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Item C15 • BOARD OF COUNTY COMMISSIONERS County of Monroe 1 Mayor Sylvia J.Murphy,District 5 - � A Mayor Pro Tern Dann L.Kolha e,District I The Florida Keys N) ) y y g r Michelle Coldiron,District 2 Heather Carruthers,District 3 David Rice,District 4 Commissioner David P.Rice 9400 Overseas Hwy., Suite 210 • Florida Keys Marathon Airport Main Terminal Marathon, FL 33050 Boccdis4@monroecounty-fl.gov 305-289-6000 Interoffice Memorandum Date: October 10,2019 To: Kevin Madok, Clerk of the Court County Clerk's Office From: Commissioner David Rice,District 4 RE: NOTICE OF VOTING CONFLICT Per Florida Statute 112.3143,I hereby disclose by written memorandum that I will abstain from the vote on certain issues brought before the Monroe County Board of Commissioners with entities with which I am involved. I will abstain from the vote on issues concerning the following entities: Guidance Care Center,Inc., a private,not-for-profit entity,which receives some of its operational funding from the County, as I currently sit on the Board of Directors of the Guidance Care Center. I am also a member of the Board of the Historic Florida Keys Foundation,Inc. At the October 16,2019 BOCC meeting,I abstained from the vote on item(s): #C1, C15, C17, C18, C20 Copy of agenda item listing from the Revised Agenda for each of the referenced item(s)is included for documentation. ATT:• State Form 8B Memorandum of Voting Conflict for County,Municipal,and Other Local Elected Officers FORM 8B MEMORANDUM OF VOTING CONFLICT FOR COUNTY, MUNICIPAL, AND OTHER LOCAL PUBLIC OFFICERS LAST NAME—FIRST NAME—MIDDLE NAME NAME OF BOARD,COUNCIL,C MMISSION,AUTHORI 0 COMMITTEE (ZLCE DAVID PA YAVt enonrva-Coo,i- , Ovarl e Comm(ssroo MAILING ADDRESS THE BOARD,COUNCIL,COMMISr�ION,AUTHORITY OR COMMITTEE ON 9 33 m o C.(!s 1-a I c (-EL Ln • WHICH I SERVE IS A UNIT F: (j CITY II u COUNTY 0 CITY COUNTY 0 OTHER LOCALAGENCY (�alra--ko n Ma n rO¢— NAAMME OF POLITICAL SUBDIVISI N: DATE ON WHICH VOTE OCCURRED ' " '�IT�aQ- �U n MY POSITION IS: )iCELECTI E ❑ APPOINTIVE WHO MUST FILE FORM 8B This form is for use by any person serving at the county, city, or other local level of government on an appointed or elected board, council, commission, authority, or committee. It applies to members of advisory and non-advisory bodies who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes. Your responsibilities under the law when faced with voting on a measure in which you have a conflict of interest will vary greatly depending on whether you hold an elective or appointive position. For this reason, please pay close attention to the instructions on this form before completing and filing the form. INSTRUCTIONS FOR COMPLIANCE WITH SECTION 112.3143, FLORIDA STATUTES A person holding elective or appointive county, municipal, or other local public office MUST ABSTAIN from voting on a measure which would inure to his or her special private gain or loss. Each elected or appointed local officer also MUST ABSTAIN from knowingly voting on a measure which would inure to the special gain or loss of a principal (other than a government agency) by whom he or she is retained (including the parent, subsidiary, or sibling organization of a principal by which he or she is retained);to the special private gain or loss of a relative;or to the special private gain or loss of a business associate.Commissioners of community redevelopment agencies(CRAs) under Sec. 163.356 or 163.357, F.S., and officers of independent special tax districts elected on a one-acre, one-vote basis are not prohibited from voting in that capacity. For purposes of this law, a "relative" includes only the officer's father, mother, son, daughter, husband, wife, brother, sister, father-in-law, mother-in-law, son-in-law, and daughter-in-law.A"business associate" means any person or entity engaged in or carrying on a business enterprise with the officer as a partner,joint venturer, coowner of property, or corporate shareholder(where the shares of the corporation are not listed on any national or regional stock exchange). * * * * * * * * * * * * * * ELECTED OFFICERS: In addition to abstaining from voting in the situations described above, you must disclose the conflict: PRIOR TO THE VOTE BEING TAKEN by publicly stating to the assembly the nature of your interest in the measure on which you are abstaining from voting; and WITHIN 15 DAYS AFTER THE VOTE OCCURS by completing and filing this form with the person responsible for recording the minutes of the meeting,who should incorporate the form in the minutes. * * * * * * * * * * * * * * * * APPOINTED OFFICERS: Although you must abstain from voting in the situations described above, you are not prohibited by Section 112.3143 from otherwise participating in these matters. However, you must disclose the nature of the conflict before making any attempt to influence the decision, whether orally or in writing and whether made by you or at your direction. IF YOU INTEND TO MAKE ANY ATTEMPT TO INFLUENCE THE DECISION PRIOR TO THE MEETING AT WHICH THE VOTE WILL BE TAKEN: • You must complete and file this form (before making any attempt to influence the decision)with the person responsible