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FY2019 10/17/2018
c� ugr a� l � o V '' Kevin Madok CPA vgo 'h ;o '' ''''' Clerk of the Circuit Court & Comptroller — Monroe County, Florida 11 4,,o; OOUN. i DATE: October 29, 2018 TO: Janet Gunderson Herbener Senior Grant & Finance Analyst FROM: Pamela G. Hanco .C. SUBJECT: October 17 BOCC Meeting Attached are electronic copies of the following Items for your handling: C20 Fiscal Year 2019 Agreement with Monroe Council of the Arts Corporation d/b /a Florida Council of the Arts in the amount of $72,765.00. C21 Agreement with Guidance /Care Center for the Community Transportation for Disadvantaged Program in the amount of $46,942.00 and Baker Act Transportation Service Program in the amount of $165,000.00 for Fiscal Year 2019. C23 Two Agreements with Guidance /Care Center for Substance Abuse Mental Health (SAMH) Services, including services provided as the Designated Centralized Receiving Facility ($859,195.00) and the Jail In -House Program ($193,847.00) for Fiscal Year 2019. The County funding for SAMH services are the local match required by Florida Statute. Copies of the agreements are provided. C26 Fiscal Year 2019 Agreement with Historic Florida Keys Foundation, Inc., established to develop, coordinate, and promote historic preservation in Monroe County, in the amount of $32,450.00. Should you have any questions, please feel free to contact me at (305) 292 -3550. Thank you. cc: County Attorney Finance File KEY WEST MARATHON PLANTATION KEY PK/ROTH BUILDING 500 Whitehead Street 3117 Overseas Highway 88820 Overseas Highway 50 High Point Road Key West, Florida 33040 Marathon, Florida 33050 Plantation Key, Florida 33070 Plantation Key, Florida 33070 305 - 294 -4641 305- 289 -6027 305 - 852 -7145 305 - 852 -7145 AGREEMENT This Agreement is made and entered into this 17th day of October, 2018, between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as "Board" or "County," and Guidance /Care Center, Inc., a Florida 501c3 not - for - profit corporation, 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 -9 -27 and P -04) attached here in (Attachment D) to provide substance abuse and mental health services; such funds shall be expended for alcohol, drug abuse, or mental health service programs and including services as the Designated Receiving Facility. 2. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially and satisfactorily performing and carrying out the duties and obligations of the Board, shall reimburse the Provider for a local match portion of the Provider's expenditures for Substance Abuse and Mental Health services, as billed by the Provider, for clients qualifying for such services under applicable state and federal regulations and eligibility determination procedures, for substance abuse treatment. This cost shall not exceed a total reimbursement of EIGHT HUNDRED FIFTY -NINE THOUSAND, ONE HUNDRED NINETY -FIVE AND NO /100 DOLLARS ($859,195.00) in fiscal year 2018- 2019. 3. TERM. This Agreement shall commence on October 1, 2018, and terminate September 30, 2019, 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 requirements Guidance Care Center -SAMH Contract FY19; page 1 shall be refunded in full to the County. Evidence of payment by the PROVIDER shall be in the form of a letter, summarizing the expenses, with supporting documentation attached. The letter should contain a notarized certification statement. An example of a reimbursement request cover letter is included as Attachment B. The organization's final invoice must be received within thirty days after the termination date of this contract shown in Article 3 above. After the Clerk of the Board examines and approves the request for reimbursement, the Board shall reimburse the PROVIDER. However, the total of said reimbursement expense payments in the aggregate sum shall not exceed the total amount shown in Article 2, above, during the term of this agreement. 5. AVAILABILITY OF FUNDS. The County reserves the right to withhold /reduce the funds to the Provider in the event that the Department of Children and Families eliminates /reduces the State contract funding. If funds cannot be obtained or cannot be continued at a level sufficient to allow for continued reimbursement of expenditures for services specified herein, this agreement may be terminated immediately at the option of the Board by written notice of termination delivered to the PROVIDER. The Board shall not be obligated to pay for any services or goods provided by the PROVIDER after the PROVIDER has received written notice of termination, unless otherwise required by law. 6. PURCHASE OF PROPERTY. All property, whether real or personal, purchased with funds provided under this agreement, shall become the property of Monroe County and shall be accounted for pursuant to statutory requirements. RECORDKEEPING 7. RECORDS. PROVIDER shall maintain all books, records, and documents directly 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(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. 8. PUBLIC ACCESS. The County and PROVIDER shall allow and permit reasonable access to, and inspection of, all documents, papers, letters or other materials in its possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the County and PROVIDER in conjunction with this Agreement; and the County shall have the right to unilaterally cancel this Agreement upon violation of this provision by PROVIDER. 9. COMPLIANCE WITH COUNTY GUIDELINES. The PROVIDER must furnish to the County the following (items A -L must be provided prior to the payment of any invoices): (a) IRS Letter of Determination and GUIDESTAR printout indicating current 501(c)(3) status; (b) Proof of registration with the Florida Department of Agriculture, as required by Florida Statute 496.405, and the Florida Department of State, as require by Florida Statute 617.01201, or proof of exemption from registration as per Florida Statute 496.406. (c) List of the Organization's Board of Directors of which there must be at least 5 and for each board member please indicate when elected to serve and the length of term of service; (d) Evidence of annual election of Officers and Directors; Guidance Care Center -SAMH Contract FY19; page 2 (e) Unqualified audited financial statements from the most recent fiscal year for all organizations that expend $150,000 a year or more; if qualified, include a statement of deficiencies with corrective actions recommended /taken; audit shall be prepared by an independent certified public accountant (CPA) with a current license, in good standing with the Florida State Board of Accountancy. If the PROVIDER receives $100,000 or more in grant funding from the County: a. The CPA that prepares the audit must also be a member of the American Institute of Certified Public Accountants (AICPA); b. The CPA must maintain malpractice insurance covering the audit services provided and c. The County shall be considered an "intended recipient" of said audit. (f) Copy of a filed IRS Form 990 from most recent fiscal year with all attached schedules; (g) Organization's Corporate Bylaws, which must include the organization's mission, board and membership composition, and process for election of officers; (h) Organization's Policies and Procedures Manual which must include hiring policies for all staff, drug and alcohol free workplace provisions, and equal employment opportunity provisions; (i) Specific description or list of services to be provided under this contract with this grant (see Attachment C, per contract ME225 -9 -27 and P -04); (j) All legally required licenses; (k) Any updates /amendments throughout the fiscal year to the South Florida Behavioral Network contract with Guidance /Care Center (ME225 -9 -27 and P -04); (I) Annual Performance Report describing services rendered during the most recently completed grant period (to be furnished within 30 days after the contract end date.) The performance report shall include statistical information regarding the types and frequencies of services provided, a profile of clients (including residency) and numbers served, and outcomes achieved; (m) Cooperation with County monitoring visits that the County may request during the contract year; and (n) Other reasonable reports and information related to compliance with applicable laws, contract provisions and the scope of services that the County may request during the contract year. 10. AUDIT. The Provider shall provide the County with an annual audit pursuant to Section 394.76(9)(a), Florida Statutes, which separately reflects the funds received from the County and related expenditures of said funds during the 2017 -2018 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, 2019. RESPONSIBILITIES 11. SCOPE OF SERVICES. The PROVIDER, for the consideration named, covenants and agrees with the Board to substantially and satisfactorily perform and provide the services outlined in Attachment C to residents of Monroe County, Florida. 12. ATTORNEY'S FEES AND COSTS. The County and PROVIDER agree that in the event any cause of action or administrative proceeding is initiated or defended by any party relative to the enforcement or interpretation of this Agreement, the prevailing party shall be entitled to reasonable attorney's fees, court costs, investigative, and out -of- pocket expenses, as an award against the non - prevailing party, and shall include attorney's fees, courts costs, investigative, and out -of- pocket expenses in appellate proceedings. Mediation proceedings initiated and conducted pursuant to this Agreement shall be in accordance with the Florida Rules of Civil Procedure and usual and customary procedures required by the circuit court of Monroe County. 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. Guidance Care Center -SAMH Contract FY19; page 3 14. CODE OF ETHICS. County agrees that officers and employees of the County recognize and will be required to comply with the standards of conduct for public officers and employees as delineated in Section 112.313, Florida Statutes, regarding, but not limited to, solicitation or acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public position, conflicting employment or contractual relationship; and disclosure or use of certain information. 15. NO SOLICITATION /PAYMENT. The County and PROVIDER warrant that, in respect to itself, it has neither employed nor retained any company or person, other than a bona fide employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bona fide employee working solely for it, any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of the provision, the PROVIDER agrees that the County shall have the right to terminate this Agreement without liability and, at its discretion, to offset from monies owed, or otherwise recover, the full amount of such fee, commission, percentage, gift, or consideration. 16. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the PROVIDER is an independent contractor and not an employee of the Board. No statement contained in this agreement shall be construed so as to find the PROVIDER or any of its employees, contractors, servants or agents to be employees of the Board. COMPLIANCE ISSUES 17. COMPLIANCE WITH LAW. In providing all services pursuant to this agreement, the PROVIDER shall abide by all statutes, ordinances, rules and regulations pertaining to or regulating 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. The COUNTY and 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 VII of the Civil Rights Act of 1964 (PL 88 -352), which prohibit discrimination in employment on the basis of race, color, religion, sex, and national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC §§ 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 § 794), which prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended (42 USC §§ 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, §§ 523 and 527 (42 USC §§ 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 §§ 3601 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 §§ 1201), as amended from time to time, relating to nondiscrimination in employment on the basis of disability; 10) Monroe County Code Chapter 14, Article II, which prohibits discrimination on the basis of race, color, sex, religion, national origin, ancestry, sexual orientation, gender identity or expression, familial status or age; and 11) any other nondiscrimination provisions in any federal or state statutes which may apply to the parties to, or the subject matter of, this Agreement. Guidance Care Center -SAMH Contract FY19; page 4 AMENDMENTS, CHANGES, AND DISPUTES 20. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the services and /or reimbursement of services shall be accomplished by an amendment, which must be approved in writing by the County. 21. ADJUDICATION OF DISPUTES OR DISAGREEMENTS. County and PROVIDER agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of the parties. The PROVIDER and County staff shall try to resolve the claim or dispute with meet and confer sessions to be commenced within 30 days of the dispute or claim. If the issue or issues are still not resolved to the satisfaction of the parties, then any party shall have the right to seek such relief or remedy as may be provided by this agreement or by Florida law. Any claims or dispute that the parties cannot resolve shall be decided by the Circuit Court, 16 Judicial Circuit, Monroe County, Florida. 22. COOPERATION. In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breach of this Agreement, County and PROVIDER agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement. County and PROVIDER specifically agree that no party to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. ASSURANCES 23. COVENANT OF NO INTEREST. County and PROVIDER covenant that neither presently has any interest, and shall not acquire any interest, which would conflict in any manner or degree with its performance under this Agreement, and that only interest of each is to perform and receive benefits as recited in this Agreement. 24. NO ASSIGNMENT. The PROVIDER shall not assign this agreement except in writing and with the prior written approval of the Board, which approval shall be subject to such conditions and provisions as the Board may deem necessary. This agreement shall be incorporated by reference into any assignment and any assignee shall comply with all of the provisions herein. Unless expressly provided for therein, such approval shall in no manner or event be deemed to impose any obligation upon the Board in addition to the total agreed upon reimbursement amount for the services of the PROVIDER. 25. NON - WAIVER OF IMMUNITY. Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the County and the PROVIDER in this Agreement and the acquisition of any commercial liability insurance coverage, self- insurance coverage, or local government liability insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall any contract entered into by the County be required to contain any provision for waiver. 26. ATTESTATIONS. PROVIDER agrees to execute such documents as the County may reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug -Free Workplace Statement. 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 Guidance Care Center -SAMH Contract FY19; page 5 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 and causes of action for medical malpractice, medical negligence, bodily injury (including death), personal injury, and property damage (including property owned by Monroe County) and any other losses, damages, and expenses (including attorney's fees) which arise out of, in connection with, or by reason of services provided by the PROVIDER occasioned by the negligence, errors, or other wrongful act or omission of the PROVIDER'S employees, agents, or volunteers. 29. PRIVILEGES AND IMMUNITIES. All of the privileges and immunities from liability, exemptions from laws, ordinances, and rules and pensions and relief, disability, workers' compensation, and other benefits which apply to the activity of officers, agents, or employees of any public agents or employees of the County, when performing their respective functions under this Agreement within the territorial limits of the County shall apply to the same degree and extent to the performance of such functions and duties of such officers, agents, volunteers, or employees outside the territorial limits of the County. 30. NO PERSONAL LIABILITY. No covenant or agreement contained herein shall be deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe County in his or her individual capacity, and no member, officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to any personal liability or accountability by reason of the execution of this Agreement. 31. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non - Delegation of Constitutional or Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any participating entity from any obligation or responsibility imposed upon the entity by law except to the extent of actual and timely performance thereof by any participating entity, in which case the performance may be offered in satisfaction of the obligation or responsibility. Further, this Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the constitutional or statutory duties of the County, except to the extent permitted by the Florida constitution, state statute, and case law. 32. NON - RELIANCE BY NON - PARTIES. No person or entity shall be entitled to rely upon the terms of this Agreement to enforce or attempt to enforce any third -party claim or entitlement to or benefit of any service or program contemplated hereunder, and the County and the PROVIDER agree that neither the County nor the PROVIDER or any agent, officer, or employee of either shall have the authority to inform, counsel, or otherwise indicate that any particular individual or group of individuals, entity or entities, have entitlements or benefits under this Agreement separate and apart, inferior to, or superior to the community in general or for the purposes contemplated in this Agreement. GENERAL 33. EXECUTION IN COUNTERPARTS. This Agreement may be executed in any number of counterparts, each of which shall be regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement by signing any such counterpart. 34. NOTICE. Any notice required or permitted under this agreement shall be in writing and hand - delivered or mailed, postage pre -paid, by certified mail, return receipt requested, to the other party as follows: For Board: Grants Administrator and Monroe County Attorney 1100 Simonton Street PO Box 1026 Key West, FL 33040 Key West, FL 33041 For PROVIDER Sharon Crippen, Senior Vice President Guidance Care Center -SAMH Contract FY19; page 6 Guidance /Care Center 1205 Fourth Street Key West, FL 33040 Copies of all default notices, notices of breach, termination, legal claim, or indemnity copied to: WestCare Foundation, Inc. Attn: Executive Vice President 1711 Whitney Mesa Drive Henderson, Nevada 89014 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 -SAMH Contract FY19; page 7 {q INN 11.I�ITNESS WHEREOF, the parties hereto have caused these presents to be executed as of 7 the; day andye' r first written above. . ti \ r c 6 �.. J \` \ - b . ,i , IA SEAL r BOARD OF COUNTY COMMISSIONERS ` +�.'- •AT MADOK CLERK OF MONROE COUNTY, FLORIDA B 4 By By Deputy Clerk Mayor /Chairman• Guidance /Care Center, Inc., a Florida 501c3 not - for - profit corporation :l [ /,�11i1 / (Federal ID No. 59 - I 3 ) Witfss Ca Witness Director Guidance /Care Center, Inc., a Florida 501c3 not - for - profit corporation MONROE COUNTY ATTORNEY - - 0 -frcep r TO MI: CHRISTINE LIMBERT - BARROWS 09 ASSISTANT C�OUNTYY O. . - : DATE:r C? s ;� :. O Cr% L. C f _`:�"_ -_ �1 L 1 C.1 --1 G� Guidance Care Center -SAMH Contract FY19; page 8 ATTACHMENT A EXPENSE REIMBURSEMENT REQUIREMENTS This document is intended to provide basic guidelines to Human Service and Community -Based Organizations, county travelers, and contractual parties who have reimbursable expenses associated with Monroe County business. These guidelines, as they relate to travel, are from the Monroe County Code of Ordinances and State laws and regulations. A cover letter (see Attachment B) summarizing the major line items on the reimbursable expense request needs to also contain the following notarized certified statement: "I certify that the above checks have been submitted to the vendors as noted and that the attached expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this organization's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source." Invoices should be billed to the contracting agency. Third party payments will not be considered for reimbursement. Remember, the expense should be paid prior to requesting a reimbursement. Only current charges will be considered, no previous balances. Reimbursement requests will be monitored in accordance with the level of detail in the contract. This document should not be considered all- inclusive. The Clerk's Finance Department reserves the right to review reimbursement requests on an individual basis. Any questions regarding these guidelines should be directed to 305 - 292 -3534. Data Processing, PC Time, etc. The vendor invoice is required for reimbursement. Inter - company allocations are not considered reimbursable expenditures unless appropriate payroll journals for the charging department are attached and certified. Payroll A certified statement verifying the accuracy and authenticity of the payroll expense is needed. If a Payroll Journal is provided, it should include: dates, employee name, salary or hourly rate, total hours worked, withholding information and paid payroll taxes, check number and check amount. If a Payroll Journal is not provided, the following information must be provided: pay period, check amount, check number, date, payee, and support for applicable paid payroll taxes. Postage, Overnight Deliveries, Courier, etc. A log of all postage expenses as they relate to the County contract is required for reimbursement. For overnight or express deliveries, the vendor invoice must be included. Rents, Leases, etc. A copy of the rental or lease agreement is required. Deposits and advance payments are not allowable expenses. Reproductions, Copies, etc. A log of copy expenses as they relate to the County contract is required for reimbursement. The log must define the date, number of copies made, source document, purpose, and recipient. A reasonable fee for copy expenses will be allowable. For vendor services, the vendor invoice and a sample of the finished product are required. Supplies, Services, etc. For supplies or services ordered, a vendor invoice is required. Telefax, Fax, etc. Guidance Care Center -SAMH Contract FY19; page 9 A fax log is required. The log must define the sender, the intended recipient, the date, the number called, and the reason for sending the fax. Telephone Expenses A user log of pertinent information must be remitted including: the party called, the caller, the telephone number, the date, and the purpose of the call. Travel and Meal Expenses Travel expenses must be submitted on a State of Florida Voucher for Reimbursement of Travel Expenses. Travel reimbursement requests must be submitted and will be paid in accordance with Monroe County Code of Ordinances and State laws and regulations. Credit card statements are not acceptable documentation for reimbursement. If attending a conference or meeting, a copy of the agenda is needed. Airfare reimbursement requires the original passenger receipt portion of the airline ticket. A travel itinerary is appreciated to facilitate the audit trail. Auto rental reimbursement requires the vendor invoice. Fuel purchases should be documented with paid receipts. Taxis are not reimbursed if taken to arrive at a departure point: for example, taking a taxi from one's residence to the airport for a business trip is not reimbursable. Parking is considered a reimbursable travel expense at the destination. Airport parking during a business trip is not. A detailed list of charges is required on the lodging invoice. Balance due must be zero. Room must be registered and paid for by traveler. The County will only reimburse the actual room and related bed tax. Room service, movies, and personal telephone calls are not allowable expenses. Mileage reimbursement shall be at the rate established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. An odometer reading must be included on the state travel voucher for vicinity travel. Mileage is not allowed from a residence or office to a point of departure. For example, driving from one's home to the airport for a business trip is not a reimbursable expense. Meal reimbursement shall be at the rates established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. Meal guidelines state that travel must begin prior to 6 a.m. for breakfast reimbursement, before noon and end after 2 p.m. for lunch reimbursement, and before 6 p.m. and end after 8 p.m. for dinner reimbursement. Non - allowable Expenses The following expenses are not allowable for reimbursement: capital outlay expenditures (unless specifically included in the contract), contributions, depreciation expenses (unless specifically included in the contract), entertainment expenses, fundraising, non - sufficient check charges, penalties and fines. Guidance Care Center -SAMH Contract FY19; page 10 ATTACHMENT B ORGANIZATION LETTERHEAD Monroe County Board of County Commissioners Finance Department 500 Whitehead Street • Key West, FL 33040 Date The following is a summary of the expenses for (Organization name) for the time period of to Check # Payee Reason Amount 101 Company A Rent $ X,XXX.XX 102 Company B Utilities XXX.XX 104 Employee A P/R ending 05/14/01 XXX.XX 105 Employee B P/R ending 05/28/01. XXX.XX (A) Total $ X,XXX.XX (B) Total prior payments $ X,XXX.XX (C) Total requested and paid (A + B) $ X,XXX.XX (D) Total contract amount $ X,XXX.XX Balance of contract (D -C) $ X,XXX.XX I certify that the above checks have been submitted to the vendors as noted and that the expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this organization's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source. Executive Director Attachments (supporting documentation) Sworn to and subscribed before me this day of 20 by who is personally known to me. Notary Public Notary Stamp Guidance Care Center -SAMH Contract FY19; page 11 ATTACHMENT C Services to be provided: Local match portion of State - Funded Substance Abuse Mental Health (SAMH) and Designated Centralized Receiving Facility services, inclusive of Baker Act services, per Florida Statutes, and contracts between Guidance Care Center and the South Florida Behavioral Health Network (ME 225- 9-27 and Amendment #1; P -04). Guidance Care Center -SAMH Contract FY19; page 12 ATTACHMENT D Contractual Agreement Guidance /Care Center and South Florida Behavioral Health Network Contract Numbers: ME225 -9 -27, Amendment #1, Contract ME225 -9 -27 and P -04 Guidance Care Center -SAMH Contract FY19; page 13 South Florida di Behavioral Health Network, Inc. rev. 07/01/2018 CFDA No (s). See Post Award Notice Client Services ® Non - Client Services ❑ CSFA No (s). See Post Award Notice Subrecipient ® Vendor ❑ Federal Funds ® State Funds STANDARD CONTRACT THIS CONTRACT is entered into between the South Florida Behavioral Health Network, Inc., (SFBHN) hereinafter referred to as the "Managing Entity" (ME) and Guidance /Care Center, Inc., hereinafter referred to as the "Network Provider." 1. Contract Document The Network provider shall provide services in accordance with the terms and conditions specified in this contract including all attachments and exhibits, and documents incorporated by reference which constitute the contract document. 2. Requirements of Section 287.058, Florida Statutes (F.S.) The Network Provider shall provide units of deliverables, including reports, findings, and drafts, as specified in this contract. These deliverables must be received and accepted by the ME contract manager and /or designee, in writing prior to payment. The Network Provider shall submit bills for fees or other compensation for services or expenses in sufficient detail for proper pre -audit and post- audit; where itemized payment for travel expenses are permitted in this contract, submit bills for any travel expenses in accordance with section 112.061, F.S., or at such lower rates as may be provided in this contract. To allow public access to all documents, papers, letters, or other public records as defined in subsection 119.011(12), F.S. and as prescribed by subsection 119.07(1) F.S., made or received by the Network Provider in conj unction 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 51., of this Standard Contract. 4. Effective and Ending Dates This contract shall begin on July 1, 2018. It shall end at midnight, local time in Miami -Dade County, Florida on June 30, 2019, subject to the survival of terms of Section 49. 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 If this contract contains federal funds and it is determined by the ME that the Network Provider is a subrecipient, the Network Provider must adhere to the terms below: a. The Network Provider shall comply with the provisions of Federal law and regulations including, but not limited to, 2 CFR, Part 200, and other applicable regulations. b. If this Contract contains $10,000 or more of Federal Funds, the Network Provider shall comply with Executive Order 11246, Equal Employment Opportunity, as amended by Executive Order 11375 and others, and as supplemented in Department of Labor regulation 41 CFR, Part 60 if applicable. c. If this Contract contains over $150,000 of Federal Funds, the Network Provider shall comply with all applicable standards, orders, or regulations issued under section 306 of the Clean Air Act, as amended (42 U.S.C. § 7401 et seq.), section 508 of the Federal Water Pollution Control Act, as amended (33 U.S.C. § 1251 et seq.), Executive Order 11738, as amended and where applicable, and Environmental Protection Agency regulations (2 CFR, Part 1500). The Network Provider shall report any violations of the above to the ME and the Depart ment. d. No Federal Funds received in connection with this Contract may be used by the Network Provider, or agent acting for the Network Provider, or subcontractor to influence legislation or appropriations pending before the Congress or any State legislature. If this Contract contains Federal funding in excess of $100,000, the Network Provider must, prior to contract execution, complete the Certification Regarding Lobbying form, Attachment III. All disclosure forms as required by the Certification Regarding Lobbying from must be completed and returned to the ME Standard Contract Guidance /Care Center, Inc. Page 1 of 13 Contract No. ME225 -9 -27 • / South Florida / Behavioral Health Network, Inc. rev. 07/01/2018 Contract Manager, prior to payment under this Contract. e. If this Contract provides services to children up to age 18, the Network Provider shall comply with the Pro - Children Act of 1994 (20 U.S.C. § 6081). Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000 for each violation or the imposition of an administrative compliance order on the responsible entity, or both. f. If the Network Provider is a federal subrecipient or pass through entity, the Network Provider and its subcontractors who are federal subrecipients or pass- through entities are subject to the following: A contract award (see 2 CFR § 180.220) must not be made to parties listed on the government -wide exclusions in the System for Award Management (SAM), in accordance with the OMB guidelines in 2 CFR, Part 180 that implement Executive Orders 12549 and 12689, "Debarment and Suspension." SAM Exclusions contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. 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 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 th is contract, at no additional cost to the ME. c. Upon demand, at no additional cost to the ME, the Network Provider will facilitate the duplication and transfer of any records or documents during the required retention period in Section 7.b. d. These records shall be made available at all reasonable times for inspection, review, copying, or audit by Federal, State, or other personnel duly authorized by the ME. e. At all reasonable times for as long as records are maintained, persons duly authorized by the ME, State, and Federal auditors, pursuant to 45 CFR, section 92.36(i)(10), shall be allowed full access to and the right to examine any of the Network Provider's contracts and related records and documents, regardless of the form in which kept. f. A financial and compliance audit shall be provided to the ME as specified in this contract and in Attachment II, Financial and Compliance Audit. 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 i n all subcontracts and assignments. 8. Inspections and Corrective Action The Network Provider shall permit all persons who are duly authorized by the ME and the Department to inspect and copy any records, papers, documents, facilities, goods and services of the Network Provider which are relevant to this contract, the scope of review being conducted, and to interview any clients, employees and subcontractor employees of the Network Provider to assure the ME of the satisfactory performance of the terms and conditions of this contract. Following such review, the ME will deliver to the Network Provider a written report of its findings, and may direct the development, by the Network Provider, of a corrective action plan where appropriate. The Network Provider hereby agrees to timely correct all deficiencies identified in the corrective action plan. This provision will not limit the ME's termination rights un der 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 sha II 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 Standard Contract Guidance /Care Center, Inc. Page 2 of 13 Contract No. ME225 -9 -27 �� ' South / B e h av i oral F lorida Health Network, Inc. rev. 07/01/2018 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 m anner 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 i s likely to become the subject of such a suit, the Network Provider may at its sole expense procure for the ME the right to continue using the product or modify it to become non - infringing. If the Network Provider is not reasonably able to modify or otherwise secure the ME the use, the ME shall not be liable for any royalties. The Network Provider's indemnification for violation or infringement of a trademark, copyright, patent, trade secret or intellectual property right shall encompass all such items used or accessed by the Network Provider, its officers, agents or subcontractors in the performance of this contract or delivered to the ME for the use of the ME, its employees, agents or contractors. c. The Network Provider shall protect, defend, and indemnify, including attorney's fees and cost, the ME for any and all claims and litigation (including litigation initiated by the ME) arising from or relating to Network Provider's claim that a document contains proprietary or tra de secret information that is exempt from disclosure or the scope of the Network Provider's redaction, as provided for under Section 32. 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), 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 N etwork 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 th e 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, judgments, fees, expenses, awards, civil monetary penalties, and costs (including reasonable attorneys' and court fees and expenses) arising out of or related to any Breach or alleged Breach of Unsecured PHI created, received, maintained, transmitted, or otherwise used by the Network Provider and arising from the Network Provider's breach, or failure to perform pursuant to this Contract (collectively, a "Claim ") up to and including the Appellate Court level and until the case is resolved. If the Network Provider is an agency or subdivision of the State, its obligation to indemnify, defend and hold harmless the ME shall be to the extent permitted by section 768.28, F.S. or other applicable law, and without waving the limits of sovereign immunity. 11. Confidential Client and Other Information Except as provided by this Contract, the Network Provider shall not disclose but shall protect and maintain the confidentiality of any client information and any other information made confidential by Florida Laws or regulations that is obtained or accessed by the Network Provider or its subcontractors incidental to performance under this contract. State laws providing for confidentiality of client and other information include but are not limited to sections 39.0132, 39.00145, 39.202, 39.809, 39.908, 63.162,. 63.165, 383.412, 394.4615, 397.501, 409.821, 409.175, 410.037, 410.605, 414.295, 415.107, 741.3165 and 916.107, F.S. Federal laws and regulations to the same effect include section 471(a)(8) of the Social Security Act, section 106(b)(2)(A)(viii) of the Child Abuse Prevention and Treatment Act, 7 U.S.C. § 2020(e)(8), 42 U.S.C. § 602 and 2 CFR § 200.303 and 2 CFR § 200.337, 7 CFR § 272.1(c), 42 CFR §§ 2.1 -2.3, 42 CFR §§ 431.300 -306, 45 CFR § 205. A summary of Florida Statutes providing for confidentiality of this and other information are found in Part 11 of the Attorney General's Government in the Sunshine Manual, as revised from time -to -time. b. The Network Provider shall not use or disclose any information concerning a recipient of services under this contract for any purpose Standard Contract Guidance /Care Center, Inc. Page 3 of 13 Contract No. ME225 - - 27 South Florida Or/ Behavioral Health Network, Inc. rev. 07/01/2018 prohibited by State or federal law or regulations except with the written consent of a person legally authorized to give that consent or when authorized by law. 12. Assignments and Subcontracts a. The Network Provider shall not assign the responsibility for this contract to another party without prior written approval of the ME, upon the ME's sole determination that such assignment will not adversely affect the public interest; however, in no event may the Network Provider assign or enter into any transaction having the effect of assigning or transferring any right to receive payment under this contract which right is not conditioned on full and faithful performance of Network Provider's duties hereunder. Any sublicense, assignment, or transfer otherwise occurring without prior approval of the ME shall be null and void. The Network Provider shall not subcontract for any of the work contemplated under this contract without prior written approval of the ME, which shall not be unreasonably withheld. b. The Network Provider shall ensure that all subcontract agreements, at any tier, for work contemplated under this contract, adhere to all of the requirements of the ME's Prime Contract with the department and all the requirements of this contract. A copy of the Prime Contract can be found at the ME's website. www.sfbhn.org. c. To the extent permitted by Florida Law, and in compliance with Section 9. of this Standard Contract, the Network Provider is responsible for all work performed and for all commodities produced pursuant to this contract whether actually furnished by the Network Provider or its subcontractors. Any subcontracts shall be evidenced by a written document. The Network Provider further agrees that the ME shall not be liable to the subcontractor in any way or for any reason. The Network Provider, at its expense, will defend the ME against su ch claims. d. The Network Provider shall make payments to any subcontractor within seven (7) working days after receipt of full or partial payments from the ME in accordance with section 287.0585, F.S., unless otherwise Stated in the contract between the Network Provider and subcontractor. Failure to pay within seven (7) working days will result in a penalty that shall be charged against the Network Provider and paid by the Network Provider to the subcontractor in the amount of one -half of one percent (.005) of the amount due per day from the expiration of the period allowed for payment. Such penalty shall be in addition to actual payments owed and shall not exceed fifteen (15 %) percent of the outstanding balance due. e. The State of Florida shall at all times be entitled to assign or transfer, in whole or part, its rights, duties, or obligations under its contract with the ME to another governmental agency in the State of Florida or to a provider of the Department's selection, upon giving prior written notice to the ME. In the event the State of Florida approves transfer of the ME's obligations, the Network Provider remains responsible for all work performed and all expenses incurred in connection with the contract. This contract shall remain binding upon the successors in interest of the Network Provider, the ME and the Department. f. The Network Provider shall include, or cause to be included, in all subcontracts (at any tier) the substance of all clauses contained in this Standard Contract that mention or describe subcontract compliance. 13. Return of Funds a. The Network Provider shall return to the ME any overpayments due to unearned funds or funds disallowed that were disbursed to the Network Provider by the ME and any interest attributable to such funds pursuant to s. 215.97, s. 215.971, F.S. Should repayment not be promptly made upon discovery by the Network Provider or its auditor or upon written notice by the ME, the Network Provider wi II be charged interest at the lawful rate of interest on the outstanding balance until returned. b. Payments made for services subsequently determined by the ME to not be in full compliance with contract requirements shall be deemed overpayments. The ME shall have the right at any time to offset or deduct from any amount due to the ME from the Network Provider under this or any other contract or agreement. c. The funds paid to the Network Provider are continually subject to Review, Revision and Adjustment after evaluation of Utilization and Performance measures monitored by ME. 14. Client Risk Prevention and Incident Reporting a. If services to clients are to be provided under this contract, the Network Provider and any subcontractors shall, in accordan ce with the client risk prevention system, report those reportable situations listed in CFOP 215 -6 in the manner prescribed in CFOP 215 -6 or circuit or region operating procedures. The Network Provider shall immediately report any knowledge or reasonable suspicion of abuse, neglect, or exploitation of a child, aged person, or disabled adult to the Florida Abuse Hotline on the Statewide toll -free telephone number (1- 800- 96ABUSE). As required by Chapters 39 and 415, F.S., this provision is binding upon both the Network Provider and its employees. b. The ME monitors timely submissions of incident reports and may impose financial penalties as described in Section 39. Financial Penalties for Failure to Comply with Requirement for Corrective Action of this Standard Contract, paragraphs b., c., and d. Standard Contract Guidance /Care Center, Inc. Page 4 of 13 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. rev. 07/01/2018 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 fo r employment) in the performance of this contract because of race, color, religion, sex, national origin, disability, age, or marital status. Further, the Network Provider shall 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 app licable and CFOP 60 -16. These requirements shall apply to all contractors, subcontractors, sub - grantees or others with whom it arranges to provide services or benefits to clients or employees in connection with its programs and activities. The Network Provider shall complete the Civil Rights Certificate, CF Form 707 and the Civil Rights Compliance Checklist, CF Form 946 in accordance with CFOP 60 -16 and 45 CFR 80. 16. Independent Capacity of the Contractor a. In performing its obligations under this contract, the Network Provider shall at all times be acting in the capacity of an independent contractor and not as an officer, employee, or agent of the ME or the State of Florida, except where the Network Provider is a State agency. Network Provider nor its agents, employees, subcontractors or assignees shall represent to others that it has the authority to bind the ME or the Department unless specifically authorized in writing to do so. This contract does not create any right to State retirement, leave benefits or any other benefits of State employees as a result of performing the duties or obligations of this contract. b. The Network Provider shall take such actions as may be necessary to ensure that each subcontractor of the Network Provider will be deemed to be an independent contractor and will not be considered or permitted to be an agent, servant, joint venture, or partner of the ME or the State of Florida. The ME will not furnish services of support (e.g., office space, office supplies, telephone service, secretarial or clerical support) to the Network Provider, or its subcontractor or assignee; unless specifically agreed to by the ME in this contract. c. All deductions for social security, withholding taxes, income taxes, contributions to unemployment compensation funds and all necessary insurance for the Network Provider, the Network Provider's officers, employees, agents, subcontractors, or assignees shall be the sole responsibility of the Network Provider. 17. Sponsorship As required by section 286.25, F.S., if the Network Provider is a non - governmental organization which sponsors a program financed wholly or in part by State funds, including any funds obtained through this Contract, it shall, in publicizing, advertising, or describing the sponsorship of the program State: "Sponsored by (Network Provider's Name), Inc., South Florida Behavioral Health Network, and the State of Florida, Department of Children and Families ". If the sponsorship reference is in written material, the words "South Florida Behaviora 1 Health Network " and "State of Florida, Department of Children and Families" shall appear in at least the same size letters or type as the name of the organization. 18. Publicity Without limitation, the Network Provider and its employees, agents, and representatives will not, without the ME's prior written consent in each instance, use in advertising, publicity or any other promotional endeavor any ME or State mark, the name of the ME's or State mark, the name of the ME, the State, or any ME or State affiliate or any officer or employee of the ME or the State , or represent, directly or indirectly, that any product or service provided by the Network Provider has been approved or endorsed by the ME, or refer to the existence of this Contract in press releases, advertising or materials distributed to the Network Provider's prospective customers. 19. Final Invoice The final invoice for payment shall be submitted to the ME no more than twenty (20) days, per the requirements stipulated in the Method of Payment section of this Contract, after the contract ends or is terminated. If the Network Provider fails to do so, all rights to payment are forfeited and the ME will not honor any requests submitted after the aforesaid time period. Any payment due under the terms of this contract may be withheld until all reports due from the Network Provider and necessary adjustments thereto, have been approved by the ME. 20. Use of Funds for Lobbying Prohibited The Network Provider shall comply with the provisions of sections 11.062 and 216.347, F.S., which prohibit the expenditure of contract funds for the purpose of lobbying the Legislature, judicial branch, or a State agency. 21. Public Entity Crime Pursuant to section 287.133, F.S., the following restrictions are placed on the ability of persons on the convicted vendor list or the discriminatory vendor list. When a person or affiliate has been placed on the convicted vendor list following a conviction for a publi c entity crime, or an entity or affiliate has been placed on the discriminatory vendor list, such person, entity or affiliate may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or the repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in section 287.017, F.S., for CATEGORY TWO Standard Contract Guidance /Care Center, Inc. Page 5 of 13 Contract No. ME225 - - 27 �� South Florida rdigi Behavioral Health Network, Inc. rev. 07/01/2018 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 or Department employee. As part of the consideration for this contract, the parties intend that this provision will survive the contract for a period of two years. In addition to any other remedies available to the ME and the Department, any violation of this provision will result in referral of the Network Provider's name and description of the violation of this term to the Department of Management Services for the potential inclusion of the Network Provider's name on the suspended vendors list for an appropriate period. The Network Provider will ensure that its subcontractors, if any, comply with these provisions. 23. Intellectual Property a. It is agreed that all intellectual property, inventions, written or electronically created materials, including manuals, presentations, films, or other copyrightable materials, arising in relation to Network Provider's performance under this contract, and the performance of all of its officers, agents and subcontractors in relation to this contract, are works for hire for the benefit of the Department, fully compensated for by the contract amount, and that neither the Network Provider nor any of its officers, agents nor subcontractors may claim any i nterest in any intellectual property rights accruing under or in connection with the performance of this contract. It is specifically agreed that the Department shall have exclusive rights to all data processing software falling within the terms of section 119.084, F.S., which arises o r 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 Department for its use or the use of its employees, agents or contractors, any design, device, or materials covered by letters, patent, or copyright, it is mutually agreed and understood without exception that the compensation paid pursuant to this contract includes all royalties or costs arising from the use of such design, device, or materials in any wa y 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 t hereafter. c. All applicable subcontracts shall include a provision that the Federal awarding agency reserves all patent rights with respect to any discovery or invention that arises or is developed in the course of or under the subcontract. Notwithstanding the foregoing provision, if the Network Provider or one of its subcontractors is a university and a member of the State University of Florida, then section 1004.23, F.S., shall apply, but the Department shall retain a perpetual, fully -paid, non - exclusive license for its use and the use of its contractors of any resulting patented, copyrighted or trademarked work products. 24. Real Property Any State funds provided for the purchase of or improvements to real property are contingent upon the Network Provider granting to the State a security interest in the property at least to the amount of the State funds provided for at least five (5) years from the date of purchase or the completion of the improvements or as further required by law. As a condition of receipt of State funding for this purpose, the Network Provider agrees that, if it disposes of the property before the Department's interest is vacated, the Network Provider will refund the proportionate share of the State's initial investment, as adjusted by depreciation. 25. Information Security Obligations a. An appropriately skilled individual shall be identified by the Network Provider to function as its Data Security Officer. The Data Security Officer shall act as the liaison to the ME's security staff and will maintain an appropriate level of data security for the information the Network Provider is collecting or using in the performance of this contract. An appropriate level of security includes approving and tracking all Network Provider employees that request or have access to any ME or DCF data system or information. b. The Data Security Officer will ensure that user access to the data system or information has been removed from all terminated Network Provider employees immediately upon termination of employment. c. The Network Provider shall provide the latest DCF HIPAA and Security Awareness Training to its staff and subcontractors who have access to ME and DCF data system, information and /or who have access to Protected Health Information regardless of format (e.g. electronic, written, audio, video or still image recording) or function. Security and HIPAA requirements extend to non - clinical or non - administrative personnel if such persons can access Protected Health Information. The Network Provider shall ensure that proof of training is maintained in each employee file. d. All Network Provider employees who have access to ME or DCF data system or information, including but not limited to access to KIS, or any data system designated by the ME, Substance Abuse and Mental Health Information System (SAMHIS), Incident Reporting and Analysis System (IRAS), Temporary Assistance for Needy Family (TANF), shall comply with, and be provided a copy of CFOP 50 -2, and shall sign the DCF Security Agreement form CF 0114 annually or immediately upon hire and annually thereafter. The Network Provider shall maintain a copy of the signed DCF Security Agreement form CF 0114 in the personnel file. The Network Provider agrees to submit copies of each signed DCF Standard Contract Guidance /Care Center, Inc. Page 6 of 13 Contract No. ME225 -9 -27 �, . South Florida � Behavioral Health Network, Inc. rev. 07/01/2018 Security Agreement form CF 0114 to the ME's Contract Manager and the ME's Director of Information Technology upon request. A copy of CF 0114 may be obtained from the contract manager. e. The Network Provider shall make every effort to protect and avoid unauthorized release of any personal or confidential information by ensuring both data and storage devices are encrypted as prescribed in CFOP 50 -2. If encryption of these devices is not possible, then the Network Provider shall assure that unencrypted personal and confidential ME or DCF data will not be stored on unencrypted storage devices. The Network Provider shall require the same of all subcontractors. f. The Network Provider agrees to notify the contract manager as soon as possible, but no later than four (4) business days following the determination of any breach or potential breach of personal and confidential ME or DCF data. The Network Provider shall require the same notification requirements of all subcontractors. g. The Network Provider shall provide notice to affected parties no later than thirty (30) days following the determination of any potential • breach of personal or confidential ME or DCF data provided in section 501.171 (4), F.S. The Network Provider shall require the same notification requirements of all subcontractors. The Network Provider shall also at its own cost implement measures deemed appropriate by the ME to avoid or mitigate potential injury to any person due to a breach of personal and confidential ME and /or DCF data. 26. Accreditation The ME is committed to ensuring provision of the highest quality services to the persons we serve. Accordingly, the ME has expectations that where accreditation is generally accepted nationwide as a clear indicator of quality service, the majority of the ME's Network Providers will take appropriate steps to maintain its accreditation or become fully accredited by June 30, 2019. 27. DEO and Workforce Florida a. The Network Provider understands the DCF, the Department of Economic Opportunity, and Worksource Florida, Inc., have jointly implemented an initiative to empower recipients in the Temporary Assistance to Needy Families Program to enter and remain in gainful employment. The ME encourages Network Provider participation with the Department of Economic Opportunity and Workforce Florida, Inc. b. Transitioning Young Adults: The Network Provider understands DCF's interest in assisting 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 In compliance with 45 CFR § 164.504 (e) , the Network Provider shall comply with the provisions of the Business Associate Agreement, incorporated herein by reference, governing the safeguarding, use and disclosure of Protected Health Information created, received, maintained, or transmitted by the Network Provider or its subcontracts incidental to the Network Provider's performance of this Contract. 29. Emergency Preparedness a. If the tasks to be performed pursuant to this contract include the physical care or supervision of clients, the Network Provider shall, within thirty (30) days of the execution of this contract, submit to the contract manager an emergency preparedness plan which shall include provisions for records protection, alternative accommodations for clients in substitute care, alternate facilities for the 24 hour facilities in case those facilities are incapacitated by the disaster and the expectation for returning exceeds emergency sheltering capabilities and time allowances supplies, and a recovery plan that will allow the Network Provider to continue functioning in compliance with the executed contract in the event of an actual emergency. For the purpose of disaster planning, the term supervision includes the responsibility of the M E, 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 a cceptance 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 beco ming aware of such actions or from the day of the legal filing, whichever comes first. Standard Contract Guidance /Care Center, Inc. Page 7 of 13 Contract No. ME225 -9 -27 � South Florida /� Behavioral Health Network, Inc, rev. 07/01/2018 31. Federal Whistleblower Requirements Pursuant to Section 11(c) of the OSH Act of 1970 and the subsequent federal laws expanding the act, the Network Provider is prohibited from discriminating against employees for exercising their rights under OSH Act. Details of the OSH Act can be found at this website: https://www.whistleblowers.gov/ 32. Proprietary or Trade Secret Information a. Unless exempted by law, all public records are subject to public inspection and copying under Florida's Public Records Law, Chapter 119, F.S. Any claim by Network Provider of proprietary or trade secret confidentiality for any information contained in Network Provider's documents (reports, deliverables or work papers, etc., in paper or electronic form) submitted in connection with this contract will be waived, unless the claimed confidential information is submitted in accordance with Section 32. b. below. b. The Network Provider must clearly label any portion of the documents, data or records submitted that it considers exempt from public inspection or disclosure pursuant to Florida's Public Records Law as proprietary or trade secret. The labeling will include a justification citing specific statutes and facts that authorize exemption of the information from public disclosure. If different exemptions are claimed to be applicable to different portions of the protected information, the Network Provider shall include information correlating the nature of the claims to the particular protected information. c. The ME, when required to comply with a public records request including documents submitted by the Network Provider, may require the Network Provider to expeditiously submit redacted copies of documents marked as confidential or trade secret in accordance with Section 32. b. above. Accompanying the submission shall be an updated version of the justification under Section 32. b., correlated specifically to redacted information, either confirming that the statutory and factual basis originally asserted remain unchanged or indicating any changes affecting the basis from the asserted exemption from public inspection or disclosure. The redacted copy must exclude or obliterate only those exact portions that are claimed to be proprietary or trade secret. If the Network Provider fails to promptly submit a redacted copy, the ME is authorized to produce the records sought without any redaction of proprietary or trade secret information. d. The Network Provider shall be responsible for defending its claim that each and every portion of the redactions of proprietary or trade secret information are exempt from inspection and copying under Florida's Public Records Law. 33. Support to the Deaf or Hard -of- Hearing a. The Network Provider and its subcontractors, where direct services are provided, shall comply with section 504 of the Reha bilitation 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 de signate a Single - Point-of- Contact 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. c. The Network Provider shall, within 30 days of the effective date of this requirement, contractually require that its subcontractors comply with section 504, the ADA, and CFOP 60 -10, Chapter 4. The Network Provider's Single Point of Contact and that of its subcontractors will process the compliance data into the Department of Children and Families HHS Compliance reporting database at https: / /fsl6. formsite. com /DCFTraining /Monthlv- Summary -Report/form login.html by the 4th working day of the month, covering the previous month's reporting, and forward the confirmation of submission to the ME's Contract Manager. The name and contact information for the Network Provider's Single Point of Contact shall be furnished to the ME's Contract Manager within fourteen (14) calendar days of the effective date of this requirement. d. The network provider shall contractually require that its subcontractors comply with Section 504, the ADA, and CFOP 60 -10, Chapter 4. A Single- Point -of- Contact shall be required for each subcontractor that employs fifteen (15) or more employees. This Single- Point -of- Contact will ensure effective communication with deaf or hard -of- hearing customers or companions in accordance with Section 504 and the ADA and coordinate activities and reports with the Network Provider's Single- Point -of- Contact. e. The Single- Point -of- Contact shall ensure that employees are aware of the requirements, roles & responsibilities, and contact points associated with compliance with Section 504, the ADA, and CFOP 60 -10, Chapter 4. Further, employees of Network Providers and its subcontractors with 15 or more employees shall attest in writing that they are familiar with the requirements of Section 504, the ADA, and CFOP 60 -10, Chapter 4. This attestation shall be maintained in the employee's personnel file. f. The Network Provider's Single- Point -of- Contact will ensure that conspicuous Notices which provide information about the availability of appropriate auxiliary aids and services at no -cost to the deaf or hard -of- hearing customers or companions are posted near where people enter Standard Contract Guidance /Care Center, Inc. Page 8 of 13 Contract No. ME225 -9 -27 South Florida / / Behavioral Health Network, Inc. rev. 07/01/2018 or are admitted within the agent locations. Such Notices must be posted immediately by Network Providers and subcontractors. The approved Notice can be downloaded through the Internet at: http: / /www.mvflfamilies.com/ service - programs/ deaf - and - hard - hearing /providers g. The Network Provider and its subcontractors shall document the customer's or companion's preferred method of communication and any requested auxiliary aids /services provided in the customer's record. Documentation, with supporting justification, must also be made if any request was not honored. The Network Provider shall distribute Customer Feedback forms to customers or companions, and submission to the Department of Children and Families Office of Civil Rights. h. If customers or companions are referred to other agencies, the Network Provider must ensure that the receiving agency is notified of the customer's or companion's preferred method of communication and any auxiliary aids /service needs. i. The network provider's and its subcontractors' direct service employees shall complete the online training annually: 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 annually or immediately upon hire and annually thereafter. Direct service employees will also print their certificate of completion, attach it to their Attestation of Understanding, and maintain them in their personnel file. 34. Contract Amount The ME shall pay for contracted services according to the terms and conditions of this Contract in an amount not to exceed $5,832,353.00, 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 54,860,294.00, subject to the delivery and billing for services. The remaining amount of 5972,059.00, 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 req uired to pay. Should the network provider receive any funding from the "Uncompensated Units Reimbursement Funds ", then the amount of Local Match as it appears on Exhibit B, Method of Payment and in Exhibit H, Funding Detail, will automatically change, utilizing the formula prescribed in the Method of Payment section of this contract. The ME's obligation to pay under this Contract is contingent upon an annual appropriation by the Legislature and the Contract between the ME and the DCF. Any costs or services eligible to be paid for under any other contract or from any other source are not eligible for payment under this Contract. 35. Contract Payment a. The network provider shall request payment monthly through submission of a properly completed invoice, per the requirements of this Contract, within eight (8) calendar days following the end of the month for which payment is being requested. b. If no services are due to be invoiced from the preceding month, the network provider shall submit a written document to the M E indicating this information within eight (8) calendar days following the end of the month. Should the network provider fail to submit an invoice or written documentation (should no services be due to be invoiced from the preceding month), within thirty (30) calendar days following the end of the month, then the ME at its sole discretion will consider these funds as lapse and may reallocate these funds within the network of providers. If the Network Provider fails to submit an invoice or written documentation for two (2) consecutive months within a twelve (12) month period, the ME at its sole discretion can terminate the contract or whole or in part. c. The ME has ten (10) working days, subject to the availability of funds, to inspect, and approve for goods and services, unless the bid specifications, purchase order, or this Contract specify otherwise. The MEs failure to pay the Network Provider within the ten (10) working days will result in penalties as referenced in the Prime Contract. Invoices returned to a Network Provider due to preparation errors will result in a non - interest bearing payment delay. Interest penalties less than one (1) dollar will not be paid unless the Network Provider requests payment. Payment shall be made only upon written acceptance by the ME and shall remain subject to the subsequent audit or review to co nfirm 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, then 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 exte nt 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. Standard Contract Guidance /Care Center, Inc. Page 9 of 13 Contract No. ME225 -9 -27 � p� South Florida / Behavioral Health Network, Inc. rev. 07/01/2018 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 Take Corrective Action In accordance with the provisions of section 402.73(1), F.S., and Rule 65- 29.001, F.A.C., should the ME require a corrective action to address noncompliance under this Contract, incremental penalties listed in section 39. a. through section 39. b. shall be imposed for Network Provider failure to achieve the corrective action. These penalties are cumulative and may be assessed upon each separate failure to co mply with instructions from the ME to complete corrective action, but shall not exceed ten (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. These penalties do not limit or restrict the ME's application of any other remedy available to it under law or this Contract. a. 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, in accordance with the following standards. b. Noncompliance that is determined by the ME 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 o r 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 th e imposition of a five percent (5 %) penalty. d. Noncompliance as a result of unacceptable performance of administrative tasks shall result in the imposition of a two percent (2 %) penalty. The deadline for payment shall be as stated in the Order imposing the financial penalties. In the event of nonpayment the ME may deduct the amount of the penalty from invoices submitted by the Network Provider. 40. Termination a. This contract may be terminated by either party without cause upon no less than thirty (30) calendar days' notice in writi ng 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 d elivery service that provides verification of delivery. The ME shall be the final authority as to the availability and adequacy of funds. In the event of termination of this contract, the Network Provider will be compensated for any work satisfactorily completed through the date of termination. c. In the event the Network Provider fails to fully comply with the terms and conditions of this contract, the ME may terminate upon no less than twenty -four (24) hours, excluding Saturday, Sunday, and Holidays, notice in writing to the Network Provider after Network Provider's failure to fully cure such noncompliance within the time specified in a written notice of noncompliance issued by the ME specifying the nature of the noncompliance and the actions required to terminate the contract. The ME's failure to demand performance of any provision of this 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 t his contract. The provisions herein do not limit the ME's right to remedies at law or in equity. d. Failure to have performed any contractual obligations with the ME in a manner satisfactory to the ME will be a sufficient cause for termination. To be terminated as a Network Provider under this provision, the Network Provider must have: (1) previously failed to satisfactorily perform in a contract with the ME, been notified by the ME of the unsatisfactory performance, and failed to correct the unsatisfactory performance to the satisfaction of the ME; or (2) had a contract terminated by the ME for cause. Termination shall be upon no less than twenty -four (24) hour notice in writing. e. Should the termination of the contract be inevitable, the Network Provider shall work in collaboration with the ME to develop a transition plan, in accordance with the Network Service Provider Contract Non - Renewal /Termination /Record Transition Plan, incorporated herein by reference, and timeline to ensure the uninterrupted continuum of services to individuals served under this contract, to include but not be Standard Contract Guidance /Care Center, Inc. Page 10 of 13 Contract No. ME225 -9 -27 ��' South Florida / Behavioral Health Network, Inc. rev. 07/01/2018 limited to the transfer of client records. A copy of the Network Service Provider Contract Non - Renewal /Termination /Record Transition Plan may be obtained from the ME's Contract Manager. f. If this Contract is for an amount of $1Million or more, the ME may terminate this Contract at any time the Network Provider is found to have submitted a false certification under section 287.135, F.S. or has been placed on the Scrutinized Companies that Boycott lsra el List, or the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List or found be engaged in business operations in Cuba or Syria. 41. Renegotiations or Modifications Modifications of provisions of this contract shall be valid only when they have been reduced to writing and duly signed by both parties. The rate of payment and the total dollar amount may be adjusted retroactively to reflect price level increases and changes in the rate of payment when these have been established through the appropriations process and subsequently included in the ME's prime contract with the DCF. 42. Dispute Resolution a. The parties agree to cooperate in resolving any differences in interpreting the contract, including but not limited to, client eligibility and /or placement into the appropriate level of care, a general dispute arising out of, or relating to this contract, or contesting a financial penalty for failure to comply with requirements of a corrective action plan. Within five (5) working days of the execution of this contra ct, 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, b ut 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 rea ch 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 leve I, 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 wi 11 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, 201 1). 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. Unauthorized Aliens and Employment Eligibility Verification (E- Verify) Unauthorized aliens shall not be employed. Employment of unauthorized aliens shall be cause for unilateral cancellation of this Contract by the ME for 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. The Network Provider and subcontracts, if applicable, will enroll in and use the E- Verify system established by the U.S. Department of Homeland Security to verify the employment eligibility of its employees and its subcontractors' employees performing under this contract. Employee assigned to the contract means all persons employed or assigned (including subcontractors) by the Network Provider during the contract term to perform work pursuant to this contract within the United States and its territories. 45. Employment Screening: The Network Provider shall ensure that all staff utilized by the Network Provider and its subcontractors (hereinafter, "Contracted Staff') that are required by Florida law and by CFOP 60 -25, Chapter 2, which is hereby incorporated by reference to be screened in accordance with chapter 435, F.S., are of good moral character and meet the Level 2 Employment Screening standards specified by sections 435.04, 110.1127, and subsection 39.001(2), F.S., as a condition of initial and continued employment that shall include but not be limited to: a. Employment history checks; Standard Contract Guidance /Care Center, Inc. Page 11 of 13 Contract No. ME225 -9 -27 �� South Florida Behavioral Health Network, Inc. rev. 07/01/2018 b. Fingerprinting for all criminal record checks; c. Statewide criminal and juvenile delinquency records checks through the Florida Department of Law Enforcement (FDLE); d. Federal criminal records checks from the Federal Bureau of Investigation via the Florida Department of Law Enforcement; and e. Security background investigation, which may include local criminal record checks through local law enforcement agencies. f. Attestation by each employee, subject to penalty of perjury, to meeting the requirements for qualifying for employment pursuant to chapter 435 and agreeing to inform the employer immediately if arrested for any of the disqualifying offenses while employed by the employer • 46. Employment Screening Affidavit: The Network Provider shall sign the Florida Department of Children and Families Employment Screening Affidavit each State fiscal year (no two such affidavits shall be signed more than 13 months apart) for the term of the Contract stating that all required staff have been screened or the Provider is awaiting the results of screening. 47. The Department requires, as applicable, the use of the Officer of Inspector General's Request for Reference Check form (CF 774), which states: "As part of the screening of an applicant being considered for appointment to a career service, selected exempt service, senior management, or OPS position with the Department of Children and Families or a Contract or sub - contract provider, a check with the Office of Inspector General (IG) is required to determine if the individual is or has been a subject of an investigation with the IG's Office. The request will only be made on the individual that is being recommended to be hired for the position if that individual has previously worked for the Contract or sub - contract provider, or if that individual is being promoted, transferred or demoted within the Contract or sub - contract provider." 48. Human Subject Research: The Network Provider shall comply with the requirements of CFOP 215 -8 for any activity under this contract involving human subject research within the scope of 45 CFR, Part 46, and 42 U.S.C. section 289, et seq., and may not commence such activity until review and approval by the Department of Children and Families Human Protections Review Committee and a duly constituted Institutional Review Board. 49. Survival of Terms: The parties agree that, unless a provision of this Contract, its Exhibits, Attachments, or incorporated documents expressly states otherwise as to itself or a named provision, all provisions of this Contract concerning obligations of the Network Provider and remedies available to the ME and /or the Department are intended to survive the ending date or an earlier termination of this Contract. The Network Provider's performance pursuant to such surviving provisions shall be without further payment, as the contract payments received during the term of this Contract are consideration for such performance. 50. Official Payee and Representatives (Names, Addresses, Telephone Numbers and E -Mail Addresses) a. The Network Provider name, as shown on page 1 of this Contract, and b. The name, address, and telephone of the Contract Manager for the mailing address of the official payee to whom the payment shall be ME for this contract is: made is: Guidance /Care Center, Inc. Elba Taveras 3000 41st Street, Ocean South Florida Behavioral Health Network, Inc. Marathon, FL 33050 7205 Corporate Center Drive, Suite 200 Miami, FL 33126 Tel. (786) 507 -7462 E -Mail: Etaveras @sfbhn.org c. The name of the contact person and street address where the d. The name, address, and telephone number of the representative of the Network Provider's financial and administrative records are Network Provider responsible for the administration of the program under maintained is: this contract is: Kristen Chaffee, Regional Controller Sharon Crippen, Sr. Vice President 100 2nd Avenue South #901 169 E. Flagler Street, Suite 1300 St. Petersburg, FL 30100 Miami, FL 33131 Office number: 727 - 490 -6767 x 30111 Office number: (305) 573 -3784 Mobile number: 727 - 465 -6083 Mobile number: (305) 815 -3702 Fax number: 727-825-0573 Fax number: (305) 381 -7733 E -Mail: kristen.chaffee @westcare.com E-Mail: sharon.crippen @westcare.com Upon change of representatives (names, addresses, telephone numbers and e-mail addresses) by either party, notice shall be provided in writing to the other party and the notification attached to the originals of this contract. 51. All Terms and Conditions Included This contract and it attachments, I. II. III. & IV and any exhibits referenced in said attachments, together with any documents incorporated by reference, including the ME prime contract (which can be found at http: / /www.sfbhn.org), contain all the terms and conditions agreed upon by the parties. There are no provisions, terms, conditions, or obligations other than those contained herein, and this contract shall supersede all Standard Contract Guidance /Care Center, Inc. Page 12 of 13 Contract No. ME225 -9 -27 South Florida 14i Behavioral Health Network, Inc. rev. 07/0112018 previous communications, representations, or agreements, either verbal or written between the parties. If any term or provision of this contract is legally determined unlawful or unenforceable, the remainder of the contract shall remain in full force and effect and such term or provision shall be stricken. In the event of a conflict between the provisions of the documents, the documents shall be Interpreted in the following order of precedence: a. Attachment I, Exhibits, the Business Associate Agreement, and other attachments, if any; b. Any documents incorporated into any Exhibit or Attachment by reference; c. The Standard Contract; d. Any documents incorporated herein by reference BY SIGNING THIS CONTRACT, THE PARTIES AGREE THAT THEY HAVE READ AND AGREE TO THE ENTIRE CONTRACT, AS DESCRIBED IN SECTION 51 . 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. NETWORK PROVIDER: Guidance /Care Center, Inc. SOUTH FLORIDA BEHAVIORAL HEALTH NETWORK, INC. SIGNE SIGNED 1 7 - // BY: BY: (7,?;a7 '' ' NAME: Sharon Criopen NAME: John W. Dow TITLE: Sr. Vice President TITLE: President and CEO DATE:. b 1 a S _ DATE: o v2 Yf f Federal Tax ID# (or SSN) 59- 1458324 Network Provider Fiscal Year Ending Date 6/30 Standard Contract Guidance/Care Center, Inc. Page 13 of 13 Contract No. ME225 -9 -27 P- South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 ATTACHMENT A. Services to be Provided 1. Program /Service Specific Terms (1) "Behavioral Health Services" are mental health services and substance abuse prevention and treatment services as defined by s. 394.9082(2)(a), F.S., and in Chapter 397. F.S. (2) 'Block Grants ": The Community Mental Health Block Grant (CMHBG), pursuant to 42 U.S.C. s. 300x, et. seq., and the Substance Abuse Prevention and Treatment Block Grant (SAPTBG), pursuant to 42 U.S.C. s. 300x -21, et. seq. (3) "Care Coordination" means the implementation of deliberate and planned organizational relationships and service procedures that improve the effectiveness and efficiency of the behavioral health system by engaging in purposeful interactions with individuals who are not yet effectively connected with services to ensure service linkage. Examples of care coordination activities include development of referral agreements, shared protocols, and information exchange procedures. The purpose of care coordination is to enhance the delivery of treatment services and recovery supports and to improve outcomes among priority populations. (4) Collaborative Planning Group Systems, Inc. is the entity contracted with the Department of Children and Families that maintains the database called Performance Based Prevention System (PBPS) that Network Providers contracted to provide substance abuse prevention services must utilize to upload substance abuse prevention data required by this contract. (5) "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. (6) "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. (7) "Contract Manager" is the ME employee who is responsible for enforcing the compliance Attachment 1 HCO2 (a) Guidance /Care Center, Inc. Page 1 of 67 Contract No. ME225 -9 -27 �� South Florida // Behavioral . Health Network, Inc. Effective: 07/01/2018 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. (8) "Co- occurring Disorder" is any combination of mental health and substance abuse in any individual, whether or not they have been already diagnosed. (9) "Co- occurring Disorder Service Capability" is the ability of any program to organize every aspect of its program infrastructure (policies, procedures, practices, documentation, and staff competencies), within its existing resources, to provide appropriately matched, integrated services to the individuals and families with co- occurring disorders that are routinely presenting for care in that program. Should services not be available at the Network Provider then then the consumer must be linked to an agency with the capability to meet the consumer's needs. (10) "Coordinated System of Care ", as described in section 394.4573, F.S.is the array of behavioral health and related services in a region or community offered by all service providers, whether participating under a contract with a Managing Entity or by another method of community partnership or mutual agreement. The essential elements of a coordinated system of care include but are not limited to: Community interventions such as prevention, primary care for behavioral health needs, therapeutic and supportive services, crisis response services, and diversion programs. and early intervention; Services provided within the System of Care must be accessible and responsive to the needs of individuals, their families, and community stakeholders. (11) "Cost Analysis" is the review of the proposed cost elements to determine if they are necessary, allowable, appropriate and reasonable. (12) "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. (13) "DCF PAM 155 -2" is the Department of Children & Families, Pamphlet 155 -2.- Mental Health and Substance Abuse Measurement and Data, effective July 2016, version 11.1.3 , or the latest revised edition thereof, means a document promulgated by the department that contains required data - reporting elements for substance abuse and mental health services, and which can be found at: http: / /www.mvflfamilies.com /service- programs/ substance - abuse /pamphlet- 155- 2 -v11, and is incorporated herein by reference. (14) "Department" means the State of Florida Department of Children and Families. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 2 of 67 Contract No. ME225 -9 -27 �� South Florida // Behavioral Health Network, Inc. Effective: 07/01/2018 (15) "Electronic Health Record (EHR)" is defined in s. 408.051(2)(a), F.S. (16) "Evidenced -Based Practices (EBP) are programs, practices or strategies that are supported by research. EBP's are programs that have demonstrated effectiveness with . established generalizability (replicated in different settings and with different populations over time) through research. Option #1: The program or strategy is recognized by a national registry of evidence -based programs and strategies as one that is appropriate for the identified outcome. It is important to note that inclusion within a registry does not reflect a program's effectiveness. Programs need to be reviewed for the intended target population, demographics, setting, and the research results for each program outcome. Additionally, the rating provided to the program by the registry must be considered prior to selection. Programs deemed not effective or inconclusive should not be selected. For a list of registries that provide information and research outcomes for evidence -based programs and strategies please referr to the Department's Guidance Document 1, Evidence Based Guidelines available at the following link: http: / /www.mvflfamilies.com /service - programs/ substance - abuse /managing- entities /2018- contract -docs Or Option #2: The program or strategy is reported in . peer- reviewed journals or has documented effectiveness which is supported by other sources of information and the consensus judgment of informed experts. When claiming this option, a provider must include: • A description of the theory of change and a logic model; and • A discussion of how the content and structure of this proposed program or strategy is similar to programs or strategies that appear in approved registry or in the peer- reviewed literature, or how it is based on sound scientific principles of community prevention or public health; and • Documentation that the program or strategy was effectively implemented in the past, with results that show a consistent pattern of credible and positive effects, including: • the number of times it was implemented, • the fidelity with which it was implemented, and • the results of any outcome evaluations; and • • Documentation of a review by, and consent of, a Panel of Informed Experts indicating that the implementation of this proposed program or strategy is appropriate for the community and likely to have a positive effect on the identified outcome and what evidence their decision was based upon. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 3 of 67 Contract No. ME225 -9 -27 �� South Florida / Behavioral Health Network, Inc. Effective: 07/01/2018 • Following the selection of an option, sufficient documentation to support the decision must be maintained by the Network Provider. • The ME does not fund Prevention services for this category. (17) "Forensic Mental Health Services" are services provided to individuals with mental illness pursuant to Chapter 916, Florida Statutes. (18) "HIPAA" is the acronym for Health Insurance Portability and Accountability Act and shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 42 U.S.C. §1320d, and 45 C.F.R. Parts 160, 162, and 164. (19) "Individual(s) Served" (synonymous with Consumer, Consumer, Participant) is an individual who receives substance abuse or mental health services, the cost of which is paid, either in part or whole, by Department appropriated funds or local match (matching). (20) "Knight Information Software (KIS) ", (synonymous with Care Coordination, Utilization Management and Financial Reporting System) is the ME's online data system which Network Providers are required to use to collect and report data and performance outcomes on consumers served whose services are paid for, in part or in whole, by the ME's Substance Abuse and Mental Health (SAMH) contract, Medicaid, local match, Temporary Assistance for Needy Families (TANF), Purchase of Therapeutic Services (PTS) and Title 21 . The KIS, or other system designated by the ME, shall be utilized to upload consumer - related data as required by this contract. (21) "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. Matching requirements may be satisfied by any or all of the following: (a) Allowable costs supported by non -State or Federal grants incurred by the service provider during the effective funding period; (b) The value of third -party funds and in -kind contributions applicable to the matching requirement period; and, (c) Costs supported by fees and program income. See § 394.67, F.S. F.S. and 65E- 14.005, F.A.C. (22) "Managing Entity (ME)" as defined in section 394.9082(2)(e), F.S., is a corporation selected by and under contract with the Department to manage the daily operational delivery of behavioral health services through a coordinated system of care. (23) "Mental Health Services" is defined pursuant to Chapter 394, F.S. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 4 of 67 Contract No. ME225 -9 -27 IP— South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 (24) "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. (25) "Network Provider" is an entity that contracts with the ME and receives funding to provide services to consumers; in this contract the Network Provider is synonymous with provider or subcontractor. (26) "Our Kids of Miami- Dade /Monroe is the Community Based Care provider under contract with the State of Florida Department of Children and Families for the child welfare system. (27) "Outcome for Individual Service Recipient" is a measure of the quantified result, impact, or benefit of services on the individual service recipient. (28) "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. (29) "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" (individual receiving services), "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. Refer to Rule 65E -14, F.A.C. and Exhibit B, Method of Payment. (30) "PBPS" is the Department's Performance Based Prevention System that collects data related to community assessments and plans and substance abuse prevention programs and activities. (31) "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. (32) "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. Additional guidance regarding prevention services can be found in the Department's Guidance Document 10, Prevention Services and is available at the following link: http: / /www.mvflfam ilies.com /service - programs /substance- abuse /managing- Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 5 of 67 Contract No. ME225 -9 -27 ■ South Florida . Behavioral Health Network, Inc: Effective: 07/01/2018 entities /2018- contract -docs Programs designed to prevent the development of mental, emotional, and behavioral disorders are commonly categorized in the following manner: (a) Universal Direct Prevention Directly serve an identifiable group of participants who have not been identified on the basis of individual risk. This includes interventions involving interpersonal and ongoing or repeated contact such as curricula, programs, and classes. These services shall address the following specific prevention strategies, as defined in Rule 65D- 30.013, F.A.C.: information dissemination, education, alternatives or problem identification and referral services. (b) Universal Indirect Prevention Universal indirect services support population -based programs and policies implemented by coalitions. These services can also include meetings and events related to the design and implementation of components of the strategic prevention framework, including needs assessments, logic models and comprehensive community action plans. The services shall address the following specific prevention strategies, as defined in Rule 65D- 30.013, F.A.C.: information dissemination, community -based processes and environmental strategies. (c) Selective Prevention Preventive interventions that are targeted to individuals or to a subgroup of the population whose risk of developing mental, emotional, or behavioral disorders is significantly higher than average. The risk may be imminent or it may be a lifetime risk. Risk groups may be identified on the basis of biological, psychological, or social risk factors that are known to be associated with the onset of a disorder. Examples include programs offered to children exposed to risk factors, such as parental divorce, parental mental illness, .death of a close relative, or abuse, to reduce risk for adverse mental, emotional, . and behavioral outcomes. (d) Indicated Prevention 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 disorders, as well as biological markers that indicate a predisposition in a person for such a disorder but who does not meet diagnostic criteria at the time of the intervention. (33) "Prime Contract" is the contract between the Department of Children and Families and the ME. (34) "Program Description" is the document the Network Provider prepares and submits to the ME for approval prior to the start of the contract period, which provides a detailed description of the services to be provided under the contract pursuant to Rule 65E -14, Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 6 of 67 Contract No. ME225 -9 -27 1 7,0" South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 F.A.C. It includes but is not limited to the Network Provider's organizational profile, the service activity description, a detailed description of each program and covered service funded in the contract, the geographic service area, service capacity, staffing information, and consumer and target population to be served. (35) "Projects for Assistance in Transition from Homelessness (PATH)" is a federal grant to support homeless individuals with mental illnesses, who may also have co- occurring substance abuse and mental health treatment needs. (36) "Protected Health Information" (PHI) relates to any information whether oral or recorded in any form or medium that is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual. (37) "Provider Network" (subcontractor or Network Provider) refers to the 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. (38) "Quality Assurance" is a process that measures performance in achieving pre- determined standards, validates internal practice, and uses sound principles of evaluation to ensure that data are collected accurately, analyzed appropriately, reported correctly and acted upon in a timely manner. The process may employ peer review, outcomes assessment, and utilization management techniques to assess quality of care. (39) "Quality Improvement /Continuous Quality Improvement" is a management technique to assess and improve internal operations and network services. It focuses on organizational systems rather than individual performance and seeks to continuously improve quality. The process involves setting goals implementing systematic changes, measuring outcomes, and making subsequent appropriate improvements. Quality improvement activities will assess compliance with contract requirements, state and Federal law and associated administrative rules, regulations, and operating procedures and validate quality improvement systems and findings. (40) "Recovery- Oriented System of Care" is defined as a coordinated network of community -based services and supports that are person - centered and build on the strengths and resilience of individuals, families and communities to achieve abstinence, and improved health and the quality of life for individuals, families, and communities.' 1 See https: / /www.samhsa.gov /sites /defaultlfiles /rosc resource guide book.pdf accessed May, 2018. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 7 of 67 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 (41) "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. (42) "SAMH" stands for the Substance Abuse and Mental Health Programs within the Department. (43) "SAVE /VIS Program" is the U.S. Department of Homeland Security (DHS) administers the Systematic Alien Verification for Entitlements (SAVE) program. This program verifies immigration status and eligibility of alien applicants for federal benefits. The alien status verification system under SAVE is entitled the Alien Status Verification Index (ASVI), as described at 60 Federal Register 52694, 52697 (1995) administered by the Computer Sciences Corporation (CSC) as the Verification Information System (VIS). The SAVE/VIS Program can and may provide assistance in verifying eligibility in cases where a consumer does not possess sufficient documentation. (44) "SOAR" stands for Supplemental Security Income /Social Security Disability Insurance (SSI /SSDI) Outreach, Access and Recovery and is a Substance Abuse and Mental Health Services Administration (SAMHSA) technical assistance initiative designed to help individuals increase earlier access to SSI and SSDI through improved approval rates on initial Social Security applications by providing training, technical assistance, and strategic planning to Network Service Providers. (45) "Stakeholder(s)" are individuals /groups with an interest in the provision of treatment services for substance abuse, mental health services, and /or co- occurring disorders in the circuits outlined in Section A.2.c.(2), of this Contract. This includes, but is not limited to, the key community constituents included in section 394.9082 , F.S. (46) "Statewide Inpatient Psychiatric Programs (SIPP) ")" are residential inpatient facilities under contract with the Agency for Health Care Administration (AHCA) under the Medicaid Institutes for Mental Disease (IMD) 1915B waiver for children under age 18 to provide diagnostic and active treatment services in a secure setting. (47) "Substance abuse" is s a pattern of chronic or harmful use of alcohol, illicit or prescribed drugs that result in adverse physical, psychological, or social consequences. Substance abuse prevention and treatment services, pursuant to Chapter 397, F.S., which are provided using state or federal funding. (48) "Substance Abuse and Mental Health Information System (SAMHIS) ". is the Department's 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. