
David Rice, District 4
Sylvia J. Murphy, District 5
County Commission Meeting
October 19, 2016
Agenda Item Number: C.38
Agenda Item Summary #2231
BULK ITEM: Yes DEPARTMENT: Budget and Finance
TIME APPROXIMATE: STAFF CONTACT: Laura DeLoach (305)292-4482
N/A
AGENDA ITEM WORDING: Guidance/Care Center - Approval of agreements with
Guidance/Care Center for FY17 Baker Act Transportations Services, Community Transportation for
the Disadvantaged, the Substance Abuse Mental Health local match funding and the Jail In -House
Program.
ITEM BACKGROUND:
The Baker Act Transportation funding is $145,000 for FY17, the same amount as in prior year. The
Community Transportation for Disadvantaged Program has a slight increase for FY17 required local
match in the amount of $47,355. The Substance Abuse Mental Health (SAMH) local matching funds
for FY17 remains the same at $690,000. A copy of the agreements requiring match are attached.
The Jail In -House Program (JIP) recommended funding for FY17 is $133,284, the same amount
awarded in the previous
PREVIOUS RELEVANT BOCC ACTION:
The FY17 funded amounts were included in the County budget process. Annually the County has
provided the required local matching funds for SAMH and Baker Act Transportation services as well
as discretionary funding for JIP.
CONTRACT/AGREEMENT CHANGES:
N/A
STAFF RECOMMENDATION: Approval
DOCUMENTATION:
GCC_ SAMH_FY17_SIGNED
GCC-Transportation _FY 17_SIGNED_2016-09-29
GCC-JIP FY17 SIGNED 2016-09-29
FINANCIAL IMPACT:
Effective Date: 10/01/2016
Expiration Date: 09/30/2016
Total Dollar Value of Contract: $192,355 (Transportation); $690,000 (SAMH); $133,284
(JIP)
Total Cost to County: $192,355; $690,000; $133,284
Current Year Portion: $192,355; $690,000; $133,284
Budgeted: Yes
Source of Funds: Ad valorem, Fine and Forfeiture
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:
10/19/16 001-045905
10/19/16 001-045903
10/19/16 001-045906
Total:
If yes, amount:
GCC SAMH FS 394.76
GCC BAKER ACT TRNSP
GCC JlP $133,284.00
REVIEWED BY:
Tina Boan
Christine Limbert
Maria Slavik
Kathy Peters
Board of County Commissioners
$690,000.00
$192,355.00
$1,015,639.00
Skipped
10/04/2016 4:27 PM
Completed
10/04/2016 4:41 PM
Completed
10/04/2016 4:42 PM
Completed
10/04/2016 5:26 PM
Pending
10/19/2016 9:00 AM
AGREEMENT
This Agreement is made and entered Into this 19th day of October, 2016, between the
BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as
"Board" or "County," and Guidance/Care Center, hereinafter referred to as "PROVIDER."
WHEREAS, the County participates in funding substance abuse and mental health (SAMH)
services within the County pursuant to Section 394.76(9)(a), Florida Statutes; and
WHEREAS, the PROVIDER is a not -for -profit corporation that provides SAMH services
within Monroe County; and
WHEREAS, it is a legitimate public purpose to provide substance abuse and mental health
services for individuals, now, therefore,
IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed
as follows:
FUNDING
1. GRANT OFFER TO THE PROVIDER. The County hereby agrees to provide local match
funding for State funding pursuant to Section 394.76(9)(a), Florida Statutes, and the contracts
between the PROVIDER and South Florida Behavioral Health Network (ME225-7-27 and PPG-2-03)
attached here in (Attachment D) to provide substance abuse and mental health services; such
funds shall be expended for alcohol, drug abuse, or mental health service programs.
2. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially
and satisfactorily performing and carrying out the duties and obligations of the Board, shall
reimburse the Provider for a local match portion of the Provider's expenditures for Substance
Abuse and Mental Health services, as billed by the Provider, for clients qualifying for such services
under applicable state and federal regulations and eligibility determination procedures, for
substance abuse treatment. This cost shall not exceed a total reimbursement of SIX HUNDRED
AND NINTY THOUSAND AND NO/100 DOLLARS ($690,000.00) in fiscal year 2016-2017.
3. TERM. This Agreement shall commence on October 1, 2016, and terminate September
30, 2017, unless earlier terminated pursuant to other provisions herein.
4. PAYMENT. Payment will be paid monthly as hereinafter set forth. Baker Act and
SAMH Billing Summary Forms, certified monthly financial and service load reports will be made
available to the Board to validate the delivery of services under this contract. The monthly
financial report is due in the office of the Clerk of the Board no later than the 15th day of the
following month. After the Clerk of the Board pre -audits the certified report, the Board shall
reimburse the Provider for its monthly expenses. However, the total of said monthly payments In
the aggregate sum shall not exceed the total amount shown in Article 2, above, during the term
of this agreement. To preserve client confidentiality required by law, copies of individual client
bills and records shall not be available to the Board for reimbursement purposes but shall be
made available only under controlled conditions to qualified auditors for audit purposes. The
organization's final invoice must be received within sixty days after the termination date of this
contract shown In Article 3 above.
Payment will be made periodically, but no more frequently than monthly, as hereinafter set
forth. Reimbursement requests will be submitted to the Board via the Clerk's Finance Office. The
County shall only reimburse, subject to the funded amounts below, those reimbursable expenses
which are reviewed and approved as complying with Monroe County Code of Ordinances, State
laws and regulations and Attachment A - Expense Reimbursement Requirements. Any funds
expended in violation of this Agreement or in violation of appropriate Federal, State, and County
Guidance Care Center-SAMH Contract FYi7, page 1
requirements shall be refunded in full to the County. Evidence of payment by the PROVIDER shall
be in the form of a letter, summarizing the expenses, with supporting documentation attached.
The letter should contain a notarized certification statement. An example of a reimbursement
request cover letter is included as Attachment B. The organization's final invoice must be
received within thirty days after the termination date of this contract shown in Article 3 above.
After the Clerk of the Board examines and approves the request for reimbursement, the
Board shall reimburse the PROVIDER. However, the total of said reimbursement expense
payments in the aggregate sum shall not exceed the total amount shown in Article 2, above,
during the term of this agreement.
S. AVAILABILITY OF FUNDS. The County reserves the right to withhold/reduce the
funds to the Provider in the event that the Department of Children and Families
eliminates/reduces the State contract funding.
If funds cannot be obtained or cannot be continued at a level sufficient to allow for
continued reimbursement of expenditures for services specified herein, this agreement may be
terminated immediately at the option of the Board by written notice of termination delivered to
the PROVIDER. The Board shall not be obligated to pay for any services or goods provided by the
PROVIDER after the PROVIDER has received written notice of termination, unless otherwise
required by law.
6. CLAIMS FOR FEDERAL OR STATE AID. PROVIDER and County agree that each shall
be, and is, empowered to apply for, seek, and obtain federal and state funds to further the
purpose of this Agreement; provided that all applications, requests, grant proposals, and funding
solicitations shall be approved by each party prior to submission.
7. PURCHASE OF PROPERTY. All property, whether real or personal, purchased with
funds provided under this agreement, shall become the property of Monroe County and shall be
accounted for pursuant to statutory requirements.
RECORDKEEPING
S. RECORDS. PROVIDER shall maintain all books, records, and documents directly
pertinent to performance under this Agreement in accordance with generally accepted accounting
principles consistently applied. Each party to this Agreement or their authorized representatives
shall have reasonable and timely access to such records of each other party to this Agreement for
public records purposes during the term of the Agreement and for four years following the
termination of this Agreement. If an auditor employed by the County or Clerk determines that
monies paid to PROVIDER pursuant to this Agreement were spent for purposes not authorized by
this Agreement, the PROVIDER shall repay the monies together with interest calculated pursuant
to Sec. 55.03, FS, running from the date the monies were paid to PROVIDER.
In addition, if PROVIDER is required to provide an audit as set forth in in Section 9(d) below, the
audit shall be prepared by an independent certified public accountant (CPA) with a current
license, in good standing with the Florida State Board of Accountancy, and maintain malpractice
insurance covering the audit services provided. If the PROVIDER receives $100,000 or more in
grant funding from the County, the CPA must also be a member of the American Institute of
Certified Public Accountant (AICPA). The County shall be considered an "intended recipient" of
said audit.
9. PUBLIC ACCESS. The County and PROVIDER shall allow and permit reasonable access
to, and inspection of, all documents, papers, letters or other materials in its possession or under
its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the
County and PROVIDER in conjunction with this Agreement; and the County shall have the right to
unilaterally cancel this Agreement upon violation of this provision by PROVIDER.
Guidance Care Center-SAMH Contract FYi7, page 2
10. COMPLIANCE WITH COUNTY GUIDELINES. The PROVIDER must furnish to the
County the following (items A-M must be provided prior to the payment of any invoices):
(a) IRS Letter of Determination and GUIDESTAR printout indicating current 501(c)(3) status;
(b)
Proof of registration with the Florida Department of Agriculture as required by Florida
Statute 496.405 and the Florida Department of State as require by Florida Statute
617.01201 or proof of exemption from registration as per Florida Stature 496.406.
(c)
List of the Organization's Board of Directors of which there must be at least 5 and for each
board member please indicate when elected to serve and the length of term of service;
(d)
Evidence of annual election of Officers and Directors;
(e)
Unqualified audited financial statement from the most recent fiscal year for all
organizations that expend $150,000 a year or more; if qualified, include a statement of
deficiencies with corrective actions recommended/taken;
1. If the PROVIDER receives $100,000 or more in grant funding from the County
an audit shall be prepared by an independent certified public accountant (CPA):
a. The CPA must have a current license, in good standing with the Florida
State Board of Accountancy;
b. The CPA must be a member of the American Institute of Certified Public
Accountant (AICPA);
c. The CPA must maintain malpractice insurance covering the audit services
provided and
d. The County shall be considered an "intended recipient" of said audit."
(f)
Copy of a filed IRS Form 990 from most recent fiscal year with all attached schedules;
(g)
Organization's Corporate Bylaws, which must include the organization's mission, board and
membership composition, and process for election of officers;
(h)
Organization's Policies and Procedures Manual which must include hiring policies for all
staff, drug and alcohol free workplace provisions, and equal employment opportunity
provisions;
(i)
Specific description or list of services to be provided under this contract with this grant
(see Attachment C, per contract ME225-7-27 and PPG-2-03);
(j)
All legally required licenses;
(k)
Any updates/amendments throughout the fiscal year to the South Florida Behavioral
Network contract with the Department of Children and Families (KH-225) and with
Guidance/Care Center (ME225-7-27 and PPG-2-03);
(1)
Annual Performance Report describing services rendered during the most recently
>-
completed grant period (to be furnished within 30 days after the contract end date.) The
i
performance report shall include statistical information regarding the types and
frequencies of services provided, a profile of clients (including residency) and numbers
served, and outcomes achieved;
i
(m) Cooperation with County monitoring visits that the County may request during the contract
year; and
(n)
Other reasonable reports and information related to compliance with applicable laws,
contract provisions and the scope of services that the County may request during the
contract year.
11. AUDIT. The Provider shall provide the County with an annual audit pursuant to Section
394.76(9)(a), Florida Statutes, which separately reflects the funds received from the County and
related expenditures of said funds during the 2015-2016 fiscal year. Provider audits shall be
performed at no cost to the County and shall be provided to the County no later than January 1,
2017.
RESPONSIBILITIES
12. SCOPE OF SERVICES. The PROVIDER, for the consideration named, covenants and
agrees with the Board to substantially and satisfactorily perform and provide the services outlined
in Attachment C to residents of Monroe County, Florida.
Guidance Care Center-SAMH Contract FYI 7; page 3
13. ATTORNEY'S FEES AND COSTS. The County and PROVIDER agree that in the event
any cause of action or administrative proceeding is initiated or defended by any party relative to
the enforcement or interpretation of this Agreement, the prevailing party shall be entitled to
reasonable attorney's fees, court costs, investigative, and out-of-pocket expenses, as an award
against the non -prevailing party, and shall include attorney's fees, courts costs, investigative, and
out-of-pocket expenses in appellate proceedings. Mediation proceedings initiated and conducted
pursuant to this Agreement shall be in accordance with the Florida Rules of Civil Procedure and
usual and customary procedures required by the circuit court of Monroe County.
14. BINDING EFFECT. The terms, covenants, conditions, and provisions of this
Agreement shall bind and inure to the benefit of the County and PROVIDER and their respective
legal representatives, successors, and assigns.
IS. CODE OF ETHICS. County agrees that officers and employees of the County
recognize and will be required to comply with the standards of conduct for public officers and
employees as delineated in Section 112.313, Florida Statutes, regarding, but not limited to,
solicitation or acceptance of gifts; doing business with one's agency; unauthorized compensation;
misuse of public position, conflicting employment or contractual relationship; and disclosure or
use of certain information.
16. NO SOLICITATION/PAYMENT. The County and PROVIDER warrant that, in respect
to itself, it has neither employed nor retained any company or person, other than a bona fide
employee working solely for it, to solicit or secure this Agreement and that it has not paid or
agreed to pay any person, company, corporation, individual, or firm, other than a bona fide
employee working solely for it, any fee, commission, percentage, gift, or other consideration
contingent upon or resulting from the award or making of this Agreement. For the breach or
violation of the provision, the PROVIDER agrees that the County shall have the right to terminate
this Agreement without liability and, at its discretion, to offset from monies owed, or otherwise
recover, the full amount of such fee, commission, percentage, gift, or consideration.
17. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the
PROVIDER is an independent contractor and not an employee of the Board. No statement
contained in this agreement shall be construed so as to find the PROVIDER or any of its
employees, contractors, servants or agents to be employees of the Board.
COMPLIANCE ISSUES
18. COMPLIANCE WITH LAW. In providing all services pursuant to this agreement, the
PROVIDER shall abide by all statutes, ordinances, rules and regulations pertaining to or regulating
the provision of such services, including those now in effect and hereinafter adopted. Any
violation of said statutes, ordinances, rules and regulations shall constitute a material breach of
this agreement and shall entitle the Board to terminate this contract immediately upon delivery of
written notice of termination to the PROVIDER.
19. PROFESSIONAL RESPONSIBILITY AND LICENSING. The PROVIDER shall assure
that all professionals have current and appropriate professional licenses and professional liability
insurance coverage. Funding by the Board is contingent upon retention of appropriate local, state
and/or federal certification and/or licensure of the PROVIDER'S program and staff.
20. NON-DISCRIMINATION. County and PROVIDER agree that there will be no
discrimination against any person, and it is expressly understood that upon a determination by a
court of competent jurisdiction that discrimination has occurred, this Agreement automatically
terminates without any further action on the part of any party, effective the date of the court
order. County or PROVIDER agree to comply with all Federal and Florida statutes, and all local
ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1)
Title VI of the Civil Rights Act of 1964 (PL 88-352) which prohibits discrimination on the basis of
race, color or national origin; 2) Title IX of the Education Amendment of 1972, as amended (20
Guidance Care Center-SAMH Contract FYI7, page 4
USC ss. 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; 3)
Section 504 of the Rehabilitation Act of 1973, as amended (20 USC s. 794), which prohibits
discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended (42
USC ss. 6101-6107) which prohibits discrimination on the basis of age; 5) The Drug Abuse Office
and Treatment Act of 1972 (PL 92-255), as amended, relating to nondiscrimination on the basis of
drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and
Rehabilitation Act of 1970 (PL 91-616), as amended, relating to nondiscrimination on the basis of
alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, ss. 523 and 527 (42 USC
ss. 690dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug abuse
patient records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC s. et seq.), as amended,
relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with
Disabilities Act of 1990 (42 USC s. 1201 Note), as maybe amended from time to time, relating to
nondiscrimination on the basis of disability; 10) Any other nondiscrimination provisions in any
Federal or state statutes which may apply to the parties to, or the subject matter of, this
Agreement.
AMENDMENTS, CHANGES, AND DISPUTES
21. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the services
and/or reimbursement of services shall be accomplished by an amendment, which must be
approved in writing by the County.
22. ADJUDICATION OF DISPUTES OR DISAGREEMENTS. County and PROVIDER
agree that all disputes and disagreements shall be attempted to be resolved by meet and confer
sessions between representatives of each of the parties. If no resolution can be agreed upon
within 30 days after the first meet and confer session, the issue or issues shall be discussed at a
public meeting of the Board of County Commissioners. If the issue or issues are still not resolved
to the satisfaction of the parties, then any party shall have the right to seek such relief or remedy
as may be provided by this Agreement or by Florida law.
23. COOPERATION. In the event any administrative or legal proceeding is instituted
against either party relating to the formation, execution, performance, or breach of this
Agreement, County and PROVIDER agree to participate, to the extent required by the other party,
In all proceedings, hearings, processes, meetings, and other activities related to the substance of
this Agreement or provision of the services under this Agreement. County and PROVIDER
specifically agree that no party to this Agreement shall be required to enter into any arbitration
proceedings related to this Agreement.
ASSURANCES
24. COVENANT OF NO INTEREST. County and PROVIDER covenant that neither
presently has any interest, and shall not acquire any interest, which would conflict in any manner
or degree with its performance under this Agreement, and that only interest of each is to perform
and receive benefits as recited in this Agreement.
25. NO ASSIGNMENT. The PROVIDER shall not assign this agreement except in writing
and with the prior written approval of the Board, which approval shall be subject to such
conditions and provisions as the Board may deem necessary. This agreement shall be
incorporated by reference into any assignment and any assignee shall comply with all of the
provisions herein. Unless expressly provided for therein, such approval shall in no manner or
event be deemed to impose any obligation upon the Board in addition to the total agreed upon
reimbursement amount for the services of the PROVIDER.
26. NON -WAIVER OF IMMUNITY. Notwithstanding the provisions of Sec. 768.28,
Florida Statutes, the participation of the County and the PROVIDER in this Agreement and the
acquisition of any commercial liability insurance coverage, self-insurance coverage, or local
government liabil',ity insurance pool coverage shall not be deemed a waiver of immunity to the
Guidance Care Center-SAMN Contract FYI , page
extent of liability coverage, nor shall any contract entered into by the County be required to
contain any provision for waiver.
27. ATTESTATIONS. PROVIDER agrees to execute such documents as the County may
reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug -
Free Workplace Statement.
28. AUTHORITY. Each party represents and warrants to the other that the execution,
delivery and performance of this Agreement have been duly authorized by all necessary County
and corporate action, as required by law.
INDEMNITY ISSUES
29. INDEMNIFICATION AND HOLD HARMLESS. The PROVIDER covenants and agrees
to indemnify and hold harmless Monroe County Board of County Commissioners from any and all
claims for bodily injury (including death), personal injury, and property damage (including
property owned by Monroe County) and any other losses, damages, and expenses (including
attorney's fees) which arise out of, in connection with, or by reason of services provided by the
PROVIDER occasioned by the negligence, errors, or other wrongful act or omission of the
PROVIDER'S employees, agents, or volunteers.
30. PRIVILEGES AND IMMUNITIES. All of the privileges and immunities from liability,
exemptions from laws, ordinances, and rules and pensions and relief, disability, workers'
compensation, and other benefits which apply to the activity of officers, agents, or employees of
any public agents or employees of the County, when performing their respective functions under
this Agreement within the territorial limits of the County shall apply to the same degree and
extent to the performance of such functions and duties of such officers, agents, volunteers, or
employees outside the territorial limits of the County.
31. NO PERSONAL LIABILITY. No covenant or agreement contained herein shall be
deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe
County in his or her individual capacity, and no member, officer, agent or employee of Monroe
County shall be liable personally on this Agreement or be subject to any personal liability or
accountability by reason of the execution of this Agreement.
32. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non -Delegation of Constitutional
or Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any
participating entity from any obligation or responsibility imposed upon the entity by law except to
the extent of actual and timely performance thereof by any participating entity, in which case the
performance may be offered in satisfaction of the obligation or responsibility. Further, this
Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the
constitutional or statutory duties of the County, except to the extent permitted by the Florida
constitution, state statute, and case law.
33. NON -RELIANCE BY NON-PARTIES. No person or entity shall be entitled to rely
upon the terms of this Agreement to enforce or attempt to enforce any third -party claim or
entitlement to or benefit of any service or program contemplated hereunder, and the County and
the PROVIDER agree that neither the County nor the PROVIDER or any agent, officer, or employee
of either shall have the authority to inform, counsel, or otherwise indicate that any particular
individual or group of individuals, entity or entities, have entitlements or benefits under this
Agreement separate and apart, inferior to, or superior to the community in general or for the
purposes contemplated in this Agreement.
GENERAL
34. Execution in Counterparts. This Agreement may be executed in any number of
counterparts, each of which shall be regarded as an original, all of which taken together shall
Guidance Care Center-SAMH Contract FYI 7, page 6
constitute one and the same instrument and any of the parties hereto may execute this
Agreement by signing any such counterpart.
35. NOTICE. Any notice required or permitted under this agreement shall be in writing
and hand -delivered or mailed, postage pre -paid, by certified mail, return receipt requested, to the
other party as follows:
For Board:
Grants Administrator and
1100 Simonton Street
Key West, FL 33040
For PROVIDER
Frank Rabbito, Senior Vice President
Guidance/Care Center
1205 Fourth Street
Key West, FL 33040
Monroe County Attorney
PO Box 1026
Key West, FL 33041
36. GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES. This
Agreement shall be governed by and construed in accordance with the laws of the State of Florida
applicable to contracts made and to be performed entirely in the State.
In the event that any cause of action or administrative proceeding is instituted for the
enforcement or interpretation of this Agreement, the County and PROVIDER agree that venue will
lie in the appropriate court or before the appropriate administrative body in Monroe County,
Florida.
The County and PROVIDER agree that, in the event of conflicting interpretations of the
terms or a term of this Agreement by or between any of them the issue shall be submitted to
mediation prior to the institution of any other administrative or legal proceeding.
37. NON -WAIVER. Any waiver of any breach of covenants herein contained to be kept
and performed by the PROVIDER shall not be deemed or considered as a continuing waiver and
shall not operate to bar or prevent the Board from declaring a forfeiture for any succeeding
breach, either of the same conditions or covenants or otherwise.
38. SEVERABILITY. If any term, covenant, condition or provision of this Agreement (or
the application thereof to any circumstance or person) shall be declared invalid or unenforceable
to any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions
and provisions of this Agreement, shall not be affected thereby; and each remaining term,
covenant, condition and provision of this Agreement shall be valid and shall be enforceable to the
fullest extent permitted by law unless the enforcement of the remaining terms, covenants,
conditions and provisions of this Agreement would prevent the accomplishment of the original
intent of this Agreement. The County and PROVIDER agree to reform the Agreement to replace
any stricken provision with a valid provision that comes as close as possible to the intent of the
stricken provision.
39. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the
parties hereto with respect to the subject matter hereof and supersedes any and all prior
agreements with respect to such subject matter between the PROVIDER and the Board.
[THIS SPACE INTENTIONALLY LEFT BLANK WITH SIGNATORY PAGE TO FOLLOW]
Guidance Care Center-SAMH Contract FYI T page 7
IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as
of the day and year first written above.
(SEAL)
ATTEST: AMY HEAVILIN, CLERK
By
Deputy Clerk
r
J l f ,7- �i, ✓/// ( cif//
Fitness
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By
Mayor/Chairman
Guidance/Care Center
{Federal ID No.59-1 '9324 )
By
Director
Guidance/Care Center
/L'
Guidance care Center-SAMH Contract Fyi 7, page a
ATTACHMENT A
EXPENSE REIMBURSEMENT REQUIREMENTS
This document is intended to provide basic guidelines to Human Service and Community -Based
Organizations, county travelers, and contractual parties who have reimbursable expenses
associated with Monroe County business. These guidelines, as they relate to travel, are from the
Monroe County Code of Ordinances and State laws and regulations.
A cover letter (see Attachment B) summarizing the major line items on the reimbursable expense
request needs to also contain the following notarized certified statement:
"I certify that the above checks have been submitted to the vendors as noted and that the
attached expenses are accurate and in agreement with the records of this organization.
Furthermore, these expenses are in compliance with this organization's contract with the Monroe
County Board of County Commissioners and will not be submitted for reimbursement to any other
funding source."
Invoices should be billed to the contracting agency. Third party payments will not be considered
for reimbursement. Remember, the expense should be paid prior to requesting a reimbursement.
Only current charges will be considered, no previous balances.
Reimbursement requests will be monitored in accordance with the level of detail in the contract.
This document should not be considered all-inclusive. The Clerk's Finance Department reserves
the right to review reimbursement requests on an individual basis. Any questions regarding these
guidelines should be directed to 305-292-3534.
Data Processing, PC Time, etc.
The vendor invoice is required for reimbursement. Inter -company allocations are not considered
reimbursable expenditures unless appropriate payroll journals for the charging department are
attached and certified.
Payroll
A certified statement verifying the accuracy and authenticity of the payroll expense is needed. If
a Payroll Journal is provided, it should include: dates, employee name, salary or hourly rate, total
hours worked, withholding information and paid payroll taxes, check number and check amount.
If a Payroll Journal is not provided, the following information must be provided: pay period, check
amount, check number, date, payee, and support for applicable paid payroll taxes.
Postage, Overnight Deliveries, Courier, etc.
A log of all postage expenses as they relate to the County contract is required for reimbursement.
For overnight or express deliveries, the vendor invoice must be included.
Rents, Leases, etc.
A copy of the rental or lease agreement is required. Deposits and advance payments are not
allowable expenses.
Reproductions, Copies, etc.
A log of copy expenses as they relate to the County contract is required for reimbursement. The
log must define the date, number of copies made, source document, purpose, and recipient. A
reasonable fee for copy expenses will be allowable. For vendor services, the vendor invoice and a
sample of the finished product are required.
Supplies, Services, etc.
For supplies or services ordered, a vendor invoice is required.
Guidance Care Center-SAMH Contract FYI T 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 5 a.m. for breakfast reimbursement, before noon and end after 2
p.m. for lunch reimbursement, and before 5 p.m. and end after 8 p.m. for dinner reimbursement.
Non -allowable Expenses
The following expenses are not allowable for reimbursement: capital outlay expenditures (unless
specifically included in the contract), contributions, depreciation expenses (unless specifically
included in the contract), entertainment expenses, Fundraising, non -sufficient check charges,
penalties and fines.
Guidance Care Center-SAMN Contract FYi7, 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
(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) 1 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
who is personally known to me.
Notary Public Notary Stamp
20_ by
Guidance Care Center-SAMH Contract FYI 7, page l f
ATTACHMENT C
Services to be provided:
(Local match portion of State -Funded Substance Abuse Mental Health Services, inclusive of Baker
Act services, per Florida Statutes, and contracts between Guidance Care Center and the South
Florida Behavioral Health Network (ME 225-7-27 and PPG-2-03).
Guidance Care Center--SAMH Contract FY17„ page 12
ATTACHMENT D
Contractual Agreement
Guidance/Care Center and
South Florida Behavioral Health Network
(Contract Nos, ME225-7-27 and PPG-2-03)
Guidance Care Center-SAMH Contract FYI 7, page 13
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Fe South Florida
Behavioral
Health Network, Inc.
WK07MYR[rc
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 defiverables
must be received and accepted by the ME contract manager and/or designee, in writing prior to payment, The Network Provider shall submit bills
for fees or other compensation for services or expenses in sufficient detail for proper pre -audit and post -audit; where itemized payment for travel
expenses are permitted in this contract, submit bills for any travel expenses in accordance with section 112.061. F.S., or at such lower rates as
may be provided in this contract. To allow public access to all documents, papers, letters, or other public records as defined in subsection
119.011(12), F.S. and as prescribed by subsection 119.07(1) F.S., made or received by the Network Provider in conjunction with this contract
except that public records which are made confidential by law must be protected from disclosure. It is expressly understood that the Network
Provider's failure to comply with this provision shall constitute an immediate breach of contract for which the ME may unilaterally terminate the
contract.
3. Provisions of the Prime Contract
All provisions, terms and conditions, or amendments, addendum, changes or revisions applicable to the Network Provider made subsequent to the
Initial execution of the Prime Contract, i e., the Contract entered into between the DCF and SFBHN (ME), not in conflict with this Contract, shall be
binding upon the Network Provider and the Network Provider agrees to comply with same. The Prime Contract is incorporated by reference in this
Contract. In case of conflict with the provisions, terms and conditions of The Prime Contract and this Contract, the provisions, terms and
conditions of this Contract will prevail. In the event of a conflict between the provisions of the documents of this contract, the documents shall be
interpreted in the order of precedence listed in Paragraph 46, of this Standard Contract.
4. Effective and Ending Dates
This contract shall begin on July 1 2016, It shall end at midnight, local time in Miami -Dade County, Florida on
5. State of Florida Law
This contract is executed and entered into in the State or Florida, and shall be construed, performed and enforced in all respects in accordance
with Florida law, without regard to Florida provisions for conflict of laws. Courts of competent jurisdiction in Florida shall have exclusive jurisdiction
in any action regarding this contract and venue shall be the appropriate State court in Miami -Dade County, Florida.
6. Federal Law
a. If this contract contains federal funds, the Network Provider shall comply with the provisions of federal law and regulations including but not
limited to, 45 Code of Federal Regulations (CFR), Part 74, 45 CFR, Part 92, and other applicable regulations,
b If this contract contains over $100,000 of federal funds, the Network Provider shall comply with all applicable standards,
orders, or regulations
issued under section 306 of the Clean Air Act, as amended (42 United States Code (U.S.C.) 7401 el seq.), section 508 of the Federal Water
Pollution Control Act, as amended (33 U.S.C. 1251 et seq.), Executive Order 11738, as amended and where applicable, and Environmental
Protection Agency regulations (40 CFR, Part 30). The Network Provider shall report any violations of the above to the ME.
c. No federal funds received in connection with this contract may be used by the Network Provider, or agent acting for the Network Provider, or
subcontractor to influence legislation or appropriations pending before the Congress or any State legislature. If this contract Contains federal
funding in excess of $100,000, the Network Provider must, prior to contract execution, complete the Certification Regarding Lobbying form,
Attachment Ill. if a Disclosure of Lobbying Activities form, Standard Form LLL, is required, it may obtained from the contract manager. All
disclosure forms as required by the Certification Regarding Lobbying form must be completed and returned to the contract manager, prior to
payment under this contract.
d. Unauthorized aliens shall not be employed. The ME shall consider the employment of unauthorized aliens a violation of section 274A(e) of the
Immigration and Nationality Act (8 U S,C 1324 a) and section 101 of the Immigration Reform and Control Act of 1986. Such violation shall be
cause for unilateral cancellation of this contract by the ME. Pursuant to Executive 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 verity the employment eligibility of its employees and the subcontractors' employees performing under this contract.
e. If this contract contains SIC 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 So 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
br Retention of all client records, financial records, supporting documents statistical records, and any ather documents (including elertroroc
Standard Contract
Guidance/Cafe Center, Inc. Page I of I I Contract No, ME225-7-27
0 "MI'd � South Florida
? Behavioral
0:;A11 Health Network, Inc. rev 07/OI12016
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, Slate, or other personnel
duly authorized by the ME.
a. 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,
I. A financial and compliance audit shall be provided to the ME as specified in this contract and in Attachment 11. Einanclal and Compliance
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 2(1.055, F,S.).
h The Network Provider shall include the aforementioned audit, inspections, investigations and record keeping requirements in all subcontracts
and assignments.
5. Inspections and Corrective Action
The Network Provider shall permit all persons who are duly authorized by the ME and the DCF to inspect and copy any records. papers,
documents, facilities, goods and services of the Network Provider which are relevant to this contract, the scope of review being conducted, and
to interview any clients, employees and subcontractor employees of the Network Provider to assure the ME of the satisfactory performance of the
terms and conditions of this contract. Following such review. the ME will deliver to the Network Provider a written report of its findings, and may
direct the development, by the Network Provider, of a corrective action plan where appropriate. The Network Provider hereby agrees to timely
correct all deficiencies identified in the corrective action plan. This provision will not limit the ME's termination rights under Section 40. Failure to
implement corrective action plans to the satisfaction of the ME, after receiving due notice, shall be grounds for contract termination,
9. Indemnification
a, The Network Provider shall be fully liable for the actions of its agents, employees, partners, or subcontractors and shall fully indemnify, defend,
and hold harmless the ME, State and the Florida Department of Children and Families (DCF), and its officers, agents- and employees, from suits,
actions, damages, and costs of every name and description, including attorneys' fees, arising from or relating to any alleged act or omission by the
Network Provider, its agents, employees, partners, or subcontractors, provided, however, that the Network Provider shall not indemnify for that
portion of any loss or damages caused by the negligent act or omission of the ME.
b. The Network Provider shall fully indemnify, defend and hold harmless the ME, the State and the DCF, from any suits, actions, damages, and
costs of every name and description , including attorneys' fees, arising from or relating to violation of infringement of a trademark, copyright,
patent, trade secret or intellectual property right, provided, however, that the foregoing obligation shall not apply to the ME's misuse or
modification of Network Provider's products or a ME's operation or use of Network Provider's products in a manner not contemplated by the
contract or the purchase order. If any product Is the subject of an infringement suit or in the Network Provider's opinion is likely to become the
subject of such a suit, the Network Provider may at its sole expense procure for the ME the right to continue using the product or modify it to
become non infringing. If the Network Provider is not reasonably able to modify or otherwise secure the ME the use. the ME shall not be livable 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 1. By execution of this contract, unless it is a State
agency or subdivision as defined by subsection 768.28(2), VS., 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
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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 of 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 Slate 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 websile. www s hn or .
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 [his
Standard Contract that mention or describe subcontract compliance,
13. Return of Funds
a, The Network Provider shall return to the ME any overpayments due to unearned funds or funds disallowed that were disbursed to the Network
Provider by the ME and any interest attributable to such funds pursuant to s 215.97. s. 215,971, F.S. Should repayment not be promptly made
upon discovery by the Network Provider or its auditor or upon written notice by the ME, the Network Provider will be charged interest at the lawful
rate of interest on the outstanding balance until returned.
b. Payments made for services subsequently determined by the ME to not be in full compliance with contract requirements shall be deemed
overpayments. The ME shall have the right at an time to offset or deduct from any amount due to the ME from the Network Provider under this or
any other contract or agreement,
c. The funds paid to the Network Provider are continually subject to Review, Revision and Adjustment after evaluation of Utilization and
Performance measures monitored by ME.
14. Client Risk Prevention and Incident Reporting
a. If services to clients are to be provided under this contract, the Network Provider and any subcontractors shall, in accordance with the client
risk prevention system, report those reportable situations listed in CFOP 215-6 in the manner prescribed in CFOP 215-6 or circuit or region
operating procedures. The Network Provider shall immediately report any knowledge or reasonable suspicion of abuse, neglect, or exploitation of
a child, aged person, or disabled adult to the Florida Abuse Hotline on the Statewide toll -free telephone number (1-800-96ABUSE). As required by
Chapters 39 and 415 F,&, this provision is binding upon both the Network Provider and Its employees.
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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 V1 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 he 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 sale
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 Stale: "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 Providers 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, FrS . 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 nut submit bids, proposals, or replies on leases of real property to a public entity: may not be
awarded of 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
8, It is agreed that at; 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
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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 failing 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 wilhout exception that the compensation paid pursuant to this
contract includes all royalties or costs arising from the use of such design, device, or materials in any way involved in the work contemplated by
this contract. For the purposes of this provision, the term -use' shall include use by the Network Provider during the term of this contract and use
by the ME, agents, or contractors and the Department during the term of this contract and perpetually thereafter.
c, All applicable subcontracts shall include a provision that the Federal awarding agency reserves all patent rights with respect to any discovery or
invention that arises or is developed in the course of or under the subcontract. Notwithstanding the foregoing provision, if the Network Provider or
one of its subcontractors is a university and a member of the State University of Florida, then section 1004 23, F.S_ shall apply, but the
Department and the ME shall retain a perpetual, fully -paid, non-exclusive license for Its use and the use of its contractors of any resulting
patented, copyrighted or trademarked work products.
24. Real Property
Any State funds provided for the purchase of or improvements to real property are contingent upon the Network Provider granting to the State a
security interest in the property at least to the amount of the State funds provided for at least five (5) years from the date of purchase or the
completion of the improvements or as further required by law, As a condition of receipt of State funding for this purpose. the Network Provider
agrees That, if It disposes of the property before the Department's interest is vacated, the Network Provider will refund the proportionate share of
the State's initial investment, as adjusted by depreciation.
25. Information Security Obligations
a. An appropriately skilled individual shall be identified by the Network Provider to function as its Data Security Officer The Data Security Officer
shall act as the liaison to the ME's security staff and will maintain an appropriate level of data security for the information the Network Provider is
collecting or using in the performance of this contract An appropriate level of security Includes approving and tracking all Network Provider
employees that request or have access to any ME or DCF data system or information,
b, The Data Security Officer will ensure that user access to the data system or information has been removed from all terminated Network
Provider employees immediately upon termination of employment.
c The Network Provider shall provide the latest DCF HIPPA and Security Awareness Training to its staff and subcontractors who have access to
ME and DCF data system, information and/or who have access to Protected Health Information regardless of format (e.g electronic. written,
audio, video or still image recording) or function. Security and HIPAA requirements extend to non -clinical or non -administrative personnel If such
persons can access Protected Health Information_ The Network Provider shall ensure that proof of training is maintained in each employee file,
d All Network Provider employees who have access to ME or DCF data system or information, including but not limited to access to KIS, or any
data system designated by the ME, Substance Abuse and Menial 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 role. 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 CIF 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 stared 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 of mitigate
potential injury to any person due to a breach of personal and confidential ME and/or DCF data.
26. Accreditation
The ME is committed to ensuring provision of the highest quality services to the persons we serve, Accordingly, the ME has expectations that
where accreditation is generally accepted nationwide as a clear Indicator of quality service, the majority of the ME's Network Providers willtake
appropriate steps to maintain its accreditation or become fully accredited by June 30 2017. Should the ME seek accreditation the Network Provider
shall collaborate with the ME in the application process.
27. Network Provider Employment Opportunities
a, Agency for Workforce Innovation and Workforce Florida: The Network Provider understands that the DCF, the Department of Economic
Opportunity, and Workforce Florida, Inc,, have jointty implemented an initiative to empower recipients In the Temporary Assistance to Needy
Families Program to enter and remain in gainful employment. The ME encourages Network Provider participation with the Department of
Economic Opportunity and Workforce Florida.
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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 at 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
04
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 04
contract manager will be notified within len (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 1-8130-543-5353.
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 Providers 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.FrR 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 Ward -of -Hearing."
ti. If the Network Provider or any of Its subcontractors employs fifteen (16) or more employees, the Network Provider shall designate a Single -
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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 "thin fourteen (14) calendar days of the effective date of this requirement.
r. The Network Provider shall, within 30 days of the effective date of this requirement, contractually require that its subcontractors comply with
section 604, the ADA, and CFOP 60-10, Chapter 4. The Network Provider's Single Point of Contact and that of its subcontractors VAII process the
compliance data into the Department of Children and Families HHS Compliance reporting database at
hit Jff I .(grrri§itg.rgmlNFTrainino/Monlhlv-Summ!2rv-ReDortiform,iggin,htmt 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
Providers 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 Pravider-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 hardaofhearing 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: hitp llwww.myflfamiligs.rpmlgervice-programsideaI and-hard-hearing1providers
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 aidsiservice 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
subject to the availability of funds and satisfactory performance of all terms by the Network Provider. Of the total Contract amount- the ME will be
required to pay $4,585,341.00, subject to the delivery and billing for services. The remaining amount of $917,068.00, represents 'Uncompensated
Units Reimbursement Funds", which the ME, at its sole discretion and subject to the availability of funds, may pay to the Network Provider, in
whole or in part, or not at all, for Exemplary Performance by the Network Provider. Exemplary Performance will be determined by the Network
Provider delivering and billing for services in excess of those units of service the ME will be required to pay. Should the network provider receive
any funding from the 'Uncompensated Units Reimbursement Funds', then the amount of Local Match as it appears on Exhibit B, Method of
Payment and in Exhibit H, Funding Detail, will automatically change, utilizing the formula prescribed in the Method of Payment section of this
contract. The ME's obligation to pay under this Contract is contingent upon an annual appropriation by the Legislature and the Contract between
the ME and the DCF. Any costs or services eligible to be paid for under any other contract or from any other source are not eligible for payment
under this Contract.
35. Contract Payment
(a) The network provider shall request payment monthly through submission of a properly completed invoice, per the requirements of this
Contract, within eight (8) calendar days following the end of the month for which payment is being requested.
(b) It no services are due to be invoiced from the preceding month, the network provider shall submit a written document to the ME indicating this
information within eight (8) calendar days following the end of the month. Should the network provider fail to submit an invoice or written
documentation (should no services be due to be invoiced from the preceding month), within thirty (30) calendar days following the end of the
month, then the ME at sole discretion will consider these funds as lapse and may reallocate these funds within the network of providers. If the
Network Provider fails to submit an invoice or written documentation for two (2) consecutive months within a twelve (12) month period, the ME at
its sole discretion can terminate the contract or whole or In part.
(c) The ME has ten (10) working days, subject to the availability of funds, to inspect, and approve for goods and services, unless the bid
specifications, purchase order. or this Contract specify otherwise. The MEs failure to pay the Network Provider within the ten (10) working days
will result in a penalties as referenced in the Prime Contract. Invoices returned to a Network Provider due to preparation errors will result in a non -
interest bearing payment delay. Interest penalties less than one (1) dollar will not be paid unless the Network Provider requests payment. Payment
shall be made only upon written acceptance by the ME and shall remain subject to the subsequent audit or review to confirm contract compliance.
36. Financial Consequences for Network Provider's Failure to Perform
If the Network Provider fails to meet the minimum level of service or performance identified in this contract, or that is customary for the industry,
than the ME will apply financial consequences commensurate with the deficiency. Financial consequences may include but are not limited to
refusing payment, withholding payments until deficiency is cured, tendering only partial payments, Imposition of penalties per Section 39 , and
termination of contract in whole or in part and requisition of services form an alternate source. Any payment made in reliance an the Network
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Provider's evidence of performance which evidence is subsequently determined to be erroneous, will be immediately due as an overpayment in
accordance With Section 13, above- entitled "Return of Funds" to the extent of such error.
37. Vendor Ombudsman
A Vendor Ombudsman has been established within the Department of Financial Services The duties of this office are found in section 215 422,
F.S , which include disseminating information relative to prompt payment and assisting vendors in receiving their payments in a timely manner
from a State agency. The Vendor Ombudsman may be contacted at (850) 413-5516.
38. Notice
Any notice that is required under this contract shall be in writing, and sent by U S. Postal Service or any expedited delivery service that provides
verification of delivery or by hand delivery, Said notice shall be sent to the representative of the Network Provider responsible for, administration of
the program, to the designated address contained in this contract.
39. Financial Penalties for Failure to Comply with Requirement for Corrective Action
a. In accordance with the provisions of section 402 73(1), F. S , and Rule 65-29.001 - F S_, corrective action plans may be required for
noncompliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed for failure to Implement or to make
acceptable progress on such corrective action plans. The ME, at Its sole discretion, will determine the findings identified in the corrective plan that
will require a financial penalty.
b. The increments of penalty imposition that shall apply, unless the ME determines that extenuating circumstances exist, shall be based upon the
severity of the noncompliance, nonperformance, or unacceptable performance that generated the need for corrective action plan. The penalty, If
imposed, shall not exceed ten percent (110%) 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 rove
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 pan 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 Providers 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-ReneweitTermination/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-RenewaliTermination/Rerord Transition Plan may be obtained from the ME's
website at www sfbhn.ora.
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 andlor
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 rive (5) working days of the execution of this contract, each party shall designate a
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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 dale of receipt of the written request for dispute resolution. If the representatives are unable to reach a mutually satisfactory resolution at
the face-to-face meeting, the dispute resolution process in Section 42.(c) shall be followed In the event of a dispute regarding client eligibility
and/or placement into the appropriate level of care, the dispute shall not preclude the Network Provider from providing the provision of services to
eligible individuals until the dispute is resolved,
(c) If the representatives are unable to reach a mutually satisfactory resolution, either representative may request referral of the issue to the
PresidenUChief 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 PresidenUChief Executive Officer of the parties cannot resolve the issue, the issue shall
be presented at the discretion of the ME either to the Board of Directors Executive Committee and/or the ME's Board of Directors. Should the
dispute not be resolved at the Board of Directors Executive Committee and/or the ME's full Board of Directors level, the decision of the ME shall
prevail subject to any legal rights that the Network Provider may have and/or wish to exercise. Venue for any court action will be in Miami•Dade
County, Florida. This provision shall not limit the parties' rights of termination under Section 40.
43. Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List
(For Contracts Valued at $1,000,000.00 (total contract value), or more, awarded, extended, or renewed on or after July 1, 2011).
The Network Provider agrees to refrain from any of the prohibited business activities with the Governments of Sudan and Iran as described in s.215,473,
F.S. Pursuant to section s.287.135(5). F.S., the ME shall immediately terminate this contract for cause If the Network Provider is found to have
submitted a false certification or if the Network Provider is placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized
Companies with Activities In the Iran Petroleum Energy Sector List during the term of the contract.
44. Employment Eligibility Verification (E-Verify)
(a) Definitions as used In this clause:
(i) 'Employee assigned to the contract' means all persons employed during the contract term by the Network Providerigrantee 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 E.
(n) 'Subcontract- means any contract entered into by a Network Provide to furnish supplies or services for performance of a prime contract or a
subcontract. It includes but is not limited to purchase orders, and changes and modifications to purchase orders.
(iii) "Subcontractor" means any supplier, distributor, vendor, or firm that furnishes supplies or services to or for the Network Provider or subcontractor
I b) Enrollment and verification requirements.
(1) The Network Providertgrantee shall:
(i) Enroll as a provider/grantee in the E-Verify program within 30 calendar days of contract award or amendment;
(0) 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/granteeisubcontractor to perform work pursuant to the contract with the ME shall be verified as
employment eligible within 3 business days after the date of hire,
(2) The Network Provider/grantee shall comply, for the period of performance of this contract, with the requirement of the E-Verify program
enrollment.
(i) The Department of Homeland Security (DHS) or the Social Security Administration (SSA) may terminate the Network Provideestgrantee's enrollment
and deny access to the E-Verify system in accordance with the terms of the enrollment. In such case, the Network Provider/grantee will be referred to a
DHS or SSA suspension or debarment official.
(ii) During the period between termination of the enrollment and a decision by the suspension or debarment official whether to suspend or debar, the
Network Provider/grantee is excused from its obligations under paragraph (b) of this clause If the suspension or deban-nent official determines not to
suspend or debar the Network Provider/grantee, then the Network Providerigrantee 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:
hit M/IwwwdhA I �-Vn _g2!L
(iv) The Network Provider/grantee is not required by this clause to perform additional employment verification using E-Verify for any employee whose
employment eligibility was previously verified by the Network Provider/grantee through the E-Verify program.
(v) Evidence of the use of the E-Verify system will be maintained in the employee's personnel file,
(vi) The Network provider/grantee shall include the requirements of this clause, including this paragraph (vi) (appropriately modified for identification of
the parties), in each subcontract.
(vii) The service provider at any tier level must comply with the E-Verify clause as subject to the same requirement as the Network Provider.
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PION
IRVJF1JFJrX_,1—Li Rolf-, wiv;itmi iNUF4 F;3 KTIC-0s] I MUIZ-s I
Employment history check&
(b) Fingerprinting for all cnminai records checks:
Ic
, ) Statewide criminal and juvenile delinquency records checks through Ole Florida Department of Law Enforcement (FDL.E)
(d) Federal criminal records check for the Federal Bureau of Investigation via the Florida Department of Law Enforcement and
"o) Security background investigation, which may include kral criminal record checks through local law enforcement agencies,
I Attestation by each employee, subject to penalty of perjury, to meeting the requirements for qualifying for employment pursuant to chapter 435 IF.&
and agreeing to Inform the employer immediately if arrested for any of the disqualng offenses while employed by the employer,
i 1W0_110INIRWRN601 D, IiR144MRW-R. 11W1i10WR1WI.WeAWN ;0i
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being promoted, transferred or demoted within the Department or Agency".
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49. Official Payee and Representatives (Names, Addresses, Telephone
Guidance/Care Center, Inc,
3000 41 st Street Ocean
Marathon, FIL 33050
C. The name of the contact person and street address where the
Provider's financial and administrative records are maintained
110
Jumbers and E-Mail Addresses)
b. The name, address, and telephone of the Contract Manager
for the ME for this contract is:
Elba Taveras
South Florida Behavioral Health Network, Inc.
7205 Corporate Center Drive. Suite 200
Miami, FL 33126
Tel, (786) 507-7462
E-Mail: Elaveras@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, FIL 33131
Office number. (305) 573-3784
Mobile number (305) 799-1286
Fax number (305) 381-7733
i—E-Mail: frabbiloMlvvesicare.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.
W All Terms and Conditions Included
This contract and it attachments, 1, 11, Ill, & IV and any exhibits referenced in said attachments, together with any documents incorporated by
reference, including the ME prime contract (which can be found at http./Iwww 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 [his contract shall supersede all previous
communications, representations, or agreements, either verbal or written between the parties, If any term or provision of this contract is legally
determined unlawful or unenforceable, the remainder of the contract shall remain in full force and effect and such term or provision shall be stricken.
In the event of a conflict between the provisions of the documents, the documents shall be interpreted in the following order of precedence:
a, Attachment 1, Exhibits, the Business Associate Agreement. and other attachments, if any:
b. Any documents incorporated into any Exhibit or Attachment by reference,
c. The Standard Contract
d, Any documents incorporated herein by reference
Standard Contract
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BY SIGNING THIS CONTRACT, THE PARTIES AGREE THAT THEY HAVE READ AND AGREE TO THE ENTIRE CONTRACT, AS
DESCRIBED IN SECTION 50. ABOVE.
IN WITNESS THEREOF, the parties have caused this contract, attachments, exhibits, and any documents referenced herein, to be executed by
their undersigned officials as duly authorized.
TITLE: LMgg&& httgf Qpembalilal ' r
GATE:
Federal Tax ID# (or SSN) 59-145M24
SOUTH FLORIDA B VIORAL HEALTH NETWORK, INC.
SIGNED
BY;
TITLE. 17nmdent.ffM C_ O
DATE:
r;
Network Provider Fiscal Year Ending Date 6130
Standard Contract
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0 :;;l0doo Behavioral
Health Network, Inc.
ATTACHMENT I
A. Services to be Provided
1. Program/Service Specific Terms
07/0112016 (res 6,22.16
Program/Service Specific Terms can be found in the South Florida Behavioral Health Networks
Glossary of Program/Service Specific Terms, which is incorporated herein by reference, and can
be obtained from the following Internet location::
http://sfbhn.org/wordpress/wp-contenYuploads/PrggramService-Specific-Teop_pdf
(1) ''Behavioral Health Serviceso are mental health services and substance abuse prevention
and treatment services as defined by s. 394.9082(2)(a), F.S., and in Chapter 397. F.S.
(2) "Block Grants" The Community Mental Health Block Grant (CMHBG), pursuant to 42
U.S.C. s. 300x, et. seq., and the Substance Abuse Prevention and Treatment Block Grant
(SAPTBG), pursuant to 42 U.S.C. s. 300x-21, et. seq.
(3) Collaborative Planning Group Systems, Inc. is the entity contracted with the Department of
Children and Families that maintains the database called Performance Based Prevention
System (PEPS) that Network Providers contracted to provide substance abuse prevention
services must utilize to upload substance abuse prevention data required by this contract.
(4) "Comprehensive Continuous Integrated System of Care (CCISC) model' is a system design
and implementation model for organizing services for individuals and families with co-
occurring disorders that is designed to improve services capability on a statewide or
regional basis to achieve: system level change; efficient use of resources; use of evidence -
based and consensus based practices; and integrated mental health and substance abuse
services throughout the system, by organizing a process in which every program improves
their provision of co-occurring disorder services, and every clinical staff person improves
their level of co-occurring disorder service competency based on their job and level of
training.
(5) "Continuous Quality Improvement" is an ongoing, systematic process of internal and
external improvements in service provision and administrative functions, taking into account
both in process and end of process indicators, in order to meet the valid requirements of
Individuals Served.
(6) "Contract Manager" is the ME employee who is responsible for enforcing the compliance
with administrative and programmatic terms and conditions of a contract. The contract
manager is the primary point of contact through which all contracting information flows
between the ME and the Network Provider. All actions related to the contract shall be
initiated by or coordinated with the contract manager,
(7) "Co-occurring Disorder" is any combination of mental health and substance abuse in any
individual, whether or not they have been already diagnosed.
(8) "Co-occurring Disorder Service Capability" is the ability of any program to organize every
aspect of its program infrastructure (policies, procedures, practices, documentation, and
staff competencies), within its existing resources, to provide appropriately matched,
Attachment 1 HCO2 (a)
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integrated services to the individuals and families with co-occurring disorders that are
routinely presenting for care in that program, Should services not be available at the
Network Provider then then the consumer must be linked to an agency with the capability to
meet the consumer's needs-
(9) 'Coordinated System of Care" is the array of mental health and substance abuse services
described in section 394.4573, F.S. The essential elements of a coordinated system of
care include but are not limited to:
(a)
Prevention and early intervention;
(b)
Emergency care;
(c)
Acute care;
(d)
Residential treatment;;
(e)
Outpatient treatment,
(f)
Rehabilitation;
(g)
Supportive services;
(h)
Recovery support;.
(i)
Consumer support services, and
(j)
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)"Cast 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 155-2M is the Department of Children & Families, Pamphlet 155-2 - Mental
Health and Substance Abuse Measurement and Data, effective July 2010 (loth 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:
ht1p/1www.dcf st t :fl.us/pL%trams/samh i ret}o s shtml,, and is incorporated herein by
reference.
(13) "Department" means the State of Florida Department of Children and Families,
(14) "Electronic Health Record (EHR)" is defined by s. 408.051(2)(a), F.S.
(15) "Evidenced -Based Practice (EBP) are practices that are based on accepted practices in the
profession and are supported by research, field recognition, or published practice guidelines.
Category #1: The intervention is included in Federal registries of evidence -based
interventions;
Or
Category #2; The proposed program or strategy is reported in one or more peer -reviewed
journals as having a positive effect on an outcome that is relevant to the identified outcome
Attachment I H02 (a)
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in the service or treatment plan of individuals receiving the specified intervention. To justify
Option Two, a provider would also include a detailed description of the evidence of a
positive effect on the selected outcome(s) and how the relevance was determined in a
literature review. In addition; a population of interest in the study must match the intended
recipients or individuals of the EBP, The ME does not fund Prevention services for this
category:.
Recognized agencies that review and rate the quality of program research evidence
include„ but are not limited to:
• Blueprints for Healthy Youth Development;
• California Evidence -Based Clearinghouse for Child Welfare;,
• U.S. Substance Abuse and Mentat Health Services Administration's (SAMHSA)
National Registry of Evidence -based Programs and Practices;
• The US Department of Health and Human Services.
(16) "Forensic Mental Health Services" are services provided to individuals with mental illness
pursuant to Chapter 916, Florida Statutes.
(17) "HIPAA" is the acronym for Health Insurance Portability and Accountability Act (42 U.S.C.
1320d„ and 45 CFR Parts 160, 162., and 164),
(18) "Individual(s) Served" (synonymous with Consumer, Client, Participant) is an individual
who receives substance abuse or mental health services, the cost of which is paid, either in
part or whole, by Department appropriated funds or local match (matching),
(19) "Knight Information Software (KIS)", (synonymous with Care Coordination; Utilization
Management and Financial Reporting System) is the ME's online data system which
Network Providers are required to use to collect and report data and performance
outcomes on clients served whose services are paid for, in part or in whole,. by the ME's
Substance Abuse and Mental Health (SAMH) contract, Medicaid, local match, Temporary
Assistance for Needy Families (TANF), Purchase of Therapeutic Services (PTS) and Title
21 . The KIS, or other system designated by the ME, shall be utilized to upload client -
related data as required by this contract.
(20) "Local Match" are funds received from governing bodies of local government,. including city
commissions, county commissions, district school boards, special tax districts„ private
hospital funds, private gifts both individual and corporate, bequests and funds received
from community drives or any other sources, See section 394.74, F:S. F.S. and 65&
14.005, F,A.C-
(21) "Managing Entity (ME)" as defined in section 394.9082(2)(d), F.S., is a corporation that is
organized in the State of Florida, is designated or filed as a non-profit organization under
section 501(c)(3) of the Internal Revenue Code; and is under contract to the Department to
manage the day-to-day operational delivery of behavioral health services through an
organized system of care.
(22) "Mental Health Services' is defined pursuant to Chapter 394, F.S,
Attachment 1 HCO2 (a)
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(23) "Motivational Support Program" are services designed to reduce the incidence of child
abuse and neglect resulting from parents' or caregivers' behavioral health and to improve
outcomes for families in the child welfare system and/or community based care.
(24) "Network Provider" is an entity that contracts with the ME and receives funding to provide
services to clients; in this contract the Network Provider is synonymous with provider
or subcontractor.
(25) "Outcome for Individual Service Recipient" is a measure of the quantified result, impact, or
benefit of services on the individual service recipient.
(26) "Payer class" Medicare, Medicare HMO, Medicaid, Medicaid HMO, private -pay health
insurance; private -pay health maintenance organization, private preferred provider
organization, the Department of Children and Family Services, other government programs,
self -pay patients. charity care and any other payer class other than the Department.
(27) "Payer of last resort' is a standard that is applied by the Network Provider to ensure that
all options to collect payment for services rendered under this contract from "First party
payer" (consumer), 'Second Party Payer or Responsible Party", and/or "Third Party Payer",
as defined in Rule 65E-14 F.A.C. are pursued prior to billing the ME. The ME is always the
payer of last resort.
"PEPS'" is the Department's Performance Based Prevention System that collects data
related to community assessments and plans and substance abuse prevention programs
and activities_
(28) ''Performance Measures are quantitative indicators, outcomes and outputs that are used
by the Department to objectively measure performance and are used by the ME and
Network Providers to improve services.
(29) "Prevention" refers to the proactive approach to preclude, forestall, or impede the
development of substance abuse or mental health related problems. These strategies focus
on increasing public awareness and education, community -based processes, and
incorporating evidence -based practices. Programs designed to prevent the development of
mental, emotional, and behavioral disorders are commonly categorized in the following
manner:
Universal Prevention
Preventive interventions that are targeted to the general public or a whole population group
that has not been identified on the basis of individual risk. The intervention is desirable for
everyone in that group.
Selective Prevention
Preventive interventions that are targeted to individuals or to a subgroup of the population
whose risk of developing mental, emotional, or behavioral disorders is significantly higher
than average. The risk may be imminent or it may be a lifetime risk. Risk groups may be
identified on the basis of biological, psychological, or social risk factors that are known to
be associated with the onset of a disorders Examples include programs offered to children
exposed to risk factors, such as parental divorce„ parental mental illness, death of a close
relative,. or abuse, to reduce risk for adverse mental, emotional, and behavioral outcomes.
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc. Page 4 of 53 Contract No ME225-7-27
W. i South Florida
Behavioral
Health Network, Inc.
07101;21116 (re%. 6.22.16)
Indicated Prevention:
Preventive interventions that are targeted to high -risk individuals who are identified as
having minimal but detectable signs or symptoms that foreshadow mental,; emotional, or
behavioral disorder; as well as biological markers that indicate a predisposition in a person
for such a disorder but who does not meet diagnostic criteria at the time of the intervention.
(30) "Prime Contract" is the contract between the Department of Children and Families and the
ME..
(31) "Program Description" is the document the Network Provider prepares and submits to the
ME for approval prior to the start of the contract period„ which provides a detailed
description of the services to be provided under the contract pursuant to Rule 65E-14,
F.A.C. It includes but is not limited to the Network Provider's organizational profile, the
service activity description, a detailed description of each program and covered service
funded in the contract; the geographic service area, service capacity, staffing information;
and client and target population to be served-
(32) "Projects for Assistance in Transition from Homelessness (PATH)' is a federal grant to
support homeless individuals with mental illnesses, who may also have co-occurring
substance abuse and mental health treatment needs,.
(33) "Protected Health Information" (PHI) relates to any information whether oral or recorded
in any form or medium that is created or received by a health care provider, health plan,
public health authority, employer, life insurer, school or university„ or health care
clearinghouse;; and relates to the past, present, or future physical or mental health or
condition of an individual; the provision of health care to an individual; or the past, present,
or future payment for the provision of health care to an individual,.
(34) "Provider Network" (subcontractor or Network Provider) refers to the group of direct
service providers, facilities, and organizations under contract with a ME to provide a
comprehensive array of emergency, acute care, residential, outpatient, recovery support,.
and consumer support services including prevention services and any other services
purchased by this contract. See section 394,9082, F.S.
(35) "Quality Assurance" is a process that measures performance in achieving pre -determined
standards, validates internal practice, and uses sound principles of evaluation to ensure
that data are collected accurately, analyzed appropriately„ reported correctly and acted
upon in a timely manner. The process may employ peer review., outcomes assessment,
and utilization management techniques to assess quality of care.
(36) "Quality Improvement/Continuous Quality Improvement" is a management technique to
assess and improve internal operations and network services. It focuses on organizational
systems rather than individual performance and seeks to continuously improve quality. The
process involves setting goals implementing systematic changes, measuring outcomes,
and making subsequent appropriate improvements. Quality improvement activities will'
assess compliance with contract requirements, state and Federal law and associated
administrative rules, regulations, and operating procedures and validate quality
improvement systems and findings.
(37) "Representative Payee" refers to an entity/individual that is legally authorized to receive
Supplemental Security Income, Social Security Income, Veterans Administration benefits,
or other federal benefits on behalf of an individual served.
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc. Page 5 of 53 Contract No. ME225-7-27
0,MSouth Florida
Behavioral
004100 Health Network, Inc.
0710112016 (re►. 6.22.16)
(38) "SAMH" stands for the Substance Abuse and Mental Health Programs within the
Department.
(39) "SAVENIS Program" is the U,S. Department of Homeland Security (DHS) administers the
Systematic Alien Verification for Entitlements (SAVE) program. This program verifies
immigration status and eligibility of alien applicants for federal benefits. The alien status
verification system under SAVE is entitled the Alien Status Verification Index (ASVI), as
described at 60 Federal Register 52694, 52697 (1995) administered by the Computer
Sciences Corporation (CSC) as the Verification Information System (VIS). The SAVENIS
Program can and may provide assistance in verifying eligibility in cases where a client does
not possess sufficient documentation.
(40) "SOAR'" stands for Supplemental Security Income/Social Security Disability Insurance
(SSIISSDI) Outreach,, Access and Recovery and is a Substance Abuse and Mental Health
Services Administration (SAMHSA) technical assistance initiative designed to help
individuals increase earlier access to SSI and SSDI through improved approval rates on
initial Social Security applications by providing training, technical assistance, and strategic
planning to Network Service Providers.
(41) "Stakeholder(s)° are individuals/groups with an interest in the provision of treatment
services for substance abuse, mental health services;, and/or co-occurring disorders in the
circuits outlined in Section A.2.c.(2), of this Contract, This includes, but is not limited to, the
key community constituents included in section 394.9082, , F.S.
(42) "Statewide Inpatient Psychiatric Programs (SIPP)" )" are residential inpatient facilities
under contract with the Agency for Health Care Administration (AHCA) under the Medicaid
Institutes for Mental Disease (IMD) 1915E waiver for children under age 18 to provide
diagnostic and active treatment services in a secure setting,
(43) "Substance abuse"is s a pattern of chronic or harmful use of alcohol, illicit or prescribed
drugs that result in adverse physical, psychological, or social consequences. Substance
abuse prevention and treatment services, pursuant to Chapter 397, F.S., which are
provided using state or federal funding.
(44) "Substance Abuse and Mental Health Information System (SAMHIS)" is the Department's
web -based data system for reporting substance abuse and mental health services,
including the Substance Abuse and Mental Health Information System (SAMHIS) or any
replacement system identified by the Department for the reporting of data by the Managing
Entity and all Network Service Providers in accordance with this contract.
(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.
(46) "Temporary Assistance to Needy Families (TANF)" are cash assistance for families,
including any family receiving cash assistance payments or TANF diversion services from
any state program as defined in under 42 U.S.C, ss. 601, et. seq., and ch. 414, F.S.
(47)"Unit Measurement" synonymous with "measurement standard" is used in billing the ME for
services. The definition of each unit of measure can be found in Rule 65E-14„ F.A.C.
(48) "Utilization Management" is a system to ensure maximum; cost-effective, and clinically
appropriate utilization of behavioral health services. The goal of the program is to eliminate
Attachment 1 HCO2 (a)
Guidances are Center, Inc.. Page 6 of 53 Contract No. ME225-7-27
r' South Florida
U100 Behavioral
Health Network, Inc.
1I7101/21116 (rc%. 6.22.1)
waitlists and maximize utilization as well as diverting individuals served to more clinically
appropriate services when applicable.
(49) "Verifiable Service" is a service provision that is documented in compliance with the
requirements contained in Rule 65E-14; F-A.C.
(50) "Wait List" is a master list for the Network, maintained by a Managing Entity that shows:
(a) The number of individuals waiting for access to the recommended service or program„
(b) The length of time each individual has been on the waiting list; and
(c) The interim services provided to the individual.
2. General Description
a. General Statement
The services provided under this contract are community -based SAMH services for a
consumer -centered and family -focused coordinated system of care. The contract requires a
qualified, direct service, community -based Network Provider who wifl provide services for
children, adolescents;, adults; and elders, as applicable, with behavioral health issues as
authorized in section 394.9082, F.S., consistent with Chapters 394, 397, 916, section 985.03,
F.S. (as applicable), and with the Substance Abuse and Mental Health Services Plan 2014-
2016, , or the latest version thereof, and in the Prime Contract (ME's contract with the
Department)„ which is incorporated herein by reference.
The Network Provider shall work in partnership with the ME to better meet the needs of
individuals with co-occurring substance abuse and mental health disorders and expand its
array of services to provide trauma informed care, as appropriate. The partnership process
will be open, transparent, dynamic; fluid, and visible. The process shall also serve as an
opportunity for collaboration to continuously improve the quality of services. During the course
of the contract period, the ME will require that the Network Provider participate in the process
of improving co-occurring disorder service capability system wide, trauma informed care
services and ensure the integration of behavioral health services and primary care services to
all the consumers in care in coordination with a Federally Qualified Health Center or other
medical facility as required by this Contract,
The Network Provider shall, work in collaboration and shall assist, upon request of the ME, in
fulfilling its contractual obligations pursuant to the Prime Contract with the Department of
Children and Families including but not limited to the following functions:
(1) System of Care Development and Management;,
(2) Utilization Management;
(3) Quality Improvement;
(4) Data Collection, Reporting, and Analysis;
(5) Financial Management;
(6) Disaster Planning and Responsiveness
b. Authority
Section 394.9082, F.S., and the Prime Contract provides the ME with the authority to contract for
these services.
Attachment 1 HCO2 (a)
GuidancerCare center, Inc. Page 7 of 53 Contract No ME225-7•27
® AV,South Florida
Behavioral
Health Network, Inc.
c. Scope of Service
07/0112€616(re%. 6,22,16)
The following scope of service applies to the contract period and any renewal or extension:
(1) The Network Provider is responsible for the administration and provision of services to the
target population(s) indicated in Exhibit A, Clients/Participants to be Served, and in
accordance with the tasks outlined in this contract. Services shall also be delivered at the
locations specified in, and in accordance with the Program Description, as required by Rule
65E-14, F.A.C., which is herein incorporated by reference, and maintained in the ME's
contract manager's file.
(2) Services are to be delivered in the following county(ies):
_ Miami -Dade County
X Monroe County
d. Major Program Goals
(1) The primary goal of the SAMH Program is to promote the reduction of substance use,
abuse, and dependence and improve the mental health and lives of the people of Florida by
making substance abuse and mental health treatment and support services available through a
comprehensive, integrated community -based System of Care and to engage and encourage
persons with or at risk of substance abuse and/or mental illness to live, work, learn, and
participate fully in their community.
(2) It is the goal of the ME and Network Provider to improve accountability, ensure quality of care
through best practice models and seek to ensure delivery of behavioral health services across the
provider network and across systems resulting in systematic access to a full continuum of care for
all children, adolescents and adults who enter the publicly -funded behavioral health services
systems.
(3) It is the goal of the ME to improve co-occurring capability, trauma informed care, ensure the
integration of behavioral health and primary health care services and expertise in all programs.
(4) The intent of substance abuse prevention is to promote and improve the behavioral health of
Florida's Southern Region communities by strategically applying substance abuse prevention
programs, and environmental strategies that are relevant to community needs as defined in a
ME approved Comprehensive Community Action Plan. Once approved, the plan can be
obtained at: www.sfbhn.or
e. Minimum Programmatic Requirements
The Network Provider shall maintain the following minimum programmatic requirements:
(1) System of Care
The consumer -centered and family -focused system of care will:
(a) Be driven by the needs and choices of the customers;
(b) Promote family and personal self-determination and choice;
(c) Be ethically, socially, and culturally responsive; and
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc, Page 8 of 53 Contract No ME225-7-27
South Florida
Behavioral
Health Network, Inc. 0790112016 (rv.. 6.2 .16)
(d) Be dedicated to excellence and quality results.
There is a commitment to expand clinical treatment to include the behavioral health
Transformation Initiative, evidence -based practices and recovery support services in
accordance with priorities established by the ME and the Department for substance
abuse, mental health treatment and/or co-occurring disorders, substance abuse prevention
services, substance abuse and mental health treatment capacity, children and families,
criminal and juvenile justice, HIV and hepatitis.
(2) Guiding Principles
Guiding principles specify that services are as follows:
(a) Inclusive - involve and engage families and consumers as full partners to
participate in the planning and delivery of services;
(b) Comprehensive - incorporating a broad array of service and supports (e.g.
physical, emotional, clinical, social„ educational and spiritual);
(c) Individualized - meeting the individual°s exceptional needs and strengths;
(d) Community -based - provided in the least restrictive, clinically appropriate setting;
(e) Coordinated -both at the system and service delivery levels to ensure that
multiple services are provided and change as seamlessly as possible when
warranted;
(f) Cultural and linguistic competence;
(g) Gender responsive, and
(h) Sexual orientation.
3. Clients to be Served
See Exhibit A, Clients/Participants to be Served
B. Manner of Service Provision
1. Service Tasks
The following tasks must be completed for each fiscal year covered in the contract period.
a. Task List
(1) Based on client needs, the Network Provider agrees to provide appropriate services from the
list of approved programs/activities described in Exhibit G, Covered Service Funding by OCA
and the description of such services specified in the Program Description as required by Rule
65E-14, F.A.C. Any change in the array of services shall be justified in writing and submitted to
the ME's contract manager for review and approval.
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc. Page 9 of 53 Contract No. ME225-7-27
®v.,00r,South Florida
Behavioral
Health Network, Inc.
07/01/2016 (re-. 6.22.16)
(2) The Network Provider shall serve the number of persons indicated in Exhibit D, Substance
Abuse and Mental Health Required Outcomes/Outputs within the activities specified in
Exhibit G, Covered Service Funding by OCA. Failure to meet the minimum numbers served
may result in a corrective action and an imposed financial penalty as described in the Standard
Contract.
(3) The Network Provider shall adhere to treatment group size limitations not to exceed fifteen (15)
individuals per group for any clinical therapy service provided,, with the exception of Outpatient
Group services. For Outpatient Group services funded under this contract, the Network
Provider shall adhere to the group size limitations outlined in the current Medicaid Handbook. In
addition to other programmatic documentation requirements, service documentation to
evidence group activities shall include the following:
(a) Data Elements,
I. Service Documentation -Group Sign in Sheet
I. Recipient name and identification number or, if non -recipient,
participant's name, address, and relation to recipient„
ii. Staff name and identification number
iii. Service date;
iv. Start time
V. Duration;
vi. Covered Service-,
vii. Service (Brief description of type of group)
viii. Group Indicator; and
ix. Program (AMH, ASA, CMH, CSA)
II. Audit Documentation -Recipient Service or Non -Recipient Chart:
1. Recipient name and identification number or if non -recipient,
participant's name, address, and relation to recipient;
ii. Staff name and identification number
iii. Service date
iv. Clinical diagnosis„
V. Start time:
vi. Duration; and
vii. Services (Group progress note)
(4) The Network Provider shall develop and implement policies so that all applicable providers'
employees abide by the terms and conditions of Paragraph 25., Information Security
Obligations„ of the Standard Contract. The Network Provider shall submit to the Managing
Entities Contract manager, by 0810112016, 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-
30i F.A.C._, Licensure Standards for Substance Abuse Services and Agency for Health Care
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc. Page 10 of 53 Contract No. ME225-7-27
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Behavioral
Health Network, Inc.