for recording the minutes of the meeting,who will incorporate the form in the minutes. (Continued on page 2) CE FORM 8B-EFF.11/2013 PAGE 1 Adopted by reference in Rule 34-7.010(1)(f),F.A.C. APPOINTED OFFICERS (continued) • A copy of the form must be provided immediately to the other members of the agency. • The form must be read publicly at the next meeting after the form is filed. IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING: • You must disclose orally the nature of your conflict in the measure before participating. • You must complete the form and file it within 15 days after the vote occurs with the person responsible for recording the minutes of -the meeting,who must incorporate the form in the minutes.A copy of the form must be provided immediately to the other members of the agency, and the form must be read publicly at the next meeting after the form is filed. DISCLOSURE OF LOCAL OFFICER'S INTEREST_ / • I, David P- A(alp , hereby disclose that on 9 /1 i(c ,20 1, (a)A measure came or will come before my agency which (check one or more) inured to my special private gain or loss; inured to the special gain or loss of my business associate, • ; inured to the special gain or loss of my relative, inured to the special gain or loss of ,by whom I am retained;or inured to the special gain or loss of ,which is the parent subsidiary, or sibling organization or subsidiary of a principal which has retained me. aohe measure before my agency and the nature of my conflicting interest in the measure is as follows: I currently sit on the Board of Directors of the Guidance Care Center,Inc. I am also a member of the Board of the Historic Florida Keys Foundation, Inc. SEE ATTACHED AGENDA ITEM SUMMARY �► � CA- C(s, CA-7 If disclosure of specific information would violate confidentiality or privilege pursuant to law or rules governing attorneys, a public officer, who is also an attorney, may comply with the disclosure requirements of this section by disclosing the nature of the interest in such a way as to provide the public with notice of the conflict. D(.'4o1 /2 2D1 / Date Filed Signature NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES §112.317, A FAILURE TO MAKE ANY REQUIRED DISCLOSURE CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING: IMPEACHMENT, REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION, REDUCTION IN SALARY, REPRIMAND, OR A CIVIL PENALTY NOT TO EXCEED $10,000. CE FORM 88-EFF. 11/2013 PAGE 2 Adopted by reference in Rule 34-7.010(1)(f),FA.C. C.15 t, BOARD OF COUNTY COMMISSIONERS County of Monroe Mayor Sylvia Murphy,District 5 The Florida Keys � � �l'U � Mayor Pro Tern Danny Kolhage,District 1 �pw° Michelle Coldiron,District 2 Heather Carruthers,District 3 David Rice,District 4 County Commission Meeting October 16, 2019 Agenda Item Number: C.15 Agenda Item Summary #6140 BULK ITEM: Yes DEPARTMENT: Budget and Finance TIME APPROXIMATE: STAFF CONTACT: Janet Gunderson (305) 292-4470 No AGENDA ITEM WORDING: Approval of two (2) agreements with Guidance/Care Center (G/CC) for 1) Substance Abuse Mental Health (SAMH) services in the amount of$862,676 and 2) the Jail In-House Program (JIP) in the amount of $117,559 for FY2020. The County funding for SAMH services are the local match required by Florida Statute. ITEM BACKGROUND: Substance Abuse Mental Health Services (SAMH): In FY2020 the required match for SAMH/CRF services is $862,676 which is approximately a 1%increase over FY2019 and will support a similar level of services as last year. The Local Match is defined in the agreement between G/CC and the South Florida Behavior Health Network(SFBHN) (see ME225-10-27 attached as Attachment D to the Agreement) and in accordance with F.S. 394.67, F.S. and 65E-14,005, Florida Administrative Code. Jail In-House Programs (JIP): The FY2020 budget request from the BOCC for the Jail In-House Program (JIP)is $117,559. The FY2020 JIP budget is supported by the County administered FDLE RSAT funding in the amount of$133,334 for the Men's JIP and a portion of the FDLE Byrne/JAG in the amount of $44,328 for the Women's JIP. Due to the increase of the RSAT award from $66,667 (FY2019) to $133,334 (FY2020) and the recommended funding of the FDLE Byrne/JAG by the Substance Abuse Policy Advisory Board (SAPAB) in the amount of$44,328, the funding provided under this Agreement will decrease from $193,847 (FY2019) to $117,559 (FY2020). The County is awaiting confirmation from FDLE on the Byrne/JAG award, but the calculation of FY2020 JIP budget requested from the BOCC anticipates receipt of funding from FDLE. The FY2020 JIP total budget was $317,499 (FY2020 JIP budget attached). The FY2020 request of support from the BOCC for the Jail In-House programs could be adjusted pending decline of FDLE grant funding. Packet Pg.438 C.15 PREVIOUS RELEVANT BOCC ACTION: The funding for SAMH and JIP programs was approved by the BOCC on September 18, 2019 during the adoption of the final Operating Budget for Fiscal Year 2020. The County, annually, funds the required local match for SAMH and also funds the JIP services. CONTRACT/AGREEMENT CHANGES: N/A STAFF RECOMMENDATION: Approval DOCUMENTATION: Contract - Guidance Care Center- JIP FY2020 FY2020 JIP Budget