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 8 of 67 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 (49) "TANF Participant" is a person or family member of that person defined in 45 C.F.R. Part 260.30 and section 414.1585 and subsection 414.0252(9), F.S. (50) "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. (51) "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. (52) "Utilization Management" is a system to ensure maximum, cost - effective, and clinically appropriate utilization of behavioral health services. The goal of the program is to eliminate waitlists and maximize utilization as well as diverting individuals served to more clinically appropriate services when applicable. (53) "Verifiable Service" is a service provision that is documented in compliance with the requirements contained in Rule 65E -14, F.A.C. (54) "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 recovery- oriented coordinated system of care. The contract requires a qualified, direct service, community -based Network Provider who will provide services for children, adolescents, adults, and elders, as applicable, with behavioral health issues as authorized in section 394.9082, F.S., consistent with Chapters 394, 397, 916, section 985.03, F.S. (as applicable), and with the Substance Abuse and Mental Health Services Plan 2014- 2016,or the latest version thereof, and in the Prime Contract (ME's contract with the Department), which is incorporated herein by reference. The Network Provider shall work in partnership with the ME to better meet the needs of individuals with co- occurring substance abuse and mental health disorders and expand its array of services to provide trauma informed care, as appropriate. The partnership process will be open, transparent, dynamic, fluid, and visible. The process shall also serve as an opportunity for collaboration to continuously improve the quality of services. During the course of the contract period, the ME will require that the Network Provider participate in Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 9 of 67 Contract No. ME225 -9 -27 � � South Florida / Behavioral Health Network, Inc. Effective: 07/01/2018 the process of improving co- occurring disorder service capability system wide, trauma informed care services and ensure the integration of behavioral health services and primary care services to all the consumers in care in coordination with a Federally Qualified Health Center or other medical facility as required by this Contract. The Network Provider shall work in collaboration and shall assist, upon request of the ME, in fulfilling its contractual obligations pursuant to the Prime Contract with the Department of Children and Families including but not limited to the following functions: (1) System of Care Development and Management; (2) Utilization Management; (3) Quality Improvement; (4) Data Collection, Reporting, and Analysis; (5) Financial Management; (6) Disaster Planning and Responsiveness b. Authority Section 394.9082, F.S., and the Prime Contract provides the ME with the authority to contract for these services. c. Scope of Service 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, Consumers /Participants to be Served, and in accordance with the tasks outlined in this contract. Services shall also be delivered at the locations specified in, and in accordance with the Program Description, as required by Rule 65E -14, F.A.C., which is herein incorporated by reference, and maintained in the ME's Contract Manager's file. (2) Unless otherwise authorized by the ME, services are to be delivered in the following county(ies): Miami -Dade County X Monroe County d. Major Program Goals The ME's goals for the SAMH Programs funded by this Contract are aligned with the Department's goals as published in the Florida Substance Abuse and Mental Health Plan — Triennial State and Regional Master Plan for Fiscal Years 2017 -19 (January 31, 2016), herein incorporated by reference, and are as follows: Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 10 of 67 Contract No. ME225 -9 -27 ••-■ South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 (1) Provide access to quality, recovery- oriented system of care and community based services and supports for persons with behavioral health disorders. (2) Community -based health and prevention promotion by encouraging overall emotional health and wellness and preventing substance use, reduce the spread of infectious diseases, prevent and reduce attempted and completed suicides, and reduce opioid related overdose deaths. (3) Integrate the Child Welfare and Substance Abuse and Mental Health systems. (4) Improve co- occurring capability, trauma informed care, ensure the integration of behavioral health and primary health care services and expertise in all programs. (5) For funded substance abuse prevention services, 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 (CCAP). The CCAP can be upon request to the ME's Director of Prevention Services. e. Minimum Programmatic Requirements The Network Provider shall maintain the following minimum programmatic requirements: (1) System of Care The consumer - centered and family- focused system of care will: (a) Be driven by the needs and choices of the customers; (b) Promote family and personal self- determination and choice; (c) Be ethically, socially, and culturally responsive; and (d) Be dedicated to excellence and quality results. There is a commitment to improve access to care, promote service continuity, support efficient and effective delivery of services that utilize evidence -based practices, recovery- oriented and peer involved approaches in accordance with priorities established by the ME and the Department for substance abuse, mental health treatment and /or co- occurring disorders and, substance abuse prevention services. (2) Guiding Principles Guiding principles specify that services are as follows: (a) Inclusive - involve and engage families and consumers as full partners to participate in the planning and delivery of services; Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 11 of 67 Contract No. ME225 -9 -27 � � South Florida // Behavioral Health Network, Inc. Effective: 07/01/2018 (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; (h) Sexual orientation; and (i) Recovery- oriented and recovery - supported as defined by the Substance Abuse and Mental Health Services Administration (SAMHSA). 3. Consumers to be Served See Exhibit A, Consumers /Participants to be Served B. Manner of Service Provision 1. Service Tasks The following tasks must be completed for each fiscal year covered in the contract period. a. Task List (1) Based on consumer needs, the Network Provider agrees to provide appropriate services from the list of approved programs /activities described in Exhibit G, Covered Service Funding by OCA and the description of such services specified in the Program Description as required by Rule 65E -14, F.A.C. Any change in the array of services shall be justified in writing and submitted to the ME's Contract Manager for review and approval. (2) The Network Provider shall serve the number of persons indicated in Exhibit D, Substance Abuse and Mental Health Required Outcomes /Outputs within the activities specified in Exhibit G, Covered Service Funding by OCA. Failure to meet the minimum numbers served may result in a corrective action and an imposed financial penalty as described in the Standard Contract. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 12 of 67 Contract No. ME225 -9 -27 I� South Florida / Behavioral Health Network, Inc. Effective: 07/01/2018 (3) 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. (4) The Network Provider shall adhere to treatment group size limitations not to exceed fifteen (15) individuals per group for any clinical therapy service provided, 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 ofgroup); viii. Group Indicator; and ix. Program (AMH, ASA, CMH, CSA) 11. Audit Documentation - Recipient Service or Non- Recipient Chart: i. Recipient name and identification number or if non - recipient, participant's name, address, and relation to recipient; ii. Staff name and identification number iii. Service date iv. Clinical diagnosis; v. Start time; vi. Duration; and vii. Services (Group progress note) (5) The Network Provider shall develop and implement policies so that all applicable providers' employees abide by the terms and conditions of Paragraph 25., Information Security Obligations, of the Standard Contract. The Network Provider shall submit to the Managing Entities Contract Manager, by 08/01/2018, 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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 13 of 67 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 Security Obligations, of the Standard Contract. (6) For licensable services purchased by this Contract, the Network Provider shall have and maintain correct and current Department of Children and Families, as required by Rule 65D- 30, F.A.C., Licensure Standards for Substance Abuse Services and Agency for Health Care Administration (AHCA) licenses and only bill for services under those licenses. In the event any of the Network Provider's license(s) is suspended, revoked, expired or terminated, the ME shall suspend payment for services delivered by the Network Provider under such license(s) until said license(s) is reinstated. (7) 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. (8) The Network Provider shall use the approved standardized assessment tool and or placement 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. (9) If the Network Provider provides medication management services, the Network Provider shall ensure that consumers discharged from state mental health treatment •facilities will be maintained on the medication that was prescribed for them by the facility at discharge pursuant to s. 394.676, F.S. Maintenance includes performing required lab tests, providing the medication, and providing appropriate physician oversight. (10) By 08/01/2018, 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. Attachment 1 HCO2 (a) - Guidance/Care Center, Inc. Page 14 of 67 Contract No. ME225 -9 -27 � � South Florida / / Behavioral Health Network, Inc. Effective: 07/01/2018 (11) Should the ME conduct a mock emergency drill, the Network Provider shall participate by activating their emergency /disaster plan and reporting on preparedness activities, response activities, and post- recovery activities. (12) By 08/01/2018, the Network Provider shall submit to the ME's Contract Manager an updated Civil Rights Compliance Checklist (CF0946). (13) By 08/01/2018, 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. (14) By 08/01/2018, 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 consumers 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. (1) The Continuous Quality Improvement Initiatives identified in SectionB.1.a.(21) below. (15) By. 10/01/2018, the Network Provider shall submit an . attestation signed by the CEO /Executive Director indicating that all applicable staff funded by this Contract have Attachment l HCO2 (a) Guidance /Care Center, Inc. Page 15 of 67 Contract No. ME225 -9 -27 PP South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 received a copy of this fully executed contract and will receive copies of any amendments . made to this Contract. (16) The Network Provider shall implement a "no wrong door" model as defined in s. 394.4573, F.S, by developing a process for assessing, referring and /or treating consumers with co- occurring disorders, to increase access of persons identified as co- occurring, to provide services for both disorders regardless of the entry point to the behavioral health system. As used in conjunction with the CCISC model, "no wrong door" (See http: / /www.kenminkoff.com /ccisc.html) requires that systems develop policies and procedures that mandate a welcoming approach to individuals with co- occurring psychiatric and substance disorders in all system programs, eliminate arbitrary barriers to initial evaluation and engagement, and specify mechanisms for helping each consumer (regardless of presentation and motivation) to get connected to a suitable program as quickly as possible. A copy of the Network Provider's "No Wrong Door" policy is maintained in the Network Provider contract file. Should any updates to the to the "No Wrong Door" policy and procedure occur during the term of this contract, the Network Provider must submit the amended procedures to the Contract Manager within thirty (30) calendar days of the adoption. (17) The Network Provider shall execute and /or maintain if executed a Memorandum of Understanding (MOU) or contract with the appropriate Federally Qualified Health Center or other medical facility. The MOU provides for integration of behavioral health services and primary health care services to the medically underserved in order to meet the goals specified in Section B.1.a.(21)(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 consumer. The MOU shall be submitted within ninety (90) days of the effective date of this contract to the ME's Contract Manager on or before the due date(s) as specified in Exhibit C, Required Reports. The Network Provider shall submit copies of any amendment to the MOU, to the ME's Contract Manager, within thirty (30) calendar days of execution. (18) Supplemental Security Income /Social Security Disability Insurance (SSI /SSDI) Outreach, Access, and Recovery (SOAR) If providing case management services to adults with mental health disorders, the Network Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 16 of 67 Contract No. ME225 -9 -27 IPP South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 • Provider shall adhere to the requirements of Exhibit AN, Supplemental Security Income /Social Security Disability Insurance (SSI /SSDI) Outreach, Access, and Recovery (SOAR). The Network Providers assign SOAR Processor /Case Manager to participate in meetings and /or trainings as requested by ME staff and shall designate SOAR Trained Processor(s) who have been trained through the SOAR Online Course developed by Policy Research Associates and SAMHSA who will process SOAR applications for all consumers receiving services through funding provided by this contract that have been screened and determined to be eligible for SOAR benefits. (19) Linkage and Referral Process (a) The Network Provider's policies and procedures must address the referral and linkage process of consumers and coordination of care to local community providers for services not offered by the Network Provider. Such services include, but are not limited to, detoxification services, linkages with community programs such as housing, employment and parenting supports, and primary health care. The Network Provider is responsible for tracking and ensuring that the proper linkages are made and documented. Network Providers are required to submit all required documentation for the initiated referral. (b) The Network Provider may only refer a consumer to a provider that offers the service for which the Network Provider created the referral. The receiving provider is responsible for follow up and linkage including proper care coordination and discharge planning back to the referring provider. The referring provider is responsible for the communication and follow up with the receiving provider. (c) lithe 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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 17 of 67 Contract No. ME225 -9 -27 �� South Florida Behavioral Health Network, . Inc. Effective: 07/01/2018 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. (20) Continuous Quality Improvement Programs (a) The Network Provider must maintain a continuous quality improvement program and report on the continuous quality improvement activities. The program is the responsibility of the Director and is subject to review and approval by the governing board of the service Network Provider. Each director shall designate a Quality Assurance Officer /Compliance Officer who will be responsible for the continuous quality improvement program. The continuous quality Improvement program should objectively and systematically monitor and evaluate the appropriateness and quality of care to ensure that services are rendered consistent with prevailing professional standards, and identify and resolve problems. (b) The quality improvement program must include at minimum: i. Activities to ensure that fraud, waste and abuse do not occur. ii. Composition of quality assurance review committees and subcommittees, purpose, scope, and objectives of the continuous quality assurance committee and each subcommittee, frequency of meetings, minutes of meetings, and documentation of meetings. iii. A framework for evaluating outcomes, including: 1. Output measures, such as capacities, technologies, and infrastructure that make up the system of care. 2. Process measures, such as administrative and clinical components of treatment. 3. Outcome measures pertaining to the outcomes of services; iv. A system of analyzing those factors which have an effect on performance; v. A system of reporting the results of continuous quality improvement reviews; and, Attachment 1 HCO2 (a) Guidance /Care Center, Inc. Page 18 of 67 Contract No. ME225 -9 -27 P-7-' South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 vi. Best practice models for use in improving performance in those areas which are deficient. vii. Establishment of a Seclusion and Restraint Oversight Committee per Chapter 65E- 5.180, F.A.C. for agencies utilizing seclusion and /or restraint. (21) Continuous Quality Improvement Initiatives - Providers must comply with all of the provisions for the initiatives outlined below: (a) Integration of Behavioral Health Services and Primary Health Care It is the goal of the ME to ensure the integration of behavioral health services and primary care services to all the consumers in care. The integration will be ensured through linkage of the behavioral health provider with the primary health care provider of the consumer through an electronic health record or other means of contact (phone, in person, etc). Referral and linkage processes will be necessary for all consumers who do not have a primary health care provider at entry into the system of care. Follow up and coordination of services are essential to meeting consumer health and behavioral health needs. Many individuals with behavioral health issues have chronic health conditions and may have neglected their primary health needs for some time. The ME and the Southern Region are committed to developing an integrated system of care that incorporates comprehensive screening and monitoring tools that identify those affected by chronic health conditions and a system of care that meets their needs. Network Providers will be implementing Integrated Primary and Behavioral Health techniques and initiatives to meet this need. This initiative will be addressed through a continuous quality improvement plan or component in the existing agency wide continuous quality improvement plan that delineates participation in the Health Integration Initiative. As part of the plan or component of the plan must include the following: i. Identification of the Federally Qualified Health Center or other medical facility where consumers who have been identified as needing primary health care services are referred to or the process established by the Network Provider to coordinate services with consumers' private primary health care provider . should such exist. ii. A process to track and report outcomes of successful referrals and linkages of consumers of behavioral health services to primary health care services. In addition to tracking and reporting outcomes of consumers referred for Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 19 of 67 Contract No. ME225 -9 -27 ■■ South Florida Behavioral Health Network, Inc. Effective: 07 /01/2018 behavioral health services by a primary health care provider to the Network Provider. The outcomes must be reported in the semi - annual Continuous Quality Improvement Updates. • iii. Identification of at least two Integrated Healthcare Champions at the beginning of the contract term and submit the names of the individuals when requested by ME staff. iv. By 08/31/2018, unless otherwise directed by the ME, the Network Provider shall submit an action plan on the template provided by the ME. The action plan must be developed based on the results of the most recently completed Site Self- Assessment Evaluation Tool for the Maine Health Access Foundation Integration Initiative (MeHAF). The action plan will outline tasks and objectives that the Network Provider must address during the fiscal year that were identified in the self- assessment as needing improvement. v. Participation in the regional Healthcare Integration Committee meetings to develop the processes and training germane to this initiative. vi. Attendance of appropriate staff at the regional trainings regarding Integrated Healthcare, as requested by the ME staff. Participation in the trainings will be documented in the Continuous Quality Improvement Updates. vii. By 03/01/2019, 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). (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: i. 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. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 20 of 67 Contract No. ME225 -9 -27 1P-2/ South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 ii. By 08/31/2018, unless otherwise directed by the ME, the Network Provider shall submit an action plan on the template provided by the ME. The action plan must be developed based on the results of the most recently completed Fallot Tool. The action plan will outline tasks and objectives that the Network Provider must address during the fiscal year that were identified in the self- assessment as needing improvement. The ME will monitor the Network Provider on its execution of the tasks and objectives identified in the action plan. iii. Participation in the regional TIC meetings to develop the process for identifying and responding to those affected by trauma. iv. Attendance at the regional trainings regarding TIC as applicable. Applicable trainings will be documented in the Continuous Quality Improvement Updates. v. Participation in all TIC related activities to ensure staff and agency become competent in all areas of trauma informed care. (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. By 08/31/2018, 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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 21 of 67 Contract No. ME225 -9 -27 P2 South Florida P-2/ Behavioral Health Network, Inc. Effective: 07/01/2018 (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. (d) Integration of Behavioral Health and the Child Welfare System i. The Network Provider will ensure that behavioral health services are available to consumers referred by the Community Based Care Organizations (CBC) or by the Department's Child Protective Investigators in cases where behavioral health indicators are present during the initial child abuse /neglect investigation or at any point during child protective supervision or out -of -home care. Priority will be given to cases where a child is at risk for immediate removal or has been removed from the family, with a goal of reunification in the family safety plan. Services may also be provided for the enrolled parent(s)' /caregiver(s)' family members, household residents, or significant others in need of behavioral health prevention or treatment services, as well as children in relative placements. For a detailed description of the consumer eligibility criteria please refer to the approved Motivational Support Program Protocols and Family Intensive Treatment Team Protocols, herein incorporated by reference, and available upon request to the MEs Contract Manager. 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's Community Based Care Provider, Our Kids of Miami - Dade /Monroe ( "Our Kids ") are committed to . developing an integrated system of care that meets the needs of children and their families as there is significant overlap between consumers. Network Providers will be implementing the Child Welfare Integration (CWI) initiative through a continuous quality improvement plan or component in the existing agency wide continuous quality improvement plan that delineates participation in the CWI initiative. As part of the plan or component of the plan must include the following: 1. Identification of at least two CWI Champions and submit the names of the individuals when requested by ME staff. In the event of change in staff occur, the Network Provider shall notify the ME's Contract Manager, in writing within ten (10) calendar days. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 22 of 67 Contract No. ME225 -9 =27 P" South Florida / / Behavioral . Health Network, Inc. Effective: 07/01/2018 2. Participation in the CWI meetings to develop the process for identifying and responding to child - welfare involved families. 3. Attendance at the monthly Integration Workgroup meetings. 4. Attendance at trainings regarding CWI when notified by the ME. Attendance at applicable trainings will be documented in the Continuous Quality Improvement Updates 5. Participation in all CWI related activities to ensure staff and agency become knowledgeable of the Child Welfare system. 6. Description of the process to monitor and ensure that requests for Clinical Summary Reports from Our Kids or an Our Kids Network Provider is provided in a timely manner. The ME's Network Provider shall provide the clinical summary reports within five (5) business days of receipt of the written request from the requestor. In cases of emergencies, (less than 24 -hour notice), the supervisor at the Network Provider will accept the telephone call request for the clinical summary report(s). The supervisor will request and ensure receipt of a written request within twenty -four (24) hours following the initial telephone call. (e) Mandatory Accreditation Accreditation by an accrediting organization recognized by the Department, as discussed in 65D- 30.0031, F.A.C., is a requirement for Iicensure of clinical substance abuse treatment services. The licensable substance abuse treatment components are listed in subsection 65D- 30.002 (17), F.A.C. Network Provider applicants for Iicensure and licensed network providers must meet the most current best practice standards related to the licensable service components of the accrediting organization. For a list of accrediting organizations recognized by the Department visit the following website: http: / /www.mvflfamilies.com /service - programs/ substance - abuse /Iicensure - regulation The Network Provider shall take appropriate steps to maintain its accreditation or become fully accredited by June 30, 2019, as required by this section, 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. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 23 of 67 Contract No. ME225 -9 -27 �� South Florida / / Behavioral Health Network, Inc. Effective: 07 /01/2018 Failure to meet the accreditation requirements will be considered by the ME to be a breach of this Contract and this contract may be subject to termination. (22) By. 8/31/2018, the Network Provider shall submit a single agency action plan which outlines , all of the components /activities identified in agency's annual self- assessments for each initiative. For example, the Integrated Healthcare Initiative (Behavioral Health and Primary Health Care) action plan should be developed based on the results of the most recently completed self- assessment, the Trauma Informed Care action plan shall be developed based on the results of the most recently completed Fallot Tool, and the Cultural and Linguistic Competence action plan shall be based on the results of the Cultural and Linguistic Competence survey. (23) Continuous Quality Improvement Updates The Network Provider shall submit semi - annual updates, by the dates specified in Exhibit C, Required Reports, on the implementation and progress of the following activities: (a) Integration of Behavioral Health Services and Primary Care as described in the agency's action plan; (b) Trauma Informed Care, as described in the agency's action plan; (c) Cultural and Linguistic Competence initiative, as described in the agency's action plan; (d) Identification of the evidence -based practices (EBPs) utilized by the agency and address how these EBPs are monitored to ensure fidelity to the model; (e) Participation in trainings and activities relating to the Integration of Behavioral Health and Child Welfare Systems; (f) Monitoring processes to ensure that licensable substance abuse and mental health treatment services are appropriately licensed by either the Florida Department of Children and Families and /or the Agency for Health Care Administration, as applicable prior the start of services. (g) Evidence of the implementation of the integration of behavioral health services and primary health care, evidence of tracking and ensuring the successful referrals and linkages of consumers of behavioral health services to primary health care services and consumers referred from the primary health care provider to the Network Provider for behavioral health services, and include progress on the implementation as described in the Network Provider's action plan to include the following: • The number of behavioral health consumers identified as needing primary care. • Number of successful linkages to primary care. Attachment l HCO2 (a) Guidance/Care Center, Inc. Page 24 of 67 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 (24) Care Coordination If providing services to an individual identified as needing care coordination services, the Network Provider is required. to implement Care Coordination as defined in section 394.4573(1)(a), F.S., is required to meet the requirements as set forth in the DCF Guidance Document 4, Care Coordination, and the ME's Care Coordination Policy and Protocol, all documents are incorporated herein by reference and available when requested to the ME's Contract Manager. Section 394.4573(1)(a), F.S.,. defines Care Coordination to "mean the implementation of deliberate and planned organizational relationships and service procedures that improve the effectiveness and efficiency of the behavioral health system by engaging in purposeful interactions with individuals who are not yet effectively connected with services to ensure service linkage. The purpose of care coordination is to enhance the delivery of treatment services and recovery supports and to improve outcomes among priority populations." The priority populations are defined in the DCF Guidance Document 4, Care Coordination. Care Coordination serves to assist individuals who are not effectively connected with the services and supports they need to transition successfully from higher levels of care to effective community -based care. Care Coordination is not intended to replace case management. The ME Care Coordination Department is responsible for identifying individuals eligible for Care Coordination through data surveillance, refer individuals to the Network Provider, track the individuals served by the Network Provider through Care Coordination, ensure the . linkages to services and monitor outcome metrics. Performance Measures: At a minimum, thirty -three percent (33 %) of the individuals referred for Care Coordination services shall be enrolled into Care Coordination services. Required Report(s): On a monthly basis, by the 5th calendar day following the month of service, the Network Provider shall submit a Care Coordination Report on the template provided in Exhibit AC, to the ME's Contract Manager. (25) Transitional Voucher Project Pursuant to the Department's Guidance Document 29 — Transitional Voucher and the ME's Care Coordination Policy. and Protocols, the Transitional Voucher Project provides care coordination and vouchers to purchase treatment and support services for adults transitioning from Florida Assertive Community Treatment (FACT) teams, acute crisis services, and institutional settings to independent community living. All Network Providers who serve individuals meeting the criteria above may participate in the Transitional Voucher Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 25 of 67 Contract No. ME225 -9 -27 s� South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 Project. Transitional vouchers provide a participant with a monthly budget to be spent on allowable services pursuant to Rule 65E- 14.021, F.A.C. This service is intended to support Care Coordination efforts outlined in the DCF Guidance Document 4 — Care Coordination. The Transitional Voucher project is a flexible, consumer - directed voucher system designed to bridge the gap for persons with behavioral health disorders as they transition from acute or more restrictive levels of care to lower levels of care. The intent of this project is to enable . individuals to live independently in the community with treatment and support services based on need and choice and build •a support system to sustain their independence, recovery, and overall well- being. The project aims to: (a) Prevent recurrent hospitalization and incarceration; (b) Provide safe, affordable, and stable housing opportunities; (c) Increase participant choice and self- determination in their treatment and support service selection; and (d) Improve community involvement and overall quality of life for program participants. To access these funds, the Network Provider must follow the ME's Care Coordination Policy and Protocols, available upon request to the ME's Contract Manager. The expenses may be authorized by the ME only to the extent that they are reasonable, allowable and necessary as determined through the assessment process; are clearly identified in the care plan; and only when no other funds are available to meet the expense. The Network Provider may be asked by the ME to provide a monthly and /or or a quarterly reports and /or data that documents transitional voucher services, in a template provided by the ME. (26) Financial Audit Reports (a) The Network Provider shall submit financial statements consisting of Balance Sheet and Statement of Activity (income statement) per the schedule and to the individual(s) identified in the Exhibit C, Required Reports. The Network Provider agrees to provide the ME with any requests for additional financial statements /documentation. (b) Network Providers who withhold income taxes, social security tax, or Medicare tax from employee's paychecks or who must pay the employer's portion of social security or Medicare tax must use Form 941, Employer's Quarterly Federal Tax Return, to report those taxes. On a quarterly basis, and by the dates specified in Exhibit C, Required Reports, the Network Provider, shall submit an attestation that Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 26 of 67 Contract No. ME225 -9 -27 PP South Florida / Behavioral Health Network, Inc. Effective: 07/01/2018 the 941 has been filed timely and any taxes due have been paid timely to IRS. (c) The Network Provider shall complete and submit the Department- approved Local Match Calculation Form as a supplemental report to the annual financial audit reports as required by Attachment II, Financial and Audit Compliance per the schedule and to the individual(s) identified in the Exhibit C, Required Reports. The Department- approved Local Match Calculation Form, Template 9 = Local Match Calculation Form is available at the following website: http: / /www.mvflfamilies.com /service - programs /substance- abuse /managing- entities /2018 - contract -dots (27) 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 and shall comply with the requirements in Section 7., Audits, Inspections, Investigations, Records, and Retention. (28) The Network Provider shall make available upon request all plans, policies, procedures, and manuals to ME staff, Department staff, Network Provider staff, and to consumers /stakeholders if applicable and appropriate. (29) The Network Provider shall comply with Children and Families Operating Procedure 215 -8, OVERSIGHT OF HUMAN SUBJECT RESEARCH AND INSTITUTIONAL REVIEW BOARD DESIGNATION. The policy and guidance can be found at: http: / /www.mvflorida.com /apps /vbs /adoc /F2551 ITN09H13GC1Addenduml0 CF0P2158.pdf Approval from the Department through the ME is mandatory for all research conducted by any employee, contracted organization or individual, or any public or private vendor, even if the aforementioned has their own Institutional Review Board which has granted approval. (30) 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 C.F.R. 96.136. (31) The Network Provider shall meet with the ME's staff at regularly scheduled or specially called meetings when notified by the ME. (32) The Network Provider shall 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. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 27 of 67 . Contract No. ME225 -9 -27 �� South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 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. (33) 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. (34) 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. (35) The Network Provider shall ensure provision of services to consumers with special needs The Network Provider shall ensure the coordination of specialty services including employability skills training and linkage, victimization and trauma services, infant mental health services, the elderly, and services to families in recovery. The Network Provider shall also ensure the availability of appropriate services to consumers with special needs such as those who are blind, deaf or hard of hearing, developmentally disabled, physically handicap, criminally involved, or forensic consumers. The ME reserves the right to modify this list as the needs of the consumers change. (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. (36) 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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 28 of 67 Contract No. ME225 -9 -27 �� South Florida / / Behavioral Health. Network, Inc. Effective: 07/01/2018 part 11 of chapter 408. Referrals to unlicensed facilities are not lawful and subject to sanctions by the Agency of Health Care Administration (AHCA). (b) The Network Provider is directed to only refer consumers of mental health services to Assisted Living Facilities with a Limited Mental Health License. It is the referring Network Provider's responsibility to verify licensure. AHCA • licenses can be verified at the following website: http:// www. floridahealthfinder. gov/ facilitvlocator /FacilitvSearch.aspx (c) In circumstances where the Network Provider determines that placement of particular individual in an Assisted Living Facilities with a Limited Mental Health. License is unsuitable, the Network Provider shall request a meeting with the appropriate ME staff to discuss alternative options. The request shall be made in writing to the ME's Contract Manager. (d) The Network Provider agrees to comply with provisions and the reporting requirements of Exhibit L, Assisted Living Facilities with a Limited Mental Health License, if services to such residents are offered. (e) On a quarterly basis, by the dates, and to the individuals identified in Exhibit C, Required Reports, the Network Provider shall submit an ALF -LMHL Consumer Report the required format as shown in Table 1, of Exhibit L, Assisted Living Facilities with a Limited Mental Health License. The ALF -LMHL Consumer Report shall be submitted in a secured, password protected, or encrypted format. (37) 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. (38) Work and Social Opportunities for Peer Specialists Nationwide, health systems have accepted peers as a valuable part of the workforce. A shift to a more person- centered approach, a focus on integrated health, and a demand for more workers have increased the role peer specialists play in Florida's mental health and substance abuse systems. In keeping with Florida's goal of increasing the number of peer specialists, the Network Provider shall provide employment and social opportunities to individuals who have lived experience of mental health and /or substance use conditions and /or lived experience of trauma. (39) Assist Stakeholder Involvement in Planning, Evaluation, and Service Delivery Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 29 of 67 • Contract No. ME225 -9 -27 �� South Florida ,/ Behavioral Health Network, Inc. Effective: 07/01/2018 (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. (40) 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. (41) Consumer 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. (42) The Network Provider agrees to assist in the development and implementation of the Care Coordination and Utilization Management (UM) System and shall maintain the capacity to perform or work towards obtaining the following functions including, but not limited to: (a) ME- approved automated, standardized, and screening and assessment instruments to improve proper evaluation and placement of individuals; (b) Automated referral and electronic consent for release of confidential information with the ME and other Network Providers, to the extent permitted by law; (c) Integrated processes for intake, admission, discharge and follow -up; (d) Encounter and progress notes to support all services provided under this contract and that automatically generate state and Medicaid billing and payment in the event Medicaid compensable services are provided to individuals eligible for Medicaid; Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 30 of 67 Contract No. ME225 -9 -27 �� South Florida P7/ Behavioral Health Network, Inc. Effective: 07/01/2018 (e) Utilization management, including but not limited to Wait Lists and capacity management; (f) Determination of financial and clinical eligibility of Individuals Served; (g) Processes to ensure the Department is the payer of last resort; (h) Electronic capability for billing, invoice payment and claims adjudication, and /or Medicaid billing and payment (HIPAA 837 and 835 Transactions); (i) Automated processes for state and federal data analysis and reporting; and (j) Full compliance with federal and state laws, rules and regulations pertaining to security and privacy of protected health information. (43) Consumer Trust Funds (CTF) (a) The Network Provider shall submit a letter to the Contract Manager certifying that they either are or are not the representative payee for Supplemental Security Income, Social Security Administration, Veterans Administration, Food Stamps, or other federal benefits on behalf of a consumer by August 1, 2018. (b) If the Network Provider is the representative payee for Supplemental Security Income, Social Security Administration, Veterans Administration, or other federal benefits on behalf of the consumer, the Network Provider shall comply with the applicable federal laws including the establishment and management of individual consumer trust accounts (20 C.F.R. 416 and 31 C.F.R. 240). (c) Any Network Provider assuming responsibility for administration of the personal property and /or funds of consumers shall follow the Department's Accounting Procedures Manual 7 APM, 6, Volume 7, incorporated herein by reference. Department or the ME personnel or their designees upon request may review all records relating to this section. Any shortages of consumer funds that are attributable to the Network Provider shall be repaid, plus applicable interest, within one (1) week of the determination. (d) All reports specified in the Department's Accounting Procedures Manual 7 APM, 6, Volume 7 shall be maintained onsite and available for review by Department or ME staff, and shall be submitted to the ME upon request. (e) The Network Provider shall also maintain and submit documentation of all payment /fees received on behalf of SAMH consumers receiving Supplemental Security Income, Social Security Administration, Veterans Administration, Food Stamps, or other federal benefits upon request from the ME. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 31 of 67 Contract No. ME225 -9 -27 IP South Florida Behavioral Health. Network, Inc. Effective: 07/01/2018 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 services purchased by this Contract 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, SAMH Programmatic State and Federal Laws, Rules, and Regulations. (2) The Network Provider shall engage in recruitment efforts to maintain as much as possible staff with the ethnic and racial composition of the consumers served. The ME, at its sole discretion may request documentation evidencing recruitment efforts. b. Professional Qualifications (1) The Network Provider shall comply with applicable rules, statutes, requirements, and standards with regard to professional qualifications. See Exhibit F, SAMH Programmatic State and Federal Laws, Rules, and Regulations and the requirements specified in Section 45. of the Standard Contract. (2) The Network Provider shall provide employment screening for all mental health personnel and all chief executive officers, owners, directors, and chief financial officers of service Network Providers using the standards for Level II screening set forth in Chapter 435, and s. 408.809 F.S., except as otherwise specified in s. 394.4572(1)(b) -(d), F.S. For the purposes of this contract, "Mental health personnel" includes all program directors, professional clinicians, staff members, and volunteers working in public or private mental health programs and facilities who have direct 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 397.4073, F.S., Background Checks for Service Provider Personnel. "All owners, directors, chief financial officers, and clinical supervisors 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 Attachment 1 HCO2 (a) Guidance /Care Center, Inc. Page 32 of 67 Contract No. ME225 -9 -27 �� South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 services or with adults who are developmentally disabled receiving services are subject to level 2 backgr 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 Tess 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. Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 33 of 67 Contract No. ME225 -9 -27 P� South Florida / Behavioral Health Network, Inc. Effective: 07/01/2018 (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 C.F.R., Part 96.135(a)(5)]. (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 C.F.R. 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 C.F.R. 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. Attachment I HCO2 (a) , Guidance/Care Center, Inc. Page 34 of 67 Contract No. ME225 -9 -27 �� South Florida / / Behavioral Health Network, Inc. Effective: 07/01/2018 (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 that: (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. Attachment I HCO2 (a) . . Guidance /Care Center, Inc. Page 35 of 67 Contract No. ME225 -9 -27 South Florida �� Behavioral Health Network, Inc. Effective: 07/01/2018 (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 or involve media coverage. 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 Contract Manager, in writing, at least ten (10) calendar days prior to any changes in location where services are being provided pursuant to Rule 65E -14, F.A.C. d. Equipment The Network Provider shall furnish all appropriate equipment necessary for the effective delivery of the services purchased. In the event that the Network Provider is allowed to purchase any non - expendable property with funds under this contract, the Network Provider will ensure compliance with the Tangible Property Requirements, Department operating Policies and Procedures as outlined in CFOP 40 -5, CFOP 80 -2, Rule 65E -14, F.A.C., which are incorporated herein by reference and may be obtained from the ME's Contract Manager. The provider shall submit an inventory report, as specified in the Network Provider Inventory List, incorporated herein by reference, and by the date(s) listed in Exhibit C, Required Reports. The Network Provider Inventory List form may be requested from ME Contract Manager. 4. Deliverables a. Services The Network Provider shall deliver the services specified in and described in the Program Description Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 36 of 67 Contract No. ME225 -9 -27 �� South Florida / Behavioral Health Network, Inc. Effective: 07/01/2018 submitted by the Network Provider in accordance with Exhibit G, Covered Services Funding by OCA and in Attachment IV, Scope of Work if prevention services are purchased through this contract. b. Records and Documentation The Network Provider shall protect confidential records from disclosure and protect consumer confidentiality in accordance with the requirements in Section 11., Confidential Client and Other Information and Section 28., Health Insurance Portability and Accountability Act, of the Standard Contract. c. Reports Where this contract requires the delivery of reports to the ME, mere receipt by the ME shall not be construed to mean or imply acceptance of those reports. It is specifically intended by the parties that acceptance of required reports shall require a separate act in writing. The ME reserves the right to reject reports as incomplete, inadequate, or unacceptable according to the parameters set forth in the resulting contract. The ME, at its sole option, may allow additional time within which the Network Provider may remedy the objections noted by the ME or the ME may, after having given the Network Provider a reasonable opportunity to comply with the report requirements, declare this agreement to be in default. (1) The Network Provider shall submit to the M E financial and programmatic reports specified in Exhibit C, Required Reports, by the dates specified or as requested by ME staff. (2) Upon request, the network provider shall submit to the ME and the Department information 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) Service data shall be submitted electronically, weekly, by 12:00 Noon every Wednesday. Final monthly service data will be submitted electronically to the ME no later than the 4th of each Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 37 of 67 Contract No. ME225 -9 -27 P� South Florida / Behavioral Health Network, Inc. Effective: 07/01/2018 month following the month of service into KIS, PBPS maintained by Collaborative Planning Group Systems, Inc., or other data reporting system designated by the ME and /or the Department. If the 4 falls on a weekend or holiday, data will be due on the next business day. 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) To establish a unique client identifier. for all individuals served, the Network Provider shall submit the Demographic Data Set required by PAM 155 -2, Chapter 4 within five (5) business days after the initial intake or admission. (b) Ensure that the data submitted clearly documents all consumer admissions and discharges which occurred under this contract. Ensure that substance abuse prevention services data entered into PBPS, or other data reporting system designated by the ME, clearly documents all program participants, programs and strategies which o ccurred under this contract, if applicable; (c) Ensure that all data submitted to KIS, or other data reporting system designated by the ME is consistent with the data maintained in the Network Provider's consumers' files /EMR -EHR systems. Ensure that substance abuse prevention services data entered into PBPS, or other data reporting system designated by the ME and /or the Department, is consistent with the data maintained in the Network Provider service documentation and /or consumer files, if applicable; (d) Review the ME's KIS error / download error reports to determine the number of records accepted and rejected. Based on this review, the Network Provider shall make sure that the rejected records are corrected and resubmitted in KIS, or other data reporting system designated by the ME. Only error -free data as processed by KIS will be accepted by the ME for monthly state reporting and payment validation; (e) Resubmit corrected records no later than the next monthly submission deadline. The failure to submit any data set or the Network Provider's total monthly submission per data set, which results in a rejection rate of 5% or higher of the number of monthly records submitted will require the Network Provider to submit a corrective action plan describing how and when the missing data will be submitted o r how and when the rejected records will be corrected and resubmitted; and (f) In accordance with the provisions of section 402.73(1), F. S., and Rule 65- 29.001, F.A.C., corrective action plans may be required for non- compliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed for failures to implement or to make acceptable progress on such corrective action plans. Failure to Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 38 of 67 Contract No. ME225 -9 -27 P� South Florida P-2. Behavioral Health Network, Inc. Effective: 07/01/2018 implement corrective action plans to the satisfaction of the ME and after receiving due notice, shall be grounds for contract termination. (8) The Network Provider must subtract all units which are billable to Medicaid, and all units for SAMH consumer services paid from other sources, including Social Security, Medicare payments, and funds eligible for local matching which include patient fees from first, second, and third- party payers, from each monthly request for payment. Should an overpayment be detected upon reconciliation of payments, the Network Provider shall immediately refund any overpayment to the ME, including but not limited to services provided to a Medicaid - eligible individual prior to becoming a Medicaid recipient when those services are subsequently covered under a retroactive Medicaid reimbursement determination. 5. Performance Specifications a. Performance Measures (1) The Network Provider shall meet the performance standards and required outcomes as specified in . Exhibit D, Substance Abuse and Mental Health . Required Performance Outcomes /Outputs. For Prevention services providers the individualized performance measure standards are specified in Attachment IV, Scope of Work. (2) The Network Provider agrees that KIS, PBPS, and SAMHIS, or other data reporting system designated by the ME, will be the source for all data used to determine compliance with performance standards and outcomes in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes /Outputs or other data system as specified by the ME. Any conflicts will be clarified by the ME and the Network Provider shall adhere to the ME's resolution. The Network Provider shall submit all service related data for consumers funded in whole or in part by SAMH funds, local match, or Medicaid. b. Performance Measurement Terms DCF PAM 155 -2 provides the definitions of the data elements used for various performance measures which are quantitative indicators, outcomes, and outputs used by the ME to objectively measure a Network Provider's performance, and contains policies and procedures for submitting the required data. Collaborative Planning Group Systems, Inc., or any other data system designated by the ME and /or the Department, maintains the procedures for submitting the required prevention data into PBPS. The ME will also monitor the Network Provider for the performance measures. c. Performance Evaluation Methodology (1) The Network Provider shall collect information and submit performance data and individual consumer outcomes, to the ME data system in compliance with DCF PAM 155 -2 requirements, or the latest revisions thereof. The specific methodologies for each performance measure may be found at the following website: Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 39 of 67 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 http: / /www.mvflfamilies.com /service - programs/ substance - abuse /pamph let- 155- 2 -v11, (2) The Network Provider is expected to have the capability to engage in organized performance improvement activities, and to be able to participate in partnership with the department and ME in performance improvement projects that are related to system wide transformation and improvement of services for individuals and families. (3) By execution of this contract the Network Provider hereby acknowledges and agrees that its performance under the contract must meet the standards set forth above and will be bound by the conditions set forth in this contract. If the Network Provider fails to meet these standards, the ME, at its exclusive option, may allow a reasonable period, not to exceed six (6) months, for the Network Provider to correct performance deficiencies. If performance deficiencies are not resolved to the satisfaction of the ME within the prescribed time and if no extenuating circumstances can be documented by the Network Provider to the ME's satisfaction, the ME must terminate the contract. The ME has the sole authority to determine whether there are extenuating or mitigating circumstances. (4) The ME will monitor the standards and outcomes specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes /Outputs. 6. Network Provider Responsibilities a. Network Provider Unique Activities (1) In the event of a dispute as to the ME's determination regarding consumer eligibility and /or placement into the appropriate level of care, the ME's dispute resolution process, as described in the Standard Contract shall be followed. An eligibility dispute shall not preclude the provision of services to Individuals Served, unless the dispute resolution process reverses the ME's determination. (2) The Network Provider 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 Attachment 1 HCO2 (a) Guidance /Care Center, Inc. Page 40 of 67 Contract No. ME225 -9 -27 �� South Florida / Behavioral Health Network, Inc. Effective: 07/01/2018 for funding by consumer, and have the ability to provide an audit trail. The Network Provider's financial management and accounting system must have the capability to generate financial reports on individual service 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 consumer 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 C.F.R. 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 C.F.R. s. 54a. (9) A Network Provider that receives block grant funding shall monitor its compliance with block grant requirements and activities. (10) A Network Provider that receives block grant funding shall comply with state or federal requests for information related to block grant. (11) A Network Provider that receive CMH block grant funding, and have been designated as a prevention provider for the purposes of H.R. Res. 3547, 113th Cong. (2014) (enacted), compliance with federal requirements. (12) None of the funds provided under the following grants may be used to pay the salary of an individual at a rate in excess of Level II of the Executive Schedule: Block Grants for Community Mental Health Services, Substance Abuse Prevention and Treatment Block Grant, Projects for Assistance in Transition from Homelessness, Project Launch, Florida Youth Transition to Adulthood; and Florida Children's Mental Health System of Care Expansion Implementation Project. (13) Any compensation paid for an expenditure subsequently disallowed as a result of the Managing Entity's or any Network Service Providers' non - compliance with state or federal funding regulations shall be repaid to the Department upon discovery. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 41 of 67 Contract No. ME225 -9 -27 I� South Florida / Behavioral Health Network, Inc. Effective: 07/01/2018 (14) The Network Provider shall make available to the ME and the Department all records . pertaining to service delivery. These records shall be made available at all reasonable times for inspection, review, copying, or audit. Service delivery records include but are not limited to, invoicing, fiscal management, data management, incident reporting, consumer records, and such documents determined to assure accountability of service provision and /or the expenditure of state and federal funds. (15) The Network Provider shall assist the ME and the Department in developing legislative budget requests based upon identified needs of the community. (16) The Network Provider shall provide to the ME, copies of, including but not limited to, evaluations, assessments, surveys, monitoring reports that pertain to licensure, accreditation, or other administrative or programmatic review, when those reports identify deficiencies that require corrective action. The Network Provider shall submit to the ME all of the applicable reports, including copies of the corrective action plan(s) within ten (10) calendar days of receipt by the Network Provider from the reviewing entity. (17) 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. (18) The Network Provider shall maintain human resource policies and procedures that provide safeguards to ensure compliance with laws, rules and regulations. Integrate current and /or new state /federal requirements and policy initiatives into its operations upon provision by the Department and /or ME of the same. (19) The Network Provider shall maintain in one place for easy accessibility and review by ME and /or Department staff all policies, procedures, tools, and plans adopted by the Network Provider. The Network Provider's policies, procedures, and plans, must conform to state and federal laws, the Florida Administrative Code, state and federal regulations, state and federal rules, and minimally meet expectations/ requirements contained in applicable Department of Children and Families and ME operating procedures. (20) The Network Provider shall maintain a mechanism for monitoring, updating, and disseminating policies and procedures regarding compliance with current government laws, rules, practices, regulations, and the ME's policies and procedures. (21) Pursuant to s. 394.74(3)(e), F.S., the Network Provider shall maintain data on the performance standards specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs, for the types of services provided under this contract. (22) The Network Provider shall comply with all other applicable federal laws, state statutes and associated administrative rules as may be promulgated or amended. See Exhibit F, SAMH Programmatic State and Federal Laws, Rules, and Regulations, and ME policies and procedures. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 42 of 67 Contract No. ME225 -9 -27 �� South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 (23) Records relating solely to actions taken in carrying out the requirements of this contract and records obtained by the ME and /or the Department to determine a Network Provider's compliance with this section are confidential and exempt from s. 119.07(1) and s. 24(a), Access to Public Records and Meetings, Article. 1, 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 enter into 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. Attachment 1 HCO2 (a) Guidance /Care Center, Inc. Page 43 of 67 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 c. State and Federal Laws, Rules, and Regulations See Exhibit F, SAMH Programmatic State and Federal Laws, Rules, and Regulations. 7. Managing Entity Responsibilities a. Managing Entity Obligations (a) The ME shall only subcontract with entities that are fiscally sound, and that can adequately ensure the accountability of public funds. (b) The ME shall assess the Network Provider's financial stability, using a risk assessment approach; the risk assessment approach will examine the impact of programmatic requirements on the Network Provider's financial stability. Any issues identified as a result of the financial risk assessment shall be reported to the Department during the monthly reconciliation and performance review identified in the Prime Contract. (c) The ME will provide administrative and programmatic oversight to ensure that Network Providers comply with all consumer - related services and other requirements of this contract. (d) The ME is solely responsible for the oversight of the Network Provider and enforcement of all terms and conditions of this contract. Any and all inquiries and /or issues arising under this contract are to be brought solely and directly to the ME for consideration and resolution between the Network Provider and the ME. In any event, the ME's decision on all issues is final and solely subject to the ME's appeal process and legal rights of the Network Provider. (e) The ME reserves the right terminate this contract in whole or in part, for non - performance as determined by the ME and to procure the services purchased through this contract to another entity and /or Network Provider. (f) The ME is responsible for the administration, management, and oversight, and through subcontracts, the provision of behavioral health services in Miami Dade and Monroe Counties. (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. (i) The ME shall work with the Department to redirect administrative cost savings into improved access to quality care, promotion of service continuity, required implementation Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 44 of 67 Contract No. ME225 -9 -27 South Florida •,--"/ Behavioral Health Network, Inc. Effective: 07/01/2018 of EBPs, the expansion of the services array, and necessary infrastructure development. It acknowledges the benefits to be realized, include improved access to quality care, promotion of service continuity, implementation of EBPs, improved performance and outcomes, expansion of the service array, and necessary infrastructure development. b. Monitoring Requirements (1) The ME will monitor the Network Provider in accordance with this contract and the ME's Contract Accountability Policies and Procedures which can be .obtained from the designated ME Contract Manager, and is incorporated herein by reference. The Network Provider shall comply with any •coordination or documentation required by the ME's monitor(s) to successfully evaluate the programs, and shall provide complete access to all budget and financial information related to services provided under this contract, regardless of the source of funds. (2) Network Providers with electronic health record (EHR) or electronic medical record systems (EMR) shall provide access to ME funded service and consumer data contained in these systems to the ME's monitoring team and provide sufficient resources to facilitate the monitoring process of services provided under this contract. Resources is defined but is not limited to, personnel, terminals, guest read -only accounts, privileges for monitors to access consumer records, and /or remote access into the systems by the monitors. (3) The ME will monitor the Network Provider on its performance of all tasks and special provisions of the contract. (4) The ME will provide a written report to the Network Provider within thirty (30) calendar days of the exit conference. If the report indicates corrective action is necessary, the Network Provider shall have ten (10) calendar days from receipt of the monitoring report to respond in writing to the request. In the sole discretion of the ME, if there is a threat to health, life, safety or well -being of consumers, the ME may require immediate corrective action or take such other action as the ME deems appropriate. Failure to implement corrective action plans to the satisfaction of the ME and after receiving due notice, shall be grounds for contract termination in whole or in part. c. Training and Technical Assistance (1) The ME's contact manager, or designee, will provide training and technical assistance concerning the terms and conditions of this contract. (2) The ME will provide technical assistance and support to the Network Provider to ensure the continued integration of services and support for consumers, to include but not limited to, quality improvement activities to implement evidenced -based practice treatment protocols, the application of process improvement methods to improve the coordination of access and services that are culturally and linguistically appropriate. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 45 of 67 Contract No. ME225 -9 -27 �� South Florida Behavioral Health Network, Inc. Effective: 07 /01/2018 (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. d. Review Compliance with Utilization Management. Criteria (1) As part of the quality improvement program, the ME will provide or coordinate reviews of service compliance with criteria and practice guidelines, such as retrospective reviews to ensure the level of placement of consumers is appropriate. The ME will take corrective action to resolve situations in which the subcontracted Network Provider is not following the guidelines or working to help the system meet its utilization goals. (2) Authorization of Services (a) The ME shall conduct authorization and reauthorizations for applicable levels of care as described in the approved Coordination of Care Plan Manual — FY 2017 -18, or the latest revision thereof, in order to ensure timely access to behavioral health services and eliminate the wait lists. The authorization processes include: (i) Timeliness standards for authorization review must adhere to timeline standards referenced in the approved Coordination of Care Plan Manual — FY 2017 -18, or the latest revision thereof, for the services provided and departmental, statutory, and judicial regulations or requirements. (ii), Processes for making the criteria on which decisions are made available to practitioners, including any standardized tools and assessments for use in determining placement and /or level of care. (iii) Provisions for providing timely appeals, or second opinions, when a request for authorization for a particular service is denied. (An appeal differs from a grievance in that grievances are used when a recipient or member of the covered population believes that he or she has been treated improperly, whereas an appeal is a request to review a judgment.) The second opinion shall be obtained according to the timeliness standards for the service in question. (3) Upon request, the ME will assist with the development and implementation of consumer admission, continued stay, discharge criteria specific to each level of care, diagnosis, presenting problems, and the establishment of review dates. (4) The ME will participate in the collaborative development and implementation of the working agreement with the Community Based Care and substance abuse and mental health Network Providers to ensure the integration of services and support within the Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 46 of 67 Contract No. ME225 -9 -27 / South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 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 1, any documents incorporated into any attachment by reference, Program Description, . and any documents incorporated by herein by reference. (2) The ME reserves the exclusive right to make certain determinations in these specifications. The absence of the ME setting forth a specific reservation of rights does not mean that all other areas of this contract are subject to mutual agreement. The ME reserves the right to make exclusively any and all determinations that it deems are necessary to protect the best interests of the State of Florida and the health, safety, and welfare of the consumers who are served by the ME either directly or through any one of its contracted Network Providers. (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 byOCA 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 2018 -2019 for SAMH services purchased under this contract. The cost savings shall be Attachment 1 HCO2 (a) Guidance /Care Center, Inc. Page 47 of 67 Contract No. ME225 -9 -27 �� South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 reallocated to support the increase of direct services, improved access to quality care, promotion of service continuity, and the implementation and /or expansion in the use of evidence -based practices. The Network Provider's SAMH Projected Operating and Capital Budget shall evidence the reduction and redistribution of the cost savings. 2. Acute Care Service Utilization Reporting for Public Receiving Facilities, Detoxification and Addiction Receiving Facilities: (a) Network Providers contracted to provide acute care services must submit acute care data (bed availability) in real time, as mandated under Section 394.9082(10), Florida Statutes. (b) Acute care data must be provided for every licensed bed, as listed by AHCA or DCF's PLADS system, whether funded through this contract or not. (c) The Network Provider shall enter accurate and consistent data (all admissions and discharges) in the KIS Express Acute Care System, the ME's designated acute care system database. Arrangements to license and access the KIS Express Acute Care system should be coordinated through the ME's IT Department. The Acute Care reporting format can be found at: http: / /www.mvflfamilies.com /service - programs /substance- abuse /reports Note: Click on the Instructional Manual for Reporting Acute are Services Utilization (ACSU) Data link 3. Real -time Data Entry: When required by the Prime Contract, state and /or federal rules, regulations, or the ME's policies and procedures, the Network Provider shall submit to the ME real -time data in KIS Express, or other similar data structure, for services purchased by this contract. The Network Provider agrees to implement the new data reporting system(s) when notified and as directed by the ME. 4. Purchase Firearms by Mentally III Persons pursuant to Chapter 790, Florida Statute, Weapons and Firearms — Applicable to Receiving and /or Treatment Facilities as defined in s. 394.455, Florida Statute (Baker Act and for Involuntary Treatment under the Marchman Act) Current law prohibits dealers from selling firearms to persons who have been adjudicated mentally defective or has been committed to a mental institution by a court or as provided in subsection 790.065 (2)(a)4.b.(II), F.S., and as a result is prohibited by state or federal law from purchasing a firearm. Subsection 790.065, F.S., provides conditions under which an individual who has been allowed to transfer to voluntary status in lieu of court- ordered involuntary commitment after being admitted for involuntary examination at a Baker Act receiving facility and is certified by an examining physician to be of imminent danger to himself of herself or others, may be prohibited from Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 48 of 67 Contract No. ME225 -9 -27 South Florida / Behavioral Health Network, Inc. Effective: 07 /01/2018 purchasing a firearm, and may not be eligible to apply for or retain a concealed weapon or firearms license. Within 24 hours after the person's agreement to voluntary admission, a record of the finding, certification, notice, and written acknowledgement ( "petition ") must be filed by the administrator of the receiving or treatment facility, as defined in s. 394.455, F.S, with the clerk of the court for the county in which the involuntary examination occurred (790.065, (2) (a).4.c.(II) F.S). No fee may be charged for such filing. On a monthly basis, the Network Provider shall submit a report on the template provided in Exhibit 0, Weapons and Firearms Court Petitions Monthly Report, with information from the preceding month that includes the number of petitions filed, the names of the individuals that the petitions were filed for, and the dates that the petitions were filed. The report shall be submitted electronically in a secured, password protected or encrypted format by the dates and to the individuals specified in Exhibit C, Required Reports. 5. Medication- Assisted Treatment Services a. The Network Provider shall discuss the option of medication - assisted treatment with individuals with opioid use disorders or alcohol use disorders. b. For individuals with opioid use disorders, the Network Service Provider shall discuss medication- assisted treatment using FDA - approved medications including but not limited to methadone, buprenorphine, and naltrexone. c. For individuals with alcohol use disorders, the Network Service Provider shall discuss medication - assisted treatment using FDA - approved medications including but not limited to disulfiram, and acamprosate products. d. The Network Provider shall actively link individuals to medication - assisted treatment providers upon request e. Access to Services: The Network Provider shall not deny eligible individual from accessing its program or services based on the individual's current or past use of FDA - approved medications for the treatment of substance use disorders. Specifically, the Network Provider shall ensure that: i. The Network Provider's programs and services do not prevent the individual from participating in methadone treatment rendered in accordance with current federal and state methadone dispensing regulations from an Opioid Treatment Program when ordered by a physician who has evaluated the client and determined that methadone is an appropriate medication treatment for the individual's opioid use disorder; Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 49 of 67 Contract No. ME225 -9 -27 17� / South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 ii. The Network Provider shall permit the individual to access medications for FDA - approved medication - assisted treatment by prescription or office -based implantation if the medication is appropriately authorized through prescription by a licensed prescriber or provider. iii. The Network Provider shall permit continuation in medication - assisted treatment for as long as the prescriber or medication- assisted treatment provider determines that the medication is clinically beneficial; and iv. The Network Provider shall prohibit compelling an individual to no longer use medication- assisted treatment as part of the conditions of any program or services if stopping is inconsistent with a licensed prescriber's recommendation or valid prescription. 6. Prevention Services, if applicable: a. The prevention services provided under this contract are to fund rigorous, effective, evidence - based, substance abuse prevention programs and strategies and promotion of wellness (positive mental health) services as part of the continuum of behavioral health care for individuals and their families. The strategies, activities, and services must be consistent with the local community ME- approved local Needs Assessment Logic Model (NALM) and the Comprehensive Community Action Plan (CCAP). The Network Provider shall work in collaboration with the funded ME Evaluation Entity, by participating in meetings and providing service data vital for the completion of a system- wide evaluation of the prevention services within the Strategic Prevention Framework. The evaluation of the prevention system is expected to be the systematic collection and analysis of information about program activities, characteristics, and outcomes to reduce uncertainty, improve effectiveness, and assist in decision - making. The information gathered from the evaluation process will help the ME, the State and communities become more skillful and exact in describing what they plan to do, monitor what they are doing, and improve the prevention system of care. Evaluation results can and should be used to determine what efforts should be sustained and to assist in sustainability planning efforts. The ME will provide substantial input, in collaboration with the Network Provider and the Evaluation Entity, both in planning and implementation of the evaluation process and activities, and will make recommendations regarding the continuance of the activities. • b. Data Submission in PBPS: Upon submission of the monthly data, the Network Provider's Director of Prevention /Supervisor, shall send an e-mail to the ME's Director of Prevention Services attesting that the data submitted has been reviewed and approved. c. The Network Provider will accurately report the performance measures specified in Attachment IV, Scope of Work. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 50 of 67 Contract No. ME225 -9 -27 �� South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 d. Based on consumer needs, the Network Provider shall adhere to services as outlined in the approved Prevention Program Description, incorporated herein by reference and as set forth in Attachment IV, Scope of Work, in addition to providing services from the list of approved covered services listed in Exhibit G, Covered Service Funding by OCA. Any change in the array of services shall be justified in writing and submitted to the ME's Contract Manager for review and approval. 7. Intern Registration Requirements pursuant to section 491.0045, F.S. a. The Network Provider shall monitor and ensure that an individual who has not satisfied the postgraduate or post- master's level experience requirements, as specified in s. 491.005(1)(c), (3)(c), or (4)(c), F.S., register as an intern in the profession for which he or she is seeking licensure before commencing the post = master's experience requirement or for an individual who intends to satisfy part of the required graduate -level practicum, internship, or field experience, outside the academic arena for any profession, the network provider must monitor and ensure that the individual registers as an intern in the profession for which he or she is seeking licensure before commencing the practicum, internship, or field experience. b. An intern registration is valid for five (5) years. c. A registration issued on or before March 31, 2017, expires March 31, 2022, and may not be renewed or reissued. Any registration issued after March 31, 2017, expires 60 months after the date it is issued. A subsequent intern registration may not be issued unless the candidate has passed the theory and practice examination described in s. 491.005(1)(d), (3)(d), and (4)(d), F.S. d. An individual who has held a provisional license issued by the board may not apply for an intern registration in the same profession. 8. Utilization Management Program: If the Network Provider contracts for services that are utilization managed by the ME, the Network Provider shall assist the ME in the reporting and managing of the Substance Abuse and Mental Health Waiting List for all applicable levels of care. The Network _Provider agrees to submit real -time data until an automated system is implemented. a. The Network Provider agrees to adhere to the utilization management protocols pursuant to the South Florida Behavioral Health Network Coordination of Care Plan Manual — FY 2017 -18, or the latest revision thereof, herein incorporated by reference and available upon request from the Contract Manager. b. The Network Provider will have a data system in place that adequately supports the collection, tracking, and analysis of data necessary to perform utilization management Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 51 of 67 Contract No. ME225 -9 -27 �� South Florida / / Behavioral Health Network, Inc. Effective: 07/01/2018 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 utilization management system to include additional treatment services authorization and to automate the pre- authorization and billing process. The Network Provider agrees to implement the changes to the utilization management program as directed and when directed by the ME. d. The Network Provider will offer consumers a multi -level continuum of care services for treatment of behavioral health services. Each level of care as identified below have durations or length of stay as specified in the Coordination of Care Plan Manual — FY 2017 -18. e. The Network Provider shall obtain written authorization from the ME prior to providing the services as specified in the Coordination of Care Plan Manual — FY 2017 -18, or the latest revision thereof. 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 of Care Plan Manual — FY 2017 -18, or the latest revision thereof. f. When a consumer has been provided residential services as a non -ME funded consumer (e.g. paid by insurance), that stay is subtracted from the prescribed length of stay should the consumer become eligible to receive Network Provider - funded services. g. The Network Provider agrees to: (1) Utilize a transmittal system, which may be a computerized management information system, for submitting /receiving and recording information and documentation required as part of the Utilization Management Program. (2) Request and receive an authorization number from the ME for all consumers requiring admission into a substance abuse and /or mental health service as Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 52 of 67 Contract No. ME225 -9 -27 / South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 specified in the Coordination of Care Plan Manual prior to the consumer being admitted to the program for treatment. (3) Complete all required assessment components outlined in the Coordination of Care Plan Manual for all consumers requiring substance abuse and /or mental health treatment services. The information will be submitted to the ME prior to the authorization request. (4) Participate and cooperate in the centralized waiting list in accordance with the waiting list policies and procedures outlined in the Coordination of Care Plan Manual. h. Pre - Authorization Utilization Management Roster and Payment for Services Specified in the Coordination of Care Plan Manual — FY 2017 -18, or the latest revision thereof. The. Network Provider shall submit a request for reimbursement on the approved ME invoices incorporated herein by reference and available upon request from the ME's Contract Manager. A listing of all prior- authorized consumers served including, consumer name, consumer I.D. number, authorization number, covered service and service period must be provided to support the invoice. This information may be submitted on Exhibit K, SAMH Pre - Authorization Utilization Management Roster, of this contract, unless the Network Provider has an agency generated report that includes the required elements indicated above. This information must be attached to the approved ME's invoice, as a prerequisite for payment. The Network Provider shall maintain back -up documentation for step -down services for a period of seven (7) years from the expiration date of the contract per Paragraph 7. of the Standard Contract. 9. Waiting List and Interim Services a. In the event that waiting lists develop, the Network Provider will collaborate with the ME to implement procedures for managing the substance abuse and mental health waiting list for all applicable levels of care including provision of interim services through utilization management strategies. The authorization of services is specified in Section B. 7., Managing Entity Responsibilities. b. Behavioral health services shall be provided to persons pursuant to s. 394.674, F.S., including those individuals who have been identified as requiring priority by state or federal law. The identified priority populations are found in Exhibit A, Consumer /Participants to be Served, however persons in categories (i) and (ii) below are specifically identified as persons to be given immediate priority over those in any other categories. These individuals may not be placed on a wait list without receiving interim services within the required timeframes. (i) Pursuant to 45 C.F.R. s. 96.131, priority admission to pregnant women and women with 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 C.F.R. s. 96.123; Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 53 of 67 Contract No. ME225 -9 -27 / � South Florida / / Behavioral Health Network, Inc. Effective: 07/01/2018 (ii) Pursuant to 45 C.F.R. s. 96.126 (b), (1) and (2), adherence with the requirement to provide interim services for injection drug users by Network Service Providers receiving SAPT Block Grant funding. (iii) Priority for services to families with children that have been determined to require substance abuse and mental health services by child protective investigators and also . meet the target populations in subsections (a) or (b), below. Such priority shall be limited to individuals that are not enrolled in Medicaid or another insurance program, or require services that are not paid by another payor source: a. Parents or caregivers in need of adult mental health services pursuant to s. 394.674(1)(a)2., F.S., based upon the emotional crisis experienced from the potential removal of children; and b. Parents or caregivers in need of adult substance abuse services pursuant to s. 394.674(1)(c)3.,.F.S., based on the risk to the children due to a substance use disorder. Failure to adhere to the requirements in Section D. 8.b. above may result in 'a request for corrective 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. 10. Incident Reports a. The Network Provider shall submit incident reports into the Incident Reporting and Analysis System (IRAS) on all reportable incidents per CFOP 215 -6, within 24 hours of receiving notification of a reportable incident. In the event an incident has an immediate impact on the health or safety of a consumer, has potential media impact, or involves employee - related incidents of criminal activity, the Network Provider must notify the ME Risk and Compliance Coordinator immediately upon discovery. Certain incidents may warrant additional follow -up by the ME. Follow -up may include on -site investigations or requests for additional information or documentation. When additional Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 54 of 67 Contract No. ME225 -9 -27 P � South Florida / Behavioral Health Network, Inc. Effective: 07/01/2018 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. 11. Mandatory Reporting Requirements a. The. Network Provider and any subcontractor must comply with and inform its employees of the following mandatory reporting requirements. Each employee of the Network Provider, and of any subcontractor, providing services in connection with this contract who has any knowledge of a reportable incident shall report such incident as follows: 1) Reportable incidents that may involve an immediate or impending impact on the health or safety of a consumer shall be immediately reported to the Contract Manager; and 2) Other reportable incidents shall be reported to the ME and Department's Office of Inspector General by completing a Notification /Investigation Request (form CF 1934) and emailing the request to the Office of Inspector General at IG.Complaints @myflfamilies.com. The Network Provider and subcontractor may also mail the completed form to the Office of Inspector General, 1317 Winewood Boulevard, Building 5, 2nd Floor, Tallahassee, Florida, 32399 -0700; or via fax at (850) 488 -1428. A reportable incident is defined in Children and Families Operating Procedures CFOP 180 -4 (CFOP 180 -4) Mandatory Reporting Requirements to The Office of The Inspector General, which can be obtained from the Contract Manager. b. In the event of a breach or potential breach of Protected Health Information, the Network Provider is directed to the reporting requirements delineated in the executed Business Associate Agreement, incorporated herein by reference. 12. Contracted Mental Health Network Providers shall participate in the Department's aftercare referral process for formerly incarcerated individuals with severe and persistent mental illness or serious mental illness who are released to the community or who are determined to be in need of long -term hospitalization is required. Participation shall be as specified in Children and Families Operating Procedure 155 -47 (CFOP 155 -47), Processing Referrals from the Department Of Corrections which can be obtained at: http : / /www.dcf.state.fl.us /admin /publications /policies.asp and is incorporated herein by reference. 13. Health, Safety, and Physical Environment Requirements for Substance Abuse and Mental Health Levels 1, 2, and 3 Residential Treatment Facilities Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 55 of 67 Contract No. ME225 -9 -27 �� South Florida P- Behavioral Health Network, Inc. Effective: 07/01/2018 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. 14. Involuntary Commitment, Placements, Services, Treatment a. Mental Health Services Provider: The Network Provider agrees to provide services to persons who have been court ordered into involuntary outpatient services in accordance with section 394.4655, F.S., court ordered into involuntary inpatient placements as defined in section 394.467, F.S., and court ordered for involuntary examination under 394.463, F.S. b. Substance Abuse Services Provider: The Network Provider agrees to provide services to persons who have been court ordered into involuntary assessment and stabilization under section 397.6818,, F.S., and /or court ordered into an involuntary substance abuse treatment under section 397.6957, F.S. It is the Network Provider's responsibility to be familiar with and ensure that the requirement's regarding involuntary admissions are followed pursuant to, including but not limited to ss. 397.6751, F.S. c. Pursuant to s. 394.4655(3) -(4), and (7), F.S. and s. 397.697(4), F.S., if the court orders involuntary services, the Network Provider shall submit a copy of the order to the ME, to the individuals specified in Exhibit C, Required Reports, within one (1) working day after it is received from the court. Similarly, if the court orders a program or a service that is not available, Network Provider 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. 15. Motivational Support Program Attachment 1 HCO2 (a) Guidance /Care Center, Inc. Page 56 of 67 Contract No. ME225 -9 -27 � � South Florida / Behavioral Health Network, Inc. Effective: 07/01/2018 The Network Provider shall comply with the provisions of Exhibit 1, Motivational Support Program Provider Protocols, and Exhibit J, Motivational Support Program Treatment Summary Report. 16. 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 and with the requirements of 42 C.F.R. Part 2. b. In accordance with 45 C.F.R. s. 96.131(b), the Network Provider that receive Block Grant funds and that serve injection drug users shall publicize the following notice: "This program receives federal Substance Abuse Prevention and Treatment Block Grant funds and serves people who inject drugs. This program is therefore federally required to give preference in admitting people into treatment as follows: 1. Pregnant injecting drug users; 2. Pregnant drug users; 3. People who inject drugs; and 4. All others." c. A Network Provider that receives SAPT block grant funding for the purpose of primary prevention, shall comply with 45 C.F.R. s. 96.125. d. Behavioral health services shall be provided to persons pursuant to s. 394.674, F.S., including . those individuals who have been identified as requiring priority by state or federal law. The identified priority populations are found in Exhibit A, Consumer /Participants to be Served, however persons in categories (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 C.F.R. s. 96.123; (ii) Pursuant to 45 C.F.R. s. 96.126 (b), (1) and (2), adherence with the requirement to provide interim services for injection drug users by Network Service Providers receiving SAPT Block Grant funding and until the clinically appropriate level of treatment can be provided to the individual as follows: 45 C.F.R. s. 96.126 (b), (1)- (2) Capacity of treatment for intravenous substance abusers and any other requirement. (1) 14 days after making the request for admission to such a program; or (2) 120 days after the date of such request, if no such program has the capacity to admit the individual on the date of such request and if interim services, including Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 57 of 67 Contract No. ME225 -9 -27 �� South Florida / Behavioral Health Network, Inc. Effective: 07/01/2018 referral for prenatal care, are made available to the individual not later than 48 hours after such request. e. Outreach Services to Injection Drug Users: The Network Provider shall carry out outreach activities to encourage injection drug users in need of treatment to undergo such treatment pursuant to the requirements in 45 C.F.R. s. 96.126(e)., The Network Provider shall document the services to demonstrate the provision of these services per the documentation requirements for Outreach services specified in Rule 65E -14, FAC. f. As required by 45 C.F.R. ss. 96.17, the Network Provider may be requested to provide information to the ME for the purposes of reporting on SAPTBG activities to the Department g. The Network Provider shall ensure compliance with 45 C.F.R. Subpart C — Financial Management. h. The Network Provider agrees to comply with the data submission requirements outlined in DCF PAM 155 -2 and by the dates specified in Exhibit C, Required Reports. i. In addition to the modifiers to procedure codes that are currently required to be utilized as per DCF PAM 155 -2, Appendix 2, the Network Provider is directed to utilize the modifiers required for Block Grant funds, where applicable. The Network Provider also agrees to report to the ME and /or the Department, information regarding the amount and number of services paid for by the Community Mental Health Services Block Grant and /or the Substance Abuse Prevention and Treatment Block Grant. j. Only if such services are purchased through this contract is the Network Provider responsible for complying with the reporting requirements outlined in Exhibit AB, Substance Abuse Prevention and Treatment Block Grant (SAPTBG) Early Intervention Funded Services for Human Immunodeficiency Virus (HIV) by the dates and to the individual(s) listed in Exhibit C, Required Reports. Subject to other applicable state and /or federal requirements, the ME may require additional reports from the Network Provider. k. Only if such services are purchased through this contract is the Network Provider responsible for complying with the for SAPTBG set -aside funded services for pregnant women and women with dependent children services, SAPTBG set -aside funded services for HIV Early Intervention Programs and the SAPTBG set -aside funds for Evidenced -based Outreach Services to Injection Drug Users as outlined in Exhibit C, Required Reports. I. The Network Provider shall make available, either directly or by arrangement with others, tuberculosis services to include counseling, testing, and referral for evaluation and treatment pursuant to 45 C.F.R. s.96.17 and in compliance with Ch. 65D- 30.004(9). F.A.C. m. 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 Attachment 1 HCO2 (a) Guidance /Care Center, Inc. Page 58 of 67 Contract No. ME225 -9 -27 � � South Florida / Behavioral Health Network, Inc. Effective: 07/01/2018 support substance abuse prevention and treatment services and are tracked to the specific substance abuse activity as listed in Exhibit G, Covered Service Funding by OCA. n. The Network Provider is required to participate in the peer -based fidelity assessment process to assess the quality, appropriateness, and efficacy of treatment services provided to individuals under this contract pursuant to 45 C.F.R. 96.136. o. The United States Public Health Service Act, Sections 1931(a)(1)(E), and 1916 (a)(5), and Title 45 of the Code of Federal Regulations, Part 96.135(a)(5) prohibit States from expending Substance Abuse Prevention and Treatment Block Grant (SAPTBG) and Community Mental Health Services funds "To provide financial assistance to any entity other than a public or non - profit private entity ". Ordinarily, the term "financial assistance" is used to describe a grant relationship as distinguished 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 C.F.R., Part 96.135(a)(5)]. 17. 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. 18. 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. 19. 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. 20. 