07101 �2701 (res. G.22.I6)
Administration (AHCA) licenses and only bill for services under those licenses. In the event
any of the Network Provider's license(s) is suspended, revoked, expired or terminated„ the
ME shall suspend payment for services delivered by the Network Provider under such
license(s) until said license(s) is reinstated.
(6) The Network Provider shall maintain and implement grievance procedures, which include an
appeal process with the ME, should the grievance not be resolved at the Network Provider level,
which applicants for, and recipients of, services being provided under this contract, may use to
present grievances to the Network Provider, or to the ME about contracted services. Prior to the
execution of this contract the Network Provider submitted a copy of its grievance procedures
both applicants for; and recipients of, services and provider staff, however, should any updates
to the grievance procedures occur during the term of this contract, the Network Provider must
submit the amended procedures to the Contract Manager within thirty (30) calendar days of the
amendment. The Network Provider shall post and provide copies of the grievance procedures
to all, consumers receiving services with funds provided for in this contract.
(7) The Network Provider shall: use the approved standardized assessment tool designated by the
ME.. Standardized tools and assessments approved by the ME must be used to determine
placement and level of care and entered into KIS.
Consumers partially treated by grants or other funding sources may be exempt from this
requirement if the funding source required a different tool. Such exemption must be granted in
writing by the ME:
(8) If the Network Provider provides medication management services, the Network Provider shall
ensure that clients discharged from state mental health treatment facilities will be maintained on
the medication that was prescribed for them by the facility at discharge pursuant to s. 394.676,
F.S. Maintenance includes performing required lab tests, providing the medication, and
providing appropriate physician oversight.
(9) By 08101/2016, the Network Provider shall submit to the ME's contract manager an updated
disaster plan consistent with Paragraph 29., Emergency Preparedness, of the Standard
Contract.
(10) Should the ME conduct a mock emergency drill, the Network Provider shall participate by
activating their emergency/disaster plan and reporting on preparedness activities, response
activities, and post -recovery activities.
(11) By 08/0112016, the Network Provider shall submit to the ME's contract manager an updated
Civil Rights Compliance Checklist (CF0946)
(12) By 0810112016, the Network Provider shall submit to the ME's contract manager an updated
Civil Rights Certificate (CF707), signed a dated by the Network Provider's contract signer.
(13) The Network Provider shall assure the delivery of services is based on Evidence -Based
Practices implemented with fidelity and in accordance with the approved Program Description.
Attachment I NCO2 (a)
Guidance/Care Center; Inc. Page I I of 53 Contract No, ME225-7,27
South Florida
Behavioral
Health Network, Inc.
117101,12016(r°cs . 6.22.16 )
(14) By 0810112016, the Network Provider shall submit to the ME's contract manager a Quality
Assurance Plan that details how the Network Provider will ensure and document that quality
services are being provided to the clients served, which is herein incorporated by reference.
The Network Provider shall submit updates as amended of the Quality Assurance Plan within
thirty (30) days of adoption. The Quality Assurance Plan should address the minimum
guidelines for the Network Provider's continuous quality improvement program, including, but
not limited to
(a) Individual care and services standards to include transfers and referrals, co-occurring
supportive services, trauma informed services, and cultural and linguistic competence.
(b) Individual records maintenance and compliance.
(c) Staff development standards..
(d) Service -environment safety and infection control standards.
(e) Peer review and utilization management review procedures.
(f) Incident reporting policies and procedures that include verification of corrective action
and a provision that specifies that a person who files an incident report, in good faith,
may not be subjected to any civil action by virtue of that incident report.
(g) Fraud, waste, abuse and other potential wrongdoing auditing; monitoring. and
remediation procedures.
(h) Evidence -based practices (EBPs) utilized by the agency and how these EBPs are
monitored to ensure fidelity to the model.
(i) The Continuous Quality Improvement Initiatives identified in Section B.1.a.(19) below.
(15) The Network Provider shall implement a "no wrong door" model as defined in s. 394.4573, F.S,
by developing a process for assessing, referring andlor treating clients with co-occurring
disorders, to increase access of persons identified as co-occurring, to provide services for both
disorders regardless of the entry point to the behavioral health system. As used in conjunction
with the CCISC model, "no wrong door" (See http/lwww.kenminkgff,com/ppisc ht ll, requires
that systems develop policies and procedures that mandate a welcoming approach to
individuals with co-occurring psychiatric and substance disorders in all system programs,
eliminate arbitrary barriers to initial evaluation and engagement, and specify mechanisms
for helping each client (regardless of presentation and motivation) to get connected to a
suitable program as quickly as possible.
A copy of the Network Provider's "No Wrong Door" policy is maintained in the Network Provider
contract file. Should any updates to the to the "No Wrong Door" policy and procedure occur
during the term of this contract, the Network Provider must submit the amended procedures to
the Contract Manager within thirty (30) calendar days of the adoption.
(16) The Network Provider shall execute and/or maintain if executed a Memorandum of
Understanding (MOU) or contract with the appropriate Federally Qualified Health Center or other
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc. Page 12 of 53 contract No ME225-7-27
South Florida
Behavioral
Health Network, Inc.
07101121116 (rc%. 6.22.16)
medical facility. The MOU provides for integration of behavioral health services and primary
health care services to the medically underserved in order to meet the goals specified in
Section 13.1.a.(19)(a) of this Attachment I. The Network Provider also agrees to accept referrals
from the primary health care provider for eligible consumers who are in need of behavioral
health services. Federally Qualified Health Centers are required to submit policies and
procedures that explain the access to primary care services to the medically underserved
behavioral health client.
The MOU shall be submitted within ninety (90) days of the effective date of this contract to the
ME's contract manager on or before the due date(s) as specified in Exhibit C, Required
Reports. The Network Provider shall submit copies of any amendment to the MOU, to the ME's
contract manager, within thirty (30) calendar days of execution.
(17) Linkage and Referral Process
(a) The Network Provider's policies and procedures must address the referral and linkage
process of clients and coordination of care to local community providers for services
not offered by the Network Provider. Such services include, but are not limited to,
detoxification services,.., linkages with community programs such as housing,
employment and parenting supports; and primary health care. The Network Provider is
responsible for tracking and ensuring that the proper linkages are made and
documented in accordance with the requirements in the Coordination Care Plan &
Utilization Management Manual. Network Providers are required to submit all required
documentation for the initiated referral.
(b) The Network Provider may only refer a consumer to a provider that offers the service
for which the Network Provider created the referral. The receiving provider is
responsible for follow up and linkage including proper care coordination and discharge
planning back to the referring provider. The referring provider is responsible for the
communication and follow up with the receiving provider; The Network Provider is
expected to adhere to the Department's Care Coordination Guidance Document which
provides guidance for the implementation, administration and management of Care
Coordination activities and adhere to any other ME directives andlor policies and
procedures.
The Department's Care Coordination Guidance Document can be accessed by visiting
the Department's website or by clicking on the link below:
contract-docs
(c) If the Network Provider is a receiving provider then the Network Provider must inform
the referring provider that the consumer was admitted/not admitted within seven (7)
calendar days, unless otherwise required by applicable state, federal rules and/or
statues.
(d) If the Network Provider is the receiving provider, the Network Provider will have
seventy-two (72) hours to respond to a new referral, unless otherwise required by
Attachment i HCO2 (a)
Guidances are Center, Inc. Page 13 of 53 Contract No ME225-7-27
South Florida
Behavioral
Health Network, Inc. 07101,12016 (re,,. 6.22.16)
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.
(18) Continuous Quality Improvement Programs
(a) The Network Provider must maintain a continuous quality improvement program and
report on the continuous quality improvement activities. The program is the
responsibility of the Director and is subject to review and approval by the governing
board of the service Network Provider. Each director shall designate a Quality
Assurance Officer/Compliance Officer who will be responsible for the continuous quality
improvement program.
The continuous quality Improvement program should objectively and systematically
monitor and evaluate the appropriateness and quality of care to ensure that services
are rendered consistent with prevailing professional standards, and identify and resolve
problems.
(b) The quality improvement program must include at minimum:
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.
IV.
V.
vi.
Guidance/Care Center, Inc..
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;;
A system of analyzing those factors which have an effect on performance,;
A system of reporting the results of continuous quality improvement reviews; and,
Best practice models for use in improving performance in those areas which are
deficient.
Attachment 1 HCO2 (a)
Pagc 14 of 53
Contract No. ME225-7-27
ppMSouth Florida
Behavioral
Health Network, Inc.
07/01/21116 (r•c%. 6.22.16)
vii. Establishment of a Seclusion and Restraint Oversight Committee per Chapter
65E-5.180, F.A.C. for agencies utilizing seclusion and/or restraint.
(19) Continuous Quality Improvement Initiatives - Providers must comply with all of the
provisions for the initiatives outlined below:
(a) Integration of Behavioral Health Services and Primary Health Care
It is the goal of the ME to ensure the integration of behavioral health services and
primary care services to all the consumers in care. The integration will be ensured
through linkage of the behavioral health provider with the primary health care provider
of the consumer through an electronic health record or other means of contact (phone,
in person, etc). Referral and linkage processes will be necessary for all consumers
who do not have a primary health care provider at entry into the system of care. Follow
up and coordination of services are essential to meeting consumer health and
behavioral health needs.
Many individuals with behavioral health issues have chronic health conditions and may
have neglected their primary health needs for some time.. The ME and the Southern
Region are committed to developing an integrated system of care that incorporates
comprehensive screening and monitoring tools that identify those affected by chronic
health conditions and a system of care that meets their needs. Network Providers will
be implementing Integrated Primary and Behavioral Health techniques and initiatives to
meet this need. This initiative will be addressed through a continuous quality
improvement plan or component in the existing agency wide continuous quality
improvement plan that delineates participation in the Health Integration Initiative. As
part of the plan or component of the plan must include the following:
i. Identification of the Federally Qualified Health Center or other medical facility
where consumers who have been identified as needing primary health care
services are referred to or the process established by the Network Provider to
coordinate services with consumers' private primary health care provider
should such exist.
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 08/3112016, unless otherwise directed by the ME, the Network Provider
shall submit an action plan on the template provided by the ME. The action
Attachment 1 HCO2 (a)
GuidanceiCare Center, Inc. Page 15 of 53 Contract No, ME225-7-27
®� South Florida
OOOBehavioral
Health Network, Inc.
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 03101/2017, unless otherwise directed by the ME, the Network Provider
shall complete an annual agency -wide self -assessment using the Site Self -
Assessment Evaluation Tool for the Maine Health Access Foundation
Integration Initiative (MeHAF). The results of the self -assessment must be
submitted by April 1, 2017, or other date specified by the ME, to the
individual(s) identified in Exhibit C. Required Reports.
(b) Trauma Informed Care
Many individuals with behavioral health issues have experienced trauma that affects their
development and adjustment. The ME and the Southern Region are committed to developing a
system of care that incorporates comprehensive assessment tools that identify those affected
by trauma and a system of care that meets their needs. Network Providers will be
implementing the Trauma Informed Care (TIC) initiative through a continuous quality
improvement plan or component in the existing agency wide continuous quality improvement
plan that delineates participation in the TIC initiative. As part of the plan or component of the
plan must include the following;
Identification of at least two TIC Champions at the beginning of the contract term and
submit the names of the individuals when requested by ME staff.
ii. By 08/3112016, unless otherwise directed by the ME, the Network Provider shall submit
an action plan on the template provided by the ME. The action plan must be developed
based on the results of the most recently completed Fallot Toole The action plan will
outline tasks and objectives that the Network Provider must address during the fiscal
year that were identified in the self -assessment as needing improvement- The ME will
monitor the Network Provider on its execution of the tasks and objectives identified in
the action plan.
iii. Participation in the regional TIC meetings to develop the process for identifying and
responding to those affected by trauma.
iv. Attendance at the regional trainings regarding TIC as applicable. Applicable trainings
will be documented in the Continuous Quality Improvement Updates.
V. Participation in all TIC related activities to ensure staff and agency become competent
in all areas of trauma informed care.
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc. Page 16 of 53 Contract No. ME225-7-27
South Florida
Behavioral
Health Network, Inc.
I17/0 V2016 (rm 6,22,10
VL By 0310112017, unless otherwise directed by the ME, the Network Provider shall
complete an annual agency -wide self -assessment using the Fallot Assessment Tool,
The results of the self -assessment must be submitted by April 1, 2017, or other date
specified by the ME, to the individual(s) identified in Exhibit C, Required Reports.
(c) Cultural and Linguistic Competence
It is the goal of the ME to become a culturally and linguistically proficient network; through the
full implementation of The National Standards for Cultural and Linguistically Appropriate
Services (the National CLAS Standards). The National Culturally and Linguistically Appropriate
Services (CLAS) Standards in Health and Health Care are intended to advance health equity,
improve quality, and help eliminate health care disparities by establishing a blueprint for health
and behavioral health care, In order to accomplish this task the Network Provider
Identification of at least two CLC Champions at the beginning of the contract term and
submit the names of the individuals when requested by ME staff.
ii. Participation in the regional CLC meetings.
iii. By 08/3112016, unless otherwise directed by the ME, the Network Provider shall submit
an action plan on the template provided by the ME. The action plan must be developed
based on the results of the most recently completed Cultural and Linguistic
Competence survey. The action plan will outline tasks and objectives that the Network
Provider must address during the fiscal year that were identified in the self -assessment
as needing improvement.
iv. Collaborate with the ME to identify and utilize the Network Provider's data to (1) identify
sub -populations (i.e., racial, ethnic, Lesbian, Gay, Bisexual, Transgender, Questioning,
Intersex, or Two -Spirited (LGBTQI-2S), minority groups) vulnerable to disparities and
(2) implement strategies to decrease the differences in access„ service use, and
outcomes among sub -populations, These strategies should include the use of the
enhanced National Standards for Culturally and Linguistically Appropriate Services
(CLAS) in Health and Health Care;.
V. Agrees to implement effective language access services to meet the needs of their
limited -English -proficient consumers and/or deaf or hard -of -hearing consumers, and
increase their access to behavioral health care by providing sign language, translation,
and interpretive services required to meet the communication needs of consumers as
required by state and federal laws, including English, Spanish and Creole. Services
will meet the cultural needs and preferences of the populations served.
vi. By 03101/2017, unless otherwise directed by the ME; the Network Provider shall
complete an annual Cultural and Linguistic survey as directed by the ME.
(d) Integration of Behavioral Health and the Child Welfare System
L The Network Provider will ensure that behavioral health services are available to clients
referred by the Community Based Care Organizations (CBC) or by the Department's
Child Protective Investigators in cases where behavioral health indicators are present
Attachment 1 HCO2 (a)
GuidanceiCare Center, Inc. Page 17 of 53 Contract No. ME225-7-27
South Florida
Behavioral
Health Network, Inc.
07A 21116 (rc%. 6.22.16)
during the initial child abuse/neglect investigation or at any point during child protective
supervision or out -of -home care. Priority will be given to cases where a child is at risk
for immediate removal or has been removed from the family, with a goal of reunification
in the family safety plan.
Services may also be provided for the enrolled parent(s)'Icaregiver(s)'' family members,
household residents, or significant others in need of behavioral health prevention or
treatment services, as well as children in relative placements. For a detailed description
of the client eligibility criteria please refer to the approved Motivational Support
Program Protocols and Family Intensive Treatment Team Protocols, herein
incorporated by reference, and available upon request to the MEs Contract Manager.
11i. The coordination of efforts between the CBC, the ME and Network Providers is
essential to the efficient service delivery for child -welfare involved families in behavioral
health treatment. The ME and the Southern Region are committed to developing an
integrated system of care that meets the needs of children and their families as there is
significant overlap between clients. Network Providers will be implementing the Child
Welfare Integration (CWI) initiative through a continuous quality improvement plan or
component in the existing agency wide continuous quality improvement plan that
delineates participation in the CWI initiative. As part of the plan or component of the
plan must include the following:
1. Identification of at least two CWI Champions and submit the names of the
individuals when requested by ME staff.
2. Participation in the CWI meetings to develop the process for identifying and
responding to child -welfare involved families.
3. Attendance at trainings regarding CWI when notified by the ME. Attendance
applicable trainings will be documented in the Continuous Quality Improvement
Updates.
4. Participation in all CWI related activities to ensure staff and agency become
knowledgeable of the Child Welfare system.
(e) Accreditation
The Network Provider shall take appropriate steps to maintain its accreditation or become fully
accredited by June 30, 2017 in order to promote best practices and the highest quality of care.
The Network Provider shall provide the ME with their full accreditation and licensing reports
upon request.
(20) By 813112016, the Network Provider shall submit a single agency action plan which outlines all
of the componentslactivities identified in agency's annual self -assessments for each initiative.
For example. the Integrated Healthcare Initiative (Behavioral Health and Primary Health Care)
action plan should be developed based on the results of the most recently completed self -
assessment, the Trauma Informed Care action plan shall be developed based on the results of
the most recently completed Fallot Tool, and the Cultural and Linguistic Competence action
plan shall be based on the results of the Cultural and Linguistic Competence survey.
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc. Page 18 of 53 Contract No, ME225-7-27
South Florida
Behavioral
Health Network, Inc.
(21)Continuous Quality Improvement Updates
0710 112016 (m,6.22,16)
The Network Provider shall submit semi-annual updates, by the dates specified in Exhibit C,
Required Reports, on the implementation and progress of the following activities:
(a) Integration of Behavioral Health Services and Primary Care as described in the agency's
action plan;
(b) Trauma Informed Care, as described in the agency's action plan;
(c) Cultural and Linguistic Competence initiative, as described in the agency's action plan;
(d) Identification of the evidence -based practices (EBPs) utilized by the agency and address
how these EBPs are monitored to ensure fidelity to the model;:
(e) Participation in trainings and activities relating to the Integration of Behavioral Health and
Child Welfare Systems; Progress on steps taken toward meeting the requirement to
become an accredited provider by June 30, 2017.
(f) Evidence of the implementation of the integration of behavioral health services and
primary health care, evidence of tracking and ensuring the successful referrals and
linkages of consumers of behavioral health services to primary health care services and
consumers referred from the primary health care provider to the Network Provider for
behavioral health services, and include progress on the implementation as described in
the Network Provider's action plan to include the following:
• The number of behavioral health consumers identified as needing primary care,
• Number of successful linkages to primary care-
(22) Care Coordination Performance Outcomes
Beginning in FY 2016-17, the ME will begin to implement Care Coordination, as defined in s.
394.4573, F.S., throughout the system of care. The Network Provider is expected to work in
collaboration with the ME to ensure that individuals with the highest level of need are being
linked to community based care and provided the appropriate supports to ensure that their
treatment needs are properly addressed. The ME will analyze the groupings of consumers and
over time, develop a framework that identifies what are the expected service levels and
frequency of services for a particular diagnosis and/or presenting combination of issues. The
ME will analyze provider data to determine baseline and determine benchmark for future
implementation. The Network Provider is expected to adhere to the Department's Care
Coordination Guidance Document which provides guidance for the implementation,
administration and management of Care Coordination activities, and adhere to any other ME
directives and/or policies and procedures -
The Department's Care Coordination Guidance Document can be accessed by visiting the
Department's website or by clicking on the link below:
http // Ifa ilie.co /se ice-oroar s/su stance- use! anin-entities/201 -
cotr ct- ocs
Attachment I HCO2 (a)
Guidance/Care Center. Inc. Page 19 of 53 Contract No.. ME225-7-27
South Florida
25 �5; 0 1, Behavioral
1 Health Network, Inc.
(23)Financial Audit Reports
07/01P2016 (m. 6.22.16)
(a) The Network Provider shall submit financial statements consisting of Balance Sheet
and Statement of Activity (income statement) per the schedule and to the individual(s)
identified in the Exhibit C, Required Reports. The Network Provider agrees to
provide the ME with any requests for additional financial statements/documentation.
(b) Network Providers who withhold income taxes.; social security tax, or Medicare tax
from employee's paychecks or who must pay the employer's portion of social security
or Medicare tax must use Form 941, Employer's Quarterly Federal Tax Return., to
report those taxes. On a quarterly basis, and by the dates specified in Exhibit C,
Required Reports, the Network Provider, shall submit an attestation that the 941 has
been filed timely and any taxes due have been paid timely to IRS.
(c) The Network Provider shaft complete and submit the DepartmentFapproved 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:
IM.....
entities/2016-contract-docs
(24)The Network Provider shall implement and maintain fiscal operational procedures. These shall
contain but, not be limited to procedures relating to overpayments, charge -backs that directly
apply to subcontractors and documentation of cost sharing (match) that comply with state and
federal rules, regulations and/or ME policies and procedures.
(25) The Network Provider shall also make available and communicate all plans, policies,
procedures, and manuals to ME staff, Department staff, Network Provider staff, and to
clients/stakeholders if applicable and appropriate.
(26) The Network Provider shall comply with Children and Families Operating Procedure 215-8,
OVERSIGHT OF HUMAN SUBJECT RESEARCH AND INSTITUTIONAL REVIEW BOARD
DESIGNATION. The policy and guidance can be found at:
Approval from the Department through the ME is mandatory for all research conducted by any
employee, contracted organization or individual; or any public or private vendor, even if the
aforementioned has their own Institutional Review Board which has granted approval.
(27) The Network Provider shall participate in the State's Peer Review process, when implemented,
to assess the quality, appropriateness, and efficacy of services provided to individuals pursuant
to 45 CFR 96.136:
(28) The Network Provider shall; meet with the ME's staff at regularly scheduled or specially called
meetings when notified by the ME.
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc. Page 20 of53 Contract No. ME225-7-27
South Florida
;,1;AO00 Behavioral
Health Network, Inc.
0710112016 (rc%. 6.22.16)
(29)The Network Provider shall ensure that individuals needing treatment services will receive
services, depending on the severity of individual need, consistent with industry standards for
distance and travel time, and as specified in the Coordination Care Plan & Utilization
Management Manual, herein incorporated by reference.
Non-compliance with timely access to care for services terms will result in a
corrective action and may result in a financial penalty as specified in the
Standard Contract.
(30)The Network Provider shall immediately upon discovery inform the ME of conditions related to
performance that may interrupt the continuity of service delivery or involve media coverage.
(31)The Network Provider will promote personal self-determination and choice by:
(a) Ensuring that the needs and preferences of consumers and their families drive treatment
planning and service delivery, and that consumers and their families (with consent) are
involved in all aspects of treatment (pre, during and post);
(b) Engaging service recipients, family members, and advocates in the design, development,
and evaluation of services;
(c) Giving consumers a choice of provider and services, whenever possible;
(d) Assessing and improving consumer satisfaction.
(32) The Network Provider shall ensure provision of services to clients with special needs
The Network Provider shall ensure the coordination of specialty services including
employability skills training and linkage, victimization and trauma services, infant mental
health services, the elderly, and services to families in recovery. The Network Provider shall
also ensure the availability of appropriate services to consumers with special needs such as
those who are blind„ deaf or hard of hearing, developmentally disabled, physically handicap,
criminally involved, or forensic clients, The ME reserves the right to modify this list as the
needs of the consumers change.
(a) The Network Provider shall provide early diagnosis and treatment intervention to enhance
recovery and prevent hospitalization.
(b) The Network Provider shall work with the ME, the state, and other stakeholders to
reduce the admissions and the length of stay for dependent children and adults with mental
illness in residential treatment services,
(33) Referrals and Case Management Services to Consumers Residing in Assisted Living
Facilities with a Limited Mental Health License
(a) It is unlawful to knowingly refer a person for residency to an unlicensed assisted living
facility;. to an assisted living facility the license of which is under denial or has been
suspended or revoked;. or to an assisted living facility that has a moratorium pursuant to
part II of chapter 408. Referrals to unlicensed facilities are not lawful and subject to
sanctions by the Agency of Health Care Administration (AHCA).
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc.. Page 21 of 53 Contract No. ME225-7-27
® South Florida
0!Behavioral
10:;A000 Health Network, Inc.
117/01/2016 (re-.. 6. 2.16)
(b) The Network Provider is directed to only refer consumers of mental health services to
Assisted Living Facilities with a Limited Mental Health License. It is the referring Network
Provider's responsibility to verify licensure. AHCA licenses can be verified at the
following website-
(c) In circumstances where the Network Provider determines that placement of particular
individual in an Assisted Living Facilities with a Limited Mental Health License is
unsuitable, the Network Provider shall request a meeting with the appropriate ME staff to
discuss alternative options. The request shall be made in writing to the ME's Contract
Manager.
(d) The Network Provider agrees to comply with provisions and the reporting requirements of
Exhibit L, Assisted Living Facilities with a Limited Mental Health License, if services
to such residents are offered,
(e) On a quarterly basis, by the dates, and to the individuals identified in Exhibit C, Required
Reports„ the Network Provider shall submit an ALF-LMHL Client Report the required
format as shown in Table 1; of Exhibit L, Assisted Living Facilities with a Limited
Mental Health License. To complete the ALF-LMHL Client Report, the Network Provider
is directed to select a sample size of twenty (20%) percent of clients residing at Assisted
Living Facilities with a Limited Mental Health License and receiving targeted case
management services from the Network Provider.. The ALF-LMHL Client Report shall be
submitted in a secured, password protected, or encrypted format.
(34)Develop and Disseminate Consumer Manual
The Network Provider shall assist the ME in developing and maintaining a manual for
service recipients which includes information about access procedures, recipient rights
and responsibilities (including grievance and appeal procedures). This information will be
available for use by the consumers within each subcontractor location.
(35) Work and Social Opportunities
The Network Provider will employ Peer Services Coordinators to develop work and social
opportunities for clients and make recommendations to the ME and subcontractors for a
consumer -driven system.
(36) Assist Stakeholder Involvement in Planning, Evaluation, and Service Delivery
(a) At the ME's request, the Network Provider will assist the ME in engaging
local stakeholders, per section 394.9082 F.S., in its support activities for the
Department's local plans.
(b) The Network Provider shall work with the ME to provide performance, utilization,
and other information for the Department's Substance Abuse and Mental Health
Services Plan, and annual updates thereof, and to provide appropriate
information for the Department's Long Range Program Plan and its Annual
Business Plan.
Attachment 1 HCO2 (a)
Guidance/Care Center„ Inc, Page 22 of 53 Contract No, ME225-7-27
�►" South Florida
Behavioral
Health Network, Inc. 07di)112016 (m,. 6.22.16)
(37) Develop, Maintain, and Improve Reporting
The Network Provider shall submit reports included in Exhibit C, Required Reports. In all
cases, the delivery of reports, ad hoc or scheduled, shall not be construed to mean
acceptance of those reports. Acceptance, in writing, of required reports shall constitute a
separate act and shall be approved by the ME's contract manager. The ME reserves the
right to reject reports as incomplete, inadequate or unacceptable.
(38) Client Satisfaction Survey
The Network Provider shall conduct satisfaction surveys of individuals served pursuant to DCF
PAM 155-2. The Network Provider shall utilize a Department- approved satisfaction survey
instrument. Failing to provide the required number of satisfaction surveys and/or utilizing a
survey instrument other than that approved by the Department will result in a corrective
action and an imposed financial penalty as described in the Standard Contract.
(39) The Network Provider agrees to assist in the development and implementation of the Care
Coordination and Utilization Management (UM) System and shall maintain the capacity to
perform or work towards obtaining the following functions including, but not limited to:
(a) ME -approved automated, standardized, and screening and assessment instruments to
improve proper evaluation and placement of individuals;
(b) Automated referral and electronic consent for release of confidential information with
the ME and other Network Providers, to the extent permitted by law;
(c) Integrated processes for intake, admission, discharge and follow-up;
(d) Encounter and progress notes to support all services provided under this contract and
that automatically generate state and Medicaid billing and payment in the event
Medicaid compensable services are provided to individuals eligible for Medicaid,;
(e) Utilization management, including but not limited to Wait Lists and capacity
management;
(0 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);
(1) 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.
(40) Client Trust Funds (CTF)
Attachment 1 HCO2 (a)
Guidance/Care Center„ Inc. Page 23 of53 Contract No. ME225-7-27'
South Florida
P—F,o� i ` Behavioral
Health Network, Inc.
0710112016 (r°ei, 6.22.16)
(a) The Network Provider shall submit a letter to the contract manager certifying that they
either are or are not the representative payee for Supplemental Security Income, Social
Security Administration, Veterans Administration;Food Stamps, or other federal
benefits on behalf of a client by August 1, 2016. .
(b) If the Network Provider is the representative payee for Supplemental Security Income,
Social Security Administration, Veterans Administration, or other federal benefits on
behalf of the client, the Network Provider shall, comply with the applicable federal laws
including the establishment and management of individual client trust accounts (20
CFR 416 and 31 CFR 240).
(c) Any Network Provider assuming responsibility for administration of the personal
property and/or funds of clients shall follow the Department's Accounting Procedures
Manual 7 APM„ 6, Volume 7, incorporated herein by reference. Department or the ME
personnel or their designees upon request may review all records relating to this
section. Any shortages of client funds that are attributable to the Network Provider
shall be repaid, plus applicable interest,, within one (1) week of the determination.
(d) All reports specified in the Department's Accounting Procedures Manual 7 APM, 6,
Volume 7 shall be maintained onsite and available for review by Department or ME
staff, and shall be submitted to the ME upon request.
(e) The Network Provider shall also maintain and submit documentation of all
payment/fees received on behalf of SAMH clients receiving Supplemental Security
Income, Social Security Administration, Veterans Administration, Food Stamps, or
other federal benefits upon request from the ME.
b. Task Limits
The Network Provider shall perform services in accordance with applicable, rules, statutes, licensing
standards and policies and procedures.
The Network Provider agrees to abide by the approved Program Description, and is not authorized by
the ME to perform any tasks related to the project other than those described in the approved Program
Description and in this contract, without the express written consent of the ME. The Network Provider
shall ensure that services are performed in accordance with applicable rules, statutes, and licensing
standards.
2. Staffing Requirements
a. Staffing Levels
(1) The Network Provider shall maintain staffing levels in compliance with applicable rules,
statutes, licensing standards and policies and procedures. See Exhibit F, State and Federal
Laws, Rules, and Regulations.
(2) The Network Provider shall engage in recruitment efforts to maintain as much as possible staff
with the ethnic and racial composition of the clients served. The ME, at its sole discretion may
request documentation evidencing recruitment efforts.
b. Professional Qualifications
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc. Page 24 of 53 Contract No. ME225-7-27
South Florida
QZ100i Behavioral
Health Network, Inc.
117101/2016 (res. 6.22.1 )
(1) The Network Provider shall comply with applicable rules, statutes, requirements, and standards
with regard to professional qualifications. See Exhibit F, State and Federal Laws, Rules, and
Regulations and the requirements specified in Section 45. of the Standard Contract.
(2) The Network Provider shall provide employment screening for all mental health personnel
and all chief executive officers, owners, directors, and chief financial officers of service Network
Providers using the standards for Level II screening set forth in Chapter 435, and s. 408.809
F.S., except as otherwise specified in s. 394.4572(1)(b)-(d), F.S. For the purposes of this
contract, "Mental health personnel" includes all program directors, professional clinicians, staff
members, and volunteers working in public or private mental health programs and facilities who
have direct contact with individuals held for examination or admitted for mental health treatment.
(3) Additionally, the Network Provider shall provide employment screening for substance abuse
personnel using the standards set forth in Chapter 397.451, F.S., Background Checks for
Service Provider Personnel. "All owners, directors, and chief financial officers of service
providers are subject to level 2 background screening as provided under chapter 435. All service
provider personnel who have direct contact with children receiving services or with adults who
are developmentally disabled receiving services are subject to level 2 background screening as
provided under chapter 435. A volunteer who assists on an intermittent basis for fewer than 40
hours per month and is under direct and constant supervision by persons who meet all
personnel requirements of this chapter is exempt from fingerprinting and background check
requirements,"
(4) Network Providers who have programs for children are required to meet the requirements of s-
39.001(2); (a) and (b) F.S which states the following;
(a) If the department contracts with a provider for any program for children, all personnel,
including owners, operators, employees, and volunteers, in the facility must be of good
moral character. A volunteer who assists on an intermittent basis for less than 10 hours per
month need not be screened if a person who meets the screening requirement of this
section is always present and has the volunteer within his or her line of sight.
(b) The department shall require employment screening, and rescreening no less frequently
than once every 5 years, pursuant to chapter 435, using the level 2 standards set forth in
that chapter for personnel in programs for children or youths.
c. Staffing Changes
The Network Provider shall notify the ME's contract manager, in writing within ten (10) calendar days of
staffing changes regarding the positions of Chief Executive Officer, Chief Financial Officer, Medical
Director, and Clinical Director, IT Director, Dispute Resolution Officer, Data Security Officer, Single Point
of Contact in accordance with Section 504 of the Rehabilitation Act of 1973 as required by Paragraph
33. of the Standard Contract, or any individuals with similar functions. Additionally, the Network Provider
will notify the ME's contract manager in writing, of changes in the Executive Director or any senior
management position.
d. Subcontractors
(1) This contract allows the Network Provider to subcontract for the provision of services related
to the performance required under this Contract, subject to the provisions relating to
Assignments and Subcontracts in the Standard Contract and referenced therein. Written
requests by the Network Provider to subcontract for the provision of services under this
Attachment 1 HCO2 (a)
Guidance/Care Center; Inc. Page 25 of 53 Contract No. ME225-7-27
South Florida
Behavioral
Health Network, Inc-
07A)1 �21116 (rn. 6.22.16)
contract will be routed through the ME's contract manager for approval. The ME is not
obligated nor will it pay for any services delivered prior to its written approval of the act of
subcontracting. The act of subcontracting shall not in any way relieve the Network Provider
of any responsibility for the contractual obligations of this contract. The pre -approval process
applies to Subcontractors and not Independent Contractors as defined below.
(2) The ME has adopted the following definitions for vendors, subcontractors andlor independent
contractors who are contracted by the Network Provider to do work contemplated under this
contract. -
(a) Vendor: A person or company offering something for sale.
(b) Subcontractor: A business to business relationship; contracting a business or person
outside of one's own company to do work as part of a larger project.
(c) Independent Contractor: a person who is in an independent trade, business, or
profession in which they offer their services and/or expert advice to an individual or
organization. The general rule is that an individual is an independent contractor if the
payer has the right to control or direct only the result of the work and not what will be
done and how it will be done, The earnings of a person who is working as an
independent contractor are subject to Self -Employment Tax.
(3) The United States Public Health Service Act, Sections 1931(a)(1)(E), and 1916 (a)(5), and
Title 45 of the Code of Federal Regulations, Part 96.135(a)(5) prohibit States from expending
Substance Abuse Prevention and Treatment Block Grant (SAPTBG) and Community Mental
Health Services funds "To provide financial assistance to any entity other than a public or
non-profit private entity". Ordinarily.; the term "financial assistance is used to describe a
grant relationship as distinguished from a procurement relationship;, typically funded by
contract. While the above -referenced statute and regulations preclude States from providing
grants to for -profit entities, procurement contracts may be entered into with for -profit entities -
This is the latest interpretation from the United States Department of Health and Human
Services Substance Abuse and Mental Health Services Administration (4/5/2009) [PHS Act,
ss. 1931(a)(1)(E), and 1916 (a)(5), and 45 CFR, Part 96.135(a)(5)].
tt -//! n.ora/ r oressl -cont nt/uoloa-a sl -Guidance-on- T-and- S -
euire ens.odf
(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), Standards Business Associate Contracts, the Privacy
Rule, the Security Rule, the Breach Notification Rule„ the Health Information Technology for
Economic and Clinical Health ("HITECH") Act, the provisions included in the Network
Provider's Business Associate Agreement with the ME; the ME's contractual requirements,
and other laws and regulations pertaining to access, use, disclosure, and management of
Protected Health Information ("PHI") without limitation., PHI in an electronic format (EPHI)
created, received, maintained„ or transmitted by the Network Provider or its subcontractors
incidental to Network Provider's performance of this Contract.
(5) All agreements„ for services contemplated under this contract„ shall adopt the applicable
terms and conditions of the Network Provider's contract with the ME, including but not limited
to, any Federal block grant requirements. In addition, all subcontract agreement's shall
Attachment I HCO2 (a)
Guidance/Care Center, Inc. Page 26 of 53 Contract No. ME225-7-27
► South Florida
Behavioral
Health Network, Inc.
071011 01G (re%. ULM)
contain the applicable terms and conditions, and any amendments thereto, found in the ME's
contract with the Department (Prime Contract), which is incorporated herein by reference.
Subcontract agreements shall include a detailed scope of work; term of the agreement,
method of payment, clear and specific deliverables; and performance standards.
(6) The Network Provider shall maintain individual subcontractor files for each subcontractor and
provide a copy of all subcontracts agreements prior to the execution of those subcontracts
and any amendments to the ME's contract manager.
(7) All independent contractor agreements, and subcontractor agreement, vendor agreements,
and business associate agreements, or other legally binding agreements, for work
contemplated under this contract shall be available upon request by ME staff and at the time
of monitoring-
(8) The Network Provider shall implement and maintain procedures for subcontract procurement,
development, performance, and management that comply with state and federal rules,
regulation, and/or ME policies and procedures„ in addition to identifying the ME's pre -approval
process for approving the Network Providers act of subcontracting.
(9) The Network Provider shall not subcontract for substance abuse/mental health services
with any person, entity, vendor, purchase orders or any like purchasing arrangements
which:
(a) is barred, suspended; or otherwise prohibited from doing business with any government
entity, or has been barred, suspended; or otherwise prohibited from doing business with any
government entity within the last 5 years;
(b) is under investigation or indictment for criminal conduct, or has been convicted of any
crime which would adversely reflect on their ability to provide services, or which adversely
reflects their ability to properly handle public funds;
(c) is currently involved, or has been involved within the last 5 years, with any litigation,
regardless of whether as a plaintiff or defendant, which might pose a conflict of interest to the
department, the state or its subdivisions, or a federal entity providing funds to the department;,
(d) had a contract terminated by the department or ME for failure to satisfactorily perform or
for cause; or,
(e) failed to implement a corrective action plan approved to the satisfaction of the ME, the
department, and other governmental entities, after having received due notice.
(10) Unless the Department agrees to an alternative payment method as authorized in section
394.9082, F.S., and prior to entering into any subcontract, or an amendment which modifies
the previously negotiated unit cost rate or adds additional covered services, the Network
Provider shall conduct a cost analysis for said subcontract, in accordance with Rule 65E-14,
F.A.C. A cost analysis is the review of the proposed cost elements to determine if they are
necessary, allowable, appropriate and reasonable. Subcontractors will be required to comply
with Rule 65E-14.19, F.A.C., Methods of Paying for Services, including but not limited to,
covered services, measurement standard, descriptions, program areas, data elements,
maximum unit cost rates, required fiscal reports, program description, setting unit cost rates,
payment for services including allowable and unallowable units and requests for payments.
(11) The Network Provider shall monitor the performance of all subcontractors, and perform
follow up actions as necessary. The Network Provider shall notify the ME immediately upon
Attachment 1 HCO2 (a)
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►f� South Florida
Behavioral
Health Network, Inc.
07/0I# 1116 (ro. (r,2 .16)
discovery hours of conditions related to subcontractor performance that could impair
continued service delivery„
3. Service Location and Equipment
a. Service Delivery Location
The location of services will be as specified in the approved Program Description required by Rule 65E
14, F.A.C.
b. Service Times
(1) A continuum of services shall be provided on the days and times as specified in the approved
Program Description and/or Attachment IV, Scope of Work if prevention services are purchased
through this contract.
(2) The Network Provider shall notify the ME's contract manager, in writing, at least ten (10) calendar
days prior to any changes in days and times where services are being provided pursuant to Rule 65E-
14, F.A.C.
c. Changes in Location
The Network Provider shall notify the ME's 65Econtract manager, in writing., at least ten (10) calendar
days prior to any changes in location where services are being provided pursuant to Rule 65E-14, F_A,C,
d. Equipment
The Network Provider shall furnish all appropriate equipment necessary for the effective delivery of the
services purchased.
In the event that the Network Provider is allowed to purchase any non -expendable property with funds
under this contract, the Network Provider will ensure compliance with the Tangible Property
Requirements, Department operating Policies and Procedures as outlined in CFOP 40-5, CFOP 80-2,
Rule 65E-14, F.A.C., which are incorporated herein by reference and may be obtained from the ME's
contract manager, The provider shall submit an inventory report, as specified in the Network Provider
Inventory List, incorporated herein by reference„ and by the date(s) listed in Exhibit C, Required
Reports. The Network Provider Inventory List form may be requested from ME Contract Manager
upon request.
4. Deliverables
a. Services
The Network Provider shall deliver the services specified in and described in the Program Description
submitted by the Network Provider in accordance with Exhibit G, Covered Services Funding by
OCA and in Attachment IV, Scope of Work if prevention services are purchased through this
contract.
b. Records and Documentation
The Network Provider shall protect confidential records from disclosure and protect client confidentiality
in accordance with ss. 397.501(7), 394.455(6), 394.4615, and 414.295, F.S and also the Health
Insurance Portability and Accountability Act (HIPAA), 42 CFR Part 2; and any other applicable State, and
Federal laws, rules, and regulations.
Attachment I HCO2 (a)
GuidancelCare Center, Inc,. Page 28 of 53 Contract No, ME225-7.27
South Florida
2102 Behavioral
Health Network, Inc.
c. Reports
117/01124116 (re%. 6.22,161
Where this contract requires the delivery of reports to the ME, mere receipt by the ME shall not be
construed to mean or imply acceptance of those reports. It is specifically intended by the parties that
acceptance of required reports shall require a separate act in writing, The ME reserves the right to
reject reports as incomplete, inadequate, or unacceptable according to the parameters set forth in the
resulting contract. The ME, at its sole option, may allow additional time within which the Network
Provider may remedy the objections noted by the ME or the ME may, after having given the Network
Provider a reasonable opportunity to comply with the report requirements, declare this agreement to
be in default.
(1) The Network Provider shall submit to the ME financial and programmatic reports specified in
Exhibit C, Required Reports, by the dates specified or as requested by ME staff.
(2) Upon request, the network provider shall submit to the ME and the Department information
regarding the amount and number of services paid for by the Substance Abuse Prevention and
Treatment Block Grant.
(3) The Network Provider shall provide performance information or reports other than those required
by this agreement at the request of the ME; the Southern Region's SAMH Regional Director, or
their designee, For requests that are complex and difficult to address, all parties will develop and
implement a mutually viable work plan,
(4) The Network Provider shall ensure that its audit report will include the standard schedules that
are outlined in Rule 65E-14„ F,A.C, and submitted within the timeframes specified in Exhibit C,
Required Reports.
(5) The Network Provider shall submit treatment data, as set out in subsection 394.74(3) (e), F.S.
and DCF PAM 155-2.
(6) The Network Provider is instructed to report the modifiers to procedure codes in compliance with
the DCF PAM 155-2, Appendix 2,
(7) Data shall be submitted electronically, weekly, by 1ZOO Noon every Wednesday. Final monthly
data will be submitted electronically to the ME no later than the 4'h of each month following the
month of service into KIS, PBPS maintained by KIT Solutions or other data reporting system
designated by the ME and/or the Department. Notwithstanding, if the Network Provider is funded
to provide substance abuse prevention services, the Network Provider shall submit
prevention services data to PBPS,. or other data reporting system as directed by the ME.,
electronically no later than the 4th of each month following the month of service- The Network
Provider shall, also;
(a) Ensure that the data submitted clearly documents all client admissions and discharges
which occurred under this contract. Ensure that substance abuse prevention services data
entered into PBPS, or other data reporting system designated by the ME, clearly
documents all program participants,, programs and strategies which occurred under this
contract, if applicable;
(b) Ensure that all data submitted to KIS, or other data reporting system designated by the ME
is consistent with the data maintained in the Network Provider's clients' fileslEMR-EHR
systems.. Ensure that substance abuse prevention services data entered into PBPS, or other
data reporting system designated by the ME and/or the Department, is consistent with the
Attachment 1 H `02 (a)
GuidancelCare Center, Inc. Page 29 of53 Contract No, ME225-7-27
O.M;1we South Florida
Behavioral
4000 Health Network, Inc.
0710110/6 (re%. 6.22.161
data maintained in the Network Provider service documentation and/or client files, if
applicable;
(c) Review the ME's KIS error / download error reports to determine the number of records
accepted and rejected. Based on this review, the Network Provider shall make sure that the
rejected records are corrected and resubmitted in KIS, or other data reporting system
designated by the ME. Only error -free data as processed by KIS will be accepted by the ME
for monthly state reporting and payment validation;
(d) Resubmit corrected records no later than the next monthly submission deadline. The failure
to submit any data set or the Network Provider's total monthly submission per data set,
which results in a rejection rate of 5% or higher of the number of monthly records submitted
will require the Network Provider to submit a corrective action plan describing how and when
the missing data will be submitted or how and when the rejected records will be corrected
and resubmitted; and
(e) In accordance with the provisions of section 402.73(1), Fm S., and Rule 65-29.001, F.A.C.,
corrective action plans may be required for non-compliance, nonperformance, or
unacceptable performance under this contract. Penalties may be imposed for failures to
implement or to make acceptable progress on such corrective action plans. Failure to
implement corrective action plans to the satisfaction of the ME and after receiving due
notice, shall be grounds for contract termination.
(8) A facility designated as a public receiving or treatment facility under this contract shall report the
following Payer Class data to the ME, unless such data are currently being submitted into KIS, or
other designated data reporting system designated by the ME, Public receiving or treatment
facilities that do not submit data into KIS, or other data reporting system designated by the ME,
shall report these data annually as specified in Exhibit C, Required Reports, even if such data
are currently being submitted to the Agency for Health Care Administration:
(a) Number of licensed beds available by payer class;
(b) Number of contract days by payer class;
(c) Number of persons served (unduplicated) in program by payer class and diagnoses;
(d) Number of utilized bed days by payer class;
(e) Average length of stay by payer class; and
(f) Total revenues by payer class.
(9) The Network Provider shall obtain the format and directions for submitting Payer Class data from
the ME.
(10)The Network Provider shall submit Payer Class data to the ME no later than 90 days following the
end of the ME's fiscal year and by the date specified in Exhibit C, Required Reports.
(11) The Network Provider must subtract all units which are billable to Medicaid, and all units for
SAMH client services paid from other sources, including Social Security, Medicare payments, and
funds eligible for local matching which include patient fees from first, second, and third -party
payers, from each monthly request for payment. Should an overpayment be detected upon
reconciliation of payments, the Network Provider shall immediately refund any overpayment to
Attachment 1 HCO2 (a)
Guidance/Care Center; Inc. Page 30 of 53 Contract No, ME22 •7-27
South Florida
Behavioral
. I Health Network, Inc.
0710112016 (re%, 6.22.16)
the ME, including but not limited to services provided to a Medicaid -eligible individual prior to
becoming a Medicaid recipient when those services are subsequently covered under a
retroactive Medicaid reimbursement determination
5. Performance Specifications
a. Performance Measures
(1) The Network Provider shall meet the performance standards and required outcomes as specified
in Exhibit D, Substance Abuse and Mental Health Required Performance
Outcomes/Outputs.
(2) The Network Provider agrees that KIS PEPS, and SAMHIS, or other data reporting system
designated by the ME, will be the source for all data used to determine compliance with
performance standards and outcomes in Exhibit D, Substance Abuse and Mental Health
Required Performance Outcomes/Outputs or other data system as specified by the ME Any
conflicts will be clarified by the ME and the Network Provider shall adhere to the ME"s resolution,
The Network Provider shall submit all service related data for clients funded in whole or in part by
SAMH funds, local match, or Medicaid.
b. Performance Measurement Terms
DCF PAM 155-2 provides the definitions of the data elements used for various performance measures
which are quantitative indicators, outcomes, and outputs used by the ME to objectively measure a
Network Provider's performance, and contains policies and procedures for submitting the required data.
KIT Solutions„ or any other data system designated by the ME and/or the Department, maintains the
procedures for submitting the required prevention data into PEPS. The ME will also monitor the Network
Provider for the performance measures
C. Performance Evaluation Methodology
(1) The Network Provider shall collect information and submit performance data and individual client
outcomes, to the ME data system in compliance with DCF PAM 155-2 requirements, or the latest
revisions thereof. The specific methodologies for each performance measure may be found at
the following website: tt :If families, cofse ice- r ra s/s st ce- use/ hl t-
155-2
(2) The Network Provider is expected to have the capability to engage in organized performance
improvement activities, and to be able to participate in partnership with the department and ME
in performance improvement projects that are related to system wide transformation and
improvement of services for individuals and families.
(3) By execution of this contract the Network Provider hereby acknowledges and agrees that its
performance under the contract must meet the standards set forth above and will be bound by the
conditions set forth in this contract. If the Network Provider fails to meet these standards, the ME,
at its exclusive option, may allow a reasonable period, not to exceed six (6) months, for the
Network Provider to correct performance deficiencies. If performance deficiencies are not
resolved to the satisfaction of the ME within the prescribed time and if no extenuating
circumstances can be documented by the Network Provider to the ME's satisfaction, the ME must
terminate the contract. The ME has the sole authority to determine whether there are extenuating
or mitigating circumstances,.
(4) The ME will monitor the standards and outcomes specified in Exhibit D, Substance Abuse and
Attachment 1 HCO2 (a)
Guidance/Care Center,Inc. Page 31 of 53 Contract No, ME225-7-27
► South Florida
Behavioral
,001A00 Health Network, Inc.
Mental Health Required Performance Outcomes/Outputs.
07101,i`2016 irgk. 6.22.16F
(5) Performance data information may be found on the department's web -based performance
Dashboard at: http //dcfdashboard dcf state.fl.usl Additional substance abuse prevention data
information may be found on the Exhibit D Report which is transmitted to the ME Director of
Prevention Services monthly.
6. Network Provider Responsibilities
a. Network Provider Unique Activities
(1) In the event of a dispute as to the ME's determination regarding client eligibility and/or placement
into the appropriate level of care, the ME's dispute resolution process, as described in the Standard
Contract shall be followed. An eligibility dispute shall not preclude the provision of services to
Individuals Served, unless the dispute resolution process reverses the ME's determination.
(2) The Network Provider is responsible for the satisfactory performance of the tasks referenced in
this contract. By executing this contract„ the Network Provider recognizes its responsibility for the
tasks, activities, and deliverables described herein and warrants that it has fully informed itself of all
relevant factors affecting the accomplishment of the tasks, activities and deliverables and agrees to
be fully accountable for the performance thereof whether performed by the Network Provider or its
subcontractors.
(3) The Network Provider agrees that services other than those set out in this contract will be
provided only upon receipt of a written authorization from the ME'S contract manager or an
authorized ME staff member. The department through the ME has final authority to make any and
all determinations that affect the health safety and well-being of the residents of the State of
Florida.
(4) The Network Provider shall be responsible for the fiscal integrity of all funds under this contract,
and for demonstrating that a comprehensive audit and tracking system exists to account for funding
by client, and have the ability to provide an audit trail. The Network Provider's financial management
and accounting system must have the capability to generate financial reports on individual service
recipient utilization; cost, claims, billing, and collections for the ME. The Network Provider must
maximize all potential sources of revenue to increase services, and institute efficiencies that will
consolidate infrastructure and management functions in order to maximize funding.
(5) The Network Provider shall ensure that the invoices submitted to the ME reconcile with the
amount of funding and services specified in this contract, as well as the Network Provider's agency
audit report and client information system and reconciled with KIS, PEPS, or other data reporting
system designated by the ME.
(6) The Network Provider shall make available source documentation of units billed by Network
Provider upon request from the ME staff. The Network Provider shall track all units billed to the ME by
program and by Other Cost Accumulator (OCA),
(7) A Network Provider that receives federal block grant funds from the Substance Abuse Prevention
and Treatment or Community Mental Health Block Grants agrees to comply with Subparts I and II of
Part B of Title XIX of the Public Health Service Act,, s. 42 U.S.C. 300x-21 et seq- (as approved
September 22, 2000) and the Health and Human Services (HHS) Block Grant regulations (45 CFR
Part 96).
(8) A Network Provider that receives funding from the SAPTBG certifies compliance with all of the
requirements of the Substance Abuse and Mental Health Services Administration (SAMHSA)
Charitable Choice provisions and the implementing regulations of 42 CFR54a.
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc. Page 32 of 53 Contract No. ME225-7-27
0 01 South Florida
Behavioral
� N0100 Health Network, Inc.
0710112016 (ro. 6.7 ,16s
(9) None of the funds provided under the following grants may be used to pay the salary of an
individual at a rate in excess of Level II of the Executive Schedule; Block Grants for Community
Mental Health Services, Substance Abuse Prevention and Treatment Block Grant, Projects for
Assistance in Transition from Homelessness, Project Launch,: Florida Youth Transition to Adulthood;
and Florida Children's Mental Health System of Care Expansion implementation Project.
(10) Any compensation paid for an expenditure subsequently disallowed as a result of the Managing
Entity's or any Network Service Providers' non-compliance with state or federal funding regulations
shall be repaid to the Department upon discovery.
(11)The Network Provider shall make available to the ME and the Department all records pertaining
to service delivery. These records shall be made available at all reasonable times for inspection,
review, copying, or audit- Service delivery records include but are not limited to, invoicing, fiscal
management, data management, incident reporting, client records, and such documents determined
to assure accountability of service provision and/or the expenditure of state and federal funds,.
(12) The Network Provider shall assist the ME and the Department in developing legislative budget
requests based upon identified needs of the community.
(13) The Network Provider shalt provide to the ME, copies of, including but not limited to, evaluations,
assessments, surveys, monitoring reports that pertain to licensure, accreditation„ or other
administrative or programmatic review, when those reports identify deficiencies that require corrective
action, The Network Provider shall submit to the ME all of the applicable reports, including copies of
the corrective action plan(s) within ten (10) calendar days of receipt by the Network Provider from the
reviewing entity.
(14) The Network Provider shall cooperate with the ME and the Department when investigations are
conducted regarding a regulatory complaint of the Network Provider. When additional information or
documentation is requested by the ME, the Network Provider will submit the information within
twenty-four (24) hours of the request unless otherwise specified in the ME's request.
(15)The Network Provider shalt maintain human resource policies and procedures that provide
safeguards to ensure compliance with laws, rules and regulations. Integrate current and/or new
state/federal requirements and policy initiatives into its operations upon provision by the Department
and/or ME of the same.
(16) The Network Provider shall maintain in one place for easy accessibility and review by ME and/or
Department staff all' policies, procedures, tools, and plans adopted by the Network Provider. The
Network Provider's policies, procedures, and plans, must conform to state and federal laws, the
Florida Administrative Code, state and federal regulations„ state and federal rules, and minimally meet
expectations/ requirements contained in applicable Department of Children and Families and ME
operating procedures:
(17) The Network Provider shall maintain a mechanism for monitoring, updating, and disseminating
policies and procedures regarding compliance with current government laws, rules, practices,
regulations,, and the ME's policies and procedures.
08)Pursuant to s. 394.74(3)(e); F.S., the Network Provider shall maintain data on the performance
standards specified in Exhibit D, Substance Abuse and Mental Health Required Performance
Outcomes and Outputs, for the types of services provided under this contract.
(19)The Network Provider shall comply with all other applicable federal laws, state statutes and
associated administrative rules as may be promulgated or amended. See Exhibit F, State and
Attachment 1 H '02 (a)
Guidance/Care Center, Inc. Page 33 of 53 Contract No. ME225-7-27
South Florida
Behavioral
Health Network, Inc. 07/11Il2016 (rep, (%22.16)
Federal Laws, Rules, and Regulations, and ME policies and procedures.
(20)Records relating solely to actions taken in carrying out the requirements of this contract and
records obtained by the ME and/or the Department to determine a Network Provider's compliance
with this section are confidential and exempt from s. 119.07(i) and s. 24(a), Access to Public
Records and Meetings, Article. I, Constitution of the State of Florida. Such records are not admissible
in any civil or administrative action except in disciplinary proceedings by the Department of Health or
the appropriate regulatory board, and are not part of the record of investigation and prosecution in
disciplinary proceedings made available to the public by the Department of Health or the appropriate
regulatory board. Meetings or portions of meetings of continuous quality improvement program
committees that relate solely to actions taken pursuant to this section are exempt from s.
286.011.F.S.
b. Coordination with other Providers/Entities
(1) The Network Provider shall develop, maintain, and improve care coordination and
integrated care systems as follows:
(a) Develop Initial Service Agreements
(i) The Network Provider shall fulfill their designated role in implementing and/or
maintaining a system of care in support of the cooperative agreements with the judicial
system and the criminal justice system which define strategies and alternatives for
diverting persons from the criminal justice system and address the provision of
appropriate services to persons with substance abuse„ mental health and/or co-
occurring disorders who are involved with the criminal justice system. These
agreements address the provision of appropriate services to persons who have
behavioral health problems and leave the criminal justice system.
(ii) The Network Provider agrees to fulfill their designated role in implementing and/or
maintaining a system of care in support of the Southern Region's SAMH Program
Office's approved working agreement with the Department's contracted Community
Based Care (CBC) providers. The intent of the working agreement is to establish a
formal linkage of partnerships with a shared vision for improving outcomes for families
involved in the child welfare system by providing integrated community support and
services.
(iii) The Network Provider may be required to develop and implement cooperative
agreements with other external stakeholders.
(2) The failure of other providers or entities does not relieve the Network Provider of any
accountability for tasks or services that the Network Provider is obligated to perform pursuant
to this contract.
C. State and Federal Laws, Rules, and Regulations
See Exhibit F, State and Federal Laws, Rules, and Regulations.
7. Managing Entity Responsibilities
Attachment 1 HCO2 (a)
GuedancelCare Center; Inc. Page 34 of 53 Contract No. ME225.7-27
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&100011 Behavioral
Health Network, Inc.
a. Managing Entity Obligations
0710112016 (m. 6. 2.16J
(a) The ME shall only subcontract with entities that are fiscally sound, and that can adequately
ensure the accountability of public funds.
(b) The ME shall assess the Network Provider's financial stability, using a risk assessment
approach; the risk assessment approach will examine the impact of programmatic
requirements on the Network Provider's financial stability. Any issues identified as a result of
the financial risk assessment shall be reported to the Department during the monthly
reconciliation and performance review identified in the Prime Contract.
(c) The ME will provide administrative and programmatic oversight to ensure that Network
Providers comply with all consumer -related services and other requirements of this contract.
(d) The ME is solely responsible for the oversight of the Network Provider and
enforcement of all terms and conditions of this contract. Any and all enquiries and/or
issues arising under this contract are to be brought solely and directly to the ME for
consideration and resolution between the Network Provider and the ME. In any event, the
ME's decision on all issues is final and solely subject to the ME's appeal process and
legal rights of the Network Provider.
(e) The ME reserves the right terminate this contract in whole or in part, for non-performance as
determined by the ME and to procure the services purchased through this contract to another
entity and/or Network Provider.
(f) The ME is responsible for the administration, management, and oversight, and through
subcontracts, the provision of behavioral health services in Miami Dade and Monroe
Counties and to include statewide beds as specified in the Prime Contract, and in this
contract.
(g) The ME shall monitor and take action when necessary so that services which meet the
standards defined herein will be provided throughout the contract period.
(h) The ME will ensure that the Network Provider utilizes the approved consumer assessment
and placement tool designated by the ME. Standardized tools and assessments approved by
the ME must be used to determine placement and level of care.
(1) The ME shallwork with the Department to redirect administrative cost savings into improved
access to quality care,promotion of service continuity, required implementation of EBPs, the
expansion of the services array, and necessary infrastructure development. It acknowledges
the benefits to be realized, include improved access to quality care, promotion of service
continuity, implementation of EBPs, improved performance and outcomes,, expansion of the
service array, and necessary infrastructure development.
b. Monitoring Requirements
(1) The ME will monitor the Network Provider in accordance with this contract and the ME's
Contract Accountability Policies and Procedures which can be obtained from the designated
ME contract manager„ and is incorporated herein by reference.. The Network Provider shall
comply with any coordination or documentation required by the ME's monitor(s) to successfully
evaluate the programs, and shall provide complete access to all budget and financial
information related to services provided under this contract, regardless of the source of funds.
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc, Page 35 of 53 Contract No. ME225-7-27
South Florida
Behavioral
Health Network, Inc.
07101/201fi (rev. f .22.i6)
(2) Network Providers with electronic health record (EHR) or electronic medical record systems
(EMR) shall provide access to ME funded service and client data contained in these systems to
the ME's monitoring team and provide sufficient resources to facilitate the monitoring process of
services provided under this contract. Resources is defined but is not limited to, personnel,
terminals, guest read-only accounts,, privileges for monitors to access client records, and/or
remote access into the systems by the monitors,
(3) The ME will monitor the Network Provider on its performance of all tasks and special
provisions of the contract-
(4) The ME will provide a written report to the Network Provider within thirty (30) calendar days
of the exit conference. if the report indicates corrective action is necessary, the Network
Provider shall have ten (10) calendar days from receipt of the monitoring report to respond in
writing to the request. In the sole discretion of the ME, if there is a threat to health, life, safety
or well-being of clients, the ME may require immediate corrective action or take such other
action as the ME deems appropriate, Failure to implement corrective action plans to the
satisfaction of the ME and after receiving due notice, shall be grounds for contract termination in
whole or in part.
c. Training and Technical Assistance
(1) The ME's contact manager, or designee, will provide training and technical assistance
concerning the terms and conditions of this contract.
(2) The ME will provide technical assistance and support to the Network Provider to ensure the
continued integration of services and support for clients, to include but not limited to, quality
improvement activities to implement evidenced -based practice treatment protocols, the
application of process improvement methods to improve the coordination of access and services
that are culturally and linguistically appropriate.
(3) The ME will provide technical assistance and support to the Network Provider for the
maintenance and reporting of data on the performance standards that are specified in Exhibit D,
Substance Abuse and Mental Health Required Performance Outcomes/Outputs.
(4) The ME implements a training program for its staff and the Network Provider staff. The
trainings assure that staff receives externally mandated and internal training. The ME may
coordinate training or directly provide training to Network Provider staff.
(5)The ME may convene cross -organizational training and assistance to help non -accredited
Network Providers become accredited..
d. Review Compliance with Utilization Management Criteria
(1) As part of the quality improvement program, the ME will provide or coordinate reviews of
service compliance with criteria and practice guidelines, such as retrospective reviews to
ensure the level of placement of clients is appropriate.. The ME will take corrective action to
resolve situations in which the subcontracted Network Provider is not following the guidelines
or working to help the system meet its utilization goals,
(2) Authorization of Services
Attachment 1 HCO2 (a)
GuidancelCare Center, Inc. Page 36 of 53 Contract No. E225-7-27
South Florida
10 !0�10001;0 , Behavioral
Health Network, Inc.
117/ill/2111G (re%. 6.22.16)
(a) The ME shall conduct authorization and reauthorizations for applicable levels of care
as described in the approved Coordination Care Plan & Utilization Management Manual,
in order to ensure timely access to behavioral health services and eliminate the wait lists.
The authorization processes includes:
(i) Timeliness standards for authorization review must adhere to timelines standards
referenced in the approved Coordination Care Plan & Utilization Management
Manual for the services provided and departmental, statutory, and judicial
regulations or requirements.
(ii) Processes for making the criteria on which decisions are made available to
practitioners, including any standardized tools and assessments for use in
determining placement and/or level of care.
(iii) Provisions for providing timely appeals, or second opinions, when a request for
authorization for a particular service is denied. (An appeal differs from a
grievance in that grievances are used when a recipient or member of the covered
population believes that he or she has been treated improperly, whereas an
appeal is a request to review a judgment.) The second opinion shall be obtained
according to the timeliness standards for the service in question.
(3) Upon request, the ME will assist with the development and implementation of client
admission, continued stay, discharge criteria specific to each level of care, diagnosis,
presenting problems, and the establishment of review dates.
(4) The ME will participate in the collaborative development and implementation of the working
agreement with the Community Based Care and substance abuse and mental health
Network Providers to ensure the integration of services and support within the
community. The ME will support the development and implementation of the working
agreement by providing an example of a policy working agreement, system of care
information, data reporting requirements and technical assistance.
(5) The ME has the right to review the Network Provider's policies, procedures, and plans.
Once reviewed by the ME, the policies and procedures may be amended provided that
they conform to state and federal laws, the state Administrative Code, and federal
regulations. Substantive amendments to submitted policies, procedures and plans shall be
provided to the ME.
(6) The ME may request supporting documentation and review source documentation of units
billed to the ME.
e. Managing Entity Determinations
The ME has exclusive authority to make the following determination(s) and to set the
procedures that the Network Provider shall follow in obtaining the required determination(s):
(1) Whether the Network Provider is meeting the terms and conditions of this contract, to
include the Standard Contract, Attachment I, any documents incorporated into any
attachment by reference, Program Description, and any documents incorporated by herein
by reference.
(2) The ME reserves the exclusive right to make certain determinations in
these specifications. The absence of the ME setting forth a specific reservation of rights
Attachment 1 H'02 (a)
Guidance/Care Center, Inc. Page 37 of 53 Contract No. ME225-7-27
;K-% South Florida
MA Behavioral
Health Network, Inc-
117 111 j2016 (m. 6.22.16)
does not mean that all other areas of this contract are subject to mutual agreement. The
ME reserves the right to make exclusively any and all determinations that it deems are
necessary to protect the best interests of the State of Florida and the health, safety, and
welfare of the clients who are served by the ME either directly or through any one of its
contracted Network Providers.
(3) In the event of any disputes regarding the eligibility of individuals served, the
determination made by the ME is final and binding on all parties.
C. Method of Payment
Exhibit B, Method of Payment
Exhibit E, Monthly Payment Request (Incorporated by reference and available from the MEs
Contract Manager upon request)
Exhibit G, Covered Service Funding by OCA
Exhibit H, Funding Detail and Local Match
D. Special Provisions
1. The Network Provider is expected to maintain its administration cost to 10.00% or less for Fiscal
Year 2016-2017 for SAMH services purchased under this contract. The cost savings shall be
reallocated to support the increase of direct services, improved access to quality care, promotion of
service continuity, and the implementation and/or expansion in the use of evidence -based practices,.
The Network Provider's SAMH Projected Operating and Capital Budget shall, evidence the reduction
and redistribution of the cost savings,.
2. Prevention Services, if applicable:
General Statement: If the Network Provider was awarded prevention services funding as a result
of successful application to the ME's Invitation to Negotiate Solicitation #004 - Prevention of
Substance Abuse, Promotion of Positive Mental Health and Related Consequences and
Evaluation of the System released on March 4, 2015 ("ITN"), the following shall apply:
(a) The prevention services provided under this contract are to fund rigorous, effective, evidence -
based, substance abuse prevention programs and strategies and promotion of wellness
(positive mental health) services as part of the continuum of behavioral health care for
individuals and their families. The strategies, activities, and services must be consistent with
the local community ME -approved local Needs Assessment Logic Model (NALM) and the
Comprehensive Community Action Plan (CLAP).
The Network Provider shall work in collaboration with the funded ME Evaluation Entity, by
participating in meetings and providing service data vital for the completion of a system -wide
evaluation of the prevention services within the Strategic Prevention Framework.
The evaluation of the prevention system, as outlined in the ITN, is expected to be the
systematic collection and analysis of information about program activities, characteristics,
and outcomes to reduce uncertainty, improve effectiveness, and assist in decision -making.
The information gathered from the evaluation process will help the ME, the State and
communities become more skillful and exact in describing what they plan to do, monitor what
they are doing, and improve the prevention system of care. Evaluation results can and should
be used to determine what efforts should be sustained and to assist in sustainability planning
efforts. The ME will provide substantial input, in collaboration with the Network Provider and
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc. Page 38 of 53 Contract No, ME225-7-27
R South Florida
Behavioral
01
Health Network, Inc.
07A)112016 (ret.6.2 .16)
the Evaluation Entity, both in planning and implementation of the evaluation process and
activities, and will make recommendations regarding the continuance of the activities.
(b) Based on client needs, the Network Provider shall adhere to services as Outlined in the
approved Prevention Program Description, incorporated herein by reference and as set forth
in Attachment 1V, Scope of Work, in addition to providing services from the list of approved
covered services listed in Exhibit G, Covered Service Funding by OCA. Any change in the
array of services shall be justified in writing and submitted to the ME's contract manager for
review and approval.
(c) Renewal: If this contract was awarded to the Network Provider as a result of a successful
response to the ME's Invitation to Negotiate Solicitation #004 - Prevention of Substance
Abuse, Promotion of Positive Mental Health and Related Consequences and Evaluation of
the System released on March 4, 2015, this contract may be renewed annually for period not
to exceed three (3) years with a projected end date of June 30, 2018, subject to the
availability of funds. Renewals for two (2) years and three (3) shall be made by mutual
agreement and shall be contingent upon satisfactory performance, monitoring and
evaluations as determined by SFBHN, subject to the availability of funds. Any renewal shall
be in writing.
3. Intern Registration Requirements pursuant to section 491.0045, F.S.
(a) The Network Provider shall monitor and ensure that an individual who has not satisfied the
postgraduate or post -master's level experience requirements, as specified in s. 491.005(1)(c),
(3)(c), or (4)(c), F.S., register as an intern in the profession for which he or she is seeking
licensure before commencing the post -master's experience requirement or for an individual who
intends to satisfy part of the required graduate -level practicum, internship, or field experience,
outside the academic arena for any profession, the network provide must monitor and ensure
that the individual registers as an intern in the profession for which he or she is seeking
licensure before commencing the practicum, internship, or field experience.
(b) An intern registration is valid for five (5) years.
(c) A registration issued on or before March 31, 2017, expires March 31, 2022, and may not be
renewed or reissued. Any registration issued after March 31, 2017, expires BO months after the
date it is issued. A subsequent intern registration may not be issued unless the candidate has
passed the theory and practice examination described in s. 491.005(1)(d), (3)(d), and (4)(d),
F.S.
(d) An individual who has held a provisional license issued by the board may not apply for an intern
registration in the same profession.
4. Real-time Data Entry:
When required by the Prime Contract, state and/or federal rules, regulations; or policies, the
Network Provider shall submit to the ME real-time data in KIS Express, or other similar data
structure, for services purchased by this contract. The Network Provider agrees to implement the
new data reporting system when notified and as directed by the ME-
5. Utilization Management Program: The Network Provider shall assist the ME in the reporting
and managing of the Substance Abuse and Mental Health Waiting List for all applicable levels of
care
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc. Page 39 of 53 Contract No ME225-7-27
®' South Florida
Behavioral
10000 Health Network, Inc.
07,411.121116 (vie:. 6.22.16)
a. The Network Provider agrees to adhere to the utilization management protocols pursuant
to the South Florida Behavioral Health Network Coordination Care Plan & Utilization
Management Manual; herein incorporated by reference and available upon request from
the Contract Manager,
b. The Network Provider will have a data system in place that adequately supports the
collection, tracking, and analysis of data necessary to perform utilization management
activities, reviews of clinical/administrative performance related to levels of care, clinical
outcomes, and adherence to clinical/administrative standards.
c. The goals of utilization management include elimination/management of wait lists, the
maximum utilization of treatment resources, and the delivery of clinically appropriate
services in the least restrictive setting and most cost effective manner, Utilization
management systems include preauthorization for some services as well as retrospective
reviews and focused reviews of individuals receiving services and subcontractors whose
utilization of services is outside of expected parameters. Utilization management includes
methods used to manage the system of care to ensure access to the appropriate level of
care, at the right frequency and for the appropriate duration. It also includes financial
screening to ensure maximization of fiscal resources including other third party payors
such as, but not limited to KidCare, Medicaid, Medicare, and other HMOs. These methods
may include programs of intervention and/or diversion. Utilization management includes
not only managerial and supervisory strategies, methods and tools to ensure timely
access to care, but also includes processes to promote continuous improvement to
manage resources: The ME is enhancing its automated utilization management system to
include additional treatment services authorization.
d. The Network Provider will comply with the utilization management protocols pursuant to
the South Florida Behavioral Health Network Coordination Care Plan & Utilization
Management Manual. The Network Provider will offer clients a multi -level continuum of
care services for treatment of behavioral health services. Each level of care as identified
below have durations or length of stay as specified in the Coordination Care Plan &
Utilization Management Manual.
e. The Network Provider shall obtain written authorization from the ME prior to providing the
services as specified in the Coordination Care Plan & Utilization Management Manual: A
written authorization will also be required, prior to the expiration of the initial length of stay,
in order to extend services. The request for an extension must be justified in accordance
with the ME approved consumer assessment and placement tool and in accordance with
the Coordination Care Plan & Utilization Management Manual.
f. When a client has been provided residential services as a non -ME funded client (e.g. paid
by insurance), that stay is subtracted from the prescribed length of stay should the client
become eligible to receive Network Provider -funded services_
g. The Network Provider agrees to:
(1) Utilize a transmittal system, which may be a computerized management
information system, for submitting/receiving and recording information and
documentation required as part of the Utilization Management Program.