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 consumers. The Network Provider agrees to comply with the provisions of Children and Families Operating Procedures 40 -50 (CFOP 40 -5) Acquisition of Vehicles For Transporting Disadvantaged Consumers if public funds provided under this contract will be used to purchase vehicles which will be used to transport consumers. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 59 of 67 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 21. 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. 22. National Provider Identifier (NPI) a. All Network Providers shall obtain and use an NPI, a HIPAA standard unique health identifier for health care providers. b. An application for an NPI may be submitted online at https: / /nppes.cros.hhs.gov /NPPES /StaticForward.do ?forward = static.npista rt. c. Additional information can be obtained from one of the following websites: (1)The Florida Medicaid HIPAA located at: http : / /www.fdhc.state.fl.us /hipaa /index.shtml (2)The National Plan and Provider Enumeration System (NPPES) located at: https://nppes.cms.hhs.gov/NPPES/Welcome.do (3)The CMS NPI located at: http: / /www. cros. hhs.gov /NationalProvldentStand/ 23. 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 Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 60 of 67 Contract No. ME225 -9 -27 �� South Florida / Behavioral Health Network, Inc. Effective: 07/01/2018 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. 24. 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. 25. 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. 26. 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. 27. 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. Attachment! HCO2 (a) Guidance /Care Center, Inc. Page 61 of 67 . Contract No. ME225 -9 -27 •- South Florida Behavioral Health Network, Inc. Effective: 07 /01/2018 28. 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 Network Provider where it shall remain until this contract is terminated or until other disposition instructions are furnished by the ME's Contract Manager. When property is transferred to the Network Provider, the department shall pay for the title transfer: The Network Provider's responsibility starts when the fully accounted for property or vehicle is assigned to and accepted by the provider. Business arrangements made between the Network Provider and its subcontractors shall not permit the transfer of title of state property to subcontractors. While such business arrangements may provide for subcontractor participation in the use and maintenance of the property under their control, the ME shall hold the Network Provider solely responsible for the use and condition of said property. Network Provider inventories shall be conducted in accordance with CFOP 80 -2. (3),If any property is purchased by the provider with funds provided by this contract, the Network Provider shall inventory all nonexpendable property including all computers. A copy of which shall be submitted to the along with the expenditure report for the period in which it was purchased. At least annually, the provider shall submit a complete inventory of all such property to the ME whether new purchases have been made or not. (4)The Network Provider Inventory List, incorporated herein by reference, and available from the designated ME Contract Manager upon request, shall include, at a minimum, the identification number; year and /or model, a description of the property, its use and condition, current location, the name of the property custodian, class code (use state standard codes for capital assets), if a group, record the number and description of the components making up the group, name, make, or manufacturer, serial number(s), if any, and if an automobile, the VIN and certificate number; acquisition date, original acquisition cost, funding source, information needed to calculate the federal and /or state share of its cost. (5)The ME's Contract Manager must provide disposition instructions to the Network Provider prior to the end of the contract period. The Network Provider cannot dispose of any property that reverts to the ME or department without the Contract Manager's approval. The Network Provider shall furnish a Closeout Inventory Form no later than 30 days before the completion or Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 62 of 67 Contract No. ME225 -9 -27 ∎� South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 termination of this contract. The Closeout Inventory Form shall include all nonexpendable property including all computers purchased by the Network Provider. The Closeout Inventory Form shall contain, at a minimum, the same information required by the annual inventory. (6)The Network Provider hereby agrees that all inventories required by this contract shall be current and accurate and reflect the date of the inventory. If the original acquisition cost of a property item is not available at the time of inventory, an estimated value shall be agreed upon by both the Network Provider and the ME and shall be used in place of the original acquisition cost. (7)Title (ownership) to and possession of all property purchased by the Network Provider pursuant to this contract shall be vested in the ME upon completion or termination of this contract. During the term of this contract, the Network Provider is responsible for insuring all property purchased by or transferred to the Network Provider is in good working order. The Network Provider hereby agrees to pay the cost of transferring title to and possession of any property for which ownership is evidenced by a certificate of title. The Network Provider shall be responsible for repaying to the ME the replacement cost of any property inventoried and not transferred to the ME upon completion or termination of this contract. When property transfers from the Network Provider to the ME, the Network Provider shall be responsible for paying for the title transfer. (8)If the Network Provider replaces or disposes of property purchased by the Network Provider pursuant to this Contract, the Network Provider is required to provide accurate and complete information pertaining to replacement or disposition of the property as required on the Network Provider's annual inventory. (9)The Network Provider hereby agrees to indemnify the ME and the department against any claim or loss arising out of the Network Provider's operations of any motor vehicle purchased by or transferred to the Network Provider pursuant to this contract. (10) A formal contract amendment is required prior to the purchase of any property item not specifically listed in the approved contract budget. b. Title to Vehicles (1) Title (ownership) to, and possession of, all vehicles acquired with funds from this contract shall be vested in the ME upon completion or termination of the contract. The Network Provider will retain custody and control during the contract period, including extensions and renewals. (2) During the term of this contract, title to vehicles furnished by the state or acquired at the direction of the state (using state or federal funds) shall not be vested in the Network Provider. Subcontractors shall not be assigned or transferred title to these vehicles. The Network Provider hereby agrees to indemnify the ME or the department against any claim or Toss arising out of the operations of any motor vehicle purchased by or transferred to the provider pursuant to this contract. 29. Health Insurance Portability and Accountability Act (HIPAA) Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 63 of 67 Contract No. ME225 -9 -27 ■� South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 a. In compliance with 45 C.F.R. 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 subcontractor's 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. 30. 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), section 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., 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: http: / /dos.mvflorida.com /elections/ for - voters / voter - registration /national- voter- registration- act/ 31. Special Insurance Provisions Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 64 of 67 Contract No. ME225 -9 -27 IPP" South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 a. The Network Provider shall notify the ME Contract Manager within thirty (30) calendar days if there is a modification to the terms of insurance including but not limited to, cancellation or modification to policy limits. b. The Network Provider acknowledges that, as an independent contractor, the Network Providers, and its subcontractors, at all tiers are not covered by the State of Florida Risk Management Trust Fund for liability created by s. 284.30, F.S. c: The Network Provider shall obtain and provide proof to the ME's Contract Manager of 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 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 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. Attachment I HCO2 (a) Guidance /Care Center, Inc. Page 65 of 67 Contract No. ME225 -9 -27 P- South Florida Behavioral Health Network, Inc. Effective: 07/01/2018 h. If any officer, employee, or agent of the Network Service Provider, at all tiers, provides any professional services or provides or administers any prescription drug or medication or controlled substance in the course of the performance of the duties of the Network Service Provider, the Managing Entity shall cause the Network Service Provider, at all tiers, to obtain and provide proof to the Managing Entity and the Department of professional liability insurance coverage, including medical malpractice liability and errors and omissions coverage, to cover all Network Service Provider employees with the same limits. i. The ME and the Department shall be exempt from, and in no way liable for, any sums of money that may represent a deductible or self- insured retention under any such insurance. The payment of any deductible on any policy shall be the sole responsibility of the Network Provider purchasing the insurance. 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 Managing Entity shall be submitted to and confirmed by the Contract Manager annually by March 31. I. The requirements of this section shall be in addition to, and not in replacement of, the requirements of Section 10, of the Standard Contract to which this Attachment I is attached, but in the event of any inconsistency between the requirements of this section and the requirements of the Standard Contract, the provisions of this section shall prevail and control. E. List of Exhibits • The Network Provider agrees to comply with the exhibits listed below. The following exhibits, or the latest revisions thereof, are incorporated in and made a part of the contract. 1. Exhibit A, Clients /Participants to be Served 2. Exhibit B, Method of Payment 3. Exhibit C, Required Reports 4. Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs 5. Exhibit E, Monthly Payment Request 6. Exhibit F, State and Federal Laws, Rules and Regulations 7. Exhibit G, Covered Service Funding by OCA 8. Exhibit H, Funding Detail & Local Match Plan Attachment I.HCO2 (a) Guidance /Care Center, Inc. Page 66 of 67 Contract No. ME225 -9 -27 �/ South Florida // Behavioral Health Network, Inc. Effective: 07/01/2018 9. Exhibit I, Motivational Support (MSP) Provider Protocols 10. Exhibit J, Motivational Support Specialist Treatment Summary Report 11. Exhibit K, SAMH Pre- Authorization Utilization Management Roster 12. Exhibit L, Assisted Living Facilities with Limited Mental Health License 13. Exhibit N, Special Provisions for the Indigent Drug Program 14. Exhibit 0, Weapons and Firearms Court Petitions 15. Exhibit Q, Missing Children 16. Exhibit R, Our Kids Miami - Dade /Monroe Child Welfare Quarterly Clinical Report 17. Exhibit V, Special Provisions for the Forensic Services Program 18. Exhibit X, Special Provisions for Projects for Assistance in Transition from Homelessness (PATH) Services 19. Exhibit AA, Motivational Support Specialist 20. Exhibit AC, Care Coordination Report Narrative and Chart 21. Exhibit AI, Family Intensive Treatment Team - Scope of Work 22. Exhibit AK, SAMH Outpatient Waitlist Report Form - Part I and Part II 23. Exhibit AM, Return on Investment - Special Appropriations Projects for Fiscal Year 2018 -19 24. Exhibit AN, Supplemental Security Income /Social Security Insurance (SSI /SSDI) Outreach, Access, and Recovery (SOAR) 25. Exhibit AP, Mental Health Case Management 26. Exhibit AS, Central Receiving Facility Attachment 1 HCO2 (a) Guidance /Care Center, Inc. Page 67 of 67 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. EXHIBIT A Consumers /Participants to be Served A. GENERAL DESCRIPTION The Network Provider shall furnish services funded by this contract to the target population(s) checked below: Non- Prevention Prevention © Adult Mental Health- Severe & Persistent Mental Illness ❑ Adult Substance Abuse © Adult Mental Health- Serious & Acute Episodes of Mental ® Children's Substance Abuse Illness © Adult Mental Health - Mental Health Problems ❑ Substance Abuse Community Coalition © Adult Mental Health- Forensic Involvement ▪ Children's Mental Health- Serious Emotional Disturbances © Children's Mental Health- Emotional Disturbances © Children's Mental Health -At Risk of Emotional Disturbances © Adult Substance Abuse © Children's Substance Abuse B. CONSUMER /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.mvflfamilies.com /service - programs /substance- abuse /publications) and is incorporated herein by reference. 2. Behavioral Health services shall be provided to persons pursuant to s. 394.674, F.S., including those individuals who have been identified as requiring priority by state or federal law. These identified priorities include, but are not limited to, the categories in sections (a) through (j), below. Persons in categories (a) and (b) are specifically identified as persons to be given immediate priority over those in any other categories. a. Pursuant to 45 C.F.R. s. 96.131, priority admission to pregnant women and women with dependent children by Network 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 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), above. 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: Exhibit A Guidance /Care Center, Inc. Page 1 of 3 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. (1) Parents or caregivers in need of adult mental health services pursuant to s. 394.674(1)(a)2., F.S., based upon the emotional crisis experienced from the potential removal of children; and (2) Parents or caregivers in need of adult substance abuse services pursuant to s. 394.674(1)(c)3., F.S., based on the risk to the children due to a substance 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 1, Chapter 394, F.S.; f. Individuals who are involuntarily admitted under Part V, Chapter 397, F.S.; g. Residents of assisted living facilities as required in. s. 394.4574 and 429.075, F.S.; h. Children referred for residential placement in compliance with. Ch. 65E-9.008(4), F.A.C.; and i. Inmates approaching the End of Sentence pursuant to Children and Families Operating Procedure (CFOP) 155 -47. j. In the event of a Presidential Major Disaster Declaration, Crisis Counseling Program (CCP) services shall be contracted for according to the terms and conditions of any CCP grant award approved by representatives of the Federal. Emergency Management Agency (FEMA) and the Substance Abuse and Mental Health Services Administration (SAMHSA). 3. Mental health crisis intervention and crisis stabilization facility services, and substance abuse detoxification and addiction receiving facility services, shall be provided to all persons meeting the criteria for admission, subject to the availability of beds and /or funds. C. CONSUMER /PARTICIPANTS DETERMINATION 1. Determination of consumer eligibility is the responsibility of the Network Provider. The Network Provider shall adhere to the eligibility requirements as specified in Exhibit F, SAMH Programmatic State and Federal Laws, Rules, and Regulations. The ME reserves the right to review the Network Provider's determination of consumer eligibility and override the determination of the Network Provider. When this occurs the Network Provider will immediately 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 consumer eligibility and /or placement into the appropriate level of care, the dispute shall not preclude the Network Provider from providing the provision of services to eligible individuals until the dispute is resolved. The dispute resolution process is described in Paragraph 42. of the Standard Contract. Exhibit A Guidance /Care Center, Inc. Page 2 of 3 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 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 by the Network Provider. Exemplary Performance will be determined by the Network Provider delivering and billing for services in excess of those units of service the ME will be required to pay. The ME's obligation to pay under this Contract is contingent upon an annual appropriation by the Legislature and the Contract between the ME and the DCF. 2. The Network Provider agrees that funds provided in this contract will not be used to serve persons outside the target population(s) specified in the paragraph above. NOTE: Prevention funds allocated to underage drinking programs and activities targeting eighteen (18) to twenty (20) year old individuals may be taken from Adult Substance Abuse Prevention funds. 3. The provision of services required under this contract are limited to eligible residents, children and adults receiving authorized services within the counties outlined in Attachment 1, 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 -9 -27 South Florida Behavioral Health Network, Inc. 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 $5,832,353.00, 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 $4,860,294.00, subject to the delivery and billing for services. The remaining amount of $972,059.00 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. Fixed Price (Unit Cost) for contracts with a hybrid method of payment: 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 ($0.00), subject to the availability of funds. The unit prices are listed on Exhibit G, Covered Services Funding by OCA. c. Cost Reimbursement for contracts with a hybrid method of payment: The ME shall reimburse the Network Provider for allowable expenditures incurred pursuant to the terms of this contract and the terms in Exhibit M -1, Services to be Provided, for a total dollar amount not to exceed ($0.00); subject to the availability of funds and Exhibit M -2, Line Item Operating Budget. d. Aftercare, Intervention, Outpatient, and Recovery Support Services (Substance Abuse) are eligible for special group rates. Group services shall be billed based on 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. e. Pursuant to s. 394.76(3), Florida Statutes (F.S.), the Network Provider agrees to provide local matching funds in the amount of 51,121,609.00 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, Exhibit B Page 1 of 6 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Funding Detail, will automatically change, utilizing the following formula: The additional match required on the uncompensated units = Uncompensated Substance Abuse Services X 16.67% + Uncompensated Mental Health Services that is not exempt from local match requirements X 33.33%.* . *The following MH services are exempt from the local match requirement i. Deinstitutionalization Projects Case Management . . Intensive Case Management Residential Services I -IV Supported Housing /Living Short Term Residential Treatment .(not exempt if funded by Baker Act funds or operated by a public receiving facility) FACT Teams ii. CMH Programs (100435 Category & 102780 (PRTS) Category) that are not grant funded. f. 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. g. 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. h. The ME's decision to reduce or withhold funds will be submitted to the, Network Provider in writing. The written notice will specify the manner in which the Network Provider has failed to comply with the terms of the. contract. When, and if, compliance is achieved, the withheld funds will be disbursed to the Network Provider. I. If the Network Provider closes or suspends the provision of services funded by this contract, the Network Provider agrees to notify the ME in writing thirty (30) calendar days prior to their intent to close, suspend or end service(s). If the Network Provider fails to notify the ME, the Network Provider hereby agrees not to request payment for services provided in prior months if the actual number of services in the month for which payment is being requested is less than twenty -five percent (25 %) of the prorated amount of services by covered service as given on Exhibit G, Covered Service Funding by OCA, or twenty -five percent (25 %) of the prorated share of the amount of funding as specified on Exhibit G, Covered Service Funding by OCA. j: 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 Exhibit B Page 2 of 6 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 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: i. Individuals who have lost coverage through Medicaid, or any another publically funded health benefits assistance program coverage for any reason during the period of non - coverage subject to the sliding fee scale requirements in Rule 65E- 14.018, F.A.C; 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. 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 are 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. Exhibit B Page 3 of 6 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. . h. The Network Provider shall assist individuals receiving services who need assistance and who meet the eligibility criteria for Medicaid to make application including assistance with medical documentation required in the disability determination process. i. The Network Provider agrees to assist individuals eligible for Medicaid covered by a Medicaid capitated entity who need and request assistance to obtain covered mental health services that the treating Network Provider considers to be medically necessary. This assistance shall include assisting clients in appealing a denial of services. 4. PAYMENT FROM MEDICAID HEALTH..MAITENANCE ORGRANIZATIOINS, PREPAID .MENTAL HEALTH PLAN, OR PROVIDER SERVICE NETWORKS Unless waived in Section D (Special Provisions) of this contract, the Network Provider agrees that payments from a health maintenance organization, prepaid mental health plan, or provider services network will 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 Network Provider's attention is directed to its obligations under applicable parts of Part A or Title IV of the Social Security Act and the Network 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: http://www.dcf.stategl.us/programs/accessidocs/TANF-Plan.pdf b . The contract shall specify the unit cost rate for each covered service contracted for TANF funding, which shall be the same rate as for non -TANF funding, but the contract shall not specify the number of TANF units or the amount of TANF funding for individual covered services. 6. INVOICE REQUIREMENTS a. The rates negotiated with any Network Provider may not exceed the rate as specified in in Exhibit G, Covered Service Funding by OCA and or the amounts listed in Exhibit M -2, Line Item Operating Budget, if applicable. . 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, 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 Exhibit B Page4of6 . Guidance/Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. the Department. The invoice Exhibit E, Monthly Payment Request, is incorporated herein by reference and available upon request from the ME's Contract Manager. 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 Network 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 Network Provider must report any payments received from all other sources on the "Schedule of Bed -Day Availability" at the end of the fiscal year and refund any overpayment. i. Invoices shall be submitted in detail sufficient for a proper pre -audit and post-audit. 7. SUPPORTING DOCUMENTAITON a. The Network Provider agrees to maintain and submit to the ME, if applicable, service documentation for each service billed to the ME pursuant to this contract. The. Network Provider shall track all units billed to the ME by program and by Other Cost Accumulator (OCA). Proper service documentation for each SAMH covered service is outlined in Rule 65E- 14.021, F.A.C., Exhibit Y, TANF SAMH Guidelines and TANF SAMH Incidental Expenditures for Housing Assistance, if applicable: Exhibit B Page 5 of 6 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. b. The Network Provider shall maintain documentation to support all units billed to the ME and units subtracted for SAMH client services on each monthly request for payment. c. The Network Provider shall ensure that all services provided are entered into KIS, PBPS, or other data system designated by the ME. d. The ME, Department and the State's Chief Financial Officer, reserve the right to request supporting documentation at any time after actual units have been delivered. 8. The . Network Provider's attention is directed to the Department of Financial Services Reference Guide for State Expenditures for guidance regarding the requirements applicable to the disbursement of funds from the State Treasury, regardless of payment methods. The Reference Guide for State Expenditures can be obtained at the following website: http: / /www.mvfloridacfo.com /aadir /reference guide /Reference Guide For State Expenditu res.pdf 9. FUNDING SWEEPS The Network Provider agrees that at the sole discretion of the ME and at such time and upon terms, conditions or criteria set by the ME, a review of the funding utilization rate or pattern of the Network Provider may be conducted by the ME. Based upon such review, if it is determined that the rate of utilization may result in a lapse of funds, then in that event the ME may amend the Network Provider's total amount of funding by reducing same 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, 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 Page6of6 Guidance/Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. • Exhibit C Required Reports 3 . Required' 11 g . 1 A ° ing r T T r `=I Response to Monitoring Reports and Corrective Within 10 calendar days from the day the 1 (Electronic Submission 1. ME Contract Manager Action Plans report is received via E -mail) 2. SFBHN staff member issuing CAP External Quality Assurance Reviews, Monitoring Within 10 calendar days from the day the 1 (Electronic Submission 1. ME Contract Manager Reports, Surveys and Corrective Actions, as report is received, or as requested by the via E-mail) applicable Contract Manager 2. Director of Contract Accountability Memorandum of Understanding (MOU) with a. Federally Qualified Health Center (FQHC) Within 90 calendar days of the effective date or of the contract (for newly executed MOU's); 1 (Electronic Submission Federally Qualified Health Centers are required Within 30 calendar days for renewed MOU's; via E -mail) ME Contract Manager to submit policies and procedures that explain Updates to P &P for FQHC's shall be submitted the access to primary care services to the within 30 calendar days of adoption medically underserved behavioral health client Sliding Fee Scale [reflecting the uniform 1 (Electronic Submission schedule of discounts referenced in 65E- Prior to contract execution via E -mail) ME Contract Manager 14.018(4)] Final FY 2018 -2019 (1) Projected Cost Center Operating and Capital Submitted annually prior to contract execution. Budget, Submit updates within 30 calendar days of 1 (Electronic Submission 1. ME Contract Manager (2) Budget Narrative, execution of an amendment to the contract via E -mail) (3) Network Providers Agency Service Capacity 2. VP of Finance Report, affecting the budget. (4) Cost Center Personnel Detail Report Program Description Annually, prior to contract execution. Submit 1. ME Contract Manager (1) Organizational Profile updates within 30 calendar days of 1 (Electronic Submission (2) Service Activity Description amendment via E -mail) 2. VP of Behavioral Health Grievance Procedures Annually, prior to contract execution. Submit 1. ME Contract Manager a) Clients (applicants or recipient of services) updates within 30 calendar days of 1 (Electronic Submission b) Agency Staff implementation via E -mail) 2. VP of CQI Affidavit Regarding Debarment Annually prior to contract execution, or as 1 ME Contract Manager requested by the Contract Manager Submit updates within 30 calendar days of amendment or as requested by 1. ME Contract Manager "No Wrong Door" Policy and Procedures 1 the contract manager and /or the QA/QI Risk & Compliance Manager 2. QA/QI Risk & Compliance Manager Within 24 hours of occurrence, in accordance with CFOP 215 -6 and reportable Incident Report incidents defined CFOP 180-4 Mandatory Submission through IRAS Submission through IRAS Reporting Requirements to the Office of the Inspector General Guidance /Care Center, Inc. Exhibit C Contract No. ME225 - 9 - 27 Page 1 of 12 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports :r, Required Reports Acute Care Service Utilization Reporting for Real -time data submission as mandated by Public Receiving Facilities, Detoxification and subsection 394.9082(10), Florida Statutes Electronically KIS Express Acute Care System Addiction Receiving Facilities. Service data shall be submitted electronically, weekly, by 12:00 Noon every Wednesday. KIS, PBPS, or other data system Monthly Data Required by DCF PAM 155 -2 Final monthly shall be submitted electronically Electronically designated by the ME or the Department to the ME no later than the 4th of each month following the month of service ADA Client Communication Assessment https: / /fs16.formsite.com /DCFTraining /Month Auxiliary Aid Service Record Monthly Summary gy the 4th business day following the Iv- Summary- Report/form login. Report 1 (Electronic Submission (Applicable to agency's that employ fifteen (15) or reporting month via E -mail) more employees) Confirmation E -mail to the ME Contract Manager Monthly, by the eighth (8th) calendar day Monthly Service Invoice after the month 1 ME Sr. Accountant (Fiscal Department) • of service Submitted with the monthly invoice, as Invoice Review Supporting Documentation appropriate, and /or as requested by SFBHN 1 As requested by SFBHN staff staff Monthly, with the monthly invoice by the eighth 1. ME Sr. Accountant (Fiscal Department) Exhibit K, Pre - Authorization Utilization (8th) calendar day Management Roster for Substance Abuse and after the month 1 2. ME ASOC Manager Mental Health Residential Level II Services of service 3. ME CSOC Manager Exhibit AC, Monthly Care Coordination Report Monthly by the 5th calendar day after the Narrative and Chart 1 ME Contract Manager month of service - Transitional Voucher Monthly Report Monthly by the 10th calendar day after the 1 ME Housing Coordinator (Reporting Template will be provided by the ME) month of service TANF SAMH Program Logs and Service Data, if As per the contract and /or as requested by 1 ME TANF Coordinator applicable the contract manager Final Invoice By July 20 of each fiscal year and /or 20 days 1 ME Sr. Accountant (Fiscal Department) after contract end date Designation of Dispute Resolution Officer Within 5 working days of contract execution 1 (Electronic Submission ME Contact Manager via E -mail) Inventory Report 8/1/2018 1 (Electronic Submission ME Contract Manager via E -mail) Guidance /Care Center, Inc. Exhibit C Contract No. ME225 - 9 - 27 Page 2 of 12 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports (}Reports f Attestation of Network Provider's Verification that all applicable employees and subcontractors with access to ME and /or DCF information systems 8/1/2018 1 (Electronic Submission ME Contract Manager have signed a DCF Security Agreement form CF via E -mail) 0114 , per the Attachment I and Standard Contract 1 (Electronic Submission 1. ME Contract Manager Emergency Preparedness Plan 8/1/2018 via E -mail) 2. QA/QI Risk & Compliance Manager Civil Rights Compliance Checklist (CF0946) 8/1/2018 1 (Electronic Submission ME Contract Manager via E -mail) Civil Rights Certificate (CF707) 8/1/2018 1 (Electronic Submission ME Contract Manager via E -mail) Client Trust Fund Letter 8/1/2018 1 (Electronic Submission ME Contract Manager via E -mail) Quality Assurance /Quality Improvement Plan 8/1/2018 1 (Electronic Submission 1. ME Contract Manager via E -mail) 2. QA/QI Risk & Compliance Manager Signed Florida Department of Children and Families Employment Screening Affidavit that all 1 (Electronic Submission required staff have been screened or Network 8/1/2018 via E -mail) ME Contract Manager Provider is awaiting the results of screening Action Plan (Integration of Behavioral Health 1 (Electronic Submission 1. ME Contract Manager • Services and Primary Care, TIC, CLC) 8/31/2018 via E -mail) 2. QA/QI Risk & Compliance Manager Attestation signed by the CEO /Executive Director indicating that all applicable staff funded by this 1 (Electronic Submission Contract have received a copy of the fully 10/1/2018 via E -mail) ME Contract Manager executed Contract and will receive a copy of any amendments made to this Contract. July 5, 2018 (Period: 04/01/18 - 06/30/18) October 5, 2018 NVRA Voter Registration Agencies Quarterly (Period: 07/01/18 - 09/30/18) 1. ME Voter Registration Activities Activities Report Form (DS- DEI31; effective January 5, 2019 1 (Electronic Submission Coordinator 01/2012 or latest revision thereof, if applicable (Period: 10 /01/18 - 12/31/18) via E -mail) April 5, 2019 2. ME Contract Manager (Period: 01/01/19 - 03/31/19) July 5, 2019 (Period: 04/01/19- 06/30/19) October 31, 2018 (Period: 07/01/18 - 09/30/18) January 31, 2019 Quarterly Financial Statements (Balance Sheet (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission 1. ME VP of Finance and Statement of Activity) Apri130, 2019 via E -mail) (Period: 01/01/19 - 03/31/19) 2. ME Contract Manager July 31, 2019 (Period: 04/01/19 - 06/30/19) Guidance /Care Center, Inc. Exhibit C Contract No. ME225 - 9 - 27 Page 3 of 12 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports - r Re uirel p orts Re s _ II ; s$fi Due Date aRII October 31, 2018 (Period: 07/01/18 - 09/30/18) January 31, 2019 Attestation indicating the filing of Form 941 and (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission payment of any taxes due to the IRS have been April 30, 2019 • via E -mail) ME Contract Manager paid. (Period: 01/01/19 - 03/31/19) July 31, 2019 (Period: 04/01/19 - 06/30/19) January 30, 2019 1. ME Contract Manager Continuous Quality Improvement Updates (Period: 07/01/18 - 12/31/18) 1 (Electronic Submission July 30, 2018 via E -mail) 2. QA/QI Risk & Compliance Manager (Period: 01/01/19 - 06/30/19) Completion of the annual self- assessment for the following initiative: 1. ME Contract Manager 3/1/2019 1 1. Integration of Behavioral Health and Primary 2. QA/QI Risk & Compliance Manager Care (MeHAF) Motivational Support Program (MSP) Treatment Per Exhibit I, Motivational Support Program Per Exhibit I, Motivational Support Program Summary Form, if applicable Provider Protocols 1 Provider Protocols 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 to each of the Certification indicating that recipient expended following unless otherwise required by Florida 1 (Electronic Submission 1. ME Contract Manager less than $750,000 in Federal Awards or in State Statutes The schedule shall be based on the fiscal year via E -mail) Awards during y revenues and expenditures recorded during 2. VP of Finance the state's fiscal year. Due 180 days after the end of the Network Provider's fiscal year or within 30 days of the recipient's receipt of the audit report, whichever occurs first, directly to each of the following unless otherwise required by Florida Schedule of State Earnings Statutes The schedule shall be based on 1 (Electronic Submission 1. ME Contract Manager revenues and expenditures recorded during via E -mail) 2. VP of Finance 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, Projected Cost Center Operating and Capital whichever occurs first, directly to each of the Budget following unless otherwise required by Florida 1 (Electronic Submission 1. ME Contract Manager Actual Expenses & Revenues Schedule Statutes The schedule shall be based on via E -mail) revenues and expenditures recorded during 2. VP of Finance the state's fiscal year. Guidance /Care Center, Inc. Exhibit C Contract No. ME225 - 9 - 27 Page 4 of 12 • South Florida Behavioral Health Network, Inc. Exhibit C Required Reports Year -End Financial Reports for Network Provider's Not Requiring Audits Per Attachment II - Continued Due 180 days after the end of the Network Local Match Calculation Form - Template 9 - Provider's fiscal year or within 30 days of the Department of Children and Families form, recipient's receipt of the audit report, available at the following website: whichever occurs first, directly to each �f the following unless otherwise required by Florida 1 (Electronic Submission 1. ME Contract Manager http://www.myflfamilies.com/service- Statutes The schedule shall be based on via E -mail) programs /substance - abuse /managing- revenues and expenditures recorded during 2. VP of Finance entitiesl2018- contract -docs 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 1. ME Contract Manager Schedule of Bed -Day Availability Payments following unless otherwise required by Florida 1 (Electronic Submission Statutes The schedule shall be based on via E -mail) 2. VP of Finance revenues and expenditures recorded during the state's fiscal year. Due 180 days after the end of the Network Provider's fiscal year or within 30 days of the recipient's receipt of the audit report, Agency Prepared Financial Statements (Balance whichever occurs first, directly to each of the 1 (Electronic Submission 1. ME Contract Manager Sheet and Statement of Activity following unless otherwise required by Florida via E -mail) Statutes The schedule shall be based on 2. VP of Finance revenues and expenditures recorded during the states fiscal year. 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, Correspondence from the Auditor showing proof whichever occurs first, directly to each of the 1 (Electronic Submission 1. ME Contract Manager of submission of the Audit Report and following unless otherwise required by Florida via E -mail) Mangement Letter to the Network Provider. Statutes The schedule shall be based on 2. VP of Finance revenues and expenditures recorded during the state's fiscal year. Due 180 days after the end of the Network Provider's fiscal year or within 30 days of the recipient's receipt of the audit report, whichever occurs first, directly to each of the 1. ME Contract Manager Management letter addressed to the Network following unless otherwise required by Florida 1 (Electronic Submission Provider issued by the Auditor Statutes The schedule shall be based on via E -mail) revenues and expenditures recorded during 2. VP of Finance 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 otherwise required by Florida 1. ME Contract Manager Financial & Compliance Audit to include the Statutes The schedule shall be based on 1 (Electronic Submission necessary schedules per Attachment II revenues and expenditures recorded during via E -mail) 2. VP of Finance the state's fiscal year. Guidance /Care Center, Inc. Exhibit C Contract No. ME225 - 9 - 27 Page 5 of 12 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports `• R e p orts _v.. ?_II _ - :.._ 2 .,r', ° ' II � d a`s of Copies ,V**liagtki , ``', Year -End Financial Reports for Network Provider's Requiring Audits Per Attachment I1- Continued Due 180 days after the end of the Network Provider's fiscal year or within 30 days of the recipient's receipt of the audit report, whichever occurs first, directly to each of the following unless otherwise required by Florida Schedule of State Earnings Statutes The schedule shall be based on 1 (Electronic Submission 1. ME Contract Manager revenues and expenditures recorded during via E -mail) 2. VP of Finance the state's fiscal year. Due 180 days after the end of the Network Provider's fiscal year or within 30 days of the recipients receipt of the audit report, whichever occurs first, directly to each of the Schedule of Related Party Transaction following unless otherwise required by Florida 1 (Electronic Submission 1. ME Contract Manager Adjustments Statutes The schedule shall be based on via E -mail) revenues and expenditures recorded during 2. VP of Finance the states fiscal year. Due 180 days after the end of the Network Local Match Calculation Form - Template 9 - Provider's fiscal year or within 30 days of the Department of Children and Families form, recipient's receipt of the audit report; available at the following website: whichever occurs first, directly to each of the following unless otherwise required by Florida 1 (Electronic Submission 1. ME Contract Manager http: /lwww.myffamilies.com /service- Statutes The schedule shall be based on via E -mail) programs /substance- abuse /managing- revenues and expenditures recorded during 2. VP of Finance entities /2018 - contract -docs 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, Projected Cost Center Operating and Capital whichever occurs first, directly to each of the Budget following unless otherwise required by Florida 1 (Electronic Submission 1. ME Contract Manager Actual Expenses & Revenues Schedule Statutes The schedule shall be based on via E -mail) revenues and expenditures recorded during 2. VP of Finance 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 otherwise required by Florida 1 (Electronic Submission 1. ME Contract Manager Schedule of Bed -Day Availability Payments Statutes The schedule shall be based on via E -mail) 2. VP of Finance revenues and expenditures recorded during the states fiscal year. Substance Abuse and Mental Health Outpatient Services Waitlist Reports 1. ME Adult System of Care Manager Monthly by the 5th for the preceding month's 1 (Electronic Submission Outpatient Wait List Report Form - services. via E -mail) and /or Exhibit AK, Part I and Part II 2. ME Children's System of Care Manager Guidance /Care Center, Inc. Exhibit C Contract No. ME225 - 9 - 27 Page 6 of 12 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports ' Vird@TCE20 (� .;;, maim e C:0 .: lI D r Reports Required for Children's Mental Health Providers, as applicable Children's Mental Health Quarterly clinical Per Exhibit R, Child Welfare Quarterly Clinical 1 Copy in client chart reports on all dependent children, if applicable Report Children's Mental Health Quarterly clinical Per Exhibit R, Child Welfare Quarterly Clinical reports on all community children, if applicable Report 1 Copy in client chart Per Exhibit S - Monthly Census Report by the One (1) Encrypted 1. ME Contract Manager Children's Crisis Response Team (CCRT) 15th of every month following the month of Electronic Submission service attachment to an email to 2. Children's System of Care Manager each recipient Reports Required for Behavioral Health Network (BNet) Provider 1. ME Contract Manager One (1) Encrypted Alternative Services Provision Documentation Within 15 calendar days after end of month Electronic Submission 2. ME BNet Coordinator (Other than Pharmaceuticals) attachment to an email to each recipient 3. Children's Mental Health State Program Office 1. ME Contract Manager One (1) Encrypted Alternative Services Provision Documentation Within 15 calendar days after end of month Electronic Submission 2. ME BNet Coordinator (Pharmaceuticals only) attachment to an email to each recipient 3. Children's Mental Health State Program Office 1. ME Contract Manager One (1) Encrypted Statement of Program Cost September 1 following close of the contract Electronic Submission 2. ME BNet Coordinator year (June 30) attachment to an email to each recipient 3. Children's Mental Health State Program Office Required Reports for Receiving Facilities and /or Treatment Facilities Weapons and Firearms Court Petitions Month/ Within 15 calendar days after end of month 1. ME Contract Manager y 1 (Electronic Submission Report, Exhibit O for the preceding month's information - ( via E -mail) Only CSU and CMHC 2. ME Data Anaylst Reports Required for Adult Mental Health Providers, as applicable PATH Annual Data Report to SAMHSA, if 1 (Electronic Submission Per instruction on the PATH Grant applicable Per PATH Grant Application Instructions via E -mail) Application Guidance /Care Center, Inc. Exhibit C Contract No. ME225 - 9 - 27 Page 7 of 12 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports - � ° ° Required Reports { • ��: t Reports Required for Adult Mental Health Providers, as applicable- Continued PATH Local Match Expenditure Report, if Monthly by the 8th of each month following the 1 (Electronic Submission 1. ME Sr. Accountant (Fiscal Department) month of service applicable via E -mail) 2. ME Contract Manager PATH Monthly Report (generated from the HMIS Monthly, by the 5th calendar day 1 (Electronic Submission . 1. ME Contract Manager system) after the month via E -mail) of service 2. ME Housing Coordinator Other PATH data reports as requested by the ME As requested by the ME As requested by the ME ME Contract Manager & Requestor October 5, 2018 (Period: 07/01/18 - 09/30/18) January 5, 2019 Assisted Living Facility with a Limited Mental (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission 1. ME Contract Manager Health License Client Quarterly Report, per April 5, 2019 Exhibit L (Period: 01/01/19 - 03/31/19) via E -mail) 2. ME Adult System of Care Manager July 5, 2019 (Period: 04/01/19 - 06/30/19) Report Required for Florida Assertive Community Treatment (FACT) Providers Vacant Position Report per Section II.H., Report Monthly by the 7th of each month following the 1 (Electronic Submission 1. ME Contract Manager in Exhibit AF month of service via E -mail) 2. ME Adult System of Care Manager October 5, 2018 (Period: 07/01/18 - 09/30/18) January 5, 2019 FACT Enhancement Reconciliation Report per (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission 1. ME Contract Manager Section II.H., Report in Exhibit AF April 5, 2019 via E -mail) (Period: 01/01/19 - 03/31/19) 2. ME Adult System of Care Manager July 5, 2019 (Period: 04/01/19 - 06/30/19) October 5, 2018 (Period: 07/01/18 - 09/30/18) January 5, 2019 Ad -Hoc Quarterly Report per Section II.H., (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission 1. ME Contract Manager Report in Exhibit AF April 5 , 2019 via E -mail) (Period: 01/01/19- 03/31/19) 2. ME Adult System of Care Manager July 5, 2019 (Period: 04/01/19 - 06/30/19) October 5, 2018 (Period: 07/01/18 - 09/30/18) January 5, 2019 Outcomes and Output Performance Measures (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission 1. ME Contract Manager Report, per Section II.H., Report in Exhibit AF April 5 , 2019 via E -mail) (Period: 01/01/19 - 03/31/19) 2. ME Adult System of Care Manager July 5, 2019 (Period: 04/01/19 - 06/30/19) Report Required for Miami -Dade Forensic Alternative (MDFAC) Providers Daily Census Report Daily, by 10:00 am, Monday - Friday 1 (Electronic Submission Regional Forensic Coordinator via E -mail) Guidance /Care Center, Inc. Exhibit C Contract No. ME225 - 9 - 27 Page 8of12 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports I __ Repo .; • • u -� Required J • 1 '• ir_.Se? {:1�C °� :_' II £lofCopies „�•��_ -_II�t�B Report Required for Miami -Dade Forensic Alternative (MDFAC) Providers- Continued Monthly Program Quality Review Tracking By the 15th of each month following the month 1 (Electronic Submission 1. ME Contract Manager Report of services via E -mail) 2. Regional Forensic Coordinator Monthly Performance Measures Report By the 15th of each month following the month 1 (Electronic Submission 1. ME Contract Manager of services via E -mail) 2. Regional Forensic Coordinator Reports Required for Forensic Services Providers Monthly Report for Individuals on Conditional 1. ME Forensic Coordinator Release, if applicable By 15th of each month 1 2. Mental Health Administrator Office Statewide Forensic Bed Census Report, if Weekly (Every Thursday by 5:00 pm) 1 ME Forensic Coordinator applicable Reports Required for Forensic Multidisciplinary Team Provider Monthly Forensic Multidisciplinary Team Report — By 10th of each month for the preceding 1 (Electronic Submission 1 • ME Contract Manager DCF Template 25 months' services via E -mail) 2, Regional Forensic Coordinator By 10th of each month for the preceding 1 (Electronic Submission 1. ME Contract Manager Monthly Vacant Position(s) Reports. This months' services via E -mail) 2. Regional Forensic Coordinator By 10th of each month for the preceding 1 (Electronic Submission 1. ME Contract Manager Monthly Court Reports. months' services via E -mail) 2. Regional Forensic Coordinator Quarterly Expenditure Reconciliation of Funds By 10th of each month for the preceding 1 (Electronic Submission 1. ME Contract Manager Report/Enhancement Reconciliation Report. months' services via E -mail) 2, Regional Forensic Coordinator Reports Required for Consumer - Driven Agencies October 5, 2018 (Period: 07/01/18 - 09/30/18) January 5, 2019 (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission Enrollment/Membership Report April 5, 2019 via E -mail) ME Contract Manager (Period: 01/01/19 - 03/31/19) July 5, 2019 (Period: 04/01/19 - 06/30/19) • • Reports Required for Substance Abuse Services Providers January 5, 2019 Report for HIV Early Intervention Services, SAPT (Period: 07/01/18 - 12/31/18) 1 (Electronic Submission Block Grant Set Aside Funded Services Only July 5 , 2019 via E -mail) ME Contract Manager (Period: 01/01/19 - 06- 30 -19) Annual Report for Evidenced -based Injection 1 (Electronic Submission Drug User Outreach Services, SAPT Block Grant Upon Request via E -mail) ME Contract Manager Mandate, Designated Providers Only Guidance /Care Center, Inc. Exhibit C Contract No. ME225 - 9 - 27 Page 9 of 12 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports __Required Reports , II - :,, .rg .Due Date Reports Required for Substance Abuse Services Providers- Continued Annual Report for Pregnant Women and Women 1 (Electronic Submission With Dependent Children SAPT Block Grant Set Upon Request via E -mail) ME Contract Manager Aside Funded Services Only Monthly Outcomes for Women's Expansion Due monthly, by the 4th of every month 1 (Electronic Submission 1. ME IT Office Grant — Special Appropriation following the month of service via E -mail) 2. ME Contract Manager Monthly STR Data Collection Report - Florida Response to the Opioid Crisis - STR - Medication Due monthly, by the 15th of every month 1 (Electronic Submission Assisted Treatment Services, OCA: MSOPM - following the month of service via E -mail) ME Contract Manager Exhibit U STR PFS Grant Hospital Peer Pilot Project - Per Due monthly, by the 20th of every month 1 (Electronic Submission ME Contract Manager Exhibit following the month of service via E -mail) Reports Required for Substance Abuse Prevention Services Providers Prevention service data shall be submitted PBPS, or other data system designated by Monthly Data Required by DCF PAM 155 -2 electronically to PBPS no later than the 4th of Electronically the ME or the Department each month following the month of service Monthly Data to the ME's contracted evaluation Monthly, by the 4th calendar day after the DOES or any other format requested by entity -BSRI month of service Electronically BSRI Monthly Service Invoice Monthly, by the eighth (8th) calendar day after 1 ME Sr. Accountant (Fiscal Department) the month of service Invoice Review Supporting Documentation - from Submitted with the monthly invoice 1 ME Sr. Accountant (Fiscal Department) PBPS in a jpeg format Monthly E -Mail Notification to the ME Prevention Services Director and ME Data Analyst verify that the data in the PBPS system has been checked 1. ME Director or Prevention Services and is correct and complete and may be used for Monthly, by the 4th calendar day after the 1 (Electronic Submission Block Grant reporting and payment. month of service via E -mail) 2. ME Data Analyst Refer to Scope of Work Attachment to the Contract for specifics Guidance /Care Center, Inc. Exhibit C Contract No. ME225 - 9 - 27 Page 10 of 12 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports • Required Reports 3,1192121511a' II II " -_ �. �a� „ - � ' .; -, II, ,, q of Copies , r0823 � st 4ri . ,, ) Reports Required for Substance Abuse Prevention Services Providers- Continued October 15, 2018 (Period: 07/01/18 - 09/30/18) January 15, 2019 1. ME Director of Prevention Services . Prevention Services Quarterly Reports (Fidelity (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission to EBPs) April 15, 2019 via E -mail) 2. BSRI - ME Contracted Prevention (Period: 01/01/19 - 03/31/19) Services Evaluation Provider July 15, 2019 (Period: 04/01/19 - 06/30/19) Final Annual Site Schedule 8/31/2018 1 (Electronic Submission 1. ME Contract Manager via E -mail) 2. ME Director of Prevention Services Memorandum of Understandin MOU with a Within 30 calendar days of the. effective date g ( ) of the contract (for newly executed MOU's) 1 (Electronic Submission 1. ME Contract Manager Community Coalition OR via E -mail) Within 30 calendar days for renewed MOU's 2. ME Director or Prevention Services Refer to Scope of Work Attachment to the 1 (Electronic Submission 1. ME Contract Manager Submission of Participant Satisfaction Survey - Contract for specifics via E -mail) 2. ME Director or Prevention Services Reports Required for Providers Receiving Specific Appropriations 1. ME Contract Manager Initial Projected Return on Investment 7/10/2018 1 (Electronic Submission via E -mail) October 10, 2018 (Period: 07/01/18 - 09/30/18) January 10, 2019 1. ME Contract Manager Quarterly Updates on Return on Investment (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission Report - Per Exhibit AM April 10 , 2019 (Period: 01/01/19 - 03/31/19) via E -mail) July 10,2019 (Period: 04/01/19- 06/30/19) Reports Required for the Navigate Program Provider October 31, 2018 (Period: 07/01/18 - 09/30/18) January 31, 2019 (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission Quarterly Services Report May 1, 2019 via E -mail) ME Contract Manager. (Period: 01/01/19 - 03/31/19) July 31, 2019 (Period: 04/01/19 - 06/30/19) October 31, 2018 (Period: 07/01/18 - 09/30/18) January 31, 2019 (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission Navigate Program Quarterly Expenditure Report May 1, 2019 via E -mail) ME Contract Manager (Period: 01/01/19 - 03/31/19) July 31, 2019 (Period: 04/01/19 - 06/30/19) Guidance /Care Center, Inc. Exhibit C Contract No. ME225 - 9 - 27 Page 11 of 12 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports RequiredRepnrts _ r i r I _. ; Due�Uate .* < II F •`» ' ofrGopies � F # _i.. °: L `v a`'a ,_ l Required Reports for Designated Central Receiving Facility Service Providers Performance Measures Report, per Exhibit's AQ By the 15th of every month following the 1 (Electronic Submission ME Contract Manager and AS, as applicable reporting month via E -mail) Reports Required for the Forensic Mental Health Services Program Appendix A, Conditional Release Report By the 10th of every month following the 1 (Electronic Submission ME Forensic Manager • reporting month via E -mail) Weekly Statewide Census Report Weekly by 12:00 Noon every Thursday 1 (Electronic Submission ME Forensic Manager via E -mail) Appendix B, Monthly Diversion Report By the 10th of every month following the 1 (Electronic Submission ME Forensic Manager reporting month via E -mail) Quarterly SMHFT Visit Report Due within thirty (30) calendar days of date of 1 (Electronic Submission ME Forensic Manager the visit via E -mail) January 5, 2018 (Period: 07/01/17 - 12/31/17) 1 (Electronic Submission Staffing Report July 5, 2018 ME Forensic Manager • . • (Period: 01/01/18 - 06- 30 -18) via E -mail) 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 -9 -27 Page 12 of 12 South Florida Behavioral Health Network, Inc. Rev. 7.1.2018 EXHIBIT D Substance Abuse & Mental Health Required Performance Outcomes & Outputs Provider Name: - Guidance /Care Center, Inc. Contract #: ; ME225 -9 -27 Date: 7/1/2018 Revision #: Table fl Network EDItiolcu Provider i Jnl - Population 1 Description Network Target Adults Community Mental Health MH003 a. Average annual days worked for pay for adults with severe and persistent mental 40 illness MH703 b. Percent of adults with serious mental illness who are competitively employed 24% MH742 c. Percent of adults with severe and persistent mental illnesses who live in stable 90% housing environment MH743 d. Percent of adults in forensic involvement who live in stable housing environment 67% MH744 e. Percent of adults in mental health crisis who live in stable housing environment 86% Adult Substance Abuse SAA73 a. Percentage change in clients who are employed from admission to discharge 10% SA754 b. Percent change in the number of adults arrested 30 days prior to admission versus 15% 30 days prior to discharge SA755 c. Percent of adults who successfully complete substance abuse treatment services 51% SA756 d. Percent of adults with substance abuse who live in a stable housing environment 94% at the time of discharge Children's Mental Health MH012 a. Percent of school days seriously emotionally disturbed (SED) children attended 86% MH377 b. Percent of children with emotional disturbances (ED) who improve their level of 64/ functioning MH378 c. Percent of children with serious emotional disturbances (SED) who improve their 65% level of functioning MH778 d. Percent of children with emotional disturbance (ED) who live in a stable housing 95% environment MH779 e. Percent of children with serious emotional disturbance (SED) who live in a stable 93% housing environment MH780 f. Percent of children at risk of emotional disturbance (ED) who live in a stable 96% housing environment Children's Substance Abuse SA725 a. Percent of children who successfully complete substance abuse treatment services 48% SA751 b. Percent change in the number of children arrested 30 days prior to admission 20% versus 30 days prior to discharge SA752 c. Percent of children with substance abuse who live in a stable housing U environment at the time of discharge 93 Exhibit D Guidance /Care Center, Inc. Page 1 of 2 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 7.1.2018 Table 2 Network Service Provider Output Measures — Persons Served For Fiscal Year FY18 -19 Service Category FY Target Residential Care 34 To L Outpatient Care 1599 �o Crisis Care 400 a State Hospital Discharges N/A Peer Support Services 0 Residential Care 0 a, 2 Outpatient Care 531 L. Crisis Care 14 Residential Care 12 Outpatient Care 305 Detoxification 215 co Women's Specific Services 0 Injecting Drug Users 0 Peer Support Services 0 Residential Care 0 Outpatient Care 284 N Detoxification 0 C Q Prevention * * Refer to Attachment IV, Scope of Work for the numbers served. ** Network Provider Compliance: Failure to meet the applicable standards established in Tables 1 and 2 shall be considered nonperformance pursuant to Standard Contract, Paragraph 36. Financial Consequences for Network Provider's Failure to Perform. Exhibit D Guidance /Care Center, Inc. Page 2 of 2 Contract No. ME225 -9 -27 South Florida. Behavioral Health Network, Inc. 7/1/2018 EXHIBIT E Monthly Payment Request 1. Exhibit E, Monthly Payment Request This exhibit is incorporated by reference and available upon request to the ME's Contract Manager Exhibit E Guidance /Care Center, Inc. 1 of 1 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Revised 71112017 Exhibit F SAMH PROGRAMMATIC STATE AND FEDERAL LAWS, RULES, AND REGULATIONS The Network Provider and its subcontractors shall comply with all applicable state and federal laws, rules and regulations, as amended from time to time, that affect the subject areas of the contract. Authorities include but are not limited to the following: F -1 Federal Authority F -1.1 Block Grants Regarding Mental Health and Substance Abuse B -1.1.1 Block Grants for Community Mental Health Services 42 U.S.C. ss. 300x, et seq. B -1.1.2 Block Grants for Prevention and Treatment of Substance Abuse 42 U.S.C. ss. 300x -21 et seq. 45 C.F.R. Part 96, Subpart L F -1.2 Department of Health And Human Services, General Administration, Block Grants 45 C.F.R. Part. 96 F -1.3 Charitable Choice Regulations Applicable to Substance Abuse Block Grant and PATH Grant 42 C.F.R. Part 54 F -1.4 Confidentiality Of Substance Use Disorder Patient Records 42 C.F.R. Part 2 F -1.5 Security and Privacy 45 C.F.R. Part 164 F -1.6 Supplemental Security Income for the Aged, Blind and Disabled 20 C.F.R. Part 416 F -1.7 Temporary Assistance to Needy Families (TANF) 42 U.S.C. ss. 601 - 619 45 C.F.R., Part 260 F -1.8 Projects for Assistance in Transition from Homelessness (PATH) 42 U.S.C. ss. 290cc-21 — 290cc -35 F -1.9 Equal Opportunity for Individuals with Disabilities (Americans with Disabilities Act of 1990) 42 U.S.C. ss. .12101 -12213 F -1.10 Prevention of Trafficking (Trafficking Victims Protection Act of 2000) 22 U.S.C. s. 7104 2 C.F.R. Part 175 F -2 Florida Statutes F -2.1 Child Welfare and Community Based Care Ch. 39, F.S. Proceedings Relating to Children Exhibit F Page l of 4 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 Ch. 402, F.S. Health and Human Services: Miscellaneous Provisions F -2.2 Substance Abuse and Mental Health Services Ch. 381, F.S. Public Health: General Provisions Ch. 386, F.S. Particular Conditions Affecting Public Health Ch. 394, F.S. Mental Health Ch. 395, F.S. Hospital Licensing and Regulation Ch. 397, F.S. Substance Abuse Services Ch. 400, F.S. Nursing Home and Related Health Care Facilities Ch. 414, F.S. Family Self- Sufficiency Ch. 458, F.S. Medical Practice Ch. 464, F.S. Nursing Ch. 465, F.S. Pharmacy Ch. 490, F.S. Psychological Services Ch. 491, F.S. Clinical, Counseling, and Psychotherapy Services Ch. 499, F.S. Florida Drug and Cosmetic Act Ch. 553, F.S. Building Construction Standards Ch. 893, F.S. Drug Abuse Prevention and Control S. 409.906(8), F.S. Optional Medicaid Services - Community Mental Health Services F -2.3 Developmental Disabilities Ch. 393, F.S. Developmental Disabilities F -2.4 Adult Protective Services Ch. 415, F.S. Adult Protective Services F -2.5 Forensics Ch. 916, F.S. Mentally Deficient and Mentally III Defendants Ch. 985, F.S. Juvenile Justice; Interstate Compact on Juveniles S. 985.19, F.S. Incompetency in Juvenile Delinquency Cases S. 985.24, F.S. Interstate Compact on Juveniles; Use of detention; prohibitions F -2.6 State Administrative Procedures and Services Ch. 119, F.S. Public Records Ch. 120, F.S. Administrative Procedures Act Ch. 287, F.S. Procurement of Personal Property and Services Ch. 435, F.S. Employment Screening Ch. 815, F.S. Computer - Related Crimes Ch. 817, F.S. Fraudulent Practices Exhibit F Page 2 of 4 Guidance/Care Center, Inc. Contract No. ME225 -9 -27 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, and invoices; processing time limits; dispute resolution; agency or judicial branch compliance S. 216.181(16)(b), F.S. Advanced funds for program startup or contracted services F -3 Florida Administrative Code F -3.1 Child Welfare and Community Based Care Ch. 65C -13, F.A.C. Foster Care Licensing Ch. 65C -14, F.A.C. Child- Caring Agency Licensing Ch. 65C -15, F.A.C. Child- Placing Agencies F -3.2 Substance Abuse and Mental Health Services Ch. 65D -30, F.A.C. 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 F -3.3 Financial Penalties Ch. 65 -29, F.A.C. Penalties on Service Providers F -4 MISCELLANEOUS F -4.1 Department of Children and Families Operating Procedures CFOP 155 -10 / 175 -40 Services for Children with Mental Health and Any Co- Occurring Substance Abuse or Developmental Disability Treatment Needs in Out- of -Home Care Placements CFOP 155 -11 Title XXI Behavioral Health Network CFOP 155 -47 Processing Referrals From The Department Of Corrections CFOP 215 -6 Incident Reporting and Analysis System (IRAS) F -4.2 Standards applicable to Cost Principles, Audits, Financial Assistance and Administrative Requirements S. 215.97, F.S. Florida Single Audit Act Exhibit F Page 3 of 4 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 • S. 215.971, F.S. Agreements funded with federal or state assistance Comptroller's Memorandum No. 03 (1999 -2000) Florida Single Audit Act Implementation CFO's Memorandum No. 03 (2014 - 2015) Compliance Requirements for Agreements 2 C.F.R., Part 200 Office of Management and Budget Guidance - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, . available at https : / /federalregister.gov /a/2013 -30465 2 C.F.R., Part 300 Department of Health and Human Services - Office of Management and Budget Guidance - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, Adoption of 2 C.F.R. Part 200 45 C.F.R., Part 75 Uniform Administration Requirements, Cost Principles, and Audit Requirements for HHS Awards F -4.3 Data Collection and Reporting Requirements S. 394.74(3)(e), F.S. Data Submission S. 394.9082, F.S. Behavioral health managing entities S. 394.77, F.S. Uniform management information, accounting, and reporting systems for providers S. 397.321(3)(c), F.S. Data collection and dissemination system DCF PAM 155 -2 Mental Health and Substance Abuse Measurement and Data «< The remainder of this page is intentionally left blank. »> Exhibit F Page 4 of 4 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 EXHIBIT G: COVERED SERVICES FUNDING BY OCA Revised: 7/1/18 Guidance /Care Center, Inc. ME225 -9 -27 AA!!! COVERED SERVICES FUNDING / RATE MH0O1 MH009 MH018 5111072 M11073 MH076 MH094 MHOPG MHOTB MH026 MHSFP TOTAL 228,629 915,082 1,130,503 160,000 - 5,945 - 90,000 - - - $ 2,530,159 01 Assessment $ 83.18 150,000 20,000 15,000 $ 185,000 02 Case Management $ 90.84 65,000 15,000 70,000 $ ' 150,000 03 Crisis Stabilization $ 351.62 1,095,503 $ 1,095,503 04 Crisis Support/Emergency $ 35.43 35,000 $ 35,000 06 Day/Night $ - $ - 07 Drop - In/Self Help Centers $ 33.43 20,000 $ 20,000 08 In- Home /On -Site $ 93.34 1,000 $ 1,000 11 Intervention - Individual $ 66.44 140,000 20,000 $ 160,000 42 Intervention - Group $ 16.61 $ - 12 Medical Services $ 484.75 425,000 35,000 $ 460,000 13 Medication - Assisted Treatment $ 21.66 $ - 14 Outpatient - Individual $ 67.09 75,000 7,000 $ 82,000 35 Outpatient - Group $ 16.77 1,000 3,000 $ 4,000 15 Outreach $ 49.85 1,000 60,000 2,000 $ 63,000 18 Residential Level I $ 291.08 50,000 $ 50,000 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ 293.96 $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ 55.70 $ - 28 Incidental Expenses $ 1.00 5,945 3,000 $ 8,945 29 Aftercare - Individual $ - $ 43 Aftercare - Group $ - $ - 30 Information & Referral $ 37.93 15,000 $ 15,000 34 FACT Team $ - $ - 36 Room & Board Level I $ - $ - 37 Room & Board Level II $ - $ - 38 Room & Board Level HI $ 105.15 178,629 $ 178,629 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ 50.69 22,082 $ 22,082 44 CCST - Individual $ - $ - 45 CCST - Group $ - $ - 46 Recovery Support - Individual $ - $ - 47 Recovery Support - Group $ - $ - 48 Prevention - Indicated $ 65.07 $ - 49 Prevention - Selective $ 68.59 $ - 50 Prevention - Universal Direct $ 68.59 $ - 51 Prevention - Universal Indirect $ - - $ - 99 Special Proviso /Cost Reimbursement $ - $ - FITT Pro :ram $ - *Hi hlighted Isdb eligible ptl'ogfl allocation TOTAL FUNDING $ 4,860,294 $ 228,629 $ 915,082 $ 1,130,503 $ 160,000 $ - $ 5,945 $ - $ 90,000 $ - $ - $ - $ 2,530,159 TOTAL UNCOMPENSATED $ 972,059 $ 506,032 Guidance /Care Center, Inc. Exhibit G Contract No. ME225 -9 -27 Page 1 of 4 • EXHIBIT G: COVERED SERVICES FUNDING BY OCA Revised: 7/1/18 Guidance /Care Center, Inc. C \I11 ME225 -9 -27 COVERED SERVICES FUNDING / RATE MH001 MH009 MH018 MH071 MHTRV MHOCN MHOCF TOTAL 470,000 15,677 - - - - $ 485,677 01 Assessment $ 83.18 45,000 $ 45,000 02 Case Management $ 90.84 10,000 $ 10,000 03 Crisis Stabilization $ 351.62 $ - 04 Crisis Support/Emergency $ 35.43 15,677 $ 15,677 06 Day/Night $ - $ - 07 Drop - In/Self Help Centers $ 33.43 $ - 08 In- Home/On -Site $ 93.34 286,000 $ 286,000 11 Intervention - Individual $ 66.44 50,000 $ 50,000 42 Intervention - Group $ 16.61 $ - 12 Medical Services $ 484.75 45,000 $ 45,000 13 Medication- Assisted Treatment $ 21.66 $ - 14 Outpatient - Individual $ 67.09 2,000 $ 2,000 35 Outpatient - Group $ 16.77 $ - 15 Outreach $ 49.85 30,000 $ 30,000 18 Residential Level I $ 291.08 $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ 293.96 $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ 55.70 $ - 28 Incidental Expenses $ 1.00 $ - 29 Aftercare - Individual $ - $ - 43 Aftercare - Group $ - $ - 30 Information & Referral $ 37.93 2,000 $ 2,000 34 FACT Team $ - $ - 36 Room & Board Level I $ - $ - 37 Room & Board Level II $ - $ - 38 Room & Board Level III $ 105.15 $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ 50.69 $ - 44 CCST - Individual $ - $ - 45 CCST - Group $ - $ - 46 Recovery Support - Individual $ - $ - 47 Recovery Support - Group $ - $ - 48 Prevention - Indicated $ 65.07 $ - 49 Prevention - Selective $ 68.59 $ - 50 Prevention - Universal Direct $ 68.59 $ - 51 Prevention - Universal Indirect $ - $ - 99 Special Proviso /Cost Reimbursement $ - $ - FITT Pro :ram $ - * i hli hted (Kgaziam eligible ti:iliEra allocation TOTAL FUNDING $ 4,860,294 $ - $ 470,000 $ 15,677 $ - $ - $ - $ - $ 485,677 TOTAL UNCOMPENSATED $ 972,059 $ 97,135 Guidance /Care Center, Inc. Exhibit G Contract No. ME225 -9 -27 Page 2 of 4 EXHIBIT G: COVERED SERVICES FUNDING BY OCA Revised: 7/1/18 Guidance /Care Center, Inc. ME225 -9 -27' COVERED SERVICES FUNDING /RATE MS003 MSO11 MS021 MS023 MS025 MS027 MSO81 MH091 MSOTB MS903 MSOPH MSOCF TOTAL - 271,791 486,643 - - - - 633,188 - - - - $ 1,391,622 01 Assessment $ 83.18 20,000 $ 20,000 02 Case Management $ 90.84 70,000 $ 70,000 03 Crisis Stabilization $ 351.62 $ - 04 Crisis Support/Emergency $ 35.43 25,000 $ 25,000 06 Day/Night $ - $ - 07 Drop - In/Self Help Centers $ 33.43 $ - 08 In- Home /On -Site $ 93.34 15,000 $ 15,000 11 Intervention - Individual $ 66.44 20,000 $ 20,000 42 Intervention - Group $ 16.61 $ - 12 Medical Services $ 484.75 $ - 13 Medication- Assisted Treatment $ 21.66 15,000 $ 15,000 14 Outpatient - Individual $ 67.09 15,000 $ 15,000 35 Outpatient- Group $ 16.77 85,000 $ 85,000 15 Outreach $ 49.85 17,000 $ 17,000 18 Residential Level I $ 291.08 $ - 19 Residential Level 11 $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ 293.96 461,643 $ 461,643 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ 55.70 14,791 $ 14,791 28 Incidental Expenses $ 1.00 $ - 29 Aftercare - Individual $ - $ - 43 Aftercare - Group $ - $ - 30 Information & Referral $ 37.93 $ - 34 FACT Team $ - $ - 36 Room & Board Level I $ - $ - 37 Room & Board Level II $ $ - - 38 Room & Board Level III $ 105.15 $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ 50.69 $ - 44 CCST - Individual $ - $ - 45 CCST - Group $ - $ - 46 Recovery Support - Individual $ - $ - 47 Recovery Support - Group $ - $ - 48 Prevention - Indicated $ 65.07 $ - 49 Prevention - Selective $ 68.59 $ - 50 Prevention - Universal Direct $ 68.59 $ - 51 Prevention - Universal Indirect $ - $ - 99 Special Proviso /Cost Reimbursement $ - $ - FITT Pro. ram 633,188 $ 633,188 *Ili • bli, hted fib[ lip ail ible J MEd allocation , TOTAL FUNDING $ 4,860,294 $ - $ 271,791 $ 486,643 $ - $ - $ - $ - $ 633,188 $ - $ - $ - $ - $ 1,391,622 TOTAL UNCOMPENSATED $ 972,059 $ 278,324 Guidance /Care Center, Inc. Exhibit G Contract No. ME225 -9 -27 Page 3 of 4 EXHIBIT G: COVERED SERVICES FUNDING BY OCA Revised: 7/1/18 Guidance /Care Center, Inc. ME225 -9 -27 (S, COVERED SERVICES FUNDING / RATE MS003 MS011 MS021 MS023 MS025 MSOPP MSOTB MS903 MSTRV MSOCN MSOCF TOTAL - 253,773 - - 199,063 - - - - - - $ 452,836 01 Assessment $ 83.18 15,000 $ 15,000 02 Case Management $ 90.84 40,000 $ 40,000 03 Crisis Stabilization $ 351.62 $ - 04 Crisis Support/Emergency $ 35.43 $ - 06 Day/Night $ - $ - 07 Drop -In /Self Help Centers $ 33.43 $ - 08 In- Home /On -Site $ 93.34 30,000 $ 30,000 11 Intervention - Individual $ 66.44 148,773 $ 148,773 42 Intervention - Group $ 16.61 $ - 12 Medical Services $ 484.75 $ - 13 Medication- Assisted Treatment $ 21.66 $ - 14 Outpatient - Individual $ 67.09 $ - 35 Outpatient - Group $ 16.77 $ - 15 Outreach $ 49.85 20,000 $ 20,000 18 Residential Level I $ 291.08 $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ 293.96 $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ 55.70 $ - 28 Incidental Expenses $ 1.00 $ - 29 Aftercare - Individual $ - $ - 43 Aftercare - Group $ - $ - 30 Information & Referral $ 37.93 $ - 34 FACT Team $ - $ - 36 Room & Board Level I $ - $ - 37 Room & Board Level II $ - $ - 38 Room & Board Level III $ 105.15 $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ 50.69 $ - 44 CCST - Individual $ - $ - 45 CCST - Group $ - $ - 46 Recovery Support - Individual $ - $ - 47 Recovery Support - Group $ - $ - 48 Prevention - Indicated $ 65.07 25,000 $ 25,000 49 Prevention - Selective $ 68.59 100,000 $ 100,000 50 Prevention - Universal Direct $ 68.59 74,063 $ 74,063 51 Prevention - Universal Indirect $ - $ - 99 Special Proviso /Cost Reimbursement $ - $ - FITT Pro jam $ - * ighlighted pub EEG ell ib1 (hp fund allocation TOTAL FUNDING $ 4,860,294 $ - $ 253,773 $ - $ - $ 199,063 $ - $ - $ - $ - $ - $ - $ 452,836 TOTAL UNCOMPENSATED $ 972,059 $ 90,567 Guidance /Care Center, Inc. Exhibit G Contract No. ME225 -9 -27 Page 4 of 4 EXHIBIT 11 - FUNDING DETAIL Revised: July 2018 Provider: Guidance /Care Center, Inc. Contract #: ME225 -9 -27 Amendment # ADULT MENTAL HEALTH CHILDREN MENTAL HEALTH OCA DESCRIPTION NEW OCA AMOUNT OCA DESCRIPTION NEW OCA AMOUNT Residential Services MH001 $ 228,629 Residential Services MH001 $ - Non-Residential Services MH009 $ 915,082 Non - Residential Services MH009 $ 470,000 Crisis and Baker Act Services MH018 $ 1,130,503 Crisis and Baker Act Services MH018 $ 15,677 Community Forensic Program MH072 $ 160,000 Special Appropriation - ICFH MHOBN $ - FACT Team MH073 $ - Purchased Residential Treatment (PATS) MH07I $ - Indigent Drug Program MH076 $ 5,945 Community Action Treatment (CAT) Team MHCAT $ - Proviso Allocation - Citrus MH094 $ - $ - PATH Grant MHOPG $ 90,000 $ - . TANF Services MHOTB $ - $ - Early Intervention - Psychotic Disorders MH026 $ - $ - Forensic Hospital Multidisciplinary Team MHOFH $ - $ - For Profit Sub - Recipeint - Key West HMA MHSFP $ - $ - Supported Employment Services MHEMP $ - $ - $ - $ $ - $ - Transition Vouchers MHTRV $ - Transition Vouchers MHTRV $. - Care Coordination MHOCN $ - Care Coordination MHOCN $ - Carry Forward MHOCF $ - Carry Forward MHOCF $ - TOTAL ADULT MENTAL HEALTH = $ 2,530,159 TOTAL CHILDREN MENTAL HEALTH = $ 485, ADULT SUBSTANCE ABUSE CHILDREN SUBSTANCE ABUSE OCA DESCRIPTION NEW OCA AMOUNT OCA DESCRIPTION NEW OCA AMOUNT Residential Services MS003 $ - Residential Services MS003 $ - Non-Residential Services MS011 $ 271,791 Non - Residential Services MS011 $ 253,773 Detox Services MS021 $ 486,643 Detox Services MS021 $ - HIV Services MS023 $ - HIV Services MS023 $ - Prevention Services MS025 $ - Prevention Services MS025 $ 199,063 Women's Services MS027 $ - Prevention Partnership Grant MSOPP $ - Pregnant Women Project MS081 $ - TANF Services MSOTB $ - Proviso Allocation - GCC MS091 $ 633,188 Proviso Allocation - Here's Help MS903 $ - TANF Services MSOTB $ - $ - Proviso Allocation - Here's Help MS903 $ - $ - Targeted Response - Opioid Crisis MSOPH $ - $ - Opioid Crisis MAT MSOPM $ - $ - $ - $ - $ - $ - $ $ Transition Vouchers MSTRV $ - •Transition Vouchers MSTRV $ - Care Coordination MSOCN $ - Care Coordination MSOCN $ - Carry Forward MSOCF $ - Carry Forward MSOCF $ - TOTAL ADULT SUBSTANCE ABUSE = $ 1,391,622 TOTAL CHILDREN SUBSTANCE ABUSE = $ 452,836 FUNDS NOT REQUIRING MATCH: Drug Abuse Services $ 687,461 TOTAL ALL PROGRAMS = $ 4,860,294 Prevention $ 199,063 UNCOMPENSATED UNITS = $ 972,059 Deinstitutionalization Project $ 123,266 TOTAL = $ 5,832,353 CMH Program $ 485,677 MH Block Grant TOTAL FUNDS REQUIRING MATCH = $ 3,364,827 TOTAL FUNDS NOT REQUIRING MATCH $ 1,495,467 LOCAL MATCH REQUIRED = $ 1,121,609 NOTES FY 2018 -19 Adjustments 2/15/18 $60,000 is reduced from MSOCN and $60,000 from MHOCN due to 1 -time only allocation. $48,548 is reduced from MHACF due to 1 -time only allocation. $115,000 is reduced from Village and added to GCC -MSC11 to reverse FY 2017 -18 adjustment. $65,285 is reduced from Village and addded to GCC -MS025 to reverse FY 2017 -18 adjustment. • $50,000 is added to MHA09 and $25,000 to MHC09 to restore the 1 -time lapse reduction. $3,468 is reduced from MHA09 and added back to MHA76 to restore the EDP allocation -all funds need to be drawn down in the incidental cost center. $50,000 is added to MSA11 and $150,000 to MSA21 to annualize the Central Re ceiving Facility. • • • Guidance /Care Center, Inc. Exhibit H Contract No. ME225 - 9 - 27 Page 1 of 1 LOCAL MATCH PLAN Revised: July 2018 Guidance /Care Center, Inc. ME225 -9 -27 REQUIRED MATCH: $ 1,121,609 AMI-I CMI -1 ASA CS COST CENTERS RATE UNITS MATCH UNITS MATCH UNITS MATCH UNITS MATCH 01 Assessment $ 83.18 240.44 $ 20,000 - 240.44 $ 20,000 - 02 Case Management $ 90.84 440.33 $ 40,000 - 825.63 $ 75,000 - 03 Crisis Stabilization $ 351.62 227.52 $ 80,000 - - - 04 Crisis Support/Emergency $ 35.43 - - - - 06 Day/Night $ - 07 Drop -In /Self Help Centers $ 33.43 - - - - 08 In- Home /On -Site $ 93.34 - - - 405.37 $ 37,837 11 Intervention - Individual $ 66.44 - - - - 42 Intervention - Group $ 16.61 - - - - 12 Medical Services $ 484.75 392.73 $ 130,000 - - - 13 Medication - Assisted Treatment $ 21.66 - - - - 14 Outpatient - Individual $ 67.09 - - 745.27 $ 50,000 - 35 Outpatient - Group $ 16.77 - - - - 15 Outreach $ 49.85 - - - - 18 Residential Level I $ 291.08 515.32 $ 150,000 - - - 19 Residential Level II $ - 20 Residential Level III $ - 21 Residential Level IV $ - 24 Substance Abuse Detox $ 293.96 - - 1,764.77 $ 518,772 - 25 Supported Employment $ - 26 Supportive Housing $ - 27 TASC $ 55.70 - - - - 28 Incidental Expenses $ 1.00 - - - 29 Aftercare - Individual $ - 43 Aftercare - Group $ - 30 Information & Referral $ 37.93 - - - - 34 FACT Team $ - 36 Room & Board Level I $ - 37 Room & Board Level II $ - 38 Room & Board Level III $ 105.15 - - - - 39 Short-term Residential Treatment $ - 40 Clubhouse Services $ 50.69 - - - - 44 ('('1'I' - Individual N - 46 Recovery Sunnort - Individual Y; - 47 Recovery Support - Group $ - 48 Prevention - Indicated $ 65.07 - - - - 49 Prevention - Selective $ 68.59 - - - - 50 Prevention - Universal Direct $ 68.59 - - - - 51 Prevention - Universal Indirect $ - 99 Special Proviso $ - MATCH ALLOCATION: $ 420,000 $ - $ 663,772 $ 37,837 GRAND TOTAL: $ 1,121,609 Local Match Plan Guidance /Care Center, Inc. Page 1 of 1 Contract No. ME225 - - South Florida Behavioral Health Network, Inc. Rev. 07.01.2018 EXHIBIT I Motivational Support Program (MSP) Provider Protocols I. POLICY: It is the policy of South Florida Behavioral Health Network (SFBHN) to establish protocols for behavioral health treatment providers that receive referrals and /or provide services to individuals that have been identified as eligible for MSP services. These protocols have been established to ensure that this high- risk, priority population receives expedited services. The protocols for the Southern Region (Miami -Dade and Monroe Counties) are available upon request to the ME Contract Manager. II. PURPOSE: The purpose of this program is to: • Engage and retain child - welfare involved families in behavioral health treatment; and • Keep families together, where appropriate, by preventing at -risk children from receiving an out - of -home placement. III. AUTHORITY: The Prime Contract between the ME and the Department provides the ME with authority to contract for these services. Refer to the Department of Children and Families Program Guidance 19, Integration with Child Welfare available at this this link: http: / /www.myflfamilies.com /service - programs/ substance - abuse /managing- entities /2018 - contract- docs IV. PROCEDURE: In accordance with the SFBHN Contract, the items delineated below are the contractually required protocols for any individual that has been identified as an MSP referral and has been referred to a contracted SFBHN behavioral health treatment provider. 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. Exhibit I Guidance /Care Center, Inc. Page 1- of 5 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 07.01.2018 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) at the designated MSP contracted network provider that provide ancillary support to the CBC Case Manager and the contracted ME behavioral health treatment provider, 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. Enrollment for Individuals served are not included in Outreach services. I. QUALIFIED PROFESSIONAL - A physician or physician assistant licensed under Chapter 458 or 459, F.S., a psychiatrist licensed under chapter 458 or chapter 459; a psychologist as defined in s. 490.003(7); or a psychiatric nurse which means an advanced registered nurse practitioner certified under s. 464.012 who has a master's or doctoral degree in psychiatric nursing, holds a national advanced practice certification as a psychiatric mental health advanced practice nurse, and has 2 years of post - master's clinical experience under the supervision of a physician a professional licensed under Chapter 490 or 491, F.S., a professional as defined in s. 394.455(5), (7), (32), (35), or (36)notwithstanding any other provision of law, a person who was certified through a certification process recognized by the - former Department of Health and Rehabilitative Services before January 1, 1995, may perform the duties of a qualified professional with respect to substance abuse treatment services as defined in this chapter, and need not meet the certification requirements contained in s. 397.311(34) (ref. §397.416 F.S.) . Exhibit I Guidance /Care Center, Inc. Page 2 of 5 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 07.01.2018 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 individual served and a further statement of possible needs based on the individuals' served condition to include the results of a urinalysis, when applicable, as specified in the Motivational Support Program Protocols, incorporated by reference herein. V. MSP Screening: a) The Motivational Support Specialist (MSS) conducts the ME approved screening tool for all referrals received through the Department of Children and Families (DCF) Program Administrator (PA) or Program Supervisor, 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. VI. 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. i. 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. i. Should the consumer be a no -show at the appointment, the provider will notify the MSS within 24 hours of the no -show. li. Should the consumer need services not available at the provider, the provider will ensure linkage to recommended services and notify the MSS case manager. VII. 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 Exhibit Guidance /Care Center, Inc. Page 3 of 5 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 07.01.2018 MSP consumer must have an ME approved assessment completed within 20 days of admission into Outpatient SA Treatment. The completed assessment must be provided to the MSS within this timeframe. If the consumer is placed in Residential SA Treatment, the ME approved assessment is due within 5 days of admission. Upon completion of the ME approved assessment tool provider will provide a copy to the MSS. b) Drug Testing: The initial drug test is conducted by the DCF Protective Investigator (PI) prior to the referral to the MSP. Subsequent weekly random drug testing will be conducted by the treatment provider commencing the date of admission. All testing will be observed by the same gender staff as the individual served. 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. VIII. 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. b) Documentation: Monthly treatment summaries will be submitted to the MSS by until such time as the case is closed with MSP. The standardize MSP Treatment Summary Form will be utilized, Exhibit J, Motivational Support Program Treatment Summary Form. i. The form must be submitted at the required intervals as specified above. ii. It must be completely filled out including: individual served 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.4 of 5 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 07.01.2018 The Network 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. IX. Direct Referrals from Protective Investigators (Pls):_Refer to the Motivational Support Program Protocol (Miami Dade County and Monroe County). Exhibit I Guidance /Care Center, Inc. Page 5 of 5 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. rev. 07.01.2018 EXHIBIT J Motivational Support Program Treatment Summary Form Initial ❑ Weekly ❑ Monthly ❑ Agency: Date: Client Name: Social Security Number: DOB: Axis I: Axis II: Axis III: Axis IV: Axis V: Progress in Treatment: Frequency of UA Testing: Urinalysis Results: Therapist. Signature and Title: Print Name: Exhibit J Guidance /Care Center, Inc. Page 1 of 1 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. EXHIBIT K Pre - Authorization Utilization Management Roster for Substance Abuse & Mental Health Residential Level II Services Only (1) Provider Name and Address: (2) Contract No: (3) SAMH Program: (4) Invoice Period: (5) Page of (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) Client Authorization Client Name Social Placement Service Cost Unit No. of Units of Total Service Count Number (Last, First) Security Authorization Period Center Rate Services Rendered Cost Number No. (Col. 13 x 14) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Totals $ Provider's Authorized Representative I CERTIFY THAT THE ABOVE IS ACCURATE AND CORRECT Provider's Signature Date Name (Print or Type) Title Exhibit K Guidance /Care Center, Inc. Page 1 of 1 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. rev. 07/01/2018 Exhibit L Assisted Living Facilities with Limited Mental Health License Authority: s. 394.4574, F.S. I. Network Providers that enter into a cooperative agreement with an Assisted Living Facility- Limited Mental Health License (ALF -LMHL) that are also responsible for providing case management services to mental health residents in the ALF -LMHL shall: 1) Ensure that the ALF -LMHL where the consumer is residing at, or referred to, maintains a current Agency for Health Care Administration (AHCA) license for ALF -LMHL facilities. The Network Provider shall maintain a copy of the AHCA ALF -LMHL facility license in each consumer file. Referrals to unlicensed ALF -LMHL are unlawful and are subject to sanctions by AHCA. The ME shall monitor the Network Provider's compliance with the terms and conditions of this exhibit. 2) Ensure that all mental health residents as defined in s. 394.4574 (1) F.S. are assessed by a psychiatrist, clinical psychologist, clinical social worker or psychiatric nurse or other mental health professional I who is supervised by one of these professionals, to establish that all residents are appropriate to reside in the ALF -LMHL. A copy of that documentation shall be provided to the ALF administrator no later than 30 days following admission. 3) Ensure that case managers are assigned to all ALF -LMHL residents who meet criteria as a mental health resident. If the resident declines case management, case managers must attempt to engage the person for a period not less than 30 days and document efforts in the ALF records. If the mental health resident continues to decline services, they must be encouraged to do so in writing, unless that is also refused. Documentation of a resident's declination of case management services and stated reason for declination must be maintained in case records at the ALF -LMHL. 4) Ensure that individuals living in ALF -LMHL and meeting the definition of a mental health resident 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 by contacting the ME's Contract Manager: 7) Ensure that the Cooperative Agreement is annually updated between the Network Provider and the ALF -LMHL Administrator. 8) Ensure that an annual community living support plan, as defined in s. 429.02 F.S., is prepared by the assigned case manager and the resident served, in consultation with the ALF -LMHL administrator of Exhibit L Guidance /Care Center, Inc. Page 1 of 3 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. rev. 07/01/2018 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 individual's 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. II. Attendance at Assisted Living Facility Public Meeting The Network Provider shall attend the ME's Assisted Living Facility with Limited Mental Health License Public Meeting as scheduled by the ME. III. Required Report On a quarterly basis, by the dates and to the individuals identified in Exhibit C, Required Reports, the Network Provider shall submit an ALF -LMHL Consumer Report the required format as shown in Table 1. below. The ALF -LMHL Consumer Report shall be submitted in a secured, password protected, or encrypted format. Left blank intentionally Exhibit L Guidance /Care Center, Inc. Page 2 of 3 Contract No. ME225 -9 -27 a Behavioral Health Network, Inc. rev. 07/01/2018 Table 1. ALF -LMHL Consumer Report ALF -LMHL Address Zip Client's Last Client's First Client's Agency Name Cooperative Annual Support Plan Case Manager Name Code Name Name D.O.B. Agreement present in Present in ALF chart with all ALF chart with all required signatures (Client, required signatures CM, & ALF -LMHL (Client, CM & ALF- Administrator) LMHL Administrator) (Yes /No) ■ { ; Exhibit L •e Center, Inc. Page 3 of 3 Contract No South Florida Behavioral Health Network, Inc. 7/1/2018 EXHIBIT N Indigent Psychiatric Medication Program The Network Provider shall follow the guidelines established by the Florida Department of Children and Families defined in Incorporated Document 13, Indigent Drug Program, dated February 13, 2018, 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, known as the Indigent Psychiatric Medication Program, known as the Indigent Drug Program (IDP) are used for eligible individuals. Section!: 1. Purpose The purpose of this guidance document is to: 1.1. Establish IDP administration procedures; 1.2. Provide written guidelines to the Managing Entities (ME) and IDP Providers; and 1.3. Establish Florida State Hospital's (IDP /FSH Warehouse) medication order guidelines and processes for receiving, storing, and shipping IDP medications. 2. Definitions 2.1. IDP Dispensing Unit: A pharmacy holding a current permit from the Florida Board of Pharmacy that dispenses medication for the IDP. 2.2. IDP /FSH Warehouse: A physical space located on the campus of Florida State Hospital (FSH) at Chattahoochee, Florida. This space is reserved for receiving, storing, and shipping IDP medications. 2.3. 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. 2.4. 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. 2.5. 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: 2.5.1. Antipsychotics; 2.5.2. Antidepressants; 2.5.3. Anxiolytics; 2.5.4. Mood stabilizers; and 2.5.5. Cerebral or psychomotor stimulants. 2.5.6. Other medications commonly used may include, but are not limited to, beta blockers, anticonvulsants, cognition enhancers, and opiate blockers. Exhibit N Guidance /Care Center, Inc. Page 1 of 10 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 2.6. 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. 3. Program Administration 3.1. Managing Entities If Managing Entities receive funding under the IDP, they will: 3.1.1. Approve organizations requesting to become IDP providers. To be eligible, organizations must be under contract with the regional ME. 3.1.2. Each July, provide a list of approved IDP providers to the Department's Office of Substance Abuse and Mental Health (SAM SAMH will then determine the provider line of credit. 3.1.3. Report bulk purchases into SAMHIS. Using the EVNT (non - client specific file upload) contractors should submit a service using the IDP OCA (MH076) with the Incidental Expense covered service (28) and the actual dollar amount for the units. 3.1.4. Ensure that agreements between IDP providers and participating pharmacies are current and executed. 3.1.5. Ensure that IDP providers use IDP funds for individuals who meet the criteria. 3.2. IDP Providers 3.2.1. IDP providers will: 3.2.1.1. Assess and enroll individuals in the IDP who meet the clinical and financial criteria established in ch. 394, F.S. 3.2.1.1.1. To meet the clinical criteria individuals: 3.2.1.1.1.1. Must be a member of at least one of the Department's priority populations; and 3.2.1.1.1.2. Must not reside in a state mental health treatment facility or an inpatient community unit. 3.2.1.1.2. To meet the financial eligibility criteria individuals: 3.2.1.1.2.1. 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; 3.2.1.1.2.2. Must lack third -party insurance or other psychotropic medications funding sources; and 3.2.1.1.2.3. 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 Exhibit N Guidance /Care Center, Inc. Page 2 of 10 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 denied benefits for these medications, they may receive IDP medications until such time as eligibility is reestablished. 3.2.1.2. 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; 3.2.1.3. 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: 3.2.1.3.1.The providers' IDP contact information including name, e-mail, and phone number; 3.2.1.3.2. The authorized person's name who approves the Supply Requisition (See Appendix 1); and 3.2.1.3.3.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. 3.2.1.4. 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: 3.2.1.4.1. Submit orders only as needed; 3.2.1.4.2.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; 3.2.1.4.3. Fax or e-mail the completed, signed, and approved Supply Requisition directly to the IDP /FSH Warehouse; and 3.2.1.4.4. Pay line of credit surpluses to IDP /FSH Warehouse before the Warehouse processes new orders. 3.2.1.5. Submit the last order and payment before May 15 of the fiscal year; 3.2.1.6. Review all orders for accuracy; 3.2.1.6.1. Review the medication with the Issue Document (See Appendix 3) to ensure accuracy; 3.2.1.6.2.1f discrepancies are found, call the IDP /FSH Warehouse within 24 hours or email the Issue Document with corrections; and 3.2.1.6.3. Retain a copy of the Issue Document. 3.2.1.7. Ensure that IDP prescriptions meet the following conditions: 3.2.1.7.1.There cannot be more than two refills, and one prescription cannot cover more than a 90 -day supply; 3.2.1.7.2. Must be listed on the IDP Inventory; and 3.2.1:7.3. Must be filled at an IDP pharmacy. 3.2.1.8. Actively participate in Patient Assistance Programs (PAP) that provide psychiatric medications without cost; Exhibit N Guidance /Care Center, Inc. Page 3 of 10 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 3.2.1.9. 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. 3.2.1.10. Review updated video presentations for medication guidelines or read the adult medication guidelines available through the Florida Mental Health Institute (FMHI) of the University of South Florida's Medicaid Drug Therapy Management Program for Behavioral Health, found at http : / /flmedicaidbh.fmhi.usf.edu /. 3.2.1.11. Review and validate the IDP /FSH Warehouse monthly statements. 3.2.1.12. Address emergency situations, including but not limited to: 3.2.1.12.1. Order additional psychiatric medications from either the IDP /FSH Warehouse or a pharmacy of their choice (for urgent needs); and 3.2.1.12.2. Pay dispensing fees to IDP Dispensing Unit for individuals who cannot afford them. 3.2.1.13. Implement medication receiving, storage, and administrative procedures that meet the current State approved prescribing instructions pursuant to s. 465.035, F.S.; and 3.2.1.14. Contact via telephone or e-mail the IDP /FSH Warehouse to cancel backorders or portions of backorders; provide the Supply Requisition number. 3.2.2. IDP Providers may: 3.2.2.1. Return outdated medications: 3.2.2.1.1. For inventory management purposes include a packaging slip that contains an itemized medication list; and 3.2.2.1.2. Clearly mark the package as outdated. 3.2.2.2. Return overstocked medications: 3.2.2.2.1.. Complete the Supply Requisition. Under the remarks section of the requisition state that overstocked medications are returned for credit and explain the reason for returning the medications; 3.2.2.2.2. Mail medications in package(s) clearly marked as overstocked; and 3.2.2.2.3. Only return unopened medications. 3.2.2.3. Submit a check to the IDP /FSH Warehouse accounting office to prepay orders to extend the line of credit. The remaining line of credit cannot be carried over into the next fiscal year. 3.3. The IDP /FSH Warehouse The IDP /FSH Warehouse will: 3.3.1. Process Supply Requisitions. 3.3.2. Mail back the packages to the providers that return their medication with an incorrect or incomplete Supply Requisition. Exhibit N Guidance /Care Center, Inc. Page 4 of 10 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 3.3.3. Provide monthly statements to the MEs no later than the 10th of the month following the end of the quarter. The statements will list each provider's approved line of credit and balance. If providers submit orders after the lines of credit have reached a zero balance, the IDP /FSH Warehouse accounting office will: 3.3.3.1. Calculate the actual cost of the order; and 3.3.3.2. Notify the provider of the cost. 3.3.4.. Release providers' line of credit as follows: 3.3.4.1. Deduct administrative costs from providers' remaining line of credit to process orders; 3.3.4.2. Bill the difference to providers during the first three quarters of the fiscal year if the cumulative order(s) amount exceeds the quarterly release; 3.3.4.3. Hold future order shipments if payment is missing; and 3.3.4.4. Call or email providers if orders exceed its line of credit during the fourth quarter. 3.3.5. Accept any returned medications with a minimum of a nine -month shelf -life left prior to their expiration dates upon receipt at the IDP /FSH Warehouse; 3.3.6.. Reject partially used medications, regardless of the expiration date; 3.3.7. E -mail providers the monthly Financial Report that shows their account credit amount; 3.3.8. Generate the Issue Document (See Appendices 3 and 4) to include actual costs billed for the medications; 3.3.9. Attach an Issue Document form to any backorders; 3.3.10.Submit copies of the Issue Documents to the pharmacies that receive the medication orders; 3.3.11.Not give credit to providers for returning outdated medications; and 3.3.12.Not accept orders or payments submitted after May 15 of the fiscal year. 3.4. Office of Substance Abuse and Mental Health The SAMH will determine the IDP provider line of credit based on available resources and actual utilization including: 3.4.1. Previous fiscal year's annual line of credit; 3.4.2. Monthly expenditures; 3.4.3. End of year balance; and 3.4.4. Funds from other funding sources expended on IDP medications. 4. Contact Information For questions regarding IDP /FSH Warehouse contact: Genea F. Dukes Florida State Hospital Indigent Psychiatric Medication Program (IDP) Exhibit N Guidance /Care Center, Inc. Page 5 of 10 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 Pharmacy Building 1235 Chattahoochee Florida 32324 E -Mail: Genea. Dukes@ myflfamilies .com @myflfamilies.com Work No. (850) 663 -7274 Intercom: 1107 Fax No. (850) 663 -7291 Exhibit N Guidance /Care Center, Inc. Page 6 of 10 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 Appendix 1 SIGNATURE AUTHORIZATION FORM pEPART, tt% ti� State of Florida Rick Scott ° • o Department of Children and Families Governor 14 ra . Mike Carroll 1. Fti AND FP Secretary MYFLFAMILIES.COM Bob Quam Signature Authorization Chief Hospital Indigent Drug Program Administrator Florida State Hospital The following persons are authorized to submit drug orders to the Indigent Drug Program warehouse. Name Facility Signature Date SIGNATURE OF APPROVAL: TITLE: DATE (Needs to be approved by supervisor of highest -level employee listed above) Florida State Hospital 100 North Main Street/POB 1000 • Chattahoochee, Florida 32324 -1000 Mission: Work in partnership with local communities to protect the vulnerable, promote strong and economically self - sufficient families, and advance personal and family recovery and resiliency If you require Americans with Disabilities Act accommodations to participate in an event at Florida State Hospital, please notify Human Resources at (850) 663 -7585 at least seven (7) days prior to the event. Deaf or hard of hearing individuals may call 1 -800- 955 -8771. $ �\ 2012F ACCREDITED GOVERNOR'S STERLING AWARD RECIPIENT Exhibit N Guidance /Care Center, Inc. Page 7 of 10 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 Appendix 2 SUPPLY REQUISITION SUPPLY INVENTORY MANAGEMENT SYSTEM , Supply Requisition Supply Use only To Be Corryleted By Requester 1. Action 2. t)IC 3. Organizational Code 4. Sub Code Si V 1On 6. Other Cost T Code O l Accumlators C� e - 1 1 I I I 1 I I I I I I I I I .. —- _ I I I. ►� V I I I 7. Grant 8. Grant 9. External Gen - anal Ledger 10 Agency Requistion Year __ r Uri he Number I I I I I .I I I I 1 1 1_- I _ -. . 11. StockNrmber 12 Quantity Unit Price Total Price 13- unit 01 Issue 14. Description I' I I. __ I I I $0.00 I I I I I I I I I I I I $0.00 I__ _ 1 1 1 1 I I I I 1 I 1 I I $0.00 • I I I I I I I I I .... ''_.I I I $0.001 I I I I I I I I I I I .__ I I I $0.00 1. 1 1 1 I I I I I 1 I I I I $0.00 1 _ - I I I I I I I I $0.00 1 , I I I I I I I I I I I I I $0.00 1_ I I I I I I I I I I I $0.00 1 11 I I I I I I I I I I $0.00 1 1 1 1 I 1 I I I I I I I $0.00 1 , 1 1 1 1 I I I I 1 I I $0.00 , � $0.00 Total . • Remarks: • 15. Requestor's Signature 16. Date , 17. Signature of Approval 18. Date 19. Reguestor's Telephone Nunter(SrbCom, if available) Filled By Date Received By Date Exhibit N Guidance /Care Center, Inc. Page 8 of 10 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 Appendix 3 ISSUE DOCUMENT TO CONFIRM EXAMPLE ISSUE DOCUMENT DELIVER TO : FROM : DP - INDIGENT DRUG PROGRAM LOC CODE STOCK NUMBER UNIT OF OBJECT SACK UNIT REQUEST ISSUED TOTAL ISSUE CODE ORDER PRICE 6505 -00I- 0694 -5 VI 344002 30 30 0 36.9867 1109.60 HALOPERIDAL DECANOATE: IOOMG /ML (HALDOL) I ML/AMPX5 NDC x+00045 - 0254 6505- 005 - 1399 -1 BT 344002 10 10 0 6.3164 63.16 MIRTAZAPINE: 15 -MG TAB (REMERON) 30 /BTL NDC #00052- 0105 -30 6505 -001- 3939 -8 BT 344002 3 3 0 157.6385 472.92 PERPHENAZINE: 4 -MG TAB (TRILAFON) 100 /BTL NDC #00172- 3668 -60. BW 1 6505- 002 -01 17 -4 BT 344002 I 1 0 150.5378 150.54 PERPHENAZINE: I6 -MG TAB (TRILAFON) 100 /BTL NDC #00172- 3670 -60, BW 6505- 005 - 1819 -4 BT 344002 10 10 0 43.2502 432.50 ZIPRASIDONE: 80-MG. CAPS ( GEODON) 60 PER BOTTLE NDC: 00049- 3990 -60 6505- 005- 1816 -0 BT 344002 6 6 0 36.9200 221.52 ZIPRASIDONE: 20 -MG, CAPS (GEODON) 60 PER BOTTLE NDC: 00049- 3960 -60 6505- 005 - 2338 -4 BT 344002 8 8 0 1038.6544 8309.24 QUETIAPINE FUMARATE XR: (SEROQUEL)300MG TABS. 60 /BOTTLE 6505- 005 - 2344 -9 BT 344002 4 4 0 805.6200 3222.48 QUETIAPINE FUMARATE XR: SEROQUEL XR: 200 MG TABS: 60/BT 6505 - 001 - 0171 -4 BT 344002 8 8 0 25.0758 200.61 VENLAFAXINE, USP: 150 -MG XR CAP (EFFEXOR) 100 /BTL NDC #00008-0836 - SH - CONFIRM SUPPLIES SHIPPED DURING PHYSICAL INVENTORY OR SYSTEM DOWN -TIME TOTAL: 19182.57 FILLED BY DATE RECEIVED BY DATE Exhibit N Guidance /Care Center, Inc. Page 9 of 10 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 Appendix 4 ISSUE DOCUMENT TO REVERSE - ISSUE DOCUMENT DELIVER TO : FROM : DP - INDIGENT DRUG PROGRAM LOC CODE STOCK NUMBER UNIT OF OBJECT HACK UNIT REQUEST ISSUED TOTAL ISSUE CODE ORDER PRICE 6505 - 001 - 0694 -5 VI 344002 30 30 0 36.9867 1109.60 HALOPERIDAL DECANOATE: 100MG /ML (IIALDOL) IML /AMPX5 NDC #00045 -0254 6505- 005 - 1399 -1 BT 344002 10 10 0 6.3164 63.16 MIRTAZAPINE: 15 -MG TAB (REMERON) 30 /BTL NDC #00052 - 0105 -30 6505 -001- 3939 -8 BT 344002 3 3 0 157.6385 472.92 PERPHENAZINE: 4 -MG TAB (TRILAFON) 100 /BTL NDC 400172- 3668 -60. BW I 6505- 002 -01 17 -4 BT 344002 1 1 0 150.5378 150.54 PERPHENAZINE: 16 -MG TAB (TRILAFON) 100 /BTL NDC #00172- 3670 -60. BW 6505 - 005 - 1819 -4 BT 344002 10 10 0 43.2502 432.50 ZIPRASIDONE: 80 -MG, CAPS ( GEODON) 60 PER BOTTLE NDC: 00049- 3990 -60 6505- 005- I816 -0 BT 344002 6 6 0 36.9200 221.52 ZIPRASIDONE: 20 -MG. CAPS (GEODON) 60 PER BOTTLE NDC: 00049- 3960 -60 6505- 005 - 2338 -4 BT 344002 8 8 0 1038.6544 8309.24 QUETIAPINE FUMARATE XR: (SEROQUEL)300MG TABS. 60 /BOTTLE 6505- 005 - 2344 -9 BT 344002 4 4 0 805.6200 3222.48 QUETIAPINE FUMARATE XR: SEROQUEL XR: 200 MG TABS; 60 /BT 6505 -00I- 0171 -4 BT 344002 8 8 0 25.0758 200.61 VENLAFAXINE, USP: 150 -MG XR CAP (EFFEXOR) 100 /BTL NDC #00008 -0836- SH - CONFIRM SUPPLIES SHIPPED DURING PHYSICAL TOTAL: 14182.57 INVENTORY OR SYSTEM DOWN -TIME FILLED BY DATE RECEIVED BY DATE http: / /sc fmzp 1 00.dcf.state. fl.us/SIMS/Home/NIain/1 ssueDocument.aspx? 6/4/2015 Exhibit N Guidance /Care Center, Inc. Page 10 of 10 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 EXHIBIT O Weapons and Firearms Court Petitions Monthly Report Template (1) Provider Name and Address: (2) Contract No: (3) Total Number of Petitions Filed for Reporting Period: _ (4) Reporting Period: (5) Page of ( ( ( ( ( Client Client's First Name Client's Middle Name Client's Last Name Date Petition was filed Count 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. Provider's Authorized Representative I CERTIFY THAT THE ABOVE IS ACCURATE AND CORRECT Provider's Signature Date Name (Print or Type) Title Exhibit 0 Guidance /Care Center, Inc. Page 1 of 1 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 07/01/2011 EXHIBIT Q Missing Children The network provider agrees when services are for children who are adjudicated dependent where the care of the child is assigned to the department or network provider, to follow the procedures outlined in Rule 65C- 30.019, F.A.C. and Rule 65C- 29.013, F.A.C. and in Children and Families Operating Procedure (CFOP) 175 -85, entitled "Prevention, Reporting, and Services to Missing Children ". The network provider will perform the departmental functions as described in Rule 65C- 30.019, F.A.C. and CFOP 175 -85 which correspond to the functional role of this contract. The network provider also agrees when services for children are community based and the child involved is not adjudicated dependent, to comply with all licensing and contracting requirements. 1. Definitions a. Designee - a person, contractual network provider or other agency or entity named by the department. b. Exigent Circumstances - situations that require immediate actions, such as the child is under the age of thirteen, believed to be out of the zone of safety for their age and development, mentally incapacitated, in a life- threatening situation, in the company of others who could endanger their welfare or is absent under circumstance inconsistent with established behaviors. c. FDLE -MCIC - Florida Department of Law Enforcement - Missing Children's Information Center. d. Family Services Counselor - a professional position responsible for case management for children placements. The term includes Department of Children and Families staff and staff working for an agency named as a designee. e. Missing Child - a person who is under the age of 18 years; whose location has not been determined; is currently placed in an out -of -home care setting; court order in -home placement; or is the subject of an active abuse investigation in which the child has been sheltered, would have 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 Exhibit Q Guidance/Care Center, Inc. Page 1 of 4 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 07/01/2011 actions and activities related to any efforts made to report and /or locate any child who is determined to be missing from their care or supervision: d. If exigent circumstances exist, the caregiver, family services counselor, or until the family services counselor is engaged, the network provider employee, who has identified that a child is missing from their care or supervision shall immediately call local law enforcement as soon as a determination has been made that a child is missing and they shall request that the responding office: (1) Take a report of the missing child. (2) Assign a case number to the missing child report and provide the case number back to the caregiver or person who is reporting the child missing. (3) Provide local law enforcement with a recent high quality photo of the child, or provide local law enforcement with a recent high quality photo when one becomes available. (4) Request that a copy of the police report be provided to the family services counselor once a police report becomes available. (5) If the responding law enforcement officer refuses to take a missing child report, for any reason, the individual attempting to report the child as missing will document the officer's name and specific local law enforcement agency name and request to speak to the law enforcement agency Watch /Shift Commander. If the law enforcement agency Watch Commander refuses to take a missing child report and it is a caregiver that is attempting to report the child as missing, the caregiver will immediately contact the family services counselor or on -call staff and provide them with all information related to .local law enforcement not issuing a missing child report. Once the family services counselor or on -call staff have learned that a local law enforcement agency will not issue a missing child report they will immediately seek assistance from the local area Community Based Care (CBC) Child Location Specialist or the Department of Children and Families Regional Criminal Justice Services Coordinator on resolving any issue related to reporting the child as missing to local law enforcement. (6) If it is a caregiver who has reported the child as missing to local law enforcement or attempted to report a child as missing to local law enforcement, they shall immediately notify the child's family services counselor or emergency on -call staff and provide them with the following information: (a) The law enforcement agency name that the child was reported as missing to or attempted to be reported as missing to; (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 Exhibit Q Guidance /Care Center, Inc. Page 2 of 4 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 07/01/2011 (g) Detailed information on any individuals that the child might be traveling with. e. If exigent circumstances do not exist, the caregiver, family services counselor, or other network provider staff will within the first four (4) hours of learning that a child might be missing check to see what, if any, of the child's personal belongings are missing or if the child left a note; and, the caregiver, family services counselor, or other staff (if the family services counselor is not yet engaged), will: (1) Contact the following persons as appropriate to ascertain if the child has been seen, or has given any indications that may explain the child's missing status: - (a) School /child's teachers and school resource officer; (b) The child's relatives /parents, both local and non - local, if appropriate, and the caregiver has the means for such contact; (c) Any friends or places that the child generally frequents, the local runaway shelter, if there is one in the community; and, (d) The child's employer, if applicable. (2) Write down any information gathered that might help locate the child. (3) Provide telephone /beeper numbers and ask for the individuals above to call back and share information if they have further information or see the child. 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 caregiver's 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 Exhibit Q Guidance /Care Center, Inc. Page 3 of 4 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 07/01/2011 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 4 of 4 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 07/01/2018 EXHIBIT R Child Welfare Quarterly Clinical Report z , � r BEHAUIORAL` HEALTHPRggIpER INFORMATION !t1 � ; a g % ; " £< Provider Name: Date of Report: Therapist Name: Title/ Credentials: Phone Number: Email Address: "CHIL.D INFO RM ATION . Y - 4"" xr y a Client Name: Date of Birth: Medicaid #: Social Security #: Gender at Birth: Male /Female Gender Preference: Male/ Female/ Neutral/ Prefer not to Answer School Name: Grade: '1 TREATMEN SUMMARY x � " ? � ' IC -10 Code: DSM -5 Diagnosis: 1. 2. 3. Service Type: Frequency: Date of Admission: Last Service Date: 1. 2. 3. Summary of Treatment Progress: Provide a description of therapeutic treatment interventions including treatment modality, child and family compliance with treatment interventions, progress toward therapeutic treatment goals, any critical incidents or barriers to treatment progress, and treatment recommendations. Exhibit R Page 1 of 2 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 07/01/2018 EXHIBIT R Child Welfare Quarterly Clinical Report 7171i , PSYCHOTROP,IC MEDI Prescribing Psychiatrist Name: Phone: Medication Name: Dosage: Range: Date Prescribed: 1. 2. 3. TREATMENT TEAM MEMBERS (Signatures) My signature confirms that this treatment plan was jointly developed by the recipient and the treatment team. In addition, the treatment plan is consistent with the identified needs, strengths, abilities, and preferences of the recipient. Therapist Signature Date Print Name Supervisor Signature Date Print Name Exhibit R Page 2 of 2 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 7.1.2018 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 r Forensic Specialists shall be granted an on -site face -to -face interview with 72 hours of referral. The Network Provider must submit written findings and recommendations to the referral source and within 48 hours of client interview. The Forensic Team shall discuss any denial of services with the ME's Forensic Coordinator within 72 hours of having received the disposition from the denying program. (b) All individuals referred for admission to a residential treatment facility by the 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 Services Manager. The Network Provider must submit written findings and recommendations to the referral source and within 48 hours of client interview. The Forensic Team shall discuss any denial of services with the ME's Forensic Coordinator within 72 hours of having received the disposition from the denying program. (c) The network providers' case manager will coordinate services and provide the court with routine progress reports as required by the conditional release order. (d) The network providers' case manager will immediately consult the Forensic Specialist regarding any apparent conditional release violation. Network Provider staff will be responsible for notifying the court and the Forensic Specialist of any conditional release violations via affidavit or sworn statement per s. 916.17(2), F.S. (e) The Network Provider will not return individuals on conditional release to court prior to consultation with the ME's Forensic Coordinator and /or assigned Forensic Specialist, except in cases of physical aggression by the individual in question. Exhibit V Guidance /Care Center, Inc. Page 1 of 4 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 7.1.2018 (f) Programs must provide services in English, Spanish and Creole. (g) Diversion- The Network Provider will be responsible for the provision of services and the monitoring of individuals charged with felonies in the Miami -Dade and Monroe County Jails who are at risk of commitment to the Department of Children and Families, but who may be diverted to the community by the Forensic Team. i. The Network Provider will facilitate and coordinate the provision of mental health treatment, competency restoration training, residential care or housing with supervision, medical and auxiliary services if appropriate, case management and monitoring of individuals who are being diverted from commitment to the Department of Children and Families, pursuant to chapter 916, F. S. ii. The Network Provider will facilitate and support the activities of the Forensic Team by providing accommodations for the provision of competency restoration training at the network provider's facility(ies). iii. The Network Provider will ensure attendance at court hearings, obtain conditional release orders and ensure individuals are monitored in the community in accordance with the terms of the conditional release order. (h) Discharge Planning — The Network Provider will be responsible for ensuring the active collaboration with the forensic specialists in discharge planning activities for forensic clients at state treatment facilities. i. The Network Provider will, per the request of the forensic specialists, participate in treatment team, and discharge planning meetings for forensic clients in state treatment facilities. ii. The Network Provider will assist the Forensic Team in the development and submission of conditional release plans, discharge plans to state treatment facilities and to the committing court. iii. If requested, the Network Provider will attend court hearings in the cases of individuals being discharged from state treatment facilities and ensure effective linkage to their service continuum. (i) Conditional Release Monitoring —The Network Provider will ensure that individuals on conditional release order in Dade and Monroe Counties, including individuals transferred into the counties from other circuits are monitored. Exhibit V Guidance /Care Center, Inc. Page 2 of 4 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 7.1.2018 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 Forensic Specialist 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 Forensic Specialist. iv. The Network Provider will maintain current copies of conditional release orders. (j) Utilization Management - The Network Provider shall facilitate the Forensic Specialists' requirement to manage the residential treatment beds funded by community forensic dollars and the statewide community forensic beds in the Southern Region. This includes a short-term residential treatment facility and residential level 2 beds. (k) Statewide Community Forensic Residential Services i. Citrus Health Network, Inc.: The Network Provider agrees to make available eight (8) residential beds in the Safe Transition and Access to Recovery (STAR) Program, for eligible consumers on conditional release from other circuits in need of forensic mental health services placed by the ME pursuant to FRCrP 3.219(b), 3.217(b) and F.S. 916.17. The STAR Program provides intensive, short-term treatment to individuals who are temporarily in need of a structured therapeutic setting in a less restrictive but longer - stay alternative to acute hospitalization. It is agreed that during the term of this agreement, these beds shall not be used for any other purpose. The Network Provider agrees that the ME's decision for placement is final and binding on all parties. The Network Provider shall submit weekly census reports by the dates and times specified in Exhibit C, Required Reports, and to the individuals identified. ii. Passageway Residence of Dade County, Inc.: The Network Provider agrees to make available fourteen (14) residential beds in both level II beds and in Room and Board with Supervision Level II for eligible consumers on conditional release from other circuits in need of forensic mental health services placed by the ME. Statewide Exhibit V Guidance /Care Center, Inc. Page 3 of 4 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 7.1.2018 admission to Passageway Residence of Dade County, Inc. is for individuals committed to the Florida Department of Children and Families, in accordance with the provisions of Florida Statutes Chapter 916, Forensic Services Act and released pursuant to FRCrP 3.219(b), 3.217(b) and F.S. 916.17. It is agreed that during the term of this agreement these beds shall not be used for any other purpose. The Network Provider agrees that the ME's decision for placement is final and binding on all parties. The Network Provider shall submit weekly census reports by the dates and times specified in Exhibit C, Required Reports, and to the individuals identified. iii. Psychosocial Rehabilitation Center, Inc. d /b /a Fellowship House: The Network Provider agrees to make available four (4) residential beds in both level II beds and in Room and Board with Supervision Level II 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 4 of 4 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7.1.2018 EXHIBIT X Projects for Assistance in Transition from Homelessness (PATH) Services I. The Network Provider receives federal PATH funds to provide support services for individual who: a. Have serious mental illnesses or serious mental illnesses and co- occurring substance use issues, and b. Are homeless or at imminent risk of becoming homeless. II. The Network Provider shall: a. Implement an approved Intended Use Plan (IUPs) which establishes PATH - funded program priorities including, at a minimum: • Targeting persons who are experiencing homelessness as a priority population and maximizing services to vulnerable adults who are literally and chronically homeless; • Conducting street outreach and case management as priority services; and b. Submit an annual IUP for Managing Entity and Department review and approval no later than March 1s The Department will provide a template. The IUP must cover needs and services during the next PATH Fiscal Year (9/1- 8/31). c. Establish a service plan for all PATH - enrolled individuals including: • Goals to obtain community mental health services for the individual; • Coordinating and obtaining needed services for the individual, including services relating to shelter, daily living activities, personal and benefits planning, • transportation, habilitation and rehabilitation services, prevocational and employment services, and permanent housing; • Assistance to obtain income and income support services, including housing assistance, Supplemental Nutrition Assistance Program (SNAP) benefits, and Supplemental Security Income /Social Security Disability Insurance (SSI /SSDI); • Referrals to other appropriate services; and • Review of the plan not Tess than once every three months. d. Maintain individual client files containing an intake form, a determination of eligibility for PATH - funded services, a service plan, and progress notes for each person served with PATH funds. e. Enter quarterly summary information about PATH programs and services into the PATH Data Exchange (PDX) at https: / /www.pathpdx.org/ no later than the 10th of the month following the quarter of services. f. Submit an annual report into PATH Data Exchange no later than November 17 via the PATH Data Exchange (PDX) at https: / /www.pathpdx.org /. Exhibit X Guidance /Care Center, Inc. Page 1 of 3 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7.1.2018 g. Enter SSI /SSDI application data into SOAR Online Application Tracking (OAT) database at soartrack.prainc.com /, in accordance with Managing Entity Contract Guidance 9, and Exhibit AN. h. Implement individual SOAR training to case managers and agency leads using the SOAR Online Course, available at: https: / /soarworks.prainc.com /course /ssissdi- outreach- access- and - recovery-soar- online- training i. Provide at least one dollar of local matching funds for every three dollars of PATH funds received and expend local matching funds to provide eligible services to PATH eligible persons. Match- funded expenditures must align with the services identified in the Local Intended Use Plan. The formula to be followed is cited in Title V, Part C, Section 524 of the Public Health Services Act (42 U.S.C. 290cc -21 et. seq.). j. Training: On an annual basis, all staff must complete the Department's online training: Serving our Customers who are Deaf and Hard of Hearing, as directed in this contract's Standard Contract, a Cultural Competency /Diversity Training, Motivational Interviewing training, Trauma Informed Care training, and WRAP training. For new employees, the Network Provider shall ensure that the Serving our Customers who are Deaf and Hard of Hearing online training and the Competency /Diversity training are completed within thirty (30) days of hire. The Motivational Interviewing, Trauma Informed Care, and WRAP trainings shall be completed within ninety (90) day's of hire. Training certificates and the Attestation of Understanding for the Department's Serving our Customers who are Deaf and Hard of Hearing shall be printed and placed in the employee file. III. The Managing Entity will: a. Conduct annual monitoring site visits of the PATH - funded Network Service Providers. b. Assess the current year's IUPs to ensure the provider is meeting the targets that were set forth. c. Monitor the NSP's program toward annual targets in IUPs as reported in the quarterly and monthly PATH reports. d. Assist PATH providers in collaborating with local resources to link people with safe, affordable housing. The ME must use Section 4 and Appendix F in the most current State PATH Contact (SPC) Welcome Manual to conduct annual monitoring site visits. The manual will be provided by the Department. IV. Local match requirements: (a) Eligible PATH local match funds must be expended in the provision of PATH eligible services to PATH eligible persons. The expenditures must match the types of services Exhibit X Guidance /Care Center, Inc. Page 2 of 3 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7.1.2018 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. V. Monthly Reporting Requirements: By the 5 of each month following the month of services, the Network Provider will submit to the individuals identified in Exhibit. C, Required Reports, a monthly report containing the information submitted into the Homeless Management Information System (HMIS), and any other report(s) requested by the ME staff. Exhibit X Guidance/Care Center, Inc. Page 3 of 3 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 7/1/17 EXHIBIT AA Motivational Support Specialists The Network Provider agrees to comply with the provisions of this Exhibit, agrees to adhere to the requirements set forth in the approved Motivational Support Program Protocols ( "Protocols "), incorporated by reference herein. The protocols for each circuit in the Southern Region (Miami Dade County and Monroe County) are available upon request to the ME's Contract Manager. The Network Provider also agrees to agree to collaborate with the ME and the Department in executing the action steps identified in the Southern Region SAMH Integration with Child Welfare plan, herein incorporated by reference. 1. PURPOSE Motivational Support Specialist (MSS) are intended to reduce the incidence of child abuse and neglect resulting from parent(s)' or caregiver(s)' behavioral health condition and to improve outcomes for the families involved in the child welfare system. 2. AUTHORITY The Prime Contract between the ME and the Department provides the ME with the authority to contract for these services. 3. PROGRAM SPECIFIC TERMS a. . CASE MANAGEMENT - Case management services consist of activities aimed at identifying the recipient's needs, planning services, linking the service system with the person, coordinating the various system components, monitoring service delivery, and evaluating the effect of the services received. b. CHILD WELFARE - Services provided directly or under contract with the Florida Department of Children and Families' Family Safety Program Office. c. . DEPARTMENT - The Department of Children and Family Services, created pursuant to Section 20.19, Florida Statues (F.S.). d. FLORIDA SAFE FAMILIES NETWORK (FSFN) — A Department of Children and Families automated data system utilized to track child welfare cases. e. FULL CASE MANAGEMENT AGENCIES - full case management agencies under contract with Our Kids of Miami - Dade /Monroe, Inc., that provide support to children and families to help ensure the best possible outcomes for children and families who are involved in the child welfare system in Miami -Dade County. f. INCIDENTAL EXPENSES = This cost center provides for incidental expenses, such as clothing, medical care, educational needs, developmental services, FACT Team housing subsidies and pharmaceuticals (if not required by the RFP to be reimbursed through a separate cost reimbursement contract), and other approved costs. All incidental expenses must have prior written authorization by the ME's authorized staff member or be authorized in the contract. Exhibit AA Guidance /Care Center, Inc. Page 1 of 11 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 7/1/17 g. INTENSIVE FAMILY PRESERVATION SERVICES: Agencies under contract with Our. Kids of Miami -Dade /Monroe, Inc. to provide intensive in -home services intended to prevent high and imminent risk families from entering the Dependency Court system while increasing the families' level of functionality. h. MOTIVATIONAL SUPPORT SPECIALISTS (MSS) — Are staff positions (Case Manager) that provide ancillary support to the CBC Case. Manager, perform linkage to the child welfare system to engage and support involved child welfare families in appropriate behavioral health treatment and recovery with a goal of improving both behavioral health treatment and child welfare outcomes. i. MOTIVATIONAL SUPPORT SPECIALISTS SUPERVISOR — A master's level supervisor who manages and oversees the Motivational Support Specialists. j. OUR KIDS OF MIAMI - DADE /MONROE, INC. ( "Our Kids ") — The Department of Children and Family Services Child Welfare Community Based Care (CBC) Lead. Agency for the Southern Region. k. OUTREACH - Outreach services are provided through a formal program to both individuals and the community. Community services include education, identification, and linkage with high -risk groups. Outreach services for individuals are designed to: encourage, educate, and engage prospective consumers who show an indication of behavioral health needs. Client enrollment is not included in Outreach services. I. QUALIFIED PROFESSIONAL - A physician or physician assistant licensed under Chapter 458 or 459, F.S., a professional licensed under Chapter 490 or 491, F.S., notwithstanding any other provision of law, a person who is certified through a department- recognized certification process as provided for in ss. 397.311(33), and 397.416, F.S. Individuals who are certified are permitted to serve in the capacity of a qualified professional, but only within the scope of their certification. m. SCREENING A process involving a brief review to determine the person's appropriateness and eligibility for behavioral health services and the possible level of service. n. SUMMARY - A written statement summarizing the results of the screening relative to the perceived condition of the client and a further statement of possible needs based on the client's condition to include the results of a urinalysis, when applicable, as specified in the Motivational Support Program Protocols, incorporated by reference herein. 4. GEOGRAPHIC AREA & LOCATION a. Services will be provided in MONROE COUNTY at the Network Provider's site and /or, or in the field (i.e. client's home, community service center, etc.) b. . MSS services should be located in a place where they will be easily available and accessible to child welfare personnel. MSS locations, where client records are maintained, must be licensed for Intervention: General Intervention and Intervention: Case Management as required by Rule 65D -30, F.A.C. Exhibit AA Guidance /Care Center, Inc. Page 2 of 11 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 7/1/17 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 for 1 staff, as per the approved operating budget, herein incorporated by reference. b. Changes to the staffing pattern must be prior approved by the ME. c. Staff shall preferably hold the appropriate clinical license or certification. The minimum qualifications for a MSS are a bachelor's degree in a social behavior science or related field and one (1) year of applicable experience. Preference should be given to certified addictions professionals or to individuals who have both behavioral health needs and child abuse /neglect knowledge and experience. All MSS services are to be provided under the supervision of a qualified professional, as required by Rule 65D -30, F.A.C. 7. CLIENT ELIGIBILITY Services may be provided to parent(s) /caregiver(s) or children referred by the CBC or by the Department Child Protective Investigators (CPI) in which behavioral health indicators are present during the initial child abuse /neglect investigation, or at any point during child protective supervision or out -of -home care. Priority will be given to cases where a child is at risk for immediate removal or has been removed from the family, with a goal of reunification in the family safety plan as defined in the Motivational Support Program Protocols, incorporated by reference herein. Services may also be provided for the enrolled parent(s)' /caregiver(s)' family members, household residents, or significant others in need of behavioral health prevention or treatment services, as well as children in relative placements. For a detailed description of the client eligibility criteria please refer to the approved Motivational Support Program Protocols, incorporated by reference herein. 8. CASELOAD Each MSS shall maintain a caseload with a maximum of forty (40) families. A family includes all members of the family who are in need of behavioral health services. Caseload size shall be based on the severity, case management needs, and resources available to support the MSS. Once the MSS case load has reached capacity, the referrals shall continue to be screened and referred to an appropriate treatment provider. 9. SCREENING AND REFERRAL OF CLIENT TO SERVICES Exhibit AA Guidance /Care Center, Inc. Page 3 of 11 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 7/1/17 a. Each MSS shall maintain a directory of treatment resources, eligibility criteria, and referral procedures for available prevention and treatment resources in each community. The MSS will establish and maintain a working relationship with Our Kids of Miami - Dade /Monroe, Inc., (Community Based Care Lead Agency or "CBC "), within the community and Community Based Care Intensive Family Preservation Provider. b. The MSS will maintain an open line of communication with all relevant stakeholders (CPI, CBC Lead Agency, CBC Full Case Management Agency, CBC Intensive Family Preservation Provider, and the ME Child Welfare Integration Coordinator) in order to coordinate care, identify and resolve all systematic and programmatic barriers to client engagement and retention in treatment in a process of continuous quality improvement. c. Referrals to the MSP may be submitted through two sources: the CBC and the DCF CPI Program Administrators. For a detailed description of the referral process criteria please refer to the approved Motivational Support Program Protocols, incorporated by reference herein. d. The Motivational Support Supervisor (MS Supervisor), who is responsible for the day to day operations of the MSP, will receive referrals via an e-mail from the CBC with a FSFN case number and intake number. The MS Supervisor will assign an MSS to the referred case. The assignment of the MSS will be documented in FSFN where the referral source can access the information. The MSS will need to respond to and administer a urinalysis to all "urgent" cases within 24 hours of receipt of referral from the CPI Program Administrator. The MSS will also administer a urinalysis to all unsafe and conditionally safe cases within the time frame detailed in the Motivational Support Program Protocol. The Department is in the process of updating and renaming the "Safety Methodology" protocol and will be renamed the Florida's "Practice Model ". Once the Practice Model is fully implemented, there will be no "Conditional Safe" cases and MSS will only serve "Unsafe cases ". It is the Network Provider's responsibility to be aware of the changes and follow the guidelines as directed by the Department and /or the ME. e. The MSS will ensure that screening and linkage to behavioral health services are completed within the required time frames as described in the approved Motivational Support Program Protocols, incorporated by reference herein. f. A brief description of the duties of the MSP Screening processes are below, however, the Network Provider is referred to the approved Motivational Support Program Protocols, incorporated by reference herein, for a detailed description of the screening and referral process. A. The MSS, upon receipt of referral, will secure an SFBHN Consent to Release Information from the consumer and will attach this consent as part of the referral packet to the behavioral health provider. If the consumer refuses to sign the Consent to Release Information to MSS, then FSFN will be updated to indicate such. B. If the case is found not to have any behavioral indicators, MSS will enter a SAMH note in FSFN indicating the result of the assessment and upload the ME approved screening tool. The progress should be rated as "adequate ". Exhibit AA Guidance/Care Center, Inc. Page 4 of 11 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 7/1/17 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. 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. Exhibit AA Guidance /Care Center, Inc. Page 5 of 11 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 7/1/17 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 consumer's clinical needs, the behavioral health provider shall Zink the consumer to an appropriate behavioral health provider. The referring behavioral health provider shall notify the MSP within one (1) business day of this occurrence. The MSS will engage the SFBHN Child Welfare Integration Coordinator for assistance with the referral, if necessary. h. The MSS will contact the new behavioral health treatment provider within 24 hours of the notification to ensure that an initial intake appointment is scheduled within the required seven (7) business day timeframe. Exhibit AA Guidance /Care Center, Inc. Page 6 of 11 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 7/1/17 i. The MSS will notify all stakeholders of the change in behavioral health treatment provider and the new date of intake, and update FSFN within forty -eight (48) hours of occurrence. 11. CASE RECORD AND PLANNING a. The MSS are responsible for developing a case management assessment and service plan for each consumer /family receiving services from MSP. The MSS is directed to follow and adopt, at a minimum, the requirements set forth in Rule 65E- 15.051, the Florida Administrative Code for Case Management. The MSS are required to provide a copy of the service plan to the child welfare worker for incorporation into the child welfare case plan. b. The MSS are responsible for reviewing and updating the case management assessment and service plan as required by Rule 65E- 15.051. An updated service plan is also required when there is a major change of status regarding the client's participation in behavioral health treatment. The MSS are required to provide a copy of the updated service plan to the child welfare worker for incorporation into the child welfare case plan. c. The MSS shall perform continued case management related to the behavioral health services needs portion of the plan. Case management activities shall be provided for a period up to ninety (90) days from the date that the case has been accepted by MSP. MSS should make contact, preferably face -to- face, at least monthly with the client. This may include participation in formal staffing or informal contact. Case management activities shall include: i. Monitoring client's condition and progress in treatment; ii. Linking clients to services as dictated by their needs; and iii. Facilitating client's participation in treatment by removing barriers. 12. PROGRESS REPORT & STAFFING a. The MSS shall provide a monthly written status report, reported through FSFN as described in the Motivational Support Program Protocols, incorporated by reference herein, throughout the duration of the open behavioral health case to the child welfare worker and /or the CBC /IFPS /FCMA Provider, indicating treatment progress and alerting the child welfare worker to any barriers or other concerns. A written report is also required when there is a major change of status regarding the client's participation, and at the close of the case. b. The MSS shall participate in staffing of the family's progress as requested by the child welfare worker, the CBC /IFPS /FCMA Provider, or the behavioral health treatment provider. The MSS will facilitate a staffing of the family's progress when there is a major change of status regarding the client's participation in behavioral health treatment. Although face -to -face staffing is preferred, interested parties may participate through telephone conferencing. c. The MSS are required to remain informed regarding the status of the child welfare case plan. 13. DEPENDENCY COURT LIAISON Exhibit AA Guidance /Care Center, Inc. Page 7 of 11 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 7/1/17 a. The MSS shall provide liaison services to the dependency court and inter- agency communication regarding the status and progress of clients in the MSS caseload who are in behavioral health treatment. In accordance with 42CFR 2.61, The MSS will aid the behavioral health treatment provider and the court through coordination of care. The behavioral treatment provider in collaboration with the child welfare staff will make recommendations to the court regarding family reunification. b. The MSS shall appear in court under any of the following circumstances: i. Clinical case staffing of the client indicates the need for the MSS; ii. The court issues a subpoena to the MSS; iii. The department or a child welfare agency provides a request to the MSS in writing, requesting client court representation; or iv. Upon request of an attorney representing the department. c. If the court requests a written status report in lieu of court appearance, the MSS shall provide said report to the department's Legal Counsel for filing with the court. Client /family requests for an MSS to appear on their behalf will be taken into consideration. 14. LENGTH OF SERVICE & DISCHARGE a. MSS services shall be provided to an eligible client receiving behavioral health treatment to ensure linkage with and support for the child welfare case plan. The MSS may continue to provide MSS services to clients in active behavioral health treatment after the child welfare case is closed. b. The client may be discharged from MSS services upon any of the following: i. Behavioral health treatment is completed; ii. The client refuses to participate in the program; or iii. The client is incarcerated, or moves to another geographic area. iv. The case has been open with MSP for 90 days. c. Decisions about when to close a case or keep it open should be made by the MSS in consultation with the behavioral health provider, child welfare worker, CBC /IFPS /FCMA Provider, and /or the court. 15. DATA REPORTING REQUIREMENTS Data shall be submitted electronically to the ME by the 4th of each month following the month of service into the Knight Information Software database or other data reporting system designated by the ME. MSS shall enter data using an MSS Staff ID as defined in PAM 155 -2 and by the dates specified in Exhibit C, Required Reports. Exhibit AA Guidance /Care Center, Inc. Page 8 of 11 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 7/1/17 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 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; ii. Funds spent on behalf of (client name); Exhibit AA Guidance /Care Center, Inc. Page 9 of 11 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 7/1/17 iii. Referral type (protective investigation /supervision); iv. Date of request; v. Description of Goods /Services requested; vi. How the purchase is related directly to the intervention plan; vii. Goal /Reason for purchase amount requested; and viii. MSS and approving authority signature with date. - 19. REQUIRED REPORTS a. The MSP Tracker, incorporated herein by reference, is due monthly by the 10th of each month following the month of service to the individuals identified in Exhibit C, Required Reports. Failure to submit the MSP Tracker by the due may result in a corrective action and 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. Exhibit AA Guidance /Care Center, Inc. Page 10 of 11 Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 7/1/17 At a minimum, ninety percent (90 %) of the service plans shall be completed within the timeframes specified in the approved Motivational Support Program Protocol. 5. Monthly progress notes shall be documented in FSFN SAMH by the MSS for one hundred percent (100 %) of the cases. b. Performance Evaluation Methodology i. The outcome measurement contained in paragraph 20. a. 1 — 5 above will be calculated as follows: 1. Numerator: Individuals identified in FSFN SAMH notes Denominator: Total number of individuals entered into the KIS data system and /or identified in the MSP Tracker 2. Numerator: Number of clients screened Denominator: Total number of screenings completed within the specified timeframe 3. Numerator: Number of clients with a completed case management assessment Denominator Total number of case management assessments completed within the specified timeframe 4. Numerator: Number of clients with a completed service plan Denominator: Total number of services plans completed within the specified timeframe 5. Numerator: Number of cases identified in FSFN SAMH notes Denominator: Total number of progress notes documented in FSFN SAMH Exhibit AA Guidance /Care Center, Inc. Page 11 of 11 Contract No. ME225 -9 -27 n ., tt.g 40 fa OFFICF OF SUIjSTANCE ABUSE P � South Florida AND NtENTAI. ►IEaUTIf / Behavioral =' MYILFAMtuMCOM Health Network, Inc. "`- 07/01/2018 Exhibit AC DCF Template 21 Monthly Care Coordination Report - Narrative Region of Service: Circuits: Managing En tity: Report Period: Month/Year This report serves to track the progress of care coordination activities statewide. Please do not repeat info rmation, if you answered a question in previous months and nothing has changed, mark "No Changes ". If applicable, describe a success story: EN/A Care Coordination Practices Describe the evidence -based or innovative practices you are implementing: ❑ No Changes What standardized level of care determination are your providers using? ❑ASAM OLOCUS ❑other: How manyy individuals in Baker Act Receiving Facilities who were either on a court order or voluntary status awaiting transfer to a SMHTF did you divert during this reporting period? Briefly describe diversionary strategies, provider partnerships, and other resources utilized: List any new partnerships established in the reporting period (i.e., Memoranda of Understandings, Referral Agreements, Data Sharing Agreements, common assessments, etc.): ❑No Changes Describe any service gaps or barriers identified and how they are being resolved (i.e., redirection of resources, purchase of out of network services, etc.): ❑No Changes Describe how contracted network service providers are implementing care coordination practices: ❑No Changes Exhibit AC Page 1 of 3 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 Describe SOAR activities: ❑ Are SOAR applications reported in OAT For this reporting period . how many SOAR applications are: �1 Pending I= Approved MI Not Eligible Reasons tor ineligibility (i.e., immigration status) How many individuals who are homeless or at risk of homelessness were housed? List types of housing resources utilized (Le., Permanent, transitional, ALF, supportive housing, etc.) If applicable, list training needs: ❑ No Changes Acronyms ASAM American Society of Addiction Medicine LOCUS Level of Care Utilization System OAT Online Application Tracking SOAR (SSI /SSDI) Outreach, Access & Recovery CSU Crisis Stabilization Unit (for purposes of this document includes facilities providing inpatient and crisis stabilization services under the Baker Act) Exhibit AC Page 2 of 3 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 EXHIBIT AC 07/01/2018 South Florida Behavioral Health Network Care Coordination Report - Chart Provider: 1 Reporting Period: # of individuals in C. # of individuals D. Total # of A .# of individuals B. # of individuals ty P # of referrals Priority Populations the engagement enrolled at newly enrolled discharged during individuals enrolled E. Total # of # of individuals # of individuals below are defined in received process during the beginning of the during reporting reporting period at the end of individuals served to identified as involved in Child Guidance 4 of the ME reporting period ** (out of those that reporting period (A + date homeless - Welfare contract (not yet enrolled)* reporting period period were enrolled) B - C) 3 or more acute care admissions within 180 day period 3 or more detox admissions within 180 day period Acute care stay of 16 days or more within 180 day period Detox stay of 16 days or more within 180 day period Individuals discharged from SMHTF Individuals awaiting placement in SMHTF Other population as approved: Other population as approved: Total * Individuals in the engagement process are those individuals that are identified as meeting Care Coordination criteria who have not yet received services under Care Coordination ** Individuals enrolled in Care Coordination are those individuals that are receiving services under Care Coordination Guidance /Care Center, Inc. Exhibit AC Contract No. ME225 -9 -27 Page 3 of 3 South Florida Behavioral Health Network, Inc. 7/1/2018 Exhibit Al Family Intensive Treatment (FIT) Model Guidelines and Requirements Scope of Work Description: Specific Appropriations 369 provide funding ... "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." The Network Provider shall adhere to the service delivery and reporting requirements described in this Exhibit, the Program Guidance for Contract Deliverables Incorporated Document 18, Family Intensive Treatment (FIT) Model Guidelines and Requirements, dated July 1, 2018, or the latest revision thereof, which is incorporated by reference, and available at the following link: http: / /www.myflfamilies.com /service - programs /substance- abuse /managing- entities /2018 - contract- docs A. Goals of the FIT Model 1. Provide intensive treatment interventions targeted to parents with Child Welfare cases determined to be unsafe; 2. Establish a team based approach to planning and service delivery with Community Based Care Lead Agencies, child welfare Case Management Organizations, Managing Entities, FIT Team Providers and other providers of services. 3. Integrate treatment for substance use disorders, parenting interventions and therapeutic treatment for all family members into one comprehensive treatment approach. This comprehensive approach includes coordinating clinical children's services which are provided outside of the FIT team funding. 4. Promote involvement in recovery- oriented services and supports; 5. Provide for immediate access to substance abuse and co- occurring mental health services for parents in the child welfare system; 6. Help parents with substance use disorders recover; 7. Promote increased engagement and retention in treatment; 8. Facilitate program completion and aftercare; and 9. In collaboration with Community Based Care Lead Agencies and child welfare Case Management Organizations: a. Promote safety of children in the child welfare system whose parents have a substance use disorder; b. Develop a safe, nurturing and stable living situation for these children as rapidly and responsibly as possible; Exhibit Al Page 1of9 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 c. Provide information to inform the safety plan; d. Reduce the number of out -of -home placements when safe to do so; and e. Reduce rates of re -entry into the child welfare system. B. Client Eligibility The FIT Team Providers shall deliver services to parents who meet all of the following criteria: 1. Are eligible for publicly funded substance abuse and mental health services pursuant to s. 394.674, F.S.; including persons meeting all other eligibility criteria who are under insured. 2. Have a substance use disorder; 3. Have at least one child between the ages of 0 and 10 years old, with priority given to families with a child between the ages of 0 and 8; 4. At the time of referral to FIT: a. A child in the family has been determined to be "Unsafe" and in need of child welfare case management; and b. The parent(s) are willing to participate in the FIT Program or the parent is court ordered to participate in FIT services. In either case, enhanced efforts to engage and retain the parent(s) in treatment are expected as a critical element of the FIT program. C. Referral Sources The FIT Team Providers shall accept families referred by the child protective investigator, child welfare case manager or Community Based Care Lead Agency, provider of family intervention services, or the dependency court system. D. FIT Process Requirements The FIT Team Providers shall deliver an array of behavioral health services to eligible parents and other adult family members when necessary. Once a referral for an eligible parent(s) is received, the. FIT Team Provider shall: 1. Initiate contact with the parent(s) to begin the engagement and enrollment process within two (2) business days of receiving a referral. The FIT Team Provider shall ensure that .initial and recurring efforts to contact and engage the referred parent(s) are documented. 2. Document the date of enrollment as the date the parent signs consent for services. 3. Complete the initial assessments to determine the level of care and severity within fifteen (15) business days of enrollment and include the following assessments, at a minimum: a. American Society of Addiction Medicine (ASAM) to assess level of care; and b. Biopsychosocial Assessment to assess the severity of substance use disorders and other behavioral health needs. Exhibit Al Page 2 of 9 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 4. Provide treatment services by the clinician within two (2) business days of completing the initial assessments (ASAM and Biopsychosocial Assessment). Completion of the treatment plan with the family may be the first service. 5. Complete the DLA -20 Adult Functioning Assessment within thirty (30) calendar days of enrollment. To effectively monitor changes in client functioning over time, the DLA -20 shall be re- administered within (60) calendar days of initial completion of the DLA -20, and continued to be administered in 60 -day intervals throughout the course of formalized treatment. A final DLA -20 shall be administered when formalized therapeutic treatment is completed. 6. Complete additional assessments within thirty (30) calendar days of enrollment, to include the following at a minimum: a. A mental health assessment when indicated; b. Adult Adolescent Parenting Inventory (AAPI -2) to assess parenting capacity and family functioning; and c. Any other assessments as designated by the Department; 7. Complete an initial Adverse Childhood Experience (ACE) screening within sixty (60) calendar days of enrollment with each parent receiving FIT services and update as needed to consider new information related to trauma that may impact the ACE score. Note: may be completed sooner if clinically appropriate. 8. Develop a comprehensive family care plan within thirty (30) calendar days of enrollment to guide the provision of FIT services. At a minimum, the comprehensive family care plan shall: a. Be developed with the participation of the family receiving services; b. Include a case management plan that shows how support services will be provide to the enrolled parent(s). The case management plan may be a separate document or included as a component of the comprehensive family care plan; c. Coordinate clinical services received by the children, to align with the parents' clinical services; d. Identify how support will be provided to parents to address the child's therapeutic, medical, and educational needs; e. Be reviewed with the family and revised as needed every three months, or more frequently to address changes in circumstances impacting treatment; and f. Align with the individual services treatment plan of the enrolled parent(s) and the child welfare case plan. If the child welfare case plan has not been developed at the time of the development of the comprehensive family care plan, the comprehensive family care plan shall be revised upon completion of the child welfare case plan. 9. If parents are not engaging in services, immediately notify the assigned child welfare case manager to allow for strategies to be developed jointly. Notification and strategy development efforts must be documented. 10. The FIT team will inform the child welfare case manager's ongoing assessments of caregiver protective capacities through their progress updates. The Community Based Care Lead Agency will keep the case open until it has been assessed, with FIT Team Provider consultation, that: Exhibit Al Page Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 a. The caregivers have enhanced their caregiver protective capacities to the point where there are no longer danger threats within the home and the children are safe, or; b. The children otherwise achieve permanency. 11. Review the family's treatment during a multidisciplinary team (MDT) meeting no later than seven (7) days prior to a family's transition from the FIT program. The review shall include the parent(s) receiving FIT services; other family members or significant others identified by the parent(s); and the child welfare case manager and other providers serving the family. If it is not possible to hold an MDT meeting prior to the family's transition from the FIT program; for example, when treatment is interrupted due to factors such as judicial action or a parent going to jail; the MDT is optional. However, communication should occur between the FIT provider and the child welfare case manager regarding the status of the family at the time of discharge. The purpose of the MDT meeting is to ensure that: a. The family will receive behavioral health services that address the behavioral health condition and promote relapse prevention and recovery; b. The family has in place the services necessary to address their physical health care including a primary care physician for the parents and children; c. The support services put in place while in FIT; such as housing supports, supportive employment, financial benefits, etc.; can be sustained; d. The FIT Team Provider has identified available community services for the parents and children to provide for their ongoing well -being such as child care, early intervention programs, therapies, and community based parenting programs; e. The family's natural supports have been engaged to the degree possible; and f. Information about community support programs such as Alcoholics Anonymous, Narcotics Anonymous, a faith-based group or other recovery supports has been provided to the family. 12. Complete a FIT services Discharge Summary no later than seven (7) business days after discharge from all FIT services, including aftercare. The summary shall, at minimum, include: a. The reason for the discharge; b. A summary of FIT services and supports provided to the family; c. A- summary of resource linkages or referrals made to other services or supports on behalf of the family; and d. A summary of each family member's progress toward each treatment goal in the substance abuse treatment plan and comprehensive family plan. E. FIT Programmatic Requirements As part of a comprehensive array of behavioral health services and supports, FIT team services shall include the following activities, tasks, and provisions: 1. An emergency contact number for parents to reach someone in case of emergency 24 hours a day, 7 days a week; 2. Peer coaching and support services to promote recovery, engagement and retention in treatment, and skill development; Exhibit Al Page 4 of 9 Guidance /Care Center, Inc. Contract No. ME225 -9 =27 South Florida Behavioral Health Network, Inc. 7/1/2018 3. Case management services to address the basic support needs of the family and coordinate the therapeutic aspects of services provided to all family members regardless of payer source; 4. . Coordination of services and supports with child protective investigators and child welfare case managers; 5. Individualized treatment provided at the level of care that is recommended by standardized placement criteria; 6. Intensive in -home treatment, inclusive of individual and family counseling, related therapeutic interventions, and treatment to address substance use disorders, based on individual and family needs and preferences; 7. Group treatment to address substance use disorders, based on individual and family needs and preferences; 8. During the first phase of treatment, approximately the initial three to four months, clinical services will occur for approximately three hours a week with additional case management and peer services. 9. . Trauma - informed treatment services for substance use disorders and co- occurring substance abuse and mental health disorders; 10. Therapeutic services and psycho- education in: a. Parenting interventions for child - parenting relationships and parenting skills; b. Natural support development, including the familyy when appropriate; and c. Relapse prevention skill development and engagement in the recovery community. 11. Care coordination with a multi - disciplinary team to promote access to a variety of services and supports as indicated by the needs and preferences of the family, including but not limited to: a. Domestic violence services; b. Medical and dental health care; c. Basic needs such as supportive housing, housing, food, and transportation; d. Educational and training services; e. Supported employment, employment and vocational services; f. Legal services; and g. Other services identified in the comprehensive family care plan. 12. The FIT Team Provider will be trained in the use of substance abuse treatment and evidence based parenting practices found effective for serving families in the child welfare system. 13. The FIT Team Provider may provide Incidental Expense services, as defined in Rule 65E- 14.021, F.A.C., to the extent the primary need for such services demonstrably removes barriers and supports the family's recovery or reunification goals as documented in the family's treatment plan. F. Contracting Requirements 1. At minimum, the FIT Team Provider must be licensed for outpatient substance abuse services pursuant to Chapter 65D -30, F.A.C. If additional service components, for which the FIT Team Exhibit AI Page 5 of 9 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 Provider is not licensed, are needed for individualized treatment, the FIT Team Provider must ' purchase the service from an appropriately licensed provider. 2. FIT Team Providers are responsible for providing or subcontracting for all behavioral health services needed by individuals enrolled in FIT that are not directly provided by the team, including: detoxification; residential; crisis stabilization; medication management; aftercare; and other Covered Services as defined in Rule 65E- 14.021, F.A.C., as needed. The FIT provider is responsible . for immediate access to these services and for coordinating all services provided or purchased. 3. The FIT funds should not be used to purchase children's services however the FIT team must coordinate clinical services with providers serving children in the family. 4. Services provided by the core FIT team staff and funded by FIT contract dollars cannot be billed to any third -party payers. Services provided outside of the core FIT team staff may be billed to Medicaid or private insurance, to the extent allowable under these programs. The FIT team remains responsible for immediate access to services for enrolled individuals, regardless of payer. G. Administrative Tasks Staffing for FIT teams started prior to July 2016 The FIT Team must include the following general functions: 1. Program Management; 2: Clinical services for Substance Use Disorders and co- occurring mental and substance use disorders; 3. Specialized Care Coordination; and 4. Family Support/Peer Services. H. Staffing for FIT teams started after July 2016 For approximately every 20 families served, programs should have a minimum of: 1. 2 Behavioral Health Clinicians; 2. 1 Case Manager; and 3. 1 Peer Specialist. Programs serving -more than 40 families must also have a program manager. Adjustments to staff and management ratios must be approved by the Managing Entity. This ratio is based on enrolled clients. I. Minimum Staffing Qualifications for FIT Teams started after July 2016 1. Program Manager - A Master's degree in Behavioral Health Sciences, such as psychology, mental health counseling, social work, art therapy, or marriage and family therapy; and an active license issued by the Florida Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling; and a minimum of three years working with adults with substance use disorders. 2. Behavioral Health Clinicians - A Master's degree in Behavioral Health Sciences, such as mental health counseling, social work, art therapy, or marriage and family therapy; and a minimum of two Exhibit AI Page Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 years of experience working with adults with substance use disorders. (in smaller teams without a program manager one behavioral health clinician must be licensed). 3. Case Manager - A Bachelor's degree with a major in counseling, social work, psychology, criminal justice, nursing, rehabilitation, special education, health education, or a related field which includes the study of human behavior and development; and a minimum of one year of experience working with adults with behavioral health needs and child welfare involvement; or a Bachelor's degree with a major in another field and a minimum of three years of experience working with adults with substance use disorders. This position does not serve as the Dependency Case Manager and FIT does not fund the Dependency Case Manager. 4.. Peer Specialist - Certification as a Certified Recovery Peer Specialist certified by the Florida Certification Board; or direct personal experience living in recovery from substance abuse and mental health conditions and has been in recovery for at least 2 years with a minimum of one year work experience as a peer. Opportunities should be provided to peers to enhance and develop their skill sets. Peers can maximize their abilities if given opportunities to receive training that will further complement their lived experience. J. Monthly Progress Report The Network Provider shall submit FIT data, using Template 17 — FIT Reporting Template, by the 15t day of the month following service delivery. Note: Reporting Template 17 is accessible by clicking on the following link: http: / /www.myflfamilies.com /service - programs /substance- abuse /managing- entities Note: To access the template click on FY18 -19 ME Templates and click on Template 17 — FIT Reporting Template. K. Performance Measures for the Acceptance of Deliverables Monthly and yearly service targets should be determined by the Managing Entity, taking into account capacity of the provider, needs of families served, as well as geographical considerations. An estimated cost of $10,000 to $12,500 per family may be used to set targets for number of families to be served during a fiscal year, taking into consideration the above factors. The estimates should assume that families will remain in treatment and after care for several months, in some cases over a year. Managing Entities may consider a higher estimated cost and must discuss this recommendation with the Regional SAMH Director and with the FIT headquarters coordinator. In the event the Provider fails to achieve the minimum performance measures, the Managing Entity may apply appropriate financial consequences. L. Programmatic Performance Measures and Methodologies The Managing Entity shall include the following performance measures and methodologies in each FIT Team Provider subcontract: 1. At discharge, 90% percent of parents served will be living in a stable housing environment: Exhibit Al Page 7 of 9 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 a. The numerator is the sum of the number of parents discharged during the reporting period who are living in a stable housing environment. b. The denominator is the sum of the total number of parents discharged during the reporting period. c. The percentage of parents living in a stable housing environment at discharge, should be equal to or greater than 90 %. 2. 80% percent of parents served will improve their level of functioning as . measured by the DLA -20 Adult Functioning Assessment. a. Measurement of improvement is based on the change in the sum total scoring of the DLA- 20 between enrollment and completion of formalized therapeutic treatment. Improvement in functioning is indicated if the sum total score of the final DLA -20 assessment is at least four points higher than the sum total score at enrollment. b. The numerator is the sum of the number of parents that completed formalized treatment during the reporting period with an overall functioning score that is at least four points higher after completion of formalized treatment than at enrollment, indicating an improvement in their level of functioning. c. The denominator is the sum of the number of parents who completed the DLA -20 at enrollment and after formalized treatment completion who complete such treatment during the reporting period. d. The percentage of parents who improve their level of functioning should be equal to or greater than 80% 3. 80% of the parents served who complete a pre- and post- Adult Adolescent Parenting Inventory (AAPI -2) will improve their parenting functioning as measured on the AAPI -2 between admission and discharge. a. Measure improvement is based on the change between the AAPI -2 completed at admission and at discharge b. The numerator is the sum ofthe number of parents discharged during the reporting period with an overall functioning score that is higher at discharge than at admission. c: The denominator is the sum ofthe total number of parents with assessments for admission and discharge with the discharge being within the reporting period. 4. The FIT Team Provider will complete 85% of Discharge Summaries within seven (7) days of discharge from services: a. The numerator is the sum of the number of parents with Discharge Summaries completed within seven days of discharge. b. The denominator is the sum of the total number of parents discharged during the reporting period. c. The percentage of parents with a Discharge Summary completed within seven days of discharge during the reporting period should be equal to or greater than 85 %. 5. The FIT Team Provider will complete 85% of the initial level of care assessments (Biopsychosocial Assessment and ASAM) within fifteen (15) days of enrollment into FIT services: Exhibit Al Page 8 of 9 - Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 a. The numerator is the sum of the number of parents who received initial assessments (Biopsychosocial Assessment and ASAM) within fifteen (15) days of enrollment into FIT services during the reporting period. b. The denominator is the sum of the total number of parents who were enrolled during the reporting period for at least five days. c. The percentage of parents who receive assessments within five (15) days of enrollment during the reporting period should be equal to or greater than 85 %. 6. The FIT Team Provider will initiate treatment services for 90% of parents within 2 business days of completing the initial assessments (Biopsychosocial Assessment and ASAM): a. The numerator is the sum of the number of parents who receive treatment services within 48 business hours of completing their initial assessments during the reporting period. b. The denominator is the sum of the total number of parents who completed the initial assessments during the reporting period. c. The percentage of parents who receive treatment services within 48 business hours of completion of their initial assessments during the reporting period should be equal to or greater than 90 %. Exhibit Al Page 9 of 9 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 • South Florida Behavioral Health Network, Inc. Exhibit AK Monthly Substance Abuse and Mental Health Provider Waiting List Report Form - II or16 - CIRCUIT NUMBER: I I AGENCY NAME: I 1 REPORTING MONTH & YEAR: ( I ADULT MEN _ ADULT WOMEN _ JUVENILES Ending TOTAL Treatment Beginning Number Number Number Ending Treatment Beginning Number Number Number Ending Treatment Beginning Number Number Number Census Ending Services Census Added Placed Terminated Census Services Census Added Placed Terminated Census Services Census Added Placed Terminated M F Census Outpatient (MH /SA) Outpatient (MH /SA) Outpatient (MH /SA) Day /Night Day /Night Day /Night Detox 0 0 0 0 0 Detox 0 0 0 0 0 Detox 0 0 0 0 0 0 0 iication Assisted Treatn 0 0 0 0 0 lication Assisted Treat 0 0 0 0 0 Jication Assisted Treat 0 0 0 0 0 0 0 Total _ I Total I Total Of the total reported above, how many were seeking IV drug treatment? _ How many IV drug users waited 8 to 14 days? I More than 14 days? On the average, was your agency operating at 90% capacity during the reporting month? Yes n No n Note: Refer to Part 11 (Page 2) of this Exhibit for PREGNANT JUVENILES PREGNANT WOMEN additional reporting requirements Treatment Beginning Number Number Number Ending Treatment Beginning Number Number Number Ending Services Census Added Placed Terminated Census Services Census Added Placed Terminated Census Outpatient (MH /SA) Outpatient (MH /SA) __ Of the total number of women /juveniles Day /Night Day /Night reported above, how many were pregnant? Detox 0 0 0 0 0 Detox 0 0 0 0 0 iication Assisted Treatn 0 0 0 0 0 iication Assisted Treat 0 0 0 0 0 Total I Total POSTPARTUM JUVENILES POSTPARTUM WOMEN Treatment Beginning Number Number Number Ending Treatment Beginning Number/ Number Number Ending Services Census Added Placed Terminated Census Services Census Added Placed Terminated Census Outpatient (MH /SA) Outpatient (MH /SA) Of the total number of women /juveniles Day /Night Day /Night reported above, how many were postpartum? Detox 0 0 0 0 0 Detox 0 0 0 0 0 iication Assisted Treatn 0 0 0 0 0 lication Assisted Treat 0 0 0 0 0 Total _ Total Beginning Census + Number Added - Number Placed- Number Terminated = Ending Census DIRECTIONS: PROVIDERS SHOULD COMPLETE AND SUBMIT THIS FORM TO SFBHN. SFBHN MUST RECEIVE THIS FORM NO LATER THAN THE 5TH OF THE MONTH. DEFINITIONS: Beginning Census - Number of individual on the waiting list at the beginning of the reporting month. Number Added - Number of individuals added to the waiting list during the month. Number Placed - Number of individuals placed into treatment services. Number Terminated - Number of individuals terminated from the waiting list for reasons other than placement into treatment (unable to contact for follow -up, individual arrested, etc.). Ending Census - Number of individuals left on the waiting list at the end of the reporting month. Staff Person Completing This Form: I I Phone: I Form updated 4/4/2018 Exhibit AK Page 1 of 2 Guidance /Care Center, Inc. - - Contract No. ME225 -9 -27 Fxhihit AK - Part II 11or16 CIRCUIT NUMBER: I I AGENCY NAME: ADULTS WHO INJECT DRUGS CHILDREN /JUVENILES WHO INJECT DRUGS Number Placed on Average Days on Average Days Between Assessment & Number Placed on Average Days on Average Days Between Waitliest Waitlist First Service Waitliest Waitlist Assessment & First Service PREGNANT WOMEN WHO INJECT DRUGS CHILDREN INVOLVED IN THE CHILD WELFARE SYSTEM Number Placed on Average Days on Average Days Between Assessment & Number Placed on Average Days on Average Days Between Waitliest Waitlist First Service Waitliest Waitlist Assessment & First Service ADULT WHO ARE HOMELESS ADULTS INVOLVED IN THE CHIL WELFARE SYSTEM Number Placed on Average Days on Average Days Between Assessment & Number Placed on Average Days on Average Days Between Waitliest Waitlist First Service Waitliest Waitlist Assessment & First Service CHILDREN WHO ARE HOMELESS CHILDREN INVOLVED IN THE JUVENILE JUSTICE SYSTEM Number Placed on Average Days on Average Days Between Assessment & Number Placed on Average Days on Average Days Between Waitliest Waitlist First Service Waitliest Waitlist Assessment & First Service WOMEN WITH DEPENDENT CHILDREN Number Placed on Average Days on Average Days Between Assessment & Waitliest Waitlist First Service DIRECTIONS: PROVIDERS SHOULD COMPLETE AND SUBMIT THIS FORM TO SFBHN. SFBHN MUST RECEIVE THIS FORM NO LATER THAN THE 5TH OF THE MONTH. Staff Person Completing This Form: ( 1 Form updated 4/4/2018 Guidance /Care Center, Inc. Exhibit AK Contract No. ME225 -9 -27 Page 2 of 2 South Florida Behavioral. Health Network, Inc. 7/1/2018 EXHIBIT AM Return on Investment — Special Project Return on Investment for FY 2018 -19 I. Pursuant to the. FY 2018 -19 General Appropriations Act, the Network Provider has been awarded funding to provide the following services: Provider: Guidance /Care Center, Inc. Specific Appropriation Line Item #369 — Family Intensive Treatment Funding Amount: $633,188.00 Designated as follows: Miami -Dade Couty: $483,871.00 Monroe County:$149,317.00 Project: Family Intensive Treatment Contract Manager: Elba Taveras From the funds in Specific Appropriation 369, General Revenue to implement the Family Intensive Treatment (FIT) team model that is designed to provide intensive team - based, family- focused, comprehensive services to families in the child welfare system with parental substance abuse. These subcontracts shall be executed and managed in accordance with Guidance 18 — Family Intensive Treatment (FIT) Model Guidelines and Requirements. Treatment shall be available and provided in accordance with the indicated level of care required and providers shall meet program specifications. Funds shall be targeted to select communities with high rates of child abuse cases. The Network Provider shall: 1. By July 10' 2018, 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. Exhibit AM Page 1 of 2 - Guidance/Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 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 2 of 2 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 7.1.2018 EXHIBIT AN Supplemental Security Income /Social Security Disability Insurance (SSI /SSDI) Outreach, Access, and Recovery (SOAR) SOAR is a national project funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) that is designed to increase access to SSI /SSDI for eligible adults with mental illnesses or co- occurring disorders who are homeless or at risk of homelessness. Access to SSI /SSDI is a major tool in recovery from mental illnesses, homelessness or co- occurring disorders to engage in treatment, to keep appointments, to maintain housing, and to meet other basic needs. I. NETWORK PROVIDER RESPONSIBILITIES 1. Designation of a SOAR Processor: The Network Provider shall have a designated Case Managers /SOAR Processors trained in the SOAR Process who will process SOAR applications for all consumers receiving case management services under this contract that have been screened and determined to be eligible for SOAR benefits. The Case Manager(s) /SOAR Processor(s is responsible for their own training in the SOAR Model through the SOAR Online Course developed by Policy Research Associates and SAMHSA available at: https: / /soarworks.prainc.com /course /ssissdi- outreach - access - and - recovery - soar - online - t raining. 2. Each Case Manager /SOAR Processor at the Network Provider is responsible for entering their information and data into the SOAR Online Application Tracking (OAT) system. The Network Provider is responsible for notifying the ME about information regarding their Case Manager /SOAR Processor. This includes their name, SOAR Training Completion status, and their registration in OAT. 3. Eligibility Screening: Screening for SOAR eligibility shall be conducted during the intake or admissions process. 4. Timeframes for Completion of Applications: SOAR applications must be completed within a maximum of sixty (60) days of the protective filing date. This may vary depending on the Social Security Administration (SSA) office and the SOAR Liaison at that office. The SOAR Processor is responsible for going to their local SSA office and forming an agreement between themselves and the SSA SOAR Liaison about specific timeframes and what form of communication is best. 5. Appeals: If applicable the SOAR Processor shall complete the appeal process for those applications which may be denied upon initial review; 6. Data Requirement (OAT System): The SOAR Processor shall start entering information into the OAT system once the protective filing date is determined. They should not wait for the application decision to be made before they enter data into the OAT system. The SOAR Exhibit AN Page 1 of 3 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 7.1.2018 Processor(s) shall input all of the data into the OAT System, at a minimum monthly, for processed applications during the reporting period. The SOAR Processor(s) shall be responsible for ensuring that the information in the OAT System is updated regularly as necessary. The OAT program is available at: https: / /soartrack.prainc.com /login.php 7. Training: New SOAR Processor(s) shall be trained within forty -five (45) days of hire. The SOAR Processor(s) is responsible for their own training in the SOAR Model through the SOAR Online Course developed by Policy Research Associates and SAMHSA available at:. https: / /soarworks.prainc.com/ course /ssissdi- outreach - access - and - recovery- soar - online - training 8. The Network Provider is responsible for notifying the ME regarding the training status of their Case Manager /SOAR Processor.• The Case Manager /SOAR Processor shall complete the SOAR Online Course even if they participated in an in- person SOAR Training in the past. 9. The SOAR Processor(s) shall attend the regularly scheduled or specially called meetings when - notified by the ME. These include SOAR group technical assistance trainings SOAR fundamental refresher trainings. 10. Performance Outcomes & Outputs: The Network Provider shall meet the standards and required outcomes specified below: a. Maintain a minimum completion rate of 75% of applications are completed and submitted within 60 days of the Protective Filing Date. b. At a minimum, the Network Provider shall have a sixty -five percent (65 %) SOAR application approval rating during each fiscal year. c. Maintain the minimum negotiated quarterly target of 4 for completed applications. Network Provider Compliance: Failure to meet the applicable standards established in Tables 1 and 2 shall be considered nonperformance pursuant to Standard Contract, Paragraph 36. Financial Consequences for Network Provider's. Failure to Perform. II. MANAGING ENTITY RESPONSIBILITES 1. The ME shall adhere to the requirements identified in the Department's Supplemental. Security Income /Social Security Disability Insurance (SSI /SSDI) Outreach, Access, and Recovery (SOAR) Guidance Document — Incorporated Document 9. The . Department's Incorporated Document 9 can be accessed by visiting the Department's website or by clicking on the link below: http: / /www.mvflfamilies.com /service - programs/ substance - abuse /managing- entities Exhibit AN Page2of Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Rev. 7.1.2018 Note: To access the form click on FY18 -19 ME Templates and click on Guidance 9 - Supplemental Security Income /Social Security Disability Insurance (SSI /SSDI) Outreach, Access, and Recovery (SOAR). 2. The ME shall ensure that the Network Provider implements the SOAR process. 3. The ME shall monitor the Network Provider's performance on all tasks identified in this Exhibit and issue corrective actions if deemed necessary. 4. The ME shall provide training and technical assistance when requested by the Network Provider. Exhibit AN Page3of3 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral_ Health Network, Inc. 7/1/2018 EXHIBIT AP Mental Health Case Management Standards A. Definitions: The definitions below are for the purposes of this Exhibit. Other definitions may exist in care coordination or other authorities. Caseload means those clients which are managed by a designated case manager. Case management services consist of activities that identify the recipient's needs, plan services, link the service system with the person, coordinate the various system components, monitor service delivery, and •evaluate the effect of the services received. This covered service shall include clinical supervision provided to a service provider's personnel by a professional qualified by degree, licensure, certification, or specialized training in the implementation of this service. (Ref. Rule 65E- 14.021(4)(c)1.) Service Plan is the part of the clinical record which outlines a comprehensive strategy for improving a client's quality of the services and resources necessary to achieve these goals and objectives. The service plan is designed to integrate the efforts and effects of multiple service and resource providers. The case manager and the client develop the service plan in conjunction with family members, service providers and other entities and individuals necessary to its implementation. Treatment Plan is an individual document or identifiable section of the service plan developed by treatment staff and the client which depicts goals or objectives for the provision of services within specific treatment environments. Examples of treatment environments include, but are not limited to, day treatment, vocational, residential, outpatient and activities of daily living programs. B. Overall Goal of Case Management. The primary goal of care management is to optimize the functioning of individuals who have complex needs by coordinating the provision of quality treatment and support services in the most efficient and effective manner. The desired outcomes for persons using the service system are self- sufficiency and satisfaction in the living, learning, work and social environments of their choice. Case managers shall have at a minimum a bachelor's degree with major course work in a human services field or equivalent training and experience on a year for year basis in a related field. (1) Case management responsibilities include, but are not limited to, the following activities: (a) Development and implementation of a case management assessment: 1. A case management assessment is a holistic review of a client's living situation which includes a determination of the client's strengths and weaknesses, the client's needs and resources, and the strengths and weaknesses of the client's support system. The case managers shall be responsible for the overall completion of the assessment, but shall work with the client and consult with relevant professionals where specific expertise is needed. Exhibit AP Page 1 of 6 Guidance /Care Center, Inc. Contract No.,ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 2. The case management assessment shall consider information from the following sources: a. Client's assessment of his or her personal situation; b. Input from the family, friends or significant others. Such input shall be sought with the consent of the client; c. Collateral information which may include records dealing with previous psychiatric hospitalizations, outpatient treatment and evaluations, summaries and progress notes from other involved human service individuals or agencies. If collateral information is not available, this shall be documented in the case record; d. Information from the referral source; e. Pertinent service agencies with whom the client is involved and an evaluation of the impact these services have on the client's life. 3. The case management assessment shall consider the following: a. The presenting problem; b. Client's current and potential strengths and deficits; c. The family's current and potential strengths and deficits; d. Client's relationship with family members and significant others; e. The impact of the currently provided services on the client's life; f. Client's involvement or need for involvement in client support groups or ancillary social support systems; g. Need for training in community living skills, medications, or activities of daily living; h. Need for education, vocational training or job- seeking skills; i. Need for housing, food, clothing, and transportation; j. Need for mental health, alcohol and drug abuse services; k. Need for medical and dental services, including current medications; I. Need for legal services; m. Need for backup support and consultation to family, friends, landlords, employers, community agencies and community members who come in contact with the client; and n. Need for and the establishment of financial resources such as Social Security, Supplemental Security Income, Veterans Administration or trust funds. 4. The case management assessment is to consist of a single identifiable, dated document, included in the clinical record. 5. The initial case management assessment must be completed within 30 days of the referral of the client for case management services. 6. A home visit is to be made prior to the completion of the Assessment, unless the case manager's supervisor deems such a visit unsafe to the case manager or such a visit is denied by the client. Exhibit AP Page 2 of 6 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 In such instances where a home visit does not occur: a. The reasons for the failure to make such a visit will be documented in the case record and signed by the case manager and the case manager supervisor. b. Subsequent visitations and the suitability of the housing shall be considerations addressed in the service plan. 7. Subsequent written case management assessments shall be completed and an updated Service Plan developed at a minimum of every 6 months, or when the client changes residence, enters or is discharged from a state treatment facility or at other times when the client's situation changes significantly. (b) Service Planning 1. Service planning is the process of developing a general strategy to utilize strengths and address weaknesses identified through case monitoring and through assessments. The case manager, in conjunction with the client, shall be responsible for the development of the service plan. However, service planning is a collaborative effort which also involves family members, service providers, or others significant to the implementation of the resultant plan. The results of the service planning process shall be a service plan. 2. The Service Plan must be on a single identifiable and dated document, developed within 15 days of a completed Assessment and signed by the client, case manager, the case manager's supervisor, and other appropriate participants involved in the service plan development. The service plan is an individualized document which meets the comprehensive needs of the client. All service plans shall be included in the client's record. 3. In cases where immediate services are needed, service delivery shall not be delayed pending completion of either the assessment or service plan. 4. The Service Plan shall contain a description of the long -term desired outcome for the case. 5. The Service Plan shall contain measurable goals and objectives derived from the assessment of client's strengths, deficits and resource needs. a. Each objective must have an identified time frame for achievement, and stated in terms of observable and measurable outcomes. b. Each objective shall state the name of the individual or agency responsible for the action to be achieved. 6. The client shall be provided a copy of the Service Plan, and this shall be documented in the record. With the approval of the client, others involved in its development or implementation shall be provided with a copy of the service plan. Exhibit AP Page 3 of 6 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 (c) Linkage and Brokerage The case manager shall ensure that the Service Plan is implemented through a variety of linkage and brokerage activities designed to procure specified services, treatment and resources for the client. 1. Such activities include verbal or written referrals, telephone calls, meetings, assistance with making appointments and completing applications, assistance at interviews and hearings, transportation and supportive counseling. 2. The case manager shall convene case staffing at major decision points during the client's involvement with the alcohol, drug abuse and mental health system. Such decision points shall include movements to a lesser or more restrictive environment in the community or transfers to and from state hospitals. Such conferences shall be attended, as appropriate, by the client, family members, service providers and significant others. (d) Monitoring Case Managers shall ensure that Service Plan goals and objectives are consistently pursued, assess the functioning level of the client, and assess progress toward the achievement of goals and objectives through a range of monitoring activities including telephone calls, home visits, case and treatment reviews, interviews and site visits. 1. Where monitoring reveals that minor adjustments are necessary in order to better accomplish the goals and objectives of the service plan, the case manager shall update these portions of the plan and take action to implement these adjustments. 2. Where monitoring reveals that conditions have changed to the extent that the service plan is no longer valid, the case manager shall make a reassessment and ensure the development of a new service plan. (e) Advocacy 1. Case managers shall function in the best interest of the client and shall intercede on behalf of the client to assure that service and resources needs are met. 2. The case manager shall identify service and resource gaps and barriers which limit a client's access to existing services and resources to client managers. • (2) The case manager shall make a minimum of a monthly face -to -face contact with all clients residing in the community. (3) Case managers may utilize contingency funds provided by the department in accordance with circuit procedures. These shall be used to provide for unmet resource needs of clients when other resources are not available or in combination with other resources. (4) For clients residing in the community, the case manager shall make a home visit or field visit within the client's natural environment at a minimum of every other month, unless the case Exhibit AP Page 4 of 6 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 manager's supervisor deems such visits unsafe to the case manager or the client declines such visitation during the planning process. In such instances where home visits are not to occur: (a) The reason for the failure to make such a visit will be documented in the case record signed by the case manager and case manager supervisor, (b) Subsequent visitations and the suitability of the housing shall be considerations in the service plan. (5) When a client misses an appointment related to the service plan or is absent from a treatment program without notification, the case manager shall attempt to contact the client either by telephone or face -to -face meeting within twenty -four hours. If initial attempts to contact the client are unsuccessful, the case manager shall make additional efforts by telephone, face -to -face meetings, or correspondence. Upon contacting the client, the case manager shall explore the reasons for the absence or the missed appointment and shall work with the client to resolve any issues inhibiting the effective implementation of the plan. Such efforts and their results shall be documented in the case record. (6) Case Management Record. 1. An individualized case record for each client shall be maintained. 2. A clearly identifiable portion of the agency's record shall be devoted to case management. This portion shall contain the demographic information and items specified in subsection 65E- 4.014(3)b., F.A.C. 3. The case record shall be maintained in accordance with Rule 65E- 4.014, F.A.C. 4. In addition to items specified in Rule 65E- 4.014, F.A.C., the record shall contain: (a) The name of the current assigned case manager (b) Any copies of a consent to give information relevant to the case. (c) Assessment information as stated above. (d) Service Plan as stated above. (e) Progress Notes, documenting all of the case manager's activities, contacts and communications on behalf of the client, including the following: 1. Date 2. Type of contact; for example, home visit, telephone, office visit 3. Contacting person 4. Person or agency contacted 5. Brief account of contact 6. Relevance to the Service Plan 7. Documentation of missed appointments, follow -up, and an explanation of why the appointments were missed 8. Documentation for the need and lack of availability of any goods or services for which contingency funds are requested (f) Advocacy efforts as specified above. Exhibit AP Page 5 of 6 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 (7) Case load. The mental health case manager's caseload shall not exceed 40 consumers at any given time. (8) Case managers shall a minimum of a bachelor's degree with major course work in a human services field or equivalent training and experience on a year for year basis in a related field. Exhibit AP Page 6 of 6 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 EXHIBIT AS Monroe. County Centralized Receiving Facility I. OVERVIEW Guidance /Care Center, Inc. ( "Network Provider") is the designated centralized receiving facility ( "CRF ") that serves as the coordinated system of entry in the central region of Monroe County for individuals with mental health or substance use disorders, or co- occurring disorders. The designation as the CRF and the services to be provided are established in accordance with Florida Statute 394, Florida Mental. Health Act, Florida Statute 397, Hal S. Marchman Alcohol and Other Drug Services Act, and in accordance with the Monroe County Designated Receiving System Plan, dated 2017 -2020, (MC -Plan, or latest revision thereof), herein incorporated by reference. The CRF is responsible for assessment and evaluation, both voluntary and involuntary, and treatment or triage and /or stabilization of persons with mental health or substance use disorder, or co- occurring disorders. The CRF shall function as a no- wrong -door model that responds to individual .needs and integrates services among various providers. The Network Provider shall participate in a coordinated system that is linked by a method to share data, formal referral agreements, and cooperative arrangements for care coordination. The Network Provider shall provide, or arrange for necessary services following an initial assessment or screening and evaluation. II. PROVISION OF THE PRIME CONTRACTS The CRF is funded with Department of Children and Families and Monroe County funding. All provisions, terms and conditions, or amendments, addendum, changes or revisions applicable to the Network Provider made subsequent to the initial execution of the Prime Contract, (the contract entered into between the Department of Children and Families and the ME, not in conflict with this Contract, shall be binding upon the Network Provider and the Network Provider agrees to comply with same. The Prime Contract is incorporated by reference in this Contract. III. MONROE COUNTY DESIGNATED RECEIVING SYSTEM PLAN The Network Provider agrees to adhere to and implement the CRF in Monroe County as described in the Monroe County Designated Receiving System Plan, dated 2017 -2020 (or the latest revision thereof), herein incorporated by reference. IV. OBJECTIVES The primary objectives of the CRF are to: 1. Provide a central receiving system serving the target populations; Exhibit AS Page 1 of 5 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 2. Provide initial screenings, assessments for consumers that meet criteria for acute care services, triage, care coordination, and related services and linkage to appropriate level of care; 3. Provide opportunities for jail diversion, offering a more suitable and less costly alternative to incarceration; 4. Reduce the inappropriate utilization of emergency rooms; 5. Increase the quality and quantity of services through coordination of care and recovery support services; 6. Implement standardized screening tools and procedures for services; and, 7. Improve access and reduce processing time for law enforcement officials transporting individuals needing behavioral health services. V. SCOPE OF THE ACTIVITIES AND SERVICES A. Target Population 1. Individuals needing evaluation or stabilization under s. 394.463, F.S., the Baker Act; 2. Individuals needing evaluation or stabilization under s. 397.675, F.S., the Marchman Act; and, 3. Individuals needing crisis services as defined in ss. 394.67(17) -(18), F.S. 4. Individuals needing screening for non -acute mental health and /or substance abuse treatment services and that meet the target population descriptions contained in s. 394.674, F.S. and described in the DCF Pamphlet 155 -2. B. Client Services 1. The Network Provider shall provide crisis stabilization, substance abuse detoxification services, crisis support emergency services, screenings, assessments for consumers that meet criteria for acute care services, and Medication Assisted Treatment, and care coordination for clients referred to other providers. 