(2) Request and receive an authorization number from the ME for all clients requiring
admission into a substance abuse and/or mental health service as specified in the
Coordination Care Plan & Utilization Management Manual prior to the client being
Attachment 1 HCO2 (a)
Guidance/Care Center: Inc, Page 40 of 53 Contract No. ME225-7-27
► � South Florida
1-40 Behavioral
Health Network, Inc. 0710V2016 (r-e%. 6,22.10)
admitted to the program for treatment.
(3) Complete all required assessment components outlined in the Coordination Care
Plan & Utilization Management Manual for all consumers requiring substance abuse
and/or mental health treatment services. The information will be submitted to the ME
prior to the authorization request.
(4) Participate and cooperate in the centralized waiting list in accordance with the waiting
list policies and procedures outlined in the Coordination Care Plan & Utilization
Management Manual.
6.Pre-Authorization Utilization Management Roster and Payment for Services Specified in the
Coordination Care Plan & Utilization Management Manual
The Network Provider shall submit a request for reimbursement on the approved ME invoices
incorporated herein by reference and available upon request from the ME's contract manager. .
A listing of all prior -authorized clients served including, client name, client I.D. number,
authorization number, covered service and service period must be provided to support the
invoice. This information may be submitted on Exhibit K, SAMH Pre -Authorization Utilization
Management Roster, of this contract, unless the Network Provider has an agency generated
report that includes the required elements indicated above. This information must be attached to
the approved ME's invoice, , as a prerequisite for payment. The Network Provider shall
maintain back-up documentation for step-down services for a period of seven (7) years from the
expiration date of the contract per Paragraph 7. of the Standard Contract.
7. Waiting List and Interim Services
a. Iln 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,. FaS:_, including
those individuals who have been identified as requiring priority by state or federal law, The
identified priority populations are found in Exhibit A, Client/Participants to be Served, however
persons in categories (1) and (2) below are specifically identified as persons to be given
immediate priority over those in any other categories. These individuals may not be placed on a
wait list without receiving interim services within the required timeframes:.
(i) Pursuant to 45 C.F.R. s. 96.131, priority admission to pregnant women and women with
dependent children by Network Service Providers receiving SAPT Block Grant funding. If
the clinically appropriate services cannot be provided for the pregnant woman, interim
services, not later than forty (48) hours after the woman seeks treatment services, shall
be provided pursuant to 45 CFR s. 96.123;
(ii) Pursuant to 45 C.F.R. s. 96.126 (b), (1) and (2), adherence with the requirement to
provide interim services for injection drug users by Network Service Providers receiving
SAPT Block Grant funding.
(iii)Priority for services to families with children that have been determined to require
substance abuse and mental health services by child protective investigators and also
meet the target populations in subsections (a) or (b), below. Such priority shall be limited
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc. Page 41 of 53 Contract No, ME225-7-27
01Pe South Florida
Behavioral
1-ri-090 Health Network, Inc.
07101/2016 (red. fi,22,16
to individuals that are not enrolled in Medicaid or another insurance program„ or require
services that are not paid by another payor source:
a. Parents or caregivers in need of adult mental health services pursuant to s,.
394.674(1)a)2., F.S., based upon the emotional crisis experienced from the
potential removal of children; and
b. Parents or caregivers in need of adult substance abuse services pursuant to s.
394:674(1)(c)3., F.S., based on the risk to the children due to a substance use
disorder.
Failure to adhere to the requirements in Section Q. 7.b. above may result in a request for
corrective action for non-performance; non-performance or unacceptable performance,. Penalties
may be imposed for failure to implement or to make acceptable progress on corrective action as
described in Section 39„ of the Standard Contract.
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.
8. 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.
9. Mandatory Reporting Requirements
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc Page 42 of 53 Contract No. E225-7-27
South Florida
Behavioral
Health Network, Inc.
07ltt1.' 016 (rn- 6,22.16
a. The Network Provider and any subcontractor must comply with and inform its employees of the
following mandatory reporting requirements. Each employee of the Network Provider, and of any
subcontractor, providing services in connection with this contract who has any knowledge of a
reportable incident shall report such incident as follows:
(1) Reportable incidents that may involve an immediate or impending impact on the health or
safety of a client shall be immediately reported to the contract manager; and
(2) Other reportable incidents shall be reported to the ME and Department's Office of
Inspector General by completing a Notification/investigation Request (form CF 1934) and
emailing the request to the Office of Inspector General at IG.Complaints@myflfamilies.com,.
The Network Provider and subcontractor may also mail the completed form to the Office of
Inspector General, 1317 Winewood Boulevard, Building 5, 2nd Floor,: Tallahassee, Florida,
32399-0700; or via fax at (850) 488-1428.
b. A reportable incident is defined in Children and Families Operating Procedures CFOP 180-4
(CFOP 180-4) Mandatory Reporting Requirements to The Office of The Inspector General, which
can be obtained from the contract manager.
c. In the event of a breach or potential breach of Protected Health Information; the Network Provider
is directed to the reporting requirements delineated in the executed Business Associate
Agreement, incorporated herein by reference.
10. Contracted Mental Health Network Providers shall participate in the Department's aftercare referral
process for formerly incarcerated individuals with severe and persistent mental illness or serious
mental illness who are released to the community or who are determined to be in need of long-term
hospitalization is required. Participation shall be as specified in Children and Families Operating
Procedure 155-47 (CFOP 155-47), Processing Referrals from the Department Of Corrections which
can be obtained at: CFOP i 5-47, Processing Referrals from the Depirtment Of
Corrections. pdf, and is incorporated herein by reference.
11. Health, Safety, and Physical Environment Requirements for Substance Abuse and Mental
Health Levels 1, 2, and 3 Residential Treatment Facilities
Unless abridged by a court of law„ the rights of individuals who are admitted into a residential
treatment facility shall be assured Each residential treatment facility shall be operated in a
manner that protects the individual's rights, life, and physical safety while under the evaluation and
treatment.
To avoid high risk situations such as suicide, death, serious injury, violence, and abuse of any
individual the contracted residential treatment network provider shall ensure that its facilities are
safe and secure, for example, exposed plumbing pipes are to be covered to prevent individual
access.
If for clinical reasons access to potentially dangerous grooming aids or other personal articles is
contradicted for residents,staff shall explain to the resident the conditions under which the articles
may be used and shall document the clinical rationale for these conditions in the resident's record.
If clinically indicated, personal articles of residents may be kept under lock and key by staff. Such
actions shall be reviewed weekly for effectiveness and continued need.
12. Involuntary Commitment, Placements, Services, Treatment
Attachment 1 HCO2 (a)
Guidance/Care Center,, Inc. Page 43 of53 Contract No. ME225-7-27
South Florida
Behavioral
Health Network, Inc.
0710112016 (re%, 6.22.16)
a. Mental Health Services Provider: The Network Provider agrees to provide services to persons
who have been court ordered into involuntary outpatient services in accordance with section
394,4655, F.S-, court ordered into involuntary inpatient placements as defined in section
394.467. F.S., and court ordered for involuntary examination under 394,463, F.S.
b. Substance Abuse Services Provider: The Network Provider agrees to provide services to
persons who have been court ordered into involuntary assessment and stabilization under
section 397.6818, F.S., and/or court ordered into an involuntary substance abuse treatment
under section 397.6957, F.S. It is the Network Provider's responsibility to be familiar with and
ensure that the requirement's regarding involuntary admissions are followed pursuant to,
including but not limited to, ss. 397.6751, F_S.
c. Pursuant to s. 394.4655(3)-(4), and (7), F.S. and s. 397.697(4), F.S., if the court orders
involuntary services, the Network Provider shall submit a copy of the order to the ME within one
(1) working day after it is received from the court. Similarly, if the court orders a program or a
service that is not available, Network Provider must notify the ME within one (1) working day after
it is received from the court indicating that the requested program or service is not available.
Documents may be electronically submitted as directed by the ME. Documents must be
submitted in a secured, password protected, or encrypted format,
13. Motivational Support Program
The Network Provider shall comply with the provisions of Exhibit I, Motivational Support Program
Provider Protocols, (and Exhibit J, Motivational Support Program Treatment Summary Report.
14. Service Provision Requirements for Substance Abuse Prevention and Treatment Block
Grants, if applicable.
a. As applicable, the Network Provider shall comply with the requirements set forth in 45 C.F.R,
Subpart L — Substance Abuse Prevention and Treatment Block Grant,
b. In accordance with 45 C.F.R. s. 96.131(b), the Network Provider that receive Block Grant funds
and that serve injection drug users shall publicize the following notice: "This program receives
federal Substance Abuse Prevention and Treatment Block Grant funds and serves people who
inject drugs. This program is therefore federally required to give preference in admitting people
into treatment as follows: 1. Pregnant injecting drug users; 2. Pregnant drug users; 3, People who
inject drugs; and 4. All others."
c. Behavioral health services shall be provided to persons pursuant to s. 394,674, F.S., including
those individuals who have been identified as requiring priority by state or federal law. The
identified priority populations are found in Exhibit A, Client/Participants to be Served, however
persons in categories (1) and (2) below are specifically identified as persons to be given
immediate priority over those in any other categories. These individuals may not be placed on a
wait list without receiving interim services within the required timeframes.
(i) Pursuant to 45 C.F.R. s, 96.131, priority admission to pregnant women and women with
dependent children by Network Service Providers receiving SAPT Block Grant funding. If
the clinically appropriate services cannot be provided for the pregnant woman, interim
services, not later than forty (48) hours after the woman seeks treatment services, shall be
Attachment 1 HCO2 (a)
Gutdance/Care Center, Inc. Page 44 of 53 Contract No. ME225-7-27
South Florida
Behavioral
Health Network, Inc. 07At)i121110 6.22.16)
provided pursuant to 45 CFR s, 96.123-0
01) 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 re uirement .
(1) 14 days after making the request for admission to such a program; or
(2) 120 days after the date of such request, if no such program has the capacity to
admit the individual on the date of such request and if interim services, including
referral for prenatal care, are made available to the individual not later than 48
hours after such request.
d. Outreach Services to Injection Drug Users, The Network Provider shall carry out outreach
activities to encourage injection drug users in need of treatment to undergo such treatment
pursuant to the requirements in 45 C.F.R_ s. 96.126(e), The Network Provider shall document the
services to demonstrate the provision of these services per the documentation requirements for
Outreach services specified in Rule 65E-14, FAC..
e. As required by 45 C.F.R. ss. 96.17, the Network Provider may be requested to provide
information to the ME for the purposes of reporting on SAPTBG activities to the Department
f. The Network Provider shall ensure compliance with 45 C.F.R. Subpart C — Financial
Management.
g. The Network Provider agrees to comply with the data submission requirements outlined in DCF
PAM 155-2 and the by the dates specified in Exhibit C, Required Reports.
h. In addition to the modifiers to procedure codes that are currently required to be utilized as per
DCF PAM 155-2, Appendix 2, the Network Provider is directed to utilize the modifiers required for
Block Grant funds, where applicable. The Network Provider also agrees to report to the ME
and/or the Department, information regarding the amount and number of services paid for by the
Community Mental Health Services Block Grant and/or the Substance Abuse Prevention and
Treatment Block Grant.
i. Only if such services are purchased through this contract is the Network Provider responsible for
complying with the reporting requirements outlined in Exhibit AB, Substance Abuse Prevention
and Treatment Block Grant (SAPTBG) Early Intervention Funded Services for Human
Immunodeficiency Virus (HIV) by the dates and to the individual(s) listed in Exhibit C,
Required Reports. Subject to other applicable state and/or federal requirements, the ME a may
require additional reports from the Network Provider.
j. Only if such services are purchased through this contract is the Network Provider responsible for
complying with the for SAPTBG set -aside funded services for pregnant women and women with
dependent children services, SAPTBG set -aside funded services for HIV Early Intervention
Programs and the SAPTBG set -aside funds for Evidenced -based Outreach Services to Injection
Drug Users as outlined in Exhibit C, Required Reports.
Altachment I HCO2 (a)
Guidance/Care Center; Inc. Page 45 of 53 Contract No. E225-7-27
South Florida
Behavioral
Health Network, Inc.
OW0112016 (re%. 6.22.16
k. The Network Provider shall make available, either directly or by arrangement with others,
tuberculosis services to include counseling, testing, and referral for evaluation and treatment.
I. The Network Provider shall use SAPTBG funds provided under this contract to support both
substance abuse treatment services and appropriate co-occurring disorder treatment services for
individuals with a co-occurring mental disorder only if the funds allocated are used to support
substance abuse prevention and treatment services and are tracked to the specific substance
abuse activity as listed in Exhibit G, Covered Service Funding by OCA.
m. The Network Provider is required to participate in the peer -based fidelity assessment process to
assess the quality, appropriateness, and efficacy of treatment services provided to individuals
under this contract pursuant to 45 CFR 96,136.
n. The United States Public Health Service Act, Sections 1931(a)(1)(E), and 1916 (a)(5), and Title
45 of the Code of Federal Regulations, Part 96.135(a)(5) prohibit States from expending
Substance Abuse Prevention and Treatment Block Grant (SAPTBG) and Community Mental
Health Services funds "To provide financial assistance to any entity other than a public or non-
profit private entity", Ordinarily, the term "financial assistance" is used to describe a grant
relationship as distinguished from a procurement relationship;, typically funded by contract. While
the above -referenced statute and regulations preclude States from providing grants to for -profit
entities, procurement contracts may be entered into with for -profit entities. This is the latest
interpretation from the United States Department of Health and Human Services Substance
Abuse and Mental! Health Services Administration (4/512009)0 [PHS Act, ss- 1931(a)(1)(E), and
1916 (a)(5), and 45 CFR; Part 96,135(a)(5)).
tt 11 org/wordpressl-contentlu ldl -Guidance-on-SAPT-and-CMHSBG-
RgcLuirements.. df
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.
16. Option for Increased Services
The Network Provider acknowledges and agrees that the contract may be amended to include
additional, negotiated, services as deemed necessary by the ME. Additional services can only be
increased if the Network Provider demonstrates competence in the provision of contractual services and
meets whatever criteria are established by the ME from time to time. The ME in its sole discretion
shall determine at what time and to which Network Provider and what amounts are to be given to
Network Providers for additional services.
17. Sliding Fee Scale
The ME requires the Network Provider to comply with the provisions of Rule 65E-14-018, F.A.C. Prior to
the execution of this contract the Network Provider submitted a copy of its sliding fee scale and policy that
reflects the uniform schedule of discounts referenced in Rule 65E-14.018, F:A.C:.
18. Transportation Disadvantaged
The Network Provider agrees to comply with the provisions of chapter 427, F.S., Part I, Transportation
Services, and Chapter 41-2, F.A.C.„ Commission for the Transportation Disadvantaged, if public funds
provided under this contract will be used to transport clients. The Network Provider agrees to comply
Attachment 1 HCO2 (a)
GuldancetCare Center; Inc. Page 46 of 53 Contract No. ME225-7-27
South Florida
Behavioral
Health Network, Inc. 07/01.121t16 (re-*. 6.22.16)
with the provisions of Children and Families Operating Procedures 40-50 (CFOP 40-5) Acquisition of
Vehicles For Transporting Disadvantaged Clients if public funds provided under this contract will be
used to purchase vehicles which will be used to transport consumers.
19. Medicaid Enrollment
a. Those Network Providers with SAMH contracts that meet Medicaid provider criteria and with
funding in excess of $500,000 annually shall enroll as a Medicaid provider. This process shall be
initiated within ninety (90) days of contract execution. A waiver of the ninety (90) day requirement
may be granted, in writing, by the Department's Director of Substance Abuse and Mental Health
Program Office, through the ME.
20. National Provider Identifier (NPI)
a. All Network Providers shall obtain and use an NPI, a HIPAA standard unique health identifier for
health care providers.
b. An application for an NPI may be submitted online at
https Wrippes.c s, hhS. govINP P ES/Static Foar . o?fo r=static.n istart.
c. Additional information can be obtained from one of the following websites:
(1) The Florida Medicaid HIPAA located at: htt9i1! .f c.st te: 1.q§1hipaa/index s truni
(2) The National Plan and Provider Enumeration System NPPES located at:
https-.Hnppes c s. hs ov! elco e.do
(3) The CMS NPI located at: http I/www.cmshhs.gov/NationalProvidentStand/
21. Ethical Conduct
The Network Provider understands that performance under this contract involves the expenditure of
public funds from both the state and federal governments, and that the acceptance of such funds
obligates the Network Provider to perform its services in accordance with the very highest standards of
ethical conduct. No employee, director, officer, agent of the Network Provider shall engage in any
business, financial or legal relationships that undermine the public trust, whether the conduct is
unethical, or lends itself to the appearance of ethical impropriety. Network Providers' directors, officers
or employees shall not participate in any matter that would inure to their special gain, and shall recuse
themselves accordingly. Public funds may not be used for purposes of lobbying, or for political
contributions, or for any expense related to such activities, pursuant to Paragraph 20. of the Standard
Contract of this contract. The Network Provider understands that the ME contracts with the department,
and as a subcontractor, recognizes that the department is a public agency which is mandated to
conduct business in the sunshine, pursuant to section 286.011, F.S., and chapter 119, Florida Law,
and that all issues relating to the business of the department, the ME and the Network Provider are
public record and subject to full disclosure. The Network Provider understands that attempting to exercise
undue influence on the ME, the department and its employees to allow deviation or variance from the
terms of this contract other than a negotiated, publicly disclosed amendment, is prohibited by the
State of Florida, pursuant to section 286.011, F.S. The Network Provider's conduct is subject to all
state and federal laws governing the conduct of entities engaged in the business of providing services
with government funds.
22. Information Technology Resources
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc. Page 47 of 53 Contract No. ME225-7-27
South Florida
Behavioral
Health Network, Inc.
tl7 O °' 016 (re%, 6.22,I6)
If applicable, the Network Providers must receive written approval from the ME prior to purchasing any
Information Technology Resource (ITR) with contract funds. The Contract Manager is responsible for
serving as the liaison between the Network Provider and the ME during the completion of the process
as instructed by the Contract Manager, The Network Provider will not be reimbursed for any ITR
purchases made prior to obtaining the ME's written approval,
23. Programmatic, Fiscal & Contractual Contract File References
All of the documentation submitted by the Network Provider which may include, but not be limited to
the Network Provider's original proposal, Program Description, SAMH Projected Operating and Capital
Budget, Agency Capacity Report, are herein incorporated by reference for programmatic, contractual
and fiscal assurances of service provision. These referenced contractual documents will be part of the
contract manager's file. Documents incorporated by reference in this contract are available in the ME
contract manager's file.
24. Employee Loans
Funds provided by the ME to the Network Provider under this contract shall not be used by the
Network Provider to make loans to their employees, officers, directors and/or subcontractors. Violation
of this provision shall be considered a breach of contract and the termination of this contract shall be
in accordance with the Paragraph 40. of the Standard Contract. A loan is defined as any
advancement of money for which the repayment period extends beyond the next scheduled pay
period..
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.
26. Property and Title to Vehicles
a. Property
(1)Nonexpendable property is defined as tangible personal property of a non -consumable
nature that has an acquisition value or cost of $1,000 or more per unit and an expected
useful life of at least one year, and hardback covered bound books that are not circulated to
students or the general public, the value or cost of which is $250 or more. Hardback books with a
value or cost of $100 or more should be classified as nonexpendable property only if they are
circulated to students or to the general public, All computers, including all desktop and laptop
Ataachment 1 HCO2 (a)
Guidance/Care Center, Inc. Page 48 of 53 Contract No, ME225-7-27
000 South Florida
Behavioral
Health Network, Inc.
117101/2016 (r€%, 6.22.1(,)
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 andlor model, a description of the property, its use and condition, current location,
the name of the property custodian, class code (use state standard codes for capital assets), if a
group, record the number and description of the components making up the group, name, make,
or manufacturer, serial number(s), if any, and if an automobile, the VIN and certificate number;
acquisition date, original acquisition cost, funding source, information needed to calculate the
federal and/or state share of its cost.
(5)The ME's contract manager must provide disposition instructions to the provider prior to the
end of the contract period. The provider cannot dispose of any property that reverts to the ME
or department without the contract manager's approval. The provider shall furnish a Closeout
Inventory Form no later than 30 days before the completion or termination of this contract. The
Closeout Inventory Form shall include all nonexpendable property including all computers
purchased by the provider. The Closeout Inventory Form shall contain, at a minimum, the same
information required by the annual inventory,
(6) The provider hereby agrees that all inventories required by this contract shall be current and
accurate and reflect the date of the inventory, If the original acquisition cost of a property item is
not available at the time of inventory, an estimated value shall be agreed upon by both the provider
and the ME and shall be used in place of the original acquisition cost.
(7) Title (ownership) to and possession of all property purchased by the provider pursuant to this
contract shall be vested in the ME upon completion or termination of this contract. During the term
of this contract, the provider is responsible for insuring all property purchased by or transferred to
the provider is in good working order. The provider hereby agrees to pay the cost of transferring
title to and possession of any property for which ownership is evidenced by a certificate of title.
The provider shall be responsible for repaying to the ME the replacement cost of any property
inventoried and not transferred to the ME upon completion or termination of this contract. When
property transfers from the provider to the ME,the provider shall be responsible for paying for
the title transfer.
Attachment I HCO2 (a)
GuidancelCare Center, Inc,. Page 49 of 53 Contract No ME225-7-27
South Florida
Behavioral
Health Network, Inc.
07A ,2016 (re-. 6.22.116)
(8) If the provider replaces or disposes of property purchased by the provider pursuant to this
contract, the provider is required to provide accurate and complete information pertaining to
replacement or disposition of the property as required on the provider's annual inventory,
(9) The provider hereby agrees to indemnify the ME and the department against any claim or loss
arising out of the operations of any motor vehicle purchased by or transferred to the provider
pursuant to this contract.
(10) A formal contract amendment is required prior to the purchase of any property item not
specifically listed in the approved contract budget.
b. Title to Vehicles
(1) Title (ownership) to, and possession of, all vehicles acquired with funds from this contract
shall be vested in the ME upon completion or termination of the contract. The provider will retain
custody and control during the contract period, including extensions and renewals.
(2) During the term of this contract, title to vehicles furnished by the state or acquired at the direction
of the state (using state or federal funds) shall not be vested in the provider- Subcontractors shall not
be assigned or transferred title to these vehicles. The provider hereby agrees to indemnify the ME or
the department against any claim or loss arising out of the operations of any motor vehicle
purchased by or transferred to the provider pursuant to this contract..
27. Health Insurance Portability and Accountability Act (HIPAA)
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.
28. National Voter Registration Act (NVRA) of 1993
a. The Network Provider shall comply with the National Voter Registration Act (NVRA) of 1993, Pub.
L. 103-31 (1993), sections 97.025, F.S.
b. As a Voter Registration Agency, the Network Providers shall designate a Voting Registration
Activities Coordinator and provide the contact information of the Coordinator by the date and to
the individual(s) identified in Exhibit C, Required Reports. The Network Provider shall notify the
ME's contract manager, in writing within (10) calendar days of staffing changes regarding this
position.
c. As a Voter Registration Agency, the Network Provider shall provide individuals seeking services
and/or individuals served with an opportunity at admission or when they change an address, to
either register or update their voter registration. The National Voter Registration Act Preference
Form/Application are DS-DE77-ENG and DS-DE77-SPN, are available at the link provided in
paragraph f., below
d. The Network Provider shall submit a NVRA Voter Registration Agencies Quarterly Activities
Report Form, DS-DE131, by the dates and to the individual(s) identified in Exhibit C, Required
Reports. The Quarterly Activity Report Form is available at the link provided in paragraph f.,
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc, Page 50 of 53 Contract No. ME225-7-27
■'" South Florida
Behavioral
Health Network, Inc.
{}W01/2016 (re%. 6.22.16)
below
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 //dos. orida co /elections/for-voters/voter-re istr tion/nation I -voter -re istrtion- ctl
29. Special Insurance Provisions
a. The Network Provider shall notify the ME Contract Manager within thirty (30) calendar days if
there is a modification to the terms of insurance including but not limited to, cancellation or
modification to policy limits,.
b. The Network Provider acknowledges that, as an independent contractor, the Network Providers,
and its subcontractors, at all tiers are not covered by the State of Florida Risk Management Trust
Fund for liability created by s. 284.30, F.S,
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 Managing Entity shall cause all Network Service Providers, at all tiers, who the Managing
Entity reasonably determines to present a risk of significant loss to the Managing Entity or the
Department, to obtain and provide proof to Managing Entity and the Department of
comprehensive general liability insurance coverage (broad form coverage), specifically including
premises, fire and legal liability covering the Network Service Provider and all of its employees.
The limits of coverage for the Managing Entity's Network Service Providers, at all tiers, shall be in
such amounts as the Managing Entity reasonably determines to be sufficient to cover the risk of
loss.
e. If any officer, employee, or agent of the Managing Entity operates a motor vehicle in the course of
the performance of its duties under this contract, the Managing Entity shall obtain and provide
proof to the Department of comprehensive automobile liability insurance coverage. The limits of
the Managing Entity's coverage shall be no less than $300,000 per occurrence with a minimal
annual aggregate of no less than $1,000,000,
f. If any officer, employee, or agent of any Network Service Provider, at all tiers, operates a motor
vehicle in the course of the performance of the duties of the Network Service Provider, the
Managing Entity shall cause the Network Service Provider to obtain and provide proof to the
Managing Entity and the Department of comprehensive automobile liability insurance coverage
with the same limits,
g. The Managing Entity shall obtain and provide proof to the Department of professional liability
insurance coverage, including errors and omissions coverage„ to cover the Managing Entity and
all of its employees= if any officer„ employee,, or agent of the Managing Entity administers any
Attachment 1 HCO2 (a)
GuIdancelCare Center, Inc. Page 51 of 53 Contract No. ME225-7-27
►� South Florida
Behavioral
Health Network, Inc.
ti714ti%201G (rew.6.22.10)
prescription drug or medication or controlled substance in the course of the performance of the
duties of the Managing Entity under this contract, the professional liability coverage shall include
medical malpractice liability and errors and omissions coverage, to cover the Managing Entity and
all of its employees. The limits of the coverage shall' be no less than $300,000 per occurrence
with a minimal annual aggregate of no less than $1,000,000.
h. If any officer„ employee, or agent of the Network Service Provider, at all tiers, provides any
professional services or provides or administers any prescription drug or medication or controlled
substance in the course of the performance of the duties of the Network Service Provider, the
Managing Entity shall cause the Network Service Provider, at all tiers; to obtain and provide proof
to the Managing Entity and the Department of professional liability insurance coverage„ including
medical malpractice liability and errors and omissions coverage, to cover all Network Service
Provider employees with the same limits.
The ME and the Department shall be exempt from, and in no way liable for, any sums of money
that may represent a deductible or self -insured retention under any such insurance. The payment
of any deductible on any policy shall be the sole responsibility of the Network Provider purchasing
the insurance.
All such insurance policies of the Network Providers, and its subcontractors at all tiers, shall be
provided by insurers licensed or eligible to do and that are doing business in the State of Florida.
Each insurer must have a minimum rating of "A" by A, M. Best or an equivalent rating by a similar
insurance rating firm, and shall name the ME and the Department as an additional insured under
the policy(ies). The Network Provider shall use its best good faith efforts to cause the insurers
issuing all such general, automobile; and professional liability insurance to use a policy form with
additional insured provisions naming the ME and the Department as an additional insured or a
form of additional insured endorsement that is acceptable to the ME and the Department in the
reasonable exercise of its judgment.
k. All such insurance proposed by the Managing Entity shall be submitted to and confirmed by the
Contract Manager annually by March 31.
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.
I. Exhibit A, C I lents/Partici pants to be Served
2. Exhibit B, Method of Payment
3. Exhibit C, Required Reports
4. Exhibit D, Substance Abuse and Mental Health Required
Outputs
5. Exhibit E, Monthly Payment Request
6. Exhibit F, State and Federal Laws, Rules and Regulations
7. Exhibit G, Covered Service Funding by OCA
8. Exhibit H, Funding Detail & Local Match Plan
S. Exhibit I, Motivational Support (MSP) Provider Protocols
Performance Outcomes and
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc, Page 52 of 53 Contract No, ME225-7.27
South Florida
Behavioral
10010 Health Network, Inc.
07J0P21016 (rn. 6.22.1f o
10. Exhibit J, Motivational Support Specialist Treatment Summary Report
11. Exhibit K, SAMH Pre -Authorization Utilization Management Roster
12. Exhibit L, Assisted Living Facilities with Limited Mental Health License
13. Exhibit N, Special Provisions for the Indigent Drug Program
14. Exhibit O, Crisis Stabilization Unit, Substance Abuse Detoxification, Addiction
Receiving Facility Daily Tracker and Data Collection
15. Exhibit O-1a-c, CSU Detox Addiction Daily Tracker
16. Exhibit 0-2a, CSU File Layout
17. Exhibit 0-2b-c, Substance Abuse Detoxification/Addition Receiving Facility Services
Utilization Data Collection Tracker
18. Exhibit Q, Missing Children
19. Exhibit R, Our Kids Miami-Dade/Monroe Child Welfare Quarterly Clinical Report
20. Exhibit V, Special Provisions for the Forensic Services Program
21. Exhibit X, Special Provisions for Projects for Assistance in Transition from
Homelessness (PATH) Services
22. Exhibit AA, Motivational Support Specialist
23. Exhibit Al, AI -A, Family Intensive Treatment Team, Scope of Work, and Monthly
Progress Report
24. Exhibit AI-B, Monthly Discharge Report
25. Exhibit AK, Outpatient Waidist Report Form
26. Exhibit AM, Return on Investment -Special Appropriations Projects for Fiscal Year
2016-17
27. Exhibit AN, Supplemental Security Income/Social Security Insurance (SSIISSDI)
Outreach, Access, and Recovery (SOAR)
Attachment 1 HCO2 (a)
Guidance/Care Center, Inc. Page 53 of 53 Contract No. ME225-7-27
South Hurida itelra %ioral [Icadth Network, ium
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. ClientlParticipant Eligibility
I. The network provider agrees that all persons meeting the target population descriptions in the
table above are eligible for services based on the availability of resources. A detailed
description of each target population is contained in s. 394,674, Florida Statutes and as
described in the Department of Children and Families Pamphlet 155-2 (PAM 155-2), based on
the availability of resources. Pamphlet 155-2 is available on the Department's website
# ilie .co /service- ro .r s/s stance- busel u lications) and is incorporated
herein by reference,
2. Behavioral Health services shall be provided to persons pursuant to s. 394.674, F.S., including
those individuals who have been identified as requiring priority by state or federal law. These
Identified priorities include, but are not limited to, the categories in sections (a) through 0),
below. Persons in categories (a) and (b) are specifically identified as persons to be given
immediate priority over those in any other categories,
a. Pursuant to 45 C,F,R. s. 96.131, priority admission to pregnant women and women
with dependent children by Network Service Providers receiving SAPT Block Grant
funding;
b. Pursuant to 45 C,F.R. s. 96.126, compliance with interim services, for injection
drug users, by Network Service Providers receiving SAPT Block Grant funding and
treating injection drug users;
c. Priority for services to families with children that have been determined to require
substance abuse and mental health services by child protective investigators and
also meet the target populations in subsections (a) or (b), below, Such priority shall
be limited to individuals that are not enrolled in Medicaid or another insurance
program, or require services that are not paid by another payor source:
(1) Parents or caregivers in need of adult mental health services pursuant to s.
394.674(1)(a)2., F.S., based upon the emotional crisis experienced from the
potential removal of children; and
(2) Parents or caregivers in need of adult substance abuse services pursuant to
Exhibit A
Guidance/Care Center, Inc. Page 1 of 3 Contract No. ME225-7-27
South Plori .a Behinic ral Heallh Newark, lnc�
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) 155A7.
j. In the event of a Presidential Major Disaster Declaration, Crisis Counseling
Program (CCP) services shall be contracted for according to the terms and
conditions of any CCP grant award approved by representatives of the Federal
Emergency Management Agency (FEMA) and the Substance Abuse and Mental
Health Services Administration (SAMHSA),
3. Mental health crisis intervention and crisis stabilization facility services, and substance abuse
detoxification and addiction receiving facility services, shall be provided to all persons meeting
the criteria for admission, subject to the availability of beds and/or funds.
C. Client/Participant Determination
Determination of client eligibility is the responsibility of the network provider, The network
provider shall adhere to the eligibility requirements as specified in Exhibit F, State and Federal
Laws, Rules, and Regulations. The ME reserves the right to review the network provider's
determination of client eligibility and override the determination of the network provider. When
this occurs the network provider will immediately provide services to the consumer until such
time the consumer completes his/her treatment, voluntarily leaves the program, or the ME's
decision is overturned as a result of the dispute resolution.
2. In no circumstances shall an individual's county of residence be a factor that denies access to
service. Authorized services shall only be provided within the serviced area(s) outlined in
Attachment 1, Section A.2.c.(2), subject to the availability of funds.
3. In the event of a dispute regarding client eligibility and/or placement into the appropriate level of
care, the dispute shall not preclude the Network Provider from providing the provision of
services to eligible individuals until the dispute is resolved. The dispute resolution process is
described in Paragraph 42. of the Standard Contract.
4. Participant eligibility (Direct Prevention) and target population eligibility (Community Prevention)
shall also be based upon the community action plan or on the relevant epidemiology data.
D. Contract Limits
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
appropriation by the Legislature and the Contract between the ME and the DCF.
Exhibit A
Guidance/Care Center, Inc, Page 2 of 3 Contract No.. ME225-727
Suulh Horida 13cha,iural Ilcalth Netmork, Inc.
2. The network provider agrees that funds provided in this contract will not be used to serve persons
outside the target population(s) specified in the paragraph above. NOTE: Prevention funds
allocated to underage drinking programs and activities targeting eighteen (18) to twenty (20) year
old individuals may be taken from Adult Substance Abuse Prevention funds.
3. The provision of services required under this contract are limited to eligible residents, children
and adults receiving authorized services within the counties outlined in Attachment I, Section A.
2. c. (2) and limited by the availability of funds.
4. The network provider may not authorize or incur indebtedness on behalf of the ME or the
Department.
Exhibit A
Guidance/Care Center, Inc. Page 3 of 3 Contract No. ME225-7-27
South Haridaa Belansioral licaltla Ne!►raark, laic.
Exhibit B
Method of Payment
1 Payment Clauses
a. This is a fixed price (unit cost) contract, The unit prices are listed on Exhibit G, 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 5 502 409.00, subject to the availability of funds and satisfactory
performance of all terms by the Network Provider- Of the total Contract amount,, the ME
will be required to pay $4,585.341.00, subject to the delivery and billing for services. The
remaining amount of $917,068.00 represents "Uncompensated Units Reimbursement
Funds", which the ME, at its sole discretion and subject to the availability of funds, may
pay to the Network Provider, in whole or in part; or not at all, for Exemplary Performance
by the Network Provider, Exemplary Performance will be determined by the Network
Provider delivering and billing for services in excess of those units of service the ME will
be required to pay. The ME's obligation to pay under this Contract is contingent upon an
annual appropriation by the Legislature and the Contract between the ME and the DCF.
Any costs or services eligible to be paid for under any other contract or from any other
source are not eligible for payment under this Contract.
b. Aftercare, Intervention, Outpatient, and Recovery Support Services (Substance Abuse) are
eligible for special group rates. Group services shall be billed on the basis of a direct staff
hour, at 25° of the contract's established rate for the individual services for the same
covered service. Excluding Outpatient, total hourly reimbursement for group services shall
not exceed the charges for fifteen individuals per group. Group size limitations outlined in the
current Medicaid Handbook apply to Outpatient group services funded under this contract,
c. Pursuant to s. 394.76(3), Florida Statutes (F.S.), the provider agrees to provide local
matching funds in the amount of $987,516.00 as indicated in Exhibit H, Funding Detail and
Local Match Plan.
Should the Network Provider receive any funding from the 'Uncompensated Units
Reimbursement Funds", then the amount of Local Match Plan as it appears on Exhibit H,
Funding Detain, will automatically change, utilizing the following formula:
The additional match required on the uncompensated units = Uncompensated Substance Abuse
Services X 16.67% + Uncompensated Mental Health Services that is not exempt from local
match requirements X 33,33%-*
*The following MH services are exempt from the local match requirement
I. Deinstitutionalization Proiects
Case Management
Intensive Case Management
Residential Services 14V
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. ME225-7-27
South Huridaa €3chmioral 11caulih Xettsaurk, Rule,
d. In accordance with the provisions of s. 402,73(i); F-S,, and Rule 65-29.001, Florida
Administrative Code (F.A, C.), corrective action plans may be required for noncompliance,
nonperformance., or unacceptable performance under this contract. Penalties may be
imposed, to include contract termination in whole or in part, for failures to implement or to
make acceptable progress on such corrective action plans.
e. The ME shall reduce or withhold funds pursuant to Rule 65-29.001, F.A.C., if the Network
Provider fails to comply with the terms of the contract and/or fails to submit client reports
and/or data as required in DCF PAM 155-2„ Rule 65E-14, F.A,C, and by the due dates listed
on Exhibit C, Required Reports.
f. The ME's decision to reduce or withhold funds will be submitted to the Network Provider in
writing. The written notice will specify the manner in which the provider has failed to comply
with the terms of the contract, When; and if, compliance is achieved, the withheld funds will
be disbursed to the Network Provider,
g. if the Provider closes or suspends the provision of services funded by this contract, the
provider agrees to notify the ME in writing thirty (30) calendar days prior to their intent to
close; suspend or end service(s). If the provider fails to notify the ME the provider hereby
agrees not to request payment for services provided in prior months if the actual number of
services in the month for which payment is being requested is less than twenty-five percent
(25%) of the prorated amount of services by covered service as given on Exhibit G, Covered
Service Funding by OCA, or twenty-five percent (25%) of the prorated share of the amount
of funding as specified on Exhibit G, Covered Service Funding by OCA.
h. The ME in its sole discretion and subject to funding availability, may purchase from any
Network Provider prior to the end of the contract period any service units provided at any
time during the term of the contract.
2. Additional Release of Funds
At its sole discretion, the ME may approve the release of more than the monthly prorated amount
when the Network Provider submits a written request justifying the release of additional funds, if
funds are available and services have been provided.
3. Third Party Billing
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:
1. 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
65Em14.018 F.A.C.
iii. The Network Provider shall ensure that Medicaid funds are accounted for
separately from funds for this contract.
Exhibit B
Page 2 of 5
Guidance/Care Center; Inc. Contract No, ME225-7-27
S aulh Phirid a Behmiuraal liculth Nemork, Inc.
c. In no event shall Medicaid, any health insurance, another publically funded health
benefits assistance program, or the ME be billed for the same service provided to the
same individual on the same day.
d. Medicaid earnings cannot be used as local match.
e. The Network Provider shall ensure that Medicaid payments are accounted for in
compliance with federal regulations.
f. The Network Provider operating a residential treatment facility licensed as a crisis
stabilization unit, detoxification facility, short-term residential treatment facility, residential
treatment facility Levels 1 or 2, or therapeutic group home that is greater than 16 beds is
not permitted to bill or knowingly access Medicaid Fee For -Service programs for any
services for individuals eligible for Medicaid while in these facilities.
g. The Network Provider operating a children's residential treatment center of greater than
16 beds is not permitted to bill or knowingly access Medicaid Fee -For Service programs
for any services for individuals meeting the eligibility criteria for Medicaid in these facilities
except as permitted under the Medicaid State Inpatient Psychiatric Program Waiver.
h. The Network Provider shall assist individuals receiving services who need assistance and
who meet the eligibility criteria for Medicaid to make application including assistance with
medical documentation required in the disability determination process.
L The Network Provider agrees to assist individuals eligible for Medicaid covered by a
Medicaid capitated entity who need and request assistance to obtain covered mental
health services that the treating provider considers to be medically necessary, This
assistance shall include assisting clients in appealing a denial of services,
4. Payments from Medicaid Health Maintenance Organizations, Prepaid Mental Health Plans, or
Provider Services Networks.
Unless waived in Section D (Special Provisions) of this contract, the provider agrees that
payments from a health maintenance organization, prepaid mental health plan, or provider
services network will be considered to be "third party payer" contractual fees as defined in Rule
65E-14,001,F.A.C. Services which are covered by the sub-capitated contracts and provided to
persons covered by these contracts must not be billed to the department.
5. Temporary Assistance to Needy Families (TANF) Billing
a. The provider's attention is directed to its obligations under applicable parts of Part A or
Title IV of the Social Security Act and the provider agrees that TANF funds shall be
expended for TANF participants in accordance with Chapters 414, and 445, F.S. and the
Department's State Plan for Temporary Assistance for Needy Families, renewal October
1, 2011 — September 30, 2014, or the latest revision thereof. Department's State Plan for
Temporary Assistance for Needy Families can be obtained from the contract manager, or
can be found at the following web site.,
tt Lwww,.dcfstat ..ul ro ra s/access/cs - I n. df
b. The contract shall specify the unit cost rate for each covered service contracted for TANF
funding, which shall be the same rate as for non-TANF funding, but the contract shall not
specify the number of TANF units or the amount of TANF funding for individual covered
services.
6. Invoice Requirements
a. The rates negotiated with any Network Provider may not exceed the rate as specified in
in Exhibit G, Covered Service Funding by OCA.
Exhibit B
Page 3 of 5
Guidance/Care Center, Inc. Contract No. ME225-7-27
Smith ➢,lorid a Rchw� ioraal I Irallh New ork, Inn,
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:
d. If no services are due to be invoiced from the preceding month;. the Network Provider
shall submit a written document to the ME indicating this information within eight (8)
calendar days following the end of the month. The Network Provider shall request
payment monthly through submission of a properly completed invoice, per the
requirements of this contract, within eight (8) calendar days following the end of the
month for which payment is being requested.
e. If no services are due to be invoiced from the preceding month, the Network Provider
shall submit a written document to the ME indicating this information within eight (8)
calendar days following the end of the month. Should the Network Provider fail to submit
an invoice or written documentation if no services are due to be invoiced from the
preceding month, within thirty (30) calendar days following the end of the month, then the
ME at sole discretion can reallocate funds. If the Network Provider fails to submit an
invoice or written documentation for two (2) consecutive months within a twelve (12)
month period, the ME at sole discretion can terminate the contract.
f. The Network Provider's final invoice must reconcile actual service units provided during
the contract period with the amount paid by the ME. The provider shall submit their fiscal
year final invoice to the ME within twenty (20) days after the end of each state fiscal year
in the contract period.
g. The Network Provider shall ensure that the year-to-date number of units of service
reported on a request for payment or any associated worksheet shall reconcile with the
total number of units reported and accepted in KIS or other data system designated by
the ME.
h. Pursuant to 65E-14.021(7)(a)2., F.A.C., the Network Provider shall not invoice for any
Covered Services paid for under any other contract or from any other source. The
Network Provider must subtract all units which are billable to Medicaid, and all units for
SAMH client services paid from other sources, including Social Security, Medicare
payments, Food Stamps,, and funds eligible for local matching which include patient fees
from first, second, and third -party payers, from each monthly request for payment. For
services provided based on bed -day availability, the provider must report any payments
received from all other sources on the "Schedule of Bed -Day Availability" at the end of
the fiscal year and refund any overpayment.
t. Invoices shall be submitted in detail sufficient for a proper pre -audit and post -audit.
Exhibit B
Page 4 of 5
Guidance/Care Center, Inc. Contract No. ME225-7-27
South Florida 13ctsmiuraal Health NeMork, Inc.
7. Supporting Documentation
a. The Network Provider agrees to maintain and submit to the ME, if applicable, service
documentation for each service billed to the ME pursuant to this contract. The Network
Provider shalltrack all units billed to the ME by program and by Other Cost Accumulator
(OCA). Proper service documentation for each SAMH covered service is outlined in Rule
65E-14.021, F.A.C., Exhibit Y, TANF SAMH Guidelines and TANF SAMH Incidental
Expenditures for Housing Assistance, if applicable.
b. The provider shall maintain documentation to support all units billed to the ME and units
subtracted for SAMH client services on each monthly request for payment.
c. The Network Provider shall ensure that all services provided are entered into KIS,
PEPS, 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:
9. Funding Sweeps
The Network Provider agrees that at the sole discretion of the ME and at such time and upon
terms, conditions or criteria set by the ME, a review of the funding utilization rate or pattern of the
provider may be conducted by the ME. Based upon such review, if it is determined that the rate
of utilization may result in a lapse of funds, then in that event the ME may amend the Network
Provider's total amount of funding by reducing same in order to prevent the potential lapse.
Additionally, the Network Provider's funding may be reduced and reallocated within the system of
care, as determined by the ME and its sole discretion, in order to meet the changing needs of the
system of care. The ME will notify the Network Provider in writing of the reduction prior to
amending the total amount of funding. The ME's Lapse Policy is incorporated herein by
reference -
Exhibit B
Page 5 of 5
Guidance/Care Center, Inc. Contract No. ME225-7-27
South Florida Eirhatinral llralth ict%urk, Inc.
Exhibit C
Ree tired Reports
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- ilk
2. SFBHN staff member issuing CAP
External Quality Assurance Reviews
Within 10 calendar days from the day the
1. ME Contract Manager
Monitoring Reports Surveys and Corrective
report is received, or as requested by the .
1 (Electronic Submission
Actions, as applicable
Contract Manager
via E-mail)
2. D,rector of Contract Accountability
Memorandum of Understanding (MOU) with a
Federally Oualified Health Center (FQHC)
within 90 calendar days of the effective
or
date of the contract (for newly executed
Federally Qualified Health Centers are
required to submit policies and procedures that
OU°s),
Within 30 calendar days for renewed
1 (Electronic Submission
E Contract Manager
exPlain the access to primary care services to
MOU°s; Updates to P&P for FQHC°s shall
via E-mai)
the medically underserved behavioral health
be submitted within 30 calendar days of
client
adoption
Sliding Fee Scale [rellecting the uniform
schedule of discounts referenced in 65E.
Prior to contract execution
i (Electronic Submission
ME Contract Manager
14.018(4)J
via E-mail)
Final FY 2016-2017
(1) Projected Cost Center Operating and
Capital
Subma@ed annually prior to contract
(execution.
budget,
(2) Budget Narrative,
Submit updates within 30
Pd
calendar days of execution of an
1 IEie nic Submission
1. ME Contract Manager
{3) Network Providers Age Service
amendment to the contract affecting the
9
via E-mail)
2. VP of Finance
Capacity Report,
budget
(4) Cost Center Personnel Detail
Report
Program De5Cfi tlOnEAnnually,
P
(1) Organizational Profit
prior to tract execution.
tes within 30 calendar days of
1 (Electronic Submission
1° ME Contract Manager
(2) Service Activity Description
amendment
vra E- il)
2, VP of Behavioral Heath
Grievance Procedures
a) Clients (applicants or recipient of services)
Annually; prior to contract execution.
Submit updates within 30 calendar days of
1 (Electronic Submission
1, ME Contract Manager
b) Agency Staff
implementation
via E-mail)
2 VP of CQI
Affidavit Regarding Debarment
Annually prior to contract execution, or as
requested by the Contract Manager
1'
ME Contract Manager
Submit updates within 30 calendar days of
amendment or
No Wrong D Policy and Procedures
as requested by
1• ME Contract Manager
the contract manager and/or the QA/QI
1'
Risk It Compliance Manager
2. OA1OI Risk 8 Compliance Manager
Guidance/Care Center, Inc. Exhib;t C . Contract NoME225-7-27
Page 1 of 10
South Florida Behn hDral 11rallh Ndvt urL, Ina
Ex ibit C
Riatuired Reports
N\
� =bl
Within 24 hours of occurrence, in
accordance with CFOP 215.6 and
Incident Report
reportable incidents defined CFOP i80-4
Mandatory
Submission through IRAS Submission through IRAS
Reporting Requirements to the Office of
the Inspector General
11. Ayana Roberts.
Crisis Stabilization Unit, Substance Abuse
E-mad: aroberts@sfbhn.org
Detoxification, AddicWn Receiving Facility
Per Exhibit 0, Section A., and Per
Daily Tracker and Data Collection, as
Exhibit W2
I (Electronic Submission
2. Joanna Ca ell:
applicable, until a new reporting system is
via E-mail)
E-mail icardwell@n org
sMh
Implemented
By 11 DO ALM JES T I based an the
I
preceding days: midnight census
i3. Betty Hernandez.
E-mail bhemandez@sfbhn org
1. Ayana Roberts
E-mailr arobens@sfbhn org
Baker Act Funding for Crisis Stabilization
Per Exhibit W, by 11 -00 A.M. [E S T
2. Joanna Cardwell -
Unit/Short Term Residential Facility, Local
based on the preceding days' midnight
I (Electronic Submission
E-ma�j rardwalt@sfbhn org
Match Requirements as applicable
census
via E-mail)
3. Betty Hernandez:
E-mail bhernandez@sfbhn org
Per Exhibit o, Section B.
Da4y, Monthly. and Annual B. Data Reporting
Daily Reporting By 11:00 A.M JE S Tj
based 'midnight
on the preceding days
for Public Receiving Families - Crisis
census
Stabilization Units, Substance Abuse
Monthly Reporting: by the 4th of each
I (Electronic Submission
Detoxificalion and/or Addiction Receiving
month following the month of service
via E-ma 1)
Facilities, as applicable, until a new data
reloOrting system is implemented.
Annual Reporting: by July 4, 2017,or the
data as directed by the ME.
Data shall be submitted electronically,
weekly, by 12:00 Noon every Wednesday
Monthly Data Required by DCF PAM 155-2
Final monthly shall be submitted
electronically to the ME no later than the
Electronically
KIS, PBPS, or other data system
4th of each month fallaMrig the month of
designated by the ME or the Department
service
ADA Client Communication Assessment
Auxiliary Aid
Service Record Monthly Summary Report,
By the 4th business day following the
I (Electronic Submission
(Applicatife to agency's that employ fifteen (15)
reporting month
via E-mail)
of more employees
Confirmation E-mail to the ME Contract
Manager
Monthly, by the eighth (ft) calendar day
Monthly Service Invoice
after the month
1
ME Sr Accountant (Fiscal Department)
of service
Guidance/Care Center, Inc. Exhib,t C Contract No, ME225-7-27
Page 2 of 1 D
South Florida flehaviaml Health Nemork, Inc.
Exhibit C
Required Retorts
WIN �0 Xf W
Submitted with the monthly invoice, as
Invoice Review Supporting Documentation
appropriate and/or as requested by
AS requested by SFBHN staff
SFBHN staff
TANF SAMH Program Logs and Service Data,
Asper the contract and/or as requested by
. . . ........
if applicable
the contract manager
ME TANF Coordinator
By July 20 of each fiscal year and/or 20
Final! In,4oice
days
1
ME Sr Accountant (Fiscal Department)
after contract end date
Inventory Report
81112016
1 (Electronic Submission ME Contract Manager
via E-mail)
�Attestation of Network Providers Verification
Ithat all applicable employees and
subcontractors with access to ME and/or DCF
information systems have signed a DCF
BIU2016
I (Electronic Submission
via E-ma,(Q
ME Contract Manager
Security Agreement form CF 0114 , per the
Attachment I and Standard Contract
Emergency Preparedness Plan
811112016
1 (Electronic Submission
11. ME Contract Manager
via E-mail)
2, QA/QI Risk & Compliance Manager
Civil Rights Compliance Checklist (CF0946)
51112016
1 (Electronic Submission
'ME Con Manager
via E-mail)ract
-mail)
Civil Rights Certificate (CF707)
8l112016
I (Electronic Submission
ME Contract Manager
via E-mail)
Client Fund Letter
WU2016
1 (Electr . onic Submission
Contract Manager
PTmust
via E-mail)
I
. . . . . . . . . . . .............................
(Quality Assurance/Ouality Improvement Plan
814/20%
1 (Electronic Submission
7. ME Contract Manager
via E-mail)
2. CAJOI Risk & Compliance Manager
Action Plan (Integration of Behavioral Health
Services and Primary Care, TIC, CLC, CWI
8/3U2016
I (Electronic Submission
1. ME Contract Manager
Initiatives)
via E-mail)
2. GAJQI R:sk & Compliance Manager
July 5, 2016
(Period 04101/16 - 06130/16)
October 5, 2016
NVRA Voter Registration Agencies Quarterly
(Period; 07101/16 - 09/30/16)
Activities Report Form (DS-DE13l,affechve
January 5, 2017
1 (Electronic Submission
1. ME Voter Registration Activities
or latest revision thereof. it applicable
(Period, 10101116 - 12131j16) 1
via E-mail)
• Coordinator
April 5, 2017
2, ME Contract Manager
(Period. 01101117 - 03/31117)
July S, 2017
(Period- 04101,17- 06130A17)
Guidance/Care Center, Inc. Exhibit C Contract No. ME225-7-27
Page 3 of TO
South Fludda Helinflaral Ilralih Network, Inc.
Exhibit C
Required Reports
......
. ..... . . ..... .. . . . . . . . ............
October 31, 2016
(Period: 07101116 - 09130/16)
January 3l,2017
Quarterly Financial Statements (Balance Sheet
(Period: 101a1/16- 12131116)
1 (Electronic Submission
1. ME VP of Finance
,and Statement of Activity)
May 1, 2017
via E-mail)
(Period: 01101117 - 03131/17)
2. ME Contract Manager
July 31, 2017
(Period: 04101117 - 06/30/17)
October 31, 2016
(Period: 07/01116 - 09130116)
Attestation indicating the filing of Form 941 and
January 31, 2017
(Period: 10101/16 - 12131116)
payment of any taxes due to the IRS have
Fite 2017
I (Electronic Submission
ME Contract Manager
been paid.
(Pld.& 01101117-03131117)
via E-mail)
July 31, 2017
(Perio& 04/01117 - 06130117)
January 30. 2017
Continuous Quality Improvement Updates
(Period: 07101116 - 12131116)
1 (Electronic Submission
'L ME Contract Manager
July 30, 2017
via E-mail)
(Period: 01101117 - W30117)
2, OA101 Risk & Compliance Manager
Campletion of the annual self -assessment for
�the (allowing initiatives.
I Integration of Behavioral Health and Primary
Care (MeHAF)
1. ME Contract Manager
2. Trauma Informed Care (Fallot Assessment
�Tool)
31112017
12. QAJQI Risk & Compliance Manager
13 Cultural and Linguistic Competence Survey
as directed by the ME
Submission of the result of the folkowing self -
assessments
I Integration of Behavioral Health and Pnmary
Care (MeHAF)
1. ME Contract Manager
2 Trauma Informed Care (Fallot Assessment
41112017
Tool)
2. OAJOI Risk & Compliance Manager i
3. Cultural and Linguistic Competence Survey
as directed by the ME
Payer Class Data, per the Attachment 1, if
November 1, 2016 (data for the previous
I (Electronic Submission
applicable
Fiscal year)
via E-mail)
ME Contract Manager
Motivational Support Program (Sp)
Treatment Summary Form, if applicable
Per Exhtbit 1, Motivational Support
Program
Per Exhibit 1, Motivational Support Program
Provider Protoccits
Provider Protocols
Designation of Dispute Resolution Officer
Within 5 working days of contract
1 (Electronic Submission
execution
via E-il)
ma
'ME Contact Manager
Local Match Calculation Form - Florida
Department of Children and Families
Upon Request
1 (Electronic Submission
ME Contract Manager
via E-mail)
Guidance/Cere Center, lint. Exhibit C Contract No, ME225-7-27
Page 4 of 10
South Florida flehavioral Health %01%ork, Inc.
Exhibit C
Reaulred Retorts
Year -End Financial Reports. for Network Proi 9 Audits Per Attachment
Due 160 days after the end of the Network
Provider's fiSCal year or within 30 days of
Certification indicating that recipient expended
The recipient's receipt of the audit report,
whichever occurs first, directly to each of
less than S500,000 ($750 ODO in Federal
Awards for fiscal years beginning an or afteric
Submission the following unless otherwise required by 1. ME Contract Manager
1 (El ectro
December 26, 2014) in State Awards during
FloridaFStatutes The schedule sha.'l he
based on revenues and expenditures via E-mail) 12. VP of Finance
the fiscal year
recorded during the state's fiscal year
Year -End Financial R"rts for Network Providees h2LRequiring Audits Per Attachment 11 - Continued
Due 180 days after the end of the Network
Provider's fiscal year or within 30 days of
the recipient's receipt of the audit report,
whichever occurs first, directly to each of
Schedule of State Eam;ngs
the fioltowing unless otherwise required by I (Electronic Submission 1, ME Contract Manager
Florida Statutes The schedule shall be
via E-mail) 2. VP of Finance
based on revenues and expenditures
recorded during the state's fiscal year,
Due 180 days after the end of the Network
Provider's fiscal year or Within 30 days of
the recipient's receipt of the audit report
Projected Cost Center Operating and Capital
Whichever occurs first, directly to each of
Budget
iActual Expenses & Revenues Schedule
the following unless Otherwise required by 1 (Electronic Submission 1. ME Contract Manager
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 NeWrk
Provider's fiscal year or within 30 days of
the recipient's receipt of the audit report
whichever occurs first, directly to each of
Schedule of Bed -Day Availability Payments
the following unless otherwise required by I (Electronic Submission 1. ME Contract Manager
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 ISO days after the end of the Network
Provider's fiscal year or within 30 days of
the recipient's receipt of the audit report,
whichever occurs first, directly to each of
Agency Prepared Financial Statements
(Balance She
-et and Statement of Activity
the following unless otherwise required by 1. ME Contract Manager
1 (Electronic Submission
Florida Statutes The schedule shall be
based on revenues and expenditures via E-mail) 12. VP of Finance
recorded during the statals fiscal year,
Guidance/Care Center, Inc. Exhibit C Contract No. ME225-7-27
Page 5 of 10
South Florida lleha% ioral lien Ith Nelm or;„ 1,nc.
Exhibit C
Required Reocirts
,VV
Year -End Financial Reports for Network Provider's Requiring Audits PerAttachment 11
Due t80 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
I (Electronic Submission 1. ME Contract Manager
necessary schedules per Attachment 11 Florida Statutes The schedule shall be
via E-maili
based on revenues and expenditures
'2. VP of Finance
recorded during the states fiscal year
Year -End Financial Reports for Network Provider's Requiring Audits Per Attachment F1 - G;6 i�ued
Due 180 days after the end of the Network
Provider's figCel year or within 30 days of
the recipient's receipt of the audit report
Whichever occurs first, directly to each of
Schedule at State Earnings the following unless otherwise required by
Florida Statutes The schedule shall be
1 (Electronic Submission 1. ME Contract Manager
based an revenues and expenditures
via E-mal� 12. VP of Finance
recorded during the state's fiscal year
Due 180 days after the end of the Network
Provider's fiscal year or within 30 days of
the recipient's receipt of the audit report, 1
whichever occurs first, directly to each of I
Schedule of Related Party Transaction the following unless otherwise required by
1 (Electronic Submission 1, ME Contract Manager
Adjustments Florida Statutes The schedule shall be
via E-mail)
based on revenues and expenditures
2. VP of Finance
recorded during the states fiscal year
Due 180 days after the end of the Network
Provider's fiscal year or within 30 days of
recipient's receipt of the audit report,
Projected Cost Center Operating and Capitalthe
whichever occurs first, directly to each of
lBudget the following unless otherwise required by
I (Electronic Sutirnission 1. ME Contract Manager
Actual Expenses & Revenues Schedule Florida Statutes The schedule shall be
via E-awil)
based an revenues and expenditures
2. VP of Finance
recorded during the state's fiscal year,
Due ISO 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, diredty to each of
the f
Schedule of Bud Day Avwlability Payments ollowing unless otherwise required by
1. ME Contract Manager
I (Electronic Submission
Florida Statutes The schedule shall be
via E-mail)
based on revenues and expenditures
2. VP of Finance
recorded during the stales fiscal year.
GuidancelCare Center, Inc. Exhibit C Contract No. ME225-7-27
Page 6 of 10
South Flarithl Bellinflaral flealgh NclAurk, Inc,
Exhibit C
Reaulred Reports
t
2-111MV-2-111.
--- — -------- -
WaMist Reports
—_12-
Outpatient
Outpatient Wait List Report Form -
Monthly by the 51h for the preceding
Exhibit AK
month's services
I (Electrank, Submission
ME System of Care Staff
via E-mail)
Reports Required for Children's Mental Health Providers, as applicable
Children's Mental Health Quarterly clinical
Per Exhibit R, Child Welfare Quarterly
reports on all dependent children, if applicable Cl-ritcal Report
Copy in client chart
Children's Mental Health Quarterly clinical
Per Exhibit R, Child Welfare Quarterly
reports an all community children, if applicable
Clinical Report
1
Copy on client chart
Reports Required for Cilldrens Mental ealth Providers, as applicable - Contlnued
July 5, 2016
(Perio& 04101/16 - 06/30/16)
October 5, 2016
(Pe rood 0710 1 it 6 - 09130116)
Infant Mental Health -Narrative Milestones
January 5, 2017
1 (Electronic Submission
1. ME Contract Manager
Report On Client Outcomes it appl,,cable
(Period 10101/16-12131116)
via E-mail)
April 6, 2017
2. VP of Behavioral Health
(Pen01/01P17-03131/17)
July 6, 2017
(Period: 04101,17- 06130117)
Reports Required for Behavioral Health Network (BNet) Providers
1. ME Contract Manager
Alternative Services Provision Documentation
(Other than Pharmaceuticals)
Within 15 calendar days after and of
One (1) hard copy, or one
(1) faxed copy, or one (1)
J
2. ME BNal Coordinator
month
encrypted attachment to an
email to each recipient-
3. Children's Mental Health State Program
------------
Office
One (1) hard copy or one
1. ME Contract Manager
Alternative Services Provision Documentation
(Pharmaceuticals only)
Within 15 calendar days after end Of
(1) faxed copy, or one (1)
2. ME BNet Coordinator
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) taxed copy, or one (1)
2 ME BNet Coordinator
contract year (June 30)
encrypted attachment to an
email to each recipient-
3. Ch4dran's Menial Health State Program
Office
Reports R uIred for Adult Mental Health Providers, as spiplicable
PATH Annual Data Report to SAMHSA, if
applicable
Per PATH Grant Application Instructions
I (Electoxinlic Submission 'Per instruction on the PATH Grant
via E-mail)
Application
Drafts to be submitted to ME, Southern
PATH Annual Reports, if applicable
Region SAMH Program Office, and DCF
Central Off" in Tallahassee when
I (Electronic Submission
1. ME Contract Manager
requested (Generally drafts are due in
via E-mail)
Z ME System of Care Staff
April or May of each fiscal year)
Guidance/Care Center, Inc.
Exhibit C
Contract No, ME225-7-27
;�E
South Florida Bellm ioril Health Net"orli, Ine-
Exhibit C
Required Re its
'2W821 M,W
MEEMMIM=
Reports Required for Adult Mental Health Providers, as applicable - Continued
PATH Local Match Expenditure Report, if Monthly by the M of each month following
I (Electmilic; 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 Sth calendar day 1 (Efectmnic Submission
after the
I I ME Contract Manager
HMIS system) month I
via E-mail)
of service
2. ME System of Care Staff
Other PATH data reports as requested by the
ME I As requested by the ME As requested by the ME
ME Contract Manager & Requestor
Reports Required for Adult Mental Health Providers, as applicable Continued
October 6, 2016
(Period: 07/01/16 - 09130116)
January 5, 2017
Assisted Living Facility with a Limited Mental (Period: 10101116 - I 2131/16)
11. ME Contract Manager
Health LicenS& Client Ouarterly Report, per April 5, 2017 1(Electmnic Submission
Exhibit L (Period 01101/17-03131117) via E-mail)
2. ME Adult System of Care Manager
July 5, 2017
(Penodr 04101/17 - 06130117)
September 15, 2016�
(Period: 0741 j 16 - 08/3 1 f 16)
November 16, 2016
(Period: 09M Ill 6 - 10/31116)
January 15, 2017
SOAR Bi-Monthly Report per Exhibit AN (Period: 11101116 - 12/31;ifi)
Match 15 2017 1 (Electronic Submission
1. ME Adult System of Care Manager
(Period- 01101117 - 02/28117) via E-mal)
2. ME Peer Services Manager
May 15, 2017
(Period 03101/17 - 04/30117)
July 15, 2017
(Period. 0510 Ill 7 - 06/30117)
Report Required for Florida Assertive community Treatment-{FACT)
— OACT) Providers
.. . ...........
October 5, 2016
(Period. 07101/16 - 09130116)
January 5, 2017
FACT Enhancement Reconciliation Report (Peni:ld: I0IOt/16 - 12/31;16) 1 (Electronic Submission
April 5, 2017
1. ME Contract Manager
(Period 011/011M7-03131117) via E-mail)
2. ME Peer Services Manager
July 5, 2017
(Period: 04/011117 - 06/30117)
Vacant Position Report Monthly by the 7thofeach month following l{Electronic Submission
1. ME Contract Manager
the month of service via E-mail)
2. ME Peer Services Manager
October 5, 2016
(Period: 07101116 - 09/30/16)
January 5, 2017
(Period. 10101/16 - 12131116)
lAd-Hoc
1. ME Contract Manager
Ouartedy Report April 5, 2017 1 (Electronic Submission
(Period: 0110IA7, 03/31,1171 via E-ma,l)
2. ME Peer Services Manager
July 5, 2017
(Period: 04101117 - 06130117)
Report Required for Mlaml-Dade Forensic Alternative (MDFAC) Providers
Daily Census Report Daily I (Electronic Sub..illl
Regional Forensic Coordinator
via E-mal
..........
Guidance/Care Center, Inc. Exhibit C Contract No. ME225-7-27
Page aciflO
South Florida Helka%ioral licalih NeAnork, Inc.
Exhihit C
Required ReDorts.
211
Report Required for Miami -Dade Forensic Alternative (MDFAC) Providers - Continued
Monthly Program Quality Review Tracking
BY the 15th of each nrionth following the 1 (Flat nit 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 Cond tianal
1. ME Forensic Coordinator
Release if applicable
By 1 Sth of each month
2. Mental Health Administrator ofrw
Statewide Forensic Bed Census Report, W
applicable
Weekly (Every Thursday by 5 00 pm) T
ME Forensic Coordinator
J
Reports Required for Consumer -Driven Agencies
October 6, 2016
(Period: 07/01116 - Ogf30116)
January 5, 2017
lEnrollment/ Membershtp Report
(Period 10101116
April 5, 2017 - 12131116) 1 (Electronn Submission
ME Contract Manager
(Period 01101117 - 03131117) via E-mail)
July 5, 2017
(Period* 04101117 - OGMG/17)
Reports Required for Substance Abuse Services Providers
January 5, 2017
Report for HIV Early Intervention Services
(Period: 07101116 - 1213116)
SAPT Block Grant Set Aside Funded Services
Only
July 5, 2017 1
ME Contract Manager
(Period: 0 110 1/17 - 06-30-17)
----__------
AnnuW Report for Evidenced -based Infection
Drug User Outreach Services, SAPT Block
Grant Mandate Designated Providers Only
Upon Request 1
ME Contract Manager
Annual Report for Pregnant Women and
Women With Dependent Children SAPT Block
Grant Set Aside Funded Services Only
Upon Request iME
Contract Manager
Monthly Outcomes for Woman's Expansion
(Grant — Special Appropriation
Due monthly, by the 4th of every month I (Electronic Submission
1. ME IT Office
following the month of service via E-mail)
2. ME Contract Manager
Reports Required for Substance Abuse Prevention Services Providers
'Prevention Data Collection Log (This log is the
� I (Electronic Submission Of
,back up to the monthly prevention services
invoice) until an alternate data system is
Monthly no later than the 4th of each the Prevention Log to the
ME Contract Manager
implemented
month following the month of service Contract Manager)
October 15, 2016
{Period 07101116 - 09/30116)
January 15, 2017
(1) ME Contract Manage
Prevention Services Quarterly Reports (Fidelity
(Period: 10101116 - 12r31116) I (Electronic Submission
(2) ME Director of Prevention Services
to EBPs)
April 15, 2017 via E-mail)
(3) BSR1 - ME Contracted Prevention
(Period- 01101117 - 03131117)
Services Evaluation Provider
July 15, 2017
(Period. 04/01117 - 06/30117)
Refer t0 ScOpe of Work attachment to the Contract for a complete list of required reports, If prevention services are contracted through this contract,
Guidance/Care Center, Inc,
ExhibitC
Contract No. ME225-7-27
�M
South Florida 11tha%kind 11rahlo Nemork Inc.
Exhibit C
Required Reports
Reports Required Moffl.fly Family Intensive �T..t,,rlt �T.., 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 Al -A, 'ME Contract Manager
(2) Utilization Report Monthly by the 15th via E-mail)
(2) Utilization Report - Exhibit Al-B for the preceding month's services
Family Intensive Treatment Team Guarterly ct I o r311,2016
Expenditure Report (Netviod( Provider (Period: 07101116 - og130116)
Specific: Guidance! Care Center, Inc.) January 27,2016
(Period. 10101116 - 121311 6)
April 2a, 2017 1 (Electronic Submission
ME Contract Manager
via E-mail)
¢Pejiod: 01101117 - 03131117)
July 28, 2017
(Period: 04101117 - 06130117)
Reports Required for Motivational Support Program (MSP) Funded Services Providers
11. ME Contract Manager
-------------
MSP Tracker By 10th of each month following the month I (Electronic Submission -___ . .... .. ...
of service via E-mail) 2. ME 01 Data Analyst
13, Child Welfare Integration Coordinator
Reports Required for Provider's Funded for Special Projects by Florida Legislature
Return an investment - Per Exhibit AM
1. ME Contract Manager
Initial Projected Return an Investment 711012016 1 (Electronic Submission
via E-mail)
October 10, 2016
(Period: 07101116 - OW30116)
January 10, 2017 1. ME Contract Manager
Quartery Updates on Return on Investment (Period: 10101116 - i 213i11m)
Report - Per Exhibit AM April 10, 2017 1 (Electronic Submission
(Period: 01101117 via E-mail)
-0=11117)
July 10, 2017
(Period. 04101117- 06130117)
Note: When a regular due date for a required report falls on a weekend or a legal holiday, the due date is extended to the
next business day immediately following the weekend or holiday.
Guidance/Care Center, Inc. Exhibit C Contract No. ME225-7.27
Page tO of 10
South Florichi Behmioraal Health Ne6iork.Ine.
Exhibit D
Substance Abuse & Mental Health Required Performance Outcomes & Outputs
Provider Name:
Contract #:
Date:
Revision M
Guidancen•`Care Center, Inc.
NIE225-7-27
July I, 2016
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 environment1
86%
SA058
I 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 discharee 1
94%
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%
MM778
d.
Percent of children with emotional disturbance (ED) who live in a stable housing
environment
95%
MH779
e.
Percent of children with serious emotional disturbance (SED) who live in a stable
housing environment
93%
MH780
f7f
Percent of children at risk of emotional disturbance (ED) who live in a stable
housing environment 1
96%
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%
SAM C. Percent of children with substance abuse who live in a stable housing
environment at the time of dischargp 93%
Guidance/Care Center, Inc. Exhibit D
Page 1 of 2 Contract No. ME225-7-27
South Florida Belinfloral Health Nelwark. Inc.
Network Provider Compliance: ' Failure to meet the applicable standards established in Tables 1 and 2
shall be considered nonperformance pursuant to Standard Contract, Paragraph 36. Financial
Consequences for Network Provider's Failure to Perform.
Guidance/Care Center, Inc. Exhibit D
Page 2 of 2 Contract No. ME225-7-27
South t=loridaa Behav,ioraal IIra th NeWork, Iric-
Exhibit E
Monthly Payment Request
1. Exhibit E, Monthly Payment Request
This exhibit is incorporated by reference and available at following website:
Exhibit E
Guidance/Care Center, Inc.
1 of Contract No, ME225-7-27
South Fiori€Ise Beha%ioral fIvnitla Nctmork Inc. 11m.7MI.2016
Exhibit F
State and Federal Laws, Rules, and Regulations
The network provider and its subcontractors shall comply with all applicable state and federal laws,
rules and regulations, as amended from time to time, that affect the subject areas of the contract.
Authorities include but are not limited to the following:
1. Federal Authority
A. Mental Health
42 U.S. C. ss. 300x, et, seq.
B. Substance Abuse Prevention and Treatment Block Grant (SAPTBG)
42 U.S.C. ss. 300x=21 et. seq.
45 C.F.R. pt. 96
C. Restrictions on expenditures of SAPTBG
45 C.F.R. s. 96.135
D. Substance Abuse -Confidentiality
42 C.F.R., pt, 2
E. Health Insurance Portability and Accountability Act (HIPAA)
45 C.F.R. pt: 164
F. Social Security Income for the Aged, Blind and Disabled
20 C.F.R. pt. 416
G. Endorsement and Payment of Checks Drawn on the United States Treasury
31 C.F.R. pt. 240
H. Temporary Assistance to Needy Families (TANF)
42 U.S.C. ss. 601, et. seq.
45 C.F.R., pt. 260
1. Projects for Assistance in Transition from Homelessness (PATH)
42 U.S. C. s. 290cc-21 et. seq.
42 C.F.R., pt. 54
J. Americans with Disabilities Act of 1990
42 U.S. C. ss. 12101 et. seq.
K. Trafficking Victims Protection Act of 200
22 U.S.C. 7104
2 CFR Part 175
Exhibit F
Page I of 4
Guidance/Care Center, Inc. Contract No. ME225-7-27
II. FLORIDA STATUTES
A. Child Welfare and Community Based Care
Ch. 39, F.S.