2. Screening services for individuals needing acute and non -acute mental health and /or substance abuse treatment services must be available through the CRF seven days per week, 365 days per year. 3. Screening Tools: The Network Provider shall utilize the AST, and the GAIN SS, or any other screening tool(s) agreed to between the ME and the Network Provider. 4. The Network Provider must have a protocol to screen and triage all individuals to determine an individual's . immediacy of needs and establish a plan for further assessment and treatment. The screening must at a minimum include: • Reason for referral • Medical needs Exhibit AS Page 2 of 5 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 • Current medications • Current substance use, and • Risk of harm to self and others C. The Network Provider's ability to accept consumers under the CRF system is to be executed according to its capabilities and limitations as described in the table below and as described in the Monroe County Transportation Plan for Involuntary Examinations (Baker Act) and Involuntary Admissions (Marchman Act), herein incorporated by reference. CRF Service Capabilities /Limitations Voluntary Assessment and Evaluation Crisis Stabilization Unit (Adults Only), Detoxification (Adults Only), Screening and Assessment Involuntary Assessment and Evaluation Crisis Stabilization Unit (Adults Only), Detoxification (Adults Only), Screening and Assessment Triage for Mental Health Services Crisis Stabilization Unit (Adults Only), Screening and Assessment Triage for Substance Use Disorder Services Detoxification (Adults Only), Screening and Assessment Involuntary Treatment for Mental Health Crisis Stabilization Unit (Adults Only) Disorders Involuntary Treatment for Substance Use Detoxification (Adults Only) Disorders D. PERFORMANCE MEASURES 1. 85% of persons who walk into the CRF requesting screening (non- acute) services shall be screened on the same day. 2. 100% of persons brought in involuntarily by law enforcement under Baker Act will be admitted for evaluation. Appropriate transfer to other CSU's /Inpatient will be secured by the Network Provider staff upon evaluation and determination that continued admission is medically required. Transportation to the referral facility will be arranged by the Network Provider. Exhibit AS Page 3 of 5 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 3. 85% of persons determined by the screening process to need outpatient services shall be linked to an appropriate provider. The CRF will secure an outpatient appointment within ten (10) business days of the date of the initial screening. 4. 85% of persons referred to outpatient services will receive a follow -up within seventy - two (72) hours of scheduled appointment to determine linkage. 5. 85% of persons determined not to have a successful linkage will receive an alternate referral for outpatient services within ten (10) business days. 6. No more than 14.81% CSU readmissions within thirty (30) calendar days for consumers referred internally for post -CSU discharge services. 7. No more than TBD% Detoxification readmissions within thirty (30) calendar days for consumers referred internally for post- detoxification discharge services. E. SERVICE SITE ADDRESS AND TELEPHONE NUMBER 3000 41s Street Ocean Marathon, FL 33050 (305) 434 -7660 F. FUNDING: The Network Provider's allocation to operate the CRF is found in Exhibit H, Funding Detail. G. METHOD OF PAYMENT: The CRF shall be paid on a fee - for - service (Unit Rate) method of payment, in accordance with the payment methodology provided for in Rule 65E- 14.019 (2), F.A.C. for the covered services listed in Exhibit G, Covered Service by OCA. H. COLLABORATIONS AND PARTNERSHIPS 1. ME's Care Coordination Department: The Network Provider shall work with the ME's Care Coordination Department if an individual entering the CRF is identified as needing care coordination services. Refer to Attachment I, Section B. 1. a. (23), Care Coordination and Reporting Requirements, for a more detailed description of Care Coordination services. 2. The Network Provider, in collaboration with the ME and Monroe County, shall review and update, as necessary, the designated receiving system at least once every three (3) years, or earlier if deemed necessary. 3. The Network Provider is expected to develop partnerships and agreements with community partners (i.e., other SFBHN contracted Network Providers, managed care organizations, criminal and juvenile justice systems, community based care organizations, housing providers, federally qualified health centers, etc.) for the coordination of care to individuals referred from the CRF, to leverage resources and share data as allowed by federal and state laws. Exhibit AS Page 4 of 5 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 7/1/2018 I. REPORTING REQUIRMENTS 1. Service Data: Service Data into KIS or any data system designated by the ME and shall be submitted per the requirements described in Attachment I, Section B. 4. Deliverables, and in Attachment I, Section D. 2., Acute Care Service Utilization Reporting for Public Receiving Facilities, Detoxification and Addiction Receiving Facilities. 2. Performance Measures Report: By the 30 of every month following the reporting month for the measures listed above in Section VI., paragraph D., Performance Measures. 3. Ad Hoc Reports: The Network Provider agrees to submit any ad -hoc and /or additional reports as determined necessary by the ME, Department of Children and Families. J. STAFFING: Any changes in staffing plan greater than 25% of either the total FTE or total salary costs, as per the approved budget, is subject to ME approval. K. MEETINGS /TRAININGS 1. The Network Provider will ensure that its staff is properly trained on CRF model, goals and objectives, evidence based practices and Screening and Level of Care Placement Tools. 2. The Network Provider shall meet with the ME's staff at regularly scheduled or specially called meetings and /or trainings when notified by the ME. Exhibit AS Page Guidance /Care Center, Inc. Contract No. ME225 -9 -27 �� South Florida / Behavioral Health Network, Inc. Effective 7.01.2018 ATTACHMENT II Financial and Audit Compliance The administration of resources awarded by the Department of Children & Families, through the Managing Entity, to the provider may be subject to audits as described in this attachment. MONITORING In addition to reviews of audits conducted in accordance with 2 Code of Federal Regulations (CFR) §§ 200.500- 200.521 and § 215.97, F.S., as revised, the Department may monitor or conduct oversight reviews to evaluate compliance with contract, management and programmatic requirements. Such monitoring or other oversight procedures may include, but not be limited to, on -site visits by Department staff, agreed - upon procedures engagements as described in 2 CFR § 200.425 or other procedures. By entering into this agreement, the recipient agrees to comply and cooperate with any monitoring procedures deemed appropriate by the Department. In the event the Department determines that a limited scope audit of the recipient is appropriate, the recipient agrees to comply with any additional instructions provided by the Department regarding such audit. The recipient further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the Department's inspector general, the state's Chief Financial Officer or the Auditor General. AUDITS PART I: FEDERAL REQUIREMENTS This part is applicable if the recipient is a State or local government or a non - profit organization as defined in 2 CFR §§ 200.500- 200.521. In the event the recipient expends $750,000 or more in Federal awards during its fiscal year, the recipient must have a single or program- specific audit conducted in accordance with the provisions of 2 CFR §§ 200.500- 200.521. The recipient agrees to provide a copy of the single audit to the Department's Single Audit Unit and its contract manager. In the event the recipient expends less than $750,000 in Federal awards during its fiscal year, the recipient agrees to provide certification to the Department's Single Audit Unit and its 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, 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 established by 2 CFR §§ 200.500- 200.521. An audit of the recipient conducted by the Auditor General in accordance with the provisions of 2 CFR Part 200 §§ 200.500- 200.521 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 2 CFR § 200.508. Attachment II Page 1 of 4 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 •• South Florida Behavioral Health Network, Inc. Effective 7.01.2018 The schedule of expenditures should disclose the expenditures by contract number for each contract with the Department in effect during the audit period. The financial statements should disclose whether or not the matching requirement was met for each applicable contract. All questioned costs and liabilities due the Department shall be fully disclosed in the audit report package with reference to the specific contract number. PART 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 ($750,000 or more for fiscal years beginning on or after July 1, 2016) 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 Department's Single Audit Unit and its contract manager. In the event the recipient expends Tess than $500,000 (less than $750,000 for fiscal years beginning on or afterJuly 1, 2016) in State financial assistance during its fiscal year, the recipient agrees to provide certification to the Department's Single Audit Unit and its 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, other state agencies, and other nonstate entities. State financial assistance does not include Federal direct or pass- through awards and resources received by a nonstate entity for Federal program matching requirements. In connection with the audit requirements addressed in the preceding paragraph, the recipient shall ensure that the audit complies with the requirements of Section 215.97(8), Florida Statutes. This includes submission of a financial reporting package as defined by Section 215.97(2), Florida Statutes, and Chapters 10.550 or 10.650, Rules of the Auditor General. The schedule of expenditures should disclose the expenditures by contract number for each contract with the Department in effect during the audit period. The financial statements should disclose whether or not the matching requirement was met for each applicable contract. All questioned costs and liabilities due the Department shall be fully disclosed in the audit report package with reference to the specific contract number. PART III: REPORT SUBMISSION Any reports, management letters, or other information required to be submitted to the Department pursuant to this agreement shall be submitted within 180 days after the end of the provider's fiscal year or within 30 (federal) or 45 (State) 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) Attachment 11 Page 2 of 4 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 P, South Florida / / Behavioral Health Network, Inc. Effective 7.01.2018 B. Department of Children & Families (1 electronic copy and management letter, if issued) Office of the Inspector General Single Audit Unit Building 5, Room 237 1317 Winewood Boulevard Tallahassee, FL 32399 -0700 Email address: HQW. IG .Single.Audit@myflfamilies.com C. Reporting packages for audits conducted in accordance with 2 CFR Part 200 §§ 200.500- 200.521, and required by Part I of this agreement shall be submitted, when required by § 200.512 (d) by or on behalf of the recipient directly to the Federal Audit Clearinghouse using the Federal Audit Clearinghouse's Internet Data Entry System at: http: / /harvester.census.gov /fac /collect /ddeindex. html and other Federal agencies and pass- through entities in accordance with 2 CFR § 200.512. D. Copies of reporting packages required by Part II of this agreement shall be submitted by or on behalf of the recipient directly to the following address: Auditor General Local Government Audits /342 Claude Pepper Building, Room 401 111 West Madison Street Tallahassee, Florida 32399 -1450 Email address: flaudgen localgovt @aud.state.fl.us Providers, when submitting audit report packages to the Department for audits done in accordance with 2 CFR §§ 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 Department or its designee, Chief Financial Officer or Auditor General access to such records upon request. The recipient shall ensure that audit working papers are made available to the Department or its designee, Chief Attachment II Page Guidance /Care Center, Inc. Contract No. ME225 -9 -27 �� South Florida / Behavioral Health Network, Inc. Effective 7.01.2018 Financial Officer or Auditor General upon request for a period of three years from the date the audit report is issued, unless extended in writing by the Department. Attachment II Page 4 of 4 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 �/ South Florida �/ Behavioral Health Network, Inc. ATTACHMENT III CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to Influence an officer or an employee of any agency, a member of congress, an officer or employee of congress, or an employee ofa member of congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all sub - awards at all tiers (including subcontracts, sub - grants, and contracts under grants, loans and cooperative agreements) and that all sub - recipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who falls to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. co /asl(r Signal e� j - Date Sharon Crippen, Sr. Vice President ME225 -9 -27 Name of Authorized Individual Application or Contract Number The Guidance / Care Center, Inc. Name of Organization 3000 41st Street Ocean, Marathon, FL 33050 Address of Organization CF 1123, PDF 03/96 Attachment III Guidance/Care Center, Inc. Page 1 of 1 Contract No. ME225 -9-27 �/ ®� South Florida Behavioral Health Network, Inc. ATTACHEMENT IV SCOPE OF WORK NAME OF PROVIDER: Guidance /Care Center NAME OF PREVENTION PROGRAM: Power of Prevention AMOUNT OF CONTRACT AWARD: $199,063.00 "Regular" Prevention Prevention Partnership Grant TYPE OF FUNDING: Services (PPG) X COST ALLOCATED TO: (check both Children's Substance Abuse Adult Substance Abuse if approved for both covered services) X Section I. DESCRIPTION OF SERVICES AND STRATEGIES FOR SERVICE DELIVERY DESCRIPTION P SERVICES SUMMARY (Include overall intention /purpose CQ program ri J p _ brief description r f program MilatIA target population f) served, kw 7 (kg ED2gb2p address gag& competency f ulT3 name (3D IRG E-BP QpD I Gi11fl2 sgbga C I implemented, describe comprehensive> , prograrrlming, and the partners EGi I coordination; efforts); The Guidance /Care Center's Prevention program, POP for Power of Prevention, consists of (3) evidence -based practices: An Apple A Day© (K -4), Alcohol Literacy Challenge (Middle School), and Teen Intervene (Middle School) of which address the specific long -term outcomes identified in the CCAP for Monroe County. The overall intention of implementing these practices is to build self- esteem, develop resiliency skills, and enable children to become caring, responsible adults. These practices also address common goals and outcomes listed in the Monroe County CCAP 2017 -2022, while integrating linkages to primary care for those participants currently lacking resources to maintain overall health and wellness. Services will build upon identified protective factors while considering identified risk factors to align with SAMHSA's CSAP Strategic Prevention Framework, the National Drug Control Strategy, and the National Underage Drinking Prevention Strategy. Using the Strategic Prevention Strategy's 5 steps, POP staff will ASSESS the needs of youth; build participant's capacity considering risk and protective factors; plan the best Prevention approaches with participants using EBP's; implement sessions based on these EBP's; and work closely with the SFBHN and Behavioral Science Research Institute (BSRI) evaluation entity to conduct evaluation of the program's outcomes and effectiveness. The Mental Health First Aid strategy will support the processes. These five steps assist youth while considering sustainability of the program and a framework of cultural competency always. The POP program staff will seek to coordinate all prevention activities with referrals from other agencies to collaborate and maximize resources when indicated and possible. EDUCATION: An Apple A Dav© is a prevention education program for K -4 that teaches children to have the inner strength, the resilience to resist substance abuse, and the power to share that strength with others. 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 School students. Teen Intervene is a brief, early intervention for Middle School students 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 Attachment IV Scope of Work Page 1 of 15 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 •• South Florida Behavioral Health Network, Inc. who are experiencing one or more acute mental health crises (i.e., suicidal thoughts and /or behavior, acute stress reaction, panic attacks, and /or acute psychotic behavior) or are in the early stages of one or more chronic mental health problems (i.e., depressive, anxiety, and /or psychotic disorders, which may occur with substance abuse). This will assist the staff in increased skills to implement the screening, assessment, and accuracy of the DCI tool and other services for enhanced participant improvements ALTERNATIVES — each program provides activities for youth to consider excluding substance use and increasing pro - social behavior. Alternatives will be used at the Florida Keys Children Shelter and Community Locations. PROBLEM IDENTIFICATION AND REFERRAL — An Apple A Day and Teen Intervene identify youth who need 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. Activ tty /Pro_'gram� N IOM Category '�X ; u 4µ`'Speclficiprimary i :{ F`,Y , Number of , Universal Indirect revention programs Unduplicated �� �� V �]niversaI Direct practices, Participants (iW , Indicated) strategies, r duplicated "n { � `� ' ,�w a nf$ p rev ention , f r No te ) strategies (l SAP) :s 4 , 4 - yy kj3 4 1 An Apple A Day© (AAAD) Selective Education 500 Elementary An Apple A Day© (AAAD) Selective Problem ID & Referral 58 * An Apple A Day© (AAAD) Selective Alternatives 25 Alcohol Literacy Challenge Selective Education 100 Alcohol Literacy Challenge Selective Alternatives 25 Teen Intervene Indicated Education 20 Teen Intervene Indicated Problem ID & Referral 4 * Health Fairs Universal Direct Information 400 Dissemination Capacity Building Universal Direct Information 150 Dissemination (50) To Be Parents of AAAD Coalition Collaboration Universal Indirect Information 400 Dissemination Section II. TARGET POPULATION — RISK AND PROTECTIVE FACTORS T RGET POPULATION !CWPARTIGIPANTS (In Jude numbers in tables eutl p MillEag descriptio ,participant characteristics °belo '.e . :;sti. ,. ; - .• _g.>_.. Description of participants to be served (describe criteria for program enrollment eligibility, geographic areas / Neighborhoods (list zip codes), risk factors of the neighborhoods, description of the sites (school, church, park, etc.), as well as any other significant demographic information), specific cultural characteristics, and describe according to the Comprehensive Community Action Plan priorities: Youth alcohol use - Abuse by Attachment IV Scope of Work Page 2 of 15 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 •■ South Florida Behavioral Health Network, Inc. "legal" age individuals, Youth /Adult marijuana use, Prescription drug misuse /abuse, over the counter drugs misuse /abuse, other illicit drug use. Participants to be served include male and female at -risk youth serving elementary and middle school ages residing in Monroe County, FI. Services will be provided county -wide (110 miles) to include all middle schools, elementary schools, and youth residing at the Florida Keys Children's Shelter, Treasure Village Montessori, Island Christian School, May Sands Montessori School, Ocean Studies Charter 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. ;TRIO gad Eirotective Factors L addressed Risk Factors: Protective Factors: Favorable attitudes towards ATOD Prosocial opportunities /activities Perceptions of harm Positive peer influence Community norms Skill /competency Self- regulation Healthy behaviors Increased knowledge /awareness Self- esteem Community values children Positive family communication Community values — children /youth TrA"�RGET POPULATION CD PARTICIPANTS p`IOM @TEGORY (include numbers rE tables aid 'brief A arrative description CQ participant @lbERNIEUM§ related above high; section below): Number of Unduplicated Universal — Direct or Indirect, Selective, Indicated Participants (if duplicated Note *) Selective - -- An Apple A Day© - K -4 - Elementary school based participants 500 Selective - -- Alternatives - An Apple A Day© - K -4 — Community partner sites 25 Selective - -- Problem ID & Referral - An Apple A Day© (AAAD) — Elementary 58 * school participants who need further services. Identify & refer to services Selective - -- Alcohol Literacy Challenge — Middle School based participants 100 Selective - -- Alternatives — Alcohol Literacy Challenge — Community sites & 25 Shelter Indicated - -- Teen Intervene — Middle school participants — Schools, 20 Community Sites, & Children's Shelter Selective - -- Problem ID & Referral — Teen Intervene — Schools & 4 * Community sites Universal Direct - -- Health Fairs — All ages — Community Sites 400 Attachment IV Scope of Work Page 3 of 15 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 � - South Id / Be havioral Health Network, Inc. Universal Direct - -- Capacity Building — Information Dissemination with 150 (50 AAAD parents) parents, school personnel, and community stakeholders — Adults — (50 of 150 to be with AAAD Parents) Universal Indirect - Coalition Collaboration Community Event Campaigns -All 400 Ages TARGET POPULATION — RISK AND PROTECTIVE FACTORS � i - 4 Pre ent i �''�" i ak € � Systenaof Progratrategy m/Sand Related " t Risk/,Protective Factors eted Y; - Care /CC -AP ge Tar Populatl ` .1f i ' ¢ 4 - g 7r � on - Y !x a f'e "0. a 't � ; Goal 4.3 • " fir,:' * h ° : Y : , . r :.� .. "Y ;Address An Apple A Day© Perceptions of Harm, Favorable Attitudes, Social 1 & 2 Skills, Literacy Skills, Clear Boundaries and Rules, Family Bonds, Resiliency Alcohol Literacy Challenge Perceptions of Harm, Favorable Attitudes, Social 1 & 2 Norms Teen Intervene Use, Perceptions of Harm, Peer Norms 1 & 2 Health Fairs Perceptions of Harm, Social Norms, Favorable 1 & 2 Attitudes Capacity Building Perceptions of Harm, Social Norms, Favorable 1 & 2 Attitudes Coalition Collaboration Perceptions of Harm, Social Norms, Favorable 1 & 2 Community Event Campaigns Attitudes Section III. SITE LOCATIONS AND INFORMATION* ,Site Name `? Add ss A ~> y Zi a Target Partic�pants � . 4:1:4" r � :� ".`="t1-11. I L Code - � (,Ch that APPIYi), ,x ; Y �w` Crh�ld / � :., , � ,; '� Parents Ot hers „dr Key Largo Middle School 104801 Overseas Key Largo 33037 X Hwy Plantation Key Middle 100 Lake Rd Tavernier 33070 X School Ocean Studies Charter 92295 Overseas Tavernier 33070 X Hwy Treasure Village Montessori 86731 Overseas Islamorada 33036 X Hwy Island Christian School 83400 Overseas Islamorada 33036 X Hwy Stanley Switlik Middle 3400 Overseas Hwy Marathon 33050 X School Sugarloaf School 255 Crane Blvd Sugarloaf 33042 X Gerald Adams Elementary 5855 W College Rd Key West 33040 X Attachment IV Scope of Work Page 4 of 15 Guidance/Care Center, Inc. Contract No. ME225 -9 -27 P" South Flid a Behav Health Network, Inc. Poinciana Elementary 1407 Kennedy Dr. Key West 33040 X Sigsbee Charter School 939 Felton Rd Key West 33040 X Horace O'Bryant School 1105 Leon Street Key West 33040 X May Sands Montessori 1400 United Street Key West 33040 X School Marathon Middle School 350 Sombrero Rd Key West 33040 X Community Partner Sites Monroe 33040 X County 33050 33037 TOTAL NUMBER TO BE SERVED 620 *Changes in sites /locations of services must adhere to contractual requirement procedures. Section IV. MAJOR REFERRAL SOURCES List the major referral sources for the services provided: Monroe County Schools — Teachers, Principals and School Counselors Department of Juvenile Justice Self- Referral Social Service Agencies Community Centers Section V. QUANTITY PERFORMANCE MEASURES Quantity Performance Measures Activities /Service Name & Description (Include frequency, intensity & Activ duration of sessions, as # # # Required T,o. Meet L % ` _ Childrenl Pare �:Othe� �. - . Selective well as the number of Sessions Required cycles/cohorts expected Youth nts rs — Indicate to be offered and Indicated tentative schedule /timing) • • Youth /Children At -Risk of Substance Abuse Problems - include individual measures that will result in achieving. the Substance Abuse& Mental Health Required Performance`Outcomes & Outputs • Parent/Families At -Risk of, Substance Abuse Problems - include individual measures that will result in achieving the Substance Abuse & Mental Health Required Performance Outcomes & Outputs 100% of 500 will An Apple A Day© 500 0 0 (8) AAAD receive services, 85% Selective Sessions for will complete AAAD each 500 and 85% of completers participants or 425 will improve from pre to post 100% of 100 will Selective Alcohol Literacy 100 0 0 (2) ALC receive services, 85% Challenge Sessions for will complete ALC and Attachment IV Scope of Work Page 5of15 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 � �d South Florida / Behavioral Health Network, Inc. each 100 85% of completers or participants 85 will improve from pre to post Teen Intervene — 100% of 20 will receive Teen Intervene 20 0 0 3 Sessions services, 85% will Indicated for each 20 complete the program participants and 85% of completers or 17 participants will improve from pre to post test in the minimum of 3 sessions (3 sessions are one cohort) 100% of 400 participants will receive Health Fairs 25 375 0 5 Events information at the Universe Health Fairs, 85% or 340 participants be Direct provided prevention framework information while attending the fairs. Quality Performance Measures (Including fidelity measures, satisfaction survey information, supervision, training, staffing, and other required information pertaining to quality) Qualit Measu I EiMarniai1G0 Reporting Tool Timing Average number of sessions Participant attendance log • Each session attended (Participant Retention) Pre -and Post - surveys from each • At beginning and end of each Number of participants participant cohort improved An Apple A Day© Participant Satisfaction Survey from • At end of each cohort 100% of 500 and 85% (425) each participant will improve based on the pre /post outcomes as measured by the approved SFBHN tool. An Apple A Day() minimum of (8) sessions Average number of sessions Participant attendance log • Each session attended (Participant Retention) Pre -and Post - surveys from each • At beginning and end of each Number of participants participant cohort improved Alcohol Literacy Challenge Attachment IV Scope of Work Page 6 of 15 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 /. Sou Fid a / Be hav th iora Health Network, Inc. 1 00% of 100 and 85% (85) Participant Satisfaction Survey from • At end of each cohort will improve based on the each participant pre /post outcome as measured by the approved SFBHN tool. Alcohol Literacy Challenge minimum of (2) sessions. Average number of sessions attended (Participant Participant attendance log • Each session Retention) Number of participants Pre and Post surveys from each • At beginning and end of each improved participant cohort Teen Intervene — 100% of 20 will receive services and 85% Alcohol Timeline Follow -back (TLFB) • At end of each cohort or 17 will complete the completed at baseline and exit from program. 85% of completers treatment will improve from pre to post test in the minimum of 3 Participant Satisfaction Surveys • At end of each cohort sessions (3 sessions are one cohort) # and % of participants 85% of participants who completed satisfied with services program(s) will complete the provided satisfaction survey and 90% will be • At the end of each cohort satisfied based on the Satisfaction Survey Quality D IT Timing Outputs e) Associated Reporting Tool Activity Staff training hours PBPS entry and Quarterly 8 hours per quarter; (capacity building) Quarterly training PBPS and provider # and % of staff working reports to be filed at check -ins. Every toward certification in the the organization and prevention staff member State of Florida in submitted by July 5, must participate in at a Prevention Certification 2019. minimum, 8 hours of Certificates of training per quarter. completion of prevention courses will be on file regularly as the courses are completed Observation of service Curriculum fidelity Three times per year. Observation of service delivery/ Fidelity checklist checklist Once by October 31, delivery/ Fidelity checklist 2018, second by completed and feedback BSRI Observer report February 28, 2019, third provided to the by May 31, 2019 organization by BSRI Documentation of During regular Documentation of structured supervision Supervisory supervisory sessions for structured supervision Tool /Checklist and each staff and not Tess Notes Attachment IV Scope of Work Page 7 of 15 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 Sou Behavio th Fl orda Health Network, Inc. than one time per during monitoring visit by month. SFBHN # and % of staff with 1000/0 Within two months of # and % of staff with necessary training hire necessary training / certification (as required / certification (as required by all entities and EBP) by all entities and EBP) Quarterly program /data U One time in each Reports, Agendas, calls with the Hialeah 100 /o quarter by the end of recommendations for Community Coalition the quarter — by October programs and strategies 1, 2018 to BSRI and SFBHN. January 15, 2019 April 1, 2019 June 30, 2019 Use the following =task list to loutliyietkeytirnelines for meeting; service. provision goals. Describe, how the program will evaluate the quantity of all seniices to. be implementetl consistenttwith�65D- • 30.013(2), F A C., in collaborationwth�the Evaulation Tea m identifiedrby ?SFBHNfeacl year ThetS Evauation Team. shall review th a results of. providers programaevaluation andWall technical materials used by providers annually to: ensure.consistency with' current resear ,in•the prevention field '. Annual Goal • ` • ; % and Total % and Total , Outcome Program � Number to be served .l to be: served }4 Activity served by _11/30 by'3/31 a .' An Apple A Day© 500 35% (175) 75% (375) 85% of participants served will have a matched pre -post test Alcohol Literacy 100 35% (35) 75% (75) 85% of participants served with Challenge have a matched pre -post test Teen Intervene 20 35% (7) 75% (15) 85% of participants served will have a matched pre -post test Health Fairs 400 0% (0) 50% (200) 100% of individuals receive materials and /or information Capacity Building 150 35% (53) 75% (112) 100% of individuals receive materials and /or information VI. TASK LIST Activities /Service Name &Description (Include � � 'Recommen , ��- o frequency, intensity, & duration of sessions; as well as the Type of , {to Meet numberof cycles /cohorts expected'to be off an d :' ;Partici a"nt t si thisOutcome p 34 Sessions • • } , 'tentative schedule /timing) - s F y, urs Activity Title: An Apple A Day© Orientation Registration Activity Description: Participants will undergo a program 500 (K -4th One (1) 100% 500 will overview and client information will be collected. grade) Orientation receive Frequency :: At the beginning of each cohort. Up to 30 Students up to 30 orientation minutes in length minutes There will be two cycles held per school year at each location (Sept — Jan & Jan — May) Attachment IV Scope of Work Page 8 of 15 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 •• South Florida Behavioral Health Network, Inc. Intensity: One session Duration: Up to 30 minutes per session Activity Title: An Apple A Day© Pre Test Activity Description: Participants will complete pre -test 500 (K-4th One (1) Pre 85% or 425 using age- appropriate assessment instrument. grade) Test up to will receive Frequency: At the beginning of each cohort. 30 minutes in Students 30 minutes pre test length Intensity: One session Duration: 30 minutes per session Activity Title: An Apple A Day© Post Test Activity Description: Participants will complete post -test 500 (K -4th One (1) 85% or 425 using age- appropriate assessment instrument. grade) Post Test will receive Frequency: At the end of each cohort. 30 minutes in length Students up to 30 post test Intensity: One session minutes Duration: 30 minutes per session Activity Title: An Apple A Day© Satisfaction Survey Activity Description: Participants will complete satisfaction 500 (K -4th One (1) 85% or 425 survey using age- appropriate assessment instrument. grade) Satisfaction will receive Frequency: At the end of each cohort. 15 minutes in length Students Survey to satisfaction Intensity: One session 15 minutes survey Duration: 15 minutes per session Activity Title: Alcohol Literacy Challenge Orientation Registration 100 One (1) 100% of 100 Activity Description: Participants will undergo a program Middle Orientation will receive overview and client information will be collected. School up to 30 orientation Frequency :: At the beginning of each cohort. Up to 30 Students minutes minutes in length There will be two cycles held per school year at each location (Sept — Jan & Jan — May) Intensity: One session Duration: Up to 30 minutes per session Activity Title: Alcohol Literacy Challenge Pre Test Activity Description: Participants will complete pre -test 100 One (1) Pre 85% or 85 will using age- appropriate assessment instrument. Middle Test up to receive pre Frequency: At the beginning of each cohort. 30 minutes in School 30 minutes test length Students Intensity: One session Duration: 30 minutes per session Attachment IV Scope of Work Page 9of15 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 Souida Behaviora Flor . Health Network, Inc. Activity Title: Alcohol Literacy Challenge Post Test Activity Description: Participants will complete post -test 100 One (1) 85% or 85 will using age- appropriate assessment instrument. Middle Post Test receive post Frequency :: At the end of each cohort. 30 minutes in length School up to 30 test Intensity: One session Students minutes Duration: 30 minutes per session Activity Title: Alcohol Literacy Challenge Satisfaction Survey 100 One (1) 85% or 85 will Activity Description: Participants will complete satisfaction Middle Satisfaction receive survey using age- appropriate assessment instrument. School Survey up satisfaction Frequency :: At the end of each cohort. 15 minutes in length Students to 15 survey Intensity: One session minutes Duration: 15 minutes per session Activity .Title: Teen Intervene Orientation Registration Activity Description: Participants will undergo a program (20) One (1) 100% or 20 overview and client information will be collected. Middle Orientation will receive Frequency: At the beginning of each cohort. Up to 15 School up to 15 orientation minutes in length Students minutes There will be two cycles held per school year at each location (Sept — Jan & Jan — May) Intensity: One session Duration: Up to 15 minutes per session Activity Title: Teen Intervene Pre Test Activity Description: Participants will complete pre -test (20) One (1) Pre 85% or 17 will using age- appropriate assessment instrument. Middle Test up to receive pre Frequency: At the beginning of each cohort. 15 minutes in School 15 minutes test length Students Intensity: One session Duration: 15 minutes per session Activity Title: Teen Intervene Post Test Activity Description: Participants will complete post -test (20) One (1) 85% or 17 will using age- appropriate assessment instrument. Middle Post Test receive post Frequency :: At the end of each cohort. 15 minutes in length School up to 15 test Intensity: One session Students minutes Duration: 15 minutes per session Activity Title: Teen Intervene Satisfaction Survey Activity Description: Participants will complete satisfaction (20) One (1) 85% or 17 will survey using age- appropriate assessment instrument. Middle Satisfaction receive Frequency :: At the end of each cohort. 15 minutes in length School Survey up satisfaction Intensity: One session Students to 15 survey Duration: 15 minutes per session minutes Attachment N Scope of Work Page 10 of 15 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 I- South Florida Behavioral Health Network, Inc. Section VII. EVIDENCE BASED PROGRAMS (EBP) Evidence Based Des,gnating "Agenc9T AN APPLE A DAY© (AAAD) SAMSHA approved, NREPP ALCOHOL LITERACY CHALLENGE (ALC) SAMSHA approved, NREPP TEEN INTERVENE SAMSHA approved, NREPP Section VIII. EVALUATION OUTCOME MEASURES Describe how,the program Will yaluate,the effectiveness of all prevention services -4 toxbe implemented consistent with -65D 30.0 13(2); F A7c in`col labo ration with °the EvaulatlonrTeamnider tified by,,SFBHN each year The SFBHN;Tvauation,Tea shall re view the result f p orov programevaluation and all technical m aterialsr used by provitlrs e ann to ensure consistency with current research in the ; prevention field. Ann G u a l s Me a n i ng ful ' > _ m Ti ,n Observation Visits ih o k Improve Pre- • y Meanmgful > • Program' Activity r � �; #:� p Improvement Num ber t serve xk Posty Satisfaction An Apple A Day© 500 85% of program 90% of program completers completers 1 visit by November 30, improve85% of demonstrate 2019 participants will 1) satisfaction with Increase program services 2 visits by May 31, 2019 perceptions of harm for a total of 3 in the tow (alcohol and programs (AAAD and tobacco) ALC) 2) Increase pro - social skills (coping, decision - making, self- esteem) 85% of participants will 1) Increase perceptions of harm (alcohol, tobacco, drugs) 2) Increase pro - social skills (coping, decision - making, self- esteem, refusal) 3) Decrease favorable attitudes (alcohol, tobacco) Alcohol Literacy 100 85% of program 90% of program 1 visit by November 30, Challenge completers improve completers 2019 1) Increase demonstrate perceptions of harm satisfaction with 2 visits by May 31, 2019 (alcohol) program services for a total of 3 in the tow 2) Increase pro- programs (AAD and social skills (coping, ALC) Attachment IV Scope of Work Page 11 of 15 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 �� South Flid a / r i t: Health Network, Inc. decision - making, refusal) 3) Decrease favorable attitudes (alcohol) 4) Decrease first use or use for those who reported using alcohol Teen Intervene 20 85% of program 90% of program N/A completers will completers improve demonstrate 85% of program satisfaction with completers improve program services 1) Increase perceptions of harm (alcohol, tobacco, marijuana, prescription /over the counter drugs) 2) Increase pro - social skills (coping, decision - making, refusal) 3) Decrease favorable attitudes (alcohol, tobacco, marijuana, prescription /over the counter drugs) 4) Decrease first use or use for those who reported using Health Fairs 400 100% of individuals N/A N/A receive materials and /or information Section IX. CAPACITY BUILDING List other'funding sou yo"ur.agency /organization hW1or prevention /youth development programming ` Describe ho the:Fp ogram wiII coordinate other progm as *and services provided [ a enc /,or amzation Describe other„ • ro rtams align ,with revention : oals 7 ; �� If funded, GCC will coordinate with PPG staff so that youth who are in need of additional prevention services are identified via problem ID and Referral strategies and are referred into Teen Intervene program. This will be noted in the Evaluation Team's BSRI DOES system. List other prevention programming and providers in sites mentioned in Section III of this document. Describe how the program will coordinate with other funded organizations' progams and services to avoid duplication of services. Attachment IV Scope of Work Page 12 of 15 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 � � South Florida / Behavioral Health Network, Inc. GCC will coordinate with The Florida Keys Children's Shelter's programs in the sites where GCC Prevention provides services; they provide the EBP All Stars. GCC will begin scheduling meetings to build capacity and cross -learn more about the programs to best develop a coordination plan documented in PBPS. In addition, GCC will build collaborative relationships with other partners as determined to leverage resources. List the coalition(s) within the target service areas in which prevention services will be provided under this Scope. Describe how the program will cooridnate with the coalition and share data /contribute to the ongoing Strategic Prevention Framework with the identified coalition(s). Monroe County Coalition (MCC) is the coalition that serves the Monroe county area of focus for all sites. GCC staff will attend MCC meetings and coordinate activities that serve Monroe County parents, school personnel and community stakeholders. GCC will help coordinate and participate in MCC community events such as "No One's House Parent Information" and "Know The Law" campaigns. GCC staff will participate in the quarterly data calls with MCC and will share program service data to track trends and inform the Monroe County strategies for youth in a comprehensive, collaborative manner. Section X. ADDITIONAL PREVENTION REQUIREMENTS 1. Site Schedule A final site schedule, on the Site Schedule form, with dates, times, and location of services shall be submitted no later than August 31 of the fiscal year or when requested by the Contract Manager. Sites schedules must be approved by SFBHN, in writing, and will be based on county need and distribution of services to avoid duplication in any geographical area or school to maximize SFBHN funding. Any change shall be justified in writing and submitted to the Managing Entity in writing and submitted to the Contract Manager for review and approval by the Prevention Director. The Contract Manager will reply with approval. The site schedules shall be submitted on the SFBHN Prevention Site Schedule format. 2. Memorandum Of Understanding (MOU) With The Community Coalition To address local community substance abuse prevention needs and wellness promotion strategies, prevention providers and the community coalition shall execute and /or maintain a memorandum of understanding (MOU) delineating the specific responsibilities of each. This MOU will be consistent with the strategies of the State of Florida Department of Children and Families' and the Managing Entity's (ME's) prevention strategy. The provider shall submit an executed copy of the MOU to the ME's Contract Manager within 30 days of the effective date of the contract (for newly executed MOUs) or within thirty (30) calendar days for renewed MOUs. SFBHN Contract Attachment — Guidance Document 10 3. Memorandum Of Understanding (MOU) With Sites To facilitate the coordination and delivery of services, all providers shall have executed Memoranda of Understanding (MOU) with the sites where services are being provided. All MOUs with the sites shall be current and up to date, outlining the terms of the agreement. • 4. Participant Satisfaction Survey Attachment IV Scope of Work Page 13 of 15 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida �/ =Tar r. Health Network, Inc. . All providers shall collect and submit participant satisfaction surveys as noted in the Scope of Work. 5. Meetings All providers shall attend scheduled Prevention meetings as required by the ME and the evaluation team, BSRI, at regularly scheduled or specially called meetings when notified by the ME. The ME will make every attempt possible to schedule meetings with advanced notice; however, there may be meetings that may be called on short notice. These include, but are not limited to, Prevention provider meetings, meetings with Behavioral Science Research Institute, individual provider quarterly meetings with BSRI and /or SFBHN, Evidence Based Practice workgroup meetings to comply with the Block Grant requirements, and other meetings as noticed by SFBHN. The contract notes the other meetings where representatives of the provider organization are required to attend. 6. Reports / Assignments and Special Reports / Assignments Providers are expected to submit reports as outlined in the contract. Prevention Partnership Grant (PPG) reporting is specifically described in the contract with dates for submission. Other reports will be requested by SFBHN. Special reports and assignments are requested from time to time to meet State /Local Department of Children and Families, State Block Grant, SFBHN, and other requirements and needs. Prevention providers are required to submit the reports in the format requested and by the timeline requested. These reports may be requested from different sources for different reasons. Requests generally come from SFBHN staff, including the Prevention Director, and may be requested verbally or in writing. There may be times when other collaborative partners request information and SFBHN will support these requests. . 7. Training The Scope of Work outlines the requirements for training to support the State Block Grant reporting requirements for workforce development as well as for strengthening the Prevention workforce. All staff of provider organizations funded by this contract, whether full -time, part-time, contractual, or consultant, who report units in the Performance Based Prevention System (not those paid by cost reimbursement or that are vendors), is required to attend eight (8) hours of training per quarter. All providers shall attend scheduled training as required by the ME, meet the ME and the evaluation team, BSRI, for technical assistance and /or training, at regularly scheduled or specially called meetings when notified by the ME. 8.. Report Cards Providers are required to comply with the measures on the Prevention Report Card. Grading for the measures will be according to compliance or lack thereof. 9. Data All providers are required to submit the program data monthly in the Performance Based Prevention System (PBPS) as required by the contract. The provider shall also: • Ensure that the data submitted clearly documents all program participants, programs, and Attachment IV Scope of Work Page 14 of 15 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 �� Souid a � Behaviora Flor Health Network; Inc. strategies which occurred under this contract and consistent with the Scope of Work in the contract; • Ensure that all data submitted to PBPS is consistent with the data maintained in the provider's file and consistent with the Scope of Work in the contract; • Review the data submitted with the evaluation team, Behavioral Science Research Institute (BSRI), monthly to determine any discrepancies in the numbers related the evaluation and the Scope of Work and make corrections prior to submission for approval by the SFBHN Prevention Director; • Submit an email to the SFBHN Prevention Director and the designated SFBHN Data Analyst verifying that the data in the PBPS system has been checked and is correct and complete and may be used for Block Grant reporting and payment. There shall be a designated individual and one back up individual at the provider organization responsible for verifying the data and submitting the email. This will imply that the data has been reviewed and is ready for submission. o The email subject line shall read: PBPS Data Submission Verification o The body of the email shall read: (name of organization) is submitting the PPG Prevention data for the month of (name of the month) in PBPS and we assure that the data is complete and correct. Our organization's data may be used to report to the State for the Block Grant report. Our organization's data may be used to reconcile with the payments for this month. • Failure to submit any data, or correct any errors in the data which results in a rejection rate of ten percent (10 %) or higher of the monthly data submitted, will require the provider to submit a corrective action plan describing: how and when the missing data will be submitted or how and when the rejected will be corrected and resubmitted; and • In accordance with the provisions of s. 402.73(1), F. S., and Rule 65- 29.001 F.A.C., corrective action plans may be required for non - compliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed for failures to implement or to make acceptable progress on such corrective action plans. 10. Evaluation Prevention providers shall work in collaboration with the evaluation team, Behavioral Science Research Institute (BSRI) by participating in meetings, training, and providing service data and other necessary identified data vital to the completion of the system -wide evaluation of the prevention services within the Strategic Prevention Framework. Data will be provided to BSRI in the BSRI data system, DOES, and in any other requested format. The data includes the numbers for outcome data and process data required that contributes to the evaluation of the Prevention System of Care. Attachment IV Scope of Work Page 15of Guidance /Care Center, Inc. Contract No. ME225 -9 -27 Amendment #1 Contract No. ME225 -9 -27 9/10/2018 THIS AMENDMENT, entered into between South Florida Behavioral Health Network, Inc. hereinafter referred to as the "ME" and Guidance /Care Center, Inc., hereinafter referred to as the "Network Provider," amends Contract No. ME225 -9 -27. PREAMBLE: This amendment reflects an addition to the contract of $750,000.00 (seven hundred fifty thousand dollars) to OCA MHCAT to fund the Community Action Treatment (CAT) Team for Monroe County, awarded by competitively procured ITN #011. Additionally, this amendment revises the Return of Funds clause in the Standard Contract, the Whistleblower clause in the Standard Contract, removes Transitional Voucher report requirement from the Exhibit C, Required Report, and adds the requirement to submit a Return on Investment for the newly acquired Community Action Treatment (CAT) Team in Exhibit AM, Return on Investment. As a result, this amendment revises the Standard .Contract; Attachment 1, List of Exhibits; Exhibit B, Method of Payment; Exhibit C, Required Reports; Exhibit G, Covered Services Funding by OCA; Exhibit H, Funding Detail, Exhibit AM, Return on Investment, adds Exhibit AJ, Community Action Treatment (CAT) Team, and Exhibit AJ -1, CAT Monthly Invoice. 1. Page 4 of 13, Standard Contract, Paragraph 13., Return of Funds, is hereby amended to read: 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. Should repayment not be made promptly 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. Payments made for services subsequently determined by the ME to not be in full compliance with contract requirements shall be deemed overpayments. The ME shall have the right at any time to offset or deduct from any payment due under this or any other contract or agreement any amount due to the ME from the Network Provider under this or any other contract or agreement. If this contract involves federal or state financial assistance, the following applies: The Grantee shall return to the ME any unused funds; any accrued interest earned; and any unmatched grant funds, as detailed in the Final Financial Report, no later than 60 days following the ending date of this Contract. b. The funds paid to the Network Provider are continually subject to Review, Revision and Adjustment after evaluation of Utilization and Performance measures monitored by ME. 2. Page 8 of 13, Standard Contract, Paragraph 31, Federal Whistleblower Requirements, hereby amended to read: 31. State and Federal Whistleblower Requirements a. In accordance with subsection 112.3187, 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, Page 1 of 4 Amendment #1 Contract No. ME225 -9 -27 9/10/2018 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. b. Pursuant to Section 11(c) of the OSH Act of 1970 and the subsequent federal laws expanding the act, the. Network Provider is prohibited from discriminating against employees for exercising their rights under OSH Act. Details of the OSH Act can be found at this website: https: / /www.whistleblowers.gov/ 3. Page 9 of 13, Standard Contract, Paragraph 34, Contract Amount, is hereby amended to read: 34. Contract Amount The ME shall pay for contracted services according to the terms and conditions of this Contract in an amount not to exceed $6,732,353.00, 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 $5,610,294.00, subject to the delivery and billing for services. The remaining amount of $1,122,059.00. 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. 4. Page 66 of 67, Attachment 1, Section E, List of Exhibits, is hereby amended to. read: E. List of Exhibits The Network Provider agrees to comply with the exhibits listed below. The following exhibits, or the latest revisions thereof, are incorporated in and made a part of the contract. 1. Exhibit A, Clients /Participants to be Served 2. Exhibit B, Method of Payment 3. Exhibit C, Required Reports 4. Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs 5. Exhibit E, Monthly Payment Request 6. Exhibit F, State and Federal Laws, Rules and Regulations 7. Exhibit G, Covered Service Funding by OCA 8. Exhibit H, Funding Detail & Local Match Plan 9. Exhibit I, Motivational Support (MSP) Provider Protocols 10. Exhibit J, Motivational Support Specialist Treatment Summary Report 11. Exhibit K, SAMH Pre - Authorization Utilization Management Roster 12. Exhibit L, Assisted Living Facilities with Limited Mental Health License 13. Exhibit N, Special Provisions for the Indigent Drug Program Page 2 of 4 Amendment #1 Contract No. ME225 -9 -27 9/10/2018 14. Exhibit 0, Weapons and Firearms Court Petitions 15. Exhibit Q, Missing Children 16. Exhibit R, Our Kids Miami- Dade /Monroe Child Welfare Quarterly Clinical Report 17. Exhibit V, Special Provisions for the Forensic Services Program 18. Exhibit X, Special Provisions for Projects for Assistance in Transition from Homelessness (PATH) Services 19. Exhibit AA, Motivational Support Specialist 20. Exhibit AC, Care Coordination Report Narrative and Chart 21. Exhibit AI, Family Intensive Treatment Team - Scope of Work 22. Exhibit AJ, Community Action Treatment (CAT) Team 23. Exhibit AJ -1, CAT Monthly Invoice 24. Exhibit AK, SAMH Outpatient Waitlist Report Form - Part I and Part II 25. Exhibit AM, Return on Investment - Special Appropriations Projects for Fiscal Year, 201849 26. Exhibit AN, Supplemental Security Income /Social Security Insurance (SSI /SSDI) Outreach, Access, and Recovery (SOAR) 27. Exhibit AP, Mental Health Case Management 28. Exhibit AS, Central Receiving Facility 5. Page 1 of 6, Exhibit B, Method of Payment, Payment Clauses a., are hereby amended to read: a. This is a fixed price (unit cost) contract. The unit prices are listed on Exhibit G, Covered Service Funding by OCA. The ME shall pay the Network Provider for the delivery of service units provided in accordance with the terms and conditions of this contract for a total dollar amount not to exceed $6,732,353.00, 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 $5,610,294.00, subject to the delivery and billing for services. The remaining amount of $1,122,059.00. 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. 6. Pages 1 -12, Exhibit C, Required Reports, are hereby deleted in their entirety and Pages 1 -13, Revised Exhibit C, Required Reports, are inserted in lieu thereof and attached hereto. 7. Pages 1 - 4, Exhibit G, Covered Services Funding by OCA, are hereby deleted in their entirety and Pages 1 — 4, Revised Exhibit G, Covered Services Funding by OCA, are inserted in lieu thereof and attached hereto. 8. Page 1 of 1, Exhibit H, Funding Detail, is hereby deleted in its entirety and Page 1 of 1, Revised Exhibit H, Funding Detail, is inserted in lieu thereof and attached hereto. 9. Page 1 of 1, Exhibit AM, Return on Investment, is hereby deleted in its entirety and Pages 1— 2, . Revised Exhibit AM, Return on Investment, is inserted in lieu thereof and attached hereto. Page 3 of 4 Amendment #1 Contract No. ME225 -9 -27 9/10/2018 10. Pages 1 -16, Exhibit AJ, Community Action Treatment (CAT) Team, inserted 9/10/2018, are hereby inserted and attached hereto. 11. Page 1 of 1, Exhibit AI -1, CAT Monthly Invoice, date 9/10/ 2018, is hereby inserted and attached hereto. This amendment shall begin on September 10. 2018. 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 forty (401 page amendment to be executed by their officials' thereunto duly authorized. GUIDANCE /CARE CENTER, INC. SOUTH FLORIDA BEHAVIORAL HEALTH NETWORK, INC. SIGNED GNED • fr BY: B : NAME: Sharon Crippen NAME: Stephen Zuckerman TITLE: Sr. Vice President TITLE: Interim Prressld t and CEO DATE: 4 I I cf ( i S DATE: Vi FEDERAL Tax. ID # (or SSN): 59- 1458324 Page 4 of 4 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports 'ReCiuired.aiitrAg I } Due 06te 1 rr , .: , # of i°-; ., Wi Wll _ _ R. a Response to Monitoring Reports and Corrective Within 10 calendar days from the day the 1 (Electronic Submission 1. ME Contract Manager Action Plans report is received via E -mail) 2. SFBHN staff member issuing CAP External Quality Assurance Reviews, Monitoring Within 10 calendar days from the day the 1 (Electronic Submission 1. ME Contract Manager Reports, Surveys and Corrective Actions, as report is received, or as requested by the via E-mail) applicable Contract Manager 2. Director of Contract Accountability Memorandum of Understanding (MOU) with a Federally Qualified Health Center (FQHC) Within 90 calendar days of the effective date or of the contract (for newly executed MOU's); 1 (Electronic Submission Federally Qualified Health Centers are required Within 30 calendar days for renewed MOU's; via E -mail) ME Contract Manager to submit policies and procedures that explain Updates to P &P for FQHC's shall be submitted the access to primary care services to the within 30 calendar days of adoption medically underserved behavioral health client Sliding Fee Scale [reflecting the uniform 1 (Electronic Submission schedule of discounts referenced in 65E- Prior to contract execution via E -mail) ME Contract Manager 14.018(4)] Final FY 2018 -2019 (1) Projected Cost Center Operating and Capital Submitted annually prior to contract execution. Budget, 1. ME Contract Manager (2) Budget Narrative, Submit updates within 30 calendar days of 1 (Electronic Submission (3) Network Providers Agency Service Capacity execution of an amendment to the contract via E -mail) 2. VP of Finance Report, affecting the budget. (4) Cost Center Personnel Detail Report Program Description Annually, prior to contract execution. Submit 1. ME Contract Manager (1) Organizational Profile updates within 30 calendar days of 1 (Electronic Submission (2) Service Activity Description amendment via E -mail) 2. VP of Behavioral Health Grievance Procedures Annually, prior to contract execution. Submit 1. ME Contract Manager a) Clients (applicants or recipient of services) updates within 30 calendar days of 1 (Electronic Submission b) Agency Staff implementation via E -mail) 2. VP of CQI Affidavit Regarding Debarment Annually prior to contract execution, or as 1 ME Contract Manager requested by the Contract Manager Submit updates within 30 calendar days of amendment or 1. ME Contract Manager "No Wrong Door" Policy and Procedures as requested by 1 the contract manager and /or the QA/QI Risk & Compliance Manager 2. QA/QI Risk & Compliance Manager Within 24 hours of occurrence, in accordance with CFOP 215 -6 and reportable Incident Report incidents defined CFOP 180-4 Mandatory Submission through IRAS Submission through IRAS Reporting Requirements to the Office of the Inspector General Guidance /Care Center, Inc. Revised Exhibit C Contract No. ME225 - 9 - 27 Page 1 of 13 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports I 'T Re wired Relilorts IIu ��1 �••as ° L'�1�3 '.'; =�.11�. S (I _ o ff" ` . _sy , .�• :'Il Acute Care Service Utilization Reporting for Real -time data submission as mandated by Public Receiving Facilities, Detoxification and subsection 394.9082(10), Florida Statutes Electronically KIS Express Acute Care System Addiction Receiving Facilities. Service data shall be submitted electronically, weekly, by 12:00 Noon every Wednesday. KIS, PBPS, or other data system Monthly Data Required by DCF PAM 155 -2 Final monthly shall be submitted electronically Electronically designated by the ME or the Department to the ME no later than the 4th of each month following the month of service ADA Client Communication Assessment httos: / /fs16.formsite.com /DCFTraininz /Month Auxiliary Aid Service Record Monthly Summary By the 4th business day following the Iv- Summarv-Report/form login.html Report 1 (Electronic Submission (Applicable to agency's that employ fifteen (15) reporting month via E -mail) or more employees) - Confirmation E -mail to the ME Contract Manager Monthly, by the eighth (8th) calendar day Monthly Service Invoice after the month 1 ME Sr. Accountant (Fiscal Department) of service Submitted with the monthly invoice, as Invoice Review Supporting Documentation appropriate, and /or as requested by SFBHN 1 As requested by SFBHN staff staff Monthly, with the monthly invoice by the eighth 1. ME Sr. Accountant (Fiscal Department) Exhibit K, Pre - Authorization Utilization (8th) calendar day Management Roster for Substance Abuse and after the month 1 2. ME ASOC Manager Mental Health Residential. Level II Services of service 3. ME CSOC Manager Exhibit AC, Monthly Care Coordination Report Monthly by the 5th calendar day after the Narrative and Chart month of service 1 ME Care Coordinator TANF SAMH Program Logs and Service Data, if As per the contract and /or as requested by 1 ME TANF Coordinator applicable the contract manager Final Invoice By July 20 of each fiscal year and /or 20 days 1 ME Sr. Accountant (Fiscal Department) • after contract end date Designation of Dispute Resolution Officer Within 5 working days of contract execution 1 (Electronic Submission via E -ma ME Contact Manager 1 (Electronic Submission Inventory Report 8/1/2018 via E -mail) ME Contract Manager Guidance /Care Center, Inc. Revised Exhibit C Contract No. ME225 - 9 - 27 Page 2 of 13 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports . ° Required o "C , _ _w,ll ci �t of '���l" II "' .s . r .f c . __i� a *-;=. _.�-I Attestation of Network Provider's Verification that all applicable employees and subcontractors with access to ME and /or DCF information systems 1 (Electronic Submission have signed a DCF Security Agreement form CF 8/1/2018 via E -mail) ME Contract Manager 0114 , per the Attachment I and Standard Contract 1 (Electronic Submission 1. ME Contract Manager Emergency Preparedness Plan 8/1/2018 via E -mail) 2. QA/QI Risk & Compliance Manager Civil Rights Compliance Checklist (CF0946) 8/1/2018 1 (Electronic Submission ME Contract Manager via E -mail) 1 (Electronic Submission Civil Rights Certificate (CF707) 8/1/2018 via E -mail) ME Contract Manager Client Trust Fund Letter 8/1/2018 1 (Electronic Submission ME Contract Manager via E -mail) Quality Assurance /Quality Improvement Plan 8/1/2018 1 (Electronic Submission 1. ME Contract Manager via E -mail) 2. QA/QI Risk & Compliance Manager Signed Florida Department of Children and Families Employment Screening Affidavit that all 1 (Electronic Submission required staff have been screened or Network 8/1/2018 via E -mail) ME Contract Manager Provider is awaiting the results of screening Action Plan (Integration of Behavioral Health 1 (Electronic Submission 1. ME Contract Manager Services and Primary Care, TIC, CLC) 8/31/2018 via E -mail) 2. QA/QI Risk & Compliance Manager Attestation signed by the CEO /Executive Director indicating that all applicable staff funded by this 1 (Electronic Submission Contract have received a copy of the fully 10/1/2018 via E -mail) ME Contract Manager executed Contract and will receive a copy of any amendments made to this Contract. July 5, 2018 (Period: 04/01/18 - 06/30/18) October 5, 2018 NVRA Voter Registration Agencies Quarterly (Period: 07 /01/18 - 09/30/18) 1. ME Voter Registration Activities Activities Report Form (DS- DE131; effective January 5, 2019 1 (Electronic Submission Coordinator 01/2012 or latest revision thereof, if applicable (Period: 10/01/18 - 12/31/18) via E -mail) April 5, 2019 2. ME Contract Manager (Period: 01/01/19 - 03/31/19) July 5, 2019 (Period: 04/01/19= 06/30/19) October 31, 2018 (Period: 07/01/18 - 09/30/18) January 31, 2019 Quarterly Financial Statements (Balance Sheet (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission 1. ME VP of Finance and Statement of Activity) April 30 , 2019 via E -mail) (Period: 01/01/19 - 03/31/19) 2. ME Contract Manager July 31, 2019 (Period: 04/01/19 - 06/30/19) Guidance /Care Center, Inc. Revised Exhibit C Contract No. ME225 - 9 - 27 Page 3 of 13 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports l Required II ° .. ckof l opies ' I' 8 J x October 31, 2018 (Period: 07/01/18 - 09/30/18) January 31, 2019 Attestation indicating the filing of Form 941 and (Period: 10/01/18 - 12/31/18) 1 (El Submission payment of any taxes due to the IRS have been April 30, 2019 via E -mail) ME Contract Manager paid. (Period: 01/01/19 - 03/31/19) July 31, 2019 (Period: 04/01/19 - 06/30/19) January 30, 2019 Continuous Quality Improvement Updates (Period: 07/01/18 - 12/31/18) 1 (Electronic Submission 1. ME Contract Manager July 30, 2019 via E -mail) 2. QA/QI Risk & Compliance Manager (Period: 01/01/19 - 06/30/19) Completion of the annual self- assessment for the following initiative: 1. ME Contract Manager 3/1/2019 1 1. Integration of Behavioral Health and Primary - 2. QA/QI Risk & Compliance Manager Care (MeHAF) Motivational Support Program (MSP) Treatment Per Exhibit I, Motivational Support Program 1 Per Exhibit I, Motivational Support Program Summary Form, if applicable Provider Protocols Provider Protocols Year -End Financial Reports for Network Provider's Not Requiring Audits Per Attachment II Due 180 days after the end of the Network Provider's fiscal year or within 30 days of the recipient's receipt of the audit report, Certification indicating that recipient expended whichever occurs first, directly to each of the 1. ME Contract Manager less than $750,000 in Federal Awards or in following unless otherwise required by Florida 1 (Electronic Submission State Awards during the fiscal year Statutes The schedule shall be based on via E -mail) 2. VP of Finance revenues and expenditures recorded during the state's fiscal year. Due 180 days after the end of the Network Provider's fiscal year or within 30 days of the recipient's receipt of the audit report, whichever occurs first, directly to each of the following unless otherwise required by Florida 1 (Electronic Submission 1. ME Contract Manager Schedule of State Earnings Statutes The schedule shall be based on via E -mail) 2. 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, Projected Cost Center Operating and Capital whichever occurs first, directly to each of the Budget following unless otherwise required by Florida 1 (Electronic Submission 1. ME Contract Manager Actual Expenses & Revenues Schedule Statutes The schedule shall be based on via E -mail) revenues and expenditures recorded during 2. VP of Finance the state's fiscal year. Guidance /Care Center, Inc. Revised Exhibit C Contract No. ME225 - 9 - 27 Page 4 of 13 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports lw . ! �. Repor s (I ,; y °QRd' ff81 fro Copies IW33d•H Year -End Financial Reports for Network Provider's Not Requiring Audits Per Attachment II - Continued Due 180 days after the end of the Network Local Match Calculation Form - Template 9 - Provider's fiscal year or within 30 days of the Department of Children and Families form, recipient's receipt of the audit report, available at the following website: whichever occurs first, directly to each of the 1. ME Contract Manager following unless otherwise required by Florida 1 (Electronic Submission http: / /www.myflfamilies.com /service- Statutes The schedule shall be based on via E -mail) 2. VP of Finance programs /substance- abuse /managing- revenues and expenditures recorded during entities /2018- contract -docs the state's fiscal year. Due 180 days after the end of the Network Provider's fiscal year or within 30 days of the recipient's receipt of the audit report, whichever occurs first, directly to each of the 1. ME Contract Manager Schedule of Bed -Day Availability Payments following unless otherwise required by Florida 1 (Electronic Submission Statutes The schedule shall be based on via E -mail) 2. 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, 1. ME Contract Manager Agency Prepared Financial Statements (Balance whichever occurs first, directly to each of the 1 (Electronic Submission Sheet and Statement of Activity following unless otherwise required by Florida via E -mail) 2. VP of Finance Statutes The schedule shall be based on revenues and expenditures recorded during the state's fiscal year. Year -End Financial Reports for Network Provider's Requiring Audits Per Attachment II Due 180 days after the end of the Network Provider's fiscal year or within 30 days of the Correspondence from the Auditor showing proof recipient's receipt of the audit report, 1. ME Contract Manager of submission of the Audit Report and whichever occurs first, directly to each of the 1 (Electronic Submission Mangement Letter to the Network Provider. following unless otherwise required by Florida via E -mail) 2. VP of Finance Statutes The schedule shall be based on 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 1. ME Contract Manager Management letter addressed to the Network following unless otherwise required by Florida 1 (Electronic Submission Provider issued by the Auditor Statutes The schedule shall be based on via E -mail) 2. VP of Finance revenues and expenditures recorded during the states fiscal year. Due 180 days after the end of the Network Providers fiscal year or within 30 days of the recipient's receipt of the audit report, whichever occurs first, directly to each of the Financial & Compliance Audit to include the following unless otherwise required by Florida 1 (Electronic Submission 1. ME Contract Manager necessary schedules per. Attachment II Statutes The schedule shall be based o via E -mail) revenues and expenditures recorded during 2. VP of Finance the state's fiscal year. Guidance /Care Center, Inc. Revised Exhibit C Contract No. ME225 - 9 - 27 Page 5 of 13 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports CaOlindi Reports II ,5 . l °c II {3d ,.a:: :, 11a3f 1t B "` .�t Year -End Financial Reports for Network Provider's Requiring Audits Per Attachment II - Continued Due 180 days after the end of the Network Provider's fiscal year or within 30 days of the recipient's receipt of the audit report, whichever occurs first, directly to each of the following unless otherwise required by Florida 1 (Electronic Submission 1. ME Contract Manager Schedule of State Earnings Statutes The schedule shall be based on via E -mail) 2. 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 1. ME Contract Manager Schedule of Related Party Transaction following unless otherwise required by Florida 1 (Electronic Submission Adjustments Statutes The schedule shall be based on via E -mail) 2. VP of Finance revenues and expenditures recorded during the states fiscal year. Due 180 days after the end of the Network Local Match Calculation Form - Template 9 - Provider's fiscal year or within 30 days of the Department of Children and Families form, recipient's receipt of the audit report, available at the following website: whichever occurs first, directly to each of the 1. ME Contract Manager following unless otherwise required by Florida 1 (Electronic Submission http: / /www.myflfamilies.com /service- Statutes The schedule shall be based on via E -mail) 2. VP of Finance programs /substance- abuse /managing- revenues and expenditures recorded during entities /2018- contract -docs 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 the 1. ME Contract Manager Budget following unless otherwise required by Florida 1 (Electronic Submission Actual Expenses & Revenues Schedule Statutes The schedule shall be based on via E -mail) 2. VP of Finance revenues and expenditures recorded during the state's fiscal year. Due 180 days after the end of the Network Provider's fiscal year or within 30 days of the recipient's receipt of the audit report, whichever occurs first, directly to each of the 1. ME Contract Manager Schedule of Bed -Day Availability Payments following unless otherwise required by Florida 1 (Electronic Submission Statutes The schedule shall be based on via E -mail) revenues and expenditures recorded during 2. VP of Finance the states fiscal year. Substance Abuse and Mental Health Outpatient Services Waitlist Reports 1. ME Adult System of Care Manager Monthly by the 5th for the preceding month's Outpatient Wait List Report Form - services. 1 (Electronic Submission and /or Exhibit AK, Part I and Part II via E -mail) 2. ME Children's System of Care Manager Guidance /Care Center, Inc. Revised Exhibit C Contract No. ME225 - 9 - 27 Page 6 of 13 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports Reports Required for Children's Mental Health Providers, as applicable Children's Mental Health Quarterly clinical Per Exhibit R, Child Welfare Quarterly Clinical 1 Copy in client chart reports on all dependent children, if applicable Report Children's Mental Health Quarterly clinical Per Exhibit R, Child Welfare Quarterly Clinical 1 Copy in client chart reports on all community children, if applicable Report Per Exhibit S - Monthly Census Report by the One (1) Encrypted 1. ME Contract Manager Children's Crisis Response Team (CCRT) 15th of every month following the month of Electronic Submission service attachment to an email to 2. Children's System of Care Manager each recipient Reports Required for Behavioral Health Network (BNet) Provider 1. ME Contract Manager One (1) Encrypted Alternative Services Provision Documentation Within 15 calendar days after end of month Electronic Submission 2. ME BNet Coordinator (Other than Pharmaceuticals) attachment to an email to each recipient 3. Children's Mental Health State Program Office 1. ME Contract Manager One (1) Encrypted Alternative Services Provision Documentation Within 15 calendar days after end of month Electronic Submission 2. ME BNet Coordinator (Pharmaceuticals only) attachment to an email to each recipient 3. Children's Mental Health State Program Office 1. ME Contract Manager One (1) Encrypted Statement of Program Cost September 1 following close of the contract Electronic Submission 2. ME BNet Coordinator year (June 30) attachment to an email to each recipient 3. Children's Mental Health State Program Office Required Reports for Receiving Facilities and /or Treatment Facilities Weapons and Firearms Court Petitions Monthl Within 15 calendar days after end of month 1 (Electronic Electronic Submission 1. ME Contract Manager Report, Exhibit 0 y for the preceding month's information - via E -mail) Only CSU and CMHC 2. ME Data Anaylst Reports Required for Adult Mental Health Providers, as applicable PATH Annual Data Report to SAMHSA, if 1 (Electronic Submission Per instruction on the PATH Grant applicable Per PATH Grant Application Instructions via E -mail) Application Guidance /Care Center, Inc. Revised Exhibit C Contract No. ME225 - 9 - 27 Page 7of13 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports I Required Reports Reports Required for Adult Mental Health Providers, as applicable- Continued PATH Local Match Expenditure Report, if Monthly by the 8th of each month following the 1 (Electronic Submission 1. ME Sr. Accountant (Fiscal Department) applicable month of service via E -mail) 2. ME Contract Manager PATH Monthly Report (generated from the HMIS Monthly, by the 5th calendar day 1 (Electronic Submission 1. ME Contract Manager system) after the month via E -mail) of service 2. ME Housing Coordinator Other PATH data reports as requested by the As requested by the ME As requested by the ME ME Contract Manager & Requestor ME October 5, 2018 (Period: 07/01/18 - 09/30/18) January 5, 2019 Assisted Living Facility with a Limited Mental (Period: 10/01/18 - 12/31/18) 1. ME Contract Manager Health License Client Quarterly Report, per April 5, 2019 1 (Electronic Submission Exhibit L (Period: 01/01/19 - 03/31/19) via E -mail) 2. ME Adult System of Care Manager July 5, 2019 (Period: 04/01/19 - 06/30/19) Report Required for Florida Assertive Community Treatment (FACT) Providers Vacant Position Report per Section II.H., Report Monthly by the 7th of each month following the 1 (Electronic Submission 1. ME Contract Manager in Exhibit AF month of service via E -mail) 2, ME Adult System of Care Manager October 5, 2018 (Period: 07/01/18 - 09/30/18) January 5, 2019 FACT Enhancement Reconciliation Report per (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission 1. ME Contract Manager Section II.H., Report in Exhibit AF April 5, 2019 via E -mail) (Period: 01/01/19 - 03/31/19) 2. ME Adult System of Care Manager July 5, 2019 (Period: 04/01/19 - 06/30/19) October 5, 2018 (Period: 07/01/18 - 09/30/18) January 5, 2019 Ad -Hoc Quarterly Report per Section II.H., (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission 1. ME Contract Manager Report in Exhibit AF April 5 , 2019 via E -mail) (Period: 01/01/19 - 03/31/19) 2. ME Adult System of Care Manager July 5, 2019 (Period: 04/01/19 - 06/30/19) October 5, 2018 (Period: 07/01/18 - 09/30/18) January 5, 2019 Outcomes and Output Performance Measures (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission 1. ME Contract Manager Report, per Section II.H., Report in Exhibit AF April 5 , 2019 via E -mail) (Period: 01/01/19 - 03/31/19) 2. ME Adult System of Care Manager July 5, 2019 (Period: 04/01/19 - 06/30/19) Report Required for Miami -Dade Forensic Alternative (MDFAC) Providers Daily Census Report Daily, by 10:00 am, Monday - Friday 1 (Electronic Submission Regional Forensic Coordinator via E -mail) Guidance /Care Center, Inc. Revised Exhibit C Contract No. ME225 - 9 - 27 Page 8 of 13 South Florida Behavioral Health Network, Inc. • Exhibit C Required Reports Required fitccurg Q CIEDCERD II 'tn Cf1 ft Report Required for Miami -Dade Forensic Alternative (MDFAC) Providers- Continued Monthly Program Quality Review Tracking By the 15th of each month following the month 1 (Electronic Submission 1. ME Contract Manager Report of services via E -mail) 2. Regional Forensic Coordinator By the 15th of each month following the month 1 (Electronic Submission 1. ME Contract Manager Monthly Performance Measures Report of services via E -mail) 2. Regional Forensic Coordinator Reports Required for Forensic Services Providers Monthly Report for Individuals on Conditional 1. ME Forensic Coordinator Release, if applicable By 15th of each month 1 2. Mental Health Administrator Office Statewide Forensic Bed Census Report, if Weekly (Every Thursday by 5:00 pm) 1 ME Forensic Coordinator applicable Reports Required for Forensic Multidisciplinary Team Provider Monthly Forensic Multidisciplinary Team Report — By 10th of each month for the preceding 1 (Electronic Submission 1. ME Contract Manager DCF Template 25 months' services via E-mail) 2. Regional Forensic Coordinator Monthly Vacant Position(s) Reports By 10th of each month for the preceding 1 (Electronic Submission 1. ME Contract Manager months' services via E -mail) 2. Regional Forensic Coordinator By 10th of each month for the preceding 1 (Electronic Submission 1. ME Contract Manager Monthly Court Reports months' services via E -mail) 2. Regional Forensic Coordinator Quarterly Expenditure Reconciliation of Funds By 10th of each month for the preceding 1 (Electronic Submission 1. ME Contract Manager Report/Enhancement Reconciliation Report. months' services via E -mail) 2, Regional Forensic Coordinator Reports Required for Consumer - Driven Agencies October 5, 2018 (Period: 07/01/18 - 09/30/18) • January 5, 2019 (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission Enrollment/Membership Report April 5, 2019 via E -mail) ME Contract Manager (Period: 01/01/19 - 03/31/19) July 5, 2019 (Period: 04/01/19 - 06/30/19) Reports Required for Substance Abuse Services Providers January 5, 2019 Report for HIV Early Intervention Services, SAPT (Period: 07/01/18 - 12/31/18) 1 (Electronic Submission Block Grant Set Aside Funded Services Only July 5 , 2019 via E -mail) ME Contract Manager (Period: 01/01/19 - 06- 30 -19) Annual Report for Evidenced -based Injection 1 (Electronic Submission Drug User Outreach Services, SAPT Block Grant Upon Request via E -mail) ME Contract Manager Mandate, Designated Providers Only Guidance /Care Center, Inc. Revised Exhibit C Contract No. ME225 - 9 - 27 Page 9 of 13 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports • .Reclui Reports Reports Required for Substance Abuse Services Providers- Continued Annual Report for Pregnant Women and Women 1 (Electronic Submission With Dependent Children SAPT Block Grant Set Upon Request via E -mail) ME Contract Manager Aside Funded Services Only Monthly Outcomes for Women's Expansion Due monthly, by the 4th of every month 1 (Electronic Submission 1. ME IT Office Grant — Special Appropriation following the month of service via E -mail) 2. ME Contract Manager Monthly STR Data Collection Report - Florida Response to the Opioid Crisis - STR - Due monthly, by the 15th of every month 1 (Electronic Submission Medication Assisted Treatment Services, OCA: following the month of service via E -mail) ME Contract Manager MSOPM - Exhibit U STR PFS Grant Hospital Peer Pilot Project - Per Due monthly, by the 20th of every month 1 (Electronic Submission ME Contract Manager Exhibit following the month of service via E -mail) Reports Required for Substance Abuse Prevention Services Providers Prevention service data shall be submitted PBPS, or other data system designated by Monthly Data Required by DCF PAM 155 -2 electronically to PBPS no later than the 4th of Electronically the ME or the Department each month following the month of service Monthly Data to the ME's contracted evaluation Monthly, by the 4th calendar day after the Electronically DOES or any other format requested by entity -BSRI month of service BSRI Monthly Service Invoice Monthly, by the eighth (8th) calendar day after 1 ME Sr. Accountant (Fiscal Department) the month of service Invoice Review Supporting Documentation - from Submitted with the monthly invoice 1 ME Sr. Accountant (Fiscal Department) PBPS in ajpeg format Monthly E -Mail Notification to the ME Prevention Services Director and ME Data Analyst verify that the data in the PBPS system has been checked 1. ME Director or Prevention Services and is correct and complete and may be used for Monthly, by the 4th calendar day after the 1 (Electronic Submission Block Grant reporting and payment. month of service via E -mail) 2. ME Data Analyst Refer to Scope of Work Attachment to the Contract for specifics Guidance /Care Center, Inc. Revised Exhibit C Contract No. ME225 - 9 - 27 Page 10 of 13 South Florida Behavioral Health Network, Inc. Exhibit C • Required Reports ,. llReports (I .�_� ... °� "{�,3 �`�I�{�8 � r � Reports Required for Substance Abuse Prevention Services Providers- Continued October 15, 2018 (Period: 07/01/18 - 09/30/18) January 15, 2019 1. ME Director of Prevention Services Prevention Services Quarterly Reports (Fidelity (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission to EBPs) April 15, 2019 via E -mail) 2. BSRI - ME Contracted Prevention (Period: 01/01/19 - 03/31/19) Services Evaluation Provider July 15, 2019 (Period: 04/01/19 - 06/30/19) Final Annual Site Schedule 8/31/2018 1 (Electronic Submission 1. ME Contract Manager via E -mail) 2. ME Director of Prevention Services Within 30 calendar days of the effective date Memorandum of Understanding (MOU) with a ME Contract Manager Community Coalition of the contract (for newly executed MOU's) 1 (Electronic Submission OR via E -mail) 2. ME Director or Prevention Services Within 30 calendar days for renewed MOU's Refer to Scope of Work Attachment to the 1 (Electronic Submission 1. ME Contract Manager Submission of Participant Satisfaction Survey Contract for specifics via E -mail) 2. ME Director or Prevention Services Reports Required for Providers Receiving Specific Appropriations 1. ME Contract Manager Initial Projected Return on Investment 7/10/2018 (PITT) 1 (Electronic Submission 10/01/2018 (CAT) via E -mail) October 10, 2018 (Period: 07/01/18 - 09/30/18) January 10, 2019 1. ME Contract Manager Quarterly Updates on Return on Investment (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission Report - Per Exhibit AM April 10 , 2019 (Period: 01/01/19 - 03/31/19) via E -mail) July 10, 2019 (Period: 04/01/19- 06/30/19) Reports Required for the Navigate Program Provider October 31, 2018 (Period: 07/01/18 - 09/30/18) January 31, 2019 (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission Quarterly Services Report May 1, 2019 via E -mail) ME Contract Manager (Period: 01/01/19 - 03/31/19) July 31, 2019 (Period: 04/01/19 - 06/30/19) October 31, 2018 (Period: 07/01/18 - 09/30/18) January 31, 2019 (Period: 10 /01/18 - 12/31/18) 1 (Electronic Submission Navigate Program Quarterly Expenditure Report May 1, 2019 via E -mail) ME Contract Manager (Period: 01/01/19 - 03/31/19) July 31, 2019 (Period: 04/01/19 - 06/30/19) Guidance /Care Center, Inc. Revised Exhibit C Contract No. ME225 - 9 - 27 Page 11 of 13 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports is Required Reports:: Required Reports Reports for Designated Central Receiving Facility Service Providers Performance Measures Report, per Exhibit's AQ By the 15th of every month following the 1 (Electronic Submission ME Contract Manager and AS, as applicable reporting month via E -mail) Reports Required for the Forensic Mental Health Services Program By the 10th of every month following the 1 (Electronic Submission Appendix A, Conditional Release Report reporting month via E -mail) ME Forensic Manager Weekly Statewide Census Report Weekly by 12:00 Noon every Thursday 1 (Electronic Submission via E -mail) ME Forensic Manager By the 10th of every month following the 1 (Electronic Submission Appendix B, Monthly Diversion Report reporting month via E -mail) ME Forensic Manager Quarterly SMHFT Visit Report Due within thirty (30) calendar days of date of 1 (Electronic Submission ME Forensic Manager the visit via E -mail) January 5, 2019 (Period: 07/01/18 - 12/31/18) 1 (Electronic Submission Staffing Report July 5, 2019 ME Forensic Manager (Period: 01/01/19 - 06- 30 -19) via E -mail) Guidance /Care Center, Inc. Revised Exhibit C Contract No. ME225 - 9 - 27 Page 12 of 13 South Florida Behavioral Health Network, Inc. Exhibit C Required Reports ' Required Reports .. _ II �:.', t r kM N Due Date �z (�.. .. # of Copies ✓* Q ssatry_ t ,:' _ . Reports Required for the Community Action Treatment (CAT) Program II, Appendix 1 - Persons Served and Performance 1 (Electronic Submission 1. Children System of Care Manager Measure Report By the 8th Calendar day of the month via E -mail) 2. Contract Manager October 10, 2018 (Period: 07/01/18 - 09/30/18) January 10, 2019 1. ME Contract Manager (Period: 10/01/18 - 12/31/18) Quarterly Updates on Retum on Investment April 10, 2019 1 (Electronic Submission Report - Per Exhibit AM via E -mail) (Period: 01 /01/19 - 03/31/19) July 10, 2019 (Period: 04/01/19- 06/30/19) Monthly shall be submitted electronically to KIS, PBPS, or other data system Monthly Data Required by DCF PAM 155 -2 the ME no later than the 4th of each month Electronically designated by the ME or the Department following the month of service Monthly, by the eighth (8th) calendar day 1. ME Sr. Accountant (Fiscal Department) Exhibit AJ -1 Monthly Service Invoice after the month 1 2, Children's System of Care Manager of service Submitted with the monthly invoice, as Invoice Review Supporting Documentation appropriate, and /or as requested by SFBHN 1 1. ME Sr. Accountant (Fiscal Department) (incidental expenses) 2. Children's System of Care Manager staff Weekly. Census Report Weekly by 12:00 noon, every Monday 1 (Electronic Submission Children's System of Care Manager via E -mail) October 10, 2018 (Period: 07/01/18 - 09/30/18) January 10, 2019 • Appendix 2 - Quarterly Supplemental Data (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission 1. Children System of Care Manager Report April 10, 2019 via E -mail) 2. Contract Manager (Period: 01/01/19 - 03/31/19) July 10, 2019 (Period: 04/01/19 - 06/30/19) 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. Revised Exhibit C Contract No. ME225 -9 -27 Page 13 of 13 Amendment #1 EXHIBIT G: COVERED SERVICES FUNDING BY OCA Revised: 9/10/1: Guidance /Care Center, Inc. ME225 -9 -27 A 111 COVERED SERVICES FUNDING / RATE MH001 MH009 MH018 MH072 MH073 MH076 M11094 MHOPG MHOTB M11026 MHOFH TOTAL 228,629 915,082 1,130,503 160,000 - 5,945 - 90,000 - - - $ 2,530,159 01 Assessment $ 83.18 150,000 20,000 15,000 $ 185,000 02 Case Management $ 90.84 65,000 15,000 70,000 $ 150,000 03 Crisis Stabilization $ 351.62 1,095,503 $ 1,095,503 04 Crisis Support/Emergency $ 35.43 35,000 $ 35,000 06 Day/Night $ - $ - 07 Drop - In/Self Help Centers $ 33.43 20,000 $ 20,000 08 In- Home /On -Site $ 93.34 1,000 $ 1,000 11 Intervention - Individual $ 66.44 140,000 20,000 $ 160,000 42 Intervention - Group $ 16.61 $ - 12 Medical Services $ 484.75 425,000 35,000 $ 460,000 13 Medication- Assisted Treatment $ 21.66 $ - 14 Outpatient - Individual $ 67.09 75,000 7,000 $ 82,000 35 Outpatient - Group $ 16.77 1,000 3,000 $ 4,000 15 Outreach $ 49.85 1,000 60,000 2,000 $ 63,000 18 Residential Level I $ 298.72 50,000 $ 50,000 19 Residential Level 11 $ $ - 20 Residential Level III $ $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ 293.96 $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ 55.70 $ - 28 Incidental Expenses $ 1.00 5,945 3,000 $ 8,945 29 Aftercare - Individual $ - $ - 43 Aftercare - Group $ - $ - 30 Information & Referral $ 37.93 15,000 $ 15,000 . 34 FACT Team $ - $ - 36 Room & Board Level I $ - $ - 37 Room & Board Level II $ - $ - 38 Room & Board Level III $ 105.15 178,629 $ 178,629 39 Short Residential Treatment $ - $ - 40 Clubhouse Services $ 50.69 22,082 $ 22,082 44 CCST - Individual $ - $ - 45 CCST - Group $ - $ _ 46 Recovery Support - Individual $ - $ - 47 Recovery Support - Group $ - $ - 48 Prevention - Indicated $ 65.07 $ - 49 Prevention - Selective $ 68.59 $ - 50 Prevention - Universal Direct $ 68.59 $ - 51 Prevention - Universal Indirect $ - $ - 99 Special Proviso /Cost Reimbursement $ - - $ - FITT Program $ - CAT Team * ighlighted Glinait3 eligible _ : TOTAL FUNDING $ 5,610,294 $ 228,629 $ 915,082 $ 1,130,503 $ 160,000 $ - $ 5,945 $ - $ 90,000 $ - $ - $ - $ 2,530,159 TOTAL UNCOMPENSATED $ 1,122,059 $ 506,032 Guidance /Care Center, Inc. Revised Exhibit G Contract No. ME225 - 9 - 27 Page 1 of 4 Amendment #1 EXHIBIT G: COVERED SERVICES FUNDING BY OCA Revised: 9/10/1: Guidance /Care Center, Inc. ME225 -9 -27 C \ 1 li COVERED SERVICES FUNDING / RATE MH001 M11009 MH018 MH071 MHCAT MHOCN MHOCF TOTAL 470,000 15,677 - 750,000 - - $ 1,235,677 01 Assessment $ 83.18 45,000 $ 45,000 02 Case Management $ 90.84 10,000 $ 10,000 03 Crisis Stabilization $ 351.62 $ - 04 Crisis Support/Emergency $ 35.43 15,677 $ 15,677 06 Day/Night $ - $ - 07 Drop -In /Self Help Centers $ 33.43 $ - 08 In- Home /On -Site $ 93.34 286,000 $ 286,000 11 Intervention - Individual $ 66.44 50,000 $ 50,000 42 Intervention - Group $ 16.61 $ - 12 Medical Services $ 484.75 45,000 $ 45,000 13 Medication- Assisted Treatment $ 21.66 $ - 14 Outpatient - Individual $ 67.09 2,000 $ 2,000 35 Outpatient - Group $ 16.77 $ - 15 Outreach $ 49.85 30,000 $ 30,000 18 Residential Level I $ 298.72 $ - _ 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ 293.96 $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ 55.70 $ - 28 Incidental Expenses $ 1.00 $ - 29 Aftercare - Individual $ - $ - 43 Aftercare - Group $ - $ - 30 Information & Referral $ 37.93 2,000 $ 2,000 34 FACT Team $ - $ - 36 Room & Board Level I $ - $ - 37 Room & Board Level II $ - $ . 38 Room & Board Level III $ 105.15 $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ 50.69 $ - 44 CCST - Individual $ - $ - 45 CCST - Group $ - $ - 46 Recovery Support - Individual $ - $ - 47 Recovery Support - Group $ - $ - 48 Prevention - Indicated $ 65.07 $ - 49 Prevention - Selective $ 68.59 $ - 50 Prevention - Universal Direct $ 68.59 $ - 51 Prevention - Universal Indirect $ - $ - 99 Special Proviso /Cost Reimbursement $ - $ - FITT Program $ - CAT Team 750,000 $ 750,000 *Hi_ cm eli_ibl. (o aid) . , TOTAL FUNDING $ 5,610,294 $ - . $ 470,000 $ 15,677 $ - $ 750,000 $ - $ - $ 1,235,677 TOTAL UNCOMPENSATED $ 1,122,059 $ 247,135 Guidance /Care Center, Inc. Revised Exhibit G Contract No. ME225 -9 -27 Page 2 of 4 • Amendment #1 EXHIBIT G: COVERED SERVICES FUNDING BY OCA Revised: 9/10/1: Guidance /Care Center, Inc. ME225 -9 -27 ‘'' COVERED SERVICES FUNDING / RATE MS003 MSO11 MS021 MS023 MS025 MS027 MSO81 MH091 MSOTB MS908 MSOPH MSOPM MS913 TOTAL - 271,791 486,643 - - - - 633,188 - - - - - $ 1,391,622 01 Assessment $ 83.18 20,000 $ 20,000 02 Case Management $ 90.84 70,000 $ 70,000 03 Crisis Stabilization $ 351.62 $ - 04 Crisis Support/Emergency $ 35.43 25,000 $ 25,000 06 Day/Night $ - $ - 07 Drop -In /Self Help Centers $ 33.43 $ - 08 In- Home /On -Site $ 93.34 15,000 $ 15,000 11 Intervention - Individual $ 66.44 20,000 $ 20,000 42 Intervention - Group $ 16.61 $ - 12 Medical Services $ 484.75 $ - 13 Medication- Assisted Treatment $ 21.66 15,000 $ 15,000 14 Outpatient - Individual $ 67.09 15,000 $ 15,000 35 Outpatient - Group $ 16.77 85,000 $ 85,000 15 Outreach $ 49.85 17,000 $ 17,000 18 Residential Level I $ 298.72 $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ 293.96 461,643 $ 461,643 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ 55.70 14,791 $ 14,791 28 Incidental Expenses $ 1.00 $ - 29 Aftercare - Individual $ - $ _ 43 Aftercare - Group $ - $ - 30 Information & Referral $ 37.93 $ - 34 FACT Team $ - $ _ 36 Room & Board Level I $ - $ - 37 Room & Board Level II $ - $ - 38 Room & Board Level III $ . 105.15 $ - 39 Short - term Residential Treatment $ - $ - 40 Clubhouse Services $ 50.69 $ - 44 CCST - Individual $ - $ - 45 CCST- Group $ - $ 46 Recovery Support - Individual $ - $ - 47 Recovery Support - Group $ - $ - 48 Prevention - Indicated $ 65.07 $ - 49 Prevention - Selective $ 68.59 $ - 50 Prevention - Universal Direct $ 68.59 $ - 51 Prevention - Universal Indirect $ - $ 99 Special Proviso /Cost Reimbursement $ - $ - FITT Program 633,188 $ 633,188 CAT Team *Highlighted Gram eligible Rpriat.1 allocation TOTAL FUNDING $ 5,610,294 $ - $ 271,791 $ 486,643 $ - $ - $ - $ - $ 633,188 $ - $ - $ - $ - $ - $ 1,391,622 TOTAL UNCOMPENSATED $ 1,122,059 $ 278,324 Guidance /Care Center, Inc. Revised Exhibit G Contract No. ME225 - 9 - 27 Page 3 of 4 Amendment #1 EXHIBIT G: COVERED SERVICES FUNDING BY OCA Revised: 9 /10 /1: Guidance /Care Center, Inc. ME225 -9 -27 .S'‘ COVERED SERVICES FUNDING / RATE MS003 MS011 MS021 MS023 MS025 MSOPP MSOTB MS903 MS913 MSOCN MSOCF TOTAL 253,773 - - 199,063 - - - - - - $ 452,836 01 Assessment $ 83.18 15,000 $ 15,000 02 Case Management $ 90.84 40,000 $ 40,000 03 Crisis Stabilization $ 351.62 $ - 04 Crisis Support/Emergency $ 35.43 $ - 06 Day/Night $ - $ - 07 Drop -In /Self Help Centers $ 33.43 $ - 08 In- Home /On -Site $ 93.34 30,000 $ 30,000 11 Intervention - Individual $ 66.44 148,773 $ 148,773 42 Intervention - Group $ 16.61 $ - 12 Medical Services $ 484.75 $ - 13 Medication- Assisted Treatment $ 21.66 $ - 14 Outpatient - Individual $ 67.09 $ - 35 Outpatient - Group $ 16.77 $ - 15 Outreach $ 49.85 20,000 $ 20,000 18 Residential Level I $ 298.72 $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ 293.96 $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ 55.70 $ - 28 Incidental Expenses $ 1.00 $ - 29 Aftercare - Individual $ - $ - 43 Aftercare - Group $ - $ - 30 Information & Referral $ 37.93 $ - 34 FACT Team $ - $ - 36 Room & Board Level I $ - $ - 37 Room & Board Level II $ - $ - 38 Room & Board Level III $ 105.15 $ - 39 Short Residential Treatment $ - $ - 40 Clubhouse Services $ 50.69 $ - 44 CCST - Individual $ - $ - 45 CCST - Group $ - $ - 46 Recovery Support - Individual $ - $ - 47 Recovery Support - Group $ - $ - 48 Prevention - Indicated $ 65.07 25,000 $ 25,000 49 Prevention - Selective $ 68.59 100,000 $ 100,000 50 Prevention - Universal Direct $ 68.59 74,063 $ 74,063 51 Prevention - Universal Indirect $ - $ - 99 Special Proviso /Cost Reimbursement $ - $ - FITT Program $ - CAT Team *Highlighted (Ram eli ibl 0:] fund allocation TOTAL FUNDING $ 5,610,294 $ - $ 253,773 $ - $ - $ 199,063 $ - $ - $ - $ - $ - $ - $ 452,836 TOTAL UNCOMPENSATED $ 1,122,059 $ 90,567 Revised Exhibit G Guidance /Care Center, Inc. Page 4 of 4 Contract No. ME225 -9 -27 EXHIBIT H - FUNDING DETAIL Revised: July 2018 Provider: Guidance /Care Center, Inc. Contract #: ME225 -9 -27 Amendment # 1 ADULT MENTAL HEALTH CHILDREN MENTAL HEALTH OCA DESCRIPTION NEW OCA AMOUNT OCA DESCRIPTION NEW OCA AMOUNT Residential Services MH001 $ 228,629 Residential Services MH001 $ - Non - Residential Services MH009. $ 915,082 Non - Residential Services MHO09 $ 470,000 Crisis and Baker Act Services MH018 $ 1,130,503 Crisis and Baker Act Services MH018 $ 15,677 Community Forensic Program MH072 $ 160,000 Special Appropriation - ICFH MHOBN $ - FACT Team M11073 $ - Purchased Residential Treatment (PRTS) MH071 $ - Indigent Drug Program MH076 $ 5,945 Community Action Treatment (CAT) Team MHCAT $ 750,000 Proviso Allocation - Citrus MI-1094 $ - $ - PATH Grant MHOPG $ 90,000 $ - TANF Services MHOTB $ - $ - Early Intervention - Psychotic Disorders MH026 $ - $ - Forensic Hospital Multidisciplinary Team MHOFH $ - $ - For Profit Sub - Recipeint - Key West HMA MHSFP $ - $ - Supported Employment Services MHEMP $ - $ - Miami-Dade County Homeless Trust MH010 $ - $ - IOS Pilot Project MH021 $ - $ - MDC - Central Receiving Facility MDCRF $ - $ - Care Coordination MHOCN $ - Care Coordination MHOCN $ - Carry Forward MHOCF $ - Carry Forward MHOCF $ - TOTAL ADULT MENTAL HEALTH = $ 2,530,159 TOTAL CHILDREN MENTAL HEALTH = $ 1,235,677 ADULT SUBSTANCE ABUSE CHILDREN SUBSTANCE ABUSE OCA DESCRIPTION NEW OCA AMOUNT OCA DESCRIPTION NEW OCA AMOUNT Residential Services MS003 $ - Residential Services MS003 $ - Non- Residential Services MSO11 $ 271,791 Non - Residential Services MS011 $ 253,773 Detox Services MS021 $ 486,643 Detox Services MS021 $ - HIV Services MS023 $ - HIV Services MS023 $ - Prevention Services MS025 $ - Prevention Services MS025 $ 199,063 Women's Services MS027 $ - Prevention Partnership Grant MSOPP $ - Pregnant Women'Project MS081 $ - TANF Services MSOTB $ - Proviso Allocation - GCC MS091 $ 633,188 Proviso Allocation - Here's Help MS903 $ - TANF Services MSOTB. $ - Here's Help Opioid Training MS913 $ - Proviso Allocation - New Hope CORPS MS908 $ - $ - Targeted Response - Opioid Crisis MSOPH $ - $ - Opioid Crisis MAT MSOPM $ - $ - Here's Help Opioid Training MS913 . $ - $ - $ - $ - $ - - $ - MDC - Central Receiving Facility MDCRF $ - $ - Care Coordination MSOCN $ - Care Coordination MSOCN $ - Carry Forward MSOCF $ - Carry Forward MSOCF $ - TOTAL ADULT SUBSTANCE ABUSE = $ 1,391,622 TOTAL CHILDREN SUBSTANCE ABUSE.= $ 452,836 FUNDS NOT REQUIRING MATCH: • Drug Abuse Services $ 687,461 TOTAL ALL PROGRAMS = $ 5,610,294 Prevention $ 199,063 UNCOMPENSATED UNITS = $ 1,122,059 Deinstitutionalization Project $ 123,266 TOTAL = $ 6,732,353 CMH Program $ 1,235,677 MH Block Grant TOTAL FUNDS REQUIRING MATCH= $ 3,364,827 TOTAL FUNDS NOT REQUIRING MATCH $ 2,245,467 LOCAL MATCH REQUIRED = $ 1,121,609 NOTES FY 2018 -19 Adjustments 2/15/18 $60,000 is reduced from MSOCN and $60,000 from MHOCN due to 1 -time only allocation. $48,548 is reduced from MHACF due to 1 -time only allocation. $115,000 is reduced from Village and added to GCC -MSCI1 to reverse FY 2017 -18 adjustment. $65,285 is reduced from Village and addded to GCC -MS025 to reverse FY 2017 -18 adjustment. $50,000 is added to MHAO9 and $25,000 to MHCO9 to restore the 1 -time lapse reduction. $3,468 is reduced from MHAO9 and added back to MHA76 to restore the EDP allocation -all funds need to be drawn down in the incidental cost center. $50,000 is added to MSA1I and $150,000 to MSA2I to annualize the Central Re ceiving Facility. '8/24/18 $750,000 is added to fund the CAT Team of Monroe County (Procured). Guidance /Care Center, Inc. Revised Exhibit H Contract No. ME225 - 9 - 27 Page 1 of 1 South Florida Behavioral Health Network, Inc. 7/1/2018 Exhibit AJ Community Action Treatment (CAT) Team The Network Provider shall operate a Community Action Treatment (CAT) program to provide community -based services to children ages 11 to 21 with a mental health or co- occurring substance abuse diagnosis with any accompanying characteristics such as being at-risk for out -of -home placement as demonstrated by repeated failures at less intensive levels of care; having two or more hospitalizations or repeated failures; involvement with the Department of Juvenile Justice or multiple episodes involving law enforcement; or poor academic performance or suspensions. Children younger than 11 may be candidates if they display two or more of the aforementioned characteristics. The Network Provider shall adhere to the service delivery and reporting requirements herein and reporting requirements. Best practice considerations and resources are provided to support continuous improvement of the CAT program; however, these are not contractually required. I. Network. Provider Responsibilities 1. The Network Provider must adhere to the service delivery and reporting requirements described in this Exhibit and in the DCF Guidance Document 32, incorporated herein by reference; 2. The Network Provider shall submit data, in accordance with the most recent version of the PAM 155 -2, and in compliance with Section C -1.4 of the Prime Contract; 3. The Network Provider shall submit Appendix 1 - Persons Served and Performance Measure Report and Appendix 2 - Quarterly Supplemental Data Report, in accordance with the following schedule: o Appendix 1— The Network Provider shall submit Appendix I, Persons Served and Performance Measure Report to the Contract Manager and the Children System of Care Manager by the 8th calendar day of the month. o Appendix 2 — Network Provider shall submit Quarterly Supplemental Data Report to the Contract Manager and the Children System of Care Manager on the dates specified in the Exhibit C, Required Reports. 4. The Network Provider shall participate in all CAT program conference calls, meetings or other oversight events scheduled by the Department; 5. The Network Provider shall submit quarterly reporting of actual expenditures, fiscal year -end financial reconciliation of actual allowable expenditures to total payments, and prompt return of any unearned funds or overpayments by the dates and to the individuals provided in Exhibit C; 6. The Network Provider shall serve a minimum of 35 children /youth per month. o In the first year of services, the Network Provider, will implement a phase -in period to achieve the minimum service target as follows: • 10 children /youth per month during the first month of services, • 20 children /youth per month during the second month, • 25 children /youth per month during the third month, and • 35 children /youth per month thereafter. Guidance /Care Center, Inc. Exhibit AJ Contract No. ME225 -9 -27 Page 1 of 15 7. The Network Provider shall be applied a financial consequence in the event a Network Provider does not meet the monthly minimum service target. Financial consequences shall be established at a $2,000 reduction of the monthly invoice amount for each individual served Tess than the monthly service target. 8. Data Submission Data shall be submitted electronically to the ME by the 4th of each month following the month of service in the Knight Information Software (KIS) database or other data reporting system designated by the ME. Network Provider shall enter data as defined in PAM 155 -2 and by the dates specified in Exhibit C, Required Reports. 9. Incidental Expenses Incidental Expenditures shall be submitted by the 8th calendar day of the month together with the monthly invoice. Prior approval from the Children System of Care Manager is required of the incidental expense expenditures. The expenditure form should include the following categories: Individual Name, Date of Birth, Purchased Item, Amount Requested, and Date of Purchase. Electronically submitted document must be in a secured, password protected, or encrypted format. 10. EXHIBIT AJ -1: Invoice The Network Provider shall ensure that the invoices submitted to the ME reconcile with the amount of funding and services specified in the contract and with the supporting documentation. Invoice is due on the 8th calendar day of the month and as indicated in Exhibit C, Required Reports. 11. WEEKLY CENSUS A weekly census of the children enrolled is required to be submitted by 12:00 noon every Monday to the Children System of Care Manager. 12. Eligible Other Cost Accumulator (OCA) and Covered Services The OCA for the CAT Team Program is: MHCAT The Covered Services allowed for the CAT Team program are: Assessment, Case Management, Crisis Support Emergency, In- Home /On -Site, Intervention Individual, Outpatient Individual, Medical Services, Outreach, Supported Employment, Supportive Housing, Incidental Expenses, Information and Referral, Clubhouse Services, CCST - Individual, CCST - Group, Recovery Support — Individual, Recovery Support — Group. II. Program Goals CAT is intended to be a safe and effective alternative to out -of -home placement for children with serious behavioral health conditions. Upon successful completion, the family should have the skills and natural support system needed to maintain improvements made during services. The goals of the CAT program are to: 1. Strengthen the family and support systems for youth and young adults to assist them to live successfully in the community; 2. Improve school related outcomes such as attendance, grades, and graduation rates; 3. Decrease out -of -home placements; 4. Improve family and youth functioning; 5. _ Decrease substance use and abuse; 6. Decrease psychiatric hospitalizations; 7. Transition into age appropriate services; and 8. Increase health and wellness. Guidance /Care Center, Inc. Exhibit AJ Contract No. ME225 -9 -27 Page 2 of 15 III. Eligibility The following participation criteria are established in proviso and shall be adhered to by the Network Provider: 1. Otherwise eligible for publicly funded substance abuse and mental health services pursuant to s. 394.674, F.S., and 2. Individuals aged 11 to 21 with a mental health diagnosis or co- occurring substance abuse diagnosis with one or more of the following accompanying characteristics: • The individual is at -risk for out -of -home placement as demonstrated by repeated failures at less intensive levels of care; • The individual has had two or more periods of hospitalization or repeated failures; • The individual has had involvement with the Department of Juvenile Justice or multiple episodes involving law enforcement; or • The individual has poor academic performance or suspensions. 3. Children younger than 11 with a mental health diagnosis or co- occurring substance abuse diagnosis may be candidates if they meet two or more of the aforementioned characteristics. Individuals residing in therapeutic placements such as hospitals, residential treatment centers, therapeutic group homes and therapeutic foster homes; and those receiving day treatment services are not eligible to receive CAT services. IV. Approved CAT Model The CAT model is an integrated service delivery approach that utilizes a team of individuals to comprehensively address the needs of the young person, and their family. The ME has approved the following staff: 1. A full -time Team Leader, 2. Clinical Coordinator, 3. Mental Health Clinicians 4. A Psychiatrist or Advanced Registered Nurse Practitioner (part- time), 5. A Registered or Licensed Practical Nurse (part- time), 6. A Case Manager, 7. Therapeutic Mentors, and 8. Research Assistant/Data Entry (Support Staff) The Network Service Provider must have these staff as part of the team; CAT members work collaboratively to deliver the majority of behavioral health services, coordinate with other service providers when necessary, and assist the family in developing or strengthening their natural support system. CAT funds are used to address the therapeutic needs of the eligible youth or young adult receiving services. However, the CAT model is based on a family - centered approach in which the CAT team assists parents or caregivers to obtain services and supports, which may include providing information and education about how to obtain services and supports, and assistance with referrals. The number of sessions and the frequency with which they are provided is set through collaboration rather than service limits. The team is available on nights, weekends, and holidays. In the event that interventions out of the scope of the team's expertise, qualifications, or licensure (i.e., eating disorder treatment, behavior analysis, psychological testing, Guidance /Care Center, Inc. Exhibit AJ Contract No. -9 -27 Page 3 of 15 substance abuse treatment, etc.) are required, referrals are made to specialists, with coordination from the team. This flexibility in service delivery is intended to promote a "whatever it takes" approach to assisting young people and their families to achieve their goals. Best Practice Considerations: Models and Approaches for Working with Young People and Their Families 1. The Transition to Independence Process (TIP) model is an evidence- supported practice based on published studies that demonstrate improvements in real -life outcomes for youth and young adults with emotional /behavioral difficulties (EBD). http: / /tipstars.orq /Home.aspx 2. The Research and Training Center for Pathways to Positive Futures (Pathways) aims to improve the lives of youth and young adults with serious mental health conditions through rigorous research and effective training and dissemination. Their work is guided by the perspectives of young people and their families, and based in a positive development framework. http://www.pathwaysrtc.pdx.edu/about 3. National Wraparound Initiative - Wraparound is an intensive, holistic and individualized care planning and management process that engages and supports individuals with complex needs (most typically children, . youth, and their families) to live in the community and realize their hopes and dreams. https://nwi.pdx.edu/wraparound-basics/ 4. Strengthening Family Support for Young People: Tip sheet for strengthening family support. http: / /www. pathwaysrtc. pdx.edu /pdf /proIPTTC- FamilvSupportTipSheet.pdf 5. Positive Youth Development (PYD), Resilience and Recovery: Actively focuses on building strengthens and enhancing healthy development. http:/ /www. pathwaysrtc. pdx.ed u/ pdf /pbCmtvBasedApproaches09 -2011. pdf 6. Section 394.491, F.S. — Guiding principles for the child and adolescent mental health treatment and support system. . http: / /www.leq. state .fl.us /statutes /index.cfm ?App mode = Displav Statute &Search String=&URL=0300- 0399 /0394 /Sections /0394.491.html 7. Youth M.O.V.E. National. Youth M.O.V.E is a youth led national organization devoted to improving services and systems that support positive growth and development by uniting the voices of individuals who have lived experience in various systems including mental health, juvenile justice, education, and child welfare. There are chapters in Florida and opportunities for young people to learn leadership and advocacy skills and to get involved with peers. http:/ /www.vouthmovenational.ora /Pages /mission- vision - purpose. html V. Serving Young Adults , The CAT program serves young adults up to the age of twenty -one (21), which includes young adults ages eighteen (18) up to twenty (20) who are legally considered adults. The Network Provider, if serving these young adults must consider their legal rights to make decisions about their treatment, who will be involved, and with whom information will be shared. In keeping with the focus of the CAT model, the Network Provider should support the young person to enhance and develop relationships and supports within their family and community, guided by their preferences. Guidance /Care Center, Inc. Exhibit AJ Contract No. ME225 -9 -27 Page 4of15 VI. Coordination With Other Key Entities It is important for the Network Provider to address the provision of services and supports from a comprehensive approach, which includes coordination with other key entities providing services and supports to the individual receiving' services. In collaboration with and based on the preferences of the individual receiving services and their parent/legal guardian (if applicable). The Network Provider should identify and coordinate efforts with other key entities as part of their case management function, which include but are not limited to: primary health care, child welfare, juvenile justice, corrections, and special education. If the individual receiving services is a minor served by child welfare, members of their treatment team shall include their child welfare Case Manager and guardian ad litem (if assigned). If and how the parent will be included in treatment should be determined in coordination with the dependency case manager, based on individual circumstances. The Network Provider shall document efforts to identify and coordinate with the other key entities in the case notes. VII. Screening and Assessment Within 45 days of an individual's admission to services, the Network Provider shall complete the North Carolina Family Assessment Scale for General Services and Reunification® (NCFAS -G +R) as the required initial assessment to assist in identifying areas of focus in treatment. The NCFAS -G +R and Plans of Care (Initial and Master) must be completed for all individuals served, to include those transferred from another program within the same agency. The Network Provider is encouraged to use a variety of reliable and valid screening and assessment tools in addition to the NCFAS -G +R as part of the assessment process, with focus on screening for co- occurring mental health and substance use disorders. Additionally, the Network Provider is encouraged to gather collateral information in coordination with the individual served and their family, to include such things as: school records; mental health and substance abuse evaluations and treatment history; and level of cognitive functioning to develop a comprehensive understanding of the young person's and their family's circumstances. As with best practice approaches such as Systems of Care and Transition to Independence, the screening and assessment process should focus on identifying competencies and resources to be leveraged as well as needs across multiple life domains, such as education, vocation, mental health, substance use, primary health, and • social connections. Best Practice Considerations: Screening and Assessment Resources 1. The California Evidenced -based Clearinghouse for Child Welfare — Assessment ratings and how to determine if an assessment is reliable and valid. http: / /www.cebc4cw.orq/ assessment - tools /assessment- ratings/ 2. The REACH Institute offers a listing of mental health screening tools, assessments and tool kits. GLAD -PC Toolkit. T -MAY 3. Screening and assessment resources for co- occurring mental health and substance use disorders. • The SAMHSA -HRSA Center for Integrated Health Solutions (CIHS) promotes the development of integrated primary and behavioral health services to better address the needs of individuals with mental health and substance use conditions and offers a compendium of validated screening and assessment instruments and tools for mental and substance use disorders. http: / /www. integration.samhsa.gov/ clinical - practice /screening -tools • SAMHSA Co- occurring Center for Excellence — Integrated Screening and Assessment http: // media. samhsa. qov /co- occurrinq /topics /screening- and- assessment/index.aspx Guidance /Care Center, Inc. Exhibit AJ Contract No. ME225 -9 -27 Page 5 of 15 • Alcohol & Drug Abuse Institute - University of Washington: Info Brief: Co- Occurring Disorders in Adolescents. Provides an extensive list of resources related to screening, assessment and integrated treatment. http: / /adai.uw.edu /pubs /infobriefs /ADAI -IB- 2011- 01.pdf 4. Casey Life Skills assessment is a free practice tool and framework developed for working with youth in foster care; however, it is beneficial for any young person. It is a self-assessment of independent living skills in eight areas that takes about 30 minutes to complete online and provides instant results. http: / /Iifeskills.casev.orq/ 5. Youth Efficacy /Empowerment Scale and Youth Participation in Planning .Scale - Portland Research and Training Center (Pathways RTC): http: / /www.pathwaysrtc. pdx. edu/ pdf/ pbCmtvBasedApproaches09- 2011.pdf VIII. Treatment Planning Process The treatment planning process serves to identify short-term objectives to build Tong -term stability, resilience, family unity and to promote wellness and illness management. A comprehensive, team -based approach is increasingly seen as the preferred mechanism for creating and monitoring treatment plans and is consistent with the CAT program. There is evidence that outcomes improve when youth and families participate actively in treatment and their involvement is essential at every phase of the treatment process, including assessment, treatment planning, implementation, and monitoring and outcome evaluation. Working as a team, the young person, family, natural supports, and professionals can effectively support individualized, strength- based, and culturally competent treatment. The Network Provider is encouraged to focus on engagement of the young person and their family as a critical first step in the treatment process, as well as the promotion of active participation as equal partners in the treatment planning process. Best Practice Considerations: Treatment Planning for Young People with Behavioral Health Needs 1. Achieve My Plan (AMP) - The AMP study is testing a promising intervention that was developed by researchers at Portland State University, in collaboration with young people who have mental health conditions, service providers and caregivers. Tip sheets for meeting facilitators and young people, the Youth Self- efficacy /Empowerment Scale and Youth Participation in Planning Scale and a video entitled Youth Participation in Planning can be found at: http://www.pathwaysrtc.pdx.edu/proi-3-amp 2. Family and Youth Participation in Clinical Decision Making. American Academy of Child and Adolescent Psychiatry. http: / /www.aacap.orq /aacap /Policv Statements /2009 /Familv and Youth Participation in Clinical Decisio n Makinq.aspx 1 See, http: //www.aacap.oralaacap /Policv Statements /2009 /Family and Youth Participation in Clinical Decision Making.aspx Guidance /Care Center, Inc. Exhibit AJ Contract No. ME225 -9 -27 Page 6of15 IX. Plan of Care 1. Initial Plan of Care Within 30 days of an individual's admission to services, the Network Provider shall complete an Initial Plan of Care to guide the provision of services by the CAT team. Services and supports by the CAT team are established in the Initial Plan of Care, which provides sufficient time to complete the NCFAS -G +R within the first 45 days. Review of the Initial Plan of Care is required to ensure that information gathered during the first 60 days is considered and that a Master Plan of Care is developed to articulate the provision of services and supports longer -term. The Network Provider must document that the Initial Plan of Care was reviewed with the individual being served and his or her parent or guardian and request that they sign the plan at the time of review. At a minimum, the Initial Plan of Care shall: • Be developed with the participation of the individual receiving services and his or her family, including caregivers and guardians; • Specify the CAT services and supports to be provided by CAT Team members, to include a focus on engagement, stabilization, and a safety planning if needed; and • Include a brief initial discharge planning discussion, to include the general goals to be accomplished prior to discharge. 2. Master Plan of Care Within 60 days after admission, the Network Provider shall review the Initial Plan of Care and update it as needed to include the NCFAS -G +R initial assessment and other information gathered since admission. The Network Provider will implement the updated Initial Plan of Care as the Master Plan of Care. The Network Provider may adopt an unrevised Initial Plan of Care if it meets the requirements of the Master Plan of Care and includes the initial NCFAS -G +R assessment. At minimum the Master Plan of Care shall: • Be strength -based and built on the individual's assets and resources; • Be individualized and developmentally appropriate to age and functioning level; • Address needs in various life domains, as appropriate; • Integrate substance abuse and mental health treatment when indicated; • Specify measurable treatment goals and target dates for services and supports; • Specify staff members responsible for completion of each treatment goal; and • Include a discharge plan and identify mechanisms for providing resources and tools for successful transition from services. At minimum, the Network Provider shall review and revise the Master Plan of Care every three months thereafter until discharge, or more frequently as needed to address changes in circumstances impacting treatment and discharge planning. In each review, the Network Provider shall include active participation by the individual receiving services, and his or her family, caregivers, guardians, and other key entities serving the individual as appropriate. Best Practice Considerations: Developing a Plan of Care 1. The Wraparound Approach in Systems of Care http: / /www.orepon.pov /oha/amh /wraparound /dots /wraparound- approach -soc. pdf Guidance /Care Center, Inc. Exhibit AJ Contract No. ME225 -9 -27 Page 7 of 15 2. Achieve My Plan (AMP): Youth participation in planning — provides tools, tip sheets for professionals and youth https://www.pathwaysrtc.pdx.edu/p3c-achieve-mv-plan 3. Journal of Child and Family Studies (May, 2017): Increasing Youth Participation in Team -Based Treatment Planning: The Achieve My Plan Enhancement for Wraparound: https://www. pathwaysrtc. pdx.ed u /pdf /pbJCFS- Walker -AM P- Enhancement- for - Wraparound -05- 20,17. pdf 4. Community-based Approaches for Supporting. Positive Development in Youth and Young Adults: RTC Pathways http: / /www. pathwaysrtc.pdx.edu/ pdf /pbCmtvBasedApproaches09- 2011.pdf X. Services and Supports The mix of services and supports provided should be dictated by individual needs and strengths, serve to strengthen their family, and provide older adolescents with supports and skills necessary in preparation for coping with life as an adult. 2 Services and supports and the manner of service provision should be developmentally appropriate for the individual: For older youth, services and supports may include supported employment and vocation certification, independent living skills training, and peer support services to assist in building social connections and learning new skills. It is important to discuss the roles and responsibilities of the CAT team members with the individual and family to ensure they understand the roles and responsibilities of each. This is especially important to clarify the role of the peer or mentor, as this person may promote social connectedness and assist in the development of a support network of friends outside of the CAT program. The Network Provider is encouraged to offer an array of formal treatment interventions and informal supports provided in the home or other community locations convenient and beneficial to the individual and family. The Network Provider is encouraged to assist the individual and family to develop connections to natural supports within their own network of associates, such as friends and neighbors, through connections with community, service and religious organizations, and participation in clubs and other civic activities. Natural supports ease the transition from formal services and provide ongoing support after discharge. Formal treatment services may include evidenced -based practices .appropriate to the circumstances of the young person and their family. The Network Provider is encouraged to leverage resources and opportunities to implement evidenced -based practices with fidelity, which may include partnering with other CAT teams or organizations in the local system of care. Support services and natural supports are interventions developed on an individualized basis and tailored to address the individual's and family's unique needs, strengths, and preferences. Support services may include but are not limited to Family Support Specialists; participation in recreational activities; youth development and leadership programs;. temporary assistance in meeting and problem solving basic needs that interfere with attaining treatment goals; and , independent living skills training. ?Chapter 394. 491, F.S. - Guiding principles for the child and adolescent mental health treatment and support system. http: //www.leg. state .fl.us /statutes /index.cfm ?App mode = Display Statute &Search String = &URL= 0300-0399 /0394 /Sections /0394.491.html 3 Transition Youth with Serious Mental Illness: http: / /www.apa.org/ about /gr /issues /cyf /transition- youth.odf Guidance /Care Center, Inc. Exhibit AJ Contract No. ME225 -9 -27 Page 8of15 Best Practice Considerations: 1. Pathways Transition Training Collaborative (PTTC): Community of Practice Training: Provides training and • TA. materials for serving youth and young adults — Set of competencies; Transition Service Provider Competency Scale; On -line training modules focused on promoting positive pathways to adulthood. https: / /www. pathwaysrtc. pdx.ed u /pathways- transition - train i nq- collaborative 2. Access to Supports and Services. National Wraparound Initiative: http:// www. nwi. pdx .edu /supportsservices.shtml #1 3. HHS: Office of Adolescent Health: Research, resources and training for providers, fact sheets, grant opportunities: https: / /www.hhs.gov/ ash /oah /adolescent- development/mental- health / mental - health - disorders /index.html 4. RTC Pathways -Youth Peer Support https : / /www.pathwaysrtc.pdx.edu /pdf /prof -5- AMP - what -is- peer- support.pdf XI. Discharge As part of the discharge planning process, CAT teams assist in identification of additional resources that help individuals and families maintain progress made in treatment. Throughout treatment, the Network Provider should focus on successful transition from services. As the individual moves into the discharge phase of treatment, the CAT Team may determine the need to modify the service array or frequency of services to ease transition to less intensive services and supports. The Network. Provider is encouraged to implement a discharge planning process that: 1. Begins at admission; 2. Includes ongoing discussion as part of the Plan of Care review; 3. Includes active involvement of the individual and family; 4. Includes transition to the adult mental health and other systems, as appropriate; and 5. Includes an aftercare plan submitted to and developed in collaboration with the individual and family that leverages available community services and supports. Within seven calendar days of an individual's discharge from services, the Provider shall complete a Discharge Summary containing the following items, at a minimum: 1. The reason for the discharge; 2. A summary of CAT services and . supports provided to the individual; 3. A summary of resource linkages or referrals made to other services or supports on behalf of the individual; and 4. A summary of the individual's progress toward each treatment goal in the Master Plan of Care. XII. Incidental Expenses Pursuant to chapter 65E- 14.021, F.A.C., temporary expenses may be incurred to facilitate continuing treatment and . community stabilization when no other resources are available. Allowable uses of incidental funds include: transportation, childcare, housing assistance, clothing, educational services, vocational services, medical care, housing Guidance /Care Center, Inc. Exhibit AJ Contract No. ME225 -9 -27 Page 9of15 subsidies, pharmaceuticals, and other incidentals that can demonstrate support of individual's treatment plan or other allowable uses. The Network Provider shall follow state purchasing guidelines and any established process for review and approval; however, the Network Provider is encouraged to be creative in using these funds within the limits of what is allowable and to consult the ME regarding allowable purchases. XIII. Third -Party Services Services provided by the core CAT Team staff and funded by CAT contract dollars cannot be billed to any third -party payers. Services provided outside of the core CAT Team staff may be billed to Medicaid or private insurance, to the extent allowable under these programs. If there is an imperative need to provide these services or supports sooner than later, the CAT team should use CAT funds to meet this need, while pursuing third -party billing. If and individual requires interventions outside the scope of a team's expertise, qualifications or licensure (i.e., eating disorder treatment, behavior analysis, psychological testing, substance abuse treatment, etc.), the team may refer to a qualified service provider. The CAT team shall work in concert with any referral providers, the individual and the family to integrate referral services into overall treatment and to monitor progress toward treatment goals In accordance with chapter 65D- 30.003, F.A.C., all substance abuse services, as defined in subsection 65D- 30.002(16), F.A.C., must be provided by persons or entities that are licensed by the department pursuant to Section 397.401, F.S., unless otherwise exempt from licensing under Section 397.405, F.S., prior to initiating the provision of services. XIV. Performance Measures The Network Provider shall meet the following performance measures: 1. School Attendance Individuals receiving services shall attend an average of 80% percent of school days, according to the following methodology: b. Calculate the percentage of available school days attended by all individuals served during the reporting period. • Include all individuals served age 15 and younger. • Include only those individuals age 16 and older who are actually enrolled in a school or vocational program. • For individuals in alternative school settings, such as virtual and home school, school attendance may be estimated based on specific requirements applicable to the setting: Examples include the percentage of work completed within a specified time- period; adherence to a schedule as reported by the parent, caregiver or legal guardian or documentation of a reporting mechanism. • Do not include individuals for whom school attendance in an alternative education setting cannot be determined. c. The numerator is the sum of the total number of school days attended for all individuals. d. The denominator is the sum of the total number of school days available for all individuals. 2. Children's Functional Assessment Rating Scales (CFARS) and Functional Assessment Rating Scale (FARS) Guidance /Care Center, Inc. Exhibit AJ Contract No. ME225 -9 -27 Page 10of15 Effective once the Network Provider discharges a minimum of 10 individuals each fiscal year, 80% of individuals receiving services shall improve their level of functioning between admission to discharge, as determined by: a. The Children's Functional Assessment Rating Scales (CFARS) if the individual is under 18 years of age; or b. The Functional Assessment Rating Scale (FARS), if the individual is 18 years of age or older. • Measure improvement is based on the change between the admission and discharge assessment scores completed using the CFARS or FARS, as determined by the age of the individual. c. The numerator is the total number of individuals whose discharge score is less than their admission assessment score. Scores are calculated by summing the score for all questions for each person discharged during the current fiscal year -to -date. A decrease in score from the admission score to the discharge score indicates that the level of functioning has improved. d. The denominator is the total number of individuals discharged with an admission and discharge assessment during the current fiscal year -to -date. 3. • Living in a Community Setting Individuals served will spend a minimum of 90% of days living in acommunity setting: a. The numerator is the sum of all days in which all individuals receiving services qualify as living in a community setting. • "Living in a community setting" excludes any days spent in jail, detention, a crisis stabilization unit, homeless, a short -term residential treatment program, a psychiatric inpatient facility or any other state mental health treatment facility. • Individuals living in foster homes and group homes are considered living in a community setting. • For children under 18 years of age, days spent on runaway status, in a residential level one treatment facility, or in a wilderness camp are not considered living in a community setting. b. The denominator is the sum of all days in the reporting period during which all individuals were enrolled for services. 4. North Carolina Family Assessment Scale for General Services and Reunification (NCFAS -G +R) Effective once the Network Provider discharges a minimum of 10 individuals each fiscal year, 65% of individuals and families receiving services shall demonstrate improved family functioning as demonstrated by an improvement in the Child Well -Being domain between admission and discharge, as determined by the North Carolina Family Assessment Rating Scale for General Services and Reunification (NCFAS- G +R), if the individual is under eighteen (18). The NCFAS -G +R is not required for individuals ages 18 or older. a. Calculate the percentage of individuals who increased their family functioning in the Child Well -Being Domain by at least one point from admission to discharge, as measured by the NCFAS -G +R. b. The numerator is the number of individuals whose score on the Child Well -Being domain at discharge is at least one point higher than their score on the Child Well -Being domain at admission during the current fiscal year -to -date. c. The denominator is the total number of individuals receiving services who were discharged during the current fiscal year -to -date and for whom the NCFAS -G +R was used at admission. Guidance /Care Center, Inc. Exhibit AJ Contract No. ME225 -9 -27 Page 11 of 15 Note: If an admission NCFAS assessment has been completed on a child and parent/caregiver and the child moves to a different home with a different caregiver; a NCFAS discharge assessment should be completed at that time to ensure the same parent/caregiver is assessed at admission and discharge. Additional consideration should be given to the following: • If CAT services are continued in the new placement with the new parent/caregiver, an admission and discharge NCFAS assessment should be completed for the new parent/caregiver. • If a child changes placements multiple times, the provider and ME should discuss how to report on the NCFAS performance measure for that child, keeping in mind that the NCFAS measures family functioning in the context of services received, so we need to know who received services to determine the level of improvement in functioning. XV. Additional Performance Measures In addition to Appendix 1, PERSONS SERVED AND PERFORMANCE MEASURE REPORT, and Appendix 2, QUARTERLY SUPPLEMENTAL DATA REPORT, the Network Provider shall submit quarterly performance measures and a final end of fiscal year report, as indicated in the Exhibit C, Required Reports, of the following: > Conduct at least 2 random fidelity checks for each EBP quarterly. > Conduct at least 2 focus groups with clients and /or staff annually. > 85% of the discharge SIPA, PSI -4, and.NCFAS +R within 14 days from discharge. • 90% of the data into the EHR and evaluation databases within 7 days of data collection entered. > Conduct 6 MI training sessions annually. > Provide Biannual Reports within 30 days of the end of the biannual period (January and July) that includes data on Client Satisfaction, Fidelity, Chart Reviews, and Performance Measures. Guidance /Care Center, Inc. Exhibit AJ _Contract No. ME225 -9 -27 Page 12 of 15 APPENDIX 1 PERSONS SERVED AND PERFORMANCE MEASURE REPORT CAT PROGRAM Provider Name Contract Number ; 1 Reporting Period From 1 I To Reporting Requirement Target This Period This Quarter to Year to Date Date DELIVERABLE Number of Persons Served Section D -2 Min _ per Pt Month = 10 month 2 nd Month =20 ' 3 Month = 25 Thereafter = 35 i 49. f 5 MINIMUM PERFORMANCE MEASURES — Section XV = i C7 ' r E •O E l C' d E C W E c e i E c e i E i ml C j 81 z c' 81 Z; c a School Attendance 80% FFPF Improved Level of Functioning, based upon 80% CFARS or FARS Living in a Community Setting 90% FPI PPP _ _ Improved Family Functioning, based on Child 65% Well -being Domain, NCFAS -G +R Notes: 1. Performance measures for CFARS /FARS and NCFAS will become effective once the Provider discharges a minimum of 10 individuals. 2. Providers may use the space below to provide performance- related details affecting the delivery of services according to the specified targets. (Optional) ATTESTATION I hereby attest the information provided herein is accurate, reflects services provided in accordance with the terms and conditions of this contract, and is supported by client documentation records maintained by this agency. _ - - Authorized Name and Title (please print) • Signature Date Exhibit AJ Page 13 of 15 Inserted 9/10/2018 APPENDIX 2 QUARTERLY SUPPLEMENTAL DATA REPORT CAT PROGRAM Provider Name Contract # .... Reporting From To Period Indiv duals D ueited from, Out of Home Placement r .. At admission, number of participants at . i . At admission, n _ sk of out - home placement due foe -` number of • Total { Total Dischar 9 P e tions i Residential artici ants not This I 1 involvement Child . Juvenile P P , mental : r - Year to Date Welfare justice - at risk of out of - Quarter health . m e commitment home. �. �i treatment ff Number of discharges removed from the home due 'to child welfare involvement :Number of discharges - admitted to a residential mental health treatment center.' - ,Number of discharges committed to juvenile justice placement.- Number of discharges living in 'the community �. Totals 1 1 I I Use the space below to provide any discussion of details affecting the delivery of services and supplemental data. (Optional) Gainful- Activity fore;Indiyid`ualiNof'Enrolletl m;Schabri a i ational Progiam Required Reporting Total : i - q p g � -�- � This'Quarter .:Total Year to.Date. Number of individuals served during the reporting period age 16 and older not included in the school attendance measure. Numberofthese individuals that engaged in at least one, gainful activity during the reporting period. Use the space below to provide example's of the gainful activities these individuals engaged in during the reporting period. ATTESTATION I hereby attest the information provided herein is accurate, reflects services provided in accordance with the terms and conditions of , this_contract, and is supported by client documentation records maintained by this agency. Authorized Name and Title (please print Signature Date Guidance /Care Center, Inc. Exhibit AJ Contract No. ME225 -9 -27 Page 14 of .15 Appendix 2 Guidance The following guidelines shall be used by CAT Network Service Providers and Managing Entities when reporting the required quarterly data using Appendix 2. 1. Discharge placements for individuals identified at admission as at risk of out of home placement A primary CAT program goal is diverting these individuals from placement within the juvenile justice, corrections, residential mental health treatment or child welfare systems, and enabling them to live effectively in the community. The considerations below are non - exhaustive guidelines by which CAT Network Service Providers can determine if an individual is at high risk of out of home placement at the time of admission. a. Residential Mental Health Treatment, including therapeutic group homes • Has a recommendation from a psychologist/psychiatrist for placement in residential mental health treatment center? • Has a recommendation from a Qualified Evaluator for placement in residential treatment (child welfare)? • Has previously been placed in residential treatment? • Is the parent/legal guardian is requesting placement in a residential mental health treatment center? b. Department of Juvenile Justice (DJJ) Placement • Are there current DJJ charges or is there a long history of charges? • Was there previous DJJ commitment placement? • Does a child aged 12 and under have current or previous DJJ charges? c. Child Welfare Out of Home Placement • Is there an open Child Welfare case or investigation? • Were there previous child welfare cases, investigations or services? • Were there any previous out -of -home Child Welfare placements? 2. Gainful Activity for Individuals Not Enrolled in School or Vocational Program Participation in gainful activities by individuals aged sixteen and older who are not enrolled in school or vocational programs is an indicators of program success in fostering self- sufficiency. These activities should focus on employment, continued education, vocation training and certification, work readiness, career planning, and skill development related to obtaining and keeping a job. These activities are opportunities for a therapeutic mentor to assist individuals in identifying personal goals and developing plans. Examples of enrichment activities include, but are not limited to, employment and supported employment; internships and apprenticeships; linkage to and services from entities such as Vocational Rehabilitation; and activities that support career planning, occupational research and assessment. Guidance /Care Center, Inc. Exhibit AJ Contract No. ME225 -9 -27. Page 15of15 Exhibit AJ -1 CAT Monthly Invoice CAT MONTHLY INVOICE PROVIDER NAME ( Guidance /Care Center, Inc. CONTRACT NO j ME225 =9.27 VENDOR ID - FEDERAL ID # _ _ _(if different from Federal ID #j_ ADDRESS INVOICE NUMER INVOICE PERIOD TOTAL AMOUNT OF INVOICE AMOUNT - Y PREVIOUS PAYMENTS TOTAL CONTRACT AMOUNT I CONTRACT BALANCE AFTER THIS PAYMENT Service Unit Description One month of CAT services provided to a minimum of 35 eligible � _ i nd i v i duals in accordance with Appendix 1 and Append ix 2 Fixed Fee Amount Requested _ I In accordance with Exhibit AJ, CAT Team, Section 1. Network Supporting. Documentation Submitted 1 Provider Responsibilities, Paragraphs 6. -10. for the month of CERTIFICATION & APPROVAL I certify the above to be accurate and in agreement with this agency's records and with the terms of this agency's contract with the Department. Additionally, I certify that all client demographic and service event data have been submitted to the Department in accordance with the terms and conditions of this contract. Authorized SiSignature _____ � ; Authorized Name and Title_(Print) __ Date Submitted - _ i I For DCFContract Manager use only: Date Invoice Received: Date Goods /Services Received: _Date Inspected and Approved: _ _ _ Description ! l Financial Consequences Applied? :1 Reduction Amount Yes No Approved Payment Amount Approved By: BE: Payment Funding Codes: E0: CAT: OCA: Exhibit AJ -1 Inserted 9/10/2018 Page 1 oft Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. Exhibit AM Return on Investment — Special Project Return on Investments for FY 2018 -19 I. Pursuant to the FY 2018 -19 General Appropriations Act, has been awarded funding to provide the following services: Provider: Guidance /Care Center, Inc. a. Specific Appropriation Line Item # 369 — Family Intensive Treatment Funding Amount: $633,188.00 Designated as follows: Miami -Dade County: $483,871.00 Monroe County: $149,317.00 From the funds in Specific Appropriation 369, General Revenue to implement the Family Intensive Treatment (FIT) team model that is designed to provide intensive team- based, family- focused, comprehensive services to families in the child welfare system with parental substance abuse. These subcontracts shall be executed and managed in accordance with Guidance 18 — Family Intensive Treatment (FIT) Model Guidelines and Requirements. Treatment shall be available and provided in accordance with the indicated level of care required and providers shall meet program specifications. Funds shall be targeted to select communities with high rates of child abuse cases. b. Specific Appropriation Line Item # 363 — Community Action Treatment (CAT) Team Amount $750,000.00 From the funds in Specific Appropriation 363, General Revenue to implement the Community Action Treatment (CAT) Team that provide community -based services to children ages 11 to 21 with a mental health or co- occurring substance abuse diagnosis with any accompanying characteristics such as being at-risk for out -of -home placement as demonstrated by repeated failures at less intensive levels of care; having two or more hospitalizations or repeated failures; involvement with the Department of Juvenile Justice or multiple episodes involving law enforcement; or poor academic performance or suspensions. Children younger than 11 may be candidates if they display two or more of the aforementioned characteristics." II. The Network Provider shall: 1. By July 10, 2018, provides an initial projected estimate of positive return on investment the state may receive by providing the funding for the project listed in Section I.a., 2. By October 10, 2018, provides an initial projected estimate of positive return on investment the state may receive by providing the funding for the project listed in Section I.b., and Revised Exhibit AM Page 1 of 2 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 South Florida Behavioral Health Network, Inc. 3. 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 projects. 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. Revised Exhibit AM. Page2of2 Guidance /Care Center, Inc. Contract No. ME225 -9 -27 � ?' South Florida / Behavioral Health Network, Inc. rev. 07/19/2018 CFDA No (s). See Post Award Notice Client Services ® Non - Client Services ❑ CSFA No (s). See Post Award Notice Subrecipient ® Vendor ❑ Federal Funds ® State Funds ❑ STANDARD CONTRACT THIS CONTRACT is entered into between the South Florida Behavioral Health Network, Inc., (SFBHN) hereinafter referred to as the "Managing Entity" (ME) and Guidance /Care Center, Inc., hereinafter referred to as the "Network Provider." 1. Contract Document The Network provider shall provide services in accordance with the terms and conditions specified in this contract including all attachments and exhibits, and documents incorporated by reference which constitute the contract document. 2. Requirements of Section 287.058, Florida Statutes (F.S.) The Network Provider shall provide units of deliverables, including reports, findings, and drafts, as specified in this contract. These deliverables must be received and accepted by the ME contract manager and /or designee, in writing prior to payment. The Network Provider shall submit bills for fees or other compensation for services or expenses in sufficient detail for proper pre -audit and post- audit; where itemized payment for travel expenses are permitted in this contract, submit bills for any travel expenses in accordance with section 112.061, F.S., or at such lower rates as may be provided in this contract. To allow public access to all documents, papers, letters, or other public records as defined in subsection 119.011(12), F.S. and as prescribed by subsection 119.07(1) F.S., made or received by the Network Provider in conj unction 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 s ubsequent 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 51., of this Standard Contract. 4. Effective and Ending Dates This contract shall begin on July 1, 2018. It shall end at midnight, local time in Miami -Dade County, Florida on June 30, 2021, subject to the survival of terms of Section 49. 5. State of Florida Law This contract is executed and entered into in the State of Florida, and shall be construed, performed and enforced in all respects in accordance with Florida law, without regard to Florida provisions for conflict of laws. Courts of competent jurisdiction in Florida shal I have exclusive jurisdiction in any action regarding this contract and venue shall be the appropriate State court in Miami -Dade County, Florida. 6. Federal Law If this contract contains federal funds and it is determined by the ME that the Network Provider is a subrecipient, the Network Provider must adhere to the terms below: a. The Network Provider shall comply with the provisions of Federal law and regulations including, but not limited to, 2 CFR, Part 200, and other applicable regulations. b. If this Contract contains $10,000 or more of Federal Funds, the Network Provider shall comply with Executive Order 11246, Equal Employment Opportunity, as amended by Executive Order 11375 and others, and as supplemented in Department of Labor regulation 41 CFR, Part 60 if applicable. c. If this Contract contains over $150,000 of Federal Funds, the Network Provider shall comply with all applicable standards, orders, or regulations issued under section 306 of the Clean Air Act, as amended (42 U.S.C. § 7401 et seq.), section 508 of the Federal Water Pollution Control Act, as amended (33 U.S.C. § 1251 et seq.), Executive Order 11738, as amended and where applicable, and Environmental Protection Agency regulations (2 CFR, Part 1500). The Network Provider shall report any violations of the above to the ME and the Department. d. No Federal Funds received in connection with this Contract may be used by the Network Provider, or agent acting for the Network Provider, or subcontractor to influence legislation or appropriations pending before the Congress or any State legislature. If this Contract contains Federal funding in excess of $100,000, the Network Provider must, prior to contract execution, complete the Certification Regarding Lobbying form, Attachment 111. All disclosure forms as required by the Certification Regarding Lobbying from must be completed and returned to the ME Standard Contract Guidance /Care Center, Inc. Page 1 of 13 Contract No. P -4 FF� •South Florida f � Behavioral . Health Network, Inc. rev. 07/19/2018 Contract Manager, prior to payment under this Contract. e. If this Contract provides services to children up to age 18, the Network Provider shall comply with the Pro - Children Act of 1994 (20 U.S.C. § 6081). Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1, 000 for each violation or the imposition of an administrative compliance order on the responsible entity, or both. f. If the Network Provider is a federal subrecipient or pass through entity, the Network Provider and its subcontractors who are federal subrecipients or pass- through entities are subject to the following: A contract award (see 2 CFR § 180.220) must not be made to parties listed on the government -wide exclusions in the System for Award Management (SAM), in accordance with the OMB guidelines in 2 CFR, Part 180 that implement Executive Orders 12549 and 12689, "Debarment and Suspension." SAM Exclusions contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. 7. Audits, Inspections, Investigations, Records and Retention a. The Network Provider shall establish and maintain books, records and documents (including electronic storage media) suffic ient to reflect all income and expenditures of funds (to include funds used to meet the local match requirements per 65 -E -14 F.A.C., if applicable, provided by the ME under this contract. The Network provider shall establish and maintain books, records and documents (including electronic storage media) sufficient to reflect that the Department is the payer of last resort for substance abuse and mental health services. b. Retention of all client records, financial records, supporting documents, statistical records, and any other documents (including electronic storage media) pertinent to this contract shall be maintained by the Network Provider for a period of seven (7) years after completion of the contract or longer when required by law. In the event an audit is required by this contract, records shall be retained for a minimum period of seven (7) years after the audit report is issued or until resolution of any audit findings or litigation based on the terms of th is contract, at no additional cost to the ME. c. Upon demand, at no additional cost to the ME, the Network Provider will facilitate the duplication and transfer of any records or documents during the required retention period in Section 7.b. d. These records shall be made available at all reasonable times for inspection, review, copying, or audit by Federal, State, or other personnel duly authorized by the ME. e. At all reasonable times for as long as records are maintained, persons duly authorized by the ME, State, and Federal auditors, pursuant to 45 CFR, section 92.36(i)(10), shall be allowed full access to and the right to examine any of the Network Provider's contracts and related records and documents, regardless of the form in which kept. f. A financial and compliance audit shall be provided to the ME as specified in this contract and in Attachment II, Financial and Compliance Audit. 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 i n all subcontracts and assignments. 8. Inspections and Corrective Action The Network Provider shall permit all persons who are duly authorized by the ME and the Department to inspect and copy any records, papers, documents, facilities, goods and services of the Network Provider which are relevant to this contract, the scope of review being conducted, and to interview any clients, employees and subcontractor employees of the Network Provider to assure the ME of the satisfactory performance of the terms and conditions of this contract. Following such review, the ME will deliver to the Network Provider a written report of its findings, and may direct the development, by the Network Provider, of a corrective action plan where appropriate. The Network Provider hereby agrees to timely correct all deficiencies identified in the corrective action plan. This provision will not limit the ME's termination rights un der 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 Standard Contract Guidance /Care Center, Inc. Page 2 of 13 Contract No. P -4 ;,/ South Florida Behavioral Health Network, Inc. rev. 07/19/2018 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 m anner 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 i s likely to become the subject of such a suit, the Network Provider may at its sole expense procure for the ME the right to continue using the product or modify it to become non - infringing. If the Network Provider is not reasonably able to modify or otherwise secure the ME the use, the ME shall not be liable for any royalties. The Network Provider's indemnification for violation or infringement of a trademark, copyright, patent, trade secret or intellectual property right shall encompass all such items used or accessed by the Network Provider, its officers, agents or subcontractors in the performance of this contract or delivered to the ME for the use of the ME, its employees, agents or contractors. c. The Network Provider shall protect, defend, and indemnify, including attorney's fees and cost, the ME for any and all clai ms and litigation (including litigation initiated by the ME) arising from or relating to Network Provider's claim that a document contains proprietary or tra de secret information that is exempt from disclosure or the scope of the Network Provider's redaction, as provided for under Section 32. d. The ME shall not be liable for any cost, expense, or compromise incurred or made by the Network Provider in any legal action. The Network Provider's inability to evaluate liability or its evaluation of liability shall not excuse its duty to defend and indemnify after receipt of notice. Only an adjudication or judgment after the highest appeal is exhausted finding the ME negligent shall excuse the Network Provider of performance under this provision, in which case the ME shall have no obligation to reimburse the Network Provider for costs of its defense. If the Network Provider is an agency or subdivision of the State, its obligation to indemnify, defend and hold harmless the ME shall be to the extent permitted by section 768.28, F.S. or other applicable law, and without waiving the limits of sovereign immunity. 10. Insurance a. Continuous adequate liability insurance coverage shall be maintained by the Network Provider during the existence of this contract and any renewal(s) and extension(s) thereof and in accordance with the requirements in Attachment I. By execution of this contract, unless it is a State agency or subdivision as defined by subsection 768.28(2), F.S., the Network Provider accepts full responsibility for identify ing 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 N etwork 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 th e 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, judgments, fees, expenses, awards, civil monetary penalties, and costs (including reasonable attorneys' and court fees and expenses) arising out of or related to any Breach or alleged Breach of Unsecured PHI created, received, maintained, transmitted, or otherwise used by the Network Provider and arising from the Network Provider's breach, or failure to perform pursuant to this Contract (collectively, a "Claim ") up to and including the Appellate Court level and until the case is resolved.. If the Network Provider is an agency or subdivision of the State, its obligation to indemnify, defend and hold harmless the ME shall be to the extent permitted by section 768.28, F.S. or other applicable law, and without waving the limits of sovereign immunity. 11. Confidential Client and Other Information Except as provided by this Contract, the Network Provider shall not disclose but shall protect and maintain the confidentiality of any client information and any other information made confidential by Florida Laws or regulations that is obtained or accessed by the Network Provider or its subcontractors incidental to performance under this contract. State laws providing for confidentiality of client and other information include but are not limited to sections 39.0132, 39.00145, 39.202, 39.809, 39.908, 63.162,. 63.165, 383.412, 394.4615, 397.501, 409.821, 409.175, 410.037, 410.605, 414.295, 415.107, 741.3165 and 916.107, F.S. Federal laws and regulations to the same effect include section 471(a)(8) of the Social Security Act, section 106(b)(2)(A)(viii) of the Child Abuse Prevention and Treatment Act, 7 U.S.C. § 2020(e)(8), 42 U.S.C. § 602 and 2 CFR § 200.303 and 2 CFR § 200.337, 7 CFR § 272.1(c), 42 CFR §§ 2.1 -2.3, 42 CFR §§ 431.300 -306, 45 CFR § 205. A summary of Florida Statutes providing for confidentiality of this and other information are found in Part 11 of the Attorney General's Government in the Sunshine Manual, as revised from time -to -time. b. The Network Provider shall not use or disclose any information concerning a recipient of services under this contract for any purpose Standard Contract Guidance /Care Center, Inc. Page 3 of 13 Contract No. P -4 de� South Florida �/ Behavioral Health Network, Inc. rev. 07/19/2018 prohibited by State or federal law or regulations except with the written consent of a person legally authorized to give that consent or when authorized by law. 12. Assignments and Subcontracts a. The Network Provider shall not assign the responsibility for this contract to another party without prior written approval of the ME, upon the ME's sole determination that such assignment will not adversely affect the public interest; however, in no event may the Network Provider assign or enter into any transaction having the effect of assigning or transferring any right to receive payment under this contract which right is not conditioned on full and faithful performance of Network Provider's duties hereunder. Any sublicense, assignment, or transfer otherwise occurring without prior approval of the ME shall be null and void. The Network Provider shall not subcontract for any of the work contemplated under this contract without prior written approval of the ME, which shall not be unreasonably withheld. b. The Network Provider shall ensure that all subcontract agreements, at any tier, for work contemplated under this contract, adhere to all of the requirements of the ME's Prime Contract with the department and all the requirements of this contract. A copy of the Prime Contract can be found at the ME's website. www.sfbhn.org. c. To the extent permitted by Florida Law, and in compliance with Section 9. of this Standard Contract, the Network Provider is responsible for all work performed and for all commodities produced pursuant to this contract whether actually furnished by the Network Provider or its subcontractors. Any subcontracts shall be evidenced by a written document. The Network Provider further agrees that the ME shall not be liable to the subcontractor in any way or for any reason. The Network Provider, at its expense, will defend the ME against such claims. d. The Network Provider shall make payments to any subcontractor within seven (7) working days after receipt of full or partial payments from the ME in accordance with section 287.0585, F.S., unless otherwise Stated in the contract between the Network Provider and subcontractor. Failure to pay within seven (7) working days will result in a penalty that shall be charged against the Network Provider and paid by the Network Provider to the subcontractor in the amount of one -half of one percent (.005) of the amount due per day from the expiration of the period allowed for payment. Such penalty shall be in addition to actual payments owed and shall not exceed fifteen (15 %) percent of the outstanding balance due. e. The State of Florida shall at all times be entitled to assign or transfer, in whole or part, its rights, duties, or obligations under i is 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 success ors 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 claus es 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. Should repayment not be made promptly 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. Payments made for services subsequently determ ined by the ME to not be in full compliance with contract requirements shall be deemed overpayments. The ME shall have the right at any time to offset or deduct from any payment due under this or any other contract or agreement any amount due to the ME fro m the Network Provider under this or any other contract or agreement. If this contract involves federal or state financial assistance, the following applies: The Grantee shall return to the ME any unused funds; any accrued interest earned; and any unmatched grant funds, as detailed in the Final Financial Report, no later than 60 days following the ending date of this Contract. b. The funds paid to the Network Provider are continually subject to Review, Revision and Adjustment after evaluation of Utiliza tion and 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 accordan ce with the client risk prevention system, report those reportable situations listed in CFOP 215 -6 in the manner prescribed in CFOP 215 -6 or circuit or region operating procedures. The Network Provider shall immediately report any knowledge or reasonable suspicion of abuse, neglect, or exploitation of a child, aged person, or disabled adult to the Florida Abuse Hotline on the Statewide toll -free telephone number (1- 800- 96ABUSE). As required by Chapters 39 and 415, F.S., this provision is binding upon both the Network Provider and its employees. b. The ME monitors timely submissions of incident reports and may impose financial penalties as described in Section 39. Financial Penalties for Failure to Comply with Requirement for Corrective Action of this Standard Contract, paragraphs b., c., and d. Standard Contract Guidance /Care Center, Inc. Page 4 of 13 Contract No. P-4 � South Florida // Behavioral Health Network, Inc. rev. 07/19/2018 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 shall 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 app licable and CFOP 60 -16. These requirements shall apply to all contractors, subcontractors, sub - grantees or others with whom it arranges to provide services or benefits to clients or employees in connection with its programs and activities. The Network Provider shall complete the Civil Rights Certificate, CF Form 707 and the Civil Rights Compliance Checklist, CF Form 946 in accordance with CFOP 60 -16 and 45 CFR 80. 16. Independent Capacity of the Contractor a. In performing its obligations under this contract, the Network Provider shall at all times be acting in the capacity of an independent contractor and not as an officer, employee, or agent of the ME or the State of Florida, except where the Network Provider is a State agency. Network Provider nor its agents, employees, subcontractors or assignees shall represent to others that it has the authority to bind the ME or the Department unless specifically authorized in writing to do so. This contract does not create any right to State retirement, leave benefits or any other benefits of State employees as a result of performing the duties or obligations of this contract. b. The Network Provider shall take such actions as may be necessary to ensure that each subcontractor of the Network Provider will be deemed to be an independent contractor and will not be considered or permitted to be an agent, servant, joint venture, 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 co ntract. c. All deductions for social security, withholding taxes, income taxes, contributions to unemployment compensation funds and all necessary insurance for the Network Provider, the Network Provider's officers, employees, agents, subcontractors, or assignees shall be the sole responsibility of the Network Provider. 17. Sponsorship As required by section 286.25, F.S., if the Network Provider is a non - governmental organization which sponsors a program financed wholly or in part by State funds, including any funds obtained through this Contract, it shall, in publicizing, advertising, or describing the sponsorship of the program State: "Sponsored by (Network Provider's Name), Inc., South Florida Behavioral Health Network, and the State of Florida, Department of Children and Families ". If the sponsorship reference is in written material, the words "South Florida Behavioral Health Network " and "State of Florida, Department of Children and Families" shall appear in at least the same size letters or type as the name of the organization. 18. Publicity Without limitation, the Network Provider and its employees, agents, and representatives will not, without the ME's prior written consent in each instance, use in advertising, publicity or any other promotional endeavor any ME or State mark, the name of the ME's or State mark, the name of the ME, the State, or any ME or State affiliate or any officer or employee of the ME or the State , or represent, directly or indirectly, that any product or service provided by the Network Provider has been approved or endorsed by the ME, or refer to the existence of this Contract in press releases, advertising or materials distributed to the Network Provider's prospective customers. 19. Final Invoice The final invoice for payment shall be submitted to the ME no more than twenty (20) days, per the requirements stipulated in the Method of Payment section of this Contract, after the contract ends or is terminated. If the Network Provider fails to do so, all rights to payment are forfeited and the ME will not honor any requests submitted after the aforesaid time period. Any payment due under the terms of this contract may be withheld until all reports due from the Network Provider and necessary adjustments thereto, have been approved by the ME. 20. Use of Funds for Lobbying Prohibited The Network Provider shall comply with the provisions of sections 11.062 and 216.347, F.S., which prohibit the expenditure of contract funds for the purpose of lobbying the Legislature, judicial branch, or a State agency. 21. Public Entity Crime Pursuant to section 287.133, F.S., the following restrictions are placed on the ability of persons on the convicted vendor list or the discriminatory vendor list. When a person or affiliate has been placed on the convicted vendor list following a conviction for a public entity crime, or an entity or affiliate has been placed on the discriminatory vendor list, such person, entity or affiliate may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or the repair of a public building or public work; may not submit bids, proposals, or replies on lea ses 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; Standard Contract Guidance /Care Center, Inc. Page 5 of 13 Contract No. P -4 South Florida / Behavioral Health Network, Inc. rev. 07/19/2018 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 or Department employee. As part of the consideration for this contract, the parties intend that this provision will survive the contract for a period of two years. In addition to any other remedies available to the ME and the Department, any violation of this provision will result in referral of the Network Provider's name and description of the violation of this term to the Department of Management Services for the potential inclusion of the Network Provider's name on the suspended vendors list for an appropriate period. The Network Provider will ensure that its subcontractors, if any, comply with these p rovisions. 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 Department, fully compensated for by the contract amount, and that neither the Network Provider nor any of its officers, agents nor subcontractors may claim a ny interest in any intellectual property rights accruing under or in connection with the performance of this contract. It is specifically agreed that the Department shall have exclusive rights to all data processing software falling within the terms of section 119.084, F.S., which arises or is developed in the course of or as a result of work or services performed under this contract, or in any way connected herewith. Notwithstanding the foregoing provision, if the Network Provider is a university and a member of the State University System of Florida, then section 1004.23, F.S., shall apply. b. If the Network Provider uses or delivers to the Department for its use or the use of its employees, agents or contractors, any design, device, or materials covered by letters, patent, or copyright, it is mutually agreed and understood without exception that the compensation paid pursuant to this contract includes all royalties or costs arising from the use of such design, device, or materials in any way involved in the work contemplated by this contract. For the purposes of this provision, the term "use" shall include use by the Network Provider during the term of this contract and use by the ME, agents, or contractors and the Department during the term of this contra ct and perpetually thereafter. c. All applicable subcontracts shall include a provision that the Federal awarding agency reserves all patent rights with res pect to any discovery or invention that arises or is developed in the course of or under the subcontract. Notwithstanding the foregoing provision, if the Network Provider or one of its subcontractors is a university and a member of the State University of Florida, then section 1004.23, F.S., shall apply, but the Department shall retain a perpetual, fully -paid, non - exclusive license for its use and the use of its contractors of any resulting patented, copyrighted or trademarked work products. 24. Real Property Any State funds provided for the purchase of or improvements to real property are contingent upon the Network Provider granting to the State a security interest in the property at least to the amount of the State funds provided for at least five (5) years from the date of purchase or the completion of the improvements or as further required by law. As a condition of receipt of State funding for this purpose, the Network Provider agrees that, if it disposes of the property before the Department's interest is vacated, the Network Provider will refund the proportionate share of the State's initial investment, as adjusted by depreciation. 25. Information Security Obligations a. An appropriately skilled individual shall be identified by the Network Provider to function as its Data Security Officer. The Data Security Officer shall act as the liaison to the ME's security staff and will maintain an appropriate level of data security for the information the Network Provider is collecting or using in the performance of this contract. An appropriate level of security includes approving and tracking all Network Provider employees that request or have access to any ME or DCF data system or information. b. The Data Security Officer will ensure that user access to the data system or information has been removed from all terminated Network Provider employees immediately upon termination of employment. c. The Network Provider shall provide the latest DCF HIPAA and Security Awareness Training to its staff and subcontractors who have access to ME and DCF data system, information and /or who have access to Protected Health Information regardless of format (e.g. electronic, written, audio, video or still image recording) or function. Security and HIPAA requirements extend to non - clinical or non - administrative personnel if such persons can access Protected Health Information. The Network Provider shall ensure that proof of training is maintained in each employee file. d. All Network Provider employees who have access to ME or DCF data system or information, including but not limited to access to KIS, or any data system designated by the ME, Substance Abuse and Mental Health Information System (SAMHIS), Incident Reporting and Analysis System (IRAS), Temporary Assistance for Needy Family (TANF), shall comply with, and be provided a copy of CFOP 50 -2, and shall sign the DCF Security Agreement form CF 0114 annually or immediately upon hire and annually thereafter. The Network Provider shall maintain a copy of Standard Contract Guidance /Care Center, Inc. Page 6 of 13 Contract No. P-4 South Florida ' Behavioral Health Network, Inc. rev. 07/19/2018 the signed DCF Security Agreement form CF 0114 in the personnel file. The Network Provider agrees to submit copies of each signed DCF Security Agreement form CF 0114 to the ME's Contract Manager and the ME's Director of Information Technology upon request. A copy of CF 0114 may be obtained from the contract manager. e. The Network Provider shall make every effort to protect and avoid unauthorized release of any personal or confidential information by ensuring both data and storage devices are encrypted as prescribed in CFOP 50 -2. If encryption of these devices is not possible, then the Network Provider shall assure that unencrypted personal and confidential ME or DCF data will not be stored on unencrypted sto rage devices. The Network Provider shall require the same of all subcontractors. f. The Network Provider agrees to notify the contract manager as soon as possible, but no later than four (4) business days following the determination of any breach or potential breach of personal and confidential ME or DCF data. The Network Provider shall require the same notification requirements of all subcontractors. g. The Network Provider shall provide notice to affected parties no later than thirty (30) days following the determination of any potential breach of personal or confidential ME or DCF data provided in section 501.171(4), F.S. The Network Provider shall require the same notification requirements of all subcontractors. The Network Provider shall also at its own cost implement measures deemed appropriate by the ME to avoid or mitigate potential injury to any person due to a breach of personal and confidential ME and /or DCF data. 26. Accreditation The ME is committed to ensuring provision of the highest quality services to the persons we serve. Accordingly, the ME has expectations that where accreditation is generally accepted nationwide as a clear indicator of quality service, the majority of the ME's Network Providers will take appropriate steps to maintain its accreditation or become fully accredited by June 30, 2019. 27. DEO and Workforce Florida a. The Network Provider understands the DCF, the Department of Economic Opportunity, and Worksource Florida, Inc., have jointly implemented an initiative to empower recipients in the Temporary Assistance to Needy Families Program to enter and remain in gainful employment. The ME encourages Network Provider participation with the Department of Economic Opportunity and Workforce Florida, Inc. b. Transitioning Young Adults: The Network Provider understands DCF's interest in assisting 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 In compliance with 45 CFR § 164.504 (e) , the Network Provider shall comply with the provisions of the Business Associate Agreement, incorporated herein by reference, governing the safeguarding, use and disclosure of Protected Health Information created, received, maintained, or transmitted by the Network Provider or its subcontracts incidental to the Network Provider's performance of this Contract. 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 ca pabilities and time allowances supplies, and a recovery plan that will allow the Network Provider to continue functioning in compliance with the executed contract in the event of an actual emergency. For the purpose of disaster planning, the term supervision includes the responsibility of the M E, 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 a cceptance 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, rel ated 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 Standard Contract Guidance /Care Center, Inc. Page 7 of 13 Contract No. P-4 Pe ,' South Florida Behavioral Health Network, Inc. rev. 07/19/2018 filing, whichever comes first. 31. State and Federal Whistleblower Act Requirements a. In accordance with subsection 112.3187, 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 Re lations or the Whistle - blower's Hotline number at 1- 800 - 543 -5353. b. Pursuant to Section 11(c) of the OSH Act of 1970 and the subsequent federal laws expanding the act, the Network Provider is prohibited from discriminating against employees for exercising their rights under OSH Act. Details of the OSH Act can be found at this website: https: / /www.whistleblowers.gov/ 32. Proprietary or Trade Secret Information a. Unless exempted by law, all public records are subject to public inspection and copying under Florida's Public Records Law, Chapter 119, F.S. Any claim by Network Provider of proprietary or trade secret confidentiality for any information contained in Network Provider's documents (reports, deliverables or work papers, etc., in paper or electronic form) submitted in connection with this contract will be waived, unless the claimed confidential information is submitted in accordance with Section 32. b. below. b. The Network Provider must clearly label any portion of the documents, data or records submitted that it considers exempt from public inspection or disclosure pursuant to Florida's Public Records Law as proprietary or trade secret. The labeling will include a justification citing specific statutes and facts that authorize exemption of the information from public disclosure. If different exemptions are claimed to be applicable to different portions of the protected information, the Network Provider shall include information correlating the nature of the claims to the particular protected information. c. The ME, when required to comply with a public records request including documents submitted by the Network Provider, may require the Network Provider to expeditiously submit redacted copies of documents marked as confidential or trade secret in accordance with Section 32. b. above. Accompanying the submission shall be an updated version of the justification under Section 32. b., correlated specifically to redacted information, either confirming that the statutory and factual basis originally asserted remain unchanged or indicating any changes affecting the basis from the asserted exemption from public inspection or disclosure. The redacted copy must exclude or obliterate only those exact portions that are claimed to be proprietary or trade secret. If the Network Provider fails to promptly submit a redacted copy, the ME is authorized to produce the records sought without any redaction of proprietary or trade secret information. d. The Network Provider shall be responsible for defending its claim that each and every portion of the redactions of proprietary or trade secret information are exempt from inspection and copying under Florida's Public Records Law. 33. Support to the Deaf or Hard -of- Hearing a. The Network Provider and its subcontractors, where direct services are provided, shall comply with section 504 of the Rehabilitat ion 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 de signate a Single - Point-of- Contact 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. c. The Network Provider shall, within 30 days of the effective date of this requirement, contractually require that its subcontractors comply with section 504, the ADA, and CFOP 60 -10, Chapter 4. The Network Provider's Single Point of Contact and that of its subcontractors will process the compliance data into the Department of Children and Families HHS Compliance reporting database at https: / /fsl6. formsite. com /DCFTraining /Monthly- Summary -Report/form login.html by the 4th working day of the month, covering the previous month's reporting, and forward the confirmation of submission to the ME's Contract Manager. The name and contact information for the Network Provider's Single Point of Contact shall be furnished to the ME's Contract Manager within fourteen (14) calendar days of the effective date of this requirement. d. The network provider shall contractually require that its subcontractors comply with Section 504, the ADA, and CFOP 60 -10, Chapter 4. A Single- Point -of- Contact shall be required for each subcontractor that employs fifteen (15) or more employees. This Single- Point -of- Contact will Standard Contract Guidance /Care Center, Inc. Page 8 of 13 Contract No. P-4 � �� South Florida / Behavioral Health Network, Inc. rev. 07/19/2018 ensure effective communication with deaf or hard -of- hearing customers or companions in accordance with Section 504 and the ADA and coordinate activities and reports with the Network Provider's Single- Point -of- Contact. e. The Single- Point -of- Contact shall ensure that employees are aware of the requirements, roles & responsibilities, and contact points associated with compliance with Section 504, the ADA, and CFOP 60 -10, Chapter 4. Further, employees of Network Providers and its subcontractors with 15 or more employees shall attest in writing that they are familiar with the requirements of Section 504, the ADA, and CFOP 60 -10, Chapter 4. This attestation shall be maintained in the employee's personnel file. f. The Network Provider's Single- Point -of- Contact will ensure that conspicuous Notices which provide information about the availability of appropriate auxiliary aids and services at no -cost to the deaf or hard -of- hearing customers or companions are posted near where people enter or are admitted within the agent locations. Such Notices must be posted immediately by Network Providers and subcontractors. The approved Notice can be downloaded through the Internet at: http: / /www.mvflfamilies.com /service - programs/ deaf - and - hard - hearing /providers g. The Network Provider and its subcontractors shall document the customer's or companion's preferred method of communication and any requested auxiliary aids /services provided in the customer's record. Documentation, with supporting justification, must also be made if any request was not honored. The Network Provider shall distribute Customer Feedback forms to customers or companions, and submission to the Department of Children and Families Office of Civil Rights. h. If customers or companions are referred to other agencies, the Network Provider must ensure that the receiving agency is notified of the customer's or companion's preferred method of communication and any auxiliary aids /service needs. i. The network provider's and its subcontractors' direct service employees shall complete the online training annually: 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 annually or immediately upon hire and annually thereafter. Direct service employees will also print their certificate of completion, attach it to their Attestation of Understanding, and maintain them in their personnel file. 34. Contract Amount The ME shall pay for contracted services according to the terms and conditions of this Contract in an amount not to exceed $450,000.00, subject to the availability of funds and satisfactory performance of all terms by the Network Provider. Of the total Contract amount, the ME will be required to pay 5450,000.00, 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 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 contra ct or from any other source are not eligible for payment under this Contract. 35. Contract Payment a. The network provider shall request payment monthly through submission of a properly completed invoice, per the requirements of this Contract, within eight (8) calendar days following the end of the month for which payment is being requested. b. If no services are due to be invoiced from the preceding month, the network provider shall submit a written document to the M E indicating this information within eight (8) calendar days following the end of the month. Should the network provider fail to submit an invoice or written documentation (should no services be due to be invoiced from the preceding month), within thirty (30) calendar days following the end of the month, then the ME at its sole discretion will consider these funds as lapse and may reallocate these funds within the network of providers. If the Network Provider fails to submit an invoice or written documentation for two (2) consecutive months within a twelve (12) month period, the ME at its sole discretion can terminate the contract or whole or in part. c. The ME has ten (10) working days, subject to the availability of funds, to inspect, and approve for goods and services, unless the bid specifications, purchase order, or this Contract specify otherwise. The MEs failure to pay the Network Provider within the ten (10) working days will result in penalties as referenced in the Prime Contract. Invoices returned to a Network Provider due to preparation errors will result in a non - interest bearing payment delay. Interest penalties less than one (1) dollar will not be paid unless the Network Provider requests payment. Payment shall be made only upon written acceptance by the ME and shall remain subject to the subsequent audit or review to co nfirm 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 Standard Contract Guidance /Care Center, Inc. Page 9 of 13 Contract No. P -4 South Florida di Behavioral Health Network, Inc. rev. 07/19/2018 industry, then the ME will apply financial consequences commensurate with the deficiency. Financial consequences may include but are not limited to refusing payment, withholding payments until deficiency is cured, tendering only partial payments, imposition of penalties per Section 39., and termination of contract in whole or in part and requisition of services form an alternate source. Any payment made in reliance on the Network Provider's evidence of performance which evidence is subsequently determined to be erroneous, will be immediately due as an overpayment in accordance with Section 13. above, entitled "Return of Funds" to the extent of such error. 37. Vendor Ombudsman A Vendor Ombudsman has been established within the Department of Financial Services. The duties of this office are found in section 215.422, F.S., which include disseminating information relative to prompt payment and assisting vendors in receiving their payments in a timely manner from a State agency. The Vendor Ombudsman may be contacted at (850) 413 -5516. 38. Notice Any notice that is required under this contract shall be in writing, and sent by U.S. Postal Service or any expedited delivery service that provides verification of delivery or by hand delivery. Said notice shall be sent to the representative of the Network Provider responsible for administration of the program, to the designated address contained in this contract. 39. Financial Penalties for Failure to Take Corrective Action In accordance with the provisions of section 402.73(1), F.S., and Rule 65- 29.001, F.A.C., should the ME require a corrective action to address noncompliance under this Contract, incremental penalties listed in section 39. a. th rough section 39. b. shall be imposed for Network Provider failure to achieve the corrective action. These penalties are cumulative and may be assessed upon each separate failure to comply with instructions from the ME to complete corrective action, but shall not exceed ten (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. These penalties do not limit or restrict the ME's application of any other remedy available to it under law or this Contract. a. The increments of penalty imposition that shall apply, unless the ME determines that extenuating circumstances exist, shall b e based upon the severity of the noncompliance, nonperformance, or unacceptable performance that generated the need for corrective action plan, in accordance with the following standards. b. Noncompliance that is determined by the ME 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. d. Noncompliance as a result of unacceptable performance of administrative tasks shall result in the imposition of a two perc ent (2 %) penalty. The deadline for payment shall be as stated in the Order imposing the financial penalties. In the event of nonpayment the ME may deduct the amount of the penalty from invoices submitted by the Network Provider. 40. Termination a. This contract may be terminated by either party without cause upon no less than thirty (30) calendar days' notice in writi ng 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 through the date of termination. c. In the event the Network Provider fails to fully comply with the terms and conditions of this contract, the ME may terminate upon no less than twenty -four (24) hours, excluding Saturday, Sunday, and Holidays, notice in writing to the Network Provider after Network Provider's failure to fully cure such noncompliance within the time specified in a written notice of nonco mpliance 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 t his contract. The provisions herein do not limit the ME's right to remedies at law or in equity. Standard Contract Guidance /Care Center, Inc. Page 10 of 13 Contract No. P -4 South Florida �' Behavioral ' Health Network, Inc. rev. 07/19/2018 d. Failure to have performed any contractual obligations with the ME in a manner satisfactory to the ME will be a sufficient cause for termination. To be terminated as a Network Provider under this provision, the Network Provider must have: (1) previously failed to satisfactorily perform in a contract with the ME, been notified by the ME of the unsatisfactory performance, and failed to correct the unsatisfactory performance to the satisfaction of the ME; or (2) had a contract terminated by the ME for cause. Termination shall be upon no less than twenty -four (24) hour notice in writing. e. Should the termination of the contract be inevitable, the Network Provider shall work in collaboration with the ME to develop a transition plan, in accordance with the Network Service Provider Contract Non - Renewal /Termination /Record Transition Plan, incorporated herein by reference, and timeline to ensure the uninterrupted continuum of services to individuals served under this contract, to include but not be limited to the transfer of client records. A copy of the Network Service Provider Contract Non - Renewal /Termination /Record Transition Plan may be obtained from the ME's Contract Manager. f. If this Contract is for an amount of $1Million or more, the ME may terminate this Contract at any time the Network Provider is found to have submitted a false certification under section 287.135, F.S. or has been placed on the Scrutinized Companies that Boycott Isra el List, or the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List or found be engaged in business operations in Cuba or Syria. 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 chan ges in the rate of payment when these have been established through the appropriations process and subsequently included in the ME's prime contract with the DCF. 42. Dispute Resolution a. The parties agree to cooperate in resolving any differences in interpreting the contract, including but not limited to, client eligibility and /or placement into the appropriate level of care, a general dispute arising out of, or relating to this contract, or contesting a financial penalty for failure to comply with requirements of a corrective action plan. Within five (5) working days of the execution of this contra ct, 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 rea ch 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 leve I, 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, 201 1). 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. Unauthorized Aliens and Employment Eligibility Verification (E- Verify) Unauthorized aliens shall not be employed. Employment of unauthorized aliens shall be cause for unilateral cancellation of this Contract by the ME for 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. The Network Provider and subcontracts, if applicable, will enroll in and use the E- Verify system established by the U.S. Standard Contract Guidance /Care Center, Inc. Page 11 of 13 Contract No. P -4 South Florida Ai Behavioral ■ Health Network, Inc. rev. 07/19/2018 Department of Homeland Security to verify the employment eligibility of its employees and its subcontractors' employees perfo rming under this contract. Employee assigned to the contract means all persons employed or assigned (including subcontractors) by the Network Provider during the contract term to perform work pursuant to this contract within the United States and its territories. 45. Employment Screening: The Network Provider shall ensure that all staff utilized by the Network Provider and its subcontractors (hereinafter, "Contracted Staff) that are required by Florida law and by CFOP 60 -25, Chapter 2, which is hereby incorporated by reference to be screened in accordance with chapter 435, F.S., are of good moral character and meet the Level 2 Employment Screening standards specified by sections 435.04, 110.1127, and subsection 39.001(2), F.S., as a condition of initial and continued employment that shall include but not be limited to: a. Employment history checks; b. Fingerprinting for all criminal record checks; c. Statewide criminal and juvenile delinquency records checks through the Florida Department of Law Enforcement (FDLE); d. Federal criminal records checks from the Federal Bureau of Investigation via the Florida Department of Law Enforcement; and e. Security background investigation, which may include local criminal record checks through local law enforcement agencies. f. Attestation by each employee, subject to penalty of perjury, to meeting the requirements for qualifying for employment pursuant to chapter 435 and agreeing to inform the employer immediately if arrested for any of the disqualifying offenses while employed by the employer 46. Employment Screening Affidavit: The Network Provider shall sign the Florida Department of Children and Families Employment Screening Affidavit each State fiscal year (no two such affidavits shall be signed more than 13 months apart) for the term of the Contract stating that all required staff have been screened or the Provider is awaiting the results of screening. 47. The Department requires, as applicable, the use of the Officer of Inspector General's Request for Reference Check form (CF 774), which states: "As part of the screening of an applicant being considered for appointment to a career service, selected exempt service, senior management, or OPS position with the Department of Children and Families or a Contract or sub - contract provider, a check with the Office of Inspector General (IG) is required to determine if the individual is or has been a subject of an investigation with the IG's Office. The request will only be made on the individual that is being recommended to be hired for the position if that individual has previously worked for the Contract or sub - contract provider, or if that individual is being promoted, transferred or demoted within the Contract or sub - contract provider." 