Proceedings Relating to Children
Ch. 119, F.S.
Public Records
Ch. 402, F.S.
Health and Human Services; Miscellaneous Provisions
Ch. 435, F.S.
Employment Screening
Ch. 490, F.S.
Psychological Services
Ch. 491, F.S.
Clinical, Counseling and Psychotherapy Services
Ch. 1002, F.S.
Student and Parental Rights and Educational Choices
B. Substance Abuse and Mental Health Services
Ch. 381, F.S.
Public Health: General Provisions
Ch. 386, F.S.
Particular Conditions Affecting Public Health
Ch. 395, F.S.
Hospital Licensing and Regulation
Ch. 394, F.S.
Mental Health
Ch. 397, F.S.
Substance Abuse Services
Ch. 400, F.S.
Nursing Home and Related Health Care Facilities
Ch. 414, F.S.
Family Self Sufficiency
Ch. 435, F.S.
Employment Screening
Ch. 458, F.S.
Medical Practice
Ch. 459, F.S.
Osteopathic Medicine
Ch. 464, F.S.
Nursing
Ch. 465, F.S.
Pharmacy
Ch. 490, F.S.
Psychological Services
Ch. 491, F.S.
Clinical, Counseling and Psychotherapy Services
Ch. 499, F.S.
Florida Drug and Cosmetic Act
Ch. 553, F.S.
Building Construction Standards
Ch. 893, F.S.
Drug Abuse Prevention and Control
S. 409.906(8), F.S.
Optional Medicaid Services - Community Mental Health
Services
C. Developmental Disabilities
Ch. 393, F.S. Developmental Disabilities
D. Adult Protective Services
Ch. 415, F.S. Adult Protective Services
E. Forensics
Ch. 916, F.S.
Mentally Deficient and Mentally III Defendants
Ch. 985, F.S.
Juvenile Justice; Interstate Compact on Juveniles
S. 985.19, F.S.
Incompetency in Juvenile Delinquency Cases
S. 985.24, F.S.
Interstate Compact on Juveniles; Use of detention;
prohibitions
F. State Administrative Procedures and Services
Ch. 120, F.S. Administrative Procedures Act
Ch. 287, F.S. Procurement of Personal Property and Services
Ch. 815, F.S. Computer - Related Crimes
Exhibit F
Page 2 of 4
Guidance/Care Cenler.. Inc. Conlract No, ME225-7-27
Ch. 817, F.S. Fraudulent Practices
S. 112.061, F.S. Per diem and Travel Expenses of public officers, employees,
and authorized persons
S. 112.3185, F.S. Additional Standards for State Agency Employees
S. 215.422, F.S. Payments, Warrants & Invoices; Processing Time Limits
S. 216.181(16)(b), F.S. Advanced funds for Program Startup or Contracted Services
III. FLORIDA ADMINISTRATIVE CODE (RULES)
A. Child Welfare and Community Based Care
Ch. 65C-12, F.A.C. Emergency Shelter Care
Ch. 65C-13, F.A.C. Foster Care Licensing
Ch. 65C-14, F.A.C. Group Care
Ch. 65C-15, F.A.C. Child -Placing Agencies
B. Substance Abuse and Mental Health Services
Ch. 65D-30, F.A.C.
Substance Abuse Services Office
Ch. 65E-4, F.A.C.
Community Mental Health Regulation
Ch. 65E-5, F.A.C.
Mental Health Act Regulation
Ch. 65E-10, F.A.C.
Psychotic and Emotionally Disturbed Children- Purchase of
Residential Services Rules
Ch. 65E-11, F.A.C.
Behavioral Health Services
Ch. 65E-12, F.A.C.
Public Mental Health Crisis Stabilization Units and Short
Term Residential Treatment Programs
Ch. 65E-14, F.A.C.
Community Substance Abuse and Mental Health Services -
Financial Rules
Ch. 65E-20, F.A.C.
Forensic Client Services Act Regulation
CH. 65E-26, F.A.C.
Substance Abuse and Mental Health Priority Populations
and Services
C. Financial Penalties
Ch. 65-29, F.A.C. Penalties on Service Providers
IV. MISCELLANEOUS
A. Department of Children and Families Operating Procedures
CFOP 155-10/175-40 Services for Children with Mental Health and Any Other Co -
Occurring Substance Abuse or Developmental Disability
Treatment Needs in Out -of -Home Care Placements
CFOP 155-11 Title XXI Behavioral Health Network
CFOP 155-47 Processing Referrals From The Department Of Corrections
CFOP 215-6 Incident Reporting and Analysis System (IRAS)
B. Standards applicable to Cost Principles, Audits, Financial Assistance and Administrative
Requirements
S. 215.97, F.S. Florida Single Audit Act
S. 215.971, F.S. Agreements funded with federal or state assistance
Comptroller's Memorandum No. 03 (1999-2000)
Florida Single Audit Act Implementation
Guidance/Care Center, Inc.
Exhibit F
Page 3 of 4
Contract No, ME225-7-27
CFO's Memorandum No. 03 (2014 .2015)
Compliance Requirements for Agreements
2 CFR, Part 200 Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards, available at
https://federairegister.gov/a/2013-30465
2 CFR, Part 300.1 Adoption of 2 CFR Part 200
45 C.F.R., pt. 75 Uniform Administration Requirements, Cost Principles, and
Audit Requirements for HHS Awards
C. Data Collection and Reporting Requirements
S. 394.74(3)(e), F.S. Data Submission
S. 394.9082, F.S. Behavioral health managing entities
S. 397.321(3)(c), F.S. Data collection & dissemination system
S. 394.77, F.S. Uniform management information, accounting, and reporting
systems for providers
DCF PAM 155-2 Mental Health and Substance Abuse Measurement and Data
Guidance/Care Center, Inc,
Exhibit F
Page 4 of 4
Contract No. ME225-7-27
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EXHIBIT 11 - FUNDING DETAIL
Provider: Guidance/Care Center, Inc.
Contract N: ME225-7-27
Amendment N
ADULT MENTAL HEALTH
CHILDREN
MENTAL HEALTH
OCA DESCRIPTION
NENI OCA
OLD OCA
AMOUNT
OCA DESCRIPTION
NEM OCA OLD OCA
AMOUNT
Residential Services
M11001
KHJAOI
S
123,266
Residential Services
N111001
Nillcol
S
-
Non -Residential Services
M 11009
N1IIA09
S
-i
915,082
Non -Residential Services
MI 1009
Nil IC09
S
4 70,000
Crisis Services
N111018
N111AIS
1-7,600
Non -Residential Services - CR
MIIO09
MHC09
$
-
Crisis Services - Baker Act
N111018
MIIAIH
S
1.112903
Crisis Services
NIHM
NUIC18
$
15,677
Community Forensic Program
N111072
Nil IA72
S
160-000
Crisis Services - Baker Act
N111018
rVillcla
$
-
FACT Team
N111073
Nil IA73
$
-
Special Appropriation - IC Fl I
N111013N
MIICBN
S
Indigent Drug Program
N111076
XTIJA76
S
5,945
Beyond Empu%%rrmcnt Grant
N11101-A
Nil 1CFA
S
Proviso Allocation - Camillus
M11093
NIIIA93
$
-
Beyond Empo%vermcm Grant
Nitior-A
&1llCrA
Proviso Allocation - Citrus
M 11094
NIIIA94
S
-
FACES Wraparound Grant
NTIMMI)
N111CMD
$
PATI I Grant
Nil IOPG
MIlAPG
S
81250
FACES Wraparound Grant - CR
MHOMD
&HICNID
$
TANF
NUMB
hillATB
S
Carry ronvard
M1101 F
N111M,
Carry ronk-4rd
Nll10CF
NlIfACF
S
-
TOTAL ADULT MENTAL IJEALTII =
S
2418046
TOTAL CHILDRENMENTAL
HEALTH
ADULT SUBSTANCE ABUSE
Cl 11 LDREN SUBSTANCE ABUSE
OCA DESCRIPTION
NEW OCA
OLD OCA
AMOUNT
OCA DESCRIPTION
NEM OCA OLD OCA
AMOUNT
Residential Services
MS003
MSA03
S
Residential Services
NIS003
MSC03
$
Non -Residential Services
NISO I I
NtSA I 1
S347
0440
=-M-4
Non-Rcsidenual Services
NISO I I
MSC I I
Ddox Services
NIS021
NISA21
S
186,643 1
Deffix Scm ices
NIS021
NISC21
S
I IIV Services
NIS023
NISA23
III V Services
NIS023
NISC23
S
Prevention Services
NIS025
SISA25
S
Prevention Services
MS025
NISC25
S
235,606
Women's Sen Ices
NIS027
NISA27
S
Prevention Services - CR
NIS025
NtSC25
$
-
Pregnant Women Project
MS081
NISA81
Prevention Partnership Grant
NISOPP
NISCPP
S
Proviso Allocation - GCC
MS()91
MSA91
,190
TANF Services
NISOTB
NISCTB
$
TANF
NISOT13
NISAM
$
-
Proviso Allocation -I [ere's Help
MS903
$
Proviso Allocation - liere's Help
N1 S 903
I'S
Cam ror%%-ard
NISK F
NISCCF
S
Carty Fonvard
1%IS0CF
NISACF
l'OTAI.,kDUI,TSUBSTANCE ,kB[PSE-IzJ66L8 73
... ..
MOUIRING MATCH:
Chill
K4011"
19
P
MATCH S 1.622.793
TOTAL CHILDREN SURS`TANCE ABUSE _S 514,745
TOTAL ALL PROGRANJS�
S 4,585341
UNCOMPENSATED UNITS
S 917,068
TOTA L
TOTAL FUNDS REQUIRING NIATCII�
S 2.962348
LOCALMATCII REQUIRED -
S _287 16
NOTES
911115 S235,606 is added to CSA-MSC25 to allcocate the Prevention funding based on the ITN
$6,409 is reduced from Akill-hillAPG due to AO R reduction
11/23115 $17,600 is added to NlIIACF to fund a Peer position to ®lark at the CSU
'2/16116 S43.746 is added to VISA I I For additional services, $16639 is reduced from NISC I I and $34,445 from NISC25 due to projected lolands.
FY 2016-17 Adjustments apsn of
312116 S 17,600 allocation in the Nil lACF OCA is withdrawn, due to I -time only allocation
1-timeonly allocations on 2116/16 are revered
S 17,600 is added to Nil IA 18 to fund a Peer Spec Palist at the CSU
Guidance/Care Center, Inc. Exhibit If Contract No. ME225-7-27
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Exhibit I
Motivational Support Program MSP
Provider Protocols
POLICY:
It is the policy of South Florida Behavioral Health Network (SFBHN) to establish protocols for treatment
providers that receive referrals and/or provide services to consumers that have been identified as MSP
consumers. These protocols have been established to ensure that this high -risk, priority population
receives expedited services.
PROCEDURE:
In accordance to the SFBHN Contract; the items delineated below are the contractually required protocols
for any consumer that has been identified as an MSP referral and has been referred to an SFBHN
treatment provider,
SFBHN will be notified by the MSP if a provider is not complying within these established protocols.
1. PROGRAM SPECIFIC TERMS
a. CASE MANAGEMENT - Case management services consist of activities aimed at identifying
the recipient's needs, planning services, linking the service system with the person, coordinating
the various system components, monitoring service delivery, and evaluating the effect of the
services received.
b. CHILD WELFARE - Services provided directly or under contract with the Florida Department
of Children and Families' Family Safety Program Office.
c. DEPARTMENT - The Department of Children and Family Services, created pursuant to
Section 20.19, Florida Statues (F.S,),
d. FLORIDA SAFE FAMILIES NETWORK (FSFN) — A Department of Children and Families
automated data system utilized to track child welfare cases.
e. FULL CASE MANAGEMENT AGENCIES - full case management agencies under contract
with Our Kids of Miami-Dade/Monroe, Inc., that provide support to children and families to help
ensure the best possible outcomes for children and families who are involved in the child welfare
system in Miami -Dade County.
f. INCIDENTAL EXPENSES - This cost center provides for incidental expenses, such as
clothing, medical care, educational needs, developmental services, FACT Team housing
subsidies and pharmaceuticals (if not required by the RFP to be reimbursed through a separate
cost reimbursement contract), and other approved costs. All incidental expenses must have prior
written authorization by the ME's authorized staff member or be authorized in the contract.
g. INTENSIVE FAMILY PRESERVATION SERVICES: Agencies under contract with Our Kids of
Miami-Dade/Monroe, Inc. to provide intensive in home services intended to prevent high and
imminent risk families from entering the Dependency Court system while increasing the families'
level of functionality.
h. MOTIVATIONAL SUPPORT SPECIALISTS (MSS) — Are staff positions (Case Manager) that
provide ancillary support to the CBC Case Manager, perform linkage to the child welfare system
to engage and support involved child welfare families in appropriate behavioral health treatment
and recovery with a goal of improving both behavioral health treatment and child welfare
outcomes.
L MOTIVATIONAL SUPPORT SPECIALISTS SUPERVISOR —A master's level supervisor who
manages and oversees the Motivational Support Specialists.
Exhibit i
Guidance/Care Center, Inc. Page 9 of 4 Contract Na, ME225-7-27
South t°Itiridla l,tchmioral Il�ciittli N;em ark Inn,
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 Screenin :
a) The Motivational Support Specialist (MSS) conducts the ME approved screening tool for all
referrals received through the Department of Children and Families (DCF) Program Administrator
(PA) or Our Kids of Miami Dade/Monroe, Inc.
b) Should the initial screening determine that the consumer is in need of behavioral health services,
the MSS will make a referral to a treatment provider for a full assessment and linkage to services
as specified below.
Referrals:
a) The MSS will contact the treatment provider to request an appointment for an individual that has
been identified by the MSS as being in need of behavioral health services.
The MSS will submit the SFBHN Consent to Release Information and the MSP Referral
form as part of the referral packet.
b) The Provider must provide the MSS an appointment for intake within seven (7) business days of
the initial phone call. An appointment must be provided within this timeframe regardless of the
indigent consumer's ability to pay. Consumers will be financially assessed utilizing the sliding fee
scale as specified in SFBHN main contract with the network provider. For consumers with
insurance, referrals will be made directly to a provider who accepts that insurance.
Exhibit I
Guidance/Care Center., Inc:. Page 2 of 4 Contract No. ME225-7-27
S1 ilh Hurida Belia-vi 9ral Health Nehi rk, Inc..
Rev. 05/11/2014
i„ Should the consumer be a no-show at the appointment, the provider will notify the MSS
within 24 hours of the no-show-
ii, Should the consumer need services not available at the provider, the provider will ensure
linkage to recommended services and notify the MSS case manager.
Substance Abuse:
a) Assessment:
Prior to the referral) to the treatment provider„ the MSS will complete the ME approved screening
tool and a copy will be provided to the treatment provider at the time of referral, The MSP
consumer must have an ME approved assessment completed within 20 days of admission into
Outpatient SA Treatment. The completed assessment must be provided to the MSS within this
timeframe.. If the consumer is placed in Residential SA Treatment, the ME approved assessment
is due within 5 days of admission. Upon completion of the ME approved assessment tool
provider will provide a copy to the MSS,.
b) Drug Testing:
The initial drug test is conducted by the QCF Protective Investigator (PI) prior to the referral to the
MSP. Subsequent weekly random drug testing will be conducted by the treatment provider
commencing the date of admission, All testing will be observed by the same gender staff as the
client- At minimum,. all MSP consumers must be drug tested once a week during the first 2 weeks
of treatment. After the initial 2 weeks, random drug testing will occur by the provider based on
the consumer's progress in treatment and the results of those drug screening will be provided to
the MSS until the case has been closed, Should the consumer be court involved„ drug screenings
will be conducted at the intervals required by the courts.
When the consumer is discharged from the MSP, subsequent random drug screenings will be
conducted as specified in the consumer's individualized treatment plan.
Mental Health:
a) Assessment:
The MSP consumer must have a complete Bio-psychosocial assessment completed within 20
days of admission into Outpatient MH Treatment. If the consumer is placed in Residential MH
Treatment, the assessment is due within 5 days of admission. The completed assessment must
be provided to the MSS within these timeframes. Upon the implementation by the Managing
Entity of a network mental health assessment, the provider will use the identified assessment for
all MSP consumers.
Documentation:
a) Monthly treatment summaries will be submitted until such time as the case is closed with MSP,
b) The standardize MSP Treatment Summary Form will be utilized.
i. The form must be submitted at the required intervals as specified above.
ii. It must be completely filled out including: client demographic information,, diagnostic
information, progress in treatment, and urinalysis results (if applicable),.
iii. The form must be signed and dated by the treating clinician -
Exhibit I
Guidance/Care Center, Inc. Page 3 of 4 Contract No. ME225-7-27
Sfouth Hor•ida Behmiural Health Nctisark, Inn.
Rev,0511112014
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 Pls : Refer to the Motivational Support Program
Protocol (Miami Dade County and Monroe County) which are available by clicking at the following link
//s ..or / rovider/contracts/
Exhibit I
Guidance/Care Center, Inc. Page 4 of 4 Contract No. ME225-7-27
Smith I lurida Behatioral licalih Nemork, Inc.
Exhibit J
Motivational Support Pro ram
Treatment Summary Form
Initial 0
Weekly [I
Monthly 0
Agency:
Date:
Client Name: Social Security Number:
Axis 1:
Axis 11:
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 ME225-7-27
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Exhibit L
Assisted Livina Facilities with
Limited Mental Health License
Authority: s. 394,4574, F.S..
Network Providers that enter into a cooperative agreement with an Assisted Living Facility -Limited
Mental Health License (ALF-LMHL) that are also responsible for providing case management
services to mental health residents in the ALF-LMHL shall:
1) Ensure that the ALF-LMHL where the consumer is residing at, or referred to, maintains a current
Agency for Health Care Administration (AHCA) license for ALF-LMHL facilities. The Network Provider
shall maintain a copy of the AHCA ALF-LMHL facility license in each consumer file. Referrals to
unlicensed ALF-LMHL are unlawful and are subject to sanctions by AHCA. The ME shall monitor the
Network Provider's compliance with the terms and conditions of this exhibit.
2) Ensure that all mental health residents as defined in se 394.4574 (1) F.S. are assessed by a
psychiatrist; clinical psychologist, clinical social worker or psychiatric nurse or other mental health
professional I who is supervised by one of these professionals, to establish that all residents are
appropriate to reside in the ALF-LMHL. A copy of that documentation shall be provided to the ALF
administrator no later than 30 days following admission.
3) Ensure that case managers are assigned to all ALF-LMHL residents who meet criteria as a mental
health resident- If the resident declines case management, case managers must attempt to engage
the person for a period not less than 30 days and document efforts in the ALF records. If the mental
health resident continues to decline services, they must be encouraged to do so in writing; unless that
is also refused. Documentation of a resident's declination of case management services and stated
reason for declination must be maintained in case records at the ALF-LMHL.
4) Ensure that individuals living in ALF-LMHL and meeting the definition of a mental health resident
served by the Network Provider are offered mental health services needed, including but not limited
to case management, psychiatric medication treatment, access to drop -in centers, clubhouses and
other services where available.
5) Ensure that a cooperative agreement to provide mental health services, including case management
as required in s. 429.075 F.S, is developed between the Network Provider and administrator of the
ALF-LMHL.
6) Ensure that the cooperative agreement identifies, at a minimum: mental health services available;
contact information for both the ALF Administrator and mental health provider, including 24/7
emergency access information; transportation provision; and services and activities available at the
ALF-LMHL. The ALF-LMHL administrators must also be given contact information for the managing
entity, as appropriate. The cooperative agreement must contain a provision requiring the provider to
maintain a file for each ALF-LMHL client with copies of all required documentation.. All ALF-LMHL
client records must be available for production by the Network Provider for monitoring purposes
A sample of the ME ALF Client Record monitoring tool can be obtained at the following website:
h p //s hn.oro/ rdpress/ Q-cotet/uolads/ALF-Client- ecord-Tool xis
7) Ensure that the Cooperative Agreement is annually updated between the Network Provider and the
ALF-LMHL Administrator.
Exhibit L
Guidance/Care Center, Inc. Page 1 of 3 Contract No. ME225-7-27
Sioulb Hurida Behavioral 11calih Nemor°k, Inc.
H.
8) Ensure that an annual community living support plan; as defined in s. 429.02 F.S., is prepared by the
assigned case manager and the resident served, in consultation with the ALF-LMHL administrator of
the facility in face-to-face meetings; At a minimum; meetings will be held for initial plan development
and annual updates to the plan. More frequent meetings shall' be held as necessary to resolve
concerns expressed by the resident., case manager, or ALF-LMHL Administrator. The plan should be
individualized and should include information about support services and special needs.
9) The case manager shall assist the mental health resident in carrying out the activities identified in the
individuals community living support plan.
10) Each case manager shall keep a record of the date and time of any face-to-face interaction with the
resident and make the record available to the ME for inspection.
The record must be retained for at least two (2) years after the date of the most recent interaction.
11) Adequate and consistent monitoring and enforcement of community living support plans and
cooperative agreements are conducted by the resident's case manager.
12) Report all concerns related to health and safety violations to appropriate officials at the Agency for
Health Care Administration and the Department's Abuse Hotline at 1-800-962-2873.
Required Report
On a quarterly basis, by the dates and to the individuals identified in Exhibit C, Required Reports, the
Network Provider shall submit an ALF-LMHL Client Report the required format as shown in Table 1.
below- To complete the ALF-LMHL Client Report, the Network Provider is directed to select a sample
size of twenty (20%) percent of clients residing at Assisted Living Facilities with a Limited Mental
Health License and receiving targeted case management services from the Network Provider. The
ALF-LMHL Client Report shall be submitted in a secured, password protected, or encrypted format.
Left blank intentionally
Exhibit L
Guidance/Care Center, Inc. Page 2 of 3 Contract No ME225-7-27
I'll, lill lo�lll llMi�l I! - -
FM M, II M I■WIFIF I'll, Iill! �
South Florida FSchmicaraal Health Nehiork, Inn.
Exhibit N
Special Provisions
For Network Provider's Participating in the Indigent Drug Program
7/1/2016
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
I. Establish IDP administration procedures;
2. Provide written guidelines to the Managing Entities (ME) and IDP Provident; and
3. Establish Florida State Hospital's (IDPIFSH 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
agencies that participate in the IDP. An inventory is also known as a formulary.
4. Patient Assistance Program (PAP): Any program offered through private agencies or pharmaceutical
manufacturers designed to provide medication at low or no cost to uninsured individuals.
5. Psychiatric or Psychotropic Medication: Any drug prescribed with the primary intent to stabilize or
improve mood, mental status, behavioral symptomatology, or mental illness. The medications include but
are not limited to the following major categories:
a. Antipsychotics;
b. Antidepressants;
c. Anxiolytics;
d. Mood stabilizers; and
e. Cerebral or psychomolor stimulants.
f. Other medications commonly used may include, but are not limited to, beta blockers,
anticonvulsants, cognition enhancers, and opiate blockers.
6. Side Effect and Adverse Drug Reaction: Any effect other than the primary intended effect resulting from
medication treatment. Side effects may be negative, neutral, or positive for the patient. An adverse drug
reaction is an undesired or unexpected side effect, allergy, or toxicity that occurs with the administration of
medication. Adverse drug reactions can range from mild side effects to very severe reactions, including
death. Onset may be sudden, or it may take days to develop undesired or toxic reactions to medications.
Exhibit N
Guidance/Care Center, Inc. Page 1 of 3 Contract No ME225-7-27
South Horidca llcrasariorat llcmatth Netmork. fnr,
Section i11, IDP Network Providers will:
7/1/2016
1. Assess and enroll individuals in the IDP who meet the clinical and financial criteria established in ch.394,
F.S.
a. To meet the clinical criteria individuals:
i. Must be a member of at least one of the Department's priority populations; and
ii. Must not reside in a stale mental health treatment facility or an inpatient community unit.
III. To meet the financial eligibility criteria individuals:
iv. Must have a net family income that is at or below 150 percent of the Federal Poverty
income Guidelines, as published annually in the Federal Register;
V. Must lack third -party insurance or other psychotropic medications funding sources; and
vi. Must not participate in a program where other funding sources pay for psychotropic
medications. If individuals have third party insurance for psychotropic medications but
were temporarily denied benefits for these medications, they may receive IDP
medications until such time as eligibility is reestablished.
2. Provide information to individuals regarding adverse effects, side effects, possible allergic reactions, co-
occurring disorders, and instructions on what to do in case of an emergency;
3. Submit updated information to the IDP/FSH Warehouse and to the ME with the first medication order, and
ensure that the following information is updated as needed:
I. The providers' IDP contact information including name, e-mail, and phone number;
ii. The authorized person's name who approves the Supply Requisition (See Appendix 1);
and
Ili. 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:
t. Submit orders only as needed;
Ill. 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;
Ili. Fax or e-mail the completed, signed, and approved Supply Requisition directly to the
IDPIFSH Warehouse; and
iv. Pay line of credit surpluses to IDPIFSH 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 IDPIFSH Warehouse within 24 hours or email the
Issue Document with corrections; and
Exhibit N
Guidance/Care Center, Inc.. Page 2 of 3 Contract No, ME225-7-27
South Florida R hra mists Maatth Nemor°k, Inc, 7/1/2016
tti. Retain a copy of the Issue Document,
7. Ensure that IDP prescriptions meet the following conditions:
I. There cannot be more than two refills, and one prescription cannot cover more than a 90
day supply;
ii. Must be listed on the IDP Inventory; and
ill. Must be filled at an IDP pharmacy.
8. Actively participate in Palient 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://Hmedicaidbh,fmhi.usf,edu/,
11. Review and validate the IDPIFSH Warehouse monthly statements.
12. Address emergency situations, including but not limited to:
t. Order additional psychiatric medications from either the IDP/FSH Warehouse or a pharmacy of
their choice (for urgent needs); and
fi. 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:
L Complete the Supply Requisition. Under the remarks section of the requisition state that
overstocked medications are returned for credit and explain the reason for resuming the
medications;
ii. Mail medications in package(s) clearly marked as overstocked; and
iii. Only return unopened medications;
3. Submit a check to the IDPIFSH Warehouse accounting office to prepay orders to extend the line of credit. The
remaining line of credit cannot be carried over into the next fiscal year.
Exhibit N
Guidance/Care Center, Inc, Page 3 of 3 Contract No.. ME225-7.27
%oath Florida ➢3e aaOuraal Heallh '%eWaark, @n€a
Exhibit O
Crisis Stabilization Unit Substance Abuse Detoxification Addiction Receivincl Facility Daily
Tracker and Data Collection
A. The Crisis Stabilization Unit, Substance Abuse Detoxification services, Addiction Receiving
Facility Network Provider shall:
(1) Submit a daily Crisis Stabilization Unit (CSU) and Substance Abuse
Detoxification/Addiction Receiving Facility (Detox) census log to the individual(s)
identified In Exhibit C, Required Reports.
(2) The daily census log shall be submitted electronically by 11:00 A.M. [E.S.T.] based on the
preceding days' midnight census. The Daily CSU and/or Detox Tracker, as applicable,
must be submitted in the template created by the ME as found in Exhibit 0-1a, Daily
CSU Tracker ("Tracker") and in Exhibit O-lb, Daily SA Detox/Addiction Receiving
Facility Tracker ("Tracker"). The tracker must be submitted in a secured, password
protected, or encrypted format.
(3) The Network Provider is not authorized to alter Exhibits O-la nor Exhibit 0-1b . Any
changes to templates will render the report unusable and will subject the Network
Provider to financial consequences/penalties.
B. Data Reporting for Public Receiving Facilities - Crisis Stabilization Units, Substance Abuse
Detoxification and/or Addiction Receiving Facilities
To meet the requirements of s. 394.9082 (10), F.S., the Network Provider shall adhere to the
following CSU data reporting requirements:
(1) Report on a daily basis, by 11:00 A.M. (E.S.T.) based on the preceding day's midnight
census, the following:
(a) All admissions and discharges of clients receiving public receiving facility
services who qualify as indigent, as defined in s. 394.4787, F.S.; and
(b) Current active census of total licensed beds, the number of beds purchased by
the department, the number of clients qualifying as indigent occupying those
beds, the number of match beds, and the total number of unoccupied licensed
beds regardless of funding.
(2) Utilize the template provided in Exhibit 0-2b Crisis Stabilization Services Utilization
Data Collection Tracker and/or Exhibit 0-2c, Substance Abuse Detoxification/Addiction
Receiving Facility Services Utilization Data Collection Tracker to report the daily census
information required in section B. 1(a) and (b) above. The report shall be submitted to
the individuals listed in Exhibit C, Required Reports. The Network Provider shall submit
Exhibit O
Page 1 of 2
Guidance/Care Center., Inc. Contract No, ME225-7-27
` otilh Horidaa Reha vi€arral Heaaith NO%4ork, Ine.
C
the manual reports until notified in writing by the ME that the daily census information
is to be submitted into KIS.
The Network Provider is not authorized to alter Exhibit 0-2b nor Exhibit 0-2c. Any
changes to the template will render the report unusable and will subject the Network
Provider to financial consequences/penalties pursuant to Section 39., Financial Penalties
for Failure to Comply with Requirement for Corrective Action, of the Standard Contract.
(3) Submit data on a monthly basis, by the 4a' of each month following the month of
service into KIS, or other data reporting system designated by the ME, which aggregates
and reconciles the daily data submitted under section B. (1) (a) and (b) above
(4) Submit data, on an annual basis by July 4"' or other date as directed by the ME, into KIS,
or other data reporting system designated by the ME, which aggregates and reconciles
the monthly data as referenced in section B. (3) above.
(5) If the monthly or annual aggregate data submitted by the Network Provider are
inconsistent with the daily or annual data submitted under paragraph the Network
Provider shall make the necessary corrections to ensure accurate data.
Real-time Data Entry::
When required by the Prime Contract, state and/or federal rules, regulations, or policies, the
Network Provider shall submit to the ME real-time data in KIS Express, or other similar data
structure, for services purchased by this contract. The Network Provider shall submit the manual
data logs required by this Exhibit until such time that a new data system is implement. The
Network Provider agrees to implement the new data reporting system when notified and as
directed by the ME.
Exhibit 0
Page 2 of 2
Guidance/Care Center, Inc. Contract No. ME225-7-27
Ith Network, Inc. Exhibit 0-1a 7/01/2016
Daily Crisis Stabilization Unit Tracker
DAILY CSIJ TRACKER (PROVIDER NAME)
Exhibit 0-1a
Page I of 1
Contract No. ME225-7-27
Exhibit O-lb
GuidancelCare Center, Inc. Page 1 of 1 Contract No. ME225-7-27
Attachment: GCC—SAMH—FY1 7—SIGNED [Revision 1] (2231 : Guidance/Care Center)
South Florida Behavioral Health Network, Inc, Exhibit 0-1c
07/01/2016
Daily CSU/Detox/Addiction Receiving Facility Tracker Data Dictionary
FIELD NAME
DEFINITION
VALIDATION
DATE OF ADMISSION
This refers to the date that the consumer was admitted to the
There is a validation that ensures that the date falls between the
CSU/Detoxification/Addiction Receiving Facility.
dates of fiscal year 2016-2017. Therefore, the date entered must
be in the following format: MM/DD/YYYY and must fall between
07/01/2016 and 06/30/2017.
TIME OF ADMISSION
This refers to the time that the consumer was admitted to the
There is a validation that ensures that the time Is entered in the
CSU/Detoxification/Addiction Receiving Facility.
following format: HH:MM AM/PM.
DATE OF DISCHARGE
This refers to the date that the consumer was discharged from the
There is a validation that ensures that the date falls between the
CSU/Detoxification/Addiction Receiving Facility.
dates of fiscal year 2016-2017. Therefore, the date entered must
be in the following format: MM/DD/YYYY and must fall between
07/01/2016 and 06/30/2017.
TIME OF DISCHARGE
This refers to the time that the consumer was discharged from the
There is a validation that ensures that the time is entered in the
CSU/Detoxification/Addiction Receiving Facility.
following format: HH:MM AM/PM.
SSN
Please enter the consumer's Social Security Number (SSN). If the consumer
There is a validation that ensures that the correct SSN is entered
doesn't have an SSN, please follow the guidelines to establish a pseudo-SSN, as
on the spreadsheet. Please enter the SSN in the following format:
follows: ExampleNl:
123-45-7890
Jane M. Doe, DOB: 01/01/1980 (pseudo-SSN: JMD-01-0180)
Example #2: Jane Doe, DOB:01/01/1980 (pseudo-SSN: JXD-01-0180)
LAST NAME
Please enter the consumer's last name.
No validations
FIRST NAME
Please enter the consumer's first name.
No validations
FINANCIAL STATUS
Please enter the funding source for the CSU/DetoxifIca tion/Addiction Receiving
The validation will only allow you to choose one of the options in
Facility stay for this consumer. The drop -down list has the following options: 1.
the drop -down box that are listed.
Medicaid, 2. Managing Entity, S. Local Match Only, A. PTS, C. Medicaid HMO, D.
Medicare, E. Medicare HMO, F. Private Pay Health Insurance, G. Private Pay
HMO, t. Self -Pay. For more information on these specific funding sources, please
follow the link to the DCF document (look at pages 7-16 through 7-17):
htt: www.c1cf-state. f 1. us/Qrog rams samh ublica€ions c7v10. df
Guidance/Care Center, Inc. Exhibit O-1cPage I of 1
Contract No. ME225-7-27
I�i��'i';T�.Ttt[eT�.^��st�I■�'�rf.'�[e��I=1r�I:T�1ti'>�kTri[eT�ti"�Ti�;TI+�?'+rs -+ter
Smith I-lorida 11chmim-al 11calth Nemork, laic.
Exhibit 0-2a
Cr you . . .. .. ... ....
d V"I'd" tions
CONTRACTORID 1
CHAR(10) The format for contractor ID must be XX-XXXXXXX
(key)
Note: Contractor ID of the managing entity must be registered in ME
-'
contract look -up table
PROVIDERID 11
CHAR(10) The format for provider ID must be XX-XXXXXXX
(key)
Note: Provider ID of the must be registered in ME contract look -up
table
PROGTYPE 21
CHAR(1) The code for program type must be I for Adult Mental HeaFth (AMH)
(key)
or 3 for Children Mental Health (CMH)
Note: the code validation edits may change in the future to reflect
other program type codes, e.g., 2 for Adult Substance Abuse (ASA)
and 41for "Children Substance Abuse (CSA)
COVRDSVCS 22
CHAR(2) The code for covered service must be 03 for Crisis Stabilization
(key)
Services
The code for covered service must be 24 for Substance Abuse
Detoxification/Addiction Receiving Facility Services
Note: the validation edits may change in the future to reflect other
bed day covered services, e.g., Residential, Inpatient, Detox, etc.
FUND 24
CHAR(1) The code for DCF funded CSU beds is 2 for SAMH.'
(key)
The code for DCF funded Substance Abuse Detoxification/Addiction
Receiving Facility beds is 24 for SAMH
Note: The validation edits may change in the future to reflect other
funding sources, e.g,, Local Match Medicaid, Medicare, Private Pay,
Health Insurance, etc.
"-EENSUSDATE 25
CHAR(8) The format for census date is MYMMDO
(key)
Note: the daily census date covers the time period between 12:00 am
and 11:59 pm.
6CE ISEBED 33
CHAR (6) The format is six numeric digits (e.g., 999999) Must be right justified
(mandatory)
and padded with 0 as needed, e.g., 000500
Note: this is the total count of state licensed beds for this contractor,
provider, program type, and covered service regardless of the funding
I source.
"DS D CFBEDS 39
CHAR (6) The format is six numeric digits (e.g., 999999). Must be right justified
(mandatory}
and padded with 0 as needed, e.g., 000300
Guidance/Care Center, Inc. Exhibit 0-2a Contract No. ME225-7-27
Page 1 of 2
Smith Florida Behavioral 11ra lta NetmDrk, Inn.
Exhibit 0-2a
t .l �t����������������� '°�� ' '. � ,. � � ��,'•.� �
�� � `fit"% '��iit �, � =t � �� � �
n'�` ,,
i Crisis StabfUzatoon 5ervice�Up lzation CSSU File Layout
Edrts and 1lalfda"tIons'
Posatfon4 '� 7ype�5tze
141
(�
Note: this is the total count of DCF funded beds for this contractor,
provider, program type, covered service, and fund source.
DCFOCCUPIED 45 CHAR (6)
The format is six numeric digits (e,g., 999999). Must be right justified
(mandatory)
and padded with 0 as needed, e.g., 000250
Note: this is the total count of DCF funded beds that are occupied for
this contractor, provider, program type, covered service, and funding
_.
source.
NONDCFOCCUPIED 51 CHAR (6)
The format is six numeric digits (e.g., 999999). Must be right justified
and padded with 0 as needed, e.g., 000100
Note: this is total count of non-DCF-funded beds that are occupied for
this contractor, provider, program type, covered service,
regardless of the funding source.
BEGCENSUS 57 CHAR (6)
The format is six numeric digits (e.g., 999999). Must be right justified
(mandatory)
and padded with 0 as needed, e.g., 000200
Note: this is the distinct count of indigent clients, who were currently
active and were admitted prior to the date of the census for this
contractor, provider, program type, covered service, and funding
source.
NEWADMIS 63 CHAR(6)
The format is six numeric digits (e.g., 999999). Must be right justified
(mandatory)
and padded with 0 as needed, e.g., 000100
Note: this is the distinct count of indigent clients, who were currently
active and were admitted on the date of the census for this
contractor, provider, program type, covered service, and funding
source.
DISCHARGES 69 CHAR (6)
The format is six numeric digits (e.g., 9-99999). Must be right justified
(mandatory)
and padded with 0 as needed, e.g., 000050
Note: this is the distinct count of indigent clients, who were
discharged on the date of the census for this contractor, provider,
program type, covered service, and funding source.
TRANSTYPE 75 CHAR(1)
This field specify the transaction type with the following code values:
A = Add New Record® C = Change or Replace Existing Record; and D =
Delete Existing Record.
Guidance/Care Center, Inc. Exhibit 0-2a Contract No, ME225-7-27
Page 2 of 2
Wlbft�2b
D04 C09-1&. T,.kcv
GuidancetCare Center, Inc- Exhibit 0-2b-c Contract No. ME225-7-27
Paqe 1 of 2
MODEM
Guidance/Care Center, Inc. Exhibit 0-2b-c Contract No. ME225-7-27
Paqe 2 of 2
South flurWat Kehmioral Iltialth Ne3itork, Inc.
Rev. 07/01/2011
Exhibit
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-MC1C - Florida Department of Law Enforcement -Missing Children's Information Center.
d. Family Services Counselor � a professional position responsible for case management for
children placements. The term includes Department of Children and Families staff and staff
working for an agency named as a designee.
e. Missing Child - a person who is under the age of 18 years; whose location has not been
determined; is currently placed in an out -of -home care setting; court order in -home placement; or
is the subject of an active abuse investigation in which the child has been sheltered, would have
been sheltered if their location had become known, or who was in the physical custody of the
department or a network provider when they went missing; and who has been or will be reported
as missing to a law enforcement agency.
2. Reporting Missing Children
a. The network provider agrees to immediately notify the family services counselor(s), their
supervisor, and/or the CBC Lead agency, and the legal guardian to ensure that they are fully
aware of the circumstances involving a missing child.
b. The network provider shall ensure and document that the family services counselor(s), their
supervisor, and/or the CBC Lead agency have assumed responsibility for taking all required steps
to recover the missing child and are fully engaged.
c. The network provider agrees to instruct caregivers, including relative and non -relative caregivers,
and all other staff that might be required to report a child as missing to local law enforcement to
immediately undertake the following activities, as applicable, and document all actions and
activities related to any efforts made to report and/or locate any child who is determined to be
missing from their care or supervision:
d. If exigent circumstances exist, the caregiver, family services counselor, or until the family services
counselor is engaged, the network provider employee, who has identified that a child is missing
from their care or supervision shall immediately call local law enforcement as soon as a
determination has been made that a child is missing and they shall request that the responding
office:
Exhibit Q
Guidance/Care Center, Inc. Page 1 of 3 Contracl No. ME225-7-27
South Vlorida tichasi€wral Ilcalth °1iemork, Ine.
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 wiff immediately seek assistance from the local area Community Based Care (CBC) Child
Location Specialist or the Department of Children and Families Regional Criminal Justice
Services Coordinator on resolving any issue related to reporting the child as missing to local
law enforcement.
(6) If it is a caregiver who has reported the child as missing to local law enforcement or
attempted to report a child as missing to local law enforcement, they shall immediately notify
the child's family services counselor or emergency on -call staff and provide them with the
following information:
(a) The law enforcement agency name that the child was reported as missing to or
attempted to be reported as missing to;
(b) The law enforcement missing child case number if one was issued by local law
enforcement;
(c) A copy of the law enforcement report when one is made available;
(d) Detailed information on the child's overall state of mind and behavior prior to the
child going missing;
(e) Detailed description of what the child was last seen wearing;
(f) Detailed information on possible locations that the child might be going to; and
(g) Detailed information on any individuals that the child might be traveling with.
e. If exigent circumstances do not exist, the caregiver, family services counselor, or other network
provider staff will within the first four (4) hours of learning that a child might be missing check to
see what,; if any, of the child's personal belongings are missing or if the child left a note; and,., the
caregiver, family services counselor, or other staff (if the family services counselor is not yet
engaged), will:
(1) Contact the following persons as appropriate to ascertain if the child has been seen, or
has given any indications that may explain the child's missing status:
(a) School/child's teachers and school resource officer;
(b) The child's relatives/parents„ both local and non -local, if appropriate, and the
caregiver has the means for such contact;
(c) Any friends or places that the child generally frequents, the local runaway shelter, if
there is one in the community; and,
Exhibit Q
Guidance/Care Center; Inc. Page 2 of 3 Contract No. ME225-7-27
Sunih Hiprida 11rhmirprO Health Nemm-k, laic. Rev. 07/01/2011
(d) The child's employer, if applicable..
(2) Write down any information gathered that might help locate the child:
(3) Provide telephone/beeper numbers and ask for the individuals above to call back and
share information if they have further information or see the child-
f. If at any time during the initial four (4) hour search for the child. if the caregiver, family services
counselor, or any other network provider employee (if the family services counselor is not yet
engaged), becomes concerned about the immediate safety and well-being of the child„ or the
child's location remains unknown after four (4) hours from the time that the caregiver, family
services counselor, or network provider employee learned that the location of the child was
unknown,, they shall immediately call local law enforcement and they shall follow the steps
outlined in Section 2. above°
g. If at any time., the child is located or returns to the caregivers home after law enforcement has
been notified of the missing child case, all law enforcement agencies and other agencies that
were notified of the missing child episode must be contacted immediately by the caregiver, family
services counselor;, or other network provider employee who made the report; If at any time new
information is obtained on a possible location of the missing child,, the caregiver, family services
counselor,or any other employee of the network provider shall immediately contact all law
enforcement agencies and other agencies that were notified of the missing child episode as to the
possible location of the child: If the Family Services Counselor has been engaged„ the network
provider shall also inform them and the legal guardian of the new information once law
enforcement has been notified.
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. ME225-7-27
South Hurid:a fichaviinraal licaalth Na;mork, Inc.
Exhibit R
Child Welfare Quarterly Clinical Report
tt�r>!lC4L
r �
I. The network provider shall complete a quarterly progress report, as shown in Section It. 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.
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#: Cel I#:
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 l:
Axis II:
Axis I[[:
Axis IV:
CGAS:
PsychotropicMedications: YIN If yes: Name of Psychiatrist:
Was Medication treatment Plan completed? YIN If yes, date of court approval:
Current medication and dosage:
Previous medication, if applicable:
Rational for current medication:
Date that child started taking the medication::
Child's Treatment Summary/Therapeutic Recommendations:
Therapist Signature
Supervisor Signature
Exhibit R
Guidance/Care Center, Inc- Page 1 of 1 Contract No. ME225-7-27
South ! laarida tichmOurid llcaalth \ctaeasrk, Inc.
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 andlor 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.
1. The Network Provider will facilitate and coordinate the provision of mental health
treatment, competency restoration training, residential care or housing with supervision,
Exhibit V
Guidance/Care Center, Inc, Page 1 of 3 Contract No, ME225-7-27
South Horialaa Reh¢avioral Hea tla Nehiaarla, liar°°
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. ME225-7-27
aorrth Horidaa Behabior°arl Iicaalth Xehr aar]k, Inn.
(k) Statewide Community Forensic Residential Services
1. 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 jo Exhibit C,
Required Reports; and to the individuals identified..
ii. Passageway Residence of Dade County, Inc,: The Network Provider agrees make
available fourteen (14) residential level 2 beds for eligible consumers on conditional
release from other circuits in need of forensic mental health services placed by the ME,
Statewide admission to Passageway Residence of Dade County, Inc. is for individuals
committed to the Florida Department of Children and Families„ in accordance with the
provisions of Florida Statutes Chapter 916, Forensic Services Act and released pursuant
to FRCrP 3.219(b), 3,217(b) and F,S. 916,1T It is agreed that during the term of this
agreement these beds shall not be used for any other purpose. The Network Provider
agrees that the ME's decision for placement is final and binding on all parties, The
Network Providers hall submit weekly census reports by the dates and dimes specified in
Exhibit C, Required Reports, and to the individuals identified.
iii. Ps chosocial Rehabilitation Center Inc. dlbla Fellowship House'. The Network
Provider agrees to make available four (4) residential level 2 beds for eligible consumers
on conditional release from other circuits in need of forensic mental health services
placed by the ME pursuant to FRCrP 3,219(b), 3.217(b) and F,.S, 916,17. It is agreed that
during the term of this agreement, these beds shall not be used for any other purpose,
The Network Provider agrees that the ME's decision for placement is final and binding on
all parties. The Network Provider shall submit weekly census reports by the dates and
times specified in Exhibit C, Required Reports, and to the individuals identified.
Exhibit V
Guidance/Care Center, Inc. Page 3 of 3 Contract No. ME225-7-27
South Horida tichwOural Width Nemork, [tic. 7.1.2016
Exhibit X
Special Provisions for
Pro ects for Assistance in Transition from Homelessness(PATH) Services
L The Network Provider shall:
(a) Submit an annual PATH application to the Mental Health Program Office as
requested;
(b) Provide support services for individuals who have a serious mental illness and/or
substance abuse and are homeless or at imminent risk of becoming homeless;
(c) Implement services and provide deliverables as set forth and described in each
approved and signed Local Intended Use Application which is a requirement of the
PATH grant application;
(d) Submit data reports to the ME upon request;
(e) Submit Annual Data Report to SAMHSA;
(f) Submit the Annual reapplication for the PATH Grant.
(g) Assure that there is a process in place which allows for information to be provided to
ME upon request and multiple staff can access all PATH related information and data
as requested-
(h) Identify, at a minimum, two (2) staff responsible for the PATH Program -
The Network Provider shall notify the ME's contract manager, in writing within (10)
calendar days of staffing changes regarding the positions
III. Local match requirements:
(a) Eligible PATH local match funds must be expended in the provision of PATH eligible
services to PATH eligible persons. The expenditures must match the types of
services outlined in the Local Intended Use Plan. The formula to be followed is cited
in Title V, Part C, Section 524 of the Public Health Services Act (42 U.S.C. 290cc-21
et. seq).
(b) The Network Provider will submit a monthly local match expenditure report
demonstrating how the agency is meeting its PATH local match obligations. The
expenditure report shall be submitted along with the monthly invoice which is due by
the 8th of each month following the month of services. The expenditure report shall
identify, by funding source, the expenditures incurred on PATH eligible services -
III. Monthly Reporting Requirements:
By the 51" of each month following the month of services, the Network Provider will submit to the
individuals identified in Exhibit C, Required Reports, a monthly report containing the
information submitted into the Homeless Management Information System (HMIS): and any
other report(s) requested by the ME staff,
Exhibit X
Guidance/Care Center, tncm Page 1 of 7 Contract No. ME225-7-27
%fjuth Florida Behaarloral Flinifth Nchiork, tree.
Exhibit AA
Motivational Support Specialists
L 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:
The Network Provider also agrees to agrees to collaborate with the ME and the Department in
executing the action steps identified in the Southern Region SAMH Integration with Child Welfare
plan, herein incorporated by reference.
1. PURPOSE
Motivational Support Specialist (MSS) are intended to reduce the incidence of child abuse and
neglect resulting from parent(s)' or caregiver(s)' behavioral health condition and to improve
outcomes for the families involved in the child welfare system.
2. AUTHORITY
The Prime Contract between the ME and the Department provides the ME with the authority to
contract for these services.
3. PROGRAM SPECIFIC TERMS
a. CASE MANAGEMENT - Case management services consist of activities aimed at identifying
the recipient's needs, planning services, linking the service system with the person; coordinating
the various system components, monitoring service delivery, and evaluating the effect of the
services received.
b. CHILD WELFARE - Services provided directly or under contract with the Florida Department
of Children and Families' Family Safety Program Office.
c. DEPARTMENT - The Department of Children and Family Services, created pursuant to
Section 20,19, Florida Statues (F.S.).
d. FLORIDA SAFE FAMILIES NETWORK (FSFN) — A Department of Children and Families
automated data system utilized to track child welfare cases.
e. FULL CASE MANAGEMENT AGENCIES - full case management agencies under contract
with Our Kids of Miami-DadelMonroe, Inc., that provide support to children and families to help
ensure the best possible outcomes for children and families who are involved in the child welfare
system in Miami -Dade County,
f. INCIDENTAL EXPENSES - This cost center provides for incidental expenses, such as
clothing, medical care, educational needs, developmental services, FACT Team housing
subsidies and pharmaceuticals (if not required by the RFP to be reimbursed through a separate
cost reimbursement contract), and other approved costs. All incidental expenses must have prior
written authorization by the ME's authorized staff member or be authorized in the contract.
g. INTENSIVE FAMILY PRESERVATION SERVICES: Agencies under contract with Our Kids of
Miami-Dade/Monroe, Inc. to provide intensive in home services intended to prevent high and
imminent risk families from entering the Dependency Court system while increasing the families'
level of functionality,
Exhibit AA
Guidance/Care Center, Inc, Page 1 of 10 Contract No. ME225-7-27
Hsu lh Horida Rch'116iaarsal ticnllta Nelm0c, Inn.
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 397.4161, F.S. Individuals who are certified are
permitted to serve in the capacity of a qualified professional, but only within the scope of their
certification.
m. SCREENING A process involving a brief review to determine the person's appropriateness
and eligibility for behavioral health services and the possible level of service.
n. SUMMARY - A written statement summarizing the results of the screening relative to the
perceived condition of the client and a further statement of possible needs based on the client's
condition to include the results of a urinalysis, when applicable, as specified in the Motivational
Support Program Protocols, incorporated by reference herein.
4. GEOGRAPHIC AREA & LOCATION
a. Services will be provided in Monroe County at the Network Provider's site andlor, or in the
field (i.e. client's home, community service center, etc.)
b. MSS services should be located in a place where they will be easily available and accessible
to child welfare personnel. MSS locations, where client records are maintained, must be licensed
for Intervention: General Intervention and Intervention: Case Management as required by Rule
65D-30, F.A.C.
5. SERVICES & TIMES
MSS's do not provide direct treatment service but shall provide behavioral health assessment
(screening), case management, outreach, and utilize incidental expenses as appropriate and
negotiated with the ME. Services will be provided, at a minimum, Monday through Friday, with
flexible hours to meet the needs of clients.
6. PROFESSIONAL QUALIFICATIONS
a. This contract provides for two 2 staff, as per the approved operating budget, herein
incorporated by reference,
b. Changes to the staffing pattern must be prior approved by the ME,
Exhibit AA
Guidance/Care Center, Inc, Page 2 of 10 Contract No, ME225-7-27
South Hurida Rcha&iaorasl llcalih Ncm ork, Inc.
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 6513-30, F.A.C.
7. CLIENT ELIGIBILITY
Services may be provided to parent(s)Icaregiver(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 n'sk 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)'J'caregiver(s)' family membersi.
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.
B. CASELOAD
Each MSS shall maintain a caseload with a maximum of forty (40) families. A family includes all
members of the family who are in need of behavioral health services. Caseload size shall be
based on the severity, case management needs, and resources available to support the MSS.
Once the MSS case load has reached capacity, the referrals shall continue to be screened and
referred to an appropriate treatment provider.
9. SCREENING AND REFERRAL OF CLIENT TO SERVICES
a. Each MSS shall maintain a directory of treatment resources, eligibility criteria, and referral
procedures for available prevention and treatment resources in each community. The MSS will
establish and maintain a working relationship with Our Kids of Miami-Dade/Monroe Inc.,
(Community Based Care Lead Agency or "CBC"), within the community and Community Based
Care Intensive Family Preservation Provider.
b. The MSS will maintain an open line of communication with all relevant stakeholders (CPI,
CSC 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 Conlract No, ME225-7-27
South Horida Be miaarasl lieaalth Nemork, Inc,
information. The MSS will need to respond to and administer a urinalysis to all 'urgent" cases
within 24 hours of receipt of referral from the CPI Program Administrator.. The MSS will also
administer a urinalysis to all unsafe and conditionally safe cases within the time frame detailed in
the Motivational Support Program Protocol, The Department is in the process of updating and
renaming the `Safety Methodology" protocol and will be renamed the Florida's "Practice Model" -
Once the Practice Model is fully implemented, there will be no "Conditional Safe" cases and MSS
will only serve "Unsafe cases": It is the Network Provider's responsibility to be aware of the
changes and follow the guidelines as directed by the Department and/or the ME
e. The MSS will ensure that screening and linkage to behavioral health services are completed
within the required time frames as described in the approved Motivational Support Program
Protocols„ incorporated by reference herein:.
f. A brief description of the duties of the MSP Screening processes are below, however., the
Network Provider is referred to the approved Motivational Support Program Protocols;
incorporated by reference herein, for a detailed description of the screening and referral process.
A. The MSS, upon receipt of referral, will secure an SFBHN Consent to Release Information
from the consumer and will attach this consent as part of the referral packet to the
behavioral health provider. If the consumer refuses to sign the Consent to Release
Information to MSS, then FSFN will be updated to indicate such.
B. If the case is found not to have any behavioral indicators„ MSS wilt' enter a SAMH note in
FSFN indicating the result of the assessment and upload the ME approved screening
tool. The progress should be rated as "adequate",
C. The MSS will utilize the ME approved screening tool as the screening tool which will
determine the need for behavioral health services for all referrals. The MSS will
determine if there has been an ME approved screening tool completed within the
previous 90 days and ascertain if another ME approved screening tool is necessary.
D. The MSS will ensure that an intake appointment is made within seven (7) business days
to a behavioral health treatment provider for a full assessment and linkage to
recommended treatment services when the screening identifies behavioral health
indicators.
E. For SFBHN Funded Consumers, the MSS will:
I. Generate a referral in the SFBHN data system for consumers funded through the
Department.
ii. Upload the ME approved screening tool into FSFN and to the data system within
three (3) business days of its completion.
iii. Document the recommendations in FSFN that are captured in the ME approved
screening tool.
Iv. Submit a referral to a behavioral health treatment provider for assessment and
linkage to treatment services, through the SFBHN data system.
V. Ensure that an initial appointment for intake takes place within seven (7)
business days of the receipt of referral from MSS, regardless of the consumer's
ability to pay,
vi. Ensure that the consumer was financially assessed utilizing the sliding fee scale
in accordance with the provisions of Rule 65E-14.018, F.A.C.
Exhibit AA
Guidance/Care Center, Inc. Page 4 of 10 Contract No. ME225-7-27
Suad h Horid a ttcluiviorill licaltij Nelisurk, Inc.
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
(3) business days of the receipt of the referral,
b. For those consumers who did not respond and/or comply to contact attempts, the MSS will
enter a note into FSFN and identify the appropriate category, based upon the response by the
consumer, by COB on the third business day.
c. This entry into FSFN will result in an alert notifying the Primary Worker (CPI or CBC
subcontracted providers), who will follow up with the family and take action., as appropriate-
d. The MSS will utilize the FSFN to regularly update the consumer's progress. The MSS shall
input all direct contact information into FSFN within forty-eight (48) hours following contact with
the consumer and will select one of the definitions of progress in treatment categories to identify
the consumer's progress. The definitions of progress in the treatment categories are found in the
approved Motivational Support Program Protocols, incorporated by reference herein.
e. Upon notification from a behavioral health provider that a consumer has missed their
scheduled initial intake appointment, the MSS shall update FSFN to document the lack of
participation and shall attempt to re-engage the consumer in behavioral health services-
f. The MSS will resubmit the referral for recommended treatment services, as appropriate, and
document in FSFN.
g. Should a behavioral health provider not be able to meet a consumers clinical needs, the
behavioral health provider shall link the consumer to an appropriate behavioral health provider.
Exhibit AA
Guidance/Care Center, Inc. Page 5 of 10 Contract No, ME225-7627
oulh 1�lurida Behmhiral I lealth Nebs a- , Inc.
The referring behavioral health provider shall notify the MSP within one (1) business day of this
occurrence, The MSS wii1. engage the SFBHN Child Welfare Integration Coordinator for
assistance with the referral, if necessary.
h. The MSS wildcontact 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 wile 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 consumerifamily 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
Ill. 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
CBCIIFPSIFCMA 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 plane
13. DEPENDENCY COURT LIAISON
Exhibit AA
Guidance/Care Center; Inc. Page 6 of 10 Contract No. ME225-7-27
South Horlda➢ Ilehav lorsal fl:-va➢lth Nemoric, Inv.
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 shalt- appear in court under any of the following circumstances:
i. Clinical case staffing of the client indicates the need for the MSS;
ii. The court issues a subpoena to the MSS;
iii. The department or a child welfare agency provides a request to the MSS in writing,
requesting client court representation-, or
iv. Upon request of an attorney representing the department.
c. If the court requests a written status report in lieu of court appearance, the MSS shall provide
said report to the department's Legal Counsel for filing with the court- Client/family requests for an
MSS to appear on their behalf will be taken into consideration,.
14. LENGTH OF SERVICE & DISCHARGE
a. MSS services shall be provided to an eligible client receiving behavioral health treatment to
ensure linkage with and support for the child welfare case plan., The MSS may continue to
provide MSS services to clients in active behavioral health treatment after the child welfare case
is closed.
b. The client may be discharged from MSS services upon any of the following:
L Behavioral health treatment is completed;
ii. The client refuses to participate in the program; or
iii. The client is incarcerated, or moves to another geographic area.
iv. The case has been open with MSP for 90 days.
c. Decisions about when to close a case or keep it open should be made by the MSS in
consultation with the behavioral health provider, child welfare worker, CBC/IFPS/FCMA Provider,
and/or the court.
15. DATA REPORTING REQUIREMENTS
Data shall be submitted electronically to the ME by the 4th of each month following the month of
service into the Knight Information Software database or other data reporting system designated
by the ME. MSS shall enter data using an MSS Staff ID as defined in PAM 155-2 and by the
dates specified in Exhibit C, Required Reports.
The MSS shall also utilize FSFN to regularly update the consumers' progress within the
timeframes specified in the Motivational Support Program Protocols, incorporated by reference
herein,.
16. TRAINING
The Network Provider agrees to ensure that MSS's participate in the MSS statewide meetings
when they occur, any training provided by the Department specifically for MSS„ and/or to attend a
work related conference,.
17. INCIDENTAL EXPENSE FUNDS
Exhibit AA
Guidance/Care Center, Inc. Page 7 of 10 Contract No. ME225-7-27
South I hDrida Behatioral Ilsaalch Nelmork, Ira€.
a. These funds may be used to remove barriers to treatment that are identified as problems in
the client's intervention plan and to provide resources that are necessary to keep the family
member in treatment. This funding may be used when no other resources are available.
b. Uses of these funds include, but are not (limited to, transportation, childcare, housing
assistance, clothing„ and educational/vocational assistance, Incidental funds may also be used
for toxicology screens when they are identified as necessary in the client's screening or case
management monitoring process; and in those instances when it is necessary to verify use or
abstinence for a client in treatment:.
c. Although use of these funds for toxicology screens is allowable, this should only occur in
situations where other resources are unavailable, Incidental Expense funds should primarily be
used to fund clients' needs to remove barriers to treatment.
d. Criteria for use of the incidental funds, procedures for accessing them, and the accounting for
expenditures will be developed cooperatively between the provider, the MSS, and the ME's
System of Care staff, The ME's System of Care staff will have final approval of the criteria,
procedures;, and accounting for these funds.
e. Each month, the Network Provider shall submit a report to the ME's Sr. Accountant, which
details year-to-date expenditures and the balance of the MSS incidental funds, along with the
corresponding incidental fund request form(s), The expenditure of MSS incidental funds will be
reflected in the incidental expenses cost center on the monthly invoice. This information must be
monitored by the Network Provider agency to ensure that the funds allocated at the beginning of
each fiscal year are not exceeded-
f. The total amount of MSS funding for this contract is $100,000.00. This includes $0.00 that
the Network Provider agrees to make available for Incidentals Expense funds.
18. INCIDENTAL FUND REQUEST FORM
a. The incidental fund request must contain, at a minimum, the information below:
I. Name of the MSS accessing funds;
it. Funds spent on behalf of (client name);
ill. Referral type (protective investigationtsupervision);
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
vill. 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
GuidancePCare Center, Inc. Page 8 of 10 Contract No. ME225-7-27
South Hurid a Be aasioraal lic alth Nelisork, Inv.
TIVIEfflim
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
L The outcome measurement contained in paragraph 19. a. 1 — 5 above will be
calculated as follows:
1, Numerator:
Denominator:
2, Numerator:
Denominator:
3,Numerator:
Denominator
Individualsidentified in FSFN SAMH notes
Total number of individuals entered into the KIS data system
and/or identified in the MSP Tracker
Number of clients screened
Total number of screenings completed within the specified timeframe
Number of clients with a completed case management assessment
Total number of case management assessments completed within the
specified timeframe
Exhibit AA
Guidance/Care Center.: Inc. Page 9 of 10 Contract No. ME225-7-27
'wouth Horida Behaniaral Ileakh NuMork, Inc,
4- Numerator:
Denominator:
5. Numerator:
Denominator:
HTMEM
Number of clients with a completed service plan
Total number of services plans completed within the specified timeframe
Number of cases identified in FSFN SAMH notes
Total number of progress notes documented in FSFN SAMH
Exhibit AA
Guidance/Gare Center, Inc. Page 10 of 10 Contract No, ME225-7-27
Soulh orida Beha%im-0 Health Net"or , Irm,
WMEMM33M
Exhibit Al
Family Intensive Treatment Team
Scope of Work
i. General Description
From the funds in Specific Appropriation, the recurring sum of $633,188.00 ($10,000
per family served) is provided to implement the Family Intensive Treatment (FIT)
team model that is designed to provide intensive team -based, family -focused,
comprehensive services to families in the child welfare system with parental
substance abuse. Treatment shall be available and provided in accordance with the
indicated level of care and program specifications in accordance with the following
incorporated documents:
a. The Network Provider hereby agrees to adhere to the requirements specified in
the abbreviated bid which is incorporated by reference and may be found at:
htt sfbh.or word ress -content u loads P T -a it -Intensive-
Treat et -Team -Procure et- .1.1 .
b. The Network Provider's response to the ME's abbreviated bid, which is
incorporated by reference and may be requested from the ME's Contract
Manager.
c. The Network Provider hereby agrees to adhere to the requirements specified in
the Program Guidance for Contract Deliverables- Incorporated Document 18,
Family Intensive Treatment (FIT) Model Guidelines and Requirements, dated July
1, 2016, or the latest revision thereof, which is incorporated by reference and
may be found at:
btip.1/www.mvflfarrilies.cou,Zse�.�
entitiesJ2016-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.
Guidance/Care Center, Inc. Exhibit Al Page 1 of 6 Contract No. ME225 7 27
South Fluridn ltaehaa%horsal Health Nemor , Ine,
Revised July 1, 2016
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.
Guidance/Care Center, Inc. Exhibit Al Page 2 of 6 Contract No, ME225-7-27
South Hurida Beha%ior l Ilealth Neltsork, Jim
Revised July i; 2016
W
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:
Required Reports: The reporting requirements may be found in Exhibit C, Required
Reports.
Remainder of the page left blank intentionally
Guidance/Care Center, Inc. Exhibit Al Page 3 of 6 Contract No. ME225 7-27
Sown Horicht BehiMoral Health Nchaork, Inc.
Revised July 1, 2016
FIT - EXHIBIT AI -A
FAMILY INTENSIVE TREATMENT SERVICES MONTHLY PROGRESS REPORT . .... .
ro r Name
Contract Number
i f — — rom=--- —
Reporting
eoaF-F
To
. ...... - . . ...—Thiidi�itii - - --
ent Annual Target Th"Is Period Year to Date
Reporting Requirern
to Date
PERFORMANCE MEASURE FOR ACCEPT,
Number of families served 64
PROGRAMMATIC PERFORMANCE MEASURES
Percentage of parents
served living in,a stable 90%
housing environment,
Percentage of parents
served who improve their
level of functioning as
measured by the Functional 80%
Assessment of Mental
Health and Addiction
(FAMHA)
— — — — -------- -
Percentage of Discharge
Summaries completed within 85%
7 days of discharge,
Percentage of initial
assessments (ASI and
ASAM) completed within five 85%
5 days of enrollment,
Percentage of parents,
receiving treatment services
within 48 business hours of 90%
completing the initial
assessments (ASI and
ASAM).
Guidance/Care Center. Inc. Exhibit Al
Page 4 of 6 Contract No. ME225-7-27
South Ilorida Belizi3Ooral Ilealth 'Selmwk, Inc.
Revised July 1, 2016
FAMILY INTENSIVE TREATMENT SERVICES MONTHLY PROGRESS REPORT
SUPPLEMENTAL DATA REPORTS
..._.._
This Quarter
ThisPeriodYear to Date
Reporting Requirement
to Date
-Number o-f-C`hild-Welfare' Cases Closed
Number of Family Reunifications
Number of Parents Receiving an Individualized
Treatment plan
I-Number of individualsReceivingChild Welfare
Services
Number of Parents Receiving Intensive lr i-Home
Treatment and Services
--F --- - ----- 7r,
Number of Parents Receiving, Detoxification
Treatment
Number of Parents Receiving Crisis Stabilization
Services
Number of Parents Receiving Inpatient Psychiatric
Services
FNumber of Parents Receiving Residential Treatment
Number of Parents Receiving Individual Therapy
[ Number of Parents Receiving Group Therapy
mber of Parents Receiving Family Therapy
Number of Parents Receiving Medication Services
Guidance/Care Center, Inc. Exhibit Al
Page 5 of 6 Contract No. ME225-7.27
South Horialaa Ilehaafloraal llesakh Nel"nark, Inc.
FAMILY INTENSIVE TREATMENT SERVICES MONTHLY PROGRESS
REPORT
Number of Parents Receiving Therapeutic Training
or Psycho -education
I' I
Number of Parents Receiving Transportation
Support
Number of Parents Receiving Supportive Housing
(Number of Parents Receiving Supported
Employment
Number of Parents Receiving Aftercare Services'
ATTESTATION._. _-.....m
hereby attest the information provided herein is accurate, reflects services provided in a eordance with the
terms and conditions of this contract, and is supported by client documentation records maintained by this
I agency.
Signature and Date _ .._.....__.. _...... _ ___.. a.
Authorized Name, Title,
and Agency Name
(please print)
r
�I g;
Guidance/Care Center, Inc. Exhibit Al Contract No ME225-7-27
Page 6 of 6
S011th flalid- Beha,�Wal HA� N�Two,k, In, Eah'vt AI=A
Mum
NOTES;
1, Report data on the number discharged during the reporting period
2. Fields highlighted In Wue are aulocalwitited
Period to indicate the reasGn for
silo
..
ono � �■0000�oo
t.
Column G - Lloyed
Column H -Went to Jawphson
Column I - DMqagemeni
Column J - Transfer to another FIT program
Column K - Died
Corumn L - Child Welfare Goal Change (TPR)
Wumn FA - Judgetcourt closed ft child welfare case
Guidance/Care Center, Inc. Exhibit A!-B
Page I of I Contract No,, ME225-7-27
Attachment: GCC_SAMH_FY1 7—SIGNED [Revision 1] (2231 : Guidance/Care Center)
South Florida Behavioral Health Network, Inc Exhibit AK
Monthly Substance Abuse and Mental Health Provider Waiting List Report Form
11 or SB
CIRCUIT NUMBER: AGENCY NAME:
REPORTING MONTH & YEAR: L�
Of the total reported above, how many were seeking IV drug treatment? How many IV drug users wailed B l0 14 days? ❑ More than 14 days?
On the average, was your agency operating at 90°Yo capacity during the reporting month? Yes ❑ No ❑
PREGNANT JUVENILES
cur
Treatment
Services
Beginning
Census
Number
Added
Number
Placed
Number
Terminated
Ending
Census
Treatment
Services
Beginning
Census
Numbe
Added
Number
IPlaced
Number
Terminated
Ending
Census
Outpatient (MHISA)
Day/Night
Outpatient (MHiSAI
DayiNight
Detax
0
0
0
0
0
Del.
0
0
0
0
0
Methadone
0
0
0
0
0
Methadone
0
0
0
0
0
Total
Total
POSTPARTUM JUVENILES
u^
Treatment
Beginning
Number
Number
Number
Ending
Treatment
Beginning
Numbee
Number
Number
Ending
Services
Census
Added
Placed
1rennInated
Census
Services
Census
Added
Placed
Terminated
Census
Outpatient (MHISA)
Outpatient 1MHlSA)
DaytNighl
Day/Night
Detox
0
0
0
0
0
Dewx
0
0
0
0
0
Methadone
1 01
0
0
0
0
Methadone
0
0
0
0
0
Total I
I
I
IITotal
Beoinnina
Census + Number
Added
- Number Plarad .
Ni ■nhnr Ta
. in,1-4
a C.w:....
re..«.e
Of the total number of womenruveniles
reported above, how many were pregnant?
Of the total number of womenfjuvenlles
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 fist at the beginning of the reporting month
Number Added - Number of individuals added to the waiting fist during the month.
Number Placed Number of individuals placed into treatment services.
Number Terminated - Number of individuals terminated from the wailing list for reasons other than placement Into treatment (unable to contact for follow up, Individual arrested, etc.).
Ending Census r Number of Individuals left on the waiting list at the end of the reporting month.
Staff Person Completing This Form; Phone:
Form updated 12W015
Exhibit AK
Guidance/Care Center, Inc. Page 1 of 1
Contract No, ME225-7-27
I�i�t t't"iT�[K1Tii..l�lril■�'lI�L+-i[ei�I=1r�±:T�1ti'.i�cTf[e�iti•'FTT�al�rrs -gym!
South Phwivai Rci€xaviomil Inca lth Nctisork, Inc.
Exhibit AM
Return on Investment —Special Project Return on Investments for FY 2016-17
L Pursuant to the FY 2016-17 General Appropriations Act,, Ch. 2016-66, Laws of Florida, the Network
Provider has been awarded funding to provide the following services:
Provider: Guidance/Care Center, Inc:
Specific Appropriation Line Item # 385 Family Intensive Treatment Funding
Amount; $633,188.00
Designated as follows:
Miami -Dade County: $483,871..00
Monroe County: $149,317.00
Project: Family Intensive Treatment - From the funds in Specific Appropriation 385, General Revenue to
implement the Family intensive Treatment (FIT) team model that is designed to provide intensive team -
based, family -focused, comprehensive services to families inthe child welfare system with parental
substance abuse.. These subcontracts shall be executed and managed in accordance with Guidance 18 -
Family Intensive Treatment (FIT) Model Guidelines and Requirements. Treatment shall be available and
provided in accordance with the indicated level of care required and providers shall meet program
specifications. Funds shall be targeted to select communities with high rates of child abuse cases.
II. The Network Provider shall:
1. By July 10.2016, provides an initial projected estimate of positive return on investment the
state may receive by providing the funding, and,
2. No later than 10 days after the completion of each fiscal quarter, provide a report
documenting the actual return on investment the state has received as a result of this
funded project,
The Network Provider shall describe the methodology by which the return of investment was
determined. A return on investment can vary and can include increased jobs and revenue to the state;
reduced recidivism or involvement in the juvenile justice system; improved health care costs, quality,
and access; or improvements to water quality. Actual returns by fiscal year should be included if state
funding was previously received, as well as projected positive returns based on current fiscal year
funding.