48. Human Subject Research:The Network Provider shall comply with the requirements of CFOP 215-8 for any activity under this contract involving human subject research within the scope of 45 CFR, Part 46, and 42 U.S.C. section 289, et seq., and may not commence such activity until review and approval by the Department of Children and Families Human Protections Review Committee and a duly constituted Institutional Review Board. 49. Survival of Terms: The parties agree that, unless a provision of this Contract, its Exhibits, Attachments, or incorporated documents expressly states otherwise as to itself or a named provision, all provisions of this Contract concerning obligations of the Network Provider and remedies available to the ME and /or the Department are intended to survive the ending date or an earlier termination of this Contract. The Network Provider's performance pursuant to such surviving provisions shall be without further payment, as the contract payments received during the term of this Contract are consideration for such performance. 50. Official Payee and Representatives (Names, Addresses, Telephone Numbers and -E -Mail Addresses) a.. The Network Provider name, as shown on page 1 of this Contract, and b. The name, address, and telephone of the Contract Manager for the mailing address of the official payee to whom the payment shall be ME for this contract is: made is: Guidance /Care Center, Inc. Elba Taveras 3000 41st Street Ocean South Florida Behavioral Health Network, Inc. Marathon, FL 33050 7205 Corporate Center Drive, Suite 200 Miami, FL 33126 Tel. (786) 507 -7462 E -Mail: Etaveras @sfbhn.org c. The name of the contact person and street address where the d. The name, address, and telephone number of the representative of the Network Provider's financial and administrative records are Network Provider responsible for the administration of the program under maintained is: this contract is: Kristen Chaffee, Regional Controller Sharon Crippen, Sr. Vice President 100 2nd Avenue South #901 169 E. Flagler Street, Suite 1300 St. Petersburg, FL 30100 Miami, FL 33131 Office number: 727 - 490 -6767 x 30111 Office number: (305) 573 -3784 Mobile number: 727 - 465 -6083 Mobile number: (305) 815 -3702 Fax number: 727-825-0573 Fax number: (305) 381 -7733 E -Mail: kristen.chaffee @westcare.com E -Mail: sharon.crippen @westcare.com Standard Contract Guidance /Care Center, Inc. Page 12 of 13 Contract No. P -4 Fe-:�� South Florida ,9 Behavioral Health Network, Inc. rev. 07/19/2018 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. 51. All Terms and Conditions Included This contract and it attachments, I. 11.111. & IV and any exhibits referenced in said attachments, together with any documents incorporated by reference, including the ME prime contract (which can be found at http: / /www.sfbhn.org), contain all the terms and conditions agreed upon by the parties. There are no provisions, terms, conditions, or obligations other than those contained herein, and this contract shall supersede all previous communications, representations, or agreements, either verbal or written between the parties. If any term or provision of this contract is legally determined unlawful or unenforceable, the remainder of the contract shall remain in full force and effect and such term or provision shall be stricken. In the event of a conflict between the provisions of the documents, the documents shall be Interpreted in the following order of precedence: a. Attachment I, Exhibits, the Business Associate Agreement, and other attachments, if any; b. Any documents incorporated into any Exhibit or Attachment by reference; c. The Standard Contract; d. Any documents incorporated herein by reference BY SIGNING THIS CONTRACT, THE PARTIES AGREE THAT THEY HAVE READ AND AGREE TO THE ENTIRE CONTRACT, AS DESCRIBED IN SECTION SI. 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. NETWORK PROVIDER: Guidance /Care Center, Inc. SOUTH FLORIDA BEHAVIORAL HEALTH NETWORK, INC. SIG SIGNS. / _,0000.1" BY. n BY: 'maw NAME: Sharon Crippen NAME: Stephen Zuckerman TITLE: Sr. Vice President TITLE: Interim. EC DATE: Fi I )1, I DATE: ( j r/k Federal Tax ID# (or SSN) 59- 1458324 Network Provider Fiscal Year Ending Date 6/30 Standard Contract Guidance /Care Center, Inc. Page 13 of 13 Contract No. P4 P� South Florida / Behavioral Health Network, Inc. Effective: 7 /01/2018 ATTACHMENT A. Service to be Provided 1. Program /Service Specific Terms (1) "Behavioral Health Services" are mental health services and substance abuse prevention and treatment services as defined by s. 394.9082(2)(a), F.S., and in Chapter 397. F.S. (2) "Block Grants ": The Community Mental Health Block Grant (CMHBG), pursuant to 42 U.S.C. s. 300x, et. seq., and the Substance Abuse Prevention and Treatment Block Grant (SAPTBG), pursuant to 42 U.S.C. s. 300x -21, et. seq. (3) "Care Coordination" means the implementation of deliberate and planned organizational relationships and service procedures that improve the effectiveness and efficiency of the behavioral health system by engaging in purposeful interactions with individuals who are not yet effectively connected with services to ensure service linkage. Examples of care coordination activities include development of referral agreements, shared protocols, and information exchange procedures. The purpose of care coordination is to enhance the delivery of treatment services and recovery supports and to improve outcomes among priority populations. (4) Collaborative Planning Group Systems, Inc. is the entity contracted with the Department of Children and Families that maintains the database called Performance Based Prevention System (PBPS) that Network Providers contracted to provide substance abuse prevention services must utilize to upload substance abuse prevention data required by this contract. (5) "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. (6) "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. (7) "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 Attachment I HCO2 (f) Page 1 of 52 Guidance /Care Center, Inc. Contract No. P -4 �,/ South Florida / Behavioral Health Network, Inc. Effective: 7 /01/2018 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. (8) "Co- occurring Disorder" is any combination of mental health and substance abuse in any individual, whether or not they have been already diagnosed. (9) "Co- occurring Disorder Service Capability" is the ability of any program to organize every aspect of its program infrastructure (policies, procedures, practices, documentation, and staff competencies), within its existing resources, to provide appropriately matched, integrated services to the individuals and families with co- occurring disorders that are routinely presenting for care in that program. Should services not be available at the Network Provider then then the consumer must be linked to an agency with the capability to meet the consumer's needs. (10) "Coordinated System of Care ", as . described in section 394.4573, F.S.is the array of behavioral health and related services in a region or community offered by all service providers, whether participating under a contract with a Managing Entity or by another method of community partnership or mutual agreement. The essential elements of a coordinated system of care include but are not limited to: Community interventions such as prevention, primary care for behavioral health needs, therapeutic and supportive services, crisis response services, and diversion programs. and early intervention; Services provided within the System of Care must be accessible and responsive to the needs of individuals, their families, and community stakeholders. (11) "Cost Analysis" is the review of the proposed cost elements to determine if they are necessary, allowable, appropriate and reasonable. (12) "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. (13) "DCF PAM 155 -2" is the Department of Children & Families, Pamphlet 155 -2 - Mental Health and Substance Abuse Measurement and Data, effective July 2016, version 11.1.3 , or the latest revised edition thereof, means a document promulgated by the department that contains required data - reporting elements for substance abuse and mental health services, and which can be found at: http: / /www.mvflfamilies.com /service- programs/ substance- abuse /pamphlet- 155- 2 -v11, and is incorporated herein by reference. (14) "Department" means the State of Florida Department of Children and Families. Attachment I 11CO2 (f) Page 2 of 52 Guidance /Care Center, Inc. Contract No. P �� South Florida / Behavioral Health Network, Inc. Effective: 7/01/2018 (15) "Electronic Health Record (EHR)" is defined in s. 408.051(2)(a), F.S. (16) "Evidenced -Based Practices (EBP) are programs, practices or strategies that are supported by research. EBP's are programs that have demonstrated effectiveness with established generalizability (replicated in different settings and with different populations over time) through research. Option #1: The program or strategy is recognized by a national registry of evidence -based programs and strategies as one that is appropriate for the identified outcome. It is important to note that inclusion within a registry does not reflect a program's effectiveness. Programs need to be reviewed for the intended target population, demographics, setting, and the research results for each program outcome. Additionally, the rating provided to the program by the registry must be considered prior to selection. Programs deemed not effective or inconclusive should not be selected. For a list of registries that provide information and research outcomes for evidence -based programs and strategies please refer to the Department's Guidance Document 1, Evidence Based Guidelines available at the following link: http: / /www.myflfamilies.com /service - programs/ substance - abuse /managing- entities /2018- contract -docs Or Option #2: The program or strategy is reported in peer- reviewed journals or has documented effectiveness which is supported by other sources of information and the consensus judgment of informed experts. When claiming this option, a provider must include: • A description of the theory of change and a logic model; and • A discussion of how the content and structure of this proposed program or strategy is similar to programs or strategies that appear in approved registry or in the peer- reviewed literature, or how it is based on sound scientific principles of community prevention or public health; and • Documentation that the program or strategy was effectively implemented in the past, with results that show a consistent pattern of credible and positive effects, including: • the number of times it was implemented, • the fidelity with which it was implemented, and • the results of any outcome evaluations; and • Documentation of a review by, and consent of, a Panel of Informed Experts indicating that the implementation of this proposed program or strategy is appropriate for the Attachment I HCO2 (f) Page 3 of 52 Guidance /Care Center, Inc. Contract No. P-4 PP- South Florida / Behavioral Health Network, Inc. Effective: 7/01/2018 community and likely to have a positive effect on the identified outcome and what evidence their decision was based upon. • Following the selection of an option, sufficient documentation to support the decision must be maintained by the Network Provider. • The ME does not fund Prevention services for this category. (17) "Forensic Mental Health Services" are services provided to individuals with mental illness pursuant to Chapter 916, Florida Statutes. (18) "HIPAA" is the acronym for Health Insurance Portability and Accountability Act and shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 42 U.S.C. §1320d, and 45 C.F.R. Parts 160, 162, and 164. (19) "Individual(s) Served" (synonymous with Consumer, Consumer, Participant) is an individual who receives substance abuse or mental health services, the cost of which is paid, either in part or whole, by Department appropriated funds or local match (matching). (20) "Knight Information Software (KIS) ", (synonymous with Care Coordination, Utilization Management and Financial Reporting System) is the ME's online data system which Network Providers are required to use to collect and report data and performance outcomes on consumers served whose services are paid for, in part or in whole, by the ME's Substance Abuse and Mental Health (SAMH) contract, Medicaid, local match, Temporary Assistance for Needy Families (TANF), Purchase of Therapeutic Services (PTS) and Title 21 . The KIS, or other system designated by the ME, shall be utilized to upload consumer- related data as required by this contract. (21) "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. Matching requirements may be satisfied by any or all of the following: (a) Allowable costs supported by non -State or Federal grants incurred by the service provider during the effective funding period; (b) The value of third -party funds and in -kind contributions applicable to the matching requirement period; and, (c) Costs supported by fees and program income. See § 394.67, F.S. F.S. and 65E- 14.005, F.A.C. (22) "Managing Entity (ME)" as defined in section 394.9082(2)(e), F.S., is a corporation selected by and under contract with the Department to manage the daily operational delivery of behavioral health services through a coordinated system of care. Attachment I HCO2 (f) Page 4 of 52 Guidance /Care Center, Inc. Contract No. P - �� South'Florida Behavioral Health Network, Inc. Effective: 7/01/2018 (23) "Mental Health Services" is defined pursuant to Chapter 394, F.S. (24) "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. (25) "Network Provider" is an entity that contracts with the ME and receives funding to provide services to consumers; in this contract the Network Provider is synonymous with provider or subcontractor. (26) "Our Kids of Miami - Dade /Monroe" is the Community Based Care provider under contract with the State of Florida Department of Children and Families for the child welfare system. (27) "Outcome for Individual Service Recipient" is a measure of the quantified result, impact, or benefit of services on the individual service recipient. (28) "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. (29) "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" (individual receiving services), "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. Refer to Rule 65E -14, F.A.C. and Exhibit B, Method of Payment. (30) "PBPS" is the Department's Performance Based Prevention System that collects data related to community assessments and plans and substance abuse prevention programs and activities. (31) "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. (32) "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. Additional guidance regarding prevention services can be . found in the Department's Guidance Document 10, Prevention Services and is available at the following link: Attachment I HCO2 (f) Page 5 of 52 Guidance /Care Center, Inc. Contract No. P-4 South Florida Behavioral Health Network, Inc. Effective: 7/01/2018 http: / /www.myflfamilies.com /service - programs /substance- abuse /managing- entities /2018- contract -docs Programs designed to prevent the development of mental, emotional, and behavioral disorders are commonly categorized in the following manner: (a) Universal Direct Prevention Directly serve an identifiable group of participants who have not been identified on the basis of individual risk. This includes interventions involving interpersonal and ongoing or repeated contact such as curricula, programs, and classes. These services shall address the following specific prevention strategies, as defined in Rule 65D- 30.013, F.A.C.: information dissemination, education, alternatives or problem identification and referral services. (b) Universal Indirect Prevention Universal indirect services support population -based programs and policies implemented by coalitions. These services can also include meetings and events related to the design and implementation of components of the strategic prevention framework, including needs assessments, logic models and comprehensive community action plans. The services shall address the following specific prevention strategies, as defined in Rule 65D- 30.013, F.A.C.: information dissemination, community -based processes and environmental strategies. (c) Selective Prevention Preventive interventions that are targeted to individuals or to a subgroup of the population whose risk of developing mental, emotional, or behavioral disorders is significantly higher than average. The risk may be imminent or it may be a lifetime risk. Risk groups may be identified on the basis of biological, psychological, or social risk factors that are known to be associated with the onset of a disorder. Examples include programs offered to children exposed to risk factors, such as parental divorce, parental mental illness, death of a close relative, or abuse, to reduce risk for adverse mental, emotional, and behavioral outcomes. (d) Indicated Prevention 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 disorders, as well as biological markers that indicate a predisposition in a person for such a disorder but who does not meet diagnostic criteria at the time of the intervention. (33) "Prevention Partnership Grant" is a program created by s. 397.99, F.S. designed to encourage school and community substance abuse prevention partnerships. The PPG program is funded through the federal Substance Abuse and Treatment Block Grant, administered by the Florida Department of Children and Families and managed by the ME. (34) "Prime Contract" is the contract between the Department of Children and Families and the ME. Attachment I HCO2 (f) Page 6 of 52 Guidance /Care Center, Inc. Contract No. P -4 South Florida . Behavioral Health Network, Inc. Effective: 7/01/2018 (35) "Program Description" is the document the Network Provider prepares and submits to the ME for approval prior to the start of the contract period, which provides a detailed description of the services to be provided under the contract pursuant to Rule 65E -14, F.A.C. It includes but is not limited to the Network Provider's organizational profile, the service activity description, a detailed description of each program and covered service funded in the contract, the geographic service area, service capacity, staffing information, and consumer and target population to be served. (36) "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. (37) "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. (38) "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. (39) "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. (40) "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. (41) "Recovery- Oriented System of Care" is defined as a coordinated network of community - based services and supports that are person- centered and build on the strengths and resilience of individuals, families and communities to achieve abstinence, and improved Attachment I HCO2 (f) Page 7 of 52 Guidance /Care Center, Inc. Contract No. P-4 South Florida Behavioral Health Network, Inc. Effective: 7/01/2018 health and the quality of life for individuals, families, and communities.' (42) "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. (43)Request for Application #10H17GN1: The Department's most recent Prevention Partnership Grant Request for Application for Fiscal Years 2018 -2021. (44) "SAMH" stands for the Substance Abuse and Mental Health Programs within the Department. (45) "SAVE /VIS Program" is the U.S. Department of Homeland Security (DHS) administers the Systematic Alien Verification for Entitlements (SAVE) program. This program verifies immigration status and eligibility of alien applicants for federal benefits. The alien status verification system under SAVE is entitled the Alien Status Verification Index (ASVI), as described at 60 Federal Register 52694, 52697 (1995) administered by the Computer Sciences Corporation (CSC) as the Verification Information System (VIS). The SAVE /VIS Program can and may provide assistance in verifying eligibility in cases where a consumer does not possess sufficient documentation. (46) "SOAR" stands for Supplemental Security Income /Social Security Disability Insurance (SSI /SSDI) Outreach, Access and Recovery and is a Substance Abuse and Mental Health Services Administration (SAMHSA) technical assistance initiative designed to help individuals increase earlier access to SSI and SSDI through improved approval rates on initial Social Security applications by providing training, technical assistance, and strategic planning to Network Service Providers. (47) "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. (48) "Statewide Inpatient Psychiatric Programs (SIPP)" are residential inpatient facilities under contract with the Agency for Health Care Administration (AHCA) under the Medicaid Institutes for Mental Disease (IMD) 1915B waiver for children under age 18 to provide diagnostic and active treatment services in a secure setting. (49) "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 1 See https: / /www.samhsa.gov /sites /default /files /rosc resourceguide book.pdf accessed May, 2018. Attachment I HCO2 (f) Page 8 of 52 Guidance /Care Center, Inc. Contract No. P-4 South Florida Behavioral Health Network, Inc. Effective: 7/01/2018 using state or federal funding. (50) "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. (51) "TANF Participant" is a person or family member of that person defined in 45 C.F.R. Part 260.30 and section 414.1585 and subsection 414.0252(9), F.S. (52) "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. (53) "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. (54) "Utilization Management" is a system to ensure maximum, cost - effective, and clinically appropriate utilization of behavioral health services. The goal of the program is to eliminate waitlists and maximize utilization as well as diverting individuals served to more clinically appropriate services when applicable. (55) "Verifiable Service" is a service provision that is documented in compliance with the requirements contained in Rule 65E -14, F.A.C. (56) "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 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 and managed by the ME. The services provided under this contract are to fund rigorous, effective, evidence - based, substance abuse prevention programs and strategies intended to prevent or reduce Florida Attachment I HCO2 (f) Page 9 of 52 Guidance /Care Center, Inc. Contract No. P-4 �� South Florida Behavioral Health Network, Inc. Effective: 7/01/2018 substance use and abuse rates at the community level. The strategies, activities, and services must be consistent with the local community ME- approved local Needs Assessment Logic Model (HALM), the Comprehensive Community Action Plan (CCAP) and with the Network Provider's Application filed with the Department in response to the Request for Applications # 10H17GN1, herein incorporated by reference and . made part of this contract. 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 is expected to be the systematic collection and analysis of information about program activities, characteristics, and outcomes to reduce uncertainty, improve effectiveness, and assist in decision - making. The information gathered from the evaluation process will help the ME, the State and communities become more skillful and exact in describing what they plan to do, monitor what they are doing, and improve the prevention system of care. Evaluation results can and should be used to determine what efforts should be sustained and to assist in sustainability planning efforts. The ME will provide substantial input, in collaboration with the Network Provider and the Evaluation Entity, both in planning and implementation of the evaluation process and activities, and will make recommendations regarding the continuance of the activities. b. Authority Section 394.9082, F.S., the Prime Contract, and the. Request for Applications # 10H17GN1, provides the ME with the authority to contract for these services. c. Scope of Service The following scope of service applies to the contract period and any renewal or extension. (1) The Network Provider is responsible for the administration and provision of services to the target population(s) indicated in Exhibit A, Consumers /Participants to be Served, and in accordance with the tasks outlined in Section B.1.a., of this contract, and the Scope of Work found. in Attachment IV. Services shall also be delivered at the locations specified in, and in accordance with the Program Description, as required by Rule 65E- 14.021, F.A.C. which is herein incorporated by reference, and maintained in the ME's Contract Manager's file. (2) Services are to be delivered in the following county(ies): Miami -Dade County X Monroe County Attachment I HCO2 (f) Page 10 of 52 Guidance /Care Center, Inc. Contract No. P -4 �� South Florida / Behavioral Health Network, Inc. Effective: 7/01/2018 d. Major Program Goals The overall scope of the grant activities for the PPG program are to: (1) Develop effective substance abuse prevention and early intervention strategies for the target populations; and, (2) Conduct prevention activities serving students who are not involved in substance abuse, 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. (3) 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) will call for evidence -based prevention program activities or strategies for which there is a demonstrated need. The CCAP guides the selection of evidence -based prevention program activities or strategies for which there is limited or no current local capacity. The principles of cultural competency must be incorporated into their needs assessment logic model and the CCAP. Each community must also include a written sustainability plan in their response which details their plan to sustain activities after funding has ended. e. Minimum Programmatic Requirements The Network Provider shall maintain the following minimum programmatic requirements: (1) System of Care The consumer - centered and family- focused system of care will: (a) Be driven by the needs and choices of the customers; (b) Promote family and personal self- determination and choice; (c) Be ethically, socially, and culturally responsive; and (d) Be dedicated to excellence and quality results. (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; Attachment I HCO2 (f) Page 11 of 52 Guidance /Care Center, Inc. Contract No. P -4 /� South Florida Behavioral Health Network, Inc. Effective: 7/01/2018 (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. Consumers to be Served See Exhibit A, Consumers /Participants to be Served B. MANNER OF SERVICE PROVISION 1. Service Tasks The following tasks must be completed for each fiscal year covered in the contract period. a. Task List (1) Based on consumer needs, the Network Provider 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) The Network Provider shall ensure the fidelity of each EBP the agency is utilizing. Attachment I HCO2 (f) Page 12 of 52 Guidance /Care Center, Inc. Contract No. P-4 �� South Florida Behavioral Health Network, Inc. Effective: 7/01/2018 (5) The Network Provider shall develop and implement policies so that all applicable providers' employees abide by the terms and conditions of Paragraph 25., Information Security Obligations, of the Standard Contract. The Network Provider shall submit to the Managing Entities Contract Manager, by 8/01/2018, verification that all Network. Provider employees and subcontractors who have access to ME and Department information systems have completed the Security Agreement form as identified in Paragraph 25. Information Security Obligations, of the Standard Contract. (6) For licensable services 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 and Agency for Health Care Administration (AHCA) licenses and only bill for services under those licenses. In the event any of the Network Provider's license(s) are suspended, revoked, expired or terminated, the ME shall suspend payment for services delivered by the Network Provider under such license(s) until said license(s) are reinstated. (7) By 08/01/2018, the Network Provider shall submit to the ME's Contract Manager grievance procedures, which include an appeal process with the ME, should the grievance not be resolved at the Network Provider level, which applicants for, and recipients of, services being provided under this contract, may use to present grievances to the Network Provider, or to the ME about contracted services. (8) By 08/01/2018, the Network Provider shall submit to the ME's Contract Manager a disaster plan consistent with Paragraph 29., Emergency Preparedness, of the Standard Contract. (9) 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. (10) By 08/01/2018, the Network Provider shall submit to the ME's Contract Manager a completed Civil Rights Compliance Questionnaire. (11) The Network Provider shall execute or maintain if executed, a Memorandum of Understanding (MOU) or contract with the appropriate Federally Qualified Health Center or other medical facility. The MOU provides for the integration of behavioral health services and primary health care services for all participants and consumers in care. Referral and linkage processes will be necessary for all participants /consumers who do not have a primary care provider at entry into the services in the system of care. Follow up and coordination of services are essential to meeting participant /consumer health and behavioral health needs which result in: Attachment I 1 (f) Page 13 of 52 Guidance/Care Center, Inc. Contract No. P -4 �,/ South Florida // Behavioral Health Network, Inc. Effective: 7/01/2018 • 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 consumers 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. 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. 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 consumer. (12) The Network Provider shall implement a "no wrong door" model as defined in s. 394.4573, F.S, by developing a process for assessing, referring and /or treating consumers with co- occurring disorders, to increase access of persons identified as co= occurring, to provide services for both disorders regardless of the entry point to the behavioral health system. (13) By 08/01/2018, 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 consumers 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. Attachment I HCO2 (f) Page 14 of 52 Guidance /Care Center, Inc. Contract No. P-4 �� South Florida / Behavioral Health Network, Inc. Effective: 7/01/2018 (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.(18) below. (14) Linkage and Referral Process (a) The Network Providers policies and procedures must address the referral and linkage process of consumers 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 Attachment I HCO2 (f) Page 15 of 52 Guidance /Care Center, Inc. Contract No. P-4 South Florida Behavioral Health Network, Inc. Effective: 7/01/2018 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) By 10/01/2018, the Network Provider shall submit an attestation signed by the CEO /Executive Director indicating that all applicable staff funded by this Contract have received a copy of this fully executed contract and will receive copies of any amendments made to this Contract. (16) 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: 1. Activities to ensure that fraud, waste and abuse do not occur. ii. Composition of quality assurance review committees and subcommittees, purpose, scope, and objectives of the continuous quality assurance committee and each subcommittee, frequency of meetings, minutes of meetings, and documentation of meetings. iii. A framework for evaluating outcomes, including: 1. Output measures, such as capacities, technologies, and infrastructure that make up the system of care. 2. Process measures, such as administrative and components of the services. 3. Outcome measures pertaining to the outcomes of services; Attachment I HCO2 (f) Page 16 of 52 Guidance /Care Center, Inc. Contract No. P-4 �� South Florida / Behavioral Health Network, Inc. Effective: 7/01/2018 iv. A system of analyzing those factors which have an effect on performance; v. A system of reporting the results of continuous quality improvement reviews; and, vi. Best practice models for use in improving performance in those areas which are deficient. vii. Establishment of a Seclusion and Restraint Oversight Committee per Chapter 65E- 5.180, F.A.C. for agencies utilizing seclusion and /or restraint. (17) .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. Attachment I HCO2 (f) Page 17 of 52 Guidance /Care Center, Inc. Contract No. P-4 P� South Florida / Behavioral Health Network, Inc. Effective: 7/01/2018 ii. A process to track and report outcomes of successful referrals and linkages of consumers of behavioral health services to primary health care services. In addition to tracking and reporting outcomes of consumers referred for behavioral health services by a primary health care provider to the Network Provider. The outcomes must be reported in the semi - annual Continuous Quality Improvement Updates. iii. Identification of at least two Integrated Healthcare Champions at the beginning of the contract term and submit the names of the individuals when requested by ME staff. iv. By 08/31/2018, unless otherwise directed by the ME, the Network Provider shall submit an action plan on the template provided by the ME. The action plan must be developed based on the results of the most recently completed Site Self- Assessment Evaluation Tool for the Maine Health Access Foundation Integration Initiative (MeHAF). The action plan will outline tasks and objectives that the Network Provider must address during the fiscal year that were identified in the self- assessment as needing improvement. v. Participation in the regional Healthcare Integration Committee meetings to develop the processes and training germane to this initiative. vi. Attendance of appropriate staff at the regional trainings regarding Integrated Healthcare, as requested by the ME staff. Participation in the trainings will be documented in the Continuous Quality Improvement Updates. vii. By 03/01/2019, 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). (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: Attachment I HCO2 (f) Page 18 of 52 Guidance /Care Center, Inc. Contract No. P-4 / � South Florida // Behavioral Health Network, Inc. Effective: 7/01/2018 I. Identification of at least two TIC Champions at the beginning of the contract term and submit the names of the individuals when requested by ME staff. ii. By 08/31/2018, unless otherwise directed by the ME, the Network Provider shall submit an action plan on the template provided by the ME. The action plan must be developed based on the results of the most recently completed Fallot Tool. The action plan will outline tasks and objectives that the Network Provider must address during the fiscal year that were identified in the self- assessment as needing improvement. The ME will monitor the Network Provider on its execution of the tasks and objectives identified in the action plan. iii. Participation in the regional TIC meetings to develop the process for identifying and responding to those affected by trauma. iv. Attendance at the regional trainings regarding TIC as applicable. Applicable trainings will be documented in the Continuous Quality Improvement Updates. v. Participation in all TIC related activities to ensure staff and agency become competent in all areas of trauma informed care. (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. By 08/31/2018, 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) Attachment I HCO2 (f) Page 19 of 52 Guidance /Care Center, Inc. Contract No. P-4 P3/ South Florida / Behavioral Health Network, Inc. Effective: 7/01/2018 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 and 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, 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 consumers referred by the Community Based Care Organizations (CBC) or by the Department's Child Protective Investigators in cases where behavioral health indicators are present during the initial child abuse /neglect investigation or at any point during child protective supervision or out -of -home care. Priority will be given to cases where a child is at risk for immediate removal or has been removed from the family, with a goal of reunification in the family safety plan. Services may also be provided for the enrolled parent(s)' /caregiver(s)' family members, household residents, or significant others in need of behavioral health prevention or treatment services, as well as children in relative placements. For a detailed description of the consumer eligibility criteria please refer to the approved Motivational Support Program Protocols and Family Intensive Treatment Team Protocols, herein incorporated by reference and available upon request to the MEs Contract Manager. 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 consumers. Network Providers will be implementing the Child Welfare Integration (CWI) initiative through a continuous quality improvement plan or component in the existing agency wide continuous quality improvement plan that delineates participation in the CWI initiative. As part of the plan or component of the plan must include the following: 1. Identification of at least two CWI Champions and submit the names of the Attachment I HCO2 (f) Page 20 of 52 Guidance /Care Center, Inc. Contract No. P South Florida Behavioral Health Network, Inc. Effective: 7/01/2018 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) Mandatory Accreditation Accreditation by an accrediting organization recognized by the Department, as discussed in 65D- 30.0031, F.A.C., is a requirement for licensure of clinical substance abuse treatment services. The licensable substance abuse treatment components are listed in subsection 65D- 30.002 (17), F.A.C. Network Provider applicants for licensure and licensed network providers must meet the most current best practice standards related to the licensable service components of the accrediting organization. For a list of accrediting organizations recognized by the Department visit the following website: httr : / /www.myflfamilies.com /service - programs/ substance - abuse /licensure - regulation The Network Provider shall take appropriate steps to maintain its accreditation or become fully accredited by June 30, 2019, as required by this section, 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. Failure to meet the accreditation requirements will be considered by the ME to be a breach of this Contract and this contract may be subject to termination. (18) By 8/31/2018, the Network Provider shall submit a single agency action plan which outlines all of the components /activities identified in agency's annual self- assessments for each initiative. For example, the Integrated Healthcare Initiative (Behavioral Health and Primary Health Care) action plan should be developed based on the results of the most recently completed self - assessment, the Trauma Informed Care action plan shall be developed based on the results of the most recently completed Fallot Tool, and the Cultural and Linguistic Competence action plan shall be based on the results of the Cultural and Linguistic Competence survey. Attachment I HCO2 (f) Page 21 of 52 Guidance /Care Center, Inc. Contract No. P-4 IPP South Florida / Behavioral Health Network, Inc. Effective: 7/01/2018 (19) Continuous Quality Improvement Updates The Network Provider shall submit semi - annual updates, by the dates specified in Exhibit C -1, 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) Participation in trainings and activities relating to the Integration of Behavioral Health and Child Welfare Systems; (e) Mandatory Accreditation Requirements: Monitoring processes to ensure that all licensable substance abuse treatment components funded by this Contract meet the most current best practice standards related to the licensable service components of the accrediting organization, as required by Rule 65D- 30.003 (2), F.A.C., Department Licensing and Regulatory Standards; (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. (20) Care Coordination and Reporting Requirements If requested by the ME, the Network Provider shall participate and comply with Care Coordination activities as defined in section 394.4573(1)(a), F.S. (21) Program Status Report The Network Provider shall submit an annual detailed report of the services and activities performed and the progress of the Program in meeting the performance measures, goals, objectives and tasks as described in Attachment IV, Scope of Work. The report shall be submitted by the due date specified in Exhibit C -1, Required Reports. Attachment I HCO2 (f) - Page 22 of 52 Guidance /Care Center, Inc. Contract No. P-4 / South Florida Behavioral Health Network, Inc. Effective: 7/01/2018 (22) PPG Specific Financial Report The Network Providers shall submit a quarterly detailed financial report of Program Expenses which are used to track all expenses associated with this Contract and reconcile these expenditures with the payments made to the Network Provider by the dates specified in Exhibit C -1, Required Reports. The financial reports track both grant award - funded and match funded expenses and encourages expenditure planning and projection. Pursuant to Rule 65E- 14.021, F.A.C., the Network Provider shall use the Department's form CF -MH 1037. The form CF -MH 1037 and the corresponding instructions are available at the following website: https: / /eds.mvflfamilies .com /DCFFormslnternet /Search /D.CFFormSearch.aspx (23) 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. 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) 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. The Department - approved Local Match Calculation Form, Template 9 — Local Match Calculation Form is available at the following website: http: / /www.mvflfamilies .com /service - programs /substance- abuse /managing- entities /2018- 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 and shall comply with the requirements in Section 7., Audits, Inspections, Investigations, Records, and Retention. (25) The Network Provider shall maintain in one place for easy accessibility and review by ME and /or Attachment I HCO2 (f) Page 23 of 52 Guidance /Care Center, Inc. Contract No. P -4 �� South Florida / Behavioral Health Network, Inc. Effective: 7/01/2018 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. (26) 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. (27) The Network Provider shall make available upon request all plans, policies, procedures, and manuals to ME staff, Department staff, Network Provider staff, and to consumers /stakeholders if applicable and appropriate. (28) The Network Provider shall comply with Children and Families Operating Procedure 215 -8, OVERSIGHT OF HUMAN SUBJECT RESEARCH AND INSTITUTIONAL REVIEW BOARD DESIGNATION. The policy and guidance can be found at: http : / /www.dcf.state.fl.us /admin /publications /policies /215 -8.pdf Approval from the Department through the ME is mandatory for all research conducted by any employee, contracted organization or individual, or any public or private vendor, even if the aforementioned has their own Institutional Review Board which has granted approval. (29) The Network Provider shall participate in the State's Peer Review process, when implemented, to assess the quality, appropriateness, and efficacy of services provided to individuals pursuant to 45 CFR 96.136. (30) The Network Provider shall attend required trainings and /or meetings as required by the ME, meet with the ME's staff at regularly scheduled or specially called meetings when notified by the ME. (31) 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. (32) Work and Social Opportunities for Peer Specialists Nationwide, health systems have accepted peers as a valuable part of the workforce. A shift to Attachment I HCO2 (f) Page 24 of 52 Guidance /Care Center, Inc. Contract No. P-4 P� South Florida Behavioral Health Network, Inc. Effective: 7/01/2018 a more person- centered approach, a focus on integrated health, and a demand for more workers have increased the role peer specialists play in Florida's mental health and substance abuse systems. In keeping with Florida's goal of increasing the number of peer specialists, The Network Provider shall will provide employment and social opportunities to individuals who have lived experience of mental health and /or substance use condition and /or lived experience of trauma. (33) 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. (34) Develop, Maintain and Improve Reporting The Network Provider shall submit reports included in Exhibit C -1, Required Reports. The Network Provider agrees to submit ad hoc and additional reports as determined by the ME and /or the Department. 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. (35) Consumer 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. (36) If requested by the ME, 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 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; Attachment I 11CO2 (f) Page 25 of 52 Guidance /Care Center, Inc. Contract No. P-4 �� South Florida Behavioral Health Network, Inc. Effective: 7/01/2018 (b) Automated referral and electronic consent for release of confidential information with the ME and other Network Providers, to the extent permitted by law; (c) Integrated processes for intake, admission, discharge and follow -up; (d) Encounter and progress notes to support all services provided under this contract and that automatically generate state and Medicaid billing and payment in the event Medicaid compensable services are provided to individuals eligible for Medicaid; (e) Utilization management, including but not limited to Wait Lists and capacity management; (f) Determination of financial and clinical eligibility of Individuals Served; (g) Processes to ensure the Department is the payer of last resort; (h) Electronic capability for billing, invoice payment and claims adjudication, and /or Medicaid billing and payment (HIPAA 837 and 835 Transactions); (i) Automated processes for state and federal data analysis and reporting; and. (j) Full compliance with federal and state laws, rules and regulations pertaining to security and privacy of protected health information. 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, SAMH Programmatic State and Federal Laws, Rules, and Regulations. Attachment I HCO2 (f) Page 26 of 52 Guidance/Care Center, Inc. Contract No. P-4 m� South Florida / Behavioral Health Network, Inc. Effective: 7 /01/2018 (2) The Network Provider shall engage in recruitment efforts to maintain as much as possible staff with the ethnic and racial composition of the consumers served. The ME, at its sole discretion may request documentation evidencing recruitment efforts. b. Professional Qualifications (1) The Network Provider shall comply with applicable rules, statutes, requirements, and standards with regard to professional qualifications. See Exhibit F, SAMH Programmatic State and Federal Laws, Rules, and Regulations and the requirements specified in Section 45. of the. Standard Contract. (2) The Network Provider shall provide employment screening for all mental health personnel and all chief executive officers, owners, directors, and chief financial officers of service Network Providers using the standards for Level II screening set forth in Chapter 435, and s. 408.809 F.S., except as otherwise specified in s. 394.4572(1)(b) -(d), F.S. For the purposes of this contract, "Mental health personnel" includes all program directors, professional clinicians, staff members, and volunteers working in public or private mental health programs and facilities who have direct 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) A Network Provider that contracts 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) Employment screening and rescreening no less frequently than once every 5 years, pursuant to chapter 435, using the level 2 standards set forth in that chapter for personnel in programs for children or youths. Attachment I HCO2 (f) Page 27 of 52 Guidance/Care Center, Inc. Contract No. P4 South Florid a Behavioral Health Network, Inc. Effective: 7/01/2018 c. Staffing Changes The Network Provider shall notify the ME's Contract Manager, in writing within (10) calendar days of staffing changes regarding the positions of Chief Executive Officer, Chief Financial Officer, Medical Director, and Clinical Director, IT Director, Dispute Resolution Officer, Data Security Officer, Single Point of Contact in accordance with Section 504 of the Rehabilitation Act of 1973 as required by Paragraph 33. of the Standard Contract, or any individuals with similar functions. Additionally, the Network Provider will notify the ME's Contract Manager in writing, of changes in the Executive Director or any senior management position. d. Subcontractors (1) This contract allows the Network Provider to subcontract for the provision of 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 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- Attachment I HCO2 (f) Page 28 of 52 Guidance /Care Center, Inc. Contract No. P-4 • � South Florida // Be He vioral Network, Inc: Effective: 7 /01/2018 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)]. (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. Attachment 11-1CO2 (f) Page 29 of 52 Guidance /Care Center, Inc. Contract No. P - �� South Florida / Behavioral Health Network, Inc. Effective: 7/01/2018 (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 that: (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, F.A.C., Unit Cost Method of Payment, including but not limited to, Covered Services, unit measurements, descriptions, program areas, data elements, maximum unit cost rates, required fiscal reports, program description, setting unit cost rates, payment for services including allowable and unallowable units and requests for payments. (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 Attachment I HCO2 (f) Page 30 of 52 Guidance /Care Center, Inc. Contract No. P -4 � � South Florida / Behavioral Health Network, Inc. Effective: 7 /01/2018 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 Attachment IV, Scope of Work. (2) The Network Provider shall notify the M E'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 M E's Contract Manager, in writing, at least ten (10) calendar days prior to any changes in location where services are being provided pursuant to Rule 65E -14, 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 -1, Required Reports. The Network Provider Inventory List form may be requested from ME Contract Manager. 4. Deliverables a. Services The Network Provider shall deliver the services specified in and described in the Program Description submitted by the Network Provider and as set forth in Exhibit G, Covered Service Funding by OCA and in Attachment IV, Scope of Work. b. Records and Documentation The Network Provider shall protect confidential records from disclosure and protect consumer confidentiality in accordance with ss. 397.501(7), 394.455(6), 394.4615, and 414.295, F.S., and also the Health Insurance Portability and Accountability Act (HIPAA), 42 CFR Part 2, and any other applicable State, and Federal laws, rules, and regulations. c. Reports Attachment I HCO2 (f) Page 31 of 52 Guidance /Care Center, Inc. Contract No. P-4 � � South Florida Behavioral Health Network, Inc. Effective: 7/01/2018 Where this contract requires the delivery of reports to the ME, mere receipt by the ME shall not be construed to mean or imply acceptance of those reports. It is specifically intended by the parties that acceptance of required reports shall require a separate act in writing. The ME reserves the right to reject reports as incomplete, inadequate, or unacceptable according to the parameters set forth in the resulting contract. The ME, at its sole option, may allow additional time within which the Network Provider may remedy the objections noted by the ME or the ME may, after having given the Network Provider a reasonable opportunity to comply with the report requirements, declare this agreement to be in default. (1) The Network Provider shall submit to the M E financial and programmatic reports specified in Exhibit C -1, Required Reports, 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 -1, Required Reports. (5) The Network Provider shall submit prevention services data to PBPS, and/or any other data reporting mechanism as directed 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 and /or any other data reporting mechanism as directed by the ME is consistent with the data maintained in the Network Providers service documentation and or /consumer files. (c) The Network Provider will accurately report the performance measures specified in Attachment IV, Scope of Work. (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 Attachment I HCO2 (f) Page 32 of 52 Guidance /Care Center, Inc. Contract No. P-4 South Florida Behavioral Health Network, Inc: Effective: 7/01/2018 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) Upon submission of the monthly data, the Network Provider's Director of Prevention /Supervisor, shall send an e-mail to the ME's Director of Prevention Services attesting that the data submitted has been reviewed and approved. (f) In accordance with the provisions of section 402.73(1), F. S., and Rule 65- 29.001, F.A.C., corrective action plans may be required for non - compliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed for failures to implementor 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. (6) 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 IV, Scope of Work. (2) The Network Provider agrees that the PBPS, KIS, 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. PBPS maintained by Collaborative Planning Group Systems, Inc. Any conflicts will be clarified by the ME and the Network Provider shall adhere to the. ME's resolution. The Network Provider shall submit all service related data for consumers funded in whole or in part by SAMH funds, local match, or Medicaid. b. Performance Measurement Terms DCF PAM 155 -2 provides the definitions of the data elements used for various performance measures which are quantitative indicators, outcomes, and outputs used by the ME to objectively measure a Network Provider's performance and contains 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 Attachment I 1{CO2 (f) Page 33 of 52 Guidance /Care Center, Inc. Contract No. P-4 South Florida Behavioral Health Network, Inc. Effective: 7/01/2018 consumer outcomes, to the ME data system in compliance with DCF PAM 155 -2 requirements. The specific methodologies for each performance measure may be found at the following website: http: / /www:mvflfamilies.com /service - programs/ substance - abuse /pamph let- 155- 2 -v11, (2) The Network Provider is expected to have the capability to engage in organized performance improvement activities, and to be able to participate in partnership with the department and ME in performance improvement projects that are related to system wide transformation and improvement of services for individuals and families. (3) By execution of this contract the Network Provider hereby acknowledges and agrees that its performance under the contract must meet the standards set forth above and will be bound by the conditions set forth in this contract. If the Network Provider fails to meet these standards, the ME, at its exclusive option, may allow a reasonable period, not to exceed six (6) months, for the Network Provider to correct performance deficiencies. If performance deficiencies are not resolved to the satisfaction of the ME within the prescribed time and if no extenuating circumstances can be documented by the Network Provider to the ME's satisfaction, the ME must terminate the contract. The ME has the sole authority to determine whether there are extenuating or mitigating circumstances. (4) The ME will monitor the standards and outcomes specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes /Outputs, the standards and outcomes and in Attachment IV, Scope of Work., during the contract period, to determine if the Network Provider is achieving the levels that are specified. (5) Substance abuse prevention data information may be found on the Exhibit D 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 (1) In the event of a dispute as to the ME's determination regarding consumer eligibility and /or placement into the appropriate level of care, the ME's dispute resolution process, as described in the Standard Contract shall be followed. An eligibility dispute shall not preclude the provision of services to Individuals Served, unless the dispute resolution process reverses the ME's determination. (2) The Network Provider is responsible for the satisfactory performance of the tasks referenced in this contract. By executing this contract, the Network Provider recognizes its responsibility for the tasks, activities, and deliverables described herein and warrants that it has fully informed itself of all relevant factors affecting the accomplishment of the tasks, activities and deliverables and agrees to be fully accountable for the performance thereof whether performed by the Network Provider or its subcontractors. Attachment I HCO2 (f) Page 34 of 52 Guidance /Care Center, Inc. Contract No. P-4 South Florida Behavioral Health Network, Inc: Effective: 7 /01/2018 (3) The Network Provider agrees that services other than those set out in this contract will be provided only upon receipt of a written _authorization from the ME's Contract Manager or an authorized ME staff member. The department through the ME has final authority to make any and all determinations that affect the health safety and well- being of the residents of the State of Florida. (4) The Network Provider shall be responsible for the fiscal integrity of all funds under this contract, and for demonstrating that a comprehensive audit and tracking system exists to account for funding by consumer, and have the ability to provide an audit trail. The Network Provider's financial management and accounting system must have the capability to generate financial reports on individual service 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 consumer information system and reconciled with KIS, PBPS, or other data reporting system designated by the ME. (6) The Network Provider shall make available source documentation of units billed by Network Provider upon request from the ME staff. The Network Provider shall track all units billed to the ME by program and by Other Cost Accumulator (OCA). (7) _ A Network Provider that receives federal block grant funds from the Substance Abuse Prevention and Treatment or Community Mental Health Block Grants agrees to comply with Subparts I and II of Part B of Title XIX of the Public Health Service Act, s. 42 U.S.C. 300x -21 et seq. (as approved September 22, 2000) and the Health and Human Services (HHS) Block Grant regulations (45 C.F.R. 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 C.F.R. s. 54a. (9) A Network Provider that receives block grant funding shall monitor its compliance with block grant requirements and activities. (10) A Network Provider that receives block grant funding shall comply with state or federal requests for information related to block grant. (11) A Network Provider that receives CMH block grant funding and has been designated as a prevention provider for the purposes of H.R. . Res. 3547, 113th Cong. (2014) (enacted), compliance with federal requirements. (12) None of the funds provided under the following grants may be used to pay the salary of an individual at a rate in excess of Level II of the Executive Schedule: Block Grants for Community Mental Health Services, Substance Abuse Prevention and Treatment Block Grant, Projects for Assistance in Attachment I HCO2 (f) Page 35 of 52 Guidance /Care Center, Inc. Contract No. P -4 PP South Florida Behavioral Health Network, Inc. Effective: 7/01/2018 Transition from Homelessness, Project Launch, Florida Youth Transition to Adulthood; and Florida Children's Mental Health System of Care Expansion Implementation Project. (13) Any compensation paid for an expenditure subsequently disallowed as a result of the Managing Entity's or any Network Service Providers' non - compliance with state or federal funding regulations shall be repaid to the Department upon discovery. (14) The Network Provider shall make available to the ME and the Department all records pertaining to service delivery. These records shall be made available at all reasonable times for inspection, review, copying, or audit. Service delivery records include but are not limited to, invoicing, fiscal management, data management, incident reporting, consumer records, and such documents . determined to assure accountability of service provision and /or the expenditure of state and federal funds. (15) The Network Provider shall assist the ME and the Department in developing legislative budget requests based upon identified needs of the community. (16) The Network Provider shall provide to the ME, copies of, including but not limited to, evaluations, assessments, surveys, monitoring reports that pertain to licensure, accreditation, or other administrative or programmatic review, when those reports identify deficiencies that require corrective action. The Network Provider shall submit to the ME all of the applicable reports, including copies of the corrective action plan(s) within ten (10) calendar days of receipt by the Network Provider from the reviewing entity. (17) 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. (18) The Network Provider shall maintain human resource policies and procedures that provide safeguards to ensure compliance with laws, rules and regulations. Integrate current and /or new state /federal requirements and policy initiatives into its operations upon provision by the Department and /or ME of the same. (19) The Network Provider shall maintain in one place for easy accessibility and review by ME and /or Department staff all policies, procedures, tools, and plans adopted by the Network Provider. The Network Provider's policies, procedures, and plans, must conform to state and federal laws, the Florida Administrative Code, state and federal regulations, state and federal rules, and minimally meet expectations/ requirements contained in applicable Department of Children and Families and ME operating procedures. (20) The Network Provider shall maintain a mechanism for monitoring, updating, and disseminating policies and procedures regarding compliance with current government laws, rules, practices, regulations, and the ME's policies and procedures. (21) Pursuant to s. 394.74(3)(e), F.S., the Network Provider shall maintain data on the performance Attachment I HCO2 (f) Page 36 of 52 Guidance /Care Center, Inc. Contract No. P -4 PIP,' South Florida / / Behavioral Health Network, Inc. Effective: 7/01/2018 standards specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs, for the types of services provided under this contract. (22) The Network Provider shall comply with all other applicable federal laws, state statutes and associated administrative rules as m_ ay be promulgated or amended. See Exhibit F, SAMH Programmatic State and Federal Laws, Rules, and Regulations, and ME policies and procedures. (23) Records relating solely to actions taken in carrying out the requirements of this contract and records obtained by the ME and /or the Department to determine a Network Provider's compliance with this section are confidential and exempt from s. 119.07(1) and s. 24(a), Access to Public Records and Meetings, Article. I, Constitution of the State of Florida. Such records are not admissible in any civil or administrative action except in disciplinary proceedings by the Department of Health or the appropriate regulatory board, and are not part of the record of investigation and prosecution in disciplinary proceedings made available to the public by the Department of Health or the appropriate regulatory board. Meetings or portions of meetings of continuous quality improvement program committees that relate solely to actions taken pursuant to this section are exempt from s. 286.011.F.S. b. Coordination with other. Providers /Entities (1) The Network Provider shall develop, maintain, and improve coordination and integrated care systems as follows: (i) Partnerships and collaborations with other community organizations /entities is expected to add value to the programs, services, strategies and community activities funded under this Contract. (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 enter into agreements with other external stakeholders (2) The failure of other providers or entities does not relieve the network provider of any accountability for tasks or services that the Network Provider is obligated to perform pursuant to this contract. c. State and Federal Laws, Rules, and Regulations See Exhibit F, SAMH Programmatic State and Federal Laws, Rules, and Regulations Attachment I 11CO2 (f) Page 37 of 52 Guidance /Care Center, Inc. Contract No. P-4 South Florida Behavioral Health Network, Inc. Effective: 7/01/2018 7. Managing Entity Responsibilities a. Managing Entity Obligations (a)The ME shall only subcontract with entities that are fiscally sound, and that can adequately ensure the accountability of public funds. (b)The ME shall assess the Network Provider's financial stability, using a risk assessment approach; the risk assessment approach will examine the impact of programmatic requirements on the Network Provider's financial stability. Any issues identified as a result of the financial risk assessment shall be reported to the Department during the quarterly /monthly reconciliation and performance review identified in the Prime Contract. (c)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. (d)The ME is solely responsible for the oversight of the Network Provider and enforcement of all terms and conditions of this contract. Any and all inquiries and /or issues arising under this contract are to be brought solely and directly to the ME for consideration and resolution between the Network Provider and the ME. In any event, the ME's decision on all issues is final and solely subject to the ME's appeal process and legal rights of the Network Provider. (e)The ME reserves the right terminate this contract in whole or in part, for non- performance as determined by the ME and to procure the services purchased through this contract to another entity and /or Network Provider. (f) The ME is responsible for the administration, management, and oversight, and through subcontracts, the provision of behavioral health services in Miami Dade and Monroe Counties. (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)If applicable, 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. (i) The ME shall work with the Department to redirect administrative cost savings into improved access to quality care, promotion of service continuity, required implementation of EBPs, the expansion of the services array, and necessary infrastructure development. It acknowledges the benefits to be realized, include improved access to quality care, promotion of service continuity, implementation of EBPs, improved performance and outcomes, Attachment I HCO2 (f) Page 38 of 52 Guidance /Care Center, Inc. Contract No. P-4 �� South Florida / Behavioral Health Network, Inc. Effective: 7/01/2018 expansion of the service array, and necessary infrastructure development. b. Monitoring Requirements (1) The ME will monitor the Network Provider in accordance with this contract and the ME's Contract Accountability Policies and Procedures which can be obtained from the designated ME Contract Manager, and is incorporated herein by reference. The Network Provider shall comply with any coordination or documentation required by the ME's monitor(s) to successfully evaluate the programs, and shall provide complete access to all budget and financial information related to services provided under this contract, regardless of the source of funds. (2) . Network Providers with electronic health record (EHR) or electronic medical record systems (EMR) shall provide access to ME funded service and consumer data contained in these systems to the ME's monitoring team and provide sufficient resources to facilitate the monitoring process of services provided under this contract. Resources is defined but is not limited to, personnel, terminals, guest read -only accounts, privileges for monitors to access consumer records, and /or remote access into the systems by the monitors. (3) The ME will monitor the Network Provider on its performance of all tasks and special provisions of the contract. (4) The ME will provide a written report to the Network Provider within thirty (30) calendar days of the conclusion of the monitoring. If the report indicates corrective action is necessary, the Network Provider shall have ten (10) calendar days from receipt of the monitoring report to respond in writing to the request. In the sole discretion of the ME, if there is a threat to health, life, safety or well -being of consumers, the ME may require immediate corrective action or take such other action as the ME deems appropriate. Failure to implement corrective action plans to the satisfaction of the ME and after receiving due notice, shall be grounds for contract termination in whole or in part. c. Training and Technical Assistance (1) The ME's contact manager; or designee, will provide training and technical assistance concerning the terms and conditions of this contract and may maintain a documentation trail demonstrating any training and /or technical assistance efforts. (2)The ME will provide technical assistance and support to the Network Provider to ensure the continued integration of services and support for consumers, to include but not limited to, quality improvement activities to implement evidenced -based practice treatment protocols, the application of process improvement methods to improve the coordination of access and services that are culturally and linguistically appropriate. (3) The ME will provide technical assistance and support to the Network Provider for the maintenance and reporting of data on the performance standards that are specified_ in Exhibit Attachment I HCO2 (f) Page 39 of 52 Guidance /Care Center, Inc. Contract No. P - �� South Florida / Behavioral Health Network, Inc. Effective: 7/01/2018 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. Managing Entity Determinations The ME has exclusive authority to make the following determination(s) and to set the procedures that the Network Provider shall follow in obtaining the required determination(s): (1) Whether the Network Provider is meeting the terms and conditions of this contract, to include the Standard Contract, Attachment I, any documents incorporated into any attachment by reference, Program Description, and any documents incorporated by herein by reference. (2) The ME reserves the exclusive right to make certain determinations in these specifications. The absence of the ME setting forth a specific reservation of rights does not mean that all other areas of this contract are subject to mutual agreement. The ME reserves the right to make exclusively any and all determinations that it deems are necessary to protect the best interests of the State of Florida and the health, safety, and welfare of the consumers who are served by the ME either directly or through any one of its contracted Network Providers. (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 from the ME's Contract Manager 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 2018 -2019 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 Attachment I IICO2 (f) Page 40 of 52 Guidance /Care Center, Inc. Contract No. P -4 PIP South Florida Behavioral Health Network, Inc: Effective: 7/01/2018 Projected Covered Service Operating and Capital Budget shall evidence the reduction and redistribution of the cost savings. 2. Intern Registration Requirements pursuant to section 491.0045, F.S. (a) The Network Provider shall monitor and ensure that an individual who has not satisfied the postgraduate or post- master's level experience requirements, as specified in s. 491.005(1)(c), (3)(c), or (4)(c), F.S., register as an intern in the profession for which he' or she is seeking licensure before commencing the post - master's experience requirement or for an individual who intends to satisfy part of the required graduate -level practicum, internship, or field experience, outside the academic arena for any profession, the network provide must monitor and ensure that the individual registers as an intern in the profession for which he or she is seeking licensure before commencing the practicum, internship, or field experience. (b) An intern registration is valid for five (5) years. (c) A registration issued on or before March 31, 2017, expires March 31, 2022; and may not be renewed or reissued. Any registration issued after March 31, 2017, expires 60 months after the date it is issued. A subsequent intern registration may not be issued unless the candidate has passed the theory and practice examination described in s. 491.005(1)(d), (3)(d), and (4)(d), F.S. (d) An individual who has held a provisional license issued by the board may not apply for an intern registration in the same profession. 3. 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. 4. 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 Attachment I HCO2 (f) Page 41 of 52 Guidance/Care Center, Inc. Contract No. P -4 Pl• South Florida Behavioral Health Network, Inc. Effective: 7/01/2018 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. 5. Mandatory Reporting Requirements a. The Network Provider and any subcontractor must comply with and inform its employees of the following mandatory reporting requirements. Each employee of the Network Provider, and of any subcontractor, providing services in connection with this contract who has any knowledge of a reportable incident shall report such incident as follows: 1) Reportable incidents that may involve an immediate or impending impact on the health or safety of a consumer shall be immediately reported to the Contract Manager; and 2) Other reportable incidents shall be reported to the ME and Department's Office of Inspector General by completing a Notification /Investigation Request (form CF 1934) and emailing the request to the Office of Inspector General at ig_complaints @dcf.state.fl.us. The Network Provider and subcontractor . may also mail the completed form to the Office of Inspector General, 1317 Winewood Boulevard, Building 5, 2nd Floor, Tallahassee, Florida, 32399 -0700; or via fax at (850) 488 -1428. A reportable incident is defined in Children and Families Operating Procedures CFOP 180 -4 (CFOP 180 -4) Mandatory Reporting Requirements to The Office of The Inspector General, which can be obtained from the Contract Manager. b. In the event of a breach or potential breach of Protected Health Information, the Network Provider is directed to the reporting requirements delineated in the executed Business Associate Agreement, incorporated herein by reference. 6. Service Provision Requirements for Substance Abuse Prevention and Treatment Block Grants 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 and with the requirements of 42 C.F.R. Part 2. 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." Attachment I HCO2 (f) Page 42 of 52 Guidance /Care Center, Inc. Contract No. P-4 �� South Florida Behavioral Health Network, Inc. Effective: 7/01/2018 c. A Network Provider that receives SAPT block grant funding for the purpose of primary prevention, shall comply with 45 C.F.R. s. 96.125. d. Behavioral health services shall be provided to persons pursuant to s. 394.674, F.S., including those individuals who have been identified as requiring priority by state or federal law. The identified priority populations are found in Exhibit A, Consumer /Participants to be Served, however persons in categories (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 C.F.R. s. 96.123; (ii) Pursuant to 45 C.F.R. s: 96.126 (b), (1) and (2), adherence with the requirement to provide interim services for injection drug users by Network Service Providers receiving SAPT Block Grant funding and until the clinically appropriate level of treatment can be provided to the individual as follows: 45 C.F.R. s. 96.126 (b), (1)- (2) Capacity of treatment for intravenous substance abusers and any other requirement. (1) 14 days after making the request for admission to such a program; or (2) 120 days after the date of such request, if no such program has the capacity to admit the individual on the date of such request and if interim services, including referral for prenatal care, are made available to the individual not later than 48 hours after such request. e. Outreach Services to Injection Drug Users: The Network Provider shall carry out outreach activities to encourage injection drug users in need of treatment to undergo such treatment pursuant to the requirements in 45 C.F.R. s. 96.126(e)., The Network Provider shall document the services to demonstrate the provision of these services per the documentation requirements for Outreach services specified in Rule 65E -14, FAC. f. As required by45 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 g. The Network Provider shall ensure compliance with 45 C.F.R. Subpart C — Financial Management. h. The Network Provider agrees to comply with the data submission requirements outlined in DCF PAM 155 -2 and by the dates specified in Exhibit C, Required Reports. i. In addition to the modifiers to procedure codes that are currently required to be utilized as per Attachment I HCO2 (f) Page 43 of 52 Guidance /Care Center, Inc. Contract No. P -4 P7 South Florida / Behavioral Health Network, Inc. Effective: 7/01/2018 DCF PAM 155 -2, Appendix 2, the Network Provider is directed to utilize the modifiers required for Block Grant funds, where applicable. The Network Provider also agrees to report to the ME and /or the Department, information regarding the amount and number of services paid for by the Community Mental Health Services Block Grant and /or the Substance Abuse Prevention and Treatment Block Grant. j. Only if such services are purchased through this contract is the Network Provider responsible for complying with the reporting requirements outlined in Exhibit AB, Substance Abuse Prevention and Treatment Block Grant (SAPTBG) Early Intervention Funded Services for Human Immunodeficiency Virus (HIV) by the dates and to the individual(s) listed in Exhibit C, Required Reports. Subject to other applicable state and /or federal requirements, the ME may require additional reports from the Network Provider. k. Only if such services are purchased through this contract is the Network Provider responsible for complying with the for SAPTBG set -aside funded services for pregnant women and women with dependent children services, SAPTBG set -aside funded services for HIV Early Intervention Programs and the SAPTBG set -aside funds for Evidenced -based Outreach Services to Injection Drug Users as outlined in Exhibit C, Required Reports. I. The Network Provider shall make available, either directly or by arrangement with others, tuberculosis services to include counseling, testing, and referral for evaluation and treatment pursuant to 45 C.F.R. s.96.17 and in compliance with Ch. 65D- 30.004(9). F.A.C. m. 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. n. The Network Provider is required to participate in the peer -based fidelity assessment process to assess the quality, appropriateness, and efficacy of treatment services provided to individuals under this contract pursuant to 45 C.F.R. 96.136. o. The United States Public Health Service Act, Sections 1931(a)(1)(E), and 1916 (a)(5), and Title 45 of the Code of Federal Regulations, Part 96.135(a)(5) prohibit States from expending Substance Abuse Prevention and Treatment Block Grant (SAPTBG) and Community Mental Health Services funds "To provide financial assistance to any entity other than a public or non - profit private entity ". Ordinarily, the term "financial assistance" is used to describe a grant relationship as distinguished 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 C.F.R., Part 96.135(a)(5)]. Attachment I HCO2 (f) Page 44 of 52 Guidance/Care Center, Inc. Contract No. P -4 P� South Florida // Behavioral Health Network, Inc. Effective: 7/01/2018 7. 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. 8. 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 a re 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. 9. Sliding Fee Scale Prevention services are exempt from the Sliding Fee Scale requirements per Rule 65E- 14.018, F.A.C. 10. 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 consumers. The Network Provider agrees to comply with the provisions of Children and Families Operating Procedures 40 -50 (CFOP 40 -5). Acquisition of Vehicles For Transporting Disadvantaged Consumers if public funds provided under this contract will be used to purchase vehicles which will be used to transport consumers. 11. Medicaid Enrollment, if applicable 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. 12. National Provider Identifier (NPI) (a) All network providers shall obtain and use an NPI, a HIPAA standard unique health identifier for health care providers. (b) An application for an NPI may be submitted online at https: // nppes. cros .hhs.gov /NPPES /StaticForward.do ?forward = static.npistart (c) Additional information can be obtained from one of the following websites: Attachment I HCO2 (t) Page 45 of 52 Guidance /Care Center, Inc. Contract No. P -4 �� South Florida / Behavioral Health Network, Inc. Effective: 7/01/2018 (1) The Florida Medicaid HIPAA located at: http: / /www.fdhc.state.fl.us /hipaa /index.shtml (2) The National Plan and Provider Enumeration System (NPPES) located at: https://nppes.cms.hhs.gov/NPPES/Welcome.do (3) The CMS NPI located at: http: / /www.cros. hhs.gov /NationalProvldentStand/ 13. 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. 14. 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. 15. Programmatic, Fiscal & Contractual Contract File References All of the documentation submitted by the Network Provider which may include, but not be limited to the Network Provider's original proposal, Program Description, Projected Covered Service Operating and Capital Budget, Agency Capacity Report and Personnel Detail Record, are herein incorporated by reference for programmatic, contractual and fiscal assurances of service provision These referenced contractual documents will be part of the Contract Manager's file. Documents Attachment I HCO2 (f) Page 46 of 52 Guidance /Care Center, Inc. Contract No. P -4 ••-,• South Florida • Behavioral Health Network, Inc. Effective: 7/01/2018 incorporated by reference in this contract are available in the ME Contract Manager's file. 16. 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. 17. 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. 18.. 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 Attachment I HCO2 (f) Page 47 of 52 Guidance /Care Center, Inc. Contract No. P -4 • South Florida Behavioral Health Network, Inc. Effective: 7/01/2018 by the ME's Contract Manager. When property is transferred to the provider, the department shall pay for the title transfer. The provider's responsibility starts when the fully accounted for property or vehicle is assigned to and accepted by the provider. Business arrangements made between the provider and its subcontractors shall not permit the transfer of title of state property to subcontractors. While such business arrangements may provide for subcontractor participation in the use and maintenance of the property under their control, the ME shall hold the provider solely responsible for the use and condition of said property. Provider inventories shall be conducted in accordance with CFOP 80 -2. (3) If any property is purchased by the provider with funds provided by this contract, the provider shall inventory all nonexpendable property including all computers. A copy of which shall be submitted to the along with the expenditure report for the period in which it was purchased. At least annually, the provider shall submit a complete inventory of all such property to the ME whether new purchases have been made or not. (4) The Network Provider Inventory List, incorporated herein by reference, and available from the designated ME Contract Manager upon request, shall include, at a minimum, the identification number; year and /or model, a description of the property, its use and condition, current location, the name of the property custodian, class code (use state standard codes for capital assets), if a group, record the number and description of the components making up the group, name, make, or manufacturer, serial number(s), if any, and if an automobile, the VIN and certificate number; acquisition date, original acquisition cost, funding source, information needed to calculate the federal and /or state share of its cost. (5) The ME's Contract Manager must provide disposition instructions to the provider prior to the end of the contract period. The provider cannot dispose of any property that reverts to the ME or department without the Contract Manager's approval. The provider shall furnish a Closeout Inventory Form no later than 30 days before the completion or termination of this contract. The Closeout Inventory Form shall include all nonexpendable property including all computers purchased by the provider. The Closeout Inventory Form shall contain, at a minimum, the same information required by the annual inventory. (6) The provider hereby agrees that all inventories required by this contract shall be current and accurate and reflect the date of the inventory. If the original acquisition cost of a property item is not available at the time of inventory, an estimated value shall be agreed upon by both the provider and the ME and shall be used in place of the original acquisition cost. (7) Title (ownership) to and possession of all property purchased by the provider pursuant to this contract shall be vested in the ME upon completion or termination of this contract. During the term of this contract, the provider is responsible for insuring all property purchased by or transferred to the provider is in good working order. The provider hereby agrees to pay the cost of transferring title to and possession of any property for which ownership is evidenced by a certificate of title. The provider shall be responsible for repaying to the ME the replacement cost of any property inventoried and not transferred to the ME upon completion or termination of this contract. When property transfers from the provider to the ME, the provider shall be responsible for paying for the title transfer. • Attachment I HCO2 (f) Page 48 of 52 Guidance /Care Center, Inc. Contract No. P-4 ∎� South Florida / Behavioral Health Network, Inc. Effective: 7/01/2018 (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. 19. Health Insurance Portability and Accountability Act (HIPAA) a. In compliance with 45 CFR s.164.504(e), the Network Provider shall comply wit h 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. 20. 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), section 97.025, F.S. b. As a Voter Registration Agency, the Network Providers shall designate a Voting Reg istration 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. The Network Provider shall notify the ME's Contract Manager, in writing within (10) calendar days of staffing changes regarding this position. Attachment I HCO2 (f) Page 49 of 52 Guidance /Care Center, Inc. Contract No. P -4 �� South Florida Behavioral Health Network, Inc. Effective: 7/01/2018 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 -1, Required Reports. The Quarterly Activity Report Form is available at the link provided in paragraph f., 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: http: / /dos.myflorida.com /elections/ for - voters /voter - registration /nationa I- voter- registration- act/ 21. 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. d. 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 Attachment I HCO2 (f) Page 50 of 52 Guidance /Care Center, Inc. Contract No. P -4 pp South Florida / Behavioral Health Network, Inc. Effective: 7/01/2018 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 prescription drug or medication or controlled substance in the course of the performance of the duties of the Managing Entity under this contract, the professional liability coverage shall include medical malpractice liability and errors and omissions coverage, to cover the Managing Entity and all of its employees. The limits of the coverage shall be no less than $300,000 per occurrence with a minimal annual aggregate of no less than $1,000,000. h. If any officer, employee, or agent of the Network Service Provider, at all tiers, provides any professional services or provides or administers any prescription drug or medication or controlled substance in the course of the performance of the duties of the Network Service Provider, the Managing Entity shall cause the Network Service Provider, at all tiers, to obtain and provide proof to the Managing Entity and the Department of professional liability insurance coverage, including medical malpractice liability and errors and omissions coverage, to cover all Network Service Provider employees with the same limits. i. The. ME and the Department shall be exempt from, and in no way liable for, any sums of money that may represent a deductible or self- insured retention under any such insurance. The payment of any deductible on any policy shall be the sole responsibility of the Network Provider purchasing the insurance. 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 Attachment I HCO2 (f) Page 51 of 52 Guidance /Care Center, Inc. Contract No. P-4 P7 �� South Florida ,0/ Behavioral Health Network, Inc. Effective: 7/01/2018 the policy(ies). The Network Provider shall use its best good faith efforts to cause the insurers issuing all such general, automobile, and professional liability insurance to use a policy form with additional insured provisions naming the ME and the Department as an additional insured or a form of additional insured endorsement that is acceptable to the ME and the Department in the reasonable exercise of its judgment. k. All such insurance proposed by the Managing Entity shall be submitted to and confirmed by the Contract Manager annually by March 31. I. The requirements of this section shall be in addition to, and not in replacement of, the requirements of Section 10, of the Standard Contract to which this Attachment l 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 Providers 4. Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs 5. Exhibit E, Monthly Payment Request 6. Exhibit F, State and Federal Laws, Rules and Regulations 7. Exhibit G, Covered Service Funding by OCA 8. Exhibit H, Funding Detail & Local Match Plan Attachment I HCO2 (f) Page 52 of 52 Guidance /Care Center, Inc. Contract No. P-4 South Florida Behavioral Health Network, Inc. EXHIBIT A Consumers /Participants to be Served A. GENERAL. DESCRIPTION The Network Provider shall furnish services funded by this contract to the target population(s) checked below: Non- Prevention Prevention ❑ Adult Mental Health- Severe & Persistent Mental Illness El Adult Substance Abuse ❑. Adult Mental Health- Serious & Acute Episodes of Mental © Children's Substance Abuse Illness ❑ Adult Mental Health - Mental Health Problems El Substance Abuse Community Coalition ❑ Adult Mental. Health- Forensic Involvement El Children's Mental Health- Serious Emotional Disturbances El Children's Mental Health- Emotional Disturbances El Children's Mental Health -At Risk of Emotional Disturbances El Adult Substance Abuse El Children's Substance Abuse B. CONSUMER/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.mvflfamilies.com /service - programs /substance abuse /publications) and is incorporated herein by reference. 2. Behavioral Health services shall be provided to persons pursuant to s. 394.674, F.S., including those individuals who have been identified as requiring priority by state or federal law. These identified priorities include, but are not limited to, the categories in sections (a) through (j), below. Persons in categories (a) and (b) are specifically identified as persons to be given immediate priority over those in any other categories. a. Pursuant to 45 C.F.R. s. 96.131, priority admission to pregnant women and women with dependent children by Network 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 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), above. 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: Exhibit A Guidance /Care Center, Inc. Page 1 of 3 Contract No. P-4 South Florida Behavioral Health Network, Inc. (1) Parents or caregivers in need of adult mental health services pursuant to s. 394.674(1)(a)2., F.S., based upon the emotional crisis experienced from the potential removal of children; and (2) Parents or caregivers in need of adult substance abuse services pursuant to s. 394.674(1)(c)3., F.S. based on the risk to the children due to a substance use disorder. d. Individuals who reside in civil and forensic state Mental Health Treatment Facilities and individuals who are at risk of being admitted into a civil or forensic state Mental Health Treatment Facility pursuant to s. 394.4573, F.S., Rules 65E- 15.031 and 65E- 15.071, F.A.C.; e. Individuals who are voluntarily admitted, involuntarily examined, or placed under Part I, Chapter 394, F.S.; f. Individuals who are involuntarily admitted under Part V, Chapter 397, F.S.; g. Residents of assisted living facilities as required in s. 394.4574 and 429.075, F.S.; h. Children referred for residential placement in compliance with Ch. 65E- 9.008(4), F.A.C.; and i. Inmates approaching the End of Sentence pursuant to Children and Families Operating Procedure (CFOP) 155 -47. j. In the event of a Presidential Major Disaster Declaration, Crisis Counseling Program (CCP) services shall be contracted for according to the terms and conditions of any CCP grant award approved by representatives of the Federal Emergency Management Agency (FEMA) and the Substance Abuse and Mental Health Services Administration (SAMHSA). 3. Mental health crisis intervention and crisis stabilization facility services, and substance abuse detoxification and addiction receiving facility services, shall be provided to all persons meeting the criteria for admission, subject to the availability of beds and /or funds. C. CONSUMER /PARTICIPANTS DETERMINATION 1. Determination of consumer eligibility is the responsibility of the Network Provider. The Network Provider shall adhere to the eligibility requirements as specified in Exhibit F, SAMH Programmatic State and Federal Laws, Rules, and Regulations. The ME reserves the right to review the Network Provider's determination of consumer eligibility and override the determination of the Network Provider. When this occurs the Network Provider will immediately 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 consumer eligibility and /or placement into the appropriate level of care, the dispute shall not preclude the Network Provider from providing the provision of services to eligible individuals until the dispute is resolved. The dispute resolution process is described in Paragraph 42. of the Standard Contract. Exhibit A Guidance /Care Center, Inc. Page 2 of 3 Contract No. P -4 South Florida Behavioral Health Network, Inc. 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. 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. P-4 South Florida Behavioral Health Network, Inc. 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 $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 ($150,000.00 per fiscal year of this contract), 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. Fixed Price (Unit Cost) for contracts with a hybrid method of payment: 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 ($0.00), subject to the availability of funds. The unit prices are listed on Exhibit G, Covered Services Funding by OCA. c. Cost Reimbursement for contracts with a hybrid method of payment: The ME shall reimburse the Network Provider for allowable expenditures incurred pursuant to the terms of this contract and the terms in Exhibit M -1, Services to be Provided, for a total dollar amount not to exceed ($0.00), subject to the availability of funds and Exhibit M -2, Line Item Operating Budget. d. Aftercare, Intervention, Outpatient, and Recovery Support Services (Substance Abuse) are eligible for special group rates. Group services shall be billed based on 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. e. Pursuant to s. 394.76(3), Florida Statutes (F.S.), the Network Provider agrees to provide local matching funds in the amount of $112,500.00 as indicated in Exhibit H, Funding Detail and Local Match Plan. Should the Network Provider receive any funding from the "Uncompensated Units Exhibit B Page 1 of 6 Guidance /Care Center, Inc. Contract. No. P -4 South Florida Behavioral Health Network, Inc. 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 Protects Case Management Intensive Case Management Residential Services I -IV Supported Housing /Living Short Term Residential Treatment (not exempt if funded by Baker Act funds or operated by a public receiving facility) FACT Teams ii. CMH Programs (100435 Category & 102780 (PRTS) Category) that are not grant funded. f. 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. g. 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. h. The ME's decision to reduce or withhold funds will be submitted to the Network Provider in writing. The written notice will specify the manner in which the Network Provider has failed to comply with the terms of the contract. When, and if, compliance is achieved, the withheld funds will be disbursed to the Network Provider. i. If the Network Provider closes or suspends the provision of services funded by this contract, the Network Provider agrees to notify the ME in writing thirty (30) calendar days prior to their intent to close, suspend or end service(s). If the Network Provider fails to notify the ME, the Network Provider hereby agrees not to request payment for services provided in prior months if the actual number of services in the month for which payment is being requested is less than twenty -five percent (25 %) of the prorated amount of services by covered service as given on Exhibit G, Covered Service Funding by OCA, or twenty -five percent (25 %) of the prorated share of the amount of funding as specified on Exhibit G, Covered Service Funding by OCA. j. 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 Exhibit B Page2of6 Guidance /Care Center, Inc. Contract No. P -4 South Florida. Behavioral Health Network, Inc. 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: i. Individuals who have lost coverage through Medicaid, or any another publically funded health benefits assistance program coverage for any reason during the period of non - coverage subject to the sliding fee scale requirements in Rule 65E- 14.018, F.A.C; 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. 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 are 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. Exhibit B Page3of6 Guidance /Care Center, Inc. Contract No. P-4 South Florida Behavioral Health Network, Inc. h. The Network Provider shall assist individuals receiving services who need assistance and who meet the eligibility criteria for Medicaid to make application including assistance with medical documentation required in the disability determination process. i. The Network Provider agrees to assist individuals eligible for Medicaid covered by a Medicaid capitated entity who need and request assistance to obtain covered mental health services that the treating Network Provider considers to be medically necessary. This assistance shall include assisting clients in appealing a denial of services. 4. PAYMENT FROM MEDICAID HEALTH MAITENANCE ORGRANIZATIOINS, PREPAID MENTAL HEALTH PLAN, OR PROVIDER SERVICE NETWORKS Unless waived in Section D (Special Provisions) of this contract, the Network Provider agrees that payments from a health maintenance organization, prepaid mental health plan, or provider services network will 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 Network_ Provider's attention is directed to its obligations under applicable parts of Part A or Title IV of the Social Security Act and the Network 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: http://www.dcf.state.fl.us/programs/access/docs/TANF-Plan.pdf b. The contract shall specify the unit cost rate for each covered service contracted for TANF funding, which shall be the same rate as for non -TANF funding, but the contract shall not specify the number of TANF units or the amount of TANF funding for individual covered services. 6. INVOICE REQUIREMENTS a. The rates negotiated with any Network Provider may not exceed the rate as specified in in Exhibit G, Covered Service Funding by OCA and or the amounts listed in Exhibit M -2, Line Item Operating Budget, if applicable. 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, 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 Exhibit B Page4of6 Guidance /Care Center, Inc. Contract No. P4 South Florida Behavioral Health Network, Inc. Department. The invoice Exhibit E, Monthly Payment Request, is incorporated herein by reference and available upon request from the ME's Contract Manager. 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 Network 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 Network Provider must report any payments received from all other sources on the "Schedule of Bed -Day Availability" at the end of the fiscal year and refund any overpayment. Invoices shall be submitted in detail sufficient for a proper pre -audit and post- audit. 7. SUPPORTING DOCUMENTAITON a. The Network Provider agrees to maintain and submit to the ME, if applicable, service documentation for each service billed to the ME pursuant to this contract. The Network Provider shall track all units billed to the ME by program and by Other Cost Accumulator (OCA). Proper service documentation for each SAMH covered service is outlined in Rule 65E- 14.021, F.A.C., Exhibit Y, TANF SAMH Guidelines and TANF SAMH Incidental Expenditures for Housing Assistance, if applicable. Exhibit B Page 5 of 6 Guidance /Care Center, Inc. Contract No. P -4 South Florida Behavioral Health Network, Inc. b. The Network Provider shall maintain documentation to support all units billed to the ME and units subtracted for SAMH client services on each monthly request for payment. c. The Network Provider shall ensure that all services provided are entered into KIS, PBPS, or other data system designated by the ME. d. The ME, Department and the State's Chief Financial Officer, reserve the right to request supporting documentation at any time after actual units have been delivered. 8. The Network Provider's attention is directed to the Department of Financial Services Reference Guide for State Expenditures for guidance regarding the requirements applicable to the disbursement of funds from the State Treasury, regardless of payment methods. The Reference Guide for State Expenditures can be obtained at the following website: http : / /www.mvfloridacfo.com /aadir /reference guide /Reference Guide For State Expenditu res.pdf 9. FUNDING SWEEPS The Network Provider agrees that at the sole discretion of the ME and at such time and upon terms, conditions or criteria set by the ME, a review of the funding utilization rate or pattern of the Network Provider may be conducted by the ME. Based upon such review, if it is determined that the rate of utilization may result in a lapse of funds, then in that event the ME may amend the Network Provider's total amount of funding by reducing same 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, 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 6of6 Guidance /Care Center, Inc. Contract No. P -4 South Florida Behavioral Health Network, Inc. Exhibit C -1 Required Reports • Required II DIGOZOR II #ofGopies I�lit°g 1. ME Contract Manager Response to Monitoring Reports and Within 10 calendar days from the day the 1 (Electronic Submission via Corrective Action Plans report is received E -mail) 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 via • Actions, as applicable Contract Manager E -mail) 2. Director of Contract Accountability Memorandum of Understanding (MOU) with a Within 90 calendar days of the effective Federally Qualified Health Center (FQHC) date of the contract (for newly executed or MOU's); 1 (Electronic Submission via Federally Qualified Health Centers are required Within 30 calendar days for renewed E -mail) ME Contract Manager to submit policies and procedures that explain MOU's; Updates to P &P for FQHC's shall the access to primary care services to the be submitted within 30 calendar days of medically underserved behavioral health client adoption Sliding Fee Scale [reflecting the uniform 1 (Electronic Submission via schedule of discounts referenced in 65E- Prior to contract execution E -mail) ME Contract Manager 14.018(4)] Final FY 2018 -2019 (1) Projected Cost Center Operating and Submitted annually prior to contract Capital execution. Submit updates within 30 1. ME Contract Manager Budget, 1 (Electronic Submission via (2) Budget Narrative, calendar days of execution of an E -mail ) (3) Network Providers Agency Service amendment to the contract affecting the 2. VP of Finance Capacity Report, budget. (4) Cost Center Personnel Detail Report Program Description Annually, prior to contract execution. 1. ME Contract Manager (1) Organizational Profile Submit updates within 30 calendar days of 1 (Electronic Submission via Service Activity Description amendment E -mail) ( ) tY P � 2. VP of Behavioral Health Grievance Procedures Annually, prior to contract execution. 1 (Electronic Submission via 1. ME Contract Manager a) Clients (applicants or recipient of services) Submit updates within 30 calendar days of E -mail) b) Agency Staff implementation 2. VP of CQI Affidavit Re ardin Debarment Annually prior to contract execution, or as g g requested by the Contract Manager 1 ME Contract Manager Submit updates within 30 calendar days of amendment or 1. ME Contract Manager "No Wrong Door" Policy and Procedures as requested by 1 the contract manager and /or the QA/QI 2. QA/QI Risk & Compliance Risk & Compliance Manager Manager Exhibit C -1 Guidance /Care Center, Inc. Page 1 of 7 Contract No. P -4 • South Florida Behavioral Health Network, Inc. Within 24 hours of occurrence, in accordance with CFOP 215 -6 and Incident Report reportable incidents defined CFOP 180-4 p Mandatory Submission through IRAS Submission through IRAS. Reporting Requirements to the Office of • the Inspector General ADA Client Communication Assessment htus://fs16.formsite.com/DcFTrain Auxiliary Aid Service Record Monthly Summary ing/Monthly Summary Report By the 4th business day following the Report/form login.html p reporting month 1 (Electronic Submission via (Applicable to agency's that employ fifteen (15) E -mail) or more employees) Confirmation E -mail to the ME Contract Manager By July 20 of each fiscal year and /or 20 ME Sr. Accountant (Fiscal Final Invoice days 1 Department) after contract end date Designation of Dispute Resolution Officer Within 5 working days of contract 1 (Electronic Submission via g p execution E -mail) ME Contact Manager Inventory Report 8/1/2018 1 (Electronic Submission via ry p E -mail) ME Contract Manager Attestation of Network Provider's Verification that all applicable employees and subcontractors with access to ME and /or DCF 8/1/2018 1 (Electronic Submission via ME Contract Manager information systems have signed a DCF E -mail) g Security Agreement form CF 0114 , per the Attachment land Standard Contract 1. ME Contract Manager • Emergency Preparedness Plan 8/1/2018 1 (Electronic Submission via E -mail) 2. QA/QI Risk & Compliance Manager • Civil Rights Compliance Checklist 8/1/2018 • 1 (Electronic Submission via CF0946 g p ( ) E -mail) ME Contract Manager • • Civil Rights Certificate (CF707) 1 (Electronic Submission via g ( ) 8/1/2018 E -mail) ME Contract Manager 1. ME Contract Manager Quality Assurance /Quality Improvement Plan 8/1/2018 1 (Electronic Submission via E -mail) 2. QA/QI Risk & Compliance Manager • Signed Florida Department of Children and Families Employment Screening Affidavit that 1 (Electronic Submission via all required staff have been screened or 8/1/2018 ME Contract Manager Network Provider is awaiting the results of E -mail) • screening • Exhibit C -1 Guidance /Care Center, Inc. Page 2 of 7 Contract No. P-4 . South Florida Behavioral Health Network, Inc. 1. ME Contract Manager Action Plan (Integration of Behavioral Health - 8/31/2018 1 (Electronic Submission via Services and Primary Care, TIC, CLC) E -mail) 2. QA/QI Risk & Compliance Manager Attestation singed by the CEO /Executive Director indicating that all applicable staff 1 (Electronic Submission via funded by this Contract have received a copy 10/1/2018 E -mail) ME Contract Manager of this fully executed Contract and willreceive any amendments made to this Contract. • July 5, 2018 (Period: 04/01/18 - 06/30/18) October 5, 2018 NVRA Voter Registration Agencies Quarterly (Period: 07/01/18 - 09/30/18) 1. ME Voter Registration Activities Report Form (DS- DE131; effective January 5 , 2019 1 (Electronic Submission via Activities Coordinator 01/2012 or latest revision thereof, if applicable (Period: 10/01/18 - 12/31/18) E -mail) 2. ME Contract Manager April 5, 2019 (Period: 01/01/19 - 03/31/19) July 5, 2019 • (Period: 04/01/19- 06/30/19) • October 31, 2018 (Period: 07/01/18 - 09/30/18) • January 31, 2019 Quarterly Financial Statements (Balance Sheet (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission via 1. ME VP of Finance and Statement of Activity) April 30 , 2019 E -mail) (Period: 01/01/19- 03/31/19) 2. ME Contract Manager July 31, 2019 (Period: 04/01/19 - 06/30/19) October 31, 2018 (Period: 07 /01/18 - 09/30/18) January 31, 2019 Attestation indicating the filing of Form 941 and (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission via payment of any taxes due to the IRS have April 30, 2019 E -mail) ME Contract Manager been paid. (Period: 01 /01/19 - 03/31/19) July 31, 2019 (Period: 04/01/19 - 06/30/19) • January 30, 2019 1. ME Contract Manager Continuous Quality Improvement Updates (Period: 07/01/18 - 12/31/18) 1 (Electronic Submission via July 30, 2019 E -mail) 2. QA/QI Risk & Compliance (Period: 01 /01/19 - 06/30/19) Manager Completion of the annual self- assessment for 1. ME Contract Manager the following initiative: 3/1/2019 1 2. QA/QI Risk & Compliance 1. Integration of Behavioral Health and Primary Care (MeHAF) Manager Year -End Financial Reports for Network Provider's Not Requiring Audits Per Attachment II Exhibit C -1 Guidance /Care Center, Inc. Page 3 of 7 Contract No. P -4 South Florida Behavioral Health Network, Inc. Due 180 days after the end of the Network Provider's fiscal year or within 30 days of the recipient's receipt of the audit report, Certification indicating that recipient expended whichever occurs first, directly to each of 1 (Electronic Submission via 1. ME Contract Manager less than $750,000 in Federal Awards or in the following unless otherwise required by E -mail ) State Awards during the fiscal year Florida Statutes The schedule shall be 2. VP of Finance based on 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 otherwise required by Schedule of State Earnings Florida Statutes The schedule shall be 1 (Electronic Submission via 1. ME Contract Manager based on revenues and expenditures E -mail) 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 the recipient's receipt of the audit report, Projected Cost Center Operating and Capital whichever occurs first, directly to each of Budget the following unless otherwise required by 1 (Electronic Submission via 1. ME Contract Manager Actual Expenses & Revenues Schedule Florida Statutes The schedule shall be E -mail ) based on revenues and expenditures 2. VP of Finance recorded during the state's fiscal year. Due 180 days after the end of the Network Provider's fiscal year or within 30 days of Local Match Calculation Form - Template 9 - the recipient's receipt of the audit report, Department of Children and Families form, whichever occurs first, directly to each of available at the following website: the following unless otherwise required by 1. ME Contract Manager Florida Statutes The schedule shall be 1 (Electronic Submission via http: / /www.myflfamilies.com /service- based on revenues and expenditures E -mail) 2. VP of Finance programs /substance- abuse /managing- recorded during the states fiscal year. entities /2018- contract -docs Due 180 days after the end of the Network Provider's fiscal year or within 30 days of the recipient's receipt of the audit report, whichever occurs first, directly to each of the following unless otherwise required by 1. ME Contract Manager Schedule of Bed -Day Availability Payments Florida Statutes The schedule shall be 1 (Electronic Submission via based on revenues and expenditures E -mail) 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 the recipient's receipt of the audit report, whichever occurs first, directly to each of 1. ME Contract Manager Agency Prepared Financial Statements the following unless otherwise required by 1 (Electronic Submission via (Balance Sheet and Statement of Activity Florida Statutes The schedule shall be E -mail) 2. VP of Finance based on revenues and expenditures recorded during the states fiscal year. Year -End Financial Reports for Network Provider's Requiring Audits Per Attachment 11 Exhibit C -1 Guidance /Care Center, Inc. page 4 of 7 Contract No. P-4 South Florida Behavioral Health Network, Inc. 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 Correspondence from the Auditor showing the following unless otherwise required by 1. ME Contract Manager proof of submission of the Audit Report and Florida Statutes The schedule shall be 1 (Electronic Submission via Mangement Letter to the Network Provider. based on revenues and expenditures E -mail) 2. VP of Finance recorded during the state's fiscal year. Due 180 days after the end of the Network Provider's fiscal year or within 30 days of the recipient's receipt of the audit report, 1. ME Contract Manager Management letter addressed to the Network whichever occurs first, directly to each of 1 (Electronic Submission via Provider issued by the Auditor the following unless otherwise required by E -mail) 2. VP of Finance Florida Statutes The schedule shall be based on 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 recipients receipt of the audit report, whichever occurs first, directly to each of 1. ME Contract Manager Financial & Compliance Audit to include the the following unless otherwise required by 1 (Electronic Submission via necessary schedules per Attachment II Florida Statutes The schedule shall be E -mail) 2. VP of Finance based on 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 Schedule of State Earnings the following unless otherwise required by 1 (Electronic Submission via 1. ME Contract Manager Florida Statutes The schedule shall be E -mail) 2. VP of Finance based on 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, Schedule of Related Party Transaction whichever occurs first, directly to each of 1 (Electronic Submission via 1. ME Contract Manager Adjustments the following unless otherwise required by E -mail ) Florida Statutes The schedule shall be 2. VP of Finance based on revenues and expenditures recorded during the states fiscal year. • Local Match Calculation Form - Template 9 - Due 180 days after the end of the Network Department of Children and Families form, Provider's fiscal year or within 30 days of available at the following website: the recipient's receipt of the audit report, whichever occurs first, directly to each of 1 (Electronic Submission via 1. ME Contract Manager http: / /www.myflfamilies.com /service- the following unless otherwise required by E -mail ) programs /substance- abuse /managing- Florida Statutes The schedule shall be 2. VP of Finance entities /2018- contract -docs based on revenues and expenditures recorded during the states fiscal year. Exhibit C -1 Guidance /Care Center, Inc. Page 5 of 7 Contract No. P South Florida Behavioral Health Network, Inc. Year -End Financial Reports for Network Provider's Requiring Audits Per Attachment II - Continued Due 180 days after the end of the Network Provider's fiscal year or within 30 days of the recipients receipt of the audit report, Projected Cost Center Operating and Capital whichever occurs first, directly to each of Budget the following unless otherwise required by 1 (Electronic Submission via 1. ME Contract Manager Actual Expenses & Revenues Schedule Florida Statutes The schedule shall be 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 the recipient's receipt of the audit report, whichever occurs first, directly to each of 1. ME Contract Manager Schedule of Bed -Day Availability Payments the following unless otherwise required by 1 (Electronic Submission via Florida Statutes The schedule shall be E -mail) 2. VP of Finance based on revenues and expenditures recorded during the states fiscal year. Additional Reports Required for Substance Abuse Prevention Services Providers Prevention service data shall be submitted PBPS, or other data system Monthly Data Required by DCF PAM 155 -2 electronically to PBPS no later than the Electronically designated by the ME or the 4th of each month following the month of Department service Monthly Data to the ME's contracted evaluation Monthly, by the 4th calendar day after the Electronically DOES or any other format entity -BSRI month of service requested by BSRI Monthly Service Invoice Monthly, by the eighth (8th) calendar day 1 ME Sr. Accountant (Fiscal after the month of service Department) Invoice Review Supporting Documentation - Submitted with the monthly invoice 1 ME Sr. Accountant (Fiscal from PBPS in a jpeg format Department) Exhibit C -1 Guidance /Care Center, Inc. Page 6 of 7 Contract No. P-4 South Florida Behavioral Health Network, Inc. Additional Reports Required for Substance Abuse Prevention Services Providers- Continued Monthly E -Mail Notification to the ME Prevention Services Director and ME Data Analyst verify that the data in the PBPS system has been checked and is correct and complete 1. ME Director or Prevention and may be used for Block Grant reporting and Monthly, by the 4th calendar day after the 1 (Electronic Submission via Services payment. month of service E -mail) . 2. ME Data Analyst Refer to Scope of Work Attachment to the Contract for specifics • 1 (Electronic Submission via 1. ME Contract Manager Final Annual Site Schedule 8/31/2018 E -mail) 2. ME Director of Prevention Services Within 30 calendar days of the effective Memorandum of Understanding (MOU) with a date of the contract (for newly executed 1. ME Contract Manager Medum Me Community Coalition MOU's) 1 (Electronic Submission via OR E -mail) 2. ME Director or Prevention Within 30 calendar days for renewed Services MOU's 1. ME Contract Manager Submission of Participant Satisfaction Survey - Refer to Scope of Work Attachment to the 1 (Electronic Submission via _ Contract for specifics E -mail) 2. ME Director or Prevention Services Additional Reports Required for Prevention Partnership Grant (PPG) Services Providers 1. ME Contract Manager Program Status Report 7/15/2019 1 (Electronic Submission via (Period:07 /01/18- 06/30/19) E -mail) 2. ME Director or Prevention Services October 31, 2018 (Period: 07/01/18 - 09/30/18) January 31, 2019 1. ME Contract Manager (Period: 10/01/18 - 12/31/18) 1 (Electronic Submission via 2. ME Director or Prevention Financial Report - April 30, 2019 E -mail) Services (Period: 01/01/19 - 03/31/19) July 31, 2019 3. ME VP for Finance (Period: 04/01/19 - 06/30/19) 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. • • Exhibit C -1 Guidance /Care Center, Inc. Page 7 of 7 Contract No. P-4 South Florida Behavioral Health Network, Inc. Rev. 7.1.2018 EXHIBIT D Substance Abuse & Mental Health Required Performance Outcomes & Outputs Provider Name: Guidance /Care: Center, Inc. l Contract #: P -04. Date: 7/1/2018 Revision #: k '`"c r �r,. `•�, �., . ..* .. Table ` " ?k ' Network Provider Network' population Eg � Description 4,*" .t+a Target Adults Community Mental Health MH003 a. Average annual days worked for pay for adults with severe and persistent mental 40 illness MH703 b. Percent of adults with serious mental illness who are competitively employed 24% MH742 c. Percent of adults with severe and persistent mental illnesses who live in stable 90% housing environment MH743 d. Percent of adults in forensic involvement who live in stable housing environment 67% MH744 e. Percent of adults in mental health crisis who live in stable housing environment 86% Adult Substance Abuse SAA73 a. Percentage change in clients who are employed from admission to discharge 10% SA754 b. Percent change in the number of adults arrested 30 days prior to admission versus 15% 30 days prior to discharge SA755 c. Percent of adults who successfully complete substance abuse treatment services 51% SA756 d. Percent of adults with substance abuse who live in a stable housing environment 94% at the time of discharge Children's Mental Health MH012 a. Percent of school days seriously emotionally disturbed (SED) children attended 86% MH377 b. Percent of children with emotional disturbances (ED) who improve their level of 64% functioning MH378 c. Percent of children with serious emotional disturbances (SED) who improve their 65% level of functioning MH778 d. Percent of children with emotional disturbance (ED) who live in a stable housing 95% environment MH779 e. Percent of children with serious emotional disturbance (SED) who live in a stable 93% housing environment MH780 f. Percent of children at risk of emotional disturbance (ED) who live in a stable 96% housing environment Children's Substance Abuse SA725 a. Percent of children who successfully complete substance abuse treatment services 48% SA751 b. Percent change in the number of children arrested 30 days prior to admission 20% versus 30 days prior to discharge SA752 c. Percent of children with substance abuse who live in a stable housing 93% environment at the time of discharge Exhibit D Guidance /Care Center, Inc. Page 1 of 2 Contract No. P -4 South Florida Behavioral Health Network, Inc. Rev. 7.1.2018 Table 2 Network Service Provider Output Measures — Persons Served For Fiscal Year FY18 -19 Service Category FY Target Residential Care N/A ro a, Outpatient Care N/A • 76 Crisis Care N/A ia Q State Hospital Discharges N/A Peer Support Services N/A Residential Care N/A aJ • s • d Outpatient Care N/A Crisis Care N/A °' Residential Care N/A Outpatient Care N/A as v Detoxification N /A CO S Women's Specific Services N/A Injecting Drug Users N/A Q Peer Support Services Residential Care N/A y Outpatient Care N/A N Detoxification N/A H .0 C Q Prevention * *Refer to Attachment IV, Scope of Work for the numbers served. ** U Network Provider Compliance: Failure to meet the applicable standards established in Tables 1 and 2 shall be considered nonperformance pursuant to Standard Contract, Paragraph 36. Financial Consequences for Network Provider's Failure to Perform. Exhibit D Guidance /Care Center, Inc. Page 2 of 2 Contract No. P-4 South Florida Behavioral Health Network, Inc. 7/1/2018 • EXHIBIT E Monthly Payment Request 1. Exhibit E, Monthly Payment Request This exhibit is incorporated by reference and available upon request to the ME's Contract Manager Exhibit E Guidance /Care Center, Inc. 1 of 1 Contract No. P -4 South Florida Behavioral Health Network, Inc. Revised 71112017 Exhibit F SAMH PROGRAMMATIC STATE AND FEDERAL LAWS, RULES, AND REGULATIONS The Network Provider and its subcontractors shall comply with all applicable state and federal laws, rules and regulations, as amended from time to time, that affect the subject areas of the contract. Authorities include but are not limited to the following: F -1 Federal Authority F -1.1 Block Grants Regarding Mental Health and Substance Abuse B- 1.1.1 Block Grants for Community Mental Health Services 42 U.S.C. ss. 300x, et seq. B -1.1.2 Block Grants for Prevention and Treatment of Substance Abuse 42 U.S.C. ss. 300x -21 et seq. 45 C.F.R. Part 96, Subpart L F -1.2 Department of Health And Human Services, General Administration, Block Grants 45 C.F.R. Part. 96 F -1.3 Charitable Choice Regulations Applicable to Substance Abuse Block Grant and PATH Grant 42 C.F.R. Part 54 F -1.4 Confidentiality Of Substance Use Disorder Patient Records 42 C.F.R. Part 2 F -1.5 Security and Privacy 45 C.F.R. Part 164 F -1.6 Supplemental Security Income for the Aged, Blind and Disabled 20 C.F.R. Part 416 F -1.7 Temporary Assistance to Needy Families (TANF) 42 U.S.C. ss. 601 - 619 45 C.F.R., Part 260 F -1.8 Projects for Assistance in Transition from Homelessness (PATH) 42 U.S.C. ss. 290cc-21 — 290cc -35 F -1.9 Equal Opportunity for Individuals with Disabilities (Americans with Disabilities Act of 1990) 42 U.S.C. ss. 12101 -12213 F -1.10 Prevention of Trafficking (Trafficking Victims Protection Act of 2000) 22 U.S.C. s. 7104 2 C.F.R. Part 175 F -2 Florida Statutes F -2.1 Child Welfare and Community Based Care Ch. 39, F.S. Proceedings Relating to Children Exhibit F Page 1 of 4 Guidance /Care Center, Inc. Contract No. P-4 Ch. 402, F.S. Health and Human Services: Miscellaneous Provisions F -2.2 Substance Abuse and Mental Health Services Ch. 381, F.S. Public Health: General Provisions Ch. 386, F.S. Particular Conditions Affecting Public Health Ch. 394, F.S. Mental Health Ch. 395, F.S. Hospital Licensing and Regulation Ch. 397, F.S. Substance Abuse Services Ch. 400, F.S. Nursing Home and Related Health Care Facilities Ch. 414, F.S. Family Self- Sufficiency Ch. 458, F.S. Medical Practice Ch. 464, F.S. Nursing Ch. 465, F.S. Pharmacy Ch. 490, F.S. Psychological Services Ch. 491, F.S. Clinical, Counseling, and Psychotherapy Services Ch. 499, F.S. Florida Drug and Cosmetic Act Ch. 553, F.S. Building Construction Standards Ch. 893, F.S. Drug Abuse Prevention and Control S. 409.906(8), F.S. Optional Medicaid Services — Community Mental Health Services F -2.3 Developmental Disabilities Ch. 393, F.S. Developmental Disabilities F -2.4 Adult Protective Services Ch. 415, F.S. Adult Protective Services F -2.5 Forensics Ch. 916, F.S. Mentally Deficient and Mentally III Defendants Ch. 985, F.S. Juvenile Justice; Interstate Compact on Juveniles S. 985.19, F.S. Incompetency in Juvenile Delinquency Cases S. 985.24, F.S. Interstate Compact on Juveniles; Use of detention; prohibitions F -2.6 State Administrative Procedures and Services Ch. 119, F.S. Public Records Ch. 120, F.S. Administrative Procedures Act Ch. 287, F.S. Procurement of Personal Property and Services Ch. 435, F.S. Employment Screening Ch. 815, F.S. Computer- Related Crimes Ch. 817, F.S. Fraudulent Practices Exhibit F Page 2 of 4 Guidance /Care Center, Inc. Contract No. P -4 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, and invoices; processing time limits; dispute resolution; agency or judicial branch compliance S. 216.181(16)(b), F.S. Advanced funds for program startup or contracted services F -3 Florida Administrative Code F -3.1 Child Welfare and Community Based Care Ch. 65C -13, F.A.C. Foster Care Licensing Ch. 65C -14, F.A.C. Child -Caring Agency Licensing Ch. 65C -15, F.A.C. Child- Placing Agencies F -3.2 Substance Abuse and Mental Health Services Ch. 65D -30, F.A.C. 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 F -3.3 Financial Penalties Ch. 65 -29, F.A.C. Penalties on Service Providers F -4 MISCELLANEOUS F -4.1 Department of Children and Families Operating Procedures CFOP 155 -10 / 175 -40 Services for Children with Mental Health and Any Co- Occurring Substance Abuse or Developmental Disability Treatment Needs in Out - of -Home Care Placements CFOP 155 -11 Title XXI Behavioral Health Network CFOP 155 -47 Processing Referrals From The Department Of Corrections CFOP 215 -6 Incident Reporting and Analysis System (IRAS) F -4.2 Standards applicable to Cost Principles, Audits, Financial Assistance and Administrative Requirements S. 215.97, F.S. Florida Single Audit Act Exhibit F Page Guidance /Care Center, Inc. Contract No. P -4 S. 215.971, F.S. Agreements funded with federal or state assistance Comptroller's Memorandum No. 03 (1999 -2000) Florida Single Audit Act Implementation CFO's Memorandum No. 03 (2014 - 2015) Compliance Requirements for Agreements 2 C.F.R., Part 200 Office of Management and Budget Guidance - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, available at https : / /federalregister.gov /a/2013 -30465 2 C.F.R., Part 300. Department of Health and Human Services - Office of Management and Budget Guidance - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, Adoption of 2 C.F.R. Part 200 45 C.F.R., Part 75 Uniform Administration Requirements, Cost Principles, and Audit Requirements for HHS Awards F -4.3 Data Collection and Reporting Requirements S. 394.74(3)(e), F.S. Data Submission S. 394.9082, F.S. Behavioral health managing entities S. 394.77, F.S. Uniform management information, accounting, and reporting systems for providers S. 397.321(3)(c), F.S. Data collection and dissemination system DCF PAM 155 -2 Mental Health and Substance Abuse Measurement and Data «< The remainder of this page is intentionally left blank. »> Exhibit F Page Guidance /Care Center, Inc. _ Contract No. P-4 July 1, 2018 - June 30, 2019 EXHIBIT G: COVERED SERVICES FUNDING BY OCA 7/1/18 P4 GCC 49 3 4 5 6 7 8 9 10 11 18 19 20 Guidance /Care Center, Inc. P -04 ;tMII COVERED SERVICES FUNDING / RATE MH001 MH009 MH018 MH072 MH073 MH076 MH094 MHOPG MHOTB MDCRF MHOCN MHOCF TOTAL - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop - In/Self Help Centers $ - $ - 08 In- Home /On -Site $ $ - 11 Intervention - Individual $ - $ - 42 Intervention - Group $ - $ - 12 Medical Services $ - $ - 13 Medication - Assisted Treatment $ - $ - 14 Outpatient - Individual $ - $ - 35 Outpatient - Group $ - $ - 15 Outreach $ $ - - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare - Individual $ - $ - 43 Aftercare - Group $ - $ - 30 Information & Referral $ - $ - 34 FACT Team $ - $ - 36 Room & Board Level I $ - $ - 37 Room & Board Level II $ - $ - 38 Room & Board Level III $ - $ 39 Short-term Residential Treatment $ - $ 40 Clubhouse Services $ - $ - 44 CCST - Individual $ - $ - 45 CCST - Group $ - $ - 46 Recovery Support - Individual $ - $ - 47 Recovery Support - Group $ - $ - 48 Prevention - Indicated $ 41.23 $ - 49 Prevention - Selective $ 59.20 $ - 50 Prevention - Universal Direct $ 59.20 $ - 51 Prevention - Universal Indirect $ 59.20 $ - 99 Special Proviso /Cost Reimbursement $ - $ - 4N /A $ - gliliRlited cr"ells a e eli ililelfoZfundrlloeation L TOTAL FUNDING $ 150,000 $ $ $ $ $ $ $ $ $ $ $ $ $ TOTAL UNCOMPENSATED 1 1 1 1 1 1 1 1 1 1 1 I I$ - Exhibit G Guidance /Care Center, Inc. Contract No. P-4 1 of4 July 1, 2018 - June 30, 2019 EXHIBIT G: COVERED SERVICES FUNDING BY OCA 7/1/18 P4 GCC 49 3 4 5 6 7 8 9 10 19 20 Guidance /Care Center, Inc. P -04 G%I11 COVERED SERVICES FUNDING / RATE MH001 MH009 MH018 MINIM MH071 MHCAT ' MHOCN MHOCF TOTAL 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop -In /Self Help Centers $ - $ - 08 In- Home /On -Site $ - $ - 11 Intervention - Individual $ - $ - 42 Intervention - Group $ - $ - 12 Medical Services $ - $ - 13 Medication- Assisted Treatment $ - $ - 14 Outpatient - Individual $ - $ - 35 Outpatient - Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare - Individual $ - $ - 43 Aftercare - Group $ - $ - 30 Information & Referral $ - $ - 34 FACT Team $ - $ - 36 Room & Board Level I $ - $ - 37 Room & Board Level II $ - $ - 38 Room & Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST - Individual $ - $ - 45 CCST - Group $ - $ - 46 Recovery Support - Individual $ - $ - 47 Recovery Support - Group $ - $ - 48 Prevention - Indicated $ 41.23 $ - 49 Prevention - Selective $ 59.20 $ - 50 Prevention - Universal Direct $ 59.20 $ - 51 Prevention - Universal Indirect $ 59.20 $ - 99 Special Proviso /Cost Reimbursement $ - $ - 1/N/A $ - y*,Hi_alighted cells are elig`itile Q,p fund , TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED 1 I 1 1 I 1 1 1 1 1$ - Guidance /Care Center, Inc. Exhibit G Contract No. P - Page 2 of 4 July 1, 2018 - June 30, 2019 EXHIBIT G: COVERED SERVICES FUNDING BY OCA 7/1/18 P4 GCC 49 3 4 5 6 7 8 9 10 11 12 18 19 20 Guidance/Care Center, Inc. P -04 � COVERED SERVICES FUNDING /RATE MS003 MSO11 . MS021 MS023 MS025 MS027 MS081 M11091 MSOTD MS908 MDCRF MSOCN MSOCF TOTAL - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop - In/Self Help Centers $ - $ - 08 In- Home /On -Site $ - $ - 11 Intervention Individual $ - $ - 42 Intervention - Group $ - $ - 12 Medical Services $ - $ - 13 Medication - Assisted Treatment $ - $ - 14 Outpatient - Individual $ - $ - 35 Outpatient - Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level 11 $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare - Individual $ - $ - 43 Aftercare - Group $ - $ - 30 Information & Referral $ - $ - 34 FACT Team $ - $ - 36 Room & Board Level I $ - $ - 37 Room & Board Level II $ - $ - 38 Room & Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST - Individual $ - $ - 45 CCST - Group $ - $ - 46 Recovery Support - Individual $ - $ - 47 Recovery Support - Group $ - $ - 48 Prevention - Indicated $ 41.23 $ - 49 Prevention - Selective $ 59.20 $ - 50 Prevention - Universal Direct $ 59.20 $ - 51 Prevention - Universal Indirect $ 59.20 $ - 99 Special Proviso /Cost Reimbursement $ - $ - #N /A $ - 1DhlightedTcells are eligible { 1 3 allocation TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED 1 1 1 1 1 1 1 1 1 1 1 1 1$ - Guidance /Care Center, Inc. Exhibit G Contract No. P Page 3 of 4 July 1, 2018 - June 30, 2019 EXHIBIT G: COVERED SERVICES FUNDING BY OCA 7/1/18 P4 GCC 49 3 4 5 6 7 8 9 10 11 19 20 Guidance /Care Center, Inc. ("SA P -04 COVERED SERVICES FUNDING / RATE MS003 MSO11 MS021 MS023 MS025 MSOPP MSOTB MS903 MS913 MSOCN MSOCF TOTAL - - - - - 150,000 - - - - - $ 150,000 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop - In/Self Help Centers $ - $ - . 08 In- Home /On -Site $ - $ - 11 Intervention - Individual $ - $ - 42 Intervention - Group $ - $ - 12 Medical Services $ - $ - 13 Medication - Assisted Treatment $ - $ - 14 Outpatient - Individual $ - $ - 35 Outpatient - Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level 11 $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare - Individual $ - $ - 43 Aftercare - Group $ - $ - 30 Information & Referral $ - $ - 34 FACT Team $ - $ - 36 Room & Board Level I $ - $ - 37 Room & Board Level II $ - $ - 38 Room & Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST - Individual $ - $ - 45 CCST - Group $ - $ - 46 Recovery Support - Individual $ - $ - 47 Recovery Support - Group $ - $ - 48 Prevention - Indicated $ 41.23 23,000 $ 23,000 49 Prevention - Selective $ 59.20 62,000 $ 62,000 50 Prevention - Universal Direct $ 59.20 65,000 $ 65,000 51 Prevention - Universal Indirect $ 59.20 $ - 99 Special Proviso /Cost Reimbursement $ - $ - #N/A $ - HigtilightedTcells aril eligible Qp fund allocation TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ 150,000 $ - $ - $ - $ - $ - $ 150,000 TOTAL UNCOMPENSATED 1 1 1 1 1 1 1 1 Guidance /Care Center, Inc. Exhibit G Contract No. P - 4 Page 4 of 4 July 1, 2019 - June 30, 2020 EXHIBIT G: COVERED SERVICES FUNDING BY OCA 7/1/18 P4 GCC 49 3 4 5 6 7 8 9 10 11 18 19 20 Guidance /Care Center, Inc. P -04 COVERED SERVICES FUNDING / RATE MH001 MH009 MH018 MH072 MH073 MH076 MH094 MHOPG MHOTB MDCRF MHOCN MHOCF TOTAL - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop - In/Self Help Centers $ - $ - 08 In- Home /On -Site $ - $ - 11 Intervention - Individual $ - $ - 42 Intervention - Group $ - $ - 12 Medical Services $ - $ - 13 Medication - Assisted Treatment $ - $ - 14 Outpatient - Individual $ - $ - 35 Outpatient - Group $ $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level 1I $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare - Individual $ - $ - 43 Aftercare - Group $ - $ - 30 Information & Referral $ - $ - 34 FACT Team $ - $ - 36 Room & Board Level I $ - $ - 37 Room & Board Level II $ - $ - 38 Room & Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST - Individual $ - $ - 45 CCST - Group $ - $ - 46 Recovery Support - Individual $ - $ - 47 _ Recovery Support - Group $ - $ - 48 Prevention - Indicated $ 41.23 $ - 49 Prevention - Selective $ 59.20 $ - 50 Prevention - Universal Direct $ 59.20 $ - 51 Prevention - Universal Indirect $ 59.20 $ - 99 Special Proviso /Cost Reimbursement $ - $ - #N /A $ - Hi cells are eliali ffor fund('allocatio TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED 1 1 1 1 1 1 1 1 1 1 1 1 1$ Guidance /Care Center, Inc. Exhibit G Contract No. P - 4 Page 1 of 4 July 1, 2019 - June 30, 2020 EXHIBIT G: COVERED SERVICES FUNDING BY OCA 7/1/18 P4 GCC 49 3 4 5 6 7 8 9 10 19 20 Guidance/Care Center, Inc. P -04 CA-11-1 - COVERED SERVICES FUNDING / RATE MHOO1 MH009 MHO18 MANN MHO71 MHCAT MHOCN MHOCF TOTAL - $ - 01 Assessment $ - $ - • 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop - In/Self Help Centers $ - $ - 08 In- Home /On -Site $ - $ - 11 Intervention - Individual $ - $ - 42 Intervention - Group $ - $ - 12 Medical Services $ - $ - 13 Medication - Assisted Treatment $ - $ - 14 Outpatient - Individual $ - $ - 35 Outpatient - Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - 1 - 28 Incidental Expenses $ - $ - 29 Aftercare - Individual $ - $ - 43 Aftercare - Group $ - $ - 30 Information & Referral $ - $ - 34 FACT Team $ - $ - 36 Room & Board Level I $ - $ - 37 Room & Board Level II $ - $ - 38 Room & Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST - Individual $ - $ - 45 CCST - Group $ - $ - 46 Recovery Support - Individual $ - $ - 47 Recovery Support - Group $ - $ - 48 Prevention - Indicated $ 41.23 $ - 49 Prevention - Selective $ 59.20 $ 50 Prevention - Universal Direct $ 59.20 $ - 51 Prevention - Universal Indirect $ 59.20 $ - 99 Special Proviso /Cost Reimbursement $ - _ $ - #N /A $ - *Hfilili"hted_ cells 039 eliTitile for fund allocation TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED 1 1 1 1 1 1 1 1 1 1$ - • Guidance /Care Center, Inc. Exhibit G Contract No. P - 4 Page 2 of 4 July 1, 2019 - June 30, 2020 EXHIBIT G: COVERED SERVICES FUNDING BY OCA 7/1/18 P4 GCC 49 3 4 5 6 7 8 9 10 ' 11 12 18 19 20 Guidance/Care Center, Inc. P -04 ‘5,t COVERED SERVICES FUNDING / RATE MS003 MS011 MS021 MS023 MS025 MS027 MSO81 MH091 MSOTB MS908 MDCRF MSOCN MSOCF TOTAL - - - - - - - - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop -In /Self Help Centers $ - $ - 08 In- Home /On -Site $ - $ - 11 Intervention - Individual $ - $ - 42 Intervention - Group $ - $ - 12 Medical Services $ - $ - 13 Medication - Assisted Treatment $ - $ - 14 Outpatient - Individual $ - $ - 35 Outpatient - Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare - Individual $ - $ - 43 Aftercare - Group $ - $ - 30 Information & Referral $ - $ - 34 FACT Team $ - $ - 36 Room & Board Level I $ - $ - 37 Room & Board Level II $ - $ - 38 Room & Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST - Individual $ - $ - 45 CCST - Group $ - $ - 46 Recovery Support - Individual $ - $ - 47 Recovery Support - Group $ - $ - 48 Prevention - Indicated $ 41.23 $ - 49 Prevention - Selective $ 59.20 $ - 50 Prevention - Universal Direct $ 59.20 $ - 51 Prevention - Universal Indirect $ 59.20 $ - 99 Special Proviso /Cost Reimbursement $ - $ - 4N /A $ - i gliligheed c["ells are elig'i6le fZafundrllocatio TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED 1 1 I 1 1 1 1 1 1 1 1 1 1$ - • Guidance /Care Center, Inc. Exhibit G Contract No. P Page 3 of 4 July 1, 2019 - June 30, 2020 EXHIBIT G: COVERED SERVICES FUNDING BY OCA 7/1/18 P4 GCC 49 3 4 5 6' 7 8 9 10 11 19 20 Guidance/Care Center, Inc. P -04 COVERED SERVICES FUNDING / RATE MS003 MSO11 MS021 MS023 MS025 MSOPP MSOTB MS903 MS913 MSOCN MSOCF TOTAL - - - 1 50,000 - - - - - $ 150,000 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop- In/Self Help Centers $ - $ - 08 In- Home /On -Site $ - $ - 11 Intervention - Individual $ - $ - 42 Intervention - Group $ - $ - 12 Medical Services $ - $ _ 13 Medication - Assisted Treatment $ - $ - 14 Outpatient - Individual $ - $ - 35 Outpatient - Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ _ 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare - Individual $ - $ - 43 Aftercare - Group $ - $ - 30 Information & Referral $ - $ - 34 FACT Team $ - $ - 36 Room & Board Level I $ - $ - 37 Room & Board Level II $ - $ - 38 Room & Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST - Individual $ - $ - 45 CCST - Group $ - $ - 46 Recovery Support - Individual $ - $ - 47 Recovery Support - Group $ - $ - 48 Prevention - Indicated $ 41.23 23,000 $ 23,000 49 Prevention - Selective $ 59.20 62,000 $ 62,000 50 Prevention - Universal Direct $ 59.20 65,000 $ 65,000 51 Prevention - Universal Indirect $ 59.20 $ - 99 Special Proviso /Cost Reimbursement $ - $ - #N/A $ - LH ill ilighiedr1ls EEG eligible '7foilfund[tallocation TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ 150,000 $ - $ - $ - $ - $ - $ 150,000 TOTAL UNCOMPENSATED 1 1 1 1 1 1 1 1 1 I Guidance /Care Center, Inc. Exhibit G Contract No. P - 4 Page 4 of 4 July 1, 2020 - June 30, 2021 EXHIBIT G: COVERED SERVICES FUNDING BY OCA 7/1/18 P4 GCC 49 3 4 5 6 7 8 9 10 11 18 19 20 Guidance /Care Center, Inc. P -04 COVERED SERVICES FUNDING / RATE MH001 MH009 MH018 MH072 MH073 MH076 MH094 MHOPG MHOTB MDCRF MHOCN MHOCF TOTAL - - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop - In/Self Help Centers $ - $ - 08 In- Home /On -Site $ - $ - 11 Intervention - Individual $ - $ - 42 Intervention - Group $ - $ - 12 Medical Services $ - $ - 13 Medication- Assisted Treatment $ - $ - 14 Outpatient - Individual $ - $ - 35 Outpatient - Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare - Individual $ - $ - 43 Aftercare - Group $ - $ - 30 Information & Referral $ - $ - 34 FACT Team $ - $ - 36 Room & Board Level I $ - $ - 37 Room & Board Level II $ - $ - 38 Room & Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST - Individual $ - $ - 45 CCST - Group $ - $ - 46 Recovery Support - Individual $ - $ - 47 Recovery Support - Group $ - $ - 48 Prevention - Indicated $ 41.23 $ - 49 Prevention - Selective $ 59.20 $ - 50 Prevention - Universal Direct $ 59.20 $ - 51 Prevention - Universal Indirect $ 59.20 $ - 99 Special Proviso /Cost Reimbursement $ - $ - #N /A $ - *�Highlighted cells are eligilifeifor rit_02 allocation TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED 1 1 1 1 1 1 1 1 1 1 1 1 1$ - Exhibit G Guidance /Care Center, Inc. Contract No. P-4 1 of4 July 1, 2020 - June 30, 2021 EXHIBIT G: COVERED SERVICES FUNDING BY OCA 7/1/18 P4 GCC 49 3 4 5 6 7 8 9 10 19 20 Guidance/Care Center, Inc. P -04 COVERED SERVICES FUNDING / RATE MHOO1 MHOO9 MHO18 MHOBN MH071 MHCAT MHOCN MHOCF TOTAL - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop - In/Self Help Centers $ - $ - 08 In- Home /On -Site $ - $ - 11 Intervention - Individual $ - $ - 42 Intervention - Group $ - $ - 12 Medical Services $ - $ - 13 Medication - Assisted Treatment $ - $ - 14 Outpatient - Individual $ - $ - 35 Outpatient - Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare - Individual $ - $ - 43 Aftercare - Group $ - $ - 30 Information & Referral $ - $ - 34 FACT Team $ - $ - 36 Room & Board Level I $ - $ - 37 Room & Board Level II $ - $ - 38 Room & Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST - Individual $ - $ - 45 CCST - Group $ - $ - 46 Recovery Support - Individual $ - $ - 47 Recovery Support - Group $ - $ - 48 Prevention - Indicated $ 41.23 $ - 49 Prevention - Selective $ 59.20 $ - 50 Prevention - Universal Direct $ 59.20 $ - 51 Prevention - Universal Indirect $ 59.20 $ - 99 Special Proviso /Cost Reimbursement $ - $ - #N /A $ - galili cells are a Eible fo'>r fuuidrilloeation TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED 1 1 1 1 1 1 1 1 1 1$ - Guidance /Care Center, Inc. - Exhibit G - Contract No. P - 4 - Page 2 of 4 July 1, 2020 - June 30, 2021 EXHIBIT G: COVERED SERVICES FUNDING BY OCA 7/1/18 P4 GCC 49 3 4 5 6 7 8 9 10 11 12 18 19 20 Guidance /Care Center, Inc. P -04 ‘S:\ COVERED SERVICES FUNDING / RATE MS003 MSO11 MS021 MS023 MS025 MS027 MS081 MH091 MSOTB MS908 MDCRF MSOCN MSOCF TOTAL - - - - - - - - $ - 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop - In/Self Help Centers $ - $ - 08 In- Home /On -Site $ - $ - 11 Intervention - Individual $ - $ - 42 Intervention - Group $ - $ - 12 Medical Services $ - $ - 13 Medication - Assisted Treatment $ - $ - 14 Outpatient - Individual $ - $ - 35 Outpatient - Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare - Individual $ - $ - 43 Aftercare - Group $ - $ - 30 Information & Referral $ - $ - 34 FACT Team $ - $ - 36 Room & Board Level I $ - $ - 37 Room & Board Level II $ - $ - 38 Room & Board Level III $ - $ - 39 Short -term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST - Individual $ - $ - 45 CCST - Group $ - $ - 46 Recovery Support - Individual $ - $ - 47 Recovery Support - Group $ - $ - 48 Prevention - Indicated $ 41.23 $ - 49 Prevention - Selective $ 59.20 $ - 50 Prevention - Universal Direct $ 59.20 $ - 51 Prevention - Universal Indirect $ 59.20 $ - 99 Special Proviso /Cost Reimbursement $ - $ - #N /A $ - j ghlighted Q•bEB3 eligible for fund allocation TOTAL FUNDING $ 150,000 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTAL UNCOMPENSATED 1 1 1 1 I 1 1 I 1 1 1 1 I$ - Guidance /Care Center, Inc. Exhibit G Contract No. P - 4 Page 3 of 4 July 1, 2020 - June 30, 2021 EXHIBIT G: COVERED SERVICES FUNDING BY OCA 7/1/18 P4 GCC 49 3 4 5 6 7 8 9 10 11 19 20 Guidance/Care Center, Inc. P -04 CSA COVERED SERVICES FUNDING / RATE MS003 MSO11 MS021 MS023 MS025 MSOPP MSOTB MS903 MS913 MSOCN MSOCF TOTAL - - - 15 0,000 - - - - - $ 150,000 01 Assessment $ - $ - 02 Case Management $ - $ - 03 Crisis Stabilization $ - $ - 04 Crisis Support/Emergency $ - $ - 06 Day/Night $ - $ - 07 Drop -In /Self Help Centers $ - $ - 08 In- Home /On -Site $ - $ - 11 Intervention - Individual $ - $ - 42 Intervention - Group $ - $ - 12 Medical Services $ - $ - 13 Medication - Assisted Treatment $ - $ - 14 Outpatient - Individual $ - $ - 35 Outpatient - Group $ - $ - 15 Outreach $ - $ - 18 Residential Level I $ - $ - 19 Residential Level II $ - $ - 20 Residential Level III $ - $ - 21 Residential Level IV $ - $ - 24 Substance Abuse Detox $ - $ - 25 Supported Employment $ - $ - 26 Supportive Housing $ - $ - 27 TASC $ - $ - 28 Incidental Expenses $ - $ - 29 Aftercare - Individual $ - $ - 43 Aftercare - Group $ - $ - 30 Information & Referral $ - $ - 34 FACT Team $ - $ - 36 Room & Board Level I $ - $ - 37 Room & Board Level II $ - $ - 38 Room & Board Level III $ - $ - 39 Short-term Residential Treatment $ - $ - 40 Clubhouse Services $ - $ - 44 CCST - Individual $ - $ - 45 CCST - Group $ - $ - 46 Recovery Support - Individual $ - $ - 47 Recovery Support - Group $ - $ - 48 Prevention - Indicated $ 41.23 23,000 $ 23,000 49 Prevention - Selective $ 59.20 62,000 $ 62,000 50 Prevention - Universal Direct $ 59.20 65,000 $ 65,000 51 Prevention - Universal Indirect $ 59.20 $ - 99 Special Proviso /Cost Reimbursement $ - $ - #N /A $ - Ifi GG' hted cells are eli.'ilile for fund allocation TOTAL FUNDING $ 150,000 $ - $ - $ - $ -- $ - $ 150,000 $ - $ - $ - $ - $ - $ 150,000 TOTAL UNCOMPENSATED 1 1 1 1 1 1 1 1 1 1 1 Guidance /Care Center, Inc. Exhibit G Contract No. P - 4 Page 4 of 4 July 1, 2018 -June 30, 2019 EXHIBIT H - FUNDING DETAIL July 2018 Provider: Guidance /Care Center, Inc. Contract #: P -04 Amendment # ADULT MENTAL HEALTH CHILDREN MENTAL HEALTH OCA DESCRIPTION NEW OCA AMOUNT OCA DESCRIPTION NEW OCA AMOUNT Residential Services MH001 $ - Residential Services MH001 $ - Non-Residential Services MH009 $ - Non - Residential Services MH009 $ - Crisis and Baker Act Services MH018 $ - Crisis and Baker Act Services MHO 18 $ - Community Forensic Program MH072 $ - Special Appropriation - ICFH MHOBN $ - FACT Team MH073 $ - Purchased Residential Treatment (PRTS) MH071 $ - Indigent Drug Program MH076 $ - Community Action Treatment (CAT) Team MHCAT $ - Proviso Allocation - Citrus MH094 $ - $ - PATH Grant MHOPG $ - $ - TANF Services MHOTB $ - $ - Early Intervention - Psychotic Disorders MH026 $ - $ - Forensic Hospital Multidisciplinary Team MHOFH $ - $ - For Profit Sub - Recipeint - Key West HMA MHSFP $ - $ - Supported Employment Services MHEMP $ - $ - Miami -Dade County Homeless Trust MH010 $ - $ - IOS Pilot Project MH021 $ - $ - MDC - Central Receiving Facility MDCRF $ - $ - Care Coordination MHOCN $ - Care Coordination MHOCN $ - Carry Forward MHOCF $ - Carry Forward MHOCF $ - TOTAL ADULT MENTAL HEALTH = $ - TOTAL CHILDREN MENTAL HEALTH = $ - ADULT SUBSTANCE ABUSE CHILDREN SUBSTANCE ABUSE OCA DESCRIPTION NEW OCA AMOUNT OCA DESCRIPTION NEW OCA AMOUNT Residential Services MS003 $ - Residential Services MS003 $ - Non-Residential Services MS011 $ - Non - Residential Services MS011 $ - Detox Services MS021 $ - Detox Services MS021 $ - HIV Services MS023 $ - HIV Services MS023 $ - Prevention Services MS025 $ - Prevention Services MS025 $ - Women's Services MS027 $ - Prevention Partnership Grant MSOPP $ 150,000 Pregnant Women Project MS081 $ - TANF Services MSOTB $ - Proviso Allocation - GCC MS091 $ - Proviso Allocation Here's Help MS903 $ - TANF Services MSOTB $ - Here's Help Opioid Training MS913 $ - Proviso Allocation - New Hope CORPS MS908 $ - $ - Targeted Response - Opioid Crisis MSOPH $ - $ - Opioid Crisis MAT MSOPM $ - $ - Here's Help Opioid Training MS913 $ - $ - $ - $ - $ - $ - MDC - Central Receiving Facility MDCRF $ - $ - Care Coordination MSOCN $ - Care Coordination MSOCN $ - Carry Forward MSOCF $ - Carry Forward MSOCF $ - TOTAL ADULT SUBSTANCE ABUSE = $ - TOTAL CHILDREN SUBSTANCE ABUSE = $ 150,000 FUNDS NOT REQUIRING MATCH:, Drug Abuse Services $ - TOTAL ALL PROGRAMS = $ 150,000 Prevention $ - UNCOMPENSATED UNITS = Deinstitutionalization Project $ - TOTAL = $ 150,000 CMH Program $ - MH Block Grant TOTAL FUNDS REQUIRING MATCH = $ 150,000 TOTAL FUNDS NOT REQUIRING MATCH $ - LOCAL MATCH REQUIRED = $ 37,500 NOTES #N /A Guidance /Care Center, Inc. Exhibit H Contract No. P - 4 Page 1 of 1 July 1, 2019 - June 30, 2020 EXHIBIT H - FUNDING DETAIL July 2019 Provider: Guidance /Care Center, Inc. Contract #: P -04 Amendment # ADULT MENTAL HEALTH CHILDREN MENTAL HEALTH OCA DESCRIPTION NEW OCA AMOUNT OCA DESCRIPTION NEW OCA AMOUNT Residential Services MH001 $ - Residential Services. MH001 $ - Non-Residential Services MH009 $ - Non - Residential Services MI1009 $ - Crisis and Baker Act Services MH018 $ - Crisis and Baker Act Services MH018 $ - Community Forensic Program MH072 $ - Special Appropriation - ICFH MHOBN $ - FACT Team MH073 $ - Purchased Residential Treatment (PATS) MH071 $ - Indigent Drug Program MH076 $ - Community Action Treatment (CAT) Team MHCAT $ - Proviso Allocation - Citrus MH094 $ - $ - PATH Grant MHOPG $ - $ - TANF Services MHOTB $ - $ - Early Intervention - Psychotic Disorders MH026 $ - $ - Forensic Hospital Multidisciplinary Team MHOFH $ - $ - For Profit Sub - Recipeint - Key West HMA MHSFP $ - $ - Supported Employment Services MHEMP $ - $ - Miami -Dade County Homeless Trust MH010 $ - $ - IOS Pilot Project MH021 $ - $ - MDC - Central Receiving Facility MDCRF $ - $ - Care Coordination MHOCN $ - Care Coordination MHOCN $ - Cany Forward MHOCF $ - Carry Forward MHOCF $ - TOTAL ADULT MENTAL HEALTH = $ - TOTAL CHILDREN MENTAL HEALTH = $ - ADULT SUBSTANCE ABUSE CHILDREN SUBSTANCE ABUSE OCA DESCRIPTION NEW OCA AMOUNT OCA DESCRIPTION NEW OCA AMOUNT Residential Services MS003 $ - Residential Services MS003 $ - Non-Residential Services MS011 $ - Non - Residential Services MSO11 $ - Detox Services MS021 $ - Detox Services MS021 $ - HIV Services MS023 $ - HIV Services MS023 $ - Prevention Services MS025 $ Prevention Services MS025 $ - Women's Services MS027 $ - Prevention Partnership Grant MSOPP $ 150,000 Pregnant Women Project MS081 $ - TANF Services MSOTB $ - Proviso Allocation - GCC MS091 $ - Proviso Allocation - Here's Help MS903 $ - TANF Services MSOTB $ - Here's Help Opioid Training MS913 $ - Proviso Allocation - New Hope CORPS MS908 $ - $ - Targeted Response - Opioid Crisis MSOPH $ - $ - Opioid Crisis MAT MSOPM $ - $ - Here's Help Opioid Training MS913 $ - $ - $ - $ - $ - $ - MDC - Central Receiving Facility MDCRF $ - $ - Care Coordination MSOCN $ - Care Coordination MSOCN $ - Carry Forward MSOCF $ - Carry Forward MSOCF $ - TOTAL ADULT SUBSTANCE ABUSE = $ - TOTAL CHILDREN SUBSTANCE ABUSE = $ 150,000 FUNDS NOT REQUIRING MATCH: Drug Abuse Services $ - TOTAL ALL PROGRAMS = $ 150,000 Prevention $ - UNCOMPENSATED UNITS = Deinstitutionalization Project $ - TOTAL = $ 150,000 CMH Program $ - MH Block Grant TOTAL FUNDS REQUIRING MATCH = $ 150,000 TOTAL FUNDS NOT REQUIRING MATCH $ - LOCAL MATCH REQUIRED = $ 37,500 NOTES #N /A Guidance /Care Center, Inc. Exhibit H Contract No. P - 4 Page 1 of 1 July 1, 2020 - June 30, 2021 EXHIBIT H - FUNDING DETAIL July 2020 Provider: Guidance/Care Center, Inc. Contract #: P -04 Amendment # ADULT MENTAL HEALTH CHILDREN MENTAL HEALTH OCA DESCRIPTION NEW OCA AMOUNT OCA DESCRIPTION NEW OCA AMOUNT Residential Services MH001 $ - Residential Services MH001. $ - Non-Residential Services MH009 $ - Non - Residential Services MH009 $ - Crisis and Baker Act Services MH018 $ - Crisis and Baker Act Services MHO18 $ - Community Forensic Program MI-1072 $ - Special Appropriation - ICFH MHOBN $ - FACT Team MH073 $ - Purchased Residential Treatment (PRTS) MH071 $ - Indigent Drug Program MH076 $ - Community Action Treatment (CAT) Team MHCAT $ - Proviso Allocation - Citrus MH094 $ - $ - PATH Grant MHOPG $ - $ - TANF Services MHOTB $ - $ - Early Intervention - Psychotic Disorders MH026 $ - $ - Forensic Hospital Multidisciplinary Team MHOFH $ - $ - For Profit Sub - Recipeint - Key West HMA MHSFP $ - $ - Supported Employment Services MHEMP $ - $ - Miami -Dade County Homeless Trust MH010 $ - $ - IOS Pilot Project MH021 $ - $ - MDC - Central Receiving Facility MDCRF $ - $ - Care Coordination MHOCN $ - Care Coordination MHOCN $ - Carry Forward MHOCF $ - Carry Forward MHOCF $ - TOTAL ADULT MENTAL HEALTH = $ - TOTAL CHILDREN MENTAL HEALTH = $ - ADULT SUBSTANCE ABUSE CHILDREN SUBSTANCE ABUSE OCA DESCRIPTION NEW OCA AMOUNT OCA DESCRIPTION NEW OCA AMOUNT Residential Services MS003 $ - Residential Services MS003 $ - Non-Residential Services MSO11 $ - Non - Residential Services MSO1 1 _ $ - Detox Services MS021 $ - Detox Services MS021 $ - HIV Services MS023 $ - HIV Services MS023 $ - Prevention Services MS025 $ - Prevention Services MS025 $ - Women's Services MS027 $ - Prevention Partnership Grant MSOPP $ 150,000 Pregnant Women Project MS081 $ - TANF Services MSOTB $ - Proviso Allocation - GCC MS091 $ - Proviso Allocation - Here's Help MS903 $ - TANF Services MSOTB $ - Here's Help Opioid Training MS913 $ - Proviso Allocation - New Hope CORPS MS908 $ - $ - Targeted Response - Opioid Crisis MSOPH $ - $ - Opioid Crisis MAT MSOPM $ - $ - Here's Help Opioid Training MS913 $ - $ - $ - $ - $ - $ - MDC - Central Receiving Facility MDCRF $ - $ - Care Coordination MSOCN $ - Care Coordination • MSOCN $ - Carry Forward MSOCF $ - Carry Forward MSOCF $ - TOTAL ADULT SUBSTANCE ABUSE = $ - TOTAL CHILDREN SUBSTANCE ABUSE = $ 150,000 FUNDS NOT REQUIRING MATCH: Drug Abuse Services $ - TOTAL ALL PROGRAMS = $ 150,000 Prevention $ - UNCOMPENSATED UNITS = Deinstitutionalization Project $ - TOTAL = $ 150,000 CMH Program $ - MH Block Grant TOTAL FUNDS REQUIRING MATCH = $ 150,000 TOTAL FUNDS NOT REQUIRING MATCH $ - LOCAL MATCH REQUIRED = $ 37,500 NOTES #N /A Guidance /Care Center, Inc. Exhibit H Contract No. P - 4 Page 1 of 1 July 1, 2018 - June 30, 2019 LOCAL MATCH PLAN July 1, 2018 REQUIRED MATCH: $ 37,500 A IVI I - C M H ASA CSA COST CENTERS RATE UNITS MATCH UNITS MATCH UNITS MATCH UNITS MATCH 01 Assessment $ - 02 Case Management $ - 03 Crisis Stabilization $ - 04 Crisis Support/Emergency $ - 06 Day/Night $ - 07 Drop - In/Self Help Centers $ - 08 In- Home /On -Site $ - 11 Intervention - Individual $ - 42 Intervention - Group $ - 12 Medical Services $ - 13 Medication - Assisted Treatment $ - 14 Outpatient - Individual $ - 35 Outpatient - Group $ - 15 Outreach $ - 18 Residential Level I $ - 19 Residential Level II $ - 20 Residential Level III $ - 21 Residential Level IV $ - 24 Substance Abuse Detox $ - 25 Supported Employment $ - 26 Supportive Housing $ - 27 TASC $ - 28 Incidental Expenses $ - 29 Aftercare - Individual $ - 43 Aftercare - Group $ - 30 Information & Referral $ - 34 FACT Team $ - 36 Room & Board Level I $ - 37 Room & Board Level II $ - 38 Room & Board Level III $ - 39 Short-term Residential Treatment $ - 40 Clubhouse Services $ - 46 Recovery Support - Individual $ - 47 Recovery Support - Group $ - 48 Prevention - Indicated $ 41.23 - - - 49 Prevention - Selective $ 59.20 - - - 20,000.00 50 Prevention - Universal Direct $ 59.20 - - - 17,500.00 51 Prevention - Universal Indirect $ 59.20 - - - - MATCH ALLOCATION: $ - $ - $ - $ 37,500 $ - GRAND TOTAL: $ 37,500 Local Match Plan Guidance /Care Center, Inc. Page 1 of 1 Contract No. P -4 July 1, 2019 - June 30, 2020 LOCAL MATCH PLAN July 1, 2019 REQUIRED MATCH: $ 37,500 A r111 CMH ASA CSA COST CENTERS RATE UNITS MATCH UNITS MATCH UNITS MATCH UNITS MATCH 01 Assessment $ - 02 Case Management $ - 03 Crisis Stabilization $ - • 04 Crisis Support/Emergency $ - 06 Day/Night $ - 07 Drop -In /Self Help Centers $ - 08 In- Home /On -Site $ - 11 Intervention - Individual $ - 42 Intervention - Group $ - 12 Medical Services $ - 13 Medication- Assisted Treatment $ - 14 Outpatient - Individual $ - 35 Outpatient - Group $ - 15 Outreach $ - 18 Residential Level I $ - 19 Residential Level II $ - 20 Residential Level III $ - 21 Residential Level IV $ - 24 Substance Abuse Detox $ - 25 Supported Employment $ - 26 Supportive Housing $ - 27 TASC $ - 28 Incidental Expenses. $ - 29 Aftercare - Individual $ - 43 Aftercare - Group $ - 30 Information & Referral $ - 34 FACT Team $ - 36 Room & Board Level I $ - 37 Room & Board Level II $ - 38 Room & Board Level III $ - 39 Short-term Residential Treatment $ - 40 Clubhouse Services $ - 46 Recovery Support - Individual $ - 47 Recovery Support - Group $ - 48 Prevention - Indicated $ 41.23 - - - - 49 Prevention - Selective $ 59.20 - - - 20,000.00 50 Prevention - Universal Direct $ 59.20 - - - 17,500.00 51 Prevention - Universal Indirect $ 59.20 - - - MATCH ALLOCATION: $ - $ - $ - $ 37,500 $ - GRAND TOTAL: $ 37,500 Local Match Plan Guidance /Care Center, Inc. Page 1 of 1 Contract No. P July 1, 2020 - June 30, 2021 LOCAL MATCH PLAN July 1, 2020 REQUIRED MATCH: $ 37,500 A INIH CMFI :ASA CSA COST CENTERS RATE UNITS MATCH UNITS MATCH UNITS MATCH UNITS MATCH 01 Assessment $ - 02 Case Management $ - 03 Crisis Stabilization $ - 04 Crisis Support/Emergency $ - 06 Day/Night $ - 07 Drop - In/Self Help Centers $ - 08 In- Home /On -Site $ - 11 Intervention - Individual $ - 42 Intervention - Group $ - 12 Medical Services $ - 13 Medication - Assisted Treatment $ - 14 Outpatient - Individual $ - 35 Outpatient - Group $ - 15 Outreach $ - 18 Residential Level I $ - 19 Residential Level II $ - 20 Residential Level III $ - 21 Residential Level IV $ - 24 Substance Abuse Detox $ - 25 Supported Employment $ - 26 Supportive Housing $ - 27 TASC $ - 28 Incidental Expenses $ - 29 Aftercare - Individual $ - 43 Aftercare - Group $ - 30 Information & Referral $ - 34 FACT Team $ - 36 Room & Board Level I $ - 37 Room & Board Level II $ - 38 Room & Board Level III $ - 39 Short-term Residential Treatment $ - 40 Clubhouse Services $ - 46 Recovery Support - Individual $ - 47 Recovery Support - Group $ - 48 Prevention - Indicated $ 41.23 - - - 49 Prevention - Selective $ 59.20 - - - 20,000.00 50 Prevention - Universal Direct $ 59.20 - - - 17,500.00 51 Prevention - Universal Indirect $ 59.20 - - - - MATCH ALLOCATION: $ - $ - $ - $ 37,500 $ - GRAND TOTAL: $ 37,500 Local Match Plan Guidance /Care Center, Inc. Page 1 of 1 Contract No. P - �� South Florida Behavioral Health Network, Inc. 7.01.2018 ATTACHMENT II Financial and Audit Compliance The administration of resources awarded by the Department of Children & Families, through the Managing Entity, to the provider may be subject to audits as described in this attachment. MONITORING In addition to reviews of audits conducted in accordance with 2 Code of Federal Regulations (CFR) §§ 200.500- 200.521 and § 215.97, F.S., as revised, the Department may monitor or conduct oversight reviews to evaluate compliance with contract, management and programmatic requirements. Such monitoring or other oversight procedures may include, but not be limited to, on -site visits by Department staff, agreed -upon procedures engagements as described in 2 CFR § 200.425 or other procedures. By entering into this agreement, the recipient agrees to comply and cooperate with any monitoring procedures deemed appropriate by the Department. In the event the Department determines that a limited scope audit of the recipient is appropriate, the recipient agrees to comply with any additional instructions provided by the Department regarding such audit. The recipient further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the Department's inspector general, the state's Chief Financial Officer or the Auditor General. AUDITS PART I: FEDERAL REQUIREMENTS This part is applicable if the recipient is a State or local government or a non - profit organization as defined in 2 CFR §§ 200.500- 200.521. In the event the recipient expends $750,000 or more in Federal awards during its fiscal year, the recipient must have a single or program- specific audit conducted in accordance with the provisions of 2 CFR §§ 200.500- 200.521. The recipient agrees to provide a copy of the single audit to the Department's Single Audit Unit and its contract manager. In the event the recipient expends less than $750,000 in Federal awards during its fiscal year, the recipient agrees to provide certification to the Department's Single Audit Unit and its 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, 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 established by 2 CFR §§ 200.500- 200.521. An audit of the recipient conducted by the Auditor General in accordance with the provisions of 2 CFR Part 200 §§ 200.500- 200.521 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 2 CFR § 200.508. Attachment II Page 1 of 4 Guidance /Care Center, Inc. Contract No. P-4 South Florida �/ Behavioral / � Health Network, Inc. 7.01.2018 The schedule of expenditures should disclose the expenditures by contract number for each contract with the Department in effect during the audit period. The financial statements should disclose whether or not the matching requirement was met for each applicable contract. All questioned costs and liabilities due the Department shall be fully disclosed in the audit report package with reference to the specific contract number. PART 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 ($750,000 or more for fiscal years beginning on or after July 1, 2016) 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 Department's Single Audit Unit and its contract manager. In the event the recipient expends less than $500,000 (less than $750,000 for fiscal years beginning on or after July 1, 2016) in State financial assistance during its fiscal year, the recipient agrees to provide certification to the Department's Single Audit Unit and its 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, other state agencies, and other nonstate entities. State financial assistance does not include Federal direct or pass- through awards and resources received by a nonstate entity for Federal program matching requirements. In connection with the audit requirements addressed in the preceding paragraph, the recipient shall ensure that the audit complies with the requirements of Section 215.97(8), Florida Statutes. This includes submission of a financial reporting package as defined by Section 215.97(2), Florida Statutes, and Chapters 10.550 or 10.650, Rules of the Auditor General. The schedule of expenditures should disclose the expenditures by contract number for each contract with the Department in effect during the audit period. The financial statements should disclose whether or not the matching requirement was met for each applicable contract. All questioned costs and liabilities due the Department shall be fully disclosed in the audit report package with reference to the specific contract number. PART III: REPORT SUBMISSION Any reports, management letters, or other information required to be submitted to the Department pursuant to this agreement shall be submitted within 180 days after the end of the provider's fiscal year or within 30 (federal) or 45 (State) 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) Attachment II Page 2 of 4 Guidance /Care Center, Inc. Contract No. P-4 P > South Florida / / Behavioral I Health Network, Inc: 7.01.2018 B. Department of Children& Families (1 electronic copy and management letter, if issued ) Office of the Inspector General Single Audit Unit Building 5, Room 237 1317 Winewood Boulevard Tallahassee, FL 32399 -0700 Email address: HQW. IG. Single.Audit(a)mvflfamilies.com C. Reporting packages for audits conducted in accordance with 2 CFR Part 200 §§ 200.500- 200.521, and required by Part I of this agreement shall be submitted, when required by § 200.512 (d) by or on behalf of the recipient directly to the Federal Audit Clearinghouse using the Federal Audit Clearinghouse's Internet Data Entry System at: http://harvester.census.gov/fac/collectiddeindex.html and other Federal agencies and pass- through entities in accordance with 2 CFR § 200.512. D. Copies of reporting packages required by Part II of this agreement shall be submitted by or on behalf of the recipient directly to the following address: Auditor General Local Government Audits /342 Claude Pepper Building, Room 401 111 West Madison Street Tallahassee, Florida 32399 -1450 Email address: flaudgen locaIgovt@aud.state.fl.us Providers, when submitting audit report packages to the Department for audits done in accordance with 2 CFR §§ 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 Department or its designee, Chief Financial Officer or Auditor General access to such records upon request. The recipient shall ensure that audit working papers are made available to the Department or. Attachment 11 Page 3 of 4 Guidance /Care Center, Inc. Contract No. P-4 �� South Florida Behavioral Health Network, Inc. 7.01.2018 its designee, Chief Financial Officer or Auditor General upon request for a period of three years from the date the audit report is issued, unless extended in writing by the Department. Attachment 11 Page • Guidance /Care Center, Inc. Contract No. P -4 e�. South Florida tllehavioral Health Network, Inc. ATTACHMENT III CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS The undersigned certifies, to the best of his or her knowledge and belief, that (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or an employee of any agency, a member of congress, an officer or employee of congress, or an employee ofa member of congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering Into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2) If any funds other than federal appropriated' funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form- LLL, °Disclosure Form to Report Lobbying,* in accordance with its Instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all sub - awards at all tiers (including subcontracts, sub - grants, and contracts under grants, loans and cooperative agreements) and that all sub - recipients shall certify and disclose accordingly. This certification Is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering Into this transaction imposed by section 1352, Titre 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. ,N $' 19-o Ili/ Signature Date Sharon Crippen P Name of Authorized Individual Application or Contract Number The Guidance Care/ Center, Inc. Name of Organization 3000 41st Street Ocean. Marathon, FL 33050 Address of Organization CF 1123, PDF 03/96 Attachment I11 Guidance/Care Center, Inc. Page 1 of 1 Contract No. P-4 South Florida Behavioral Health Network, Inc. Attachment IV 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 Children's Substance Abuse Adult Substance Abuse COST ALLOCATED TO: (check both if approved for both covered services) X Section I. DESCRIPTION OF SERVICES AND STRATEGIES FOR SERVICE DELIVERY DESCRIPTION CT gAZIEISUMMARY (Include overall intention /purpose d program Ea] u flow, "; ',brief description c0 program 5g1t122R, target population 93 Lx served, km ahrg address, competency,; ft name (s) v deg EBP E 1 GSA IE f implemented, describe comprehensive program�lriRg the:partn, ers and coordination efforts)q ..;d The Guidance /Care Center's (GCC) will provide the Project SUCCESS program using the Substance Abuse and Mental Health and Services Administration (SAMHSA) Center for Substance Abuse Prevention (CSAP) Project SUCCESS program recognized in the National Registry of Evidence -based Programs and Practices (NREPP). The program will be available and accessible to high risk youth ages 12 -18 who have experimented with alcohol, are showing early danger signs and multiple risk factors for substance abuse and who attend Monroe County High Schools. Project SUCCESS relies primarily on Education as a strategy. Services include school wide activities targeting the entire school population and are designed to increase awareness of mental health and substance abuse issues, small groups targeting youth identified as being at risk, prevention education groups targeting all 9th graders, and individual counseling to those in need of additional supportive counseling. CCAP Goals: Goal 1: Reduce DUI crashes countywide amongst 18 -20 -year olds by 10% 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. Guidance /Care Center, Inc. Attachment IV Contract No. P-4 Scope of Work Activity /Program IOM-Category Specific primary5 Number of (Universal Indirect, prevention programs,: Unduplicated Universal Direct, practices, and Participants (if Selective, Indicated) . ,strategies in each of duplicated the six. prevention ~ } note) strategies (CSAP) School wide activities Universal Information 2,500 Dissemination 9th grade PES Selective Education 450 Screening Selective Problem ID and referral 750 Small groups Selective Education 40 Student Assistance Selective Problem ID and referral 750 One on One Indicated Education 35 Capacity Building Adults Universal Direct Education 250 Section II. TARGET POPULATION — RISK AND PROTECTIVE FACTORS TARGET POPULATION OR PARTICIPANTS (Include nta rribers,m tables and.a nar**tlescriptlon of participant., characteristicsA;below) f. ^.:_; 1. a � , 4 : _. _ , x ..,., ..,.... Description of participants to be served (describe criteria for program enrollment eligibility, geographic areas / Neighborhoods (list zip codes), risk factors of the neighborhoods, description of the sites (school, church, park, etc.), as well as any other significant demographic information), specific cultural characteristics, and describe according to the Comprehensive Community Action Plan priorities: Youth alcohol use - Abuse by "legal" age individuals, Youth /Adult marijuana use, Prescription drug misuse /abuse, over the counter drugs misuse /abuse, other illicit drug use. Participants will be students at the 3 High Schools in Monroe County and Middle School students in Marathon. School wide activities and Prevention Education Groups are universal in nature while small groups and individual counseling are targeted at youth identified as at risk. At risk students might be identified by parents, teachers, and other community agencies or by themselves. Project SUCCESS is designed to be implemented in school settings. Each counselor has been provided with adequate space and access to student populations to fully implement the program as designed. GCC has made changes to its Prevention programming for the coming year in that most all grade levels will be covered. Apple a Day will cover K through grade 4, Alcohol Literacy and Teen Intervene will cover middle schools and Project SUCCESS will be in the high schools. The comparison of percentage of Monroe County youth and Florida Statewide youth who reported having used a list of 14 various drugs in their lifetimes reveals that percentages for Monroe County youth exceed those for the state in every category (FYSAS 2010). A significantly greater percentage of Monroe County High School students (40.9 %) 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: Favorable attitudes towards ATOD Perceptions of harm Community Norms Self- regulation Protective factors: Prosocial opportunities /activities Guidance /Care Center, Inc. Attachment Iv Contract No. P -4 Scope of Work Positive peer influence Skill /competency Healthy behaviors Increased knowledge /awareness T ARGET POPULATION OR PAT ICIPANTS f'IOTA ACTEGO — Fit (I elude numbersAln tables and�a brief parratl eidescrlptlon oftpart eipant char�actenstics related to aboue_Urtithe section Number of Unduplicated Universal — Direct or Indirect, Selective, Indicated Participants (if duplicated note) School wide Activities is a Universal Direct prevention strategy. 9 months out of the school year Project SUCCESS staff will conduct activities designed to inform and increase awareness of varying targets of prevention services (suicide awareness, 2500 mental health and substance use awareness for example). 9 grade Prevention Education Series is a Selective prevention strategy which 450 consists of 4 topics taught in 4 to 8 sessions to all 9 graders enrolled in the district Screening is a Selective prevention strategy in which all students who are enrolled in 750 the school are screened for prevention and other needs. Small groups is a Selective prevention strategy which consists of small group 40 activities organized around various themes used to serve youth who are identified as being at risk. Student Assistance is a Selective prevention strategy in which students who are 750 identified as needing a services are provided that service by Project SUCCESS staff or referred elsewhere for the needed service. One on One is an Indicated prevention strategy in which a student can receive up to 35 3 individual prevention sessions as need. Capacity Building is a Universal Direct prevention strategy which will include presentations on ATOD prevention and other relevant topics in both school and non- 250 traditional settings. TARGET POPULATION - RISK AND PROTECTIVE FACTORS ,:� � , .• r ;�.' �` +� � � r,+ , �z �r vie. ^ �,o,,. -. � x.,, �� m . `?a. '+ ' s »r ' s. .'ssc > i . r" t ,� 4 f ` a a t " z at 4z '` '' " . Y Prevention ProgramIStrategy o,Related f > —Risk/Protective Factors Targeted. are /eCAPt Target Popu� latio tr ,"�.. x Goal ,ra-, °. , z S �,++ a,'� v''c ` b.�, S,e��'> .'�` t °SAS„ ';�,,xv:� Addressed r`r School wide activities Favorable attitudes towards ATOD 1 & 2 Perceptions of harm Prosocial opportunities /activities Positive peer influence,. Healthy behaviors . Increased knowledge /awareness 9th Grade Prevention Education Favorable attitudes towards ATOD 1 & 2 Perceptions of harm Self- regulation Skill /competency Healthy behaviors Increased knowledge /awareness Screening Screening to identify and broad range of risk factors 1 & 2 with the intent to mitigate those risk factors Guidance /Care Center, Inc. Attachment IV Contract No. P -4 Scope of Work Small groups Favorable attitudes towards ATOD 1 & 2 Perceptions of harm Self- regulation Prosocial opportunities /activities Positive peer influence Skill/competency Healthy behaviors Increased knowledge /awareness Self- Esteem Positive family communications Community values Student Assistance Favorable attitudes towards ATOD 1 & 2 Perceptions of harm Self- regulation Prosocial opportunities /activities Positive peer influence Skill/competency Healthy behaviors Increased knowledge /awareness Self- Esteem. Positive family communications Community values One on one Indicated Favorable attitudes towards ATOD 1 & 2 Perceptions of harm Self- regulation Prosocial opportunities /activities Positive peer influence Skill/competency Healthy behaviors Increased knowledge /awareness Self- Esteem Positive family communications Community values Capacity Building Favorable attitudes towards ATOD 1 & 2 Perceptions of harm Increased knowledge /awareness Community values Skill /competency Section III. SITE LOCATIONS AND INFORMATION* T-7 Target Participants gin MILO Eal= Address My Code ... (Check Em that Apply') fi Child/ t-tt Wouth Parents Others Key West High School 2100 Flagler Avenue Key West 33040 X Coral Shores High School 89901 Old Highway Tavernier 33070 X Marathon Middle /High School 350 Sombrero Road Marathon 33050 X Total number to be served 2,500 *Changes in sites/locations of services must adhere to contractual requirement procedures. Guidance/Care Center, Inc. Attachment Iv Contract No. P-4 Scope of Work Section IV. MAJOR REFERRAL SOURCES List major ricitiad sources F the eazilEco ; proxide_d. Monroe County Public Schools Parents Self- referral Other community agencies Section V. PERFORMANCE MEASURES Quality Performance Measures (Include fidelity measures, satisfaction survey information, supervision, training, staffing, and other required information pertaining to quality) Qualit7jMea E 1 II C-GL Reporting Tool Timing Average number of sessions 85% of 490 participants will complete Measured at the end of each cohort attended (participant retention) Project SUCCESS pre /posts, attendance records and minimally 85% of scheduled sessions 85 % of 490 youth will increase Project SUCCESS pre and posttests Collected immediately prior to the 1st their attitudes and beliefs related session and immediately following the to risk of harm associated with last session underage drinking Collected immediately prior to the 1st 85 % of 490 youth will have no session and immediately following the or 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 490 youth will decrease Project SUCCESS pre and post tests session and immediately following the favorable attitudes toward last session alcohol and drug use # and % of youth /participants 90 % or participants show satisfaction Measured at the end of each program satisfied with services provided on the Satisfaction Survey cohort 100% of participant with pre /post tests matched and meeting outcomes will complete the Satisfaction Surveys Observation of service Curriculum fidelity checklist Three times per year in delivery/Fidelity checklist coordination with the Evaluation Supervisor /Observer Report Team, one time in Quarter 2, one time in Quarter 3, and one time in Quarter 4 unless the EBP indicates otherwise Documentation of structured Supervisory record, Supervisory Tool, or During regular supervisory sessions supervision Checklist and notes in staff file and not less than one time per month # and % of staff with necessary 100% At the time of contract monitoring training # and % of staff working Staff will show courses and documents toward Prevention from the Florida Certification Board at certification with the Florida 500/0 the time of contract monitoring. Certification Board Guidance /Care Center, Inc. Attachment IV Contract No. P -4 Scope of Work Quantity Performance Measures Activities /Service Name & Description Activity (Include frequency, intensity, & duration # % To Level of sessions, as well as the number of # # Required Meet Selectiv cycles /cohorts expected to be offered Children/ Parents Others Session Require e - and tentative schedule /timing) Youth s d Indicate d • Youth/Children At -Risk of Substance Abuse Problems — include individual measures that will result in achieving the Substance Abuse & Mental Health Required Performance Outcomes & Outputs • Parent/Families At -Risk of Substance Abuse Problems — include individual measures that will result in achieving the Substance Abuse & Mental Health Required Performance, Outcomes & Outputs Prevention Education Series 450 4 to 8 85% Selective Project SUCCESS Of scheduled sessions and 85% of participant pre /post tests matched and meeting outcomes School Wide Activities 2500 9 90% Universal Small Groups 40 4 - 85% Selective Newco mer group sessio ns 85% of other sched uled small group sessio ns and 85% of partici pant pre /po st tests match ed and Guidance /Care Center, Inc. Attachment IV Contract No. P -4 Scope of Work meetin 9 outco mes Individual Sessions 50 1 - 3 85% Indicated Sessio ns, with justific ation if differe nt and 85% of partici pant pre /po st tests match ed and meetin 9 outco mes Guidance /Care Center, Inc. Attachment IV Contract No. P-4 Scope of Work VI. TASK LIST Activities /Service Name Description (Include ITP }"frequencyg Ii:221KM, 8 duration d sessions, as E {. iX ' Recommend Q3Q� number di cycles /cohorts expected f offered anti Particip an l T y p e an ts , CO Sessions Outcome tentative''schedule /,filming) a? Hours Activity Title: Recruitment/Screening 750 N/A 85% and 85% Activity Description:. All students referred or presenting for of participant service will receive an initial screening of risk and protective pre /post tests factors matched and Frequency: One time upon program entry Intensity: one session meeting Duration: 15 mins. outcomes Activity Title: Intake/ Assessment 50 45 — 60 mins. 85% and 85% Activity Description: Participants who become enrolled in of participant the program will complete a detailed intake of service needs pre /post tests Frequency: Once, upon enrollment in the program matched and Intensity: One session meeting Duration: 60 mins. outcomes Activity Title: Project SUCCESS Prevention Education Series 450 85% of 85% and 85% Curriculum scheduled of participant Activity Description:. 9th graders will participate in a 4 topic sessions (6 pre /post tests Prevention Education Curriculum — 8) matched and Frequency: one time per week For 45 — meeting Intensity: 6 — 8 sessions, based on class time restrictions mins outcomes Duration: 45 to 50 mins. Activity Title: Pre and Post - testing 490 45 to 60 min. 85 % and 85% Activity Description:. All large and small group participants sessions of participant will be pre and post tested for the knowledge, beliefs, pre /post tests attitudes and use of substances matched and Frequency: Twice meeting Intensity: once before first session, once at completion of outcomes last session Duration: 45 to 50 mins. Activity Title: Small group activities 40 45 to 60 min. 85% and 85% Activity Description:. At risk students will participate in sessions of participant small group sessions designed to mitigate risk factors and pre /post tests enhance protective factors matched and Frequency: One session per week meeting Intensity: 4 -8 sessions depending on the group subject and outcomes with the exception of New Comers groups which only meet 3 times. Duration: 45 to 50 mins. Guidance /Care Center, Inc. Attachment Iv Contract No. P -4 Scope of Work Section VII. EVIDENCE BASED PROGRAMS (EBP) f�,, w �' � °- � a : ,. x s r.• > u tir?.? a ml+. Evidence BasedhProgram .. „ .._ De's ig nating Agency” Project SUCCESS SAMHSA approved, NREPP Section VIII. EVALUATION Outcome Measures (Include fidelity measures, satisfaction survey information, supervision, training, Staffing, and other required information pertaining to quality) Describe how the„program wlll evaluate the effects , efiess of�all:preventior services t° belfmplemented A consistent withi65D"3® Ov13(2), F C in col with the Euaula o n Team identified by `SFB each;year TheSFBHN E vaua tio n Team�s I r of; o viders p ogram evalu ton and -all o technical material used ` by p roviders d wall tt e nsu a c on s sten wlth tcu rent esearch in t hey prevention�feld � �;. � < s . � _ �.� t74 ; 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 Posttests as well as results of the Satisfaction Surveys. 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. aiii; T i ming wh enlaeach � Dat Source / 1 , Measure ata s o u rgeirneasure Outputs Associated f Wpm �t Measurement ec > Actuuity 11 �� :will be collec . . . k »� �.� ate.,, <..,. .. ...� , , - , , a +` ,. Average number of Attendance At end of the cohort of Entered into DOES sessions attended services (Participant Retention) Staff training hours PBPS entry and quarterly 8 hours is required; PBPS (capacity . building) training reports and provider check -ins Participant satisfaction Satisfaction surveys At the end of each Entered into DOES cohort; semi- annually Increase in perceptions Pre - posttest outcomes At the end of each Matched pre - posts; entry of harm cohort; semi - annually into DOES Guidance /Care Center, Inc. Attachment Iv Contract No. P -4 Scope of Work Section IX. CAPACITY BUILDING `List other funding sources your agency /o g nlzation has fot prevention /youthdvelopment programming_ iDekril5e,hqw.the program, coordinate other progams provided f fiunded s �' agent' /organization Desenbe other - programs funded align prevention goals GCC currently receives funding from SFBHN Regular Prevention which supports An Apple A Day serving K through 4th grade, Alcohol Literacy Challenge and Teen Intervene in the Middle Schools. Since Project SUCCESS focuses on High School students there is no overlap. Prevention staff participate in clinical staff meetings in each location and can make referrals for higher levels of care as needed. List other prevention programming and providers in sites mentioned in Section III f this document. Describe how the program will coordinate with other funded organizations' progams and services to avoid duplication of services. GCC is aware that the Florida Keys Children's Shelter operates Prevention services using the EBP All Stars. GCC and FKCS are currently in the process of scheduling a meeting to build capacity and cross learn about each other's programs to coordinate services and avoid duplication. List the coalition(s) within the target service areasin which prevention services will be provided under this Scope. Describe how the program will cooridnate with the coalition and share data /contribute to the ongoing Strategic Prevention Framework with the identified coalition(s). GCC works with the Monroe County Coalition by attending all meetings and coordinating activities county wide. MCC has been particularly helpful in supporting Project SUCCESS school wide activities by providing student hand -outs and incentives. GCC will coordinate and participate in MCC community events such as "No One's House Parent Information" and "Know the Law" campaigns. Section X. ADDITIONAL PREVENTION REQUIREMENTS 1. Site Schedule A final site schedule, on the Site Schedule form, with dates, times, and location of services shall be submitted no later than August 31 of the fiscal year or when requested by the Contract Manager. Sites schedules must be approved by SFBHN, in writing, and will be based on county need and distribution of services to avoid duplication in any geographical area or school to maximize SFBHN funding. Any change shall be justified in writing and submitted to the Managing Entity in writing and submitted to the Contract Manager for review and approval by the Prevention Director. The Contract Manager will reply with approval. The site schedules shall be submitted on the SFBHN Prevention Site Schedule format. 2. Memorandum of Understanding (MOU) with the Community Coalition To address local community substance abuse prevention needs and wellness promotion strategies, prevention providers and the community coalition shall execute and /or maintain a memorandum of understanding (MOU) delineating the specific responsibilities of each. This MOU will be consistent with the strategies of the State of Florida Department of Children and Families' and the Managing Entity's (ME's) prevention strategy. The provider shall submit an executed copy of the MOU to the ME's Contract Manager within 30 days of the effective date of the contract (for newly executed MOUs) or within thirty (30) calendar days for renewed MOUs. SFBHN Contract Attachment — Guidance Document 10 Guidance /Care Center, Inc. Attachment Iv Contract No. P -4 Scope of Work 3. Memorandum of Understanding (MOU) With Sites To facilitate the coordination and delivery of services, all providers shall have executed Memoranda of Understanding (MOU) with the sites where services are being provided. All MOUs with the sites shall be current and up to date, outlining the terms of the agreement. 4. Participant Satisfaction Survey All providers shall collect and submit participant satisfaction surveys as noted in the Scope of Work. 5. Meetings All providers shall attend scheduled Prevention meetings as required by the ME and the evaluation team, BSRI, at regularly scheduled or specially called meetings when notified by the ME. The ME will make every attempt possible to schedule meetings with advanced notice; however, there may be meetings that may be called on short notice. These include, but are not . limited to, Prevention provider meetings, meetings with Behavioral Science Research Institute, individual . provider quarterly meetings with BSRI and /or SFBHN, Evidence Based Practice workgroup meetings to comply with the Block Grant requirements, and other meetings as noticed by SFBHN. The contract notes the other meetings where representatives of . the provider organization are required to attend. 6.. Reports / Assignments and Special Reports / Assignments Providers are expected to submit reports as outlined in the contract: Prevention Partnership Grant (PPG) reporting is specifically described in the contract with dates for submission. Other reports will be requested by SFBHN. Special reports and assignments are . requested from time to time to meet State /Local Department of Children and Families, State Block Grant, SFBHN, and other requirements and needs. Prevention providers are required to submit the reports in the format requested and by the timeline requested. These reports may be requested from different sources for different reasons. Requests generally come from SFBHN staff, including the Prevention Director, and may be requested verbally or in writing. There may be times when other collaborative partners request information and SFBHN will support these requests. 7. Training The Scope of Work outlines the requirements for training to support the State Block Grant reporting requirements for workforce development as well as for strengthening the Prevention workforce. All staff of provider organizations funded by this contract, whether full -time, part-time, contractual, or consultant, who report units in the Performance Based Prevention System (not those paid by cost reimbursement or that are vendors), is required to attend eight (8) hours of training per quarter. All providers shall attend scheduled training as required by the ME, meet the ME and the evaluation team, BSRI, for technical assistance and /or training, at regularly scheduled or specially called meetings when notified by the ME. 8. Report Cards Providers are required to comply with the measures on the Prevention Report Card. Grading for the measures will be according to compliance or lack thereof. Guidance /Care Center, Inc. Attachment IV Contract No. P -4 Scope of Work 9. Data All providers are required to submit the program data monthly in the Performance Based Prevention System (PBPS) as required by the contract. The provider shall also: • Ensure that the data submitted clearly documents all program participants, programs, and strategies which occurred under this contract and consistent with the Scope of Work in the contract; • Ensure that all data submitted to PBPS is consistent with the data maintained in the provider's file and consistent with the Scope of Work in the contract; • Review the data submitted with the evaluation team, Behavioral Science Research Institute (BSRI), monthly to determine any discrepancies in the numbers related the evaluation and the Scope of Work and make corrections prior to submission for approval by the SFBHN Prevention Director; • Submit an email to the SFBHN Prevention Director and the designated SFBHN Data Analyst verifying that the data in the PBPS system has been checked and is correct and complete and may be used for Block Grant reporting and payment. There shall be a designated individual and one back up individual at the provider organization responsible for verifying the data and submitting the email. This will imply that the data has been reviewed and is ready for submission. o The email subject line shall read: PBPS Data Submission Verification o The body of the email shall read: (name of organization) is submitting the PPG Prevention data for the month of (name of the month) in PBPS and we assure that the data is complete and correct. Our organization's data may be used to report to the State for the Block Grant report. Our organization's data may be used to reconcile with the payments for this month. • Failure to submit any data, or correct any errors in the data which results in a rejection rate of ten percent (10 %) or higher of the monthly data submitted, will require the provider to submit a corrective action plan describing how and when the missing data will be submitted or how and when the rejected will be corrected and resubmitted; and • In accordance with the provisions of s. 402.73(1), F. S., and Rule 65- 29.001 F.A.C., corrective action plans may be required for non - compliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed for failures to implement or to make acceptable progress on such corrective action plans. 10. Evaluation Prevention providers shall work in collaboration with the evaluation team, Behavioral Science Research Institute (BSRI) by participating in meetings, training, and providing service data and other necessary identified data vital to the completion of the system -wide evaluation of the prevention services within the Strategic Prevention Framework. Guidance /Care Center, Inc. Attachment IV Contract No. P -4 Scope of Work Data will be provided to BSRI in the BSRI data system, DOES, and in any other requested format. The data includes the numbers for outcome data and process data required that contributes to ' the evaluation of the Prevention System of Care. Prevention providers are required to participate in fidelity checks, meetings, training, and other fidelity activities related to the outcomes in the Scope of Work and for the larger Prevention System of Care evaluation. BSRI will report compliance and collaboration to SFBHN per. the BSRI Scope. of Work requirements. Guidance /Care Center, Inc. Attachment IV Contract No. P-4 Scope of Work ATTACHMENT E PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a CONTRACTOR, supplier, subcontractor, or CONTRACTOR under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list." 1� I have read the above and state that neither Mello L - 11(eLW /(Respondent's name) nor any Affiliate has been placed on the convicted vendor list within the last 36 months. AMA 11_, . 4 4NA (Signature ( I Date: \'o 6 1 V- STATE OF: F( COUNTY OF: M 614 re--C. Subscribed and sworn to (or affirmed) before me on a a L V I f l S (date) by PlGUA,(�'�`evi to -I1 (`eA(J (name of affiant). He /She i personally known to me or has produced J O- (type of identification) as identification. e Notary Public State of Florida ' ili j j i / A � 1he Maryanne L Johnson NOT Y PUBLIC • My Commission GG 175345 �' 4 . 0 „,ov Expires 01/15/2022 + • • . • ` My Commission Expires: / /J/ /_nirinnno (`are. Onninr_CdMI -1 (:nntrart FV1Q• manta 14 ATTACHMENT F SWORN STATEMENT UNDER ORDINANCE NO. 010 -1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE &A c� c��c� Cie �� ►mac . (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." Si nature ) ( 9 + Date: [ D [ t STATE OF: PI tV1 COUNTY OF: Mk ('i Subscribed and sworn to (or affirmed) before me on 001 -e,v / , 0 1,6 (date) by �'U41 t'u t (name of affiant). He /She i personally known to me or has produced d(o. I (type of identification) as identification. .isot '� Notary Public State of Florida Maryanne L J i A M o r d ExpCes 0 i / ssio 022 175345 J /fa /1 i /rTARY PU :Y' My Commission Expires: ha.,rer_cannl -! f`nnhronf FV10• nnna 1 ri ATTACHMENT G DRUG -FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: 6 L,t i c a r c i Cc_t-r-e_ C- en-1--er r\c • (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. (Signat re) I r 1 Date: GO 1 1 . STATE OF: FlnrteCct- COUNTY OF: 0 kl, Subscribed and sworn to (or affirmed) before me on OOL2e. 1, NM (date) by /16 G4wt�O -� (name of affiant). He /She is� personally known to me or has produced /� (type of identitication� s identification. _/I 4...,.i? ✓.thL /41/ NOT A ; PUBLIC ] . 'w,. Notary Public State of Florida Maryanne L Johnson My Commission Expires: /"/6 7.--2- My Commission GG 175345 va ' � w w / Expires 01/15/2022 (_nirianna ran, (orifar_CAMH ('.rnlrart FY1Q• ()aria 1 R ATTACHMENT H FY19 Annual Performance Report (For year October 1, 2018 — September 30, 2019) Agency Name POC Phone /Email Grant Amount Per Section 8 of your contract, it is required that you fill out the entire form and answer every question. Narrative on the FY19 Performance (i.e. successes, challenges, etc): Questions: 1. Please list services and client information below for the program /activities funded by the Monroe County award. of persons in Total =# of- clients Services Target Population target'population served in FY19 Unduplicated Clients Served 2. What were the measurable outcomes (including numbers) accomplished in FY19? 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 FY19; and /or 200 %; and /or another standard used by your organization? 4. Were all the awarded funds used in FY19? If not, please explain. 5. What is the number of FTEs working on the program(s) funded by the award in FY19? 6. Were the awarded funds used as match in FY19? If so, please list matching sources. Guidance Care Center -SAMH Contract FY19; page 17 7. What area of Monroe County did you serve in FY19? 8. How many total FTEs in your organization? 9. Volunteers: hours of program service were contributed by volunteers in FY19. 10. What was the CEO /Executive Director (or highest paid title) compensation in FY19? (Please breakdown between salary and benefits.) 11. What is your organization's fiscal year? For the following questions, please use the number as reported on your FY18 IRS Form 990. If your FY19 IRS Form 990 is not yet prepared, please provide an estimate for the following questions. 12. What were your organization's total expenses in FY19? 13. What was your organization's total revenue in FY19? 14. What was the organization's total in grants and contracts for FY19? 15. What was the organization's total donations and in -kind (fundraising) in FY19? 16. What percentage of your expenses are program service expenses versus management and general expenses in FY19 as reported on your IRS Form 990? (Program service expenses are defined as expenses needed to run your programs. Management and general expenses encompass expenses such as fundraising, human resources, salaries of those not working directly with programs, legal services, accounting services, insurance expenses, office management, auditing, and other centralized services.) Guidance Care Center -SAMH Contract FY19; page 18