The Network Provider shall submit the reports to the ME's Contract Manager by the dates specified in
Exhibit C, Required Reports.
Exhibit AM
Page 1 of 1
Guidance/Care Center, Inc. Contract No. ME225-7-27
South Florida Behavioral stealth Network, Inc.
EXHIBIT AN
Supplemental Security Income/Social Security Disability Insurance (SSIISSDI) 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 SSIISSDI for eligible adults with mental illnesses who
are homeless or at risk of homelessness; Access to SSIISSDI is a major tool in recovery from mental
illness and homelessness to engage in treatment„ to keep appointments, to maintain housing, and to
meet other basic needs.
Network Provider Responsibilities
1, Designation of a SOAR Processor; The Network Provider shall have a designated SOAR trained
Processor(s) who will process SOAR applications for all consumers receiving adult mental health
case management services under this contract that have been screened and determined to be
eligible for SOAR benefits.
2. Eligibility Screening. Screening for SOAR eligibility shall be conducted during the intake or
admissions process.
3. Timeframes for Completion of Applications.: SOAR applications must be completed within two (2)
weeks of the protective filing date. For additional information regarding the processing of
applications; please refer to the SFBHN SOAR Basics Guide ("Guide"), The Guide is hereby
incorporated by reference and can be obtained by contacting the ME's Adult System of Care
Manager or the ME's Peer Services Manager.
4. Data Requirement OATS stem : The SOAR Processor(s) shall input data into the OAT System,
at a minimum monthly, for processed applications during the reporting period. The SOAR
Processor(s) shall be responsible for ensuring that the information in the OAT System is updated
regularly as necessary.
5. Training. The SOAR Processor(s) shall be retrained every two (2) years. New SOAR
Processor(s) shall be trained within forty-five (45) days of hire and every two years thereafter.
6. Meetings: The SOAR Processor(s) shall attend the regularly scheduled or specially called
meetings when notified by the ME.
7. Required Reports: The Network Provider shall submit to the ME's Adult System of Care Manager
or the ME's Peer Services Manager a bi-monthly report by the dates specified in Exhibit C,
Required Reports, containing the following elements:
a. Number of screenings completed for the reporting period
b. Number of eligible SOAR consumers
c. Number of applications submitted
Performance Outcomes & Outputs: The Network Provider shall meet the standards and required
outcomes specified below:
a. At a minimum, seventy percent (70%) or a total of fifty (50) screened consumers,
whichever is greater, determined to be eligible for SOAR shall have a SOAR application
submitted.
b. At a minimum, the Network Provider shall have a sixty-five percent (65%) SOAR
application approval rating during each fiscal year.
Exhibit AN
Page 1 of 2
Guidance/Care Center, Inc. Contract No. ME225-7-27
South Florida BehavioralHealth Network, Inc.
Network Provider Compliance'. Failure to meet the applicable standards established in Tables 1 and 2
shall be considered nonperformance pursuant to Standard Contract, Paragraph 36. Financial
Consequences for Network Provider's Failure to Perform.
Managing Entity Responsibilities
1- The ME shall adhere to the requirements identified in the Department's Supplemental Security
Income/Social Security Disability Insurance (SSIISSDI) 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:
htt ://Www.m familles.com/service- ro ramstsubstance-abuse/managing-entities/2016-contract-
dots
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
Guidance/Care Center, Inc.
Exhibit AN
Page 2 of 2
Contract No. ME225-7-27
�1;00' SoWh Florida
Behavioral
00 Health Network, Inc. Rev. 51412015
ATTACHMENT If
Financial and Audit Compliance
The administration of resources awarded by the Managing Entity (ME) to the Network
Provider may be subject to audits as described in this attachment.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Uniform Guidance:
Cost Principles, Audit, and Administrative Requirements for Federal Awards (also
known as the OMB Uniform Guidance), Section 200.500- 200.521 and Section 215.97,
F.S., as revised, the ME may monitor or conduct oversight reviews to evaluate
compliance with contract, management and programmatic requirements. Such
monitoring or other oversight procedures may include, but not be limited to, on -site visits
by ME staff, limited scope audits as defined by OMB Uniform Guidance, Section
200.331, as revised, or other procedures. By entering into this agreement, the recipient
agrees to comply and cooperate with any monitoring procedures deemed appropriate by -
the ME. In the event the ME determines that a limited scope audit of the recipient is
appropriate, the recipient agrees to comply with any additional instructions provided by
the ME regarding such audit. The recipient further agrees to comply and cooperate with
any inspections, reviews, investigations, or audits deemed necessary by the ME,
Department of Children and Families inspector general, the state's Chief Financial
Officer or the Auditor General.
AUDITS
PART I: FEDERAL REQUIREMENTS
This part is applicable if the recipient is a State or local government or a non-profit
organization as defined in OMB Uniform Guidance, Section 200.500-200.521, as revised.
In the event the recipient expends $500,000 (S750,000 for fiscal }�eais beginning on or
noel• Decenrhel- 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 & FamiIies through the ME, Federal
government (direct), other state agencies, and other non -state entities. The determination
of amounts of Federal awards expended should be in accordance with guidelines
Attachment 11
Page 1 of a
Guidance/Care Center, Inc, Contract No. ME225-7-27
South Florida
Behavioral
Health Network, Inc.
Rev. 54/2015
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 IL 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 I0.650, 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
GuidancelCare Center, Inc. Contract No. ME225-7-27
South Florida
!F
Behavioral
Health Network, Inc.
Rev. 1*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 ( I 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: sin le. i tcc;aiiyl' f ilies.c
C. Reporting packages for audits conducted in accordance with Uniform Guidance,
Section 200.500-200.52I, as revised, and required by Part I of this agreement shall be
submitted, when required by Section 200.512 (d), OMB Uniform Guidance, as
revised, by or on behalf of the recipient directly to the Federal Audit Clearinghouse
using the Federal Audit Clearinghouse's Internet Data Entry System at:
htt :?'/hareester.census.nova/fac/collect/ddeindex.ht
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 40I
1 1 1 West Madison Street
Tallahassee, Florida 32399-1450
Email address: H(.)W.I . ingle Au tt ct m� families.ca
Attachment 11
Page 3 of 4
Guidance/Care Center, Inc. Contract No. ME225-7-27
V� South Florida
/ Behavioral
Health Network, Inc.
Rev. 5*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 11
Page 4 of 4
Guidance/Care Center, Inc. Contract No. ME225-7-27
QSouth Florida
Pro.. 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 ofe 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-racipients 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 fans to file the required certification shall be subject to a civil
penally of 0,
$10.000 and not more than $100.000 for each such failure.
�441"
Signalure Dale
the of Authorized Individual Application or Contract Number
Lit &OLAL e Ca f-e 4 (A- C ,
Name of Organization ,
CF 1123, PDF 03/W
Attachment III
GuklancelCare Center, Inc. Page l of I Contract No. ME225.7-27
South Florida
®Behavioral
Health Network, Inc.
Attachment IV
SCOPE OF WORK
Section I. DESCRIPTION OF SERVICES AND STRATEGIES FOR SERVICE DELIVERY
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 ESP's; implement sessions based on these EBP's; and work closely with the SFBHN
and Behavioral Science Research Institute (BSRI) evaluation entity to conduct evaluation of the program's
outcomes and effectiveness. The Mental Health First Aid strategy will support the processes. These five
steps assist youth while considering sustainability of the program and a framework of cultural competency
at all times. The POP program staff will seek to coordinate all prevention activities with referrals from
:
of eraencl to - £. agencies collaborate and maximize resources when indicated and possible.
y
EDUCATION — Alcohol Literacy Challenge is a brief classroom -based program designed to alter alcohol
expectancies and reduce the quantity and frequency of alcohol use among middle and high school
students. PRIME for Life is a motivational intervention used in group settings to prevent alcohol and other
drug problems (Marijuana, Prescription, and Over -the -Counter Drugs), and/or provide early interventions.
Teen Intervene is a brief, early intervention for 12-19 year olds who display early stages of alcohol or drug
involvement. The program staff will be trained in Mental Health First Aid, an NREPP designated Evidence
Based Practice, which is an adult public education program that can be adapted to adolescents and
designed to improve participants' knowledge and modify their attitudes and perceptions about mental
health and related issues, including how to respond to individuals who are experiencing one or more
acute mental health crises i.e., suicidal thoughts and/or behavior, acute stress reaction, panic attacks.
Attachment [V
Guidance/Care Center, Inc, Page I or 9 Contract No, ME225-7-27
South Ftodda
Behavioral
Health Network, Inc.
and/or acute psychotic behavior) or are in the early stages of one or more chronic mental health problems
(i.e., depressive, anxiety, and/or psychotic disorders, which may occur with substance abuse). This will
assist the staff in increased skills to implement the screening, assessment, and accuracy of the DCI tool
and other services for enhanced participant improvements.
ALTERNATIVES — each program provides activities for youth to consider excluding substance use and
increasing pro -social behavior.
PROBLEM IDENTIFICATION AND REFERRAL —Teen Intervene and PRIME for Life identifies youth who
have experimented with substances and assesses further services and referrals to those services.
INFORMATION DISSEMINATION - through the Prevention programs offered, and the collaboration of
Agencies, youth in the community and community members will become more aware of the risks of
underage drinking and drug use.
Section II. TARGET POPULATION — RISK AND PROTECTIVE FACTORS
Universal Direct —_Alcohol I
Indicated —Teen Intervene
Selective — PRIME for Life
Universal Direct — Health F
*Participants may be duglic
across
e
348"
48"
190*
300
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 (100 miles) to include all 3 high schools, 3 middle schools, youth
residing at the Florida Keys Children's Shelter, and youth attending various community programs as well
as youth involved in the Juvenile Justice System. Educational priorities in accordance with the Monroe
County CCAP are Youth Alcohol Use/Abuse, Youth Drug Use/Abuse.
Participants to be served include Health Fairs throughout Monroe County. Including handing out
materials concerning the prevention programs and meeting with participants face to face. Universal
Indirect will only be used for meetings and strategizing with the Monroe County Coalition per the financial
rule.
Risk Factors:
Favorable attitudes towards ATOD
Perceptions of harm
Community norms
Self -regulation
Protective Factors:
Prosocial opportunities/activities
Positive peer influence
Skill/competency
Healthy behaviors
Increased knowledge/awareness
Self-esteem Community values children
Positive family communication
Community values — children/vouth
Attachment IV
GutdancelCare Center, Inc, Page 2 of 9 Contract No. ME225-7-27
South Florida
Behevlorar
Health Network. Inc.
Section III. SITE LOCATIONS AND INFORMATION*
Section IV. MAJOR REFERRAL SOURCES
Section V. PERFORMANCE MEASURES
Attachment IV
Guidance/Care Center., Inc- Page 3 of 9 Contract No,. ME225-7=27
South Florida
®Behavioral
Health Network, Inc.
Alcohol Literacy Challenge
190
0
0 1 ALC
Session
for each
of 190
participan
is
100% of 190 will
receive services,
85% will complete
ALC and 85% of
completers or 162
will improve on
the ALC
Universal
- Direct
PRIME for Life
348
0
0 Minimum
PRIME for Life —
Selective
4.5 hours
100% of 348 will
and up to
receive services,
a
85% will complete
maximum
the program in a
of 20
minimum of 4.5
hours
sessions
per the
and 85% of
EBP
completers will
improve based on
the outcome
measures
Teen Intervene
48
0_
0 3
Teen Intervene —
Indicate
sessions
100% of 48 will
d
receive services,
85% will complete
the program and
85% of
completers or 41
participants will
improve from pre
to post test in the
minimum of 3
sessions (3
sessions is one
cohort
Health Fairs
100
200
0 5
100% of 300
Health
participants will
Fairs
receive
information at the
Health Fairs, 85%
or 255
participants be
provided
prevention
framework
information while
attending the
fairs.
Attachment IV
Guidance/Care Center; Inc. Page 4 of 9 Contract No, ME225-7-27
South Florida
Behavioral
Health Network, Inc,
Quality Performance Measures
(Including fidelity measures, satisfaction survey information, supervision, training,
staffing, and other required information pertaining to quality)
,.
t
3
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
1 participant
services
improved
Participant Satisfaction Survey
Alcohol Literacy Challenge -
100% of 190 and 85% 162
will improve based on the
pre/post outcome as
measured by the approved
SFBHN tool Alcohol Literacy
Challenge minimum of 1
session
Average number of sessions
Participant sign -in sheet collected at
attended (Participant
each session .
At the end of each cohort
Retention)
Alcohol Timeline Followback (TLFB)
session
Number of participants
completed at baseline and exit from .
At the end of each of the
improved
treatment
services
Teen Intervene --100% of 48
Participant Satisfaction Surveys
will receive services and 85%
will complete the program.
85 % of completers will
improve from pre to post test
in the minimum of 3
sessions(3 sessions is one
cohort)
Participant Sign -in sheets collected
Average number of sessions
at each session .
At the end of each cohort
attended (Participant
Survey from each participant at start
Retention)
and exit
session
Number of participants
.
Evaluation — curriculum
At the end of each of the
improved
assessment completed at baseline
services
PRIME for Life —100% of 348
and exit by each participant
will receive services, 85% of
348 or 296 will complete the
program in a minimum of 4.5
sessions
and 85% of completers will
improve based on the
outcome measures
# and % of participant
85% of participants who completed .
At the end of each cohort
satisfied with services
program will complete the a
At the end of the services
provided
satisfaction survey and 80% will be
_
satisfied based on the Satisfaction
Attachment IV
Guidance/Care Center, Inc. Page 5 of Contract No. ME225-7-27
V,Pe' South Florida
Othavloral
Mol Health Network, Inc.
I
Survey
Observation of service
Curriculum fidelity checklist Four times per year in coordination
delivery/ Fidelity checklist
Supervisor/Observer report with the Evaluation Team — One
time in FY Quarter 1, one time in
FY Quarter 2, on time in FY
Quarter 3, and one time in FY
Quarter 4 with identified needs and
changes to be reported to SFBHN
in the Quarterly Report
Documentation of structured Supervisory Too]/Checklist and During regular supervisory
supervision
Notes
sessions for each staff and not
less than one time per month. (Per
the Rule, "Supervisor Instructions"
# and % of staff with
100% of staff with necessary Attendance at prevention training
necessary training
training/certification
every quarter. Every prevention
/ certification (as required by
staff member must participate in at
all entities and EBP)
a minimum, 8 hours of training per
quarter.
# and % of staff working
100°/® of staff working towards By October 2016 or one month
toward achieving certification achieving certification by attending after hire of one new staff, all staff
in the State of Florida in
SFBHN and other training consistent not certified, will be working
Prevention Certification
with FCB's criteria
towards State of Florida
(FC
. Prevention Certification
Section A. Participant Outcomes
CCAP Goal
Goal 1: By June 30,
Goal 1: By June 30, Goal 1: 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 Ik Expand Long. Goal III: Expand
the community
the community the community
messaging and
messaging and messaging and
communication strategy
communication strategy communication strategy
to more effectively build
to more effectively build to more effectively build
community ownership of
community ownership of community ownership of
the underage drinking
the underage drinking the underage drinking
problems in Monroe
problems in Monroe problems in Monroe
County through
County through County through
formalizing of new
formalizing of new formalizing of new
relationships with key
relationships with key relationships with key
community and
community and community and
business leaders using
business leaders using business leaders using
the Strategic Prevention
the Strategic Prevention the Strategic Prevention
Framework.
Framework. Framework.
SFBHN Goal(s)
SFBHN Prevention Goal
SFBHN Prevention Goal SFBHN Prevention Goal
ALI., Decrease norms and
#1: Decrease norms and #2: Increase education
acceptance of alcohol,
acceptance of alcohol, and awareness
madjuana, and other
marijuana, and,other regarding alcohol,'
Attachment IV
Guidance/Care Center, Inc.
Page 6
of 9 Contract No, ME225-7-27
South Florida
Behavioral
Or
Health Network, Inc.
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.
drug use (inclusive of drug, use (inclusive of marijuana use
peer and parent peer and parent
attitudes), attitudes). ` SFBHN Prevention Goal
#4: Increase healthy
SFBHN Prevention Goal behaviors and self
#3: Increase age of esteem
onset for marijuana use
Prelpost 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
Activlty Title: ALCOHOL LITERACY CHALLENGE (ALC)
Activity Descil tion: Participants will be recruited from
partners/agencies and will receive a 1-15 minute pre -survey of
their risk and protective factors. The curriculum will be
administered a minimum of 1x, and 1-15 minute post -survey will
be administered at end of session. The staff will employ the
Mental Health First Aid skill sets during the session. If
participant's post -survey indicates high risk factors, participant
to have 1 other-30 minute referral to another Prevention
program. 1-30 minute registration, 1-30 minute screening.
• Meet & communicate with school person nellpa rtner
• Meet and
communicate with
school personnel
• /partner agencies
• Prepare program
materials
• Administer
Participant
Registration Form
and prepost tests
• Administer
Satisfaction Survey
• Travel to/from
session
• Data Entry
348 youth 11 session per 1 100% of
ages 13-
participant
youth will
18
and 2
receive
sessions per
services,
participant
85% will
needing
complete
referral to
ALC and
additional
85% of
services
completers
will
improve
based on
Attachment IV
GuidancelCare Center; Inc. Page 7 of 9 Contract No. ME225-7-27
U► South Flmlda
/ Behar�Ioral
Health Network, Inc.
agencies
the Quality
• Prepare program materials
Outcome
• Administer Participant Registration Form
Measure
+ Administer Satisfaction Survey
• Travel to/from session
• Data Entry
Fre uenc : 1 or 2 sessions
Intensity: 90 minutesxi session or 45 minutesx2 sessions
Duration: 1 session, # of Cohorts Q 6 youth each
Activity Title: PRIME for Life (PFL)
348 youth 4.5 to 20
100% of
Activity Description: Participants will be recruited from
ages 13- hours per the
348
partners/agencies and will be guided in self -assessing their level
18 EBP for each
participants
of progression toward or into dependence or addiction to alcohol
participant,
in PFL will
or other drugs. Participants will be assisted in developing a
documenting
receive
detailed plan for successfully following through with behavior
the need
services,
change in addition to workbook activities. The staff will employ
85% will
the Mental Health First Aid skill sets during the session. 1-30
complete
minute registration, 1-30 minute screening, 1-30 minute pre/post
the
surveys, 1 30 minute referral.
program
• Meet & communicate with school personnel/partner
and 85% of
agencies
completers
• Prepare program materials
will show
• Administer Participant Registration Form
improveme
+ Administer Mental Health First Aid screening tool
nt on the
• Administer Satisfaction Survey
pre/post
• Travel to/ from session
surveys
• Data Entry
based on
Frectuency, 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
outeach
Activity Title: Teen Intervene
48 youth 3 sessions
100% of 48
Activity Description: Participants required to attend (3) 90
ages 13-
youth will
minute session, 1- 30 minute registration, 1- 30 minute
18
receive
screening, 1- 30 minute pre/post survey, and 1- 30 minute
services,
referral. The staff will employ the Mental Health First Aid skill
85% will
sets during the sessions,
complete
Frequency: once weekly session
the Teen
Intensity., Three sessions
Intervene
Duration: one 90 minute session
sessions
and 85% of
completers
will show
improveme
nt based
on the
Quality
Outcome
Activity Title: EVALUATION —Curriculum evaluation tools.
r.
190* 2
measures
85%
These assessment tools match thezervices provided.
Activity Description: Instrument used to identify substance
abuse and other needs.
Altacliment IV
Guidance/Care Center, Inc. Page 8 of 9
a l i N o 25_7-27
South Florida
Behavioral
Health Network, Inc
Frectuencw 2 sessions
Intensi : 30 minutes/session
Duration: 1 survey per youth completed at baseline and at exit
for PRIME for Life, # of Cycles: 10 cycles @ 10 youth
"duplication OF 190 PRIME FOR LIFE #
Section Vill. EVIDENCE BASED PROGRAMS (EBP)
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.
GCCIPOP 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 Fallow Back. POP will use results from previous years' FYSAS as the baseline and utilize more
results by 2017 during course of this project to define meaningful improvement and gauge POP participant
outcomes as they relate to the overall goals of the CCAP.
-Adhere to the Fidelity requirements of each program.
-Any problem areas in the classrooms or in the groups, will be discussed and addressed at weekly
Supervision meetings.
-The effectiveness of all 4 programs will be evaluated through the pre and post surveys and client
satisfaction surveys.
-Random observations will be done by Prevention Coordinator and Research Assistant.
-All activities for Prevention will be consistent with the agency's Quality Assurance/Quality Improvement
Plan.
-Activity Logs will be maintained for all Prevention activities and client charts will be maintained for
Indicated Prevention Activities.
-Coordinate with the Evaluation Team regularly, attend meetings, and submit the required documentation.
Attachment IV
Guidance/Care Center, Inc. Page 9 of Contract No. ME225-T27
PROOOPPI
South Florida
;.1;:4110400 Behavioral
Health Network, Inc.
rev 0,7101r015
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 GuidancelCare 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 Jerined 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 some The Prime Contract is incorporated by reference in this
Contract. in case of conflict with the provisions, terms and conditions of The Prime Contract and this Contract, the provisions, terms and
conditions of this Contract will prevail. In the event of a conflict between the provisions of the documents of this contract, the documents shall be
interpreted in the order of precedence listed in Paragraph 46, of this Standard Contract.
4. Effective and Ending Dates
This contract shall begin on September 1, 2015. It shall end at midnight, local time in Miami -Dade County, Florida on June_30, 2018.
5. State of Florida Law
This contract is executed and entered into in the State of Florida„ and shall be construed; performed and enforced in all respects in accordance
with Florida law, without regard to Florida provisions for conflict of laws. Courts of competent jurisdiction in Florida shall have exclusive jurisdiction
in any action regarding this contract and venue shall be the appropriate state court in Miami -Dade County, Florida.
6. Federal Law
a. If this contract contains federal funds, the Network Provider shall comply with the provisions of federal law and regulations including but not
limited to, 45 Code of Federal Regulations (CFR), Part 74, 45 CFR, Part 92, and other applicable regulations.
b. It this contract contains over $100,000 of federal funds, the Network Provider shall comply with all applicable standards, orders, or regulations
issued under section 306 of the Clean Air Act, as amended (42 United States Code (U.S.C.) 7401 et seq.), section 508 of the Federal Water
Pollution Control Act, as amended (33 U.S.C. 1251 el 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 fowl must be completed and returned to the contract manager, prior to
payment under this contract.
d. Unauthorized aliens shall not be employed. The ME shall consider the employment of unauthorized aliens a violation of section 274A(e) of the
Immigration and Nationality Act (8 U.S.C. 1324 a) and section 101 of the Immigration Reform and Control Act of 1986. Such violation shall be
cause for unilateral cancellation of this contract by the ME. Pursuant to Executive Order 11-2 signed on January 4, 2011, the Network Provider,
and if applicable all subcontractors for work contemplated under this contract, shall use the E-Verify system established by the U.S, Department of
Homoland 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, it 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 penally 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 I of 10 Contract No. PPG-2-03
® South Florida
Behavioral
Health Network, Inc.
rev 07101!?015
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,
cw 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 limes 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 Providers 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
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, Slate 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 hord 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 Wulation 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 Providers 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 Providers 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 duly 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 76828, F,S or other applicable law,
and without waiving the limits of sovereign immunity.
10. Insurance
a. Continuous adequate liability insurance coverage shalt be maintained by the Network Provider during the existence of this contract and any
renewal(s) and extensions) and in accordance with the requirements in Attachment 1. By execution of this contract. unless it is a stale 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 Iiabilily 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 Stale of Florida. The ME reserves the right to require additional insurance as specified in this contract. The
Standard Contract
Guidance Care Center, Inc: Page 2 of 10 Contract No PPG-2-03
r' South Florida
Behavioral
Health Network, Inc.
rev 0710IR 13
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 stale 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 websile, wwwLs hn.or .
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 slated 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 Slate 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 resumed.
b. Payments made for services subsequently determined by the ME to not be in full compliance with contract requirements shallbe 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 loll -free telephone number (1-800.96ABUSE). As required by
Chapters 39 and 415, F,S., this provision is binding upon both the Network Provider and its employees.
Standard Contract
Guidance Care Center; inc. Page 3 of 10 Contract No, PPG-2-03
® South Florida
i0i Behavioral
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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 limes 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 stale 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 slate 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 Slate 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, ar 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 "Stale of
Florida Department of Children and Families' shall appear in at least the same size letters or type as the name of the organization..
1s. 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 Slate mark, the name of
the ME, the Stale, 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 falls 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 slate 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 fist 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
affillate 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 an 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 [hat 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
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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
b f
men, or a 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 t5) 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 HIPPA 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 or
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 polity 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 miligale
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.
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b. Transilioning 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 transilioning 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 lime 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
safely, 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 relativelnon-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 10 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 bear 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
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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 (his requirement, contractually require that its subcontractors comply with
section 504, the ADA, and CFOP 60-10, Chapter 4. The Network Providers 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
htl�s.61ts16.formsite.com! CFTrainina/Monthiv-Summarv-Re)orUform login hlrnl 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 V411
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.
I. 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: trito.i mull(amities.coml5ervice•orociramsBdeaf and-hard-hearingtoroviders
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 [heir certificate of completion, attach it to their Attestation of Understanding, and maintain them in their
personnel rile.
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 5450.000.00, 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 J450,000.00. subject to the delivery and billing for services. The remaining amount of 0.00 represents "Uncompensated Units
Reimbursement Funds", which the ME, at its sole discretion and subject to the availability of funds, may pay to the Network Provider, in whole or
in part, or not at all, for Exemplary Performance by the Network Provider. Exemplary Performance will be determined by the Network Provider
delivering and billing for services in excess of those units of service the ME will be required to pay. Should the network provider receive any
funding from the "Uncompensated Units Reimbursement Funds", then the amount of Local Match as it appears on Exhibit H, Funding Detail, will
automatically change, utilizing the formula prescribed in the Method of Payment section of this contract, The ME's obligation to pay under this
Contract is contingent upon an annual appropriation by the Legislature and the Contract between the ME and the DCF. Any costs or services
eligible to be paid for under any other contract or from any other source are not eligible for payment under this Contract.
315. 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 fall 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 01 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.
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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 stale agency. The Vendor Ombudsman may be contacted at (850) 413-5516.
38. Notice
Any notice that is required under this contract shall be in writing,, and sent by U.S. Postal Service or any expedited delivery service that provides
verification of delivery or by hand delivery. Said notice shall be sent to the representative of the Network Provider responsible for administration of
the program, to the designated address contained in this contract.
39. Financial Penalties for Failure to Comply with Requirement for Corrective Action
a. In accordance with the provisions of section 402.73(1), F.S., and Rule 65-29.001, F.S., corrective action plans may be required for
noncompliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed for failure to implement or to make
acceptable progress on such corrective action plans. The ME, at its sole discretion, will determine the findings denlified in the corrective plan that
will require a financial penally.
b. The increments of penalty imposition that shall apply, unless the ME determines that extenuating circumstances exist; shall be based upon the
severity of the noncompliance, nonperformance, or unacceptable performance that generated the need for corrective action plan. The penalty, If
imposed, shall not exceed ten percent (10%) of the total contract payments during the period in which the corrective action plan has not been
implemented or In which acceptable progress toward implementation has not been made. Noncompliance that is determined to have a direct effect
on client health and safety shall result in the imposition of a ten percent (10) penalty of the total contract payments during the period in which the
corrective action plan has not been implemented or in which acceptable progress toward implementation has not been made.
c. Noncompliance involving the provision of service not having a direct effect on client health and safety shall result in the imposition of a five
percent (5) penalty, Noncompliance as a result of unacceptable performance of administrative tasks shall result in the imposition of a two
percent (2%) penalty. The ME at is sole discretion may terminate a contract in whole or in part for failure to comply with requirements for
corrective action.
d. The deadline for payment shall be as stated in the notice imposing the financial penalties. In the event of nonpayment the ME may deduct the
amount of the penalty from invoices submitted by the Network Provider..
40. Termination
a. This contract may be terminated by either party without cause upon no less than thirty (30) calendar days' notice in writing to the other party
unless a sooner time is mutually agreed upon in writing. Said notice shall be delivered by U.S Postal Service or any expedited delivery service
that provides verification of delivery or by hand delivery to the contract manager or the representative of the Network Provider responsible for
administration of the program, This provision shall not limit the ME's ability to terminate this contract for cause according to other provisions
herein.
b In the event funds for payment pursuant to this contract become unavailable, the ME may terminate this contract upon no less than twenty-four
(24) hour notice in writing to the Network Provider Said notice shall be sent by U.S. Postal Service or any expedited delivery service that provides
verification of delivery- The ME shall be the final authority as to the availability and adequacy of funds. In the event of termination of this contract,
the Network Provider will be compensated for any work satisfactorily completed.
c, In the event the Network Provider fails to fully comply with the terms and conditions of this contract, the ME may terminate upon no less than
twenty-four (24) hours (excluding Saturday„ Sunday; and Holidays) notice in writing to the Network Provider after Network Provider's failure to fully
cure such noncompliance within the time specified in a written notice of noncompliance issued by the ME specifying the nature of the
noncompliance and the actions required to terminate the contract. The ME's failure to demand performance of any provision of this contract shall
not be deemed a waiver of performance. The ME's waiver of any one breach of any provision of this contract shall not be deemed to be a waiver
of any other breach and neither event shall be construed to be a modification of the terms and conditions of this contract. The provisions herein
do not limit the ME's right to remedies at law or In equity.
d. Failure to have performed any contractual obligations with the ME in a manner satisfactory to the ME will be a sufficient cause for termination.
To be terminated as a Network Provider under this provision, the Network Provider must have: (1) previously failed to satisfactorily
perform in a contract with the ME, been notified by the ME of the unsatisfactory performance, and failed to correct the unsatisfactory performance
to the satisfaction of the ME: or (2) had a contract terminated by the ME for cause. Termination shall be upon no less than twenty-four (24) hour
notice in writing-
e. Should the termination of the contract be inevitable, the network provider shall work In collaboration with the ME to develop a transition plan, in
accordance with the Network Service Provider Contract Non-RenewalfTerminalion/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-RenewalfferminationlRecord 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.
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(a) The parties agree to cooperate in resolving any differences in Interpreting the contract, including but not limited to, client eligibility and/or
placement into the appropriate level of care, a general dispute arising out of, or relating to this contract, or contesting a financial penalty for failure
to comply with requirements of a corrective action plan, Within five (5) working days of the execution of this contract, each party shall designate a
Dispute Resolution Officer with the requisite authority to act as its representative for dispute resolution purposes, and provide that information to
the other party.
(b) Within five (5) working days from delivery to the Dispute Resolution Officer of the other party of a written request for dispute resolution, the
representatives will conduct a face-to-face meeting to resolve the disagreement amicably, If the parties are not able to meet within the five (5)
working days due to scheduling difficulties, the meeting shall occur as mutually agreed to by the parties, but no later than ten (10) working days
from the date of receipt of the written request for dispute resolution, If the representatives are unable to reach a mutually satisfactory resolution at
the face-to-face meeting, the dispute resolution process in Section 42.(c) shall be followed. In the event of a dispute regarding client eligibility
and/or placement into the appropriate level of care, the dispute shall not preclude the Network Provider from providing the provision of services to
eligible individuals until the dispute is resolved.
(c) If the representatives are unable to reach a mutually satisfactory resolution, either representative may request referral of the issue to the
President/Chief Executive Officer of the respective parties. Upon referral to this next step, the President/Chief Executive Officer of the parties shall
confer in an attempt to amicably resolve the issue. If the President/Chief Executive Officer of the parties cannot resolve the issue, the Issue shall
be presented at the discretion of the ME either to the Board of Directors Executive Committee and/or the ME's Board of Directors. Should the
dispute not be resolved at the Board of Directors Executive Committee and/or the ME's full Board of Directors level, the decision of the ME shall
prevail subject to any legal rights that the Network Provider may have and/or wish to exercise. Venue for any court action will be in Miami -Dade
County, Florida. This provision shall not limit the parties' rights of termination under Section 40.
43. Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List
(For Contracts Valued at $1,000,000.00 (total contract value), or more, awarded, extended, or renewed on or after July 1; 2011).
The Network Provider agrees to refrain from any of the prohibited business activities with the Governments of Sudan and Iran as described In s.219 473,
F.S. Pursuant to section s.287.135(5), F.S., the ME may immediately terminate this contract for cause if the Network Provider is found to have
submitted a false certification or If the Network Provider is placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized
Companies with Activities in the Iran Petroleum Energy Sector List during the term of the contract.
44. Employment Eligibility Verification (E-Verify)
(a) Definitions as used in this clause.
(i) "Employee assigned to the contract' means all persons employed during the contract term by the Network Provider/grantee to perform work pursuant
to this contract within the United States and its territories, and all persons (including subcontractors) assigned by the Network Provider/grantee to
perform work pursuant to the contracUgrant with the ME.
(ii) "Subcontract" means any contract entered into by a Network Provide to fumish supplies or services for performance of a prime contract or a
subcontract. It includes but is not limited to purchase orders, and changes and modifications to purchase orders.
(III) "Subcontractor" means any supplier, distributor, vendor, or firm that furnishes supplies or services to or for the Network Provider or subcontractor.
(b) Enrollment and verification requirements.
(1) The Network Provider/grantee shall,
-
(I) Enroll as a provider/grantee in the E-Verfy program within 30 calendar days of contract award or amendment;
(ii) Within 90 calendar days of enrollment in the E- Verify program, begin to use E-Verify to initiate verification of employment eligibility. All new
employees assigned by the Network Provider/grantee/subcontractor to perform work pursuant to the contract with the ME shall be verified as
employment eligible within 3 business days after the date of hire.
(2) The Network Provider/grantee shall comply, for the period of performance of this contract, with the requirement of the E-Verify program
enrollment.
(i) The Department of Homeland Security (DHS) or the Social Security Administration (SSA) may terminate the Network Provider's/grantee's enrollment
and deny access to the E-Verify system in accordance with the terms of the enrollment. In such case, the Network Provider/grantee will be referred to a
DHS or SSA suspension or debarment official.
(ii) During the period between termination of the enrollment and a decision by the suspension or debarment official whether to suspend or debar, the
Network Provider/grantee is excused from its obligations under paragraph (b) of this clause. If the suspension or debarment official determines not to
suspend or debar the Network Provider/grantee, then the Network Provider/grantee must reenroll in E-Verily.
(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:
hUp:/i ds. oviE-V rift/
(iv) The Network Provider/grantee is not required by this clause to perform additional employment verification using E-Verify for any employee whose
employment eligibility was previously verified by the Network Provider/grantee through the E-Verify program.
(v) Evidence of the use of the E-Verify system will be maintained in the employee's personnel file.
Standard Contract
Guidance Care Center; Inc. Page 9 of 10 Contract No. PPG-2-03
South on a
Behavioiral
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re
the parties), in each subcontract v 07/OV2015
(vm) The Network rfgrantee shall include the requirements of this clause, including this paragraph (vi) (appropriately modified for identification of
(viii) 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 Conlrad, and
mailing address of the official payee to whom the payment
shall be made is:
Guidance/Care Center, Inc.
3000 41 at 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 41st Street, Ocean
Marathon, FL 33050
Office number. 305-434.7660
Mobile number 305-731-3343
Fax number. 305-434-9040
E-Mail: madanne.benvenul tcare.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 Nve, Suite 200
Miami, FL 33126
TeL (786) 607-7474
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 coraract Is:
Frank C. Rabbilo, Sr. VP
169 E. Flagler Street, Suite 1300
Miami, FL 33131
Office number (305) 573-3784
Mobile number. (305) 7W1286
Fax number (305) 381-7733
E-Mail: frabbit slcam,com
Upon mange of representatives (names, addresses, telephone numbers and a -mail address
es) by either party, notice shall be provided in writing to
party and the notification attached to the originals of this contract.
46. All Terms and Conditions Included
This contract and it attachments, I, II. Ill, d, 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 httpJhvww.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. Allachment I, exhibits, the Business Associate Agreement, and other allaclunents. if any;
b. Any documents incorporated into any attachment by reference:
c. The Standard Contract;
d. Any documents incorporated herein by reference
By SIGNING THIS CONTRACT, THE PARTIES AGREE THAT THEY HAVE READ AND AGREE TO THE ENTIRE CONTRACT, AS
DESCRIBED IN SECTION 46 . ABOVE.
IN WITNESS THEREOF, the parties have caused this contract, attachments, exhibits, and any documents referenced herein, to he executed by
their undersigned officials as duly authorized.
PROVIDER: Care Center, Inc..
TITLE. r Vii r ni
DATE: i
Federal Tax ID# (or SSN) 59-14SM24
SOUTH FLORIDA BEHAVIORAL HEALTH NETWORK, INC.
TITLE._
GATE:
Network Provider Fiscal Year Ending Date
Standard Contract
Guidance Cara Center, Inc. Page 10 of 10 Contract No, PPG-2-03
■"' South Florida
Behavioral
Health Network, Inc.
ATTACHMENT
A. SERVICES TO BE PROVIDED
I. Prevention Services and other Program/Service Specific Terms
Contract and programiservice specific terms used in this document can be found in the Florida
Department of Children and Families Prevention Partnership Grant (Fiscal Year 2015-2018)
Request for Applications (RFA) #LHZ03,, herein incorporated by reference.
Additional Program/Service Specific Terms can be found in the South Florida Behavioral
Health Network's Glossary of Program/Service Specific Terms, which is incorporated herein
by reference, and can be obtained from the following internet location:
(1) "Application is the proposal submitted by an organization to the Department of Children
and Families Office of Substance Abuse and Mental Health in response to Request for
Applications (RFA) #LHZ03.
(2) -Behavioral Health Services" are mental health services and substance abuse prevention
and treatment services as defined in chapters 394, 397 and 916, F.S. which are provided
using state and federal funds,
(3) "Capacity Building": Efforts that increase or improve the resources available to establish or
maintain prevention activities.
(4) "Comprehensive Community Action Plan (CCAP)". A document that describes and depicts
goals and objectives related to the state consumption priorities and the proposed programs
and strategies. It also describes and depicts intermediate changes to risk and protective
factors and process -based objectives. Applications must include at least one objective that
addresses sustainability and at least one objective that addresses capacity building. Goals
and objectives are subject to modification during the negotiation process.
(5) "Continuous Quality Improvement" is a systematic on -going process of improving
performance, both in process and end of process indicators, in order to meet the individual
service recipient's valid requirements.
(6) "Contract Manager" is the ME employee who is responsible for enforcing the compliance
with administrative and programmatic terms and conditions of a contract. The contract
manager is the primary point of contact through which all contracting information flows
between the ME and the Network Provider, All actions related to the contract shall be
initiated by or coordinated with the contract manager.
(7) "Cost Analysis" means the review of the proposed cost elements to determine if they are
necessary, allowable, appropriate and reasonable.
(8) "Cultural and Linguistic Competence" is a set of congruent behaviors, attitudes, and
policies that come together in a system,, agency,, or among professional that enable
effective work in cross-cultural situations that provides services that are respectful and/or
responsive to cultural and linguistic needs.
Attachment 1 HCO2 (d)
Guidance Care Center, Inc, Page I of40 Contract No. PPG-2-03
t� South Florida
Behavioral
2Health 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:
tt a .. cf state fl.usl ro ra stsa / u s reports 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.
(11) "Department" means the State of Florida Department of Children and Families.
(12) -Evaluation Plan" A document that explains and describes program assessment,
improvement, and strategic managementA The evaluation plan explains and describes
program assessment, improvement,, and strategic management. The assessment portion
should address the process for verification and documentation as well as how program
activities and their effects will be quantified, Additionally, areas that can be improved or
enhanced need to be identified to address areas of weakness. The final piece of strategic
management will provide information that can help an agency or organization make
decisions about how resources should be applied in the future to better serve its mission or
goals.
(13) "Evidence -Based" Prevention programs, practices, or strategies in the substance abuse
profession are those that are supported by research. Based on the evidence -based
practices, Center for Substance Abuse Prevention (CSAP) Options of the Strength of
Evidence include:
Option 1) this proposed program or strategy is recognized by a Federal registry of
evidence -based prevention programs and environmental strategies as having a strong and
consistent positive effect on an outcome that is relevant to the identified intermediate
outcome. Federal registries include but are not limited to the National Registry of evidence -
based Programs and Practices (NREPP) with relevant element scores; Blueprints for
Violence Prevention; Models of Exemplary, Effective and Promising Alcohol or Other Drug
Abuse Prevention Programs on College Campuses; Blueprints for Healthy Youth
Development; California evidence -based Clearinghouse for Child Welfare; U.S., Substance
Abuse and Mental Health Services Administration's (SAMHSA) National Registry of
evidence -based Programs and Practices; or The US Department of Health and Human
Services.
Option 2) this proposed program or strategy is reported in two or more peer -reviewed
journals as having positive effects on an outcome that is relevant to the identified
intermediate outcome. Provide a detailed description of the evidence of a positive effect on
an outcome that is relevant to the identified intermediate outcome and how the relevance
was determined..
(14) "Evaluation Plan" A document that explains and describes program assessment,
improvement., and strategic management. The evaluation plan explains and describes
program assessment, improvement, and strategic management. The assessment portion
Attachment 1 HCO2 (d)
Guidance Care Center., Inc. Page 2 of 40 Contract No. PPG-2-03
South Florida
Behavioral
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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.
05) "Evidence -Based. Prevention programs, practices, or strategies in the substance abuse
profession are those that are supported by research. Based on the evidence -based
practices, Center for Substance Abuse Prevention (CSAP) Options of the Strength of
Evidence include:
Option 1) this proposed program or strategy is recognized by a Federal registry of
evidence -based prevention programs and environmental strategies as having a strong
and consistent positive effect on an outcome that is relevant to the identified
intermediate outcome. Federal registries include but are not limited to the National
Registry of evidence -based Programs and Practices (NREPP) with relevant element
scores; Blueprints for Violence Prevention; Models of Exemplary, Effective and
Promising Alcohol or Other Drug Abuse Prevention Programs on College Campuses;
Blueprints for Healthy Youth Development; California evidence -based Clearinghouse for
Child Welfare; U-S, Substance Abuse and Mental Health Services Administration's
(SAMHSA) National Registry of evidence -based Programs and Practices; or The US
Department of Health and Human Services„
• Option 2) this proposed program or strategy is reported in two or more peer -reviewed
journals as having positive effects on an outcome that is relevant to the identified
intermediate outcome. Provide a detailed description of the evidence of a positive effect
on an outcome that is relevant to the identified intermediate outcome and how the
relevance was determined,
(16) "Fidelity" is the degree to which the evidence -based practice implemented adheres to the
Practice's implementation design.
(17) "Harmful Consequences" Negative effects caused by drug use, such as diseases, fatalities,
academic failures; and criminal behavior.
(18) "HIPAA" is the acronym for Health Insurance Portability and Accountability Act (42 U.S.0
1320d, and 45 CFR Parts 160, 162, and 164):.
(19) "Local Match" means funds received from governing bodies of local government, including
city commissions, county commissions, district school boards, special tax districts, private
hospital funds„ private gifts both individual and corporate, bequests and funds received
from community drives or any other sources. See section 394.67(14), F.S. and 65E-14.005,
F_A,C.
(20) "Managing Entity (ME)" means pursuant to section 394.9082(2)(d), F.S., a corporation
that is organized in the State of Florida, is designated or filed as a non-profit organization
under section 501(c)(3) of the Internal Revenue Code, and is under contract to the
Department to manage the day-to-day operational delivery of behavioral health services
through an organized system of care.
(21) "Needs Assessment Logic Model (NALM) A visual depiction of the relationships between
risk and protective factors, drug consumption, and harmful consequences. A logic model
Attachment 1 HCO2 (d)
Guidance Care Center, Inc. Page 3 of 40 Contract No. PPG-2-03
&South Florida
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1000 Health Network, Inc.
visually demonstrates the causal mechanisms and interconnections between variables
using arrows to show the direction of influence.
(22) "Network Provider" is an entity that Contracts with the ME and receives funding to provide
services to clients; in this contract the network provider is synonymous with provider
or subcontractor_
(23) "Outcome" is a change in behavior, physiology® attitudes„ or knowledge that can be
quantified using standardized scales or assessment tools. In the context of NREPP,
outcomes refer to measurable changes in the health of an individual or group of people that
are attributable to the intervention.
(24) "Outcome evaluation'" is an evaluation to determine the extent to which an intervention
affects its participants and the surrounding environments. Several important design issues
must be considered, including how to best determine the results and how to best contrast
what happens as a result of the intervention with what happens without the program.
(25) "Participant" is means any individual who takes part in targeted substance abuse
prevention programs, activities or services which are paid, in part or in whole, by the
Department through the ME.
(26) "Performance Measures" are quantitative indicators, outcomes and outputs that are used
by the Department to objectively measure performance and are used by the ME and
Network Providers to improve services_
(27) Prevention, A process involving strategies aimed at the individual or the environment
which preclude, forestall, or impede the development of substance abuse problems and
promote healthy development of individuals, families and communities as defined in Rule
65E-14.021(4) (v) — (y).
(28) "Prime Contract" is the contract between the Department of Children and Families and the
ME.
(29) "Program Description" is the document the Network Provider prepares and submits to the
ME for approval prior to the start of the contract period, which provides a detailed
description of the services to be provided under the contract pursuant to Rule 65E-14,021,
F.A.C. It includes but is not limited to the Network Provider's organizational profile, a
detailed description of each program and cost center funded in the contract, the
geographic service area, service capacity, staffing information, and client and target
population to be served.
(30) "Prorated Share" is the total number of unpaid units or funds divided by the number of
months remaining between the time the prorated share is calculated and the end date of
the contract.
(31) "Protected Health Information" (PHI) is any information whether oral or recorded in any
form or medium that is created or received by a health care provider„ health plan,. public
health authority, employer, life insurer, school or university, or health care clearinghouse;
and relates to the past, present, or future physical or mental health or condition of an
individual; the provision of health care to an individual; or the past, present, or future
payment for the provision of health care to an individual.
(32) "Provider Network" (subcontractor or Network Provider) is the direct service agencies that
are under contract with a ME and that together constitute a comprehensive array of
Attachment 1 HCO2 (d)
Guidance Care Center, Inc. Page 4 of 40 Contract No. PPG-Z03
South Florida
PJAO-A's, Behavioral
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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 ImprovementlContinuous Quality Improvement" is a management technique to
assess and improve internal operations and network services. It focuses on organizational
systems rather than individual performance and seeks to continuously improve quality, The
process involves setting goals implementing systematic changes„ measuring outcomes,
and making subsequent appropriate improvements. Quality improvement activities will
assess compliance with contract requirements, state and Federal law and associated
administrative rules, regulations, and operating procedures and validate quality
improvement systems and findings,
(35) "SAMH" means the Substance Abuse and Mental Health Programs within the Department
(36) "SAVENIS Program is the U.S. Department of Homeland Security (DHS) administers the
Systematic Alien Verification for Entitlements (SAVE) program- This program verifies
immigration status and eligibility of alien applicants for federal benefits. The alien status
verification system under SAVE is entitled the Alien Status Verification Index (ASVI), as
described at 60 Federal Register 52694, 52697 (1995) administered by the Computer
Sciences Corporation (CSC) as the Verification Information System (VIS), The SAVENiS
Program can and may provide assistance in verifying eligibility in cases where a client does
not possess sufficient documentation.
(37) "Service Units" are those units of measure specified in Rule 65E-14.021, F,A,C. and in the
Substance Abuse Recovery Support Services, Adult Comprehensive Community Service
Teams, Children''s Comprehensive Community Service Teams and Clinical Supervision for
Evidence Based Practices exhibits.
(38) "Stakeholder(s)" are individualstgroups 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 1 HCO2 (d)
Guidance Care Center, Inca Page 5 of40 Contract No. PPG-2-03
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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 Careis defined pursuant to section 397.311, F.S., and interpreted to include
the comprehensive array of Behavioral Health Services per section 394.9082(1)(e), F.S.,
that includes the following elements:,
i.
Prevention and early intervention;
ii.
Emergency care;
iii.
Acute care;
iv.
Residential treatment;
V.
Outpatient treatment;.
vi.
Rehabilitation,;
vii.
Supportive intervention;
vill.
Recovery support; and
ix.
Consumer support services.
Services provided as the SOC must be assessable and responsive to the needs of
individuals' substance, their families, and community Stakeholders.
(42) Target Population. The PPG target population is students ages 0 to 20. Parents, teachers
and other school staff, coaches, social workers, case managers, and other prevention
stakeholders may also be the target of proposed activities because of their ability to
influence students ages 0 to 20. Activities that target the behavior of these stakeholders for
change can be considered process measures. Approved performance measures, on the
other hand, must measure improvements in the attitudes and behaviors of students ages 0
to 20.
(43) "Verifiable Service" is a service provision that is documented in compliance with the
requirements contained in Rule 65E-14.021, F.A.C.
2. General Description
General Statement
The Prevention Partnership Grants (PPG) program, created by s. 397.99, F.S., is
designed to encourage school and community substance abuse prevention
partnerships. The PPG program is funded through the federal Substance Abuse
Prevention and Treatment Block Grant (Block Grant), administered by the Florida
Department of Children and Families (Department) and contracted through this
contract with the ME.
Attachment i HCO2 (d)
Guidance Care Center, Inc. Page 6 of 40 Contract No. PPG-2-03
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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
Section 394.9082, F.S., Prevention Partnership Grant Request for Applications #LHZ03, and the
Prime Contract provides the ME with the authority to contract for these services,.
b. Scope of Service
The following scope of service applies to the contract period and any renewal or
extension:
(1) The Network Provider is responsible for the administration and provision of services to the
target population(s) indicated in Exhibit A, Clients/Participants to be Served, and in
accordance with the tasks outlined in Section B.1.a., of this contract. Services shallalso 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 1 HCO2 (d)
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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 1 HCO2 (d)
Guidance Care Center. Inc. Paget of 40 Contract No. PPG-2-03
► South Florida
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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 Repo : 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
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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 ticense(s) until
said license(s) are reinstated by the Department of Children and Families:
(9) By 1111312015, 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 1111312015. 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 emergencyldisaster plan and reporting on preparedness activities, response
activities, and post -recovery activities.
(12) By 11/1312016. 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 part icipantslconsumers 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.
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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
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report on the continuous quality improvement activities as required in Section B.1.a.
(17) and (19) respectively. The program is the responsibility of the Director and is
subject to review and approval by the governing board of the service Network Provider,
Each director shall designate a Quality Assurance Officer/Compliance Officer who will
be responsible for the continuous quality improvement program.
The continuous quality improvement program should objectively and systematically
monitor and evaluate the appropriateness and quality of care to ensure that services
are rendered consistent with prevailing professional standards„ and identify and resolve
problems,.
(b) The quality improvement program must include at minimum.-
i. Activities to ensure that fraud, waste and abuse do not occur:
ii. Composition of quality assurance review committees and subcommittees,
purpose,, scope, and objectives of the continuous quality assurance committee
and each subcommittee; frequency of meetings, minutes of meetings; and
documentation of meetings -
III. A framework for evaluating outcomes, including:
I. 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
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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:
L 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
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system of care that incorporates comprehensive assessment tools that identify those affected
by trauma and a system of care that meets their needs. Network Providers will be
implementing the Trauma Informed Care (TIC) initiative through a continuous quality
improvement plan or component in the existing agency wide continuous quality improvement
plan that delineates participation in the TIC initiative. As part of the plan or component of the
plan must include the following:
Identification of at least two TIC Champions at the beginning of the contract term and
submit the names of the individuals when requested by ME staff.
ii. By 03/01/2016 Completion of an annual agency -wide self -assessment using the Fallot
Assessment Tool. The results of the self -assessment must be submitted by April 1,
2016, to the individual(s) identified in Exhibit C-1, Required Reports for PPG.
Iii. Provide an annual action plan which outlines all of the components/activities identified
in agency's annual self -assessments for the TIC initiative.
iv. Participation in the regional TIC meetings to develop the process for identifying and
responding to those affected by trauma.
V. Attendance at the regional trainings regarding TIC as applicable. Applicable trainings
will be documented in the Continuous Quality Improvement Updates,
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
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(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;
V1. 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;
vill. 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
I. The Network Provider will ensure that behavioral health services are available to clients
referred by the Community Based Care Organizations (CBC) or by the Department's
Child Protective investigators in cases where behavioral health indicators are present
during the initial child abuse/neglect investigation or at any point during child protective
supervision or out -of -home care. Priority will be given to cases where a child is at risk
for immediate removal or has been removed from the family„ with a goal of reunification
in the family safety plan.
Services may also be provided for the enrolled parent(s)Icaregiver(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
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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 CWl 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 11/0212015, the Network Provider shall submit to the ME's contract manager a Quality
Assurance Plan that details how the Network Provider will ensure and document that quality
services are being provided to the clients served, which is herein incorporated by reference.
This requirement may be waived if the Network Provider has submitted a Quality Assurance
Plan as a requirement of any other contract held between the Network Provider and the ME for
the current fiscal year. The Network Provider shall submit updates as amended of the Quality
Assurance Plan within thirty (30) days of adoption. The Quality Assurance Plan should address
the minimum guidelines for the Network Provider's continuous quality improvement program,
including, but not limited to:
(a) Individual care and services standards to include transfers and referrals, co-occurring
supportive services, trauma informed services, and cultural and linguistic competence,
(b) Individual records maintenance and compliance..
(c) Staff development standards,
(d) Service -environment safety and infection control standards.
(e) Peer review and utilization management review procedures,
(f) Incident reporting policies and procedures that include verification of corrective action
and a provision that specifies that a person who files an incident report, in good faith„
may not be subjected to any civil action by virtue of that incident report.
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(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 componentslactivities 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);
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Networking capacities with local providers in the community for persons with
trauma;
iii. Strategies and activities to develop or improve TIC service capability;
iv. Scope of services and programs to be included in the process; and
V. Timeframes for reviewing TIC capability within each Network Provider program
(d) Evidence of the implementation of Cultural and Linguistic Competence, including
progress on the implementation of the Cultural and Linguistic Competence Action Plan.
(e) Evidence of the progress on steps to taken towards meeting the requirement to become
an accredited provider or meet the CARF Standards for Unaccredited Providers.
(f) Document participation in trainings and activities relating to the Child Welfare Integration
Initiative.
(21)Financial Audit Reports
(a) The Network Provider shall submit quarterly financial statements consisting of Balance
Sheet and Statement of Activity (income statement) per the schedule and to the
individual(s) identified in the Exhibit C-1, Required Reports for PPG. The Network
Provider agrees to provide the ME with any requests for additional financial
statements/documentation:
(b) Network Providers who withhold income taxes, social security tax, or Medicare tax from
employee's paychecks or who must pay the employer's portion of social security or
Medicare tax must use Form 941, Employer's Quarterly Federal Tax Return, to report
those taxes. On a quarterly basis., and by the dates specified in Exhibit C-1, Required
Reports:, the Network Provider, shall submit an attestation that the 941 has been filed
timely and any taxes due have been paid timely to IRS.
(c) Quarterly and Final Expenditure Report: The Network Provider shall submit a
quarterly expenditure report to by the dates and to the individuals identified in Exhibit C-
1, Required Reports for PPG. The expenditure report will track program expenses that
are associated with the grant and reconciles these expenditures with the payments
made to the Network Provider. The expenditure report will track both grant award -
funded and match -funded expenses.
The Network Provider shall return to the ME any unused PPG funds and unmatched
grant funds no later than sixty (60) days following the end of each fiscal year.
(d) The Network Provider shall complete and submit the Department -approved Local Match
Calculation Form, per the schedule and to the individual(s) identified in the Exhibit C-1
Required Reports for PPG. The Department -approved Local Match Calculation Form is
available at the following website:
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httpWsfbhn,o. d: - ■ a ;2-es a
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(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:
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 andlor meetings as required by the ME;
meet with the ME's staff at regularly scheduled or specially called meetings when notified by the
ME.
(26)The Network Provider shall maintain in one place for easy accessibility and review by ME and/or
Department staff all policies, procedures, tools, and plans adopted by the Network Provider,
The Network Provider's policies, procedures, and plans, must conform to state and federal laws,
the Florida Administrative Code, state and federal regulations„ state and federal rules, and
minimally meet expectations/ requirements contained in applicable Department of Children and
Families and ME operating procedures.
(27) The Network Provider shall maintain a mechanism for monitoring, updating, and disseminating
policies and procedures regarding compliance with current government laws, rules; practices;
regulations, and the ME's policies and procedures.
(28) Develop and Disseminate Consumer Manual
The Network Providers shall assist the ME in developing and maintaining a manual for
service recipients which includes information about access procedures„ recipient rights and
responsibilities (including grievance and appeal procedures). This information will be available
for use by the consumers within each subcontractor location.
(29) Work and Social Opportunities
The Network Provider will employ Peer Services Coordinators to develop work and social
opportunities for clients and make recommendations to the ME and subcontractors for a
consumer -driven system.
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(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;
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(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
u) Full compliance with federal and state laws, rules and regulations pertaining to security
and privacy of protected health information.
b. Task Limits
The Network Provider shall perform services in accordance with applicable, rules, statutes, licensing
standards the approved Prevention Program Description and with the deliverables as set forth in The
Network Provider is not authorized by the ME to perform any tasks related to the project other than
those described and referenced in in this contract, without the express written consent of the ME.
2. Staffing Requirements
(a) Staffing Levels
(1) The Network Provider shall maintain staffing levels in compliance with applicable rules„
statutes, and licensing standards. See Exhibit F, State and Federal Laws, Rules and
Regulations.
(2) The Network Provider shall engage in recruitment to maintain as much as possible staff with
the ethnic and racial composition of the clients/participants served.
(b) Professional Qualifications
0) 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(l)(b)-(c), F.S. For the purposes
of this contract, "Mental health personnel" includes all program directors, professional
clinicians, staff members,, and volunteers working in public or private mental health programs
and facilities who have direct contact with individuals held for examination or admitted for
mental health treatment.
(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 1 HCO2 (d)
Guidance Care Center. Irrc Page 21 of40 Contract No. PPG-2-03
10000 South Florida
Behavioral
Health Network, Inc.
s. 39.001(2), (a) and (b) F.S which states the fallowing:
a. If the department contracts with a provider for any program for children, all personnel,
including owners, operators, employees, and volunteers, in the facility must be of good
moral character. A volunteer who assists on an intermittent basis for less than 10 hours
per month need not be screened if a person who meets the screening requirement of
this section is always present and has the volunteer within his or her line of sight.
b. The department shall require employment screening, and rescreening no less frequently
than once every 5 years, pursuant to chapter 435, using the level 2 standards set forth
in that chapter for personnel in programs for children or youths.
(c) Staffing Changes
The Network Provider shall notify the ME's contract manager, in writing within ten (10) calendar days of
staffing changes regarding the positions of Chief Executive Officer, Chief Financial Officer, Medical
Director, and Clinical Director, IT Director, Dispute Resolution Officer, Data Security Officer, Single Point
of Contact in accordance with Section 504 of the Rehabilitation Act of 1973 as required by Paragraph
33. of the Standard Contract, or any individuals with similar functions. Additionally; the Network Provider
will notify the ME's contract manager in writing;, of changes in the Executive Director or any senior
management position-
(d) Subcontractors
(1) This contract allows the Network Provider to subcontract for the provision of services related
to the performance required under this Contract, subject to the provisions relating to
Assignments and Subcontracts in the Standard Contract and referenced therein. Written
requests by the Network Provider to subcontract for the provision of services under this
contract will be routed through the ME's contract manager for approval. The ME is not
obligated nor will it pay for any services delivered prior to its written approval of the act of
subcontracting. The act of subcontracting shall not in any way relieve the Network Provider
of any responsibility for the contractual obligations of this contract. The pre -approval process
applies to Subcontractors and not Independent Contractors as defined below.
(2) The ME has adopted the following definitions for vendors, subcontractors and/or independent
contractors who are contracted by the Network Provider to do work contemplated under this
contract:
(a) Vendor: A person or company offering something for sale.
(b) Subcontractor: A business to business relationship; contracting a business or person
outside of one's own company to do work as part of a larger project.
(c) Independent Contractor: a person who is in an independent trade, business, or
profession in which they offer their services and/or expert advice to an individual or
organization. The general rule is that an individual is an independent contractor if the
payer has the right to control or direct only the result of the work and not what will be
done and how it will be done. The earnings of a person who is working as an
independent contractor are subject to Self -Employment Tax.
(3) The United States Public Health Service Act, Sections 1931(a)(1)(E), and 1916 (a)(5), and
Title 45 of the Code of Federal Regulations, Part 96.135(a)(5) prohibit States from expending
Attachment 1 HCO2 (d)
Guidance Care Center, Inc. Page 22 of 40 Contract No. PPG-2-03
® South Florida
Behavioral
Health Network, Inc.
Substance Abuse Prevention and Treatment Block Grant (SAPTBG) and Community Mental
Health Services funds "To provide financial assistance to any entity other than a public or
non-profit private entity". Ordinarily, the term "financial assistance" is used to describe a
grant relationship as distinguished from a procurement relationship, typically funded by
contract. While the above -referenced statute and regulations preclude States from providing
grants to for -profit entities, procurement contracts may be entered into with for -profit entities -
This is the latest interpretation from the United States Department of Health and Human
Services Substance Abuse and Mental Health Services Administration (41512009)e [PHS Act,
ss. 1931(a)(1)(E), and 1916 (a)(5), and 45 CFR, Part 96.135(a)(5)]d
tt Hsfbhn.oLqfwordl?ress/wp-content/uploads/SAMI-iSA-Guidance-on-SAPT-and:gMHSBG-
RgqUkgM2ntL2!Lft
(4) Any vendor, subcontractor, or independent contractor the Network Provider contracts to do
work contemplated under this contract, and who meets the definition of a Business Associate
as defined in 45 CFR 160.103, must sign a legally binding document with the Network
Provider that contains the same restrictions and conditions of the Business Associate
Agreement between the Network Provider with the ME. The binding document must meet the
requirements of 45 CFR s.164.504(e), Standard: Business Associate Contracts, the Privacy
Rule, the Security Rule, the Breach Notification Rule, the Health Information Technology for
Economic and Clinical Health ("HITECH") Act, the provisions included in the Network
Provider's Business Associate Agreement with the ME, the ME's contractual requirements,
and other laws and regulations pertaining to access, use, disclosure„ and management of
Protected Health Information ("PHI") without limitation, PHI in an electronic format (EPHI)
created, received, maintained, or transmitted by the Network Provider or its subcontractors
incidental to Network Provider's performance of this Contract,
(5) All agreements, for services contemplated under this contract, shall adopt the applicable
terms and conditions of the Network Provider's contract with the ME, including but not limited
to, any Federal block grant requirements. In addition, all subcontract agreement's shall
contain the applicable terms and conditions, and any amendments thereto, found in the ME's
contract with the Department (Prime Contract), which is incorporated herein by reference.
Subcontract agreements shall include a detailed scope of work; term of the agreement,
method of payment, clear and specific deliverables; and performance standards.
(6) The Network Provider shall maintain individual subcontractor files for each subcontractor and
provide a copy of all subcontracts agreements prior to the execution of those subcontracts
and any amendments to the ME's contract manager-
(7) All independent contractor agreements, and subcontractor agreement, vendor agreements,
and business associate agreements, or other legally binding agreements, for work
contemplated under this contract shall be available upon request by ME staff and at the time
of monitoring.
(8) The Network Provider shall implement and maintain procedures for subcontract procurement,
development, performance, and management that comply with state and federal rules,
regulation„ and/or ME policies and procedures; in addition to identifying the ME's pre -approval
process for approving the Network Providers act of subcontracting.
(9) The Network Provider shall not subcontract for substance abuselmental 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 1 HCO2 (d)
Guidance Care Center; Inc. Page 23 of40 Contract No. PPG-2-03
Pp South Florida
Behavioral
Health Network, Inc.
entity,or has been barred„ suspended, or otherwise prohibited from doing business with any
government entity within the last 5 years,
(b) is under investigation or indictment for criminal conduct, or has been convicted of any
crime which would adversely reflect on their ability to provide services, or which adversely
reflects their ability to properly handle public funds;
(c) is currently involved„ or has been involved within the last 5 years, with any litigation,.
regardless of whether as a plaintiff or defendant, which might pose a conflict of interest to the
department, the state or its subdivisions, or a federal entity providing funds to the department;
(d) had a contract terminated by the department or ME for failure to satisfactorily perform or
for cause, or,
(e) failed to implement a corrective action plan approved to the satisfaction of the ME, the
department,, and other governmental entities, after having received due notice.
(10) Unless the Department agrees to an alternative payment method as authorized in section
394,9082, F.S., and prior to entering into any subcontract, or an amendment which modifies
the previously negotiated unit cost rate or adds additional covered services, the Network
Provider shall conduct a cost analysis for said subcontract, in accordance with Rule 65E-14.
F.A,C, A cost analysis is the review of the proposed cost elements to determine if they are
necessary, allowable, appropriate and reasonable. Subcontractors will be required to comply
with Rule 65E-14.19, F.A.C., Methods of Paying for Services, including but not limited to,
covered services, measurement standard, descriptions, program areas, data elements,
maximum unit cost rates, required fiscal reports, program description, setting unit cost rates,
payment for services including allowable and unallowable units and requests for payments.
(11) The Network Provider shall monitor the performance of all subcontractors, and perform
follow up actions as necessary. The Network Provider shall notify the ME immediately upon
discovery hours of conditions related to subcontractor performance that could impair
continued service delivery.
3. Service Location and Equipment
a. Service Delivery Location
The location of services will be as specified in the approved Prevention Program Description
required by Rule 65E-14, F.A.C. and/or as specified in ..
b. Service Times
(1) A continuum of services shall be provided on the days and times as specified in the
approved Program Description and/or.
(2) The Network Provider shall notify the ME's contract manager, in writing, at least ten (10)
calendar days prior to any changes in days and times where services are being provided
pursuant to Rule 65E-14, F.A.C.
c. Changes in Location
The Network Provider shal
calendar days prior to any
Rule 65E-14, F.A.C.
I notify the ME's contract manager, in writing, at least ten (10)
changes in location where services are being provided pursuant to
Attachment 1 HCO2 (d)
Guidance Care Center, Inc. Page 24 of40 Contract No. PPG-2-03
South 1Fiorida
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 clientlparticipant
confidentiality in accordance with ss. 397.501(7), 394.455(3), 394.4615, and 414.295, F.S., and also the
Health Insurance Portability and Accountability Act (HIPAA), 42 CFR Part 2, and any other applicable
State, and Federal laws, rules, and regulations.
c. Reports
Where this contract requires the delivery of reports to the ME, mere receipt by the ME shall not be
construed to mean or imply acceptance of those reports. It is specifically intended by the parties that
acceptance of required reports shall require a separate act in writing. The ME reserves the right to reject
reports as incomplete, inadequate, or unacceptable according to the parameters set forth in the
resulting contract. The ME, at its sole option, may allow additional time within which the Network
Provider may remedy the objections noted by the ME or the ME may, after having given the Network
Provider a reasonable opportunity to comply with the report requirements, declare this agreement to be in
default.
(1) The Network Provider shall submit to the ME financial and programmatic reports specified in
Exhibit C-1, Required Reports for Prevention Partnership Grant„ by the dates specified or as
requested by ME staff.
(2) Upon request, the network provider shall submit to the ME and the Department information
regarding the amount and number of services paid for by the Substance Abuse Prevention and
Treatment Block Grant.
(3) The Network Provider shall provide performance information or reports other than those required by
this agreement at the request of the ME, the Southern Region's SAMH Regional Director, or their
designee. For requests that are complex and difficult to address, all parties will develop and implement a
Attachment 1 HCO2 (d)
Guidance Care Center, Inc: Page 25 of 40 Contract No. PPG-2M
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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 website7
,4 - M # #. r 1 - I - -. - R- .. i -
(6) In addition to utilizing the modifiers to procedure codes for block grant funds identified in Section B.
4. (5) above„ the Network Provider, upon request by the ME or the Department, shall submit information
regarding the amount and number of services paid for by the Community Mental Health Services Block
Grant and/or the Substance Abuse Prevention and Treatment Block Grant, if such funding is received,
(7) The Network Provider shall submit prevention services data to PBPS or other data/reporting system
designated by the ME. The data shall be submitted electronically no later than the 4th of each month
following the month of service- The Network Provider shall also:
(a) Ensure that the data submitted clearly documents all program participants, programs, and
strategies which occurred under this contract.
(b) Ensure that one -hundred percent (100%) of all data submitted to PBPS, or other designated
reporting system„ is consistent with the data maintained in the Network Providers service
documentation and od client files.
(c) Resubmit corrected records no later than the next monthly submission deadline. The failure to
submit any data set or the Network Providers total monthly submission per data set, which results
in a rejection rate of 54 or higher of the number of monthly records submitted will require the
Network Provider to submit a corrective action plan describing how and when the missing data will
be submitted or how and when the rejected records will be corrected and resubmitted; and
(d) In accordance with the provisions of section 402-73(1), F. S., and Rule 65-29.001, F.A.C.,
corrective action plans may be required for non-compliance, nonperformance, or unacceptable
performance under this contract. Penalties may be imposed for failures to implement or to make
acceptable progress on such corrective action plans. Failure to implement corrective action plans
to the satisfaction of the ME and after receiving due notice, shall be grounds for contract
termination.
(8) Upon request, the Network Provider shall submit to the ME and/or the Department, information
regarding the amount and number of services paid for by Substance Abuse Prevention and Treatment
Block Grant.
5. Performance Specifications
a. Performance Measures
(1) The Network Provider shall meet the performance standards and required outcomes as specified
in Exhibit D, Substance Abuse and Mental Health Required Performance
Outcomes/Outputs and as outlined in.
Attachment I HCO2 (d)
Guidance Care Center, Inc, Page 26 of40 Contract No. PPG-2-03
South Florida
Behavioral
Health Network, Inc.
(2) The Network Provider agrees that the ODH, PBPS, and SAMHIS, or other data repotting 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:
(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: tt :I/cfd sor.dcf.tate.fl.usl. 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 of40 Contract No. PPG-2d03
&South Florida
1000 Behavioral
Health Network, Inc.
(2) In the event of a dispute as to the ME's determination regarding client/participant eligibility and/or
placement into the appropriate level of care, the ME's dispute resolution process, incorporated herein
by reference and available upon request from the ME's contract manager, shall be followed. An
eligibility dispute shall not preclude the provision of services to Individuals Served, unless the dispute
resolution process reverses the ME's determination.
(3) The Network Provider is responsible for the satisfactory performance of the tasks referenced in
this contract. By executing this contract, the Network Provider recognizes its responsibility for the
tasks, activities, and deliverables described herein and warrants that it has fully informed itself of all
relevant factors affecting the accomplishment of the tasks, activities and deliverables and agrees to
be fully accountable for the performance thereof whether performed by the Network Provider or its
subcontractors.
(4) The Network Provider agrees that services other than those set out in this contract will be
provided only upon receipt of a written authorization from the ME's contract manager or an
authorized ME staff member. The department through the ME has final authority to make any and
all determinations that affect the health safety and well-being of the residents of the State of
Florida.
(5) The Network Provider shall be responsible for the fiscal integrity of all funds under this
contract, and for demonstrating that a comprehensive audit and tracking system exists to account
for funding by client/participant, and have the ability to provide an audit trail. The Network
Provider's financial management and accounting system must have the capability to generate
financial reports on individual service recipient utilization, cost, claims, billing, and collections for
the ME. The Network Provider must maximize all potential sources of revenue to increase
services, and institute efficiencies that will consolidate infrastructure and management functions in
order to maximize funding.
(6) The Network Provider shall ensure that the invoices submitted to the ME reconcile with the
amount of funding and services specified in this contract, as well as the Network Provider's agency
audit report and client/participant information system and reconciled with ODH, PEPS„ or other data
reporting system designated by the ME.
(7) The Network Provider shall make available source documentation of units billed by Network
Provider upon request from the ME staff. The Network Provider shall track all units billed to the ME by
program and by Other Cost Accumulator (OCA).
(8) The Network Provider receives federal block grant funds from the Substance Abuse Prevention
and Treatment or Community Mental Health Block Grants and by signing this contract agrees to
comply with Subparts 1 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 1 HCO2 (d)
Guidance Care Center; Inc. Page 28 of40 Contract No. PPG-2-03
South Florida
Behavioral
Health Network, Inc.
to assure accountability of service provision and/or the expenditure of state and federal funds.
(11)The Network Provider shall assist the ME and the Department in developing legislative budget
requests based upon identified needs of the community.
02)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 andlor 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 1 HCO2 (d)
Guidance Care Center., Inc. Page 29 of 40 Contract No. PPG-2-03
South Florida
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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:
(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
i f • 41 11 TIMi 4 ! R ■ i�
b. Coordination with other Providers/Entities
(1) The Network Provider shall develop, maintain, and improve care coordination and
integrated care systems as follows:
0) 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 famillies involved in the child
welfare system by providing integrated community support and services.
Attachment 1 HCO2 (d)
Guidance Care Center, Inc. Page 30 of 40 Contract No. PPG_2-03
® South Florida
Behavioral
Health Network, Inc.
(2) The failure of other providers or entities does not relieve the network provider of any
accountability for tasks or services that the Network Provider is obligated to perform pursuant
to this contract.
c. State and Federal Laws, Rules, and Regulations
See Exhibit F, State and Federal Laws, Rules and Regulations.
7. ME Responsibilities
a. ME Obligations
(1) The ME shall only subcontract with entities that are fiscally sound, and that can adequately
ensure the accountability of public funds.
(2) The ME shall assess the Network Provider's financial stability, using a risk assessment
approach;, the risk assessment approach will examine the impact of programmatic requirements
on the Network Provider's financial stability,. Any issues identified as a result of the financial risk
assessment shall be reported to the Department during the quarterly/monthly reconciliation and
performance review identified in the Prime Contract.
(3) The ME will: provide administrative and programmatic oversight to ensure that the Network
Provider comply with all consumer -related services and other requirements of this contract.
(4) The ME is solely responsible for the oversight of the Network Provider and
enforcement of all terms and conditions of this contract. Any and all inquiries and/or issues
arising under this contract are to be brought solely and directly to the ME for consideration and
resolution between the Network Provider and the ME In any event, the ME's decision on all
issues is final and solely subject to the ME's appeal process and legal rights of the Network
Provider,
(6) 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 E13Ps, 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 EI3Ps, improved performance and outcomes„ expansion of the service array,
and necessary infrastructure development.
b. Monitoring Requirements
Attachment 1 HCO2 (d)
Guidance Care Center, Inc. Page 31 of 40 Contract No. PPG-2-03
&'Mire ie. South Florida
Behavioral
Health Network, Inc.
(1) The ME will monitor the Network Provider in accordance with this contract and the ME's
Contract Accountability Policies and Procedures which can be obtained from the designated
ME contract manager, and is incorporated herein by reference: The Network Provider shall
comply with any coordination or documentation required by the ME's monitor(s) to successfully
evaluate the programs, and shall provide complete access to all budget and financial
information related to services provided under this contract, regardless of the source of funds.
(2) Network Providers with electronic health record (EHR) or electronic medical record systems
(EMR) shall provide access to ME funded service and clienUparticipant 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
0)The ME's contact manager, or designee, will provide training and technical assistance
concerning the terms and conditions of this contract.
(2) The ME will provide technical assistance and support to the Network Provider to ensure the
continued integration of services and support for clients/participants„ to include but not limited to,
quality improvement activities to implement evidenced -based practice treatment protocols, the
application of process improvement methods to improve the coordination of access and services
that are culturally and linguistically appropriate.
(3) The ME will provide technical assistance and support to the Network Provider for the
maintenance and reporting of data on the performance standards that are specified in Exhibit D,
Substance Abuse and Mental Health Required Performance Outcomes/Outputs. In
addition, the ME may convene cross -organizational training and assistance to help non -
accredited Network Providers become accredited.
(4) The ME implements a training program for its staff and the Network Provider staff, The
trainings assure that staff receives externally mandated and internal training. The ME may
coordinate training or directly provide training to Network Provider staff.
d. ME Determinations
The ME has exclusive authority to make the following determination(s) and to set the procedures that
the Network Provider shall follow in obtaining the required determination(s):
Attachment 1 HCO2 (d)
Guidance Care Center, Inc. Page 32 of 40 Contract No. PPG-2-03
South Florida
Behavioral
Health Network, Inc.
(1) Whether the Network Provider is meeting the terms and conditions of this contract, to
include the Standard Contract, Attachment I, any documents incorporated into any attachment
by reference, Program Description, and any documents incorporated by herein by reference.
(2) The ME reserves the exclusive right to make certain determinations in these
specifications. The absence of the ME setting forth a specific reservation of rights does not
mean that all other areas of this contract are subject to mutual agreement. The ME reserves
the right to make exclusively any and all determinations that it deems are necessary to protect
the best interests of the State of Florida and the health, safety, and welfare of the
clients/participants who are served by the ME either directly or through any one of its
contracted Network Providers.
(3) In the event of any disputes regarding the eligibility of individuals served, the determination
made by the ME is final and binding on all parties.
C. Method of Payment
Exhibit B, Method of Payment
Exhibit E, Monthly Payment Request (Incorporated herein by reference and available at
following website: http //s hn org/providers/co tracts/
Exhibit G, Covered Service Funding by OCA
Exhibit H, Funding Detail and Local Match
D. Special Provisions
1. The Network Provider is expected to reduce its administration cost to 10.00% or less for Fiscal Year
2015-2016 for SAMH services purchased under this contract. The cost savings shall be reallocated to
support the increase of direct services, improved access to quality care, promotion of service continuity,
and the implementation and/or expansion in the use of evidence -based practices. The Network Provider's
SAMH Projected Operating and Capital Budget (CF-MH 1042, July 2014, Rule 65E-14.021(5), F.A.C.)
shall evidence the reduction and redistribution of the cost savings.
2. Renewal: This is a three (3) year contract, subject to the availability of funds, awarded to the Network
Provider as a result of a successful response to the Florida Department of Children and Families
Prevention Partnership Grant Fiscal Year 2015-2018 Request for Applications (RFA) #LHZ03. This
contract may be renewed only as directed by the Florida Department of Children and Families.: Funding
in Years 2 and 3 are contingent upon compliance with the requirements of the PPG Program and
demonstration of performance towards meeting the grant goals and objectives and the availability
of funds: Any renewal shall be in writing.
3. Incident Reports
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 1 HCO2 (d)
Guidance Care center;. Inc. Page 33 of 40 contract No PPG-2 03
&1South Florida
00000 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.
S. 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 1 HCO2 (d)
Guidance Care Center; Inc. Page 34 of 40 Contract No. PPG-2-03
► South Florida
Behavioral
11000 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.
hito:// fa iiies.c lservice-pro ra s/su stance-abuse/pa hl t-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 (415/2009); [PHS Act, ss. 1931(a)(1)(E), and
1916 (a)(5), and 45 CFR, Part 96135(a)(5)]
http://sfbhn.org/wordp ss/w-conte t/ load s/SAMH S - ui ance-o -SA Tan C
eairements pdf
6. Option for Increased Services
The Network Provider acknowledges and agrees that the contract may be amended to include
additional, negotiated, services as deemed necessary by the ME, Additional services can only be
increased if the Network Provider demonstrates competence in the provision of contractual services and
meets whatever criteria are established by the ME from time to time. The ME in its sole discretion
shall determine at what time and to which Network Provider and what amounts are to be given to
Network Providers for additional services.
7. Sliding Fee Scale
Prevention services are exempt from the Sliding Fee Scale requirements per Rule 65E-14.018,
F.A,C.:
8. Medicaid Enrollment
Those Network Providers with SAMH contracts that meet Medicaid provider criteria and with funding
in excess of $500,000 annually shall enroll as a Medicaid provider. This process shall be initiated
within ninety (90) days of contract execution. A waiver of the ninety (90) day requirement may be
granted, in writing, by the Department's Director of Substance Abuse and Mental Health Program
Office, through the ME:
9. National Provider Identifier (NPI)
a. All Network Providers shall obtain and use an NPI, a HIPAA standard unique health identifier for
health care providers.
b. An application for an NPI may be submitted
https //n pes.c s. s.g ov/NPPES/StaticForward, do?fo rward=st tic. npistart.
c. Additional information can be obtained from one of the following websites:
online at
Attachment 1 HCO2 (d)
Guidance Care Center, Inc. Page 35 of 40 Contract No, PPG-2-03
&r South Florida
Behavioral
1040001 Health Network, Inc.
(1) The Florida Medicaid HIPAA located at: http Wwww.f c.state. .us/hioa i e s t 1
(2) The National Plan and Provider Enumeration System NPPES located at:
tt s://pe.c s.hhs. ovl elc e.do
(3) The CMS NPI located at: http://www.cms.hhs ov/ ational rovi nt Land/
10. Ethical Conduct
The Network Provider understands that performance under this contract involves the expenditure of
public funds from both the state and federal governments, and that the acceptance of such funds
obligates the Network Provider to perform its services in accordance with the very highest standards of
ethical conduct. No employee, director, officer, agent of the Network Provider shall engage in any
business, financial or legal relationships that undermine the public trust, whether the conduct is
unethical, or lends itself to the appearance of ethical impropriety. Network Providers' directors, officers
or employees shall not participate in any matter that would inure to their special gain, and shall recuse
themselves accordingly.
Public funds may not be used for purposes of lobbying, or for political contributions, or for any
expense related to such activities, pursuant to Paragraph 20. of the Standard Contract of this contract.
The Network Provider understands that the ME contracts with the department, and as a subcontractor,
recognizes that the department is a public agency which is mandated to conduct business in the
sunshine„ pursuant to section 286,011, F.S,, and chapter 119, Florida Law, and that all issues relating
to the business of the department, the ME and the Network Provider are public record and subject to full
disclosure, The Network Provider understands that attempting to exercise undue influence on the ME,
the department and its employees to allow deviation or variance from the terms of this contract other
than a negotiated, publicly disclosed amendment, is prohibited by the State of Florida, pursuant to
section 286,011, F.S. The Network Provider's conduct is subject to all state and federal laws governing
the conduct of entities engaged in the business of providing services to government.
11. Information Technology Resources
If applicable, the Network Providers must receive written approval from the ME prior to purchasing any
Information Technology Resource (ITR) with contract funds. The Contract Manager is responsible for
serving as the liaison between the Network Provider and the ME during the completion of the process as
instructed by the Contract Manager.. The Network Provider will not be reimbursed for any ITR purchases
made prior to obtaining the ME's written approval.
12. Programmatic, Fiscal & Contractual Contract File References
All of the documentation submitted by the Network Provider which may include, but not be limited to the
Network Provider's original proposal, Program Description; SAMH Projected Operating and Capital
Budget, Agency Capacity Report, are herein incorporated by reference for programmatic, contractual and
fiscal assurances of service provision. These referenced contractual documents will be part of the
contract manager's file. Documents incorporated by reference in this contract are available in the ME
contract manager's file.
13. Employee Loans
Funds provided by the ME to the Network Provider under this contract shall not be used by the Network
Provider to make loans to their employees, officers, directors and/or subcontractors. Violation of this
provision shall be considered a breach of contract and the termination of this contract shall be in
Attachment I HCO2 (d)
Guidance Care Center, Inc. Page 36 of 40 Contract No, PPG-2-03
. South Florida
Behavioral
Health Network, Inc.
accordance with the Paragraph 40. of the Standard Contract. A loan is defined as any advancement of
money for which the repayment period extends beyond the next scheduled pay period.
14. Travel
The Network Provider's internal procedures will assure that: travel voucher Form DFS-AA-15, State of
Florida Voucher for Reimbursement of Traveling Expenses, incorporated herein by reference, be utilized
completed and maintained on file by the Network Provider. Original receipts for expenses incurred during
officially authorized travel, items such as car rental and air transportation, parking and lodging, tolls and
fares, must be maintained on file by the Network Provider. Section 287.058 (1) (b) F.S., requires that bills
for any travel expense shall be maintained in accordance with Section 112.061, F.S. governing payments
for traveling expenses. CFOP 40-1 (Official Travel of State Employees and Non -Employees) provides
further explanation, clarification, and instruction regarding the reimbursement of traveling expenses
necessarily incurred during the performance of business.
The Network Provider must retain on file documentation of all travel expenses to include the following
data elements: name of the traveler, dates of travel, travel destination, purpose of travel, hours of
departure and return, per diem or meals allowance, map mileage, incidental expenses, signature of
payee and payee's supervisor.
15. Property and Title to Vehicles
a. Property
(1) Nonexpendable property is defined as tangible personal property of a non -consumable
nature that has an acquisition value or cost of $1,000 or more per unit and an expected useful life
of at least one year, and hardback covered bound books that are not circulated to students or the
general public, the value or cost of which is $250 or more. Hardback books with a value or cost of
$100 or more should be classified as nonexpendable property only if they are circulated to students or
to the general public. All computers, including all desktop and laptop computers, regardless of the
acquisition cost or value are classified as nonexpendable property. Motor vehicles include any
automobile, truck, airplane, boat or other mobile equipment used for transporting persons or cargo.
(2) When state property will be assigned to a provider for use in performance of a contract„ the
title for that property or vehicle shall be immediately transferred to the provider where it shall, remain
until this contract is terminated or until other disposition instructions are furnished by the ME's
contract manager. When property is transferred to the provider, the department shall pay for the title
transfer. The providers 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 of40 Contract No PPG-2-.a3
® South Florida
Behavioral
Health Network, Inc.
record the number and description of the components making up the group, name, make, or
manufacturer, serial number(s), if any, and if an automobile, the VIN and certificate number;
acquisition date, original acquisition cost, funding source, information needed to calculate the federal
and/or state share of its cost.
(5) The ME's contract manager must provide disposition instructions to the provider prior to the
end of the contract period. The provider cannot dispose of any property that reverts to the ME or
department without the contract manager's approval. The provider shall furnish a Closeout Inventory
Form no later than 30 days before the completion or termination of this contract. The Closeout
Inventory Form shall include all nonexpendable property including all computers purchased by the
provider. The Closeout Inventory Form shall contain, at a minimum, the same information required by
the annual inventory.
(6) The provider hereby agrees that all inventories required by this contract shall be current and
accurate and reflect the date of the inventory- If the original acquisition cost of a property item is not
available at the time of inventory, an estimated value shall be agreed upon by both the provider and the
ME and shall be used in place of the original acquisition cost.
(7) Title (ownership) to and possession of all property purchased by the provider pursuant to this
contract shall be vested in the ME upon completion or termination of this contract. During the term of
this contract:, the provider is responsible for insuring all property purchased by or transferred to the
provider is in good working order. The provider hereby agrees to pay the cost of transferring title to
and possession of any property for which ownership is evidenced by a certificate of title. The provider
shall be responsible for repaying to the ME the replacement cost of any property inventoried and not
transferred to the ME upon completion or termination of this contract. When property transfers from
the provider to the ME the provider shall be responsible for paying for the title transfer..
(8) If the provider replaces or disposes of property purchased by the provider pursuant to this
contract, the provider is required to provide accurate and complete information pertaining to
replacement or disposition of the property as required on the provider's annual inventory.
(9) The provider hereby agrees to indemnify the ME and the department against any claim or loss
arising out of the operations of any motor vehicle purchased by or transferred to the provider
pursuant to this contract.
(10) A formal contract amendment is required prior to the purchase of any property item not
specifically listed in the approved contract budget.
b. Title to Vehicles
(1) Title (ownership) to, and possession of, all vehicles acquired with funds from this contract shall
be vested in the ME upon completion or termination of the contract. The provider will retain
custody and control during the contract period„ including extensions and renewals.
(2) During the term of this contract, title to vehicles furnished by the state or acquired at the direction of
the state (using state or federal funds) shall not be vested in the provider. Subcontractors shall not
be assigned or transferred title to these vehicles. The provider hereby agrees to indemnify the ME
or the department against any claim or loss arising out of the operations of any motor vehicle
purchased by or transferred to the provider pursuant to this contract.
16. Special Insurance Provisions
a. The Network Provider shall notify the ME Contract Manager within thirty (30) calendar days if
there is a modification to the terms of insurance including but not limited to, cancellation or
Attachment I HCO2 (d)
Guidance Care Center, Inc, Page 38 of 40 Contract No PPG-2-03
South Florida
Behavioral
Health Network, Inc.
modification to policy limits.
b. The Network Provider acknowledges that, as an independent contractor, the Network Providers,
and its subcontractors, at all tiers are not covered by the State of Florida Risk Management Trust
Fund for liability created by s. 284.30, F.S.
c. The Network Provide shall obtain and provide proof to the ME's Contract Manager of
comprehensive general liability insurance coverage (broad form coverage), specifically including
premises, fire and legal liability to cover managing the Network Provider and all of its employees.
The limits of Network Provider's coverage shall be no less than $300,000 per occurrence with a
minimal annual aggregate of no less than $1,000,000.
d. The ME shall cause all Network Service Providers, at all tiers, who the ME reasonably determines
to present a risk of significant loss to the ME or the Department, to obtain and provide proof to
ME and the Department of comprehensive general liability insurance coverage (broad form
coverage), specifically including premises, fire and legal liability covering the Network Service
Provider and all of its employees. The limits of coverage for the ME's Network Service Providers,
at all tiers, shall be in such amounts as the ME reasonably determines to be sufficient to cover
the risk of loss.
e. if any officer, employee, or agent of the ME operates a motor vehicle in the course of the
performance of its duties under this contract, the ME shall obtain and provide proof to the
Department of comprehensive automobile liability insurance coverage. The limits of the ME's
coverage shall be no less than $300,000 per occurrence with a minimal annual aggregate of no
less than $1,000,000.
f. if any officer, employee, or agent of any Network Service Provider, at all tiers, operates a motor
vehicle in the course of the performance of the duties of the Network Service Provider, the ME
shall cause the Network Service Provider to obtain and provide proof to the ME and the
Department of comprehensive automobile liability insurance coverage with the same limits.
g. The ME shall obtain and provide proof to the Department of professional liability insurance
coverage, including errors and omissions coverage, to cover the ME and all of its employees. If
any officer, employee, or agent of the ME administers any prescription drug or medication or
controlled substance in the course of the performance of the duties of the ME under this contract,
the professional liability coverage shall include medical malpractice liability and errors and
omissions coverage, to cover the ME and all of its employees. The limits of the coverage shall be
no less than $300,000 per occurrence with a minimal annual aggregate of no less than
$1,000,000.
h. If any officer, employee, or agent of the Network Service Provider, at all tiers, provides any
professional services or provides or administers any prescription drug or medication or controlled
substance in the course of the performance of the duties of the Network Service Provider, the 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.
I. The ME and the Department shall be exempt from, and in no way liable for, any sums of money
that may represent a deductible or self -insured retention under any such insurance. The payment
of any deductible on any policy shall be the sole responsibility of the Network Provider purchasing
the insurance.
Attachment 1 HCO2 (d)
Guidance Care Center„ Inc. Page 39 of 40 Contract No. PPG-2-03
South Florida
Behavioral
Health Network, Inc.
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
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
4. Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs
5. Exhibit E, Monthly Payment Request
8. 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 [ HCO2 (d)
Guidance Care Center; Inc. Page 40 of40 Contract No PPG-2-03
om1h Florida B hmiurarl Ilcarlth Nemarr°k, Inc.
Exhibit A
ClientslParticipants to be Served
A. General Description
The network provider shall furnish services funded by this contract to the target population(s) checked
below.
Non -Prevention
Prevention
❑
Adult Mental Health -Severe & Persistent Mental Illness
® Adult Substance Abuse
❑ Adult Mental Health -Serious & Acute Episodes of Mental
Illness
® Children's Substance Abuse
❑
Adult Mental Health -Mental Health Problems
❑ Substance Abuse Community Coalition
❑
Adult Mental Health -Forensic Involvement
❑
Children's Mental Health -Serious Emotional Disturbances
Children's Mental Health -Emotional Disturbances
El
Children's Mental Health -At Risk of Emotional Disturbances
Adult Substance Abuse
ChildreWs Substance Abuse
B. Client/Participant Eligibility
1. The network provider agrees that all persons meeting the target population descriptions in the
table above are eligible for services based on the availability of resources„ A detailed
description of each target population is contained in s. 394.674, Florida Statutes and as
described in the Department of Children and Families Pamphlet 155-2 (PAM 155-2), based on
the availability of resources. Pamphlet 155-2 is available on the Department's website
(www,dcf.state slarpgra slsa /pubs rasa ns s t I) and is incorporated herein by
reference.
2. Behavioral Health services shall be provided to persons pursuant to s, 394.674, F.S., including
those individuals who have been identified as requiring priority by state or federal law. These
identified priorities include, but are not limited to, the categories in sections (a) through 0):,
below. Persons in categories (a) and (b) are specifically identified as persons to be given
immediate priority over those in any other categories.
a. Pursuant to 45 C.F.R. s. 96.131, priority admission to pregnant women and women
with dependent children by Network Service Providers receiving SAPT Block Grant
funding;
b. Pursuant to 45 C.F.R. s. 96.126, compliance with interim services, for injection
drug users, by Network Service Providers receiving SAPT Block Grant funding and
treating injection drug users;
c. Priority for services to families with children that have been determined to require
substance abuse and mental health services by child protective investigators and
also meet the target populations in subsections (a) or (b), below. Such priority shall
be limited to individuals that are not enrolled in Medicaid or another insurance
program, or require services that are not paid by another payor source::
(1) Parents or caregivers in need of adult mental health services pursuant to s.
394.674(1)(a)2., F.S., based upon the emotional crisis experienced from the
potential removal of children; and
(2) Parents or caregivers in need of adult substance abuse services pursuant to
Exhibit A
Guidance Care Center, Inc, Page i of 3 Contract No PPG-2-03
Sonih Plorida Behavioral iicaalflu Nct%sur , wor
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. 394A573, 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
L Inmates approaching the End of Sentence pursuant to Children and Families
Operating Procedure (CFOP) 155-47,
j. In the event of a Presidential Major Disaster Declaration, Crisis Counseling
Program (CCP) services shall be contracted for according to the terms and
conditions of any CCP grant award approved by representatives of the Federal
Emergency Management Agency (FEMA) and the Substance Abuse and Mental
Health Services Administration (SAMHSA).
3. Mental health crisis intervention and crisis stabilization facility services, and substance abuse
detoxification and addiction receiving facility services„ shall be provided to all persons meeting
the criteria for admission, subject to the availability of beds and/or funds,
C. Client/Participant Determination
Determination of client eligibility is the responsibility of the network provider- The network
provider shall adhere to the eligibility requirements as specified in Exhibit F, State and Federal
Laws, Rules, and Regulations. The ME reserves the right to review the network provider's
determination of client eligibility and override the determination of the network provider. When
this occurs the network provider will immediately provide services to the consumer until such
time the consumer completes his/her treatment., voluntarily leaves the program, or the ME's
decision is overturned as a result of the dispute resolution.
2. In no circumstances shall i an individual's county of residence be a factor that denies access to
service. Authorized services shall only be provided within the serviced area($) 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 and of the contract term, when the ME at it
sole discretion may pay, subject to the availability of funds, the network provider for
"Uncompensated Units Reimbursement Funds", in whole or in part, or not at all, for Exemplary
Performance by the network provider. Exemplary Performance will be determined by the network
provider delivering and billing for services in excess of those units of service the ME will be
required to pay. The ME's obligation to pay under this Contract is contingent upon an annual
appropriation by the Legislature and the Contract between the ME and the DCF.
Exhibit A
Guidance Care Center, Inc. Page 2 of 3 Contract No. PPG-2-03
South I° oridaa Rehaawiorat ttcaatth Nctw+awk, Inc.
2. The network provider agrees that funds provided in this contract will not be used to serve persons
outside the target populations) 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"
a. The network provider may not authorize or incur indebtedness on behalf of the ME or the
Department.
Exhibit A
Guidance Care Center; Inc. Page 3 of 3 Contract No. PPG-2-03
Smith Hurada Hch-w iaral llca th Nensork, Inc.
Exhibit B
Method of Payment
1. Payment Clauses
This is a fixed price (unit cost) contract. The unit prices are listed on Exhibit G, Covered
Service Funding by OCA. The ME shall pay the Network Provider for the delivery of service
units provided in accordance with the terms and conditions of this contract for a total dollar
amount not to exceed $450,000.00 ($150,000.00 Per fiscal year of this contract), subject to
the availability of funds and satisfactory performance of all terms by the Network Provider.
Of the total Contract amount, the ME will be required to pay $450,000.00, subject to the
delivery and billing for services The remaining amount of 0.00 represents
"Uncompensated Units Reimbursement Funds", which the ME, at its sole discretion and
subject to the availability of funds, may pay to the Network Provider, in whole or in part, or
not at all, for Exemplary Performance by the Network Provider. Exemplary Performance
will be determined by the Network Provider delivering and billing for services in excess of
those units of service the ME will be required to pay. The ME`s obligation to pay under this
Contract is contingent upon an annual appropriation by the Legislature and the Contract
between the ME and the DCF Any costs or services eligible to be paid for under any other
contract or from any other source are not eligible for payment under this Contract-
b. Pursuant to s. 394.76(3), Florida Statutes (F.S.), the provider agrees to provide local
matching funds in the amount of ,$112,500.00 ($37,500.00 per fiscal year of this contract) as
indicated in Exhibit H, Funding Detail and Local Match Plan,
c. Should the Network Provider receive any funding from the 'Uncompensated Units
Reimbursement Funds", then the amount of Local Match Plan as it appears on Exhibit H,
Funding Detail, will automatically change, utilizing the following formula:
The additional match required on the uncompensated units = Uncompensated Substance Abuse
Services X 16,67% + Uncompensated Mental Health Services that is not exempt from local
match requirements X 33.33%."
'The following MH services are exempt from the local match requirement
i. Deinstitutionalization Pro"ects
Case Management
Intensive Case Management
Residential Services I -IV
Supported Housing/Living
Short Term Residential Treatment (not exempt
operated by a public receiving facility)
FACT Teams
if funded by Baker Act funds or
ii. CMH Programs (100435 Category & 102780 (PRTS) Category) that are not grant
funded.
d. In accordance with the provisions of s. 402.73(1), F.S.„ and Rule 65-29.001, Florida
Administrative Code (F.A. C.), corrective action plans may be required for noncompliance,
nonperformance, or unacceptable performance under this contract. Penalties may be
imposed, to include contract termination in whole or in part; for failures to implement or to
make acceptable progress on such corrective action plans.
Exhibit B
Page 1 of 5
Guidance Care Center; Inc. Contract No. PPG-2-03
South ➢ trarialaa Behaflurad Hrwitta Neliviork, Inc.
e. The ME shall reduce or withhold funds pursuant to Rule 65-29.001, F.A.C., if the Network
Provider fails to comply with the terms of the contract and/or fails to submit client reports
and/or data as required in DCF PAM 155-2, Rule 65E-14, F.A.C. and by the due dates listed
on Exhibit C-1, Required Reports.
f. The ME's decision to reduce or withhold funds will be submitted to the Network Provider in
writing. The written notice will specify the manner in which the provider has failed to comply
with the terms of the contract. When,, and if; compliance is achieved, the withheld funds will
be disbursed to the Network Provider.
g. If the Provider closes or suspends the provision of services funded by this contract, the
provider agrees to notify the ME in writing thirty (30) calendar days prior to their intent to
close, suspend or end service(s).. if the provider fails to notify the ME, the provider hereby
agrees not to request payment for services provided in prior months if the actual number of
services in the month for which payment is being requested is less than twenty-five percent
(25%) of the prorated amount of services by covered service as given on Exhibit G, Covered
Service Funding by OCA, or twenty-five percent (25%) of the prorated share of the amount
of funding as specified on Exhibit G„ Covered Service Funding by OCA.
h. The ME in its sole discretion and subject to funding availability, may purchase from any
Network Provider prior to the end of the contract period any service units provided at any
time during the term of the contract.
2. Additional Release of Funds
At its sole discretion, the ME may approve the release of more than the monthly prorated amount
when the Network Provider submits a written request justifying the release of additional funds, if
funds are available and services have been provided.
3. Third Party Billing, if applicable.
a. The Department is always the payer of last resort. The ME and the Network Provider
specifically agree that the Department,, through the ME,, is never a liable third party. The
Network Provider shall not bill the ME for services provided to:
I. Individuals who have third party insurance coverage when the services provided
are covered under the insurance plan; or
Pi. 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:
L Individuals who have lost coverage through Medicaid, or any other publically
funded health benefits assistance program coverage for any reason during the
period of non -coverage, or
ii. Individuals who have a net family income at or above 150 percent of the Federal
Poverty Income Guidelines, subject to the sliding fee scale requirements in Rule
65E-14.018 F.A.C.
III. The Network Provider shall ensure that Medicaid funds are accounted for
separately from funds for this contract.
c. In no event shall Medicaid, any health insurance, another publically funded health
benefits assistance program, or the ME be billed for the same service provided to the
same individual on the same day.
d. Medicaid earnings cannot be used as local match.
Exhibit B
Page 2 of 5
Guidance Care Center, Inc, Contract No. PPG-2-03
South Horid:a 11chmiur.al Health Xchiork, lase:.
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.
L The Network Provider agrees to assist individuals eligible for Medicaid covered by a
Medicaid capitated entity who need and request assistance to obtain covered mental
health services that the treating provider considers to be medically necessary.. This
assistance shall include assisting clients in appealing a denial of services,
4. Payments from Medicaid Health Maintenance Organizations, Prepaid Mental Health Plans; or
Provider Services Networks, as applicable.
Unless waived in Section D (Special Provisions) of this contract, the provider agrees that
payments from a health maintenance organization, prepaid mental health plan, or provider
services network will be considered to be "third party payer" contractual fees as defined in Rule
65E-14.001,F.A.C. Services which are covered by the sub-capitated contracts and provided to
persons covered by these contracts must not be billed to the department.
5. Invoice Requirements
a. The rates negotiated with any Network Provider may not exceed the rate as specified in
in Exhibit G, Covered Service Funding by OCA.
b. Network Providers are required to comply with Rule 65E-14.021, F.A.C., Schedule of
Covered Services, including but not limited to, covered services, methods of
payments, descriptions, program areas, data elements, , required fiscal reports,
program description, rate setting process, payment for services including allowable and
unallowable units and requests for payments,
c. The Network Provider shall request payment monthly through submission of a properly
completed invoice, Exhibit E, Monthly Payment Request, within eight (8) days following
the end of the month for which payment is being requested for the delivery of service.
Payment to the Network Provider by the ME is subject to the availability of funds and
payments received from the Department. Exhibit E, Monthly Payment Request, is
incorporated herein by reference and available at the following website_
d. If no services are due to be invoiced from the preceding month, the Network Provider
shall submit a written document to the ME indicating this information within eight (8)
calendar days following the end of the month. The Network Provider shall request
payment monthly through submission of a properly completed invoice, per the
Exhibit B
Page 3 of 5
Guidance Care Center; Inc. Contract No. PPG-2-03
South Huridad Behadviadradl 11`alth Xchsor , lim
requirements of this contract, within eight (8) calendar days following the end of the
month for which payment is being requested.
e. If no services are due to be invoiced from the preceding month, the Network Provider
shall submit a written document to the ME indicating this information within eight (8)
calendar days following the end of the month- Should the Network Provider fail to submit
an invoice or written documentation if no services are due to be invoiced from the
preceding month„ within thirty (30) calendar days following the end of the month, then the
ME at sole discretion can reallocate funds. If the Network Provider fails to submit an
invoice or written documentation for two (2) consecutive months within a twelve (12)
month period, the ME at sole discretion can terminate the contract.
f. The Network Provider's final invoice must reconcile actual service units provided during
the contract period with the amount paid by the ME. The provider shall submit their fiscal
year final invoice to the ME within twenty (20) days after the end of each state fiscal year
in the contract period.
g. The Network Provider shall, ensure that the year-to-date number of units of service
reported on a request for payment or any associated worksheet shall reconcile with the
total number of units reported and accepted in ODH or other data system designated by
the ME,
h. Pursuant to 65E-14.021(7)(a)2:, F.A.C.,, the Network Provider shall not invoice for any
Covered Services paid for under any other contract or from any other source. The
Network Provider must subtract all units which are billable to Medicaid, and all units for
SAMH client services paid from other sources, including Social Security, Medicare
payments, Food Stamps, and funds eligible for local matching which include patient fees
from first; second, and third -party payers, from each monthly request for payment; For
services provided based on bed -day availability, the provider must report any payments
received from all other sources on the "Schedule of Bed -Day Availability" at the end of
the fiscal year and refund any overpayment.
Invoices shall be submitted in detail sufficient for a proper pre -audit and post -audit
6. Supporting Documentation
a. The Network Provider agrees to maintain and submit to the ME, if applicable, service
documentation for each service billed to the ME pursuant to this contract. The Network
Provider shall track all units billed to the ME by program and by Other Cost Accumulator
(OCA). Proper service documentation for each SAMH covered service is outlined in Rule
65E-14.021, F.A.C.
b. The provider shall maintain documentation to support all units billed to the ME and units
subtracted for SAMH client services on each monthly request for payment.
c. The Network Provider shall ensure that all services provided are entered into ODH,
PBPS, or other data system designated by the ME.
d. The ME, Department and the State's Chief Financial Officer, reserve the right to request
supporting documentation at any time after actual units have been delivered.
7. The Network Provider's attention is directed to the Department of Financial Services Reference
Guide For State Expenditures for guidance regarding the requirements applicable to the
disbursement of funds from the State Treasury, regardless of payment methods. The
Reference Guide For State Expenditures can be obtained at the following website:
Exhibit B
Page 4 of 5
Guidance Care Center, Inc.. Contract No, PPG-2.03
Sough Horidar Itehinioraal Health NeW ark, Inc.
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,
N
Exhibit B
Page 5 of 5
Guidance Care Center, Inc. Contract No. PPG-2-03
South Florida Behavioral Health Network, Inc,
Exhibit C-1
Required Reports for PPG
For Fiscal Year 2015-16
r-r-2, ZTT-t WMW109
ME Contract Manager
riesponsetaMonitoring RepWsend Corrective
Within 10 calendar days from the day
I (Electronic Submission
Action Plans
the report Is received
via E-mail)
SFBHN staff member issuing
CAP
External Quality Assurance Reviews, Monitoring
WlhinlO calendar days from the day
ME Contract Manager
Reports, Surveys and Corrective Actions, as
iapplicable
the report Is received or as requested,
I (Electronic Submission
by the Contract Manager
via E-ma,rj
Director of Contract
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
Federally Qualified Health Centers are required
executed MOU's).
Within 30 calendar days for renewed
I (Electronic Submission
ME Contract Manager
to submit policies and procedures that explain
MOU's, Updates to P&P for FQHC`s
via E-main
the access to primary care services to the
shall be submitted within 30 calendar
medically underserved behavioral heath client
days of adoption
Final FY 2015.2016
- - ------------ -
(1) Projected Cost Center OperaLng and
Capital
Submitted annually prior to contract
Budget,
execution. Submit updates within 30
I (Electronic Submission
ME Contract Manager
(2) Budget Narrative,
calendar days of execution of an
via E-ma 1),
&
,(3) Network Providers Agency Service Capacity
amendment to the contract affecting
VP of Finance
Report,the
budget
(4) Cost Center Personnel Detail
Report
Program Description
(1) organizational Profile
Annually, prior to contract execution
Submit updates within 30 calendar
I (Electronic Submission
!ME Contract Manager
a
(2) Service Activity Description
days of amendment
via E-mail)
VP of Behavioral Health
Grievance Procedures, unless waived
Annually, prior to contract execution,
I (Eliectronic: Submission
ME Contract Manager
18) Clients (applicants or recipient of services)
Submit updates within 3D calendar
thin
b) Agency Staff
days of Implementation
..... - - -------
via E-mall)
VP of Cal
Affidavit Regarding Debarment
Anually prior to contract execution, or
as requested by the Contract Manager'
t
ME Contract Manager
Submit up -dales Mth,n 30 calendar
days of amendment or
!ME Contract Manager
No Wrong Door" Policy and Procedures
as requested by
the contract manager andlor the
QA/QI Risk & Compliance
OA101 Risk & Compliance Manager
Manager
Within 24 hours of occurrence, in
. . ........
accordance with CFOP 215-6 and
ME Contract Manager
Indent Report
reportable incidents defined CFOP 180,
4 Mandatory
submission through IRA$
&
ONCII Risk & Compliance
Reponmg Requirements to the Office
Manager
of the Inspector General
Exhibit C-1
Guidance Care Center, Inc. Page I of 5
Contract No, PPG-2-03
South Florida Behavioral Health Network, Inc.
Data shay be submitted electronically
weekly, by 12:D0 Noon every
Monthly Data Required by DCF PAM 155.2
monthly shall be
Wednetltsday. Finaled
Electronically
DDH, POPS, or other data
system designated by the ME or
su�n electronically 10the ME no
later than the 4th of each month
the Department
following the month of service
Des ination of Dis a Resolution Officer
g
Within 5 working days of contract
1 (Eledmn c Submission
ME Contact Manager
execution
via E-mail)
ADA Client Communication Assessment
itr s' fst6 t �rmsin.com5t Frrain
Auxiliary Aid
Service Record Monthly Summary Report,
By the 41h business day following the
1 (Electronic Submission
ine/rylonthlVAummary
ore rr torn io irt.hnmi
(Applicableto agency's that employ fifteen (15)
reporting north
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
t (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 allemate data system is
month following the month of service
Contract Manager)
implemented
By July 20 of each fiscal year and/or
Final Invoice
20 days
1
ME Sr Accountant (Fiscal
after contract end dale
Department)
Invent Re
Inventory poi
111212015
1 (Electronic Submission
Contract Manager
via E-mail)ME
Attestation of Network Provider's Verification
that all applicable employees and
subcontractors with access to ME and/or DCF
111212015
1 (Electronic Submission
ME Contract Manager
information systems have signed a DCF
via E-mail)
Security Agreement fora CF 0114 , per the
Attachment I and Standard Contract
ME Contract Manager
Emergency Preparedness Plan
11113/2015
1 (Electronic Submission
&
via E-ma l
OA1QI Risk a Compliance
Manager
Civil Rights Compliance Checklist (CF0946)
11/13/201
1 (Electronic Submission5
ME Contract Manager
via E mai")
Civ i Rights Certificate (CF707)
11113r2015
1 ;Electronle Submission
ME Cont Manager
via E-mail)ract
ME Contract Manager
Qualty AssuranceliQualty, Improvement Plan
11/212015
1 (Electronic Submission
&
via E-main
QA/QI Risk & Compliance
Manager
Action Plan fintegration of Behavioral death
ME Contract Manager
Services and Primary Care, TIC. CLC. CWI
11PJ0/2015
1 (Electronic Submission
&
Inilatives)
via E-maill
QAIQI Risk & Compliance
Manager
Exhibit C-1
Page 2 of 5
Guidance Care Center, Inc. Contract No PPG-2-03
South Florida Behavioral Health Network, Inc.
January 30, 2016
ME Contract Manager
Continuous Quality Improvement Updates
(Period: 10101115 - 12131115)
1 (ElecUcinic Submission
a
July 30, 2016
via E-maiq
QA OI Risk a Compliance
(Period: 0 110 1116 - WWII
Manager
October 31, 2015
(Period: 07/01115 - 09130d15)
January 31, 2016
(Period: 10101115 - 12131115)
ME Contract Manager
Quarterly Program Status Report
April 30, 20t6
ril 3116
1 (Electronic Submission
a
(Period: 0 - 03131l1fi)
via E-mail)
ME Director of Prevention
July 31, 2016
Services
(Period: 04101/16 - Ofi130116)
October 31, 2015
(Period: 07101/15 - 09130115)
January 31, 2016
Quarterly Financial Statements (Balance Sheet
(Period: 10101/15 - 12MI115)
1 (Electronic Submission
ME VP of Finance
and Statement of Activity)
April 30, 2016
via E-mail]
a
(Period: 0W1116- 03131116)
ME Contract Manager
July 31, 2016
(Period: 04M I116 - 06W16)
October 31, 2015
(Period: 07101/15 - 091=15)
January 31, 2016
Attestation Indicating the filing of Form 941 and
(Period: 10101115 - 12131/15)
1 (Electronic Submission
ME VP of Finance
payment of any taxes due to the IRS have been
April 30, zols
via E-mail)
a
pact
(Period 01101116 - 03r31116)
ME Contract Manager
July 31, 2016
(Period: 04/01/16 - 06130116)
October 31, 2015
(Period; 07101115 - 09WI5)
January 31, 2016
Quarterly and Final Expenditure Report per the
(Period: 10101/15 - 12131115)
ME VP o} Finance
requirements le Attachment I, Section S. 1 a.
April 30, 2016
1 (Electronic Submission
a
(21)
(Period: 01/01/16 - 03131116)
via E-mail)
ME Contract Manager
July 31, 2016
(Final Expenditure Report)
(Period: 04/01116 - 06130116)
Laval Match Calculation Form - Florida
Department of Children and Families
Upon Request
1 (Electronic Submission
via E-mail)
ME Contract Manager
Year -End Financial Reports for Network Provider's Not Requiring Audits Per Attachment II
Due 150 days alter the end of the
Network Providers fiscal year or within
30 days of the recipient's receipt of the
Certification indicating that recipient expended
audit repot, whichever occurs first,
less than $500,000 ($750,000 In Federal
directly to each of the fallowing unless
ME Contract Manager
Awards for fiscal years beginning on or after
otherwise required by Forida Statutes
1 (Electronic Submission
a
December 26, 2014) in State Awards during the
The schedule shall be based on
via E-maiq
VP of Finance
fiscal year
revenues and expenditures recorded
during the state's fiscal year
Exhibit C-1
Page 3 of 5
Guidance Care Center, Inc Contract No, PPG-2-03
South Florida Behayloral Health Network, Inc.
Year -End Financial Reports for Network Provider's Not Requiring Audits Per Attachment 11
Due 180 days after the end of the
Network Provider's fiscal year or within
30 days of the recipient's receipt of the
audit report, whichever occurs first,
directly 10 each of the following unless ME Contract Manager
ic Submission &
Schedule of Stale 8amings otherwise required by Florida Statutes I {Electronic
The schedule shag be based on via VP of Finance
revenues and expenditures recorded
during the states 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 Statute.
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 staters fiscal year,
Due I BO days after the end of the
Network Provider's fiscal year or within
30 days of the recipient's receipt or the
Projected Cost Center Operating and Capital
audit repot, whichever occurs first,
Budget
directly to each of the following unless
I (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 staters fiscal year
Due 180 days alter the end of the
Network Provides fiscal year or within
30 days of the recipient's receipt of the
audit report, whichever occurs first,
Schedule of Bed -Day Availability Payments
directly to each or the following unless
otherwise required by Flodda Statutes
I (Electronic Submission
ME Contract Manager
&
The schedule shall be based on
via E-mail}
VP of Finance
revenues and expenditures recorded
during the staters fiscal year
Due 180 days after the and or 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
I (Electronic Submission
ME Contract Manager
(Balance Sheet and Statement of Activity
The schedule shag be based on
via E-malQ
&
revenues and expenditures recorded
VP of Finance
during the state's Fiscal year.
Exhibit C-1
Guidance Care Center. Inc, Page 4 of 5
Contract No, PPG-2-03
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
I (Electronic Submission
ME Contract Manager
necessary schedules per Attachment if
otherwise required by Florida Statutes
via E-mail)
a
The schedule shall be based on
VP of Finance
revenues and expenditures recorded
during the state's fiscal year
Due ISO 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 State Earnings
directly to each of the following unless
I {Electronic Submission
ME Contract Manager
otherwise required by Florida Statutes
via E-maill
&
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 Providers fiscal year or within
30 days of the reciplem'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
I (Elecumic Submission
ME Contract Manager
Adjustments
The schedule shall be based on
via E-mail)
&
VP of Finance
revenues and expenditures recorded
during the states fiscal year
Due 180 days after the end of the
Network Provider's fiscal year or within
30 days of the recipient's receipt of the
Projected Cost Center Operating and Capital
audit report, whichever Occurs first,
directly to each of the following unless
Budget
othefWse required by Florida Statutes
I (Electronic Submission
ME Contract Manager
&
Actual Expenses & Revenues Schedule
The schedule shall be based on
via E-mail)
VP of Finance
revenues and expenditures recorded
during the states 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 Bad -Day Avalability, Payments
otherwise required by Florida Statutes
I (Electronic Submission
&
The schedule shall be based on
via E-mail)
VP of Finance
revenues and expenditures recorded
during the stale's fiscal year
Exhibit C-1
Guidance Care Center, Inc..Page 5 of S
Contract No., PPG-2-03
South Florida Behmioral Ifealth Neti%vrk. Inc.
Exhibit D
Substance Abuse & Mental Health Required Performance Outcomes & Outputs
Provider Name:
Contract
Date:
Revision
Guidanc-ciCare Center, Inc.
PPG-2-03
September 1, 2015-June 30, 2018
5 WIN
I
10
Adults Corrtmunt 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%
Percent of adults in mental health crisis who live in stable housing environment
86%
Adult 'Substance
Abuse,
SAOSS
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%
SAM
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
1
1 at the time of discharge
94%
Children's Meintall,
Health i
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
environment
95%
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%
Chlldren'$�Substance
Abiti6d
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
1
J
environment at the time of discharge I
93%
Guidance Care Center, Inc. Exhibit D
Page 1 of 2 Contract No. PPG -2-03
South Florida Behavioral Health Network, Inc.
Table 2
Network Service Provider Output Measures - Persons Served
For Fiscal Year FY15-16
Service Category
FY
Target
Residential Care
0
z r
Outpatient Care
0
G! y
m
Crisis Care
0
a+ ar
ax
State Hospital Discharges
N/A
Peer Support Services
0
Residential Care
N/A
L z
Outpatient Care,
N/A
Crisis Care
N/A
U N
SIPP, Discharge
N/A
d
Residential Care
0
V
G
Outpatient Care
0
IA
N a
Detoxification
0
y
Women's Specific Services
0
_5a
-
Q
Injecting Drug Users
0
Residential Care
IN/A
Outpatient Care
'kN/A
Detoxification
N/A
L ¢'
**Refer to Attachment IV, Scope
'a
Prevention
of Work for the,numbers
U
served.**
Network Provider Compliance: Failure to meet the applicable standards established in Tables 1 and 2
shall be considered nonperformance pursuant to Standard Contract, Paragraph 36. Financial
Consequences for Network Provider's Failure to Perform.
Guidance Care Center, Inc. Exhibit D Contract No, PPG-2-03
Page 2 of 2
South Horida Behavioral Ilea kh Nemork, Inc.
Exhibit E
Monthly Payment Request
1. Exhibit E, Monthly Payment Request
This exhibit is incorporated by reference and available at following website:
Exhibit E
Guidance Care Center. Inc. 1 of 1 Contract No. PPG-2-03
South F oritla t ell-nioral I lealth 'Network, Incflea. 2.23.2015
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:
1. 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 ll of 4
Guidance Care Center, Inc. Contract No. PPG-2-03
II. FLORIDA STATUTES
A. Child Welfare and Community Based Care
Ch. 39, F.S.
Proceedings Relating to Children
Ch. 119, F.S.
Public Records
Ch. 402, F.S.
Health and Human Services; Miscellaneous Provisions
Ch. 435, F.S.
Employment Screening
Ch. 490, F.S.
Psychological Services
Ch. 491, F.S.
Clinical, Counseling and Psychotherapy Services
Ch. 1002, F.S.
Student and Parental Rights and Educational Choices
B. Substance Abuse and Mental Health Services
Ch. 381, F.S.
Public Health: General Provisions
Ch. 386, F.S.
Particular Conditions Affecting Public Health
Ch. 395, F.S.
Hospital Licensing and Regulation
Ch, 394, F.S.
Mental Health
Ch. 397, F.S.
Substance Abuse Services
Ch. 400, F.S.
Nursing Home and Related Health Care Facilities
Ch. 414, F.S.
Family Self Sufficiency
Ch. 435, F.S.
Employment Screening
Ch. 458, F.S.
Medical Practice
Ch. 459, F.S.
Osteopathic Medicine
Ch. 464, F.S.
Nursing
Ch. 465, F.S.
Pharmacy
Ch. 490, F.S.
Psychological Services
Ch. 491, F.,S.
Clinical, Counseling and Psychotherapy Services
Ch. 499, F.S.
Florida Drug and Cosmetic Act
Ch. 553, F.S.
Building Construction Standards
Ch. 893, F.S.
Drug Abuse Prevention and Control
& 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
Guidance Care Center; Inc. Contract No, PPG-2-03
S. 112.061, F.S. Per diem and Travel Expenses of public officers, employees, and
authorized persons
S. 112.3185, F.S. Additional Standards for State Agency Employees
S. 215.422, F.S. Payments, Warrants & Invoices; Processing Time Limits
S. 216.181(16)(b), F.S. Advanced funds for Program Startup or Contracted Services
Ill. FLORIDA ADMINISTRATIVE CODE (RULES)
A. Child Welfare and Community Based Care
Ch. 65C-12, F.A.C.
Emergency Shelter Care
Ch. 65C-13, F.A.C.
Foster Care Licensing
Ch. 65C-14, F.A.C.
Group Care
Ch. 65C-15, F.A.C.
Child -Placing Agencies
B. Substance Abuse and Mental Health Services
Ch. 65C-12, F.A.C.
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-15, F.A.C.
Ch. 65E-20, F.A.C.
CH. 65E-26, F.A.C.
C. Financial Penalties
Ch. 65-29, F.A.C.
Reduction or withholding of funds
Ch. 65-29.001, F.A.C.
IV. MISCELLANEOUS
Emergency Shelter Care
Substance Abuse Services Office
Community Mental Health Regulation
Mental Health Act Regulation
Psychotic and Emotionally Disturbed Children- Purchase of Residential
Services Rules
Behavioral Health Services
Public Mental Health Crisis Stabilization Units and Short Term Residentia
Treatment Programs
Community Substance Abuse and Mental Health Services -Financial Rule!
Continuity of Care Case Management
Forensic Client Services Act Regulation
Substance Abuse and Mental Health Priority Populations and
Services
Penalties on Service Providers
Financial Penalties for a Provider's Failure to Comply With a
Requirement for Corrective Action
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. PPG-2-03
OMB Circular A-102 Grants and Cooperative Agreements with State and Local
Governments
OMB Circular A-122 Cost Principles for Non-profit Organizations
C. Audits
OMB Circular A-133 Audits of States, Local Governments and Non -Profit
Organizations
Ch. 215.97, F.S. Florida Single Audit Act
Comptrollers Memorandum
No. 03 (1999-2000): Florida Single Audit Act Implementation
D. Administrative Requirements
45 C.F.R., pt., 74 Uniform Administration Requirements for Awards and
Subawards to Institutions of Higher Education, Hospitals,
other Non -Profit Organizations and Other Commercial
Organizations
45 C.F.R., pt. 92 Uniform Administrative Requirements for Grants and
Cooperative Agreements to State and Local Governments
OMB Circular A110 Uniform Administrative Requirements for Grants and
Agreements With institutions of Higher Education,
Hospitals, and Other Non -Profit Organizations
E. Data Collection and Reporting Requirements
S. 397.321(3)(c), F.S. Data collection & dissemination system
S. 394.74(3)(e), F.S. Data Submission
S. 394.77, F.S. Uniform management information, accounting, and
reporting systems for providers
S. 394,9082, F.S. Behavioral health managing entities
PAM 155-2 Mental Health and Substance Abuse Data Measurement
Handbook
Guidance Care Center, Inc.
Exhibit F
Page 4 of 4
Contract No. PPG-2-03
EXHIBIT Q COVERED SERVICES BY OCA
September 2015
� Ilia t �IIIfn),j
M11018 %111411N %1111172 %t111073 ,M11076 1111093 %tul(194 R111111.6 N111i11j] %IFFIX1,
FUNDING r M1101 N111A09
PIIIAIX P111AIS %111A72 M11A73 MIIA76 iNIIIA93 NIIIA94 MHAM M11ATH N111ACF TOTAL
RATE
a
$ .
r
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S
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$ .
$
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$
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S 43.12
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$ -
S 48.68
$ -
c
s -
$ -
I
-
S 1511,000 $ $
$ $ - s - S $ $ $ s - s $ - $ -
Exhibit G
Page I of 4 Contract No. PPG-2-03
EXHmt G:COVEREz DSERVICESliOCA
September &r
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Page 2of4
Contract No. PPG-2-03
September 1, 2015 -June 30, 2016
Guidance/Care Center, Inc. - PPG
PPG-2-03
COVERED SERVICES
tit
Assessment
t12
Casc Management
tt3
Crisis Stabilization
04
Crisis SupporVE-mergency
06
Day/Night
07
Drop-Im'Selfllelp Centers S
(,'-S
In-Iiome,On-Site
I I
Intervention - Individual
17
Intervention - Group
I?
Medical Services S
l
Outpatient - Individual
5
Outpatient - Group
15
Outreach
18
Residential Level I
11)
Residential Level 11
20
Residential Level III ;
Residential Level IV
2-1
Substance Abuse Detox
75
Supported Employment
fit,
Supportive Housing
_7
TASC S
'28
Incidental Expenses
21}
AAercure - Individual
4,
Aftercare - Group
M
Information & Referral
A
FACT Team
6
Room & Board Level I
a7
Room & Board Level E1
'tit
Room & Board Level III
W
Short-term Residential rreatment S
,;0
Clubhouse Services
-14
CCST - Individual
45
CCST - Group 1
-16
Recovery Support - Individual
47
Recovery Support = Group S
48
Prevention - Indicated S
49
Prevention - Selective S
50
Prevention = t..'niversal Direct S
51
Prevention = Universal Indirect S
')')
Special Proviso
TOTAL FUNDING S
TOTAL UNCOMPENSATED
EXHIBIT G: COVERED SERVICES B1 OCA
September 2015
NIwo3 Milli I A4"J21 5151123 %N112" )IS02"
UMkW3 1 io,I %twilit it4=1113 SISKF
FUNDING \ISA03 ]IS,V I INISA21 NISA23 11SA25 NISA27
NISA81 MSA91 1ISATp NISACF TOTAL
RATE
_
$
m
$ -
g
$
e
$
S -
S
S -
$
43.12
$ _
48.68
$
48.68
$
48.68
$ .
-
g _
urn
150,001I $ $ S - $ _ $ - $
$ - $ - $ - $ - $ - $
Guidance Care Center, Inc Exhibit GPaige 3 of 4 Contract No. PPG-2-03
I�i���TuTT.T[KKtt�c.:���il■�'llFLci[el�I=1r�I:T�1ti'i'l`t?tif[e�itf'�a[�rrs-tl�a�!
September 1, 2015 - June 30, 2016
Guidance/Care Center, Inc. - PPC
PPC-2-03
COVERED SERVICES
01
Assessment
tip
Case Management
0
Crisis Stabilization
01
Crisis Support/Emergency
W)
Day/Night
0"
Drop-Ina'SelfIlelpCenters
08
In -Home sOn-Site
I I
Intervention - Individual
4?
Intervention - Group
I,
Medical Services
14
Outpatient - Individual
+5
Outpatient - Group
Iw
Outreach
18
Residential Level I
11)
Residential Level 11
20
Residential Level III
? I
Residential Level IV 5
4
Substance Abuse Ill
55
Supported Employment S
?0
Supportive I Iousing w
27
TASC
Incidental Expenses
29
Aftercare - Individual
1_
Altercarc - Group 'S
30
Information & Referral 5
4
FACT Team 5
i6
Room & Board Level I
5 i
Room & Board Level 11
ig
Room & Board Level III 5
ilt
Short-term Residential Treatment 5
40
Clubhouse Services
44
CCST - Individual 4
45
CCST - Group S
-16
Recovery Support - Individual
47
Recovery Support - Group
48
Prevention - Indicated $
49
Prcvcntion - Selective 5
50
Prevention = Universal Direct S
51
Prevention - Universal Indirect S
N
Special Proviso
'TOTAL FUNDING S
TOTAL UNCOMPENSATED
E\I11131'1' G: COVERED SERVICES HY OCA
741103
Jill, 'Ems
11SOI I NlVlp1 %IS023 ti1.5I125 Styl2r,-1 t8 NI 41't' tiIsarli
9IS41663 11 1tC't,
FUNDING I 11SC03
1ISCIt NISC21 11S023 \ISC25 \ISC25 CR 11SCI'I, \ISC H
NISCCF
TOTAL
RATE
150,000
$
150,000
a
$
-
$
-
o
$
_
m
$
$
-
$
$
_
43.12
10.469
$
10,469
48•f8
13A86
$
13.486
48.68
126045
$
126,045
48.68
$
-
1501000 S
$ - $ - $ - $ - $ $ 150,000 $
$ $ - $
150,000
September 2015
Guidance Care Center„ Inc. Exhibit GPage 4 of Contract No. PPG-2-03
I �i�i'. r'i';T�.T[eT�.^� � �t� I ■ �'lt�f�'� [e� � I =1 ��±:��1ti'i'�CTri[e1'1'G,FTiTT;�I+I�?�s -ts'�f
July 1, 2016 - June 30, 2017
EXIIIBIT G: COVERED SERVICES 11YOCA
September 2015
Guidance/Care Center, Inc. - PPG
III
PPG=2-03
-INN
A111018 NIIIIIIIIIS N1111111172 11111173 N1111176 1111093
5111094 111110116 Nil 11) 1 H %IF IAX 1-
COVERED SERVICES
FUNDING I
NIIIIIA011 MIMI -NIIIAIX M11A18 IIIIIIIIIIA72 M11A73 5111A76 A11IA93
5111A94 M11AP6 1%111ATH NIIIACF TOTAL
RATE
$
01 Assessment
$
07 Case Management
$
0i Crisis Stabilization
$
04 Crisis Support/Emergency
S
$
06 Day/Night
S
07 Drop-Iniscir Help Centers
$
08 In -I lomc.:'On-Site
$
I I Intervention - Individual
S
$
4? Intervention - Group
S
$
17 Medical Services
$
14 Outpatient - Individual
)5 Outpatient - Group
15 Outreach
$
18 Residential Level I
11) Residential Level 11
?0 Residential Level III
2 F Residential Level IV
S
21 Substance Abuse Detox
S
$
�5 Supported Employment
5
$
26 Supportive I lousing
S
$
27 TASC
$
? S Incidental Expenses
$
?1) Aftercare - Individual
I Aftercare - Group
0 Information & Referral
4 FACT Team
36 Room & Board Level I
$
37 Room & Board Level 11
S
$
38 Room & Board Level III
$
-
$
31) Short-term Residential Treatment
I"
40 Clubhouse Services
4-4 CCST - Individual
-15 CCST - Group
S
$
.46 Recovery Support - Individual
$
S
4- Recovery Support - Group
S
$ -
48 Prevention - Indicated
S
43.12
$
49 Prevention - Selective
S
48.68
$
50 Prevention - Vniversal Direct
S
48.68
5 I Prevention - Universal Indirect
S
48.68
$
Special Provbio
$
pi-
$
$
TOTAL FUNDING
S
150'1w0
$ $
$ $ $
TOTAL UNCOMPENSATED
$
Guidance Care Center, Inc.
Exhibit G
Page I of 4
Contract No. PPG-2-03
July 1, 2016 - June 30, 2017 EXHIBIT G: COVERED SERVICES BYOCA September 2015
Guidance/Care Center, Inc.- PPG
PPG-2-03
A I I IN] 1 WIN9 %1111109-(6 N111018 %111018 %1111111% N1110FA it N1110.N11) %1111AID-CR MF10CF
COVERED SERVICES FUNDING 1 INHIC01 N111C09 1I1IC09-0 iNHICIN A111CIN A111C1)N N111CFA M11CFA-CR N1110-11) NINCINID-CR NIIICCF W-17AIL
RATE
01 Assessment $
(12 Case Management $
0', Crisis Stabilization S $
$
04 Crisis Suppori/Emergency S
00 Day/Night $
0-7 Drop-in/Self I lelp Centers $
()In-Home/On-SiteS
I I Intervention - Individual S
42 Intervention - Group $
12 Medical Services $
14 Outpatient - Individual $
`5 Outpatient- Group $
$
15 Outreach
18 Residential Level I $
$
11) Residential Level H
$
,0 Residential Level III $
? I Residential Level IV S
24 Substance Abu5c Dem $
15 Supported Employment S $
26 Supportive I low ing S $
?7 TASC $
28 Incidental Expenses
71) Aftercare - Individual
41 Aftercare - Group
311 Information & Referral S
34 FAST Team
6 Room & Board Level I $
,7 Room & Board Level 11 S $
18 Room & Board Level III S $
-11) Short-term Residential Treatment S $
40 Clubhouse Services ± $
44 CCST - Individual $
15 CCST - Group
-16 Recovery Support - Individual
-17 Recovery Support - Group $
48 Prevention - Indicated S 43.12 $
49 Prevention - Selective S 48.68 $
51) Prevention - Universal Direct S 48.68 $
51 Prevention - Universal Indirect S 48.68
IN' Special Proviso
TOTAL FUNDING S 151),000 S $ $ s $ $ $ S $
TOTAL UNCOMPENSATED S
Guidance Care Center, Inc. Exhibit G
Page 2 of 4 Contract No. PPG-2-03
WI, 17,01 kyl I I E Will
July 1, 2016 - June 30, 2017
EXHIBIT 6: COVERED SERVICES BY OCR
September 2015
Guidance/Care
Center, Inc. - PPG
PPG-2-03visaAIN4191
I[%(]'[ It MINIAU
COVERED SERVICES
FUNDING f AISA03
AISA I I NIS= AISA23 MSA25 NISA27 SISA81 NISA91 -NISATH
A15ACF TOTAL
RATE
01
Assessment
021
Case Management
$
03
Crisis Stabilization
M
Crisis Support/Emergency
06
Day/Night
0
Drop-Im'Self Help Centers
$
MS
In -I lomcOn-Site
$
I I
Intervention - Individual
S
$
1
Intervention - Group
$
I "
Medical Services
$
14
Outpatient - Individual
$
,5
Outpatient - Group
$
15
Outreach
IS
Residential Level I
11)
Residential Level II
20
Residential Level III
$
21
Residential Level IV
S
$
24
Substance Abuse Dctox
$
25
Supported Employment
$
2(1
Supportive I lousing
$
?7
TASC
$
28
Incidental Expenses
$
?1)
Aftercare - Individual
$
4 1
Aftercare - Group
$
30
Information & Rererral
$
I
FACT Team
$
6
Room & Board Level I
$
7
Room & Board Level 11
S
$
8
Room& Board Level III
$
,9
Short-term Residential Treatment
$
10
Clubhouse Services
44
COST- Individual
45
CCST - Group
46
Recovery Support - Individual
S
47
Recovery Support - Group
%'
-
$
48
Prevention - Indicated
S
43.12
$
49
Prevention - Selective
S
48.68
$
50
Prevention - Universal Direct
S
48.68
$
51
Prevention - Universal Indirect
S
48.68
$
Special Proviso
-
$
S 1 _-7j
4-4 W" wo_a� =3
$
TOTAL FUNDING
S
150,01)(1 S
$ $ - $ - $ $ $ $ $
$
TOTAL UNCOMPENSATED
Guidance Care Center, Inc.
Exhibit G
Page 3 or4
Contract No. PPG-2-03
Attachment: GCC—SAMH—FY1 7—SIGNED [Revision 1] (2231 Guidance/Care Center)
July 1, 2016 - June 30, 2017
Guidance+Cure Center, Inc. - 11116
PPG-2-03
COVERED SERVICES
01
Asscssmcnt
€i?
Caw, Management
1)-,
Crisis Stabilization
04
Crisis Support/Emerl;ency
06
Day/Night
07
Drop -in SelfIle 1p Centers
08,
In-llomee'On-Site
I I
Intervention - Individual
'12
Intervention - Group
12
Medical Services
14
Outpatient - Individual
35
Outpatient - Group
15
Outreach
18
Residential Level I
1 gl
Residential Level 11
'0
Residential Level III
7 i
Residential Level IV
24
Substance Abuse Dctox
25
Supported Employment
Zo
Supportive I lousing
TASC
78
Incidental Expenses
21t
Aftercare - Individual
43
Aftercare - Group
Information & Referral
FACT Team
Room & Board Level
17
Room & Board Level 11
,8
Room & Board Level 111
39
Short-term Residential Treatment
10
Clubhouse Services
-14
CCST- Individual
1 1
CCST - Group
46
Recovery Support - Individual
l `
Recovery Support - Group
48
Prevention - Indicated S
49
Prevention - Selective S
50
Prevention - Universal Direct $
51
Prevention - Universal Indirect S
Y1.
Special Proviso
TOTAL FUNDING S
TOTAL UNCOMPENSATED
EXHIBIT G. COVERED SERVICES BY OCA
NNW
1IS01 I NlYDI 1 NIS023 MM125 AIS025-[ R 41. 1'11 %lSorl n 's i �,N13
SI vt S 3
FUNDING / 1115C113
DISCI I hISC21 NISC23 SISC25 %1SC2 -CR \ISCpp NISCr11
NISCCF
TOTAL
RATE -
150,
$
150,000
m
$
-
$
5
e
$
_
m
$
a
$
$
-
43.12
10,469
$
10.469
48.68
13,486
$
13.486
48.68
126.045
$
126,045
48.68
$
$
1.50,0t10 $ -
$ - $ - $ - $ $ $ IS0.000 $ - $ -
$ - $
150-000
Guidance Care Center_ Inc. Exhibit GPage 4 of 4
September 2015
Contract No. PPG-2-03
I �iiTa �� r't"it -�. [1�Kni■t..1 � ��1I ■ i;it'ltrL+-i [N � I=11►� I:T�1<fs;'.TtTii[t11f'FTiTI•;�I+IIr?'+rs-111a1a�!
July 1, 2017 - June 30, 2018
Guidance/Care Center, Inc. - PPG
PPG-2-03
COVERED SERVICES
111
Assessment
0?
Case Management
W
Crisis Stabilization
(14
Crisis SupporUE-mergcncy
06
Day/Night
07
Drop-In/Self I-IcIp Centers
08
In-] lome/On-Site
I I
Intervention - Individual
12
Intervention - Group
17
Medical Services
I ;
Outpatient - Individual
'5
Outpatient - Group
15
Outreach
18
Residential Level I
19
Residential Level 11
21)
Residential Level III
71
Residential Level IV
24
Substance Abuse Detax
25
Supported Employment
76
Supportive I lousing
?7
TASC
29
Incidental Expenses
21)
Aftercare -Individual
13
Anercare - Group
Information & Referral
14
FACT Team
its
Room & Board Level 1
,7
Room & Board Level 11
18
Room & Board Level III
Short-term Residential Treatment
40
Clubhouse Services
44
CCST - Individual
15
CCST - Group
46
Recovery Support - Individual.
4 �
Recovery Support - Group
48
Prevenlion - Indicated
49
Prevention - Selective
50
Prevention - Universul Direct
51
Prevention - Universal Indirect
,1')
Special Proviso
TOTAL FUNDING S
TOTAL UNCOMPENSATED
EXI IIBIT 6: COVERED SERVICES 13YOCA September 2015
EMS=
1110119 %111018 N11 W18 %11107.2 %111073 9111076 %111093 N111094 %H101% % H 10 111 Nialff, I -
FUNDING NIIIA111 %IIIA09 r*111A18 11111AIN MIIA72 11IIIA73 NIIIA76 NIIIA93 NIIIA94 A111MIG MHATH Almiciz TOTAL
RATE $
43.12
411.68
48.68
48.68
150'(100 S - $ - $ - $ - $ - $ - $ - S - $ - s - $ - $ -
Guidance Care Center, Inr Exhibit G
Page I of 4
S
S
$
Contract No. PPG-2-03
July 2, 2017 - June 30, 2018 EXHIBIT G: COVERED SERVICES BYOCA September 2015
GuidanceiCare Center, Inc. - PPG
PPG-2-03
%I1I()u1 NI11009 111100944 M11018 N111018 %111011% N11101-A 11110FA-( It
N111MID NIIIIINIM-11 NII111CF
COVERED SERVICES
FUNDING
N111col %nicog vnicu%ci miit:18 1111ciR �jjjcjiv N1110-A-CR
NIIICNID NIIIICNID-CR 3IIICCF TOTAL
01
Assessment
S
S
02
Case Management
S
01
Crisis Stabilization
0-1
Crisis Support/Emergency
06
DayfNight
07
Drop-ln.'Self I lelp Ccriters
ON
In -I lome!On-S ite
$
I I
Intervention - Individual
$
42
Intervention - Group
$
12
Medical Services
$
I I
Outpatient - Individual
S
15
Outpatient - Group
15
Outreach
$
IS
Residential Level I
S
$
11)
Residential Level 11
$'
$
20
Residential Level III
$
I
Residential Level IV
74
Substance Abuse Detox
$
25
Supported Employment
S
S
6
Supportive Housing
$
27
TASC
$
29
Incidental Expenses
29
Aftercare - Individual
43
Aftercare - Group
M
Information & Referral
i I
FACT Team
$
16
Room & Board Level I
$
'7
Room & Board Level 11
S
38
Room & Board Level 111
$
39
Short-term Residential Treatment
$
40
Clubhouse Services
$
44 'CCST
- Individual
S
15
CCST - Group
S
-
$
,16
Recovery Support - Individual
IS
-
S -
47
Recovery Support - Group
S
$
48
Prevention - Indicated
S
43.12
S
49
Prevention - Selective
S
48.68
$
50
Prevention - Universal Direct
S
48.68
$
51
Prevention- Universal Indirect
S
48.68
$
'J'J
Special Proviso
-
$
I Aor16
$
-
$
TOTAL FUNDING
S
1511,000
ss $
$
TOTAL UNCOMPENSATED
-
$
Guidance Care Center. Inc.
Exhibit G
Page 2 oF4
Contract No. PPG-2-03
July 1, 2017 - June 30, 2018
Guidance/Care Center, Inc. - 1'PG
I PG-2-03
COVERED SERVICES
01
Assessment
02
Case Management
03
Crisis Stabilization
04
Crisis Support/Emergency
(Its
Day/Night
07
Drop -In Self l lelp Centers
S
(I8
In-f fome"On-Site
I I
Intervention - Individual
42
Intervention - Group
12
Medical Services
14
Outpatient - Individual
s
5
Outpatient - Group
15
Outreach
18
Residential Level I
19
Residential Level 11
?0
Residential Level III
IN
1
Res:idential Level IV
7.1
Substance Abuse Detox
25
Supported Employment
S
26
Supportive I lousing
S
27
TASC
28
incidental Expenses
S
?9
Aftercare - Individual
4
Aftercare - Group
$
€3
Information & Referral
4
FACT Team
;6
Room & Board Level
p7
Room & Board Level II
i8
Room & Board Level III
P)
Short-term Residential Treatment
10
Clubhouse Services
-1.1
CCST - Individual
I
CCST - Group
46
Recovery Support - Individual
4`
Recovery Support - Group
48
Prevention - Indicated
S
49
Prevention - Selective
S
50
Prevention - Universal Direct
S
it
Prevention - Universal Indirect
S
IN
Special Proviso
,.
TOTAL FUNDING S
TOTAL UNCOMPENSATED
EXHIBIT G: COVERED SERVICES 111` OC.\
September 2015
AIS0113 NI tI 51sivil MY123 %1%025 Ntstj2i
M'SIAl �ISAIAIJ NIM11,11 Siti9o3 %1w-t
FUNDING / ►1SA03 \ISAII MSA21 1fSA23 AISA25 NISA27
31SA81 MSA91 111SAT11 AISACF TOTAL
RATE
_
$ -
m
$ _
m
$
$
$
_
S -
S -
$
43.12
$
48.68
$ .
48.68
$ -
48.68
$
tangy y
$ _
1511,000 $ $ $ - $ . $ - $
$ - $ $ - $ - $ - $ -
S -
Guidance Care Center, Inc. Exhibit GPage 3 of 4 Contract No. PPG-2-03
I �i� �� r't"iT�ll<KK�t,.1 � �r� I ■ �'ltrL+-i [N � I=11►� l:i<�fl <iY.i':T�tTii[e11'rFTi�a(tl�rrs-t1�1�!
July 1, 2017 - June 30, 2018
Guidance/Care Center, [Be. - PPG
PPG-2-03
COVERED SERVICES
01
Assessment
0?
Case Management
07
Crisis Stabilization
01
Crisis Support/Emergency
S
06
Day/Night
ill
Drop-In'Self I lelp Centers
08
In-l-tomeOn-Site
I I
Intervention - Individual
g7
Intervention - Group
1"'
Medical Services
14
Outpatient - Individual
75
Outpatient - Group
15
Outreach
18
Residential Level I
11)
Residential Level 11
'20
Residential Level III
1
Residential Level IV
74
Substance Abuse Detos
25
Supported Employment
26
Supportive Housing
77
TASC
5
'8
Incidental Expenses
79
ANercam - Individual
4 i
Aftercare - Group
5
0
Information & Referral
i l
FACT Team
1
.16
Room & Board Level 1
e37
Room & Board Level 11
18
Room & Board Level III
9
Short-term Residential Treatment
40
Clubhouse Services
-11
CCST- Individual
41
CCST - Group
-t£f
Recovery Support - India^idcial
4'
Recovery Support - Group
48
Prevention - Indicated
S
49
Prevention - Selective
S
50
Prevention - Universal Direct
S
SI
Prevention - Universal Indirect
S
st`t
Special Proviso
TOTAL FUNDING S
TOTAL UNCOMPENSATED
Guidance Care Center, Inc.
EXHIBIT G: COVERED SERVICES BV OC:\
t34+��.1
�i�a�t t t1ss1�t 1tMce� vt�1m5 ®® )TH i
MM125-Ull 51SR11 1 �tS A 1,1
)PINc to
FUNDING M-SC03
NSCII MSC2I NISC23 PISC2S \1SC2;-CR AISCPP NISCT11
111SCCF
TOTAL
RATE
150,000
$
150,000
$
$
m
$
_
g
_
$
43.12
10,469
$
10469
48.68
13,486
$
13,486
48.68
126.045
$
126,045
48.68
$
-
$
150,000 S -
$ - $ - $ - $ - $ - S 150,000 $ - $
S - $
150,000
Exhibit G
September 2015
Page 4 of 4 Contract No. PPG-2-03
I �i� �rTiTT.T[KKtit..7 � ��� I ■ �'ltE�.'i [N � I=1 r� I:T�EI <hi�tTE##E;e�Ri 'E-"iiiT;�I+1�?'+rs -+I�r
September 2, 2015-June 30, 2016 EXHIBIT H - FUNDING DETAIL September 20 t 5
Pro%ider: Guidance/Care Center, Inc. - PPG Cant rat 14: PPG-2-03 Amendment 4
ADULT %
- MENTAL HEALTH
—
CHILDREN MENTAL HEALTH
OCA DESCRIPTION
NEM OCA
OLD OCA
AMOUNT
OCA DESCRIPTION
NEM OCA OLD OCA
AMOUNT
Residential Services
M11001
NIIIA01
S
Residential Services
N111001
NI 11CO I
$
Non -Residential Services
M11009
NIIIA09
S
Non -Residential Services
hl 11009
MHC09
S
Crisis Services
N111018
MIIA18
S
Non -Residential Services - CR
Ml 1009
milcog
T—_
Crisis Services - Baker Act
1011018
MIIA18
S
Crisis Services
rVII10 18
NIIIC18
S
Community Forensic Program
M11072
NIIIA72
S
CFiNiS Services - Baker Act
N111018
MITC18
S -
FACT Team
N111073
MEIA73
S i
Special Appropriation - ICFf I
M11013N
Nil ICBN
$ -
Indigent Drug Program
M11076
NIIIA76
S
FACES Expansion Grant
M1I0FA
N111CFA
$ -
Proviso Allocation - Camillus
NI 11093
Nil IA93
S
FACES Expansion Grant - CR
M1101-A
NITICFA
$ -
Proviso Allocation - Citrus
M11094
MI IA94
S
FACES Wraparound Grant
N1110NID
N111CMD
S -
PATI I Grant
NHIOPG
MIIAPG
S
FACES Wraparound Grant - CR
NIHOMD
MIlCMD
7 ---
TANF
M110"M
Nil IATB1
S
Carry Forward
N1110CF
NIIICCF
T_-
Carry Forward
N1110C17
MllACF
S
TOTAL ADULT MENTAL
HEALTH =
S
TOT,%LCIIILDREN�lEiN"I'ALIIEALTI[m
S
ADULT SUBSTANCE ABUSE
CHILDREN SUBSTANCE ABUSE
OCA DESCRIPTION,
NEXI OC,.%
OLD OCA
AMOUNT
—i---
OCA DESCRIPTION'
NEWOCA OLD OCA
AMOUNT
Residential Services
MS003
NISA03
u
Residential Services
MS003
MSC03
$ -
Nan -Residential Services
Niso I I
MSAI I
S
Non -Residential Services
Msoll
MSCl I
S
Delox Services
NIS021
NISA21
S
Milos Services
MS021
MSC21
T__-
I [IV Services
MS023
MSA23
IIIV Services
MS023
SISC23
S
Prevention Services
MS025
MSA25
Prevention Services
IVIS025
MSC25
_j_-
Women's Services
NIS027
NISA27
S
Prevention Services - CR
NIS025
MSC25
S -
Pregnant Women Project
MS08 I
NISARI
S
Prevention Partnership Grant
NIS0111,
NISC111)
$ 150,000
Proviso Allocation - GCC
MS091
NISA91
5
TANF Services
NISOTO
NISCT13
$ -
TANF
NISOTB
NISAT13
S
Proviso Allocation - I feres I lelp
MS903
S
Proviso Allocation - I feres I lelp
NIS903
S
Carry Forward
MSOCF
NISCCF
S
Carry Forward
NtS[)CF
MSACF
TOTAL ADULT SUBSTANCE ABUSE m S
IEOUIRING MATCH:
........ . ..
If Block Grant _7
A _FUNDS S 11111 1—
tNOf11EQUlk REQUIRING MATCi_1__ -
104--201 -) $150,000 is allocated for the PPG Giant funded prevention services per the RFA
TOTAL CHILDREN SUBSTANCE ABUSE ®
TOTAL ALL PROGRAMS = S
150,00U
UNCOMPENSATED UNITS —
TOTAL —
TOTAL FUNDS REQUIRING MATCH - S
150.000
LOCALMATCH REQUIRED —
Guidance Care Center, Inc. Exhibit 11 Contract No. PPG-2-03
Page I of 1
July 1, 2016- June 30, 2017
Provider: GuidancefCare Center, Inc. - PPG
OCA DESCRIPTION
Residential Services
Nan -Residential Services
Crisis Services
Crisis Services - Baker Act
Community Forensic Program
FACT Team
Indigent Drug Program
Proviso Allocation - Camillus
Proviso Allocation - Citrus
PATI I Grant
TANF
Carry ron%ard
EXHIBIT 11 - FUNDING DETAIL September 2015
Contract 4: PPG-2-03 Amendment M
NTAL IlEALTH
CHILDREN MENTAL IIEALTII
EIVOCA
N111001
M11009
M11018
N111018
N111072
NIH073
NIU076
N111093
MH094
NI1I0PG
N111M
OLD OCA
NIIIA01
NHIA09
NIIIAIH
NIIIAIS
MlIA72
NHIA73
NIIIA76
MIIA93
NIIIA94
MllAPG
NIIIATB
AMOUNT
S
S
S
S
$
S
S
$
5
$
S
OCA DESCRIPTION
Residential Services
Nan -Residential Services
Non -Residential Services - CR
Crisis Services
Crisis Services - Baker Act
Special Appropriation - ICFI I
FACES Expansion Grant
FACES Expansion Grant - CR
FACES Wraparound Grant
FACES Wraparound Grant - CR
Carry Forward
NE% OCA OLD OCA
M11001 milcol
NI 11009 NIUC09
MI 1009 Nil IC09
N111018 MUCH
N111018 MUCH
hillOBN NIIICBN
M110FA NIIICrA
M110FA M11CF-A
NIHONID NIEICMD
MHONID Nil ICNID
NII IOCF N1I1CCF
AMOUNT
—S
S
$
$ -
$
S
S
S
S
Nil I0CF NIIIACr LS
TOTAL ADULT MENTAL HEALTH - - S I TOTAL CHILDRENNIEN-I'AL IlEALTII = S
ADULT
Residential Services
Non -Residential Services
Detux Services
I [IV Services
Prevention Services
Women's Services
Pregnant Women Project
Proviso Allocation - GCC
TANF
Proviso Allocation - I lere s I felp
Carry For%vard
Da"1111-F."I'Duall
CHILDREN SUBSTANCE ABUSE
NEW OCA
OLD OCA
ANIOUN'T
OCA DESCRIPTION
NIA% OCA OLD OCA
AMOUNl
MS003
MSA03
$
Residential Services
NIS003
NISCO3
$
NIS01 I
NISA I I
S
Non -Residential Services
NISOI I
NISCH
$
NIS02 I
NISA21
j__
Dclox Services
NIS021
NISC21
S
NIS023
NISA23
S
I 11V Services
MS023
NISC23
S
NIS025
MSA25
S
Prevention Services
NIS025
NISC25
$ -
NIS027
SISA27
S
Prevention Services - CR
N15025
NISC25
S
NIS081
MSA81
Prevention Partnership Grant
NISOPP
NISCIT
S 15001
MS09 I
NISA91
$
TANF Services
NIS(YI'B
MSCTB
NISOTB
NISAT13
S
Proviso Allocation - I [ere's I lelp
NIS903
NIS903
Carry Forward
NISOCT"
MSCCF
I t
NISGCF
NISAcr
TOTAL ADULT SUBSTANCE ABUSE w S
Services
V Mi
.11
s
NOT REQUIRING MATCH S - I
NOTES
M12015 S150,000 isallocated for the PPG Grant funded prevention services per the RFA
TOTAL CHILDRENSUBSTANCE ABUSE- S 150,000
TOTAL ALL PROGRAMS w S 150,000
UNCONI PENSATE D UNITS =
TOTAL =
TOTAL FUNDS REQUIRING MATCH S 150.000
LOCAL MATCH REQUIRED -_S 3.7 5oo
Guidance Care Center, Inc. Exhibit I I Contract No. PPG-2-03
Page I of I
July 1, 2017- June 30, 2018
EXHIBIT H - FUNDING DETAIL
Provider: Guidance/Care Center, Inc. - PPG Contract M PPG-2-03 Amendment #
ADULT MENTAL HEALTH
CHILDREN MENTAL lIEALTI[
OCA DESCRIPTION
NEW OCA
OLD OCA
AMOUNT
OCA DESCRIPTION
%Ell OCA OLD OCA
AMOUNT
Residential Services
Milool
MIIAOI l�
S -
Residential Services
N111001
N1IC01
S
Nan -Residential Services
NIH009
NIIIA09
S -
Non -Residential Services
M11009
Nillcog
-F—_
Crisis Services
N111018
MIJAIS
S -
Non -Residential Services - CR
N411009
1,111C09
T--
Crisis Services - Baker Act
N111018
MIIA18
$
Crisis Services
N111018
rvlllcl8
Community Forensic Program
NIII072
NIIIA72
$ -
Crisis Services- Baker Act
M11018
IVIIICIS
FACT Tcam
Nil 1073
MlIA73
$ -
Special Appropriation - ICFl I
NlII0BN
NIIICBN
Indigent Drug Program
NIII076
MEIA76
$ -
_T
FACES Expansion Grant
MI OFA
MI 1CFA
S
Proviso Allocation - Camillus
Nil 1093
NIIIA93
-
FACES Expansion Grant - CR
NIHOFA
M I ICIFA
Proviso Allocation - Citrus
M11094
NIIIA94
S -
FACES Wraparound Grant
Nil IONID
N111CMD
1,
PATI I Gran[
NIFIOPG
MIIAPG
S -
FACES Wraparound Grant-CR
NIEIONID
MIICNtD
FSS
TANF
N1110
MIIATB
S - i
Carry Forward
NIII0CF
Nmccr
Carry Fonvard
111110CF
NIIIACFM
_§ J
---
TOTALADULT MENTAL 11
EALTI I=
s
TOTAL CHILDREN MENTAL
HEALTH -
S
ADULT SUBSTANCE ABUSE
CHILDREN SUBSTANCE ABUSE
OCA DESCRIPTION
NE%VOCA
OLD OCA
AMOUNT
OCA DESCRIPTION
NFV1 OCA OLD OCA
AMOUNT
Residential Services
MS003
MSA03
$ -
Residential Services
1NIS003
NISC03
-T--
Non-Rcsidential Services
NIS01 I
MSA I I
S -
_T
Non -Residential Services
NIS01 I
NISC I I
S
Delox Scr% ices
NIS021
NISA21
-
Detox Services
NIS021
NISC21
—j--
I I IV Services
XIS023
MSA23
S
III V Services
NIS023
MSC23
S
Prevention Services
NIS025
MSA25
S
Prevention Services
NIS025
MSC25
$
Women's Services
NIS027
MSA27
S
Prevention Services - CR
NIS025
NISC25
S -
Pregnant Women Project
MS081
NISA81
$
Prevention Partnership Grant
NIS01111
MSCPP
T 15-0,000
Proviso Allocation - GCC
MS091
NISA91
S
TANF Services
NISOTB
MSCTI3
S -
TANF
NISOT13
NISATB
Proviso Allocation - I leres I lelp
MS903
$ -
Proviso Allocation - licre's licip
NIS903
Carry Forward
NISOCF
MSCCF
S
Carry Forward
NISOCF
MSACF
S
TOTAL ADULT SUBSTANCE ABUSE= S
1EQUIRING MATCH:
R �mp ;k6u�e � �cei;W - ----- ,r ......
stitutionalization Project
FINDS NOT REQUIRINGMATCH S
10"It-1015 $ 150 000 is allocated for the PPG Grant funded Prevention sen ices per the RFA
TOTAL CHILDREN SUBSTANCE ABUSE= S 150.000
mzm==m�
TOTAL ALL PROGRAMS a S
150000
UNCOMPENSATED UNITS =
TOTAL w =L==
=15=060�00
TOTAL FUNDS REQUIRING MATCH - S
150,000
LOCAL MATCH REQUIRED w S
3711;00
Guidance Care Center, Inc, Exhibit I I Contract No. PPG-2-03
Page 1 of I
September 1, 2015- June 30, 2016 LOCAL >NIATCli PLAN September 1. 2015
Guidance/Care Venter, Inc. - PPG
PPG-2-03
REQUIRED I\I tTCII: S 37,500
COST CENTERS
RATE
01
Assessment
$ _
i12
Case Management
$
03
Crisis Stabilization
$ -
IW
Crisis Support/Emergency
$ -
(16
Day/Night
$ _
07
Drop-In/Self Help Centers
$
08
In-Ilome/On-Site
$ -
11
Intervention - Individual
$ -
42
Intervention - Group
$ _
12
Medical Services
$ _
Id
Outpatient - Individual
$ _
35
Outpatient - Group
$ _
15
Outreach
$ _
18
Residential Level 1
$
19
Residential Level 11
$
21)
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
$ _
341
Information & Referral
$ -
34
PACT Team
$ _
36
Room & Board Level 1
$ -
37
Room & Board Level 11
$
38
Room & Board Level III
$
39
Short-term Residential Treatment
$ -
40
Clubhouse Services
$ -
44
COST- Individual
$ _
45
CCST - Group
S
46
Recovery Support - Individual
$ -
47
Recovery Support - Group
$
48
Prevention - Indicated
S 43.12
49
Prevention - Selective
$ -
50
Prevention - Universal Direct
$ -
51
Prevention - Universal Indirect
$ -
99
Special Proviso
$ -
MATCll ALLOCATION:
GRAND TOTAL:
S 37,500
Guidance Care Center, Inc.
UNITS MATCH UNITS MATCH UNITS ,MATCH UNITS ,INIATCII
Local Match Plan
Page 1 of I
869.67 $ 37,500
S 37,500
Contract No. PPG-2-03
I �i�i'. r r'i';T�.T[eT�t.^� � �r� I ■ �'ll�f�'1 [e1 � I =1 ��±:��1ti'i'4CTri[e1'1'G,FTiTT;1'I+�?�s =tts'�f
July 1, 2016- June 30, 2017 LOCAL NIATC1I PLAN September I, 2015
Guidance/Care Center. Inc. - PPG
PPG-2-03
(11
02
03
04
(16
07
08
11
42
12
14
35
15
18
19
20
21
24
25
26
27
28
29
43
30
34
36
37
38
39
41)
44
45
46
47
48
49
50
51
99
REQUIRED MATCH: S
COST CENTERS
37,500
RATE 1 NITS \I;ATCII UNITS AIATCII i'NITS NIATCII UNITS XIATC11
Assessment
$ -
Case Management
$ -
Crisis Stabilization
$ _
Crisis Support/Emergency
$ -
Day/Night
S
Drop-In/Self I lelp Centers
S -
In-1-lome/On-Site
$ -
Intervention - Individual
$ -
Intervention - Group
$ -
Medical Services
$ -
Outpatient - Individual
$ -
Outpatient - Group
$ -
Outreach
S -
Residential Level I
S
Residential Level II
$
Residential Level III
$
Residential Level IV
$ _
Substance Abuse Detox
$ _
Supported Employment
$ -
Supportive I lousing
$ _
TASC
$ -
Incidental Expenses
S -
ARercare - Individual
S -
Aflercare - Group
$ -
Information & Referral
$ -
FACT Team
$ _
Room & Board Level I
$ -
Room & Board Level II
$ -
Room & Board Level I I
$ -
Short-term Residential Treatment
$ -
Clubhouse Services
S
CCST- Individual
$
CCST - Group
$ _
Recovery Support - Individual
$ -
Recovery Support - Group
$ -
Prevention - Indicated
S 43.12
Prevention - Selective
$ -
Prevention - Universal Direct
S -
Prevention - Universal Indirect
S -
Special Proviso
S
MATCH ALLOCATION:
GRAND TOTAL:
S 37,500
$
Guidance Care Center, Inc, Local Match Nan
Page I of 1
$
$
869.67 S 37.500
$ 37,500
Contract No. PPG-2-03
I �i1:T� �� r't"iT�[KK��..1 � �r� I ■ �'ltrL+-i [N � I=1 r31! I:T�1 ti'.i�tT f[e1tG,(ti�7Ts =tt1�a�!
July 1, 2017- Jude 30, 2018 LOCAL MATCH PLAN September 1, 2015
Guidance/Care Center, Inc. - PPG
PPG-2-03
01
02
03
04
06
07
08
11
42
12
Id
35
15
IN
19
20
21
24
25
26
27
28
29
43
30
34
36
37
38
39
40
44
45
46
47
48
49
50
51
99
REQUIRED NIATCII:
S
37,500
COST CENTERS
RATE UNITS MATCH UNITS MATCH UNITS ]IATCII UNITS MATCH
Assessment
S
Case Management
$
-
Crisis Stabilization
$
-
Crisis Support/Emergency
$
-
Day/Night
$
-
Drop-In/Self Help Centers
$
-
In -I Tome/On-Site
$
_
Intervention - Individual
$
Intervention - Group
$
Medical Services
$
_
Outpatient - Individual
$
-
Outpatient - Group
S
_
Outreach
$
_
Residential Level I
S
_
Residential Level 11
S
_
Residential Level III
S
-
Residential Level IV
$
_
Substance Abuse Detox
$
Supported Employment
$
-
Supportive I In using
S
-
TASC
S
Incidental Expenses
S
Aftercare - Individual
$
_
Aftercare - Group
$
_
Information & Referral
$
FACT Team
$
_
Room & Board Level 1
$
-
Room & Board Level 11
S
.
Room & Board Level III
S
-
Short-term Residential Treatment
$
-
Clubhouse Services
$
-
CCST- Individual
$
_
COST- Group
S
_
Recovery Support - Individual
S
-
Recovery Support - Group
S
-
Prevention - Indicated
S
43.12 869.67 S 37.500
Prevention - Selective
$
Prevention - Universal Direct
$
-
Prevenlion - Universal Indirect
$
-
Special Proviso
$
_
MATCH ALLOCATION:
$ - $ $ - $ 37.500
GRAND TOTAL:
S
37,500
Guidance Care Center, Inc.
Local Match Plan
Page I of I Contract No. PPG-2-03
I�i���TiT>Z[Kt�ttt..l��r�I■�'ltrL+-i[N�1=1t►7I;T�1<IYiTtTi■��11'rFTT�a(t�rrs -�»!
U00'000
South Florida
Behavioral
Health Network, Inc. Rev. 5:A/2015
ATTACHMENT lI
Financial and Audit Compliance
The administration of resources awarded by the Managing Entity (ME) to the Network
Provider may be subject to audits as described in this attachment.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Uniform Guidance:
Cost Principles, Audit, and Administrative Requirements for Federal Awards (also
known as the OMB Uniform Guidance), Section 200.500- 200.521 and Section 215.97,
F.S., as revised, the ME may monitor or conduct oversight reviews to evaluate
compliance with contract, management and programmatic requirements. Such
monitoring or other oversight procedures may include, but not be limited to, on -site visits
by ME staff, limited scope audits as defined by OMB Uniform Guidance, Section
200.331, as revised, or other procedures. By entering into this agreement, the recipient
agrees to comply and cooperate with any monitoring procedures deemed appropriate by
the ME. In the event the ME determines that a limited scope audit of the recipient is
appropriate, the recipient agrees to comply with any additional instructions provided by
the ME regarding such audit. The recipient further agrees to comply and cooperate with
any inspections, reviews, investigations, or audits deemed necessary by the ME,
Department of Children and Families inspector general, the state's Chief Financial
Officer or the Auditor General.
AUDITS
PART I: FEDERAL REQUIREMENTS
This part is applicable if the recipient is a State or local government or a non-profit
organization as defined in OMB Uniform Guidance, Section 200.500-200.521, as revised.
In the event the recipient expends $500,000 ($750,000 for fiscal years beginning on or•
cf er December 26, 201 4) 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 I of 4
Guidance Care Center, Inc. Contract No, PPG-2-03
South Florida
.'Behavioral
Health Network, Inc.
Rev. 5*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 I0.650
(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 11
Page Z of a
Guidance Care Center, Inc, Contract No, PPG-2-03
WSouth Florida
Behavioral
Health Network, Inc.
Rev. 5./ 412015
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 ( I 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: sing=le.audit`4fafla ilies.co
C. Reporting packages for audits conducted in accordance with Uniform Guidance,
Section 200.500-200.521, as revised, and required by Part I of this agreement shall be
submitted, when required by Section 200.512 (d), OMB Uniform Guidance, as
revised, by or on behalf of the recipient directly to the Federal Audit Clearinghouse
using the Federal Audit Clearinghouse's Internet Data Entry System at:
ttQ:1e h_arvester.cen,s ein ex.fitmI
and other Federal agencies and pass -through entities in accordance with Section
200.5I2 (e), OMB Uniform Guidance, as revised.
D. Copies of reporting packages required by Part If of this agreement shall be submitted
by or on behalf of the recipient directs to the following address:
Auditor General
Local Government Audits/342
Claude Pepper Building, Room 401
1 1 1 West Madison Street
Tallahassee, Florida 32399-1450
Email address: .IG.Single.Audit@myflfamilies.com
Attachment II
Page 3 of 4
Guidance Care Center, Inc, Contract No.. PPG-2-03
U20South Florida
Behavioral
Health Network, Inc.
Rev. 5412015
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 I0.558(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 11
Page a of 4
Guidance Care Center, Inc. Contract No. PPG-2-03
ehlavioral
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-
LLI_, 'Disclosure Form to Report Lobbying,' in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be Included in the award documents for
all sub -awards at all tiers (including subcontracts, sub -grants, and contracts under grants,. loans and
cooperative agreements) and that all sub -recipients shall certify and disclose accordingly -
This certification is a material representation of fact upon which reliance was placed when this transaction was made
or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed
by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil
penalty of not less a10,000 and not more than $100,000 for each such failure.
"Ab
Name ulhorized Individual
t
d
Name of Organization
k{
Address of Organization
CF 1123, PDF 03196
Attachment III
Guidance Care Center, Inc. Page I of I
i7ate
Application or Contract Number
33,(7'\
Contract No. PPC-2-03
�/ South Flarlda
a.ha,rW l
OWI w. Ith ta.t d4 k .
Attachment IV
PREVENTION SCOPE OF WORK
NAME OF PROVIDER: Guidance/Care Center
NAME OF PREVENTION PROGRAM: Project SUCCESS
AMOUNT OF CONTRACT AWARD: $150,000.00 for each year of the contract
"Regular" Prevention Services Prevention Partnership Grant
TYPE OF FUNDING: PPG
X
COST ALLOCATED TO: (check both Children's Substance Abuse Adult Substance Abuse
if approved for both covered services) X X
Section I. DESCRIPTION OF SERVICES AND STRATEGIES FOR SERVICE DELIVERY
The Guidance/Care Center's (GICC) 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 9"' 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,
unuvtr bAL. — rnCf1rect/Direct: Information Dissemination
SELECTIVE: Education — Project SUCCESS and Alternatives
INDICATED: Problem Identification and Referral and Alternatives
Attachment I'
Page 1 of 14
Guidance Care Center, Inc, Contract No. PPG-2-03
%/ South Florida
Iehavkwal
Health N~rk, 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 11. TARGET POPULATION — RISK AND PROTECTIVE FACTORS
Attachment IV
Page 2 of 14
Guidance Care Center; Inc, Contract No. PPG-2-
V/ South FWWM
B®huvloral
Ffrahh Network, tnc..
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 touristivacation
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 druq use.
Section III. SITE LOCATIONS AND INFORMATION*
Manager.
Section IV. MAJOR REFERRAL SOURCES
Section V. PERFORMANCE MEASURES
Attachment IV
Page 3 of 14
Guidance Care Center, Inc.
Contract No. PPG-2-03
South Florida
fthavloral
Hoalth
Network, Inc.
Prevention Education Series'
335
6to 8 85%® Universal
Project SUCCESS
Of
scheduled
sessions
School Wide Activities
2500
9 90% Universal
Small Groups
$0, ---2
—85—
% Selective
Newcomer
group
sessions
85% of
other
scheduled
small group
sessions
Individual Sessions
130
1-3 85% Indicated
Sessions,
with
justificatio
n if
different
Quality Performance Measures
(include fidelity measures, satisfaction survey Information, supervision,
training, staffing,
and other required information pertaining to quality)
ZI
Average number of sessions
85% of 545 participants will compiii—e
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 andpost tests
Collected —immediately prior to the Is'
attitudes and beliefs related to
session and immediately following the
risk of harm associated with
last session
underage drinking
Collected immediately prior to the Is'
85 % of the youth will have no or
session and immediately following the
a decrease in past 30 day
Project SUCCESS pre and post tests
last session
alcohol use by curriculum
completion
Collected immediately prior to the 1st
85 % of youth will decrease
Project SUCCESS pre and post tests
session and immediately following the
favorable attitudes toward
last session
alcohol and drug use
Attachment IV
Page 4 of 14
Guidance Care Center, Inc.
Contract No PPG-2-03
South Fbrlda
®Behavioral
Health Network, hm
# and % of youth/participants
satisfied with services provided
90 % Satisfaction Survey
Measured at the end of each program
cohort
Observation of service
Curriculum fidelity checklist
Measured at the end of each program
delivery/Fidelity checklist
cohort
SupervisorlObserver Report
Documentation of structured
Supervisory record, Supervisory Tool, or
During regular supervisory sessions
supervision
Checklist and notes in staff file
and not less than one time per month
# and % of staff with necessary
100%
At the time of contract monitoring
training
# and % of staff working
Staff will show courses and documents
toward Prevention
50%
from the Florida Certification Board at
certification with the Florida
the time of contract monitoring.
Certification Board
Section VI. Participant Outcomes
Will be completed with the Evaluation Team and l
CCAP Objective; By June 30, 2018, reduce the rate of past 30 day alcohol use and the rate of Binge Drin11 king
among underage young adults and youth in Monroe County.
CCAP Outcome: By June 30, 2018, there will be a 5% reduction of 30 day use of alcohol and a 2.5% reduction
of binge drinking among the underage young adults and youth of Monroe Countv.
Cohorts Section VII. TASK LIST
Attachment IV
Page 5of14
Guidance Care Center, Inc. Contract No PPG-2-03
�/ South Florida
Behavioral
Health Network, Inc
Duration: 60 mins.
Activity Title: Project SUCCESS Prevention Education Series Curriculum
35
5 of
Activity Description,. 91" graders will participate in a 4 topic
scheduled
Prevention Education Curriculum
sessions ( 6 — )
Frequency: one time per week
For 4 — 6
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.
Activit Title: Pre- and Post testing
45
45 to 60 min.
5 %
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
30
45 to 60 ruin:
5%
ActfvIty 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
Intel 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)
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 Survevs.
Attachment [V
Page 6of14
Guidance Care Center, Inc- Contract No PPG-2-03
�/ P � South Florida
Sehavloral
Heahh N*Wmrk hv-
4- Activity Logs are maintained for all Universal and Selective activities.
5- Client charts are maintained for all Indicated Prevention activities and are included in the GCC Peer Review
process.
6- All activities for Prevention will be consistent with the agency's Quality Assurance Quality Improvement Plan.
GCC will coordinate with the Evaluation Team, Behavioral Science Research Institute (BSRI)„ for process and
outcome data as required- The Data will support any processes from the Westcare Team,
Attachment IV
Page 7 of 14
Guidance Care Center, Inc, Contract No. PPG-2-03
�� South Florida
/ Behavioral
Haa thNotWork4hlG
Immediate Outcome(s):
Increase knowledge and
skills among minors.
Section X. EVALUATION PLAN
Monitoring the I I
Students Surveys 1,260 (420
Future Survey annually)
Attachment IV
Page 8 of 14
Beginning and Research
end of curriculum Assistant collects
completion and enters data
Evaluator
analyzes and
reports data
Guidance Care Center, Inc. Contract No. PPG-2-03
I �iiTa t t't"iT�[KKB�..1 � ��� I ■ �'ltrL+'i [N � I=1 tl�±:Ir�i�:7CTi�t1 ti'.i�tT f[e1tG,(t1�7Ts =tt�m!
,� South Florida
Behavioral
%//
/J Health Network. Inc.
Intermediate Outcomes(s):
Monitoring the
Students
Surveys
1,2G0 (420
Beginning and
Research
Reduce the number of
Future Survey
annually)
end of curriculum
Assistant collects
underage alcohol drinkers
completion
and enters data
who report buying alcohol
Evaluator
in a store..
analyzes and
reports data
Objective 2 from CCAP: Reduce
the underage young
adult (18-20) and youth
(12 to 17) attitudes
of the acceptance of
alcohol use.
Immediate Outcome(s):
Fidelity Measures
Prevention
Observations
Minimum of 3
Random
Research
Provide increased and
for Project
Counselor
observations
Assistant and
consistent messaging
SUCCESS
quarterly
Prevention
about the consequences of
Curriculum
Supervisor
alcohol abuse
Intermediate Outcomes(s):
Fidelity Measures
Prevention
Observations
Minimum of 3
Random
Research
Consistency of Evidence
for Project
Counselor
observations
Assistant and
Based Programs
SUCCESS
quarterly
Prevention
Curriculum
Supervisor
Guidance Care Center, Inc.
Attachment IV
Page 9of14
Contract No. PPG-2-03
I �i�i'1. r r'i';T3f.�[e��.^� � ��� I ■ �'lt�f�'� [e� � I =1 �31!±:��1ti'i'�C�ri[e1'1'G,FTiTT;�I+i1�?�s -ts'�f
�� South Ftorlda
/ Behavioral
Health Network, Inc -
Long term Outcome: By
G=CC
Hard copy singed
1 agency
Coalition
Annually
Program Director
2018, MCC will have
documents
Involvement
signed Coalition
Agreement
involvement Agreements,
which will create
ownership among the
community to change the
community norms that are
favorable to Underage
drinking.
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.
Guidance Care Center, Inc..
Attachment IV
Page 10 of 14
Contract No. PPG-2-03
I�i��rTiTT.�[KKta�..7��r�I■�'lI�L+'i[ei�I=1r�±:T�1ti'.il!tTf[e�itf'FTiT�altl�rrs =�a�!
RJ,e,1 I South Florida
'A
KKPBehavioral
.Wd Health Network, Inc
lxkilvltles
_71meline
Party Aesponsible
Stan Date
I End Date
Prepare, organize educational materials
Sept.
may
12016
Project SUCCESS counselors
2015
Conduct follow-up on previous yr. clients
Sept.
Oct.
12015
Project SUCCESS counselors
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.
12015
Oct.
Project SUCCESS counselors
2015
Implement Prevention Series groups
Oct.
12016
Apr.
Project SUCCESS counselors
2015
Conduct Individual Assessments
Sept. I
May
Project SUCCESS counselors
2015
2016
Test for program fidelity
Nov.
May
Project SUCCESS counselors
2015
2016
Conduct Pre and Post tests
Sept. 1
May
Project SUCCESS counselors
2015
2016
Attachment IV
Page 11 of 14
Guidance Care Center, Inc.
Contract No. PPG-2-03
v/ South Fladda
sthavieral
H@&M Notwadc' Inc.
School wide awareness activities
I During the
Project SUCCESS counselors
months of
Oct. Nov.,
Dec. 2015
Feb. Mar.
Apr May
2416
Conduct weekly clinical supervision with Counselors
Sept.
June
12016
Program Coordinator
2015
Conduct monthly PS staff meetings with all Program Staff
Sept.
June
Program Coordinator
2015
2016
Identify and refer students in need of services during the summer months
Apr.
June
Project SUCCESS counselors
2016
2016
Inmellne
Party Responsible
YEAR 2,Acfliltfes
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
L_
2016
.2017
Coordinate & finalize program logistics w/targeted schools
Sept.
12016
Oct.
Project SUCCESS counselors
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
JAug.
Oct.
Project SUCCESS counselors
2016
1
2016
Implement Prevention Series groups
Sept.
Apr.
Project SUCCESS counselors
2016
20171
FA
;ME=
I JM V411.1 0 EJ
Guidance Care Center, Inc.
Contract No. PPG-2-03
South Florida
Behavioral
H*xIthN@twofLIm
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
2017
School wide awareness activities
During the
Project SUCCESS counselors
months of
Sept., Oct.
Nov., Dec.
2016 Feb.
Mar. Apr
May 2017
Conduct weekly clinical supervision with Counselors
Jul. 2016
June
Program Coordinator
2017
Conduct monthly PS staff meetings with all Program Staff
Jul. 2016
June
Program Coordinator
2017
Identify and refer students in need of services during the summer months
Apr.
June
Project SUCCESS counselors
2016
2017
--YEAR 3 Actliritl6i
71meline
Party- Respens:Ible
Start Date
End Dale
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
0:18
Present program update to Community Coalition
Jul 2017
June
Program Coordinator
2018
Attachment IV
Page 13 of 14
Guidance Care Center, Inc.
Contract No. PPG-2-03
ng_;00�
South Florida
Behavioral
Reafth 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
1
2018
Attachment IV
Page 14 of 14
Guidance Care Center, Inc.
Contract No, PPG-2-03
Amendment #1
Contract No. PPG-2-03
THIS AMENDMENT, entered into between South Florida Behavioral Health Network, Inc. hereinafter
referred to as the "ME" and Guidance Care Center Inc. hereinafter referred to as the "Network
Provider," amends Contract No. PPG-2-03.
PREAMBLE: This amendment is to revise Exhibit G, Covered Services Funding by OCA for Fiscal Years
2015-2016, 2016-2017 and 2017-2018 to reflect funding reallocations within the Children Substance
Abuse Program, Other Cost Accumulator (OCA) MSCPP (MSOPP-new OCA) at the provider's request.
1. Pages 1- 4, Exhibit G, Covered Services Funding by OCA for September 1, 2015-June 30, 2016
are hereby deleted in their entirety and Pages 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 113) page amendment to be
executed by their officials' thereunto duly authorized.
GUIDANCE/CARE CENTER, INC. SOUTH FLORIDA BEHAVIORAL HEALTH
NETWORK, INC.
SIGNED SIGNED
BY: BY: "o 0',
t"� n
NAME: Frank Rabbito MiivanY1q-,� &,Iww 4WJohn W. Dow
TITLE: Senior Vice President R trA 4 TITLE:
DATE: lam I A�{ I DATE:
FEDERAL Tax ID # (or SSN): 59-1458324
Guidance Care Center, Inc. Page t of 1
President and CEO
Contract No. PPG-2.03
September 1, 2015 - lune 30, 2016
EXIIJBIT G: COVERED SERVICES FUNDING 11YOCA
Guida ocelCa re Center, Inc. - PPG
lmnlii EMM-1
PPG3
tit V6 5311M %111094 %ilawf, N titu rn NLiM I
COVERED SERVICES
FINDING C
NIIIIAGI A111AD9 A1111AIR MIJAIN MIA72 %T11AT3 NIIIA-16 MIA93 51IIA94 N111APG A11111AT111 MHAEF TOTAL
31ATE
01 Assessment
$
02 Case Management
$
03 Crisis Stabilization
S
S
04 Crisis Suppow-VErnerg.cricy
5
WDay„,Night i Day
S
0i Drop-In/Sclrl lelp Centers
$
H In-flome(On-Site
S
I I Intervention - Individual
S
-12 intervention - Group
I Z Medical Services
14 Outpatient -individual
S
;i Outpatient - Group
I S Outreach
I X Residential Level I
S
11) Residential Level 11
S
20 Residential Level IH
21 Residential Level IV
S
24 Substance Abuse Detox
$
25 Supported Employment
1-6 Supportive Housing
S
S
27 TASC
S
2 M! Incidental Expenses
S
29 Aficrcare - Individual:
S
S LL
43 Aflercare - Group
$
S
10 Information & Referral
S
$
34 FACT Team
S
to Room & Board Level 1
5
S
Room & Board Level 11
$
S
M Room & Board Level 111
5
S
31 Short-term Residential Treatment
S
S
411 Clubhouse Services
S
44 CCST - Individual
45 CCST - Group
46 Recovery S u ppon - Ind i vidual
S
-17 Recovery Support- Group
S
S
48 Prevention - Indicated
S
43.12
S
S
49 Prevention - Selective
$
48.68
S
51) Prevention - Universal Direct
S
48.68
51 Prevention - Universal Indirect
S
48.68
s
Special Proviso
S
TOTAL KNI)ING
5
150,000
S SS S S 5 S S S S S
TOTAL UNCOMEIMSATED
S
Guidance Care Center, Inc. Revised Exhibit G
Page I of 4
Contract No. PPG-2-03
Revised April 20 16
Amendment N I
September 1, 2015- June 30, 2016
EXIIIHIT G: COVERED SERVICES FUNDING BYOC,'k
GuidnncefCare Center, Inc. - PPG
M
PPG3
MIUMN %1111HYMF 5111018 M11018 N11101IN M11*1% NIMPFAA R AMMID %l110%1D_CH
M114)(11.
COVERED SERVICES
FI"ND]NG I
Imlicitt snicog knicag-cl '%jjjC38 'kIncts slitcn.4 A111CF,1 AMCFA-CR alit S1111 ATITCAHICR
SUICCIF 10TAL
R,%TE
S
01 Assessment
S
02 Case Management
S
01 Crisis Stabilization
S
04 Crisis Support/Emcryeacy
S
$
(16 DagNight
y
01 Drop-In/Sell f I lelp Centers
4 In-liome/On-Site
S
I I Intervention - Individual
S
42 Intervention - Group
$
5
12 Medical Services
S
1.1 Outpatient -Individual
S
P; Outpatient - Group
I � Outreach
18 Residential Level I
11) Residential Level H
20 Residential Level M
S
21 Residential Level IV
S
'4 Substance Abuse Dc(ox
25 Supported Employment
S
2: 6 Supportive I loosing
S
27 TASC
S
$
28 Incidental Expenses
S
S
_'9 Aftercare- Individual
S
$
AI Aftercare - Group
S
0 Information & Referral
S
5
34 FACT Team
S
S
16 Room & Board Level 1
5
5
37 Room & Board Level 11
5
5
IS Room & Board Level 111
5
S
W Short-term Residential Treatment
S
S
40 Clubhouse Services
S
S
44 CCST- Individual
5
4i CCST- Group
S
46 Recovery Support - Individual
S
-17, Recovery Support - Group
$
S
48 Prevention - Indicated
S
43.12
49 Prevention - SeleciKe
S
48.68
50 Prevention - Universal Direct
S
48.68
51 Prevention - Universal Indirect
S
48.68
S
Special Proviso
S
TOTAL FUNDING
S
150,000
5 1 S S S S S S S $
S S
TOTAL UNCOMPENSATED
5
Guidance Care Center, Inc, Revised Exhibit G
Page 2 of 4
Contract No. PPG-2-03
Revised April 2016
Amendment N I
September 1, 2015- June 30, 2016 EXHIBIT G: COVERED SERVICES FUNDING HVOCA Revised April 2016
Guidnnee,'Care Center, Inc. - IIPG ... ..... .. .. . . Amendment 9 1
PPG3
COVERED SERVICES
FUNDING I SISAW NISAII NIS421 MA23 14SA25 MSA27 MARI AISA91 %TSATH
SISACF TOU0,
RATE
S
0]
Assessment
S
1) 2
Case Management
S
W
Crisis Stabilization
S
04
Crisis Support/Emergcney
,6
Day.'Night
07
Drop-In/Self I [elp Centers
S
h'
In-llomc/On-Site
S
S
I
Intervention - Individual
S
42
Intervention -Group
12
Medical Services
S
14
Outpatient - Individual
S
Outpatient - Group
$
IS
Outreach
$
18
Residential Level 1
$
S
11)
Residential Level H
$
S
20
Residential Level [if
S
S
21
Residential Level IV
S
$
24
Substance Abuse Dctox
S
-
S
2i
Supported Employment
S
S
26
Supportive I lousing
S
27
TASC
S
2S
Incidental Expenses
S
S
1-9
Aftercare - Individual
$
41
Aflercarc - Group
S
10
Information & Referral
S
34
FACT Team
16,
Room & Board Level 1
5
17
Room & Board Level 11
f,
38,
Room & Board Level [it
S
11)
Short-term Residential Treatment
S
,")
Clubhouse Services
S
44
CCST- Individual
S
11:
CCST - Group
S
S
6
Recovery Support - Individual
S
S
47
Recovery Support - Group
$
-
$
48
Prevention - Indicated
S
43.12
S
49
Prevention - Selective
S
48.68
50
Prevention - Universal Direct
S
48.68
51
Prevention - Universal Indirect
S
48.68
S
Special Proviso
TOTAL FUNDING
S
150,000 5 S 5 S $ S S S
S S
TOTAL UNCOMPENSATED
S
Guidance Care Center, Inc. Reviscil Exhibit G
Page 3 of 4 Contract No. PPG-2-03
Attachment: GCC—SAMH—FY1 7—SIGNED [Revision 1] (2231 : Guidance/Care Center)
September 1, 2015- June 30, 2016 EXIIIIJIT G. COVERED SERVICES FUNDING 11% OCA Revised April 2016
Amendment 9 1
Guidance/Care Cenler, Inc. - I'PG
PPG3 AlSocks %1M] I N 1: V1, 1 WON NISlill, NIS111:5"E H NISON, 'MWIR %IS910 '%ISIKF
COVERED SERVICES
FUNDING I AtSC03
AISCI I AISCII NISC23 NISC25 NtSC25-CR NISCIT %tscrli
NISCCF
TOTAL
RATE
150.000
S
150,000
(H
Assessment
S
S
-
i i 2
Case Management
$
S
1),
Crisis Stabilization
S
S
01
Crisis Supporl/Emergency
S
S
of)
Day/Night
S
017
Drop-In/Self I Iclp Centers
S
5
k " S
In-1 lome.--On. Site
$
$
I 1
Intervention - Individual
S
S
42
Intervention - Group
S
S
12
Medical Services
&
S
I"
Outpatient - Individual
S
S
�-- �
Outpatient - Group
5
S
15
Outreach
S
5
b 9
Residential Level 1
5
$
19
Residential Level 11
S
S
21)
Resadcrawl Level III
S
21
Residential Level IV
S
24
Substance Abuse Wax
25
Supponcd Employment
26
Supportive I lousing
s
27
TASC
S
5
2 K
Incidental Expenses
S
S
29
AtIcreare - Individual
S
4 1
Aflercare - Group
S
s0
Information & Rcferrai
S
S
34
FACT Team
S
36
Room & Board Level I
S
5
17
Room & Board Level 11
S,
;X
Room & Board Level III
S
N
Short-term Residential Treatment
$
S
441
Clubhouse Services
S
S
44
CCST- Individual
S
$
4 5,
CCST - Group
11 -
$
" 6
Recovery Support - Individual
S
s
47
Recovery Support - Group
5
S
48
Prevention -Indicated
S 43.12
22,469
5
22,469
49
Prevention - Seleclive
S 48.68
53A1t6
S
53,486
50
Prevention - Universal Direct
S 48.68
74.045
S
74,045
51
Prevention - Universal Indirect
S 48.68
S
-
Soecial Proviso
S
S
S
TOTAL FUNDING
5 150,000
$ S S S S 150,000 S S
7_
S
150,000
TOTAL UNCOMPENSATED
Guidance Care Center, Inc. Revised Exhibit 0 Contract No. PPG-2-03
Page 4 of 4
Attachment: GCC—SAMH—FY1 7—SIGNED [Revision 1] (2231 : Guidance/Care Center)
July 2, 2016-June 30, 2017 EXHIBIT G: COVERED SERVICES FUNDING HV Off A
Guidance/Cure Center, Inc. - PPG
I1PG3 WIN'l I AMIM MIMIR MINION NUID72 M1107.3 WID-16 1111093 M11094 %11101% 5 1 IM I V M I IIK
FUNDING I hill-kel XIIIA09 %TFIAIS NIIIAIS NIIIA72 NIIIA73 MIIA76 MIIA93 NIIIA94 NIIIAIIG MIRTH 111]IACF TOTAL
COVERED SERVICES 1341ru
01
Assessment
02
Case Management
0 j
Crisis Stabilizaimn
S
0 11
Crisis Support/limci-gency
S
S
A
Day;Night
S
S
07
Drop-In/Self] Icip Centers
S
5
08
In-llome/On-Site
S
I I
Intervention - Individual
S
4'
Intervention - Group
$
12
Medical Services
S
S
14
Outpatient - Individual
S
Outpatient - Group
15
Outreach
Residential Level I
S
S
P)
Residential Leve, 11
S
S
? 0
Residential Level III
S
2
Residential Level IV
S
'4
Substance Abuse Delox
5
24
Supported Employment
S
2116
Supportive I lousing
=
S
2 '
TASC
S
29
Incidental Expenses
$
�9
Aftercare - Individual
S
S
4
Aftercare - Group
S
S
Information & Referral
S
S
34
FACTTcarn
$
-
S
16
Room & Board Level I
S
37
Room & Board Level If
M
Room & Board Level H]
S
S
311
Short-term Residential Treatment
S
S
40
Clubhouse Services
$
-
S
44
COST- Individual
S
S
4S
CCST - Group
$
S
46
Recovery Support - Individual
S
S
47
Recovery Support - Group
5
S
48
Prevention - Indicated
S
43.12
S
49
Prevention - Selective
S
48.68
S
50
Prevention - Universal Direct
S
48.68
S
51
Prevention - Universal Indirect
S
48.68
S
I" ILI
Special Proviso
-
S
S
TOTAL FUNDING
S 150,0011 S
S s S $ S S S S -S S
TOTAL UNCOMPENSATED
Guidance Care Center, Inc. Revised Exhibit G
Page I of 4
Contract No. PPG-2-03
July 1, 2016-June 30, 2017
EXHIBIT G: COVERED SERVICES F(INDING 11YOCA
GuldanceXarc Center, Inc. - PPG
, 1 11 111
PPG3
M114A)l 31110(r) %1110115 S11108 %11101-CH 11t1I1111 %1114MO-CR
COVERED SERVICES
FUNDING I
7*111C01 M111C119 WIC1119-Cl 51111CIS 11111108 M111CON AMCFA M1111CFA-CR A1111CM) SHICAID-CH
'A111CCF TOTAL
RATE
01 Assessment
02 Case Management
03 Crisis Stabilization
04 1- n54s Support.Emcrgenev
(16 Day"'Night
S
07 Drop- In/Self I IcIp Centers
_S
S
08 In-llome. On -Site
$
I " Intervention - Individual
S
42 Intervention - Group
S
12 Medical Services
S
S
14 Outpatient - Individual
S
S
35 Outpatient -Group
S
I � Outreach
S
18 Residential Level I
S
$
11) Residential Level H
S
5
20 Residential Level III
1 Residential Level IV
S
S
24' Substance Abuse Decor
S
�5 Supported Employment
2fi Supportive I lousing
'2 7 TASC
S
24 Incidental Expenses
S
1_9 Aftercare -Individual
S
43, Aftercare -Group
Inf ormat4on & Referral
34 FACT Team
$
16 Room & Board Level I
S
37 Room 8. Board Level 11
5
S
18 Room &, Board Level III
S
31) Short-term Residential Treatment
5
40 Clubhousc - Services
S
44 CCST - Individual
S
d ' i CCST - Group
S
S
46 Recovery Support - Individual
S
S
4
47 Recovery Support -Group
S
-
48 Prevention - Indicated
S
43.12
S
49 Prevention -Selective
S
48.68
$
50 Prevention - Universal Direct
S
48.68
S
51 Prevention - Universal Indirect
S
48.68
S
Special Proviso
$
S
S
TOTAL FUNDING
S
150,000
5 S S, S S
S S
TOTAL UNCOMPENSATED
S
Guidance Care Center. Inc. Revised Exhibit G
rage of
Revised April 2016
Amendment N I
Contract No. PPG-2-03
July 1, 2016-June 30, 2017 EXIIIIIIT G: COVERED SERVICES FUNDING IlY0C_-% Revised April 2016
Guidance/Care Center, Inc. - PPG iAmendment #I
PPG3 11ti911 NIS1111 %1'4021 4IS0.13 AIS02% I NIS981 % I SO $ Also Fl; %MW 91SUE I
COVERED SERVICES
KND ING I ATSA03 1419All INISAll AISA23 AISA25 MSA27 XISA81 51SA91 NISATIS
%ISACF TOTAL
RATE
S
01
Assessment
$
I P2
Case Management
$
1 H
Crisis Stabilization
-S
S
04
Crisis Suppon.-Ernergoncy
S
S
Day/Night
S
07
Drop-In/Self I lelp Centers
S
08
hi -I lomiclOn-Site
S
I i
Intervention - Individual
S
42
Intervention - Group
S
12
Medical Services
S
14
Outpatient - Individual
$
141
Outpatient - Group
S
15
Outreach
S
18
Residential Level I
S
11)
Residential Level 11
S
Residential Level III
S
Residential Level IV
24
Substance Abuse Dom
S
2S
Supported Employment
S
26,
Supportive I lousing
S
�7
TASC
S
S
28
Incidental Expenses
$
-
$
29
Aftercare - Individual
S
S
4 3
Aftercare - Group
$
6
Information & Referral
S
S
34
FACTrearn
$
S
31�
Room & Board Level I
S
S
-17
Room & Board Level 11
$
-
S
3 H
Room & Board Level III
S
S
Short-term Residential Treatment
S
S
Clubhouse Services
S
S
44
COST- Individual
S
S
4 i
CCST- Group
46
Recovery Support - Individual
-47
Recovery Support - Group
S
48
Prevention - Indicated
S
43.12
S
49
Prevenlion - Sclec live
S
48.68
50
Prevention - Universal Direct
5
48.68
51
Prc% enlion. - Universal Indirect
S
48.68
S
Special Proviso
S
S
TOTAL FUNDING
S
150,000 S S S S S S S S
S S
TOTAL UNCOMPENSATED
S
Guidance Care Center, Inc, Revised Exhibit G
Page 3 oF4 Contract No. PPG -2-03
Attachment: GCC—SAMH—FY1 7—SIGNED [Revision 1] (2231 : Guidance/Care Center)
July 1, 2016-June 30, 2017 EXHIBIT G: COVERED SERVICES FUNDING RVOCA Revised April 2016
Guidance/Care Center, Inc. - PPG 101 ''1 1 11 Amendment N I
l'PG3 Us"W3 AVA I E A141' 1, 11511z3 %jSs'S M-6152r'-f R
r. amw 1i mwP3 %tsig P
COVERED SERVICES
FUNDING NISC03
NISC I I %ISCZ I AISC23 AISC25 NISC25-01: 11115C111, AISCIEI
5115CCIF
TOTA L
RATE
tsn,otltl
S
150j)(10
01
Assessment
S
412
Case Management
S
03
Crisis Stabilization
S
04
Crisis Support/Emergency
06
Day!Nighl
07
Drop-In/Self Help Centers
08
In-Ilome/On-Site S
I I
Intervention - Individual 5
42
Intervention - Group S
S
12
Medical Services S
5
14
Outpatient - Individual $
5
34q
Outpatient - Group $
S
I i
Outreach S
S
18
Residential Level I
$
11;
Residential Level 11
S
20
Residential Level 111
5
21
Residential Level IV S
24
Substance Abuse Detox S
25
Supported Employment S
S
26,
Supportive Mousing $
17
TASC $
28
Incidental Expenses $
S
2)
Aftercare - Individual
S
41
A Acircure - Group
S
W
Information & Rcrerral.
3 4
FACT Team
S
36
Room & Board Level I S
S
37
Room & Board Level 11 S
iX
Room & Board Level [H
S
11)
Short-term Residential Treatment S
S
441
Clubhouse Services
44
COST- Individual
41
CCST - Group S
S
46
Recovery Support - Individual $
S
47
Recovery Support - Group $
S
48
Prevention - Indicated S
43.12
22409
S
22,469
49
Prevention - Selective S
48.68
53,486
S
53,486
50
Prevention - Universal Direct S
48.68
74,045
S
74,045
51
Prevention - Universal Indirect S
48.68
S
T,
Special Proviso
S
S
TOTAL FUNDING S
150,000 S
5 S S S S 150.000 S
S S
150,000
TOTAL UNCOMPENSATED
Guidance Care Center, Inc. RcvosLd Exhibit G Contract No. PPG-2-03
Page 4 of 4
Attachment: GCC—SAMH—FY1 7—SIGNED [Revision 1] (2231 : Guidance/Care Center)
July 1, 2017-June 30,2018 EXHIBIT G: COVERED SERVICES FUNDING 11YOCA
Guidaner,'Care Center, Inc. - PPG 111111111
PPG3 %*10111 jjjjjj7j
COVERED SERVICES FUNDING 1 5111.401 MIIA09 NUIA1111 MIME %tIIA72 NIIIA73 NIIIA76 %IIIA93 NIIIA94 SHIMIG A111ATR N111ACF TOTAL
01 Assessment
S
02 Case Management
S
03 Crisis Stabilization
5
S
04 Crisis Support/Emergency
S
S
E 16 Day-INigh(
S
07 Drop-[n/Sclf I lelp Centers
S
11' In -I lome/On-Sitc
S
$
I I Intervention - Individual
S
S
42 Intervention - Group
S
12 Medical Services
$
14' Outpatient - Individual
35 Outpatient - Group
S
15 Outreach
S
18 Residential Level I
S
VResidential Level 11
y
S
2 20 Residential Level H]
21 Residential Level IV
S
24 Substance Abuse Detox
S
2) 5 Supported Employment
S
26 Supportive I loosing
S
27 TASC
S
S
28 Incidental Expenses
S
S
29 Aftercare - Individuat
S
43 Aftercare - Group
30 Inrormation & Referral
S
34 FACT Team
S
36 Room & Board Level 1
5
S
37 Room & Board Level 11
$
S
38 Room & Board Level 111
5
Short-term Residentia- Treatment
5
40 Clubhouse Services
$
$
4 CCST- Individual
S
S
CCST - Group
$
S
46 Recovery Support - Individual
S
S
47 Recovery Support - Group
S
-
48 Prevention - Indicated
S
43.12
49 Prevention - Selective
S
48.68
50 Prevention - Universal Direct
S
48.68
51 Prevention - Universal Indirect
S
48.68
S
Spcout Proviso
$
TOTAL FUNDING
S
1501000 S S
$ S S S S s S S 5 S 5
TOTAL UNCOMPENSATED
S
Guidance Care Center, Inc. Revised Exhibit G
Page I of 4
Revised April 2016
Amendment N I
Contract No. PPG-2-03
July 1, 2017-June 30, 2018
EXHIBIT G: COVERED SERVICES FUNDING BYOCA
Guidance/Care Center, Inc. - 1111G
MENNIMMEM - I
PPG3
%111001 11116" %11100'4N111018 511101A %111011N %111aFA %IHIPPA-C R %1110MI) WIDNID-CR
%1111K1
COVERED SERVICES
IFUNDING;
suicoi wictig wictig-ci runcts hilicis hillcuN %111cm M,11CFj,-CR 1.1111c"1111 A111CMD-CR
M11CCE' TOTAL
RATE
S
,11 Assessment
S
02 Case Management
S
03 Crisis Stabilization
S
(14 Crisis Suppon/Emergency
S
S
('6 DayiNight
S'
$
0? Drop-In/ScI f I lei p Centers
S
S
;Its In-Ilome/On-Site
S
$ Intervention - Individual
S
42 Intervention - Group
S
S
I' Medical Services
S
S
Outpatient - Individual
S
J Outpatient -Group
S
Outreach
S
I X Residential Level I
S
11) Residential Level 11
S
20 Residential Level H]
S
21 Residential Level IV
24 Substance Abuse Dctox
S
2S Supported Employment
S
20 Supportive Housing
S
27 TASC
S
28 Incidental Expenses
$
31, Aflercare - Individual
$
41 Allercare - Group
S
S
;qj Information & Referral
S
S
34 FACTTcam
$
S
36 Room & Board Level I
Room & Board Level 11
38 Room & Board Level III
31) Short-term Residential Treatment
S
40 Clubhouse Services
S
44 CCST - Individual
$
S
'1 5 CCST-Group
5
46 Recovery Support - Individual
5
$
47 Recovery Support - Group
5
S
48 Prevention - indicated
S
43.12
S
49 Prevention - Selective
S
48.68
50 Prevention - Universal Direct
S
48.611
51 Prevention - Universal Indirect
S
48.68
`-;'J Special Proviso
5
S
S
S
TOTAL FUNDING
S
1501000
5 S S S S 5 S S S
S S
TOTAL UNCOMPENSATED
S
Guidance Care Center, Inc. Revised Exhibit G
Page 2 of 4
Revised April 2016
Amendment # I
Contract No. PPG-2-03
July 1, 2017-June 30, 2018 EXHIBIT G: COVERED SERVICES Fj'NDING BY OCA
Guidance/Care Censer, Inc. - PPG I Niglio Bill Munn MutilgrimmmLli
PPG3 SIM1*1 Ntsln U NISA.1 MS025 W0.1- NNAAI MS091 NMI H %ISM3 %1SK F
COVERED SERVICES
FUNDING MSA*3 XISAI I MSA21 MSA23 AISA25 %1SAV SISA81 MSA91 NISAT11
NISACF TOTAL
RATE
M
Assessment
02
Case Management
W ,
Crisis Stabilization
S
04
Crisis Support' �'Emcrgcncy
S
4t6
Day-INight
07
Dtop-in/Self I lelp Centers
S
VX
In-] lornc/On-Suc
S
S
I I
Intervention - Individual
S
42
Intervention - Group
S
i 2
Medical Services
S
S
14
Outpatient - Individual
S
S
3
Outpatient - Group
S
15
Outreach
S
18
Residential Level I
S
19
Residential Level 11
S
20
-;
Residential Level 111
S
S
I
Residential Level IV
S
24
Substance Abuse Dew,
S
2-,
Supported Employment
26
Supportive I lousing
S
27
TASC
28
Incidental Expenses
2. 1)
Aftercare -Individual
S
4 1
Aftercare - Group
S
10
Information & Referral
S
S
34
FACT Team
156
Room & Board Level 1
37
Room & Board Level H
S
M
Room & Board Level III
S
31)
Short-term Residential Treatment
S
441
Clubhouse Services
S
S
44
CCST - Individual
S
S
45
CCST - Group
$
S
46
Recovery Support - Individual
$
17
Recovery Support - Group
S
48
Prevention - Indicated
S
43.12
S
49
Prevention - Selecli%,e
S
48.68
S
50
Prevention - Universal Direct
S
48,68
S -
51
Prevention - Universal Indirect
S
48.68
5
J
`�
Special Proviso
$
S
S
TOTAL FUNDING
S
1501000 S S S S S S
S $
TOTAL UNCOMPENSATED
S
Guidance Care Center, Inc. Revised Exhibit G
Page 3 oF4
Contract No- PPG-2-03
Revised April 2016
Amendment N I
July 1, 2017•June 30, 2018 EXHIBIT G: COVERED SERVICES FUNDING mil° OCA Revised April 2016
GuidancclCare Center, Inc. - PPGAmendment 91
PPG3 WISH '7011 %iND11 MSQ3 %IS09 NdsiMk.s it %1Slipl, %1Sr11'11 NISI1t F
COVERED SERVICES
FUNDING a WISCa3
NISC11 htS01 16ISC23 MSC25 RISC25•CR WVIT 1"rH
WISCCF
TOTAL
RATE
150000
S
150,000
01
Assessment
S
02
Case Management
S
N
Crisis Stabilization
S
5
04
Crisis Support/Emergency
SS
06
Day.=Night
S
5
07
Drop-In/Self I lelp Centers
S
S
1W
In-IlumeIOn-Sue
S
S
1 1
Intervention - Individual
S
5
32
Intervention - Group
S
S
17
Medical Services
S
S
14
Outpatient - Individual
S
5
35
Outpatient - Group
S
S
i
Outreach
S
S
lit
Residential Level 1
S
5
H
Residential Level 11
S
S
20
Residential Level III
S
31
Residential Level IV
S
$
w
Substance Abuse Deiox
S
S
39
Supported Employment
S
5
26
Supportive I lousing
S
37
TASC
S
28
Incidental Expenses
S.
S
29
Aftercare- Individual
41
A14crcare - Group
S
5
10
Information & Referral
S
S
3=4
FACT Team
S
S
36
Room & Board Level I
S
S
s 7
Room & Board Level Il
S
S
33
Room g Board Level fit
S
S
39
Short-term Residential Treatment
S
S
41i
Clubhouse Services
S
5
_=
CCST- Individual
S
S
qS
CCST- Group
S
=46
Recovery Support - Individual
S
S
47
Recovery Support - Group
S
S
48
Prevention - Indicaled
S
43.12
22.469
S
22,467
49
Prevention - Selective
S
48.68
53,486
$
53,486
50
Prevention - Universal Direct
S
48.68
74,045
5
74 045
51
Prevention - Universal indirect
5,
48.68
S
Special Proviso
S
-
TOTAL. FUNDING
S
1501000 5
S- 5 S S- 5 S 150,000 S S-
5_ 5
15W"j
TOTAL UNCOMPENSATED
Guidance Care Center, Inc,
Revised Exhibit G Contract No. PPG-2-03
Page 4 of 4
Attachment: _ _ Y _ I[Revision ] (2231 : Guidance/Care Center)
Contractual Agreement between
Florida Department of Children and Families and
South Florida Behavioral Health Network
KH-225 - Contract Amendment #0022
(September 15, 2015)
September 15, 2015
Contract No. KH225
Amendment #0022
THIS AMENDMENT, entered into between the State of Florida, Department of Children and
Families, hereinafter referred to as the "Department," and South Florida Behavioral Health
Network, Inc., hereinafter referred to as the "Provider," amends Contract No. KH225.
The purpose of Amendment #0022 is to:
• Renew contract KH225 for an additional four (4) years and nine (9) months, through June
30, 2020, pursuant to Section D. Paragraph 3 of Attachment I.
• Amend the Standard Contract to increase the total contract funding to align with the Approved
Operating Budget for FY2015-2016 and also include estimated funding for the renewal
period. This increases the total value of the contract by $395,137,582.25.
• Amend Attachment I, section BA.a.(5), to add the statutory requirements regarding the
collection of Crisis Stabilization Utilization data due to changes in Chapter 397, F.S.
• Amend Attachment 1, Method of Payment, which updates Table 1. Contract Funding to align
the funding for FY15-16 as outlined in the Schedule of Funds dated 08/19/2015 and include
estimated funding for the renewal period. Also, to update Paragraph 2. to remove any
reference to the 16.72% in regard to Advances.
• Amend Exhibit E-3, with the Schedule of Funds dated 08/19/2015 for FY2015-2016.
• Amend Exhibit F, Region Specific Exhibit, to include the addition of item C. which specifies
reporting requirements, including requirements from the Office of the Governor which
instructs those providers who receive special project funding in FY15-16 to report return on
investment projections and quarterly updates directly to the Governor's Office. Also includes
revisions to Table A: Program Specific Fund Summary, to include Appropriations for FY15-
16 and Prevention Partnership Grant (PPG) recipients; adds item E. which specifies PPG
Requirements; and adds item F. which lists the Appropriations for FY15-16.
As a result, the Standard Contract, Attachment I, Exhibit E-3, ME Schedule of Funds, and
Exhibit F, Region -Specific Exhibit are hereby amended to read:
1. Page 1, Standard Contract (dated 0512014), Section 2, Effective and Ending Dates, is
hereby amended to read:
2. Effective and Ending Dates. This Contract shall be effective on October 1, 2010 or the last date
executed by a party, whichever is later. The service performance period under this Contract shall
commence on October 1, 2010 or the effective date of this Contract, whichever is later, and it shall
end at midnight, Eastern Time, on June 30, 2020, subject to the survival of terms provisions of
Section 33.j hereof.
2. Page 1, Standard Contract (dated 05/2014), Section 3, Payment for Services, as
previously amended on Page 1 of Amendment #0021, is hereby amended to read:
3. Payment for Service. The Department shall pay for contracted services performed by the Provider
during the service performance period of this Contract according to the terms and conditions of this
contract of an amount not to exceed $770,836,059.00 or the rate schedule, subject to availability of
funds and the Department's determination of satisfactory performance of all terms by the Provider.
The State of Florida's performance and obligation to pay under this Contract is contingent upon an
annual appropriation by the Legislature. Any costs or services paid for under any other contract or
from any other source are not eligible for payment under this Contract.
South Florida Behavioral Health Network, Inc. Page 1
Southern Region SAMH Managing Entity
September 15, 2015
Contract No. KH225
Amendment #0022
3. Page 9, Standard Contract, Signature Block, second sentence, is hereby amended to
read:
IN WITNESS THEREOF, the parties hereto have caused this seventy-one (71] page Contract to be
executed by their undersigned officials as duly authorized
4. Page 20, Attachment I (dated 07/0112015), Section B. Manner of Service Provision,
Paragraph 1.a.(5), Function 5. Data Collection, Reporting, and Analysis, as previously
amended on Page 1 of Amendment #0021, is hereby amended to read:
(5) Function 5. Data Collection, Reporting, and Analysis
(o) No later than August 1, 2015, the Managing Entity shall require public receiving facilities within
its Network Service Providers, pursuant to s. 394.9082(10), F.S., to collect and submit the crisis
stabilization service utilization data specified therein on a daily basis using a file transfer protocol
process or a web portal developed by the Managing Entity.
5. Page 30, Attachment I (dated 07101/2015), Section C. Method of Payment, Paragraph 1,
as previously amended on Page 1 of Amendment #0021, is hereby amended to read:
1. Payment Clause
a. This advance fixed price, fixed payment contract is comprised of federal and state funds, subject
to reconciliation. Exhibit E, ME Schedule of Funds identifies the type and amount of funding
provided.. At the beginning of each fiscal year, the Exhibit E, ME Schedule of Funds will be
amended into this contract, and the total contract amount wiff be adjusted accordingly,.
b. The Department will pay the Managing Entity an operational cost for the management of the
Network in accordance with the terms and conditions of this contract. The direct service cost is
defined as the annual value of the contract less the operational cost of the Managing Entity.
c. The contract total dollar amount shall not exceed $770,836,059.00, subject to the availability of
funds, as outlined below:
Table 1: Contract Funding
State Fiscal Year
Managing Entity
Operational Cost
Direct Service Cost
Total Value of Contract
2010-2011 (9 months)
$3.399,627.00
$52,952,530.00
$56,352,157.00
2011-2012
$3,491,295.00
$72,420,596A0
$75,911,891.00
2012-2013
$3,465,665,00
$70,244,946.00
$73,710,611.00
2013-2014
$3,432,250.00
$72,178,646.00
$75,610,896.00
2014-2015
$3,481,522-37
$72,203,746,63
$75,685,269.00
2015-2016 (3 months)
$866,416.00
$19„811,84575
$20,678,261.75
2015-2016 (9 months)
$2,599,248,00
$59435,537.25
$62,034,785.25
2016-2017
$3,465,664.00
$79,247,383,00
$82,713,047.00
2017-2018
$3465,664.00
$79,247,383.00
$82,713,047.00
2018-2019
$3 465 664.00
$79,247,383.00
$82,713,047.00
2019-2020
$3,465,664.00
$79,247,383:00
$82,713,047.00
Total
$34,598,679.37
$736,237,379.63
$770,836,059.00
South Florida Behavioral Health Network, Inc; Page 2
Southern Region SAMH Managing Entity
September 15, 2015
Contract No. KH225
Amendment #0022
6. Page 31, Attachment I (dated 07/01/2015), Section C. Method of Payment, Paragraph 2.
Payment, as previously amended on Page 1 of Amendment #0021, is hereby amended
to read:
2. Payment
a. In accordance with s. 394 9082, F.S., at the beginning of each fiscal year the Managing Entity
may request an advance payment equal to two months of the current fiscal year contract value.
Thereafter,. the Managing Entity shall request monthly fixed payments equal to the fiscal year
contract balance divided by the number of months remaining in the fiscal year. The payment
request may be subject to financial consequences, pursuant to Section B.51
b. The Managing Entity shall temporarily invest surplus advance funds in an insured or interest
bearing account, in accordance with s. 216.181(16)(b), F.S. The Managing Entity shall remit to
the Department,, on a quarterly basis, any interest earned on advance funds via check. The
Managing Entity must submit documentation from the financial entity where said funds are
invested, evidencing the Annual Percentage Rate and actual interest income for each month.
c. The Managing Entity shall expend any advance in accordance with the General Appropriations
Acf.
d. The Managing Entity shall request payment in accordance with Section U., below.
e. The Department will pay the Managing Entity according to the following schedule:
Table 2: Invoice and Expenditure Report Submission Schedule
7. Page 66, Exhibit E-3, ME Schedule of Funds, as previously amended on Page 1 of
Amendment #0021, is hereby deleted in its entirety and Page 55, Revised Exhibit E-3,
ME Schedule of Funds (dated 08119/2016) is Inserted in lieu thereof and attached hereto.
8. Pages 56 - 59, Exhibit F, Region -Specific Provisions, as previously amended on Page
1 of Amendment #0021, are hereby deleted in their entirety and Pages 56 - 62, Revised
Exhibit F, are inserted in lieu thereof and attached hereto.
South Florida Behavioral Health Network; Inc. Page 3
Southern Region SAMH Managing Entity
f»t«eyrl?#22
S. race ;t +«««>m+m § 9»ed <»<«d#<d. Certification Regarding Lobbying,
previously J«a<m ed on Page +rAmendment #0021, Is hereby renumbered sPage
63.
<t Pages 61Attachment e Financial and Compliance Audit (dated $ y262+}d,as
previously amened on PageIofAe«omen Pages
64-66.
<> Page: 64 »t Attachment IVf.y<x§ ream Information(dd>¥ 0710£2014)as
: edonP geIofAmendme22»?» wcrenumbredasP *«
previously amended onherebyv..
67-71.
and nine Si»+d§»
TITLE: x< w4 Chief Exec: ??,
#±<y \ \~?
FEDERAL ID NUMBER., 59-3380599
dd.y Regional �anaging Director
�
Revised Exhibit E-3
ME Schedule of Funds
South Florida Behavioral Health Network, Inc. - Contract# KH225
FY 2015-16 Use Designation - As of 8119/2015
Other Cost Accumulators Title
Other cost
Accumulators
Federal
State
Total
Y.._t5 \ }
3 _}}
l tlli����
��������� �����1�11�1��r�..�ttt��
Managing Entity Administrative Costs MHSOO
232,1991
3,233,465
3,4�6i5,6J+{{64
tjy 2 �..
ME Services & Supports Provider Activity - Mental Health MH000
4,233,170
�
29,703,175
.�,
� .�,.
33,936,345
ME Early Intervention Services for SMI & Pysch Disorder
MH026
-
-
-
Purchase of Residential Treatment Services for Emotionally Disturbed Children and
MH071
342,970
342,970
Community Forensic Beds
MH072
-
3,027,332
3,027,332
Florida Assertive Community Treatment (FACT)
MH073
1,164,515
2,289„063
3,453,578
Indigent Psychiatric Medication Program
MH076
-
113,991
113,991
Clay Behavioral Health Center
MH089
-
-
-
Camillus House Mental HeallhlSubstance Abuse Treatment - Homeless
MH093
-
200,000
200,000
Citrus Health Network
MH094
- I
455,000
455,0
Jerome Golden Center
MH096
-
-
-
Crisis Center of Tampa Bay
MH097
-
-
-
ME Saluscare Center
NIH098
-
-
-
Gracepoint Center
MH819
-
-
-
Lifestream Center
MHS50
-
-
Meridian Behavioral Healthcare
MHSMB
-
-
-
Renaissance Center
MHRMS
-
Circles of Care - Cedar Village
MHS51
-
Circles of Care - Crisis Stabilization
MHS52
-
Grants PATH
MHOPG
467,611
-
467,611
Florida Youth Transillon of Adulthood
MHOTA
-
-
-
Temporary Assistance for Needy Families (TANF)
MSOTB
797.249
-
797,249
Title XXI Children's Health Insurance Program (Behavioral Health Network)
MHOBN
874,757
108,831
983,568
ME Crisis Stabilization Services
MHOCS
21,429
-
21,429
Grant Miami -Dade County Wraparound FACES
MHOFA
11600,000
-
1,600,000
Grants Miami -Dade County Wraparound
MHOM❑
764,788
-
764,768
Grants Project Launch
MHOPL
I -
-
-
21111f,411 3®' — —' I , .,s };#�� ) ? t}��� tcc rIffi9,
ME Services & Supports Provider Activity - Substance Abuse MS000
( gq��pp
BUMP cy �,,(.�{1
12,377,077
12„053,156
24,440,233
HIV Services
MS023
869,289
-
869,289
Prevention Services
MS025
3,477,156
-
3,477,156
Projects Expansion of Substance Abuse Services for Pregnant Women and their
affected families
MS081
-
1,812,723
1,812,723
Family Intensive Treatment (FIT)
MS091
-
633,190
633,190
ME Data Management Support
MS092
-
-
-
Temporary Assistance for Needy Families (TANF)
MSOTB
830,123
-
830,123
Drug Abuse Comprehensive Coordinating Treatment (DACCO)
MS095
-
-
-
First Step of Sarasota
MS902
-
-
-
Here's Help
MS903
200,000 1
200,000
Prrevj�ention Partnership Grant (PPG)5
MSOPP 1
820,788
-
820,788
�
Total All Fund Sources
ry{Q
28,530,151
54,182,896
82,713,047 i
Revised Contract KH225
South Florida Behavioral Health Network, Inc. Page 55 Amendment $10022
Contract KH225
FY15-16
Region -Specific Provisions
Revised Exhibit F
A. Pursuant to the terms of Attachment I, Section B.3.b., the Managing Entity shall subcontract for the
legislatively appropriated program -specific funds listed in Table A with each specified Network Service
Provider. Each subcontract shall require the Network Service Provider to use these funds only for the
legislatively specified service and to report the unique numbers of persons served or services provided
with these funds as distinct reporting elements within the subcontract report requirements.
B. The Managing Entity shall provide the Department with a copy of the executed subcontract document
for each program -specific fund no later than 30 days after this exhibit is incorporated into the Managing
Entity's contract. The subcontract document shall include:
1. A description of the service purchased with the specific appropriation;
2. The payment methodology and rate applied to the service;
3. Output and outcome performance measures applied to the service; and
4. The reporting requirements implemented to ensure regular and ad hoc status updates to the
Department.
C. At a minimum, the managing entity shall ensure each Network Service Provider:
1. Reports the following performance metrics in the format specified by the Department:
a. Number of clients served,
b. Number of adults served,
c. Number of children served,
d. Number of clients admitted in a residential treatment center,
e. Type of services provided to the clients, and
f. Number of clients discharged.
2. Beginning with Fiscal Year 2015-16, provide reports directly to the Executive Office of the
Governor Office of Policy and Budget (EOG/OPB) documenting the return on investment for any
specific appropriation identified with the acronym "EOG/OPB" in Table A.
a. An initial report identifying the positive return the state will receive by providing the funding
shall be submitted to EOG/OPB on or before July 31, 2015.
b. The initial report shall include actual returns by fiscal year if the provider previously received
state funding, and projected positive returns based on the Fiscal Year 2015-16 funding.
c. Quarterly update reports shall be submitted to EOG/OPB within 30 days after the end of each
fiscal year quarter thereafter.
d. All reports shall be submitted to ary th.icrs lasbs.stte.l.s and a copy submitted
to the Managing Entity subcontract file.
Table A — Program -Specific Fund Summary
Year
Specific
Appropriation
Provider
Amount
FY14-15
351
Citrus Health Network
$ 455,000.00
351
Camillus House
$ 25,000.00
351
Guidance Care Center of Key West
$ 100,000.00
South Florida Behavioral Health Network, Inc. Revised KH225 Amendment #0022
Page 56
Contract KH225
Revised
Exhibit F
FY15-16
Table A - Program -Specific Fund Summary
SpecificAppropriationAppropriation
.a w_
Provider
Amount
FY14-15
372
Pregnant and Post-Partum Women Funding
$1,812,723.00
Allocated to the following providers and amounts
1. South Florida Jail Ministries, Inc.: $970,841.00
2. The Village South, Inc.: $841,882.00
372
_
Family Intensive Treatment (FIT) funding, allocated to
the following amounts for services in the designated
locations. The Managing Entity shall designate a service
provider for each location in accordance with Section
D.S. of this Exhibit.
1.Miami-Dade County — Liberty City, specifically
$483,871.00
limited to address child welfare cases referred
from zip codes 33147 and 33142
2. Monroe County
_.._ ....�.a
$149,317.00
FY15-16
PPG
Guidance Care Center, Inc.
$150,OOO.00
through
Solicitation
Village South/WestCare Foundation
$150,000.00
FY17-18
LHZ03
Miami Coalition for a Drug -Free Community
$150,000.00
HOPE for Miami
$150,000.00
Switchboard of Miami, Inc.
$150,000.00
Gang Alternatives, Inc.
$70,788.00
FY15-16
377H
Citrus Health Network
$455,000.00
EOG/OPB
377J
Pregnant Women, Mothers, and Affected Families
$1,812,723.00
Funding
Allocated to the following providers
p for
providers will
1. South Florida Jail Ministries, Inc.
be specified in
2. The Village South, Inc.
a report
submitted with
the Final Fiscal
Year Invoice
Family Intensive Treatment (FIT) funding, allocated to the following
amounts for services in the designated locations. The Managing Entity
shall designate a service provider for each location in accordance with
Section F.3. of this Exhibit.
EOG/OPB
1. Miami -Dade County— Liberty City, specifically
$483,871.00
limited to address child welfare cases referred
from zip codes 33147 and 33142
2. Monroe County
$149,317.00
Here's Help, Inc.
$200,000.00
EOG/OPB
Camillus House
$200,000.00
EOG/OPB
South Florida Behavioral Health Network, Inc. Revised KH225 Amendment #0022
Page 57
Contract KH225
FY15-16
D. Fiscal Year 2014-15 Appropriations
Revised Exhibit F
Pursuant to the FY14-15 General Appropriations Act, Ch. 2014-51, Laws of Fla., the Managing Entity shall
implement the following:
1. Specific Appropriation 351—Citrus Health Network, Inc.
During Fiscal Year 2014-2015, from the funds in Specific Appropriation 351, the recurring sum of
$455,000.00 from the General Revenue Fund shall continue to be provided to the Citrus Health
Network.
2. Specific Appropriation 351 — Camillus House
During Fiscal Year 2014-2015, from the funds in Specific Appropriation 351, the nonrecurring sum of
$25,000.00 from the General Revenue Fund is provided for Camillus House mental health and
substance abuse treatment for the homeless.
3. Specific Appropriation 351 — Guidance Care Center of Key West
During Fiscal Year 2014-2015, from the funds in Specific Appropriation 351, the nonrecurring sum of
$100,000.00 from the General Revenue Fund is provided to Guidance Care Center of Key West for
mental health and substance abuse treatment services.
4. Specific Appropriation 372 —Pregnant and Post-Partum Women Funding
From the funds in Specific Appropriation 372, the recurring sum of $1,812,723.00 from the General
Revenue fund is provided for the expansion of substance abuse services for pregnant women and
their affected families. These services shall include the expansion of residential treatment, outpatient
treatment with housing support, outreach, detoxification, child care and post-partum case
management supporting both the mother and child consistent with recommendations from the
Statewide Task Force on Prescription Drug Abuse and Newborns. Priority for services shall be given to
counties with greatest need and available treatment capacity.
S. Specific Appropriation 372 —Family Intensive Treatment Funding
From the funds in Specific Appropriation 372, the recurring sum of $633,188.00 from the General
Revenue Fund is provided to implement the Family Intensive Treatment (FIT) team model that is
designed to provide intensive team -based, family -focused, comprehensive services to families in the
child welfare system with parental substance abuse. Treatment shall be available and provided in
accordance with the indicated level of care required and providers shall meet program specifications.
Funds shall be targeted to select communities with high rates of child abuse cases.
a. The Managing Entity shall designate a Network Service Provider to deliver the FIT model for
each location specified above and shall subcontract with the provider to implement this proviso
appropriation by August 15, 2014.
b. The Managing Entity shall subcontract with the Network Service Providers providing FIT
model services for the full amount of funding specified in Table A and shall not reduce payment
to these providers for any operational costs, including behavioral health fees, of the Managing
Entity associated with the administration of the subcontracts.
c. To ensure the implementation and administration of the FIT team model complies with the
Department's programmatic standards, the Managing Entity shall require Network Service
South Florida Behavioral Health Network, Inc. Revised KH225 Amendment #0022
Page 58
Contract KH22S
FY1S-16
Revised Exhibit F
Providers providing FITmodel services adhere to the staffing, service delivery and reporting
requirements of Incorporated Document 32: FIT Model Guidelines and Requirements, which is
hereby incorporated by reference.
E. Prevention Partnership Grants
Pursuant to the Notice of Award for the PPG procurement RFA #LHZ03, the Managing Entity shall execute
3 year subcontracts with Network Service Providers for the annual amounts detailed in Table A for the
implementation of the PPG program.
1. The Managing Entity shall negotiate PPG services within the scope of work detailed in the Network
Service Provider's application.
2. The Subcontract shall incorporate the specifications and elements detailed in the RFA, including
but not limited to objectives, measures, and reporting.
3. The Subcontract shall incorporate funding as detailed in the Table A for reasonable, allowable,
and necessary expenditures required to perform PPG services.
4. The Subcontract shall require the Network Service Provider to enter all prevention data into the
Department's Performance Based Prevention System (PBPS).
F. Fiscal Year 2015-16 Appropriations
Pursuant to the FY15-16 General Appropriations Act, Ch. 2015-232, Laws of Fla., the Managing Entity shall
implement the following:
1. Specific Appropriation 377H —Citrus Health Network
From the funds in Specific Appropriation 377H, the sum of $455,000 from the General Revenue Fund
shall continue to be provided to the Citrus Health Network for behavioral health services.
2. Specific Appropriation 377J —Pregnant Women, Mothers, and Affected Families Funding
From the funds in Specific Appropriation 377J, the recurring sum of $1,812,723.00 from the General
Revenue fund is provided for the expansion of substance abuse services for pregnant women and
their affected families. These services shall include the expansion of residential treatment, outpatient
treatment with housing support, outreach, detoxification, child care and post-partum case
management supporting both the mother and child consistent with recommendations from the
Statewide Task Force on Prescription Drug Abuse and Newborns. Priority for services shall be given to
counties with greatest need and available treatment capacity.
The Managing Entity shall subcontract with the Network Service Providers for this funding as listed in
Table A. With the submission of the Final Fiscal Year Invoice, the Managing Entity will submit a report
that details for each provider the sub contractual amount, actual amount paid, and total units
purchased. This report shall also contain the total of any anticipated carry forward funds of Specific
Appropriation 377J — Pregnant and Post-Partum Women Funding. These anticipated carry forward
funds will also be included on Incorporated Document 27: Managing Entity Carry Forward
Expenditure Report.
3. Specific Appropriation 377J —Family Intensive Treatment Funding
From the funds in Specific Appropriation 377J, the recurring sum of $633,190.00 from the General
Revenue Fund is provided to implement the Family Intensive Treatment (FIT) team model that is
designed to provide intensive team -based, family -focused, comprehensive services to families in the
child welfare system with parental substance abuse. Treatment shall be available and provided in
South Florida Behavioral Health Network, Inc. Revised KH225 Amendment #0022
Page 59
Contract KH225
FY15-16
Revised Exhibit F
accordance with the indicated level of care required and providers shall meet program specifications.
Funds shall be targeted to select communities with high rates of child abuse cases.
a. The Managing Entity shall designate Network Service Providers to deliver the FIT model
for each location specified above and shall subcontract with the provider to implement
this proviso appropriation by July 31, 2015.
b. The Managing Entity shall subcontract with the Network Service Providers providing FIT
model services for the full amount of funding specified in Table A and shall not reduce
payment to these providers for any operational costs, including behavioral health fees, of
the Managing Entity associated with the administration of the subcontracts.
c. To ensure the implementation and administration of the FIT team model complies with
the Department's programmatic standards, the Managing Entity shall require Network
Service Providers providing FIT model services adhere to the staffing, service delivery and
reporting requirements of Incorporated Document 32: FIT Model Guidelines and
Requirements, which is hereby incorporated by reference.
4. Specific Appropriation 377J — Here's Help, Inc.
From the funds in Specific Appropriation 377J, $200,000 from the General Revenue Fund shall
continue to be provided to Here's Help, Inc.
S. Specific Appropriation 377M —Camillus House
From the funds in Specific Appropriation 377M, the nonrecurring sum of $200,000 from the General
Revenue Fund is provided to Camillus House for behavioral health services.
G. The Miami -Dade Wraparound Project
Families and Communities Empowered for Success (FACES)
The Miami Dade Wraparound Project, also known as Families and Communities Empowered for Success
(FACES), was initially awarded to the Department of Children and Families, Substance Abuse and Mental
Health by the Substance Abuse and Mental Health Services Administration (SAMHSA) on September 9,
2010. The "Miami -Dade Wraparound Project" is a collaborative effort to enhance, expand and strengthen
the existing community -based family and youth mental health services in Miami -Dade County, in order to
better serve children and youth who have serious emotional disturbances (SED) and their families or
caretakers in Miami -Dade County, Florida.
The Department assigns the funding, subcontracting, reporting, and monitoring responsibilities of this
grant to the Provider. The Provider shall ensure compliance with the terms and conditions specified in the
grant award, which is incorporated by reference, federal and state law, Department standards, and this
contract. The Provider will be responsible for invoice documentation, verification of service delivery, and
compliance monitoring. The Provider will manage all aspects of the grant under the direction of the
Substance Abuse and Mental Health Program Office.
H. The Miami -Dade County FACES Wraparound Project Expansion
Effective July 1, 2013, the Substance Abuse and Mental Health Services Administration (SAMHSA)
awarded the Miami -Dade County FACES Wraparound Project Expansion in support of expanding the
current FACES initiative to include 225 transitioning youth ages 18-21 who entered the mental health
system prior to the age of 18.
The Department assigns the funding, subcontracting, reporting, monitoring, and evaluation
responsibilities of this grant to the Provider. The Provider shall ensure compliance with the terms and
South Florida Behavioral Health Network, Inc. Revised KH225 Amendment #0022
Page 60
Contract KH225 Revised Exhibit F
FY15-16
conditions specified in the grant award, which is incorporated by reference, federal and state law,
Department standards, and this contract. The Provider will be responsible for invoice documentation,
verification of service delivery, and compliance monitoring. The Provider will manage all aspects of the
award under the direction of the Substance Abuse and Mental Health Program Office.
I. Motivational Support Program (MSP)
In addition to the requirements in Attachment I and Incorporated Document 23, Integration with Child
Welfare, the Provider agrees to contract with a community Network Service Provider to operationalize
the current MSP protocol for the purpose of enhancing the integration across the behavioral health and
child welfare systems. The Provider will ensure the implementation and efficiency of the MSP protocol
and report monthly progress to the Regional SAMH Program Office. This protocol is agreed upon with the
Department, the Provider, the Community -Based Care organization (CBC), and the contracted Network
Service Provider.
J. Community Action Team Program (CAT)
The Provider agrees that, in collaboration with the Department, they will develop, and enter into a
Memorandum of Understanding (MOU) with each of the Community Action Team (CAT) providers within
sixty (60) calendar days of contract execution. The MOU will operationalize the referral process between
the Provider and the CAT programs, (including but not limited to identifying youths that meet the specified
criteria for referral to the program as stated below). It is the Department's intent to reserve the CAT
program for community -based services to children ages 11 to 21 with a mental health diagnosis or co-
occurring substance abuse diagnosis at -risk for out -of -home placement as demonstrated by repeated
failures at less intensive levels of care; having two or more hospitalization or repeated failures;
involvement with the Department of Juvenile Justice or multiple episodes involving law enforcement; or,
poor academic performance and/or suspensions.
K. Statewide Forensic Beds
For the following programs, the Provider shall make services available to eligible consumers on conditional
release from other Circuits through their Network Service Providers at:
1. Public Health Trust/Jackson Health System — Miami -Dade Forensic Alternative Center (MDFAC) —
Up to six (6) beds shall be available to Broward residents who meet MDFAC's Eligibility Criteria, which
is incorporated by reference. MDFAC is a locked and staff secured facility intended to serve adult
forensic consumers charged with second or third degree felonies who are committed to the
department under Sections 916.13 and 916.15, F.S. These consumers have been found by a circuit
court to be incompetent to proceed due to a serious mental illness or not guilty by reason of insanity
and who do not have a significant history of violence.
2. Citrus Health Network, Inc. -Eight (8) statewide residential beds in the Safe Transition and Access
to Recovery (STAR) Program shall be available to eligible consumers on conditional release in need of
forensic mental health services placed by the Managing Entity pursuant to FRCrP 3.219(b), 3.217(b)
and F.S. 916.17. The STAR Program provides intensive, short-term treatment to individuals who are
temporarily in need of a structured therapeutic setting in a less restrictive but longer -stay alternative
to acute hospitalization.
3. Passageway Residence of Dade County, Inc. — Fourteen (14) statewide residential level 2 beds
shall be available to eligible consumers on conditional release who are in need of forensic mental
health services placed by the Managing Entity. Statewide admission to Passageway Residence of Dade
County, Inc. is for individuals committed to the Florida Department of Children and Families, in
South Florida Behavioral Health Network, Inc. Revised KH225 Amendment #0022
Page 61
Contract KH225
FY15-16
Revised Exhibit F
accordance with the provisions of Florida Statutes Chapter 916, Forensic Services Act and released
pursuant to FRCrP 3.219(b), 3.217(b) and F.S. 916.17.
4. Psychosocial Rehabilitation Center d.b.a Fellowship House - Four (4) statewide residential level 2
beds shall be available to eligible consumers on conditional release who are in need of forensic mental
health services placed by the Managing Entity pursuant to FRCrP 3.219(b), 3,217(b) and F.S. 916.17.
L. Regionally Necessary Services
1. The Managing Entity shall subcontract with the following Network Services Provider with
locations in Broward County for the specified Regionally Necessary Services:
a. Citrus Health Network, Inc. for Statewide Inpatient Psychiatric Programs (SIPP) and Short -
Term Residential Treatment (SRT) services; and
2. The Managing Entity Forensic Team shall provide outreach services to individuals residing in the
following State Hospitals and counties:
a. Florida State Hospital, Gadsden County
b. North Florida Evaluation and Treatment Center, Alachua County
c. Northeast Florida State Hospital, Baker County
d. Treasure Coast Forensic Treatment Center, Martin County
e. South Florida State Hospital, Broward County
f. South Florida Evaluation and Treatment Center, Miami -Dade County
South Florida Behavioral Health Network, Inc. Revised KH225 Amendment #0022
Page 62
ATTACHMENT E
PUBLIC ENTITY CRIME STATEMENT
"A person or affiliate who has been placed on the convicted vendor list following a conviction for
public entity crime may not submit a bid on a contract to provide any goods or services to a public
entity, may not submit a bid on a contract with a public entity for the construction or repair of a public
building or public work, may not submit bids on leases of real property to public entity, may not be
awarded or perform work as a CONTRACTOR, supplier, subcontractor, or CONTRACTOR under a
contract with any public entity, and may not transact business with any public entity in excess of the
threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months from
the date of being placed on the convicted vendor list."
I have read the above and state that neither (Respondent's name) nor
any Affiliate has been placed on the convicted vendor list within the la t 36 months.
y�
(Signature)
Date: �/
STATE OF: RMOR
COUNTY OF: rwav
Subscribed and sworn �rto (or affirmed) before me on rWho
(date) by U l (name of affiant). H h is personally
known to me or has produced
identification.
(type o identification) as
NOTARY PUBLIC
My Commission Expires:
••a� 'g+,'•• CAROL A. DOCHUW
Holary Public - Stale of Florida
My Comm. Expires Jun 7, 2018
Commission FF 104268
0®Y645
Guidance Care Center-SAMH Contract FYI 7 page 14
ATTACHMENT F
SWORN STATEMENT UNDER ORDINANCE NO.010-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
6M b4��LZ-JcA245 C�� f-jtEFZ l M(—
(Company)
"...warrants that he/it has not employed; retained or otherwise had act on his/her behalf any former
County officer or employee in violation of Section 2 of Ordinance No. 010-1990 or any County officer
or employee in violation of Section 3 of Ordinance No. 010-1990. For breach or violation of this
provision the County may, in its discretion, terminate this Agreement without liability and may also, in
its discretion, deduct from the Agreement or purchase price, or otherwise recover, the full amount of
any fee, commission, percentage, gift„ or consideration paid to the former County officer or
employee."
(Signature)
Date: 6) - mt('::�
STATE OF: 1- M, f
lv
COUNTY OF:
Subscribed and sworn to (or affirmed) before me on 4f 4u
(date) by , ��Ut 1 (name of affiant). Hee is personally�
known to me or has produced
identification) as identification.
K"KAWA
NOTAkY
oe ��i p`.%n✓e��
�,• s
CAROL A. OOCHOW
Nota'y PublIC - State al Florida .'
My Comm. Expires Jun 7, 20ia
®.:
:y P'
Commisslon N FF 10426a
,e
Guidance Care Center-SAMH Contract FY171 page 15
ATTACHMENT G
DRUG -FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
Gvl 1yJLac f GCE !N �-
(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.
yY 1
(Signature)
Date:
STATE OF: m
COUNTY OF: niffi V d[/
Sub d wd wo to ior affirmed) before me on (date) by
(name of affiant . Hel h is personally known tome
or has produced type of identification) as
identification. Paw � I In
NOTARY PUBLIC
uy , CAROL A. OOCHOW
"o Notary Public State of Florida My Commission Expires:
my Comm. Expires Jun 7, 2458
14�".• Commission # FF ID4268
Guidance en er- A M Contract FY- l page 16
AGREEMENT
This Agreement is made and entered into this 191h day of October, 2016, between the
BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as
"Board" or "County," and the Guidance/Care Center, hereinafter referred to as "Provider."
WHEREAS, the PROVIDER is a not -for -profit corporation established to provide
transportation services to the citizens of Monroe County, and
WHEREAS, it is a legitimate public purpose to provide transportation services to the
residents of Monroe County, 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 carrying out the duties of the Board, shall reimburse the
PROVIDER for providing transportation services as billed by the PROVIDER for clients qualifying
for such services under applicable state and federal regulations and eligibility determination
procedures. The cost shall not exceed a total reimbursement of ONE HUNDRED NINETY-TWO
THOUSAND THREE HUNDRED FIFTY-FIVE DOLLARS ($192,355.00), during the fiscal year 2016-
2017, payable as follows:
a) the sum of ONE HUNDRED FORTY FIVE THOUSAND DOLLARS ($145,000.00) for Baker Act
transportation services pursuant to Chapter 394, Florida Statutes; and
b) the sum of FORTY-SEVEN THOUSAND THREE HUNDRED FIFTY-FIVE DOLLARS
($47,355.00), for Community Transportation Coordinator -related transportation services to
residents of Monroe County.
2. TERM. This Agreement shall commence on October 1, 2016, and terminate September
30, 2017, unless earlier terminated pursuant to other provisions herein.
3. PAYMENT. Payment for Baker Act and Marchman Act transportation services shall be
made according to the rate schedule set forth in Attachment D, subject to the maximum amounts
set forth in Paragraph 1. a. above. 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 Paragraph 1,
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 thirty days after the
termination date of this contract shown in Paragraph 2 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. 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
Guidance Care Center —Transportation: Baker Act and CTD FY17; page 1
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 Z 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 Paragraph 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. CLAIMS FOR FEDERAL OR STATE AID. PROVIDER and County agree that each shall
be, and is, empowered to apply for, seek, and obtain federal and state funds to further the
purpose of this Agreement; provided that all applications, requests, grant proposals, and funding
solicitations shall be approved by each party prior to submission.
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
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, F.S., running from the date the monies were paid to PROVIDER.
In addition, if PROVIDER is required to provide an audit as set forth in in Section 9(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, and maintain malpractice
insurance covering the audit services provided. If the PROVIDER receives $100,000 or more in
grant funding from the County, the CPA must also be a member of the American Institute of
Certified Public Accountant (AICPA). The County shall be considered an "intended recipient" of
said audit.
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.
Pursuant to F.S. 119.0701, PROVIDER and its subcontractors shall comply with all public records
laws of the State of Florida, including but not limited to:
(a) Keep and maintain public records that ordinarily and necessarily would be required by
Monroe County in order to perform the service.
Guidance Care Center —Transportation: Baker Act and CTD FYI 7; page 2
(b) Provide the public with access to public records on the terms and conditions that Monroe
County would provide the records and at a cost that does not exceed the cost provided in Florida
Statutes, Chapter 119 or as otherwise provided by law.
(c) Ensure that public records that are exempt or confidential and exempt from public records
disclosure requirements are not disclosed except as authorized by law.
(d) Meet all requirements for retaining public records and transfer, at no cost, to Monroe County
all public records in possession of the contractor upon termination of the contract and destroy any
duplicate public records that are exempt or confidential and exempt from public records disclosure
requirements. All records stored electronically must be provided to Monroe County in a format
that is compatible with the information technology systems of Monroe County.
9. 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 Stature 496.406.
(c) List of the Organization's Board of Directors of which there must be at least 5 and for each
board member please indicate when elected to serve and the length of term of service;
(d) Evidence of annual election of Officers and Directors;
(e) Unqualified audited financial statement from the most recent fiscal year for all
organizations that expend $150,000 a year or more; if qualified, include a statement of
deficiencies with corrective actions recommended/taken;
1. If the PROVIDER receives $100,000 or more in grant funding from the County
an audit shall be prepared by an independent certified public accountant (CPA):
a. The CPA must have a current license, in good standing with the Florida
State Board of Accountancy
b. The CPA must be a member of the American Institute of Certified Public
Accountant (AICPA);
c. The CPA must maintain malpractice insurance covering the audit services
provided and
d. The County shall be considered an "intended recipient" of said audit."
(f) Copy of a filed IRS Form 990 from most recent fiscal year with all attached schedules;
(g) Organization's Corporate Bylaws, which must include the organization's mission, board and
membership composition, and process for election of officers;
(h) Organization's Policies and Procedures Manual which must include hiring policies for all
staff, drug and alcohol free workplace provisions, and equal employment opportunity
provisions;
(i) Specific description or list of services to be provided under this contract with this grant
(see Attachment C);
(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
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.
Guidance Care Center —Transportation: Baker Act and CTD FYI 7; page 3
RESPONSIBILITIES
10. SCOPE QF SERVICES. The Provider, for the consideration named, covenants and
agrees with the Board to substantially and satisfactorily perform and carry out the duties of the
Board in rendering counsel in the matter of mental health and guidance to the citizens of the
Monroe County, Florida. The Provider shall provide Baker Act transportation services in
compliance with Florida Statutes Chapter 394. Baker Act and Marchman Act transportation
services which are covered under this agreement may be subcontracted, but are subject to the
rates set forth in Attachment D, and the limitations above. The subcontractor shall be subject to
all of the conditions of this contract, including but not limited to insurance and hold -harmless
requirements, as is the Provider.
11. ACCESS TO FUELING FACILITIES. The County shall provide access to the
L
Provider's vehicles at all County fueling facilities. The County shall grant the Provider a license for
the use of the real property and its improvements for each fueling site.
The Provider agrees that only those individuals authorized by the County to use the fueling
sites designated in this agreement shall have twenty-four hour access to said sites, and that they
shall either be maintained open or access otherwise provided to them by a uniform key system on
such a twenty-four hour basis.
The County shall bill the Provider for fueling and other related services and materials
utilized by the Provider at the fueling sites within the County's immediate control and as
N
previously set forth in this agreement. Said billing by the County to the Provider shall include an
CD
administrative surcharge, as adopted by the Monroe County Board of County Commissioners
annually, for processing, servicing, and handling. The Provider shall reimburse the County withinCD
thirty (30) days of the date of issuance of the bill.
N
Access to the Fuel Sentry System shall be provided by an electronic memory key, which
i
shall be issued by the County to all authorized designated users of the fueling sites, and as
contemplated by this Agreement. For purposes of uniformity, the Monroe County Fleet
—
Management Department shall be responsible for establishing a uniform electronic key system for
i
use by both the County and the Provider under this agreement, and shall establish and maintain
policies and procedures for identification, control, and distribution of all keys issued.
i
r_
0
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
tf
the enforcement or interpretation of this Agreement, the prevailing party shall be entitled to
CLa
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.
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.
Guidance Care Center —Transportation: Baker Act and CTD FYI 7; page 4
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
the provision of such services, including those now in effect and hereinafter adopted. Any
violation of said statutes, ordinances, rules and regulations shall constitute a material breach of
this agreement and shall entitle the Board to terminate this contract immediately upon delivery of
written notice of termination to the PROVIDER.
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,
relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with
Disabilities Act of 1990 (42 USC s. 1201 Note), as maybe amended from time to time, relating to
nondiscrimination on the basis of disability; 10) Any other nondiscrimination provisions in any
Federal or state statutes which may apply to the parties to, or the subject matter of, this
Agreement.
AMENDMENTS, CHANGES, AND DISPUTES
Guidance Care Center -Transportation: Baker Act and CTD FYI 7; page 5
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. If no resolution can be agreed upon
within 30 days after the first meet and confer session, the issue or issues shall be discussed at a
public meeting of the Board of County Commissioners. If the issue or issues are still not resolved
to the satisfaction of the parties, then any party shall have the right to seek such relief or remedy
as may be provided by this Agreement or by Florida law.
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.
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
Guidance Care Center -Transportation: Baker Act and CTD FYI 7; page 6
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, or any of them, 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:
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 Inc.
Guidance Care Center —Transportation: Baker Act and CTD FY17; page 7
1205 Fourth Street
Key West, Florida 33040
35. 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 —Transportation: Baker Act and CTD FYI 7; page 8
IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as
of the day and year first written above.
(SEAL) BOARD OF COUNTY COMMISSIONERS
ATTEST: AMY HEAVILIN, CLERK OF MONROE COUNTY, FLORIDA
By-___ ----------- By
Deputy Clerk Mayor/Chairman
GUIDANCE/CARE CENTER
if' A (Federal ID No.,_. -1Z )
Wiffiess
ey
Wit Director
Guidance/Care Center
ID14-JILO
Guidance Care Center —Transportation Baker Act and CTO FY1Z page 9
ATTACHMENT A
EXPENSE REIMBURSEMENT REQUIREMENTS
This document is intended to provide basic guidelines to Human Service and Community -Based
Organizations, county travelers, and contractual parties who have reimbursable expenses
associated with Monroe County business. These guidelines, as they relate to travel, are from the
Monroe County Code of Ordinances and State laws and regulations.
A cover letter (see Attachment B) summarizing the major line items on the reimbursable expense
request needs to also contain the following notarized certified statement:
"I certify that the above checks have been submitted to the vendors as noted and that the
attached expenses are accurate and in agreement with the records of this organization.
Furthermore, these expenses are in compliance with this organization's contract with the Monroe
County Board of County Commissioners and will not be submitted for reimbursement to any other
funding source."
Invoices should be billed to the contracting agency. Third party payments will not be considered
for reimbursement. Remember, the expense should be paid prior to requesting a reimbursement
Only current charges will be considered, no previous balances.
Reimbursement requests will be monitored in accordance with the level of detail in the contract.
This document should not be considered all-inclusive. The Clerk's Finance Department reserves
the right to review reimbursement requests on an individual basis. Any questions regarding these
guidelines should be directed to 305-292-3534.
Data Processing, PC Time, etc.
The vendor invoice is required for reimbursement. Inter -company allocations are not considered
reimbursable expenditures unless appropriate payroll journals for the charging department are
attached and certified.
Payroll
A certified statement verifying the accuracy and authenticity of the payroll expense is needed. If
a Payroll Journal is provided, it should include: dates, employee name, salary or hourly rate, total
hours worked, withholding information and paid payroll taxes, check number and check amount.
If a Payroll Journal is not provided, the following information must be provided: pay period, check
amount, check number, date, payee, and support for applicable paid payroll taxes.
Postage, Overnight Deliveries, Courier, etc.
A log of all postage expenses as they relate to the County contract is required for reimbursement
For overnight or express deliveries, the vendor invoice must be included.
Rents, Leases, etc.
A copy of the rental or lease agreement is required. Deposits and advance payments are not
allowable expenses.
Reproductions, Copies, etc.
A log of copy expenses as they relate to the County contract is required for reimbursement. The
log must define the date, number of copies made, source document, purpose, and recipient. A
reasonable fee for copy expenses will be allowable. For vendor services, the vendor invoice and a
sample of the finished product are required.
Supplies, Services, etc.
For supplies or services ordered, a vendor invoice is required.
Guidance Care Center -Transportation: Baker Act and CTD FYI 7; page 10
Telefax, Fax, etc.
A fax log is required. The log must define the sender, the intended recipient, the date, the
number called, and the reason for sending the fax.
Telephone Expenses
A user log of pertinent information must be remitted including: the party called, the caller, the
telephone number, the date, and the purpose of the call.
Travel and Meal Expenses
Travel expenses must be submitted on a State of Florida Voucher for Reimbursement of Travel
Expenses. Travel reimbursement requests must be submitted and will be paid in accordance with
Monroe County Code of Ordinances and State laws and regulations. Credit card statements are
not acceptable documentation for reimbursement. If attending a conference or meeting, a copy
of the agenda is needed. Airfare reimbursement requires the original passenger receipt portion of
the airline ticket. A travel itinerary is appreciated to facilitate the audit trail. Auto rental
reimbursement requires the vendor invoice. Fuel purchases should be documented with paid
receipts. Taxis are not reimbursed if taken to arrive at a departure point: for example, taking a
taxi from one's residence to the airport for a business trip is not reimbursable. Parking is
considered a reimbursable travel expense at the destination. Airport parking during a business
trip is not.
A detailed list of charges is required on the lodging invoice. Balance due must be zero. Room
must be registered and paid for by traveler. The County will only reimburse the actual room and
related bed tax. Room service, movies, and personal telephone calls are not allowable expenses.
Mileage reimbursement shall be at the rate established by ARTICLE XXVI, TRAVEL, PER DIEM,
MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. An odometer reading
must be included on the state travel voucher for vicinity travel. Mileage is not allowed from a
residence or office to a point of departure. For example, driving from one's home to the airport
for a business trip is not a reimbursable expense.
Meal reimbursement shall be at the rates established by ARTICLE XXVI, TRAVEL, PER DIEM,
MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. Meal guidelines state
that travel must begin prior to 6 a.m. for breakfast reimbursement, before noon and end after 2
p.m. for lunch reimbursement, and before 6 p.m. and end after 8 p.m. for dinner reimbursement
Non -allowable Expenses
The following expenses are not allowable for reimbursement: capital outlay expenditures (unless
specifically included in the contract), contributions, depreciation expenses (unless specifically
included in the contract), entertainment expenses, fundraising, non -sufficient check charges,
penalties and fines.
Guidance Care Center —Transportation: Baker Act and CTD FYI 7; page 11
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) TotalXXX_XX
(B) Total prior payments $ X,XXX.XX
(C) Total requested and paid (A + B) $ X,XXX.XX
(D) Total contract amount $ XXX.XX
Balance of contract (D-C) $ XXXX_.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.
Executive Director
Attachments (supporting documentation)
Sworn to and subscribed before me this day of
who is personally known to me.
Notary Public Notary Stamp
20by
Guidance Care Center —Transportation: Baker Act and CTD FYI 7; page 12
ATTACHMENT C
Services to be provided:
Baker Act/Marchman Act transportation services and Community Transportation
Coordinator related services.
Guidance Care Center —Transportation: Baker Act and CTD FYI 7; page 13
ATTACHMENT D
Copy of the Sub -Contract for Baker Act transportation services. See attached.
9
-1
Guidance Care Center —Transportation: Baker Act and CTD FYI 7; page 14
GUIDANCE/CARE CENTER, INC.
300041 IT STREET, OCEAN
MARATHON, FL 33050
(v) 305/434-7660 / (f) 305/434-9040
September 15, 2016
Lee Connell
800 14t" Street
Key West, FL 33040
RE: LETTER OF AGREEMENT 2016-2017
Dear Mr. Connell:
The Guidance/Care Center, Inc. (G/CC) hereby enters into an agreement with Elanjess LLC
to provide coordination and transportation services for Baker Act/Marchman Act (BA/MA)
clients throughout Monroe County to/from Miami -Dade County as well as other destinations.
The terms and conditions of this agreement are effective October 1, 2016, and will continue
through September 30. 2017.
G/CC will supply Elanjess with two Ford Crown Victoria vehicles, meeting Elanjess
maintenance specifications; one to be stationed in Key West at an Elanjess location and the
other in Marathon at G/CC headquarters.
G/CC will pay for the fuel and maintenance of the two vehicles used for BA/MA
transportation. Elanjess will coordinate the maintenance for the Crown Victoria located in
Key West. Invoices for routine maintenance (labor and parts) on the Crown Victoria will be
forwarded quarterly to G/CC's Transportation Coordinator for payment. Elanjess will not
charge an extra fee for coordinating the maintenance of the vehicle. Elanjess must obtain
prior approval from the G/CC Transportation Coordinator to initiate major vehicle repairs.
G/CC will coordinate the maintenance for the Crown Victoria located in Marathon.
G/CC will maintain insurance on both of the vehicles. Elanjess will also be named as an
"additional insured" for these two cars. All Elanjess drivers operating G/CC vehicles will hold
a minimum of a Class E Florida Driver's License and be approved for G/CC insurance
coverage by the Transportation Coordinator. Upon execution of this agreement, Elanjess will
fax/email to G/CC's Transportation Coordinator a current list of drivers - including a copy of
the driver's license and social security number for each driver - for approval to operate G/CC
vehicles. Prior to adding a driver, Elanjess will fax or email to G/CC's Transportation
Coordinator or designee a copy of the driver's license, social security number and signed
"Request for Check of Driving Record" form of the person. G/CC will initiate procedures to
add the driver to G/CC vehicle insurance. Elanjess cannot use the driver for BA/MA
transports until it has received written notification that the driver has been added to the G/CC
insurance coverage.
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All drivers are required to have at minimum 3-year clean driving record. Additionally,
Elanjess will fax a copy of picture identification and social security number for each escort to
G/CC's Transportation Coordinator or designee. Elanjess cannot use the escort for BA/MA
transports until it has received written notification that the escort has been approved by
G/CC. All BA/MA approved drivers must read and sign the acknowledgement of reading and
receiving (Attachment 1) Transportation Protocol.
Elanjess will report and document accidents involving G/CC vehicles and incidents involving
clients to the proper authorities and immediately thereafter contact G/CC. Following an
accident, GCC Vehicle Incident protocol must be followed. A Vehicle Incident Kit
(Attachment 4) has been provided for each vehicle with instructions. Additionally, anyone
involved in an accident with a GCC vehicle MUST BE DRUG TESTED as soon as possible
following the incident. Drug testing forms are included in the kit.
Any citations received while driving a GCC vehicle will be the responsibility of the driver.
Refusal or failure to accept responsibility for citations may result in removal of driving
privileges.
All drivers will be required to complete a verbal de-escalation training within 30 days of
approval to drive. GCC will provide details for accessing the training which will be available
online. All BA/MA approved drivers must read and sign the acknowledgement of completing
the assigned training (Attachment 5).
Elanjess will follow the transportation protocol and complete the documentation provided as
Attachment 1-3 herein.
Elanjess, upon approval of drivers, will issue an identification badge.
The following fee
structure is established for
the period of the agreement:
Estimated
Elanjess
# Roundtri s*
Client Picku Point
Client Drop-off Point
Payment
Key West
Key West
$115
Marathon
Marathon
$115
450
Key West
Marathon
$145
Marathon
Key West
$145
Marathon
Key Largo
$145
_Key Largo
Marathon
$145
40
Marathon
Miami -Dade County
$385
KeyLar o
Miami -Dade Count
$385
40
Key West
Miami -Dade Count
$385
G/CC Preauthorization Required for All Trips Below
*Approval for below fees will be granted only when the Marathon BA/MA vehicle is engaged
with another BA/MA trip that would preclude anotheric®kupuvvithin a reasonable period of time.
Estimated Car Client Pickup Elanjess
PointPa meat
Client Drop-off Point
# Roundtri s Locationa
5 Key West Marathon & North Marathon $145
5 Marathon Key West Marathon $145
2 Key West Marathon & North Key Largo $225
3 Key West Marathon & North Miami -Dade Count $385
Rvsdhvwd. Ifin 0916
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s
G/CC Preauthorization Required for All Trips Below
Estimated
Elanjess
# Roundtrips*
Client Pickup Point
Client Drop-off Point
Payrment
Key Largo
Avon Park (Area)
$770
1
Marathon
Avon Park (Area)
$770
Key West
Avon Park (Area)
$770
Key Largo
Up -State (McClenny Area)
$1,200
1
Marathon
Up -State (McClenny Area)
$1,200
Kev West
UP-State(McClenny Area
$1,200
Timely payment for services rendered is ensured by adherence to the following invoicing
procedures:
• Elanjess will submit one statements/invoice per month, within 5 business days after
the end of the billing period.
• Elanjess will include required documentation with each statement/invoice.
• Elanjess statements/invoices for BA/MA trips will be submitted to the attention of
G/CC Inpatient Unit Coordinator.
• G/CC's Inpatient Unit Coordinator will review statement/invoice, mediate any
discrepancies with Elanjess, and forward approved invoice to G/CC Finance
Department.
• Elanjess will submit vehicle maintenance bills for the KW car quarterly to the
Transportation Coordinator
• G/CC will mail payment to Elanjess within 14 working days (Finance Department)
upon receipt of statement/invoice by the Inpatient Unit Coordinator.
The agreement can be cancelled by either party with 30 days written notice.
G/CC and Elanjess enter into this agreement including Attachments 1-5 by affixing
signatures below:,
Maureen emp , NfA, NCC, LMHC Date
Area Director, Guidance Care Center
El e LC L,tc. Covw,,cl11 Date
Co -Signer (print name/title)
Date
Attachments:
1. G/CC Transportation Protocol
2. G/CC Transportation Record and Payment Authorization Sheet
3. Statement
4. Vehicle Incident Kit
5. De-escalation attestation
Rvsd/rvwd: ft 09*16
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U
ATTACHMENT 1
GUIDANCE /CARE CENTER TRANSPORTATION PROTOCOL:
THE TRANSPORTATION OF BAKER ACT AND MARCHMAN ACT CLIENTS
Client Related Rules:
1. Confidentially of a client and client related information shall be maintained at all
times.
2. Each client shall be treated with respect and dignity at all times.
3. No information with client information shall leave the clinic unless part of a client
transfer packet to a designated facility. (No driver/escort shall maintain a personal
copy of the Transportation Record and Payment Authorization Sheet.)
4. Client transportation within Monroe County may be conducted with a driver and an
escort.
5, Client transportation outside of Monroe County must be made with one driver and
one escort.
6 A client must be observed for any unusual behaviors including hurting self/others or
sudden medical conditions. Respond to a medical emergency by calling 911.
Otherwise, contact the nurse at the transferring (pick-up) facility for consultation.
7. At the time of pick up for a Baker Act or Marchman Act client, a driver must obtain
the original Baker Act or Marchman Act paper work from the Pick Up facility. If the
original paper work is not available the driver must immediately report this
information to the G/CC Nurse on Duty for further instructions.
8. A female client requires a female escort or a female driver.
9. A parent is not allowed to travel in the Baker Act vehicle with a Baker Act or
Marchman Act minor.
• When a parent or other responsible party reports he/she plans to follow the
Baker Act vehicle, the Baker Act driver advises the parent/party that our
primary responsibility is to the child and ensuring the safety of the child
therefore following our vehicle as a method of direction is not encouraged.
10. Only one client may be transported at a time in the Baker Act vehicle.
11. Drivers, Escorts and Clients are not to smoke in the car at any time.
12. Clients are not to be placed in handcuffs or any type of restraints for any reason by a
driver or escort — or to be placed in the vehicle by others (i.e. Law Enforcement) in
handcuffs or any type of restraints
13. A client's movement is not to be impeded with any physical restraint unless directed
by a nurse/MD/law enforcement officer.
14. If a client is violent during transport and poses a threat to safety, stop the vehicle and
call 911, than notify the Nurse on Duty of the situation at (305) 434-7660 ext. 31123
15. A client shall not be left alone in the vehicle during the trip for any reason.
16. A client shall be under the observation of the driver or escort at all times during the
transport.
17, Client is encouraged to use restroom facilities prior to departure. If the trip is
generated from Key West and a stop is required, the G/CC may be used for that
purpose.
Rvsd/lfm 9.2016
18. A client may not use aluminum/metal cans. Items for drinking shall be provided only
in a plastic container.
19. Clients may not have any metal utensils, glass or other hard products such as
pencils or pens.
20. A client may not shop during a stop. All efforts should be made to avoid stops. If a
stop is required, it should be short and without delay.
21. If a client must use a public facility, the dent must be escorted to the restroom and
the driver must remain outside the restroom door until the client leaves the restroom.
The driver will remain in conversation with client while the client is in the restroom.
Coordination of Transportation Rules:
1. Transportation arrangements for Baker Act and Marchman Act clients are under the
direction of the Unit Nurse on Duty/G/CC per contractual arrangement Elanjess LLC
No other agency is authorized to contact Elanjess directly for transportation.
2. Final decision for a driver to transport is made by the nurse on duty. The nurse may
request a BAL be conducted or send a drivers/escort home if he/she has a concern.
3. "A driver shall not be permitted or required to drive more than 12 hours in any one
24-hour period, or drive after having been on duty for 16 hours in any one 24-hour
period. "
4. All trips will be made within the approved fee structure.
5. All trips will be made using the closest vehicle and the shortest distance unless
preauthorization is obtained from the Unit Nurse on Duty at the G/CC.
& Clients may be picked up at only approved locations. The G/CC Nurse on Duty will
communicate the pick up location. Approved locations will include:
Hospitals, Detention Facility
Mental Health Clinics, Anchor Away
With a G/CC staff member
Or otherwise authorized by the G/CC IP Unit Coordinator
7. De oo Hospital : Pick-up / drop-off is now located in the rear next to the handicap
parking. Upon arrival, call the nurse's station directly from the vehicle at 305-294-
5531 x8330. Hospital staff will escort the client to/from the building.
8. Pick-up / drop-off is at the ER entrance. Upon arrival, call 305-294-5531 x3202.
Hospital staff will escort the client to/from the building.
9. At G/CC: Use the telephone call box next to the elevator.
10. At G/CC, staff members shall place the client in the vehicle for departure and will
assist the client from the vehicle at time of arrival.
11. The facility responsible for the departing client for a trip longer than 2 hours shall
provide a brown bag snack. All minors shall be supplied with a snack for any trip
over 1 hour.
12. When a driver reports a client is too dangerous to transport, the nurse on duty shall
work with the Sheriffs department to transport the client
13. If a client absconds at time of or during transport, immediately report the information
to the G/CC Nurse on Duty. Do not go after the client.
14. Neither Drivers nor Escorts are permitted to physically restrain a client.
15. "Jail Hold" clients from the Monroe County Detention Facility shall be picked up from
Rvsd/lfm 9.2016
-2-
the Sallyport area only. To access the Sallyport area, the driver must drive the car
within 1 foot of the Sallyport entrance. If the door does not open, the escort must use
the speaker mounted on the wall next to the Sallyport entrance to request entrance.
Once inside, Detention Facility staff will bring the client to the car. When the client is
inside the car and the doors are locked, the Sallyport area exit doors will open.
16. The driver/escort must determine from the Pick Up facility if the client has been
searched and encourage staff to conduct a search prior to transport. If the client is
not searched prior to transport, the driver must communicate this information to the
Duty Staff Member prior to opening the client door at the Designation point.
17. Driver/escort MUST respond to the pick up point within a maximum time -frame of
1 hour and 15 minutes.
C. Reimbursement related rules
1. All cancelled and otherwise diverted trips will be reported on the Transportation
Record and Payment Authorization Sheet.
2. Transportation Record and Payment Authorization Sheets and a Statement of
services rendered will be faxed to the IP Unit Coordinator on the first and sixteenth
of each month.
3. G/CC does not reimburse Elanjess for cancelled trips. Compensation to the
drivers/escorts for cancelled trips is at the discretion of Elanjess.
4. If the driver arrives without the original Baker or Marchman Act paperwork, Elanjess
will obtain the paper work without charge to the G/CC.
D. Other
1. Drivers must wear their Elanjess issued ID badge at all times
I acknowledge I have received and read the above BA/MA Transportation Protocol.
Driver/Escort Signature
Printed Name
Rvsd/lfm 9.2016
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Date
ATTACHMENT 2
GUIDANCE/CARE CENTER
3000 41ST ST. Ocean
Marathon, FL 33050
Voice 305-434-7660 e Fax 305-434-9040
TRANSPORTATION RECORD AND PAYMENT AUTHORIZATION SHEET
Transportation Type:
Date:
Time Called:
o Baker Act ❑ Marchman Act
Client Name: DOB:
Time of Pick Up:
Time of Drop Off: Time van returned to Duty:
Vehicle: KW vehicle Mar vehicle
Place of Pick Up:
(Where did you pick up the Client: Facility Name/City)
Authorized Staff Signature at Pick Up Facility:
Time:
Destination:
(Where did you take the Client: Facility Name/City)
Authorized Staff Signature at Designation Facility:
(Staff member accepting client)
Driver Name:
Escort Name:
Beginning Miles:
Drop Off Miles:
Time:
Pick Up Miles:
Ending Miles:
...,...... ,----------------["FOR
_-.____- ._...
[VeFOR G/CC USE ONLY.
Amount to be paid:
Unit Director Signature:
:..................... -- ...... ....._... ....... __ .
\\westcare.local\Files\FL-GCC\Global Share\Transportation\Baker Act\16-17 elanjess\16-17 Attachment 2 - auth sheet.doc
RVSDO912
Attachment 3
Statement
Date:
Elanjess LLC
800 14th Street
Key West, Florida 33040
Inpatient Unit Coordinator
Guidance/Care Center
3000 41 st St. Ocean
Marathon, FL 33050
Re: Baker Act and Marchman Act transportation
Elanjess LLC Representative Signature G/CC Finance Director or Designee Signature
\\westcare.local\Files\FL-GCC\Global Share\Transportation\Baker Act\16-17 elanjess\16-17 Attachment 3 -Statement for Elanjes.doc
Rvsd: 10/10 rvwd:0914
Contents:
Vehicle Incident- Protocol and Reporting Policy
Vehicle Incident Report Form
Vehicle Incident- Passenger/Witness Statement Forms*
Vehicle Incident Traffic Diagram
Disposable Camera
12 Pens
*Number of Statement Forms Required is to equal vehicle passenger capacity
plus an additional two for other witnesses.
"Drivers are responsible for making sure this kit is complete at all tunes.
Vehicle Incident Protocol and Re orting Poi
(Vehicle Incident Kit Copy)
DO IMMEDIATELY:
1. Immediately after the incident, examine and question persons for bodily injury and them
examine vehicle for damage.
2. If there is an accident involving another vehicle or if persons involved require immediate
medical attention, call 911 or 311 accordingly.
3. If involved persons do not report injury, authorities still need to be contacted and a notice
repon requested. If the request for a police report is declined, the reason and dispatcher name
and badge number need to be noted.
4. After authorities have been called, your supervisor needs to be called.
DO NOT:
I . DONOTadmit fault if you are truly not at fault.
2. DO NOT leave the scene of an accident.
3. DO NOT drive the vehicle if you feel it is unsafe.
4. DO NOT drive the vehicle if you feel physically incapable of driving safely.
5. DO NOT discuss the .incident with anyone other than law enforcement authorities, your
supervisors, or a claims adjuster from York Claims Service Inc.
GATHER INFORMATION & COMPLETE INCIDENT REPORT:
1. An incident will be defined as any occurrence that resulted in damage to the vehicle and/or
injury to any person. Damage to a vehicle will be defined as anything that resulted in the
property not being left in the same condition as before the incident.
2. Locate and complete the Vehicle Incident Form, complete all the information requested
regarding incident and parties involved and take photos of damage with camera provided.
3. All passengers and other available witnesses, if applicable, need to complete the statement
form.
4. After police report has been completed (if it was not declined), persons have been cared for
(if injury occurred), and vehicle is operational, return to the office.
5. Any and all vehicle incidents must also be reported electronically upon return to the office
by attending supervisor by transferring information from Vehicle Incident Form. The
incident report.will be completed online by logging into the Westcare Intranet at
httias://secure.westeare.coina'int •a/.
6. An additional email must also be sent by the attending supervisor to the following
management staff summarizing the incident and action taken; Program Director/Coordinator,
Area Director and/or Vice President, and Michael Lavin, Sr. VP of Operations.
7. Supervisor will await further instructions by Program Director/Coordinator and/or Area
Director/Vice President and Michael Lavin, Sr. VP of Operations.
MANDATORY DRUG TEST
The driver of the vehicle involved MUST immediately take a drug test upon completion of the
Vehicle Incident Report Form. The driver's supervisor will provide the documents needed for
the designated laboratory.
Approved bpi Senior Management 712009
Westcare Vehicle .incident Re ort Form
This form is to be completed by driver immediately after a vehicle incident, when all persons involved have
been checked for injury and provided medical attention (if applicable), and while all parties are still present.
Basic Information:
Incident Date and Time:
Incident Location:
Were Authorities called? Yes / No
If no, explain why?
If yes, was a police report request granted? Yes / No
If yes, list police report number and attending officer name:
If no, list reason why it was declined?
Dispatcher Name and Badge Number:
Was citation issued? Yes or No If yes, to whom:
Westcare Vehicle Information:
Year/Make/Model:
\O
Plates:
State:
Description of Damage:
Please take pictures of damage with disposable camera provided in Vehicle Incident Kit.
Driver Information:
Driver Name and Job Title:
Driver License Number: State:
Involved Party 1:
Year/Make/Model:
Role in Incident:
Description of Damage:
Please take pictures of damage with disposable camera provided in Vehicle Incident Kit.
Insurance Company: Claims Phone:
Policy # .............. ........ w ----- __ _ License #
Driver Name: Phone:
Injured? Yes or No If yes, explain:
Passenger 1 Name: License #
Injured? Yes or No If yes, explain:
State:
State:
C.38.b
Passenger 2 Name: License # State:
Injured? Yes or No If yes, explain:
Passenger 3 Name: .............,_un .. _,.._ ._.__ License # - State:
Injured? Yes or No If yes, explain:
(Attach sheet if more passengers present)
Involved Party
Year/Matte/Model:
Role in Incident:
Description of Damage: w
Please take pictures of damage with disposable camera provided in Vehicle Incident Kit.
Insurance Company: _ - __........,._.._ ,Claims Phone: —
Policy # _ _ ..n.��. a _ .. _ .m License #
Driver Name:
Injured? Yes or No If Yes, explain:
Passenger 1 Name:
Injured? Yes or No If yes, explain:
Passenger 2 Name:
Injured? Yes or No If yes, explain:
Passenger 3 Name:
Injured? Yes or No If yes, explain: -
(Attach sheet if more parties involved)
Phone:
License #
License #
License #
Passengers Present in Westcare 'Vehicle:
All passengers must complete a Vehicle Incident Passenger Statement Form.
1. Staff or Client
Name:
Injured? Yes or No
If Yes, explain: -
2. Staff or Client
Name:
Injured? Yes or No
If Yes, explain:
3. Staff or Client
Name
Injured? Yes or No
If Yes, explain:
4. Staff or Client
Name: _ma .
Injured? Yes or No
If Yes, explain:
State:
State:
State:
State:
S. Staff or Client
Name:
If Yes, explain:
6. Staff or Client
Name:
If Yes, explain: _
7. Staff or Client
Name:
If Yes, explain:
8. Staff or Client
Name:
If Yes, explain:
(Attach sheet if more passengers present)
Detailed E,xplanaitioan of Incident:
Was this a preventable incident? Yes or No
Explain why or why not:
Injured? Yes or No
Injured? Yes or No
Injured? Yes or No
Injured? Yes or No
I confirm the information provided in this report is as accurate to my knowledge and as thorough as possible.
Name:
Signature:
*This report must be sent to the attending supervisor as promptly as possible. Attending supervisor must complete and
submit an electronic incident report via the Westcare Intranet and email management.
* *The Driver of the Westcare vehicle must take a drug test, as required by company policy, immediately after the vehicle
incident and attending supervisor needs to know the time of completion.
Approved by Senior Management 712009
Westcare Vehicle Incident Passen er/Witness Statement Form
Name:
Are you Westcare Staff, a Westcare Client, or Other?
Are you a Driver, Passenger or Other Witness?
If Other Witness, please list Contact Information:
Address:
City: St:
Phone: { )
Incident Date and Time:
Incident Location:
Westcare Vehicle Make/Model:
Description of Incident/Event:
Are you injured? Yes or No
If yes, please explain:
I was offered medical evaluation: Yes or No
If yes, I: Accepted or Declined Signature:
Zip
I certify that the above information is as accurate to my knowledge and as thorough as possible.
Signature
Date
This form will be forwarded to attending supervisor to be part of the Vehicle Incident Report.
Thank you for your cooperation.
Approved by Senior Management 7/2009
S. L.
Westeare Vehicle Incident Passenger/Witness Statement Form
Name:
Are you Westeare Staff, a Westeare Client, or Other?
Are you a Driver, Passenger or Other Witness?
If Other Witness, please list Contact Information:
Address:
-
City: St:
Phone: _
Incident Date and Time:
Incident Location:
Westeare Vehicle Make/ModeI:
Description of Incident/Event:
Are you injured? Yes or No
If yes, please explain:
I was offered medical evaluation: Yes or No
If yes, I: Accepted or Declined Signature:
Zip
I certify that the above information is as accurate to my knowledge and as thorough as possible.
Signature
Date
This form will be forwarded to attending supervisor to be part of the Vehicle Incident Report.
Thank you for your cooperation.
Approved kv Senior Management 712009
S. L.
Westcare Vehicle Incident Passes Fez/Wit Bess statement Forru.
Name:.
Are you Westcare Staff, a Westcare Client, or Other?
Are you a Driver, Passenger or Other Witness?
If Other Witness, please list Contact Information:
Address:
City: St:
Phone: �)
Incident Date and Time:
Incident Location:
Westcare Vehicle Make/Model:
Description of Incident/Event:
Are you injured? Yes or No
If yes, please explain: y
I was offered medical evaluation: Yes or No
If yes, I: Accepted or Declined Signature:
Zip
I certify that the above information is as accurate to my knowledge and as thorough as possible.
Signature
Date
This form will be forwarded to attending supervisor to be part of the Vehicle Incident Report.
Thank you for your cooperation.
Approved by Senior Management 712009
S. L.
Westcare Vehicle Incident Passenger/Witness Statement 1+"ori
Name:
Are you Westcare Staff, a Westeare Client, or Other?
Are you a Driver, Passenger or Other Witness?
If Other Witness, please list Contact Information:
Address:
City: St:
Phone:
Incident Date and Time:
Incident Location:
Westcare Vehicle Malce/Model:
Description of Incident/Event:
Are you injured? Yes or No
If yes, please explain:
I was offered medical evaluation: Yes or No
If yes, I: Accepted or Declined Signature:
Zip
I certify that the above information is as accurate to my knowledge and as thorough as possible
Signature
Date
This form will be forwarded to attending supervisor to be pant of the Vehicle Incident Report.
Thank you for your cooperation.
Approved by Senior Management 712009
SS L.
Additional Sheet for More Information
9
-1
Approved by Senior Management 7/2009
Traffic Diaerams
Inteisection
3
4
5
I,
W,
F
GUIDANCE/CARE CENTER, INC.
3000 41ST STREET, OCEAN
MARATHON, FL 33050
(v) 305/434-7660 / (0 305/434-9040
I acknowledge I have completed DE-ESCALATION TRAINING
ttp.//www.hiii corn/videos/s ar h EDe+ -scaly ion+Traiiiin +Video&&view=detail&mi
d=AC9FB1689A985EE5E794AC9FB1689A985EE5E794&FORM=VRDGAR
Driver/Escort Signature
Printed Name
Date
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 I r&n(Respondent's name) nor
any Affiliate has been placed on the convicted vendor list within the last 36 months.
(Signature)
Date
STATE OF:
COUNTY OF.
Subscribed and sworn to (or affirmed) before me on'
(date) by GAt (name of affiant). He Sh is personally
known to me or has produced (type of identification) as
identification.
l
NOTARY PUBLIC
My Commission Expires:
=Public
. DOCHOW State of Floridares Jun 7, 2018# FF 104268
Guidance Care Center —Transportation: Baker Act and CTD FY17; page 15
ETHICS CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY, FLORIDA
(Company)
ATTACHMENT F
"...warrants that he/it has not employed, retained or otherwise had act on his/her behalf any former
County officer or employee in violation of Section 2 of Ordinance No. 010-1990 or any County officer
or employee in violation of Section 3 of Ordinance No. 010-1990. For breach or violation of this
provision the County may, in its discretion, terminate this Agreement without liability and may also, in
its discretion, deduct from the Agreement or purchase price, or otherwise recover, the full amount of
any fee, commission, percentage, gift, or consideration paid to the former County officer or
employee."
(Signature
Date:
STATE OF:
COUNTY OF: rWtRJ
Subscribed and sworn to (or affirmed) before me on 2o1
(date) by f+� (name of affiant), H Sh is personally
known to me or has produced
identification) as identification.
NOTARY PUBLIC
My Commission Expires:
ititi9 i
CAROL A. DOCHOW
Notary Publlc - State of Florida
My Comm. Expires Jun 7, 2018
r= ta?* Commission # FF 104268
(type of
Guidance Care Center —Transportation: Baker Act and CTD FYI 7; page 16
ATTACHMENT G
DRUG -FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
- c ljC,
(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 CD
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. LD
_
As the person authorized to sign the statement, I certify that this firm complies fully with the above
requirements.
(signature)
Date: • a" '�%
STATE OF:
COUNTY OF:
Subscribd and sworn to (or affirmed) before me on (date) by
(name of affian ). Hel h is personally known to me
or has produced _ type �" as
identification.
._ NC)TARY PUBLIC
:,wT�*, CAROL A. DOCHOW
ae � Notary Public - State of Florida , M Commission Expires:
�,w r My Comm. Expires Jun 7, 2018 y p
`"�;,e �,? Commission # FF 104268
R
4 �xlba
Guidance Care Center —Transportation: Baker Act and CTD FYI 7; page 17
AGREEMENT
This Agreement is made and entered into this 19th day of October, 2016, between the
BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as
"Board" or "County," and Guidance/Care Center, hereinafter referred to as "PROVIDER."
WHEREAS, the 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 carrying out the duties and obligations of the
Board, shall reimburse the Provider for a portion of the Provider's expenditures for the Jail In -
House Program services (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 THIRTY THREE THOUSAND TWO HUNDRED
EIGHTY FOUR AND NO/100 DOLLARS ($133,284) during the fiscal year 2016-2017.
2. TERM. This Agreement shall commence on October 1, 2016, and terminate September
30, 2017, 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. CLAIMS FOR FEDERAL OR STATE AID. PROVIDER and County agree that each shall
be, and is, empowered to apply for, seek, and obtain federal and state funds to further the
Contract -Guidance Care Center -Jail Program -FYI 7; page 1
purpose of this Agreement; provided that all applications, requests, grant proposals, and funding
solicitations shall be approved by each party prior to submission.
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
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.
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-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 Stature 496.406.
(c) List of the Organization's Board of Directors of which there must be at least 5 and for each
board member please indicate when elected to serve and the length of term of service;
(d) Evidence of annual election of Officers and Directors;
(e) Unqualified audited financial statement from the most recent fiscal year for all
organizations that expend $150,000 a year or more; if qualified, include a statement of
deficiencies with corrective actions recommended/taken;
1. If the PROVIDER receives $100,000 or more in grant funding from the County
an audit shall be prepared by an independent certified public accountant (CPA):
a. The CPA must have a current license, in good standing with the Florida
State Board of Accountancy;
b. The CPA must be a member of the American Institute of Certified Public
Accountant (AICPA);
c. The CPA must maintain malpractice insurance covering the audit services
provided and
d. The County shall be considered an "intended recipient" of said audit."
(f) Copy of a filed IRS Form 990 from most recent fiscal year with all attached schedules;
(g) Organization's Corporate Bylaws, which must include the organization's mission, board and
membership composition, and process for election of officers;
(h) Organization's Policies and Procedures Manual which must include hiring policies for all
staff, drug and alcohol free workplace provisions, and equal employment opportunity
provisions;
(i) Specific description or list of services to be provided under this contract with this grant
(see Attachment C);
Contract -Guidance Care Center -Jail Program -FYI 7; page 2
(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
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
10. 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.
11. 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.
12. 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.
13. 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.
14. 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.
15. 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
16. 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
Contract -Guidance Care Center -Jail Program -FYI 7; page 3
the provision of such services, including those now in effect and hereinafter adopted. Any
violation of said statutes, ordinances, rules and regulations shall constitute a material breach of
this agreement and shall entitle the Board to terminate this contract immediately upon delivery of
written notice of termination to the PROVIDER.
17. 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.
18. NON-DISCRIMINATION. County and PROVIDER agree that there will be no
discrimination against any person, and it is expressly understood that upon a determination by a
court of competent jurisdiction that discrimination has occurred, this Agreement automatically
terminates without any further action on the part of any party, effective the date of the court
order. County or PROVIDER agree to comply with all Federal and Florida statutes, and all local
ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1)
Title VI of the Civil Rights Act of 1964 (PL 88-352) which prohibits discrimination on the basis of
race, color or national origin; 2) Title IX of the Education Amendment of 1972, as amended (20
USC ss. 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; 3)
Section 504 of the Rehabilitation Act of 1973, as amended (20 USC s. 794), which prohibits
discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended (42
USC ss. 6101-6107) which prohibits discrimination on the basis of age; 5) The Drug Abuse Office
and Treatment Act of 1972 (PL 92-255), as amended, relating to nondiscrimination on the basis
of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and
Rehabilitation Act of 1970 (PL 91-616), as amended, relating to nondiscrimination on the basis of
alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, ss. 523 and 527 (42 USC
ss. 690dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug abuse
patient records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC s. et seq.), as amended,
relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with
,
Disabilities Act of 1990 (42 USC s. 1201 Note), as maybe amended from time to time, relating to
nondiscrimination on the basis of disability; 10) Any other nondiscrimination provisions in any
Federal or state statutes which may apply to the parties to, or the subject matter of, this
Agreement.
_
i
AMENDMENTS, CHANGES, AND DISPUTES
19. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the services
CLi
and/or reimbursement of services shall be accomplished by an amendment, which must be
approved in writing by the County.
20. ADJUDICATION OF DISPUTES OR DISAGREEMENTS. County and PROVIDER
agree that all disputes and disagreements shall be attempted to be resolved by meet and confer
sessions between representatives of each of the parties. If no resolution can be agreed upon
within 30 days after the first meet and confer session, the issue or issues shall be discussed at a
public meeting of the Board of County Commissioners. If the issue or issues are still not resolved
to the satisfaction of the parties, then any party shall have the right to seek such relief or remedy
as may be provided by this Agreement or by Florida law.
21. 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-FY17; page 4
ASSURANCES
22. 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.
23. 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.
24. 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.
25. 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.
26. 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
27. 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.
28. 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.
29. 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.
30. 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
Contract -Guidance Care Center -Jail Program-FY17; page 5
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.
31. 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
32. 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.
33. NOTICE. Any notice required or permitted under this agreement shall be in writing
and hand -delivered or mailed, postage pre -paid, by certified mail, return receipt requested, to the
other party as follows:
For Board:
Grants Administrator and
1100 Simonton Street
Key West, FL 33040
For PROVIDER
Frank Rabbito, Senior Vice President
Guidance/Care Center
1205 Fourth Street
Key West, FL 33040
Monroe County Attorney
PO Box 1026
Key West, FL 33041
34. 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.
35. 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.
Contract -Guidance Care Center -Jail Program -FYI 7; page 6
36. 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.
37. 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]
IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as
of the day and year first written above.
(SEAL)
ATTEST: AMY HEAVILIN, CLERK
BY..
Deputy Clerk
n
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By.
Mayor/Chairman
Guidance/Care Center
Contract -Guidance Care Center -Jail Program-FYI7 page 7
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.
IQ
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. C,
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 -FYI 7; page 8
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 -FYI 7; page 9
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)
(D) Total contract amount
Balance of contract (D-C)
$ X,XXX.XX
$ X,XXX.XX
I certify that the above checks have been submitted to the vendors as noted and that the
expenses are accurate and in agreement with the records of this organization. Furthermore,
these expenses are in compliance with this organization's contract with the Monroe County Board
of County Commissioners and will not be submitted for reimbursement to any other funding
source.
Chief Executive Officer
Attachments (supporting documentation)
Sworn to and subscribed before me this
who is personally known to me.
Notary Public
day of
Notary Stamp
20 by
Contract -Guidance Care Center -Jail Program -FYI 7; page 10
ATTACHMENT C
Services to be provided:
Guidance/Care Center, Inc. will provide substance abuse services including
assessment, case management, individual therapy, group therapy, drug testing
and vocational workshops to men and women in the Monroe County Detention
Center (also known as the ]ail In -House Program)
Contract -Guidance Care Center -Jail Program -FYI 7; page 11
ATTACHMENT D
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."
have read the above and state that neither IV(Respondent's name) nor
any Affiliate has been placed on the convicted vendor list within the last 6rn�onths.
(Signature)
Date. g '
STATE OF: l U
COUNTY OF
Subscribed and sworn to (or affirmed) before me on� 1
(date) by Mew) .` A (name of affiant). e Sh is personally
known t A -or has produced (type of identification) as
identification.
NOTARY PUBLIC
My Commission Expires;
CAROL A. DOCHO]2018
Notary Public - State of
�'. My Comm. Expires Jun Commission #! FF 10
Contract -Guidance Care Center -Jail Program -FYI 7; page 12
ETHICS CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY, FLORIDA
(Company)
ATTACHMENT E
"...warrants that he/it has not employed, retained or otherwise had act on his/her behalf any former -
County officer or employee in violation of Section 2 of Ordinance No. 010-1990 or any County officer
or employee in violation of Section 3 of Ordinance No. 010-1990. For breach or violation of this
provision the County may, in its discretion, terminate this Agreement without liability and may also, in
its discretion, deduct from the Agreement or purchase price, or otherwise recover, the full amount of
any fee, commission, percentage, gift, or consideration paid to the former County officer or
employee."
(Signaturre'')
01
Date: "I � 0(y
STATE OF: NWAON
COUNTY OF:
Subscribed and sworn to (or affirmed) before me on 29
(date) by 1 t (name of affiant). Hehe is personally
.`_
known to me or has produced
identification) as identification,
NOTARY PUBLIC
My Commission Expires:
_. CAROL A. DOCHOW
_` ~$"+ a Notary Public - State of Florida
My Comm. Expires Jun 7, 2018
IL
, , Commission M FF 104268
of sY�6l1
(type of
Contract -Guidance Care Center -Jail Program -FYI 7; page 13
ATTACHMENT F
DRUG -FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
te,- _-rnL .
(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: G
STATE OF:
COUNTY OF: C v
( affirmed) before me on `� (date) by
ubs �d sworn to (name of affiant). He/ h is personally known to me
or has produced (type of i n- fit as
identification.
NOTARY PUBLIC
CAROL A DOCHOW
Notary Public - State of Florida
i My Commission Expires:
is My Comm. Expires Jun 7, 2018
u
'. Commission N FF 104268
Contrac -Gut ante a e era r- iF rya a - page 14
ATTACHMENT G
FY17 Annual Performance Report
(For year October 1, 2016 — September 30, 2017)
. .... ..__.__.__.____
Agency Name
POC
Phone/Email
Grant Amount
Per Section 9 of your contract, it is required that you fill out the entire form and answer
every question.
101090MINNIN
1. Please list services and client information below for the program/activities funded by the
Monroe County award.
2. What were the measurable outcomes (including numbers) accomplished in FY17? 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 FY17; and/or 200%; and/or another standard used by your organization?
Contract -Guidance Care Center -Jail Program -FYI 7; page 15
4. Were all the awarded funds used in FY17? If not, please explain.
5. What is the number of FTEs working on the program(s) funded by the award in FY17?
6. Were the awarded funds used as match in FY17? If so, please list matching sources.
7. What area of Monroe County did you serve in FY17?
8. How many total FTEs in your organization?
9. Volunteers: hours of program service were contributed by _ _ volunteers in FY17.
10. What was the CEO/Executive Director (or highest paid title) compensation in FY17?
(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 FY17 IRS Form
990. If your FY17 IRS Form 990 is not yet prepared, please estimate for now, and re-
submit revised when you have the final numbers.
12. What were your organization's total expenses in FY17?
13. What was your organization's total revenue in FY17?
14. What was the organization's total in grants and contracts for FY17?
15. What was the organization's total donations and in -kind (fundraising) in FY17?
16. What percentage of your expenses are program service expenses versus management and
general expenses in FY17 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.)
Contract -Guidance Care Center -Jail Program-FY17; page 16