Contract - Guidance Care Center-SAMH FY2020 FINAL FINANCIAL IMPACT: Effective Date: 10/01/2019 Expiration Date: 09/30/2020 Total Dollar Value of Contract: $980,235 SAMH, including Designated Receiving Facility = $862,676 JIP = $117,559 Total Cost to County: $980,235 Current Year Portion: $980,235 Budgeted: $980,235 Source of Funds: 001 CPI: N/A Indirect Costs: N/A Estimated Ongoing Costs Not Included in above dollar amounts: N/A Revenue Producing: N/A If yes, amount: Grant: N/A County Match: N/A Insurance Required: N/A Additional Details: N/A 10/16/19 001-045905 GCC SAMH FS 394.76 $862,676.00 10/16/19 001-045906 GCC JIP $117,559.00 Total: $980,235.00 Packet Pg.439 C.15 REVIEWED BY: Tina Boan Completed 10/01/2019 3:29 PM Christine Limbert Completed 10/01/2019 3:54 PM Maria Slavik Completed 10/01/2019 3:57 PM Kathy Peters Completed 10/01/2019 4:36 PM Board of County Commissioners Pending 10/16/2019 9:00 AM Packet Pg.440 C.15.a AGREEMENT This Agreement is made and entered into this 16th day of October 2019, between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as "Board" or "County," and Guidance/Care Center, Inc., a Florida 501(c)(3) not-for-profit corporation, hereinafter referred to as "PROVIDER." WHEREAS, the PROVIDER is a not-for-profit corporation established for the provision of t.3 behavioral health services throughout the Florida Keys, and WHEREAS, it is a legitimate public purpose to provide behavioral health services including comprehensive substance abuse services for individuals in the Jail In-House Program at the Monroe County Detention Center, now, therefore, IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as follows: FUNDING 1. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially and satisfactorily performing and providing services to incarcerated persons in the Monroe County jail, shall reimburse the Provider for a portion of the Provider's expenditures for the Jail In-House Program (including substance abuse and mental health services, such as psychosocial assessment, individual counseling, group therapy and case management, to those incarcerated individuals that qualify for the program), as billed by the Provider. This cost shall not exceed a total reimbursement of ONE HUNDRED SEVENTEEN THOUSAND FIVE HUNDRED FIFTY-NINE AND NO/100 DOLLARS ($117,559) during the fiscal year 2020. N N 2. TERM. This Agreement shall commence on October 1, 2019, and terminate September 30, 2020, unless earlier terminated pursuant to other provisions herein. cv 3. PAYMENT. Payment will be made periodically, but no more frequently than monthly, as hereinafter set forth. Reimbursement requests will be submitted to the Board via the Clerk's Finance Office. The County shall only reimburse, subject to the funded amounts below, those reimbursable expenses which are reviewed and approved as complying with Monroe County Code of Ordinances, State laws and regulations and Attachment A - Expense Reimbursement Requirements. Evidence of payment by the PROVIDER shall be in the form of a letter, summarizing the expenses, with supporting documentation attached. The letter should contain a notarized certification statement. An example of a reimbursement request cover letter is included as � Attachment B. The organization's final invoice must be received within thirty days after the termination date of this contract shown in Article 2 above. After the Clerk of the Board examines and approves the request for reimbursement, the Board shall reimburse the PROVIDER. However, the total of said reimbursement expense payments in the aggregate sum shall not exceed the total amount shown in Article 1, above, during the term of this agreement. 0 4. AVAILABILITY OF FUNDS. If funds cannot be obtained or cannot be continued at a level sufficient to allow for continued reimbursement of expenditures for services specified herein, this agreement may be terminated immediately at the option of the Board by written notice of E 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. Contract-Guidance Care Center-Jail Program-FY20;page 1 Packet Pg.441 C.15.a S. PURCHASE OF PROPERTY. All property, whether real or personal, purchased with funds provided under this agreement, shall become the property of Monroe County and shall be accounted for pursuant to statutory requirements. Funding under this agreement shall not be used to purchase capital assets. RECORDKEEPING 6. RECORDS AND RIGHT TO AUDIT. 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. Right to Audit. Availability of Records. The records of the parties to this Agreement relating to the Project, which shall include but not be limited to accounting records (hard copy, as well as computer readable data if it can be made available; general ledger entries detailing cash and if applicable trade discounts earned, insurance rebates and dividends; any other supporting evidence IL deemed necessary by County or the Monroe County Office of the Clerk of Court and Comptroller (hereinafter referred to as "County Clerk") to substantiate charges related to this agreement, and all other agreements, sources of information and matters that may in County's or the County Clerk's reasonable judgment have any bearing on or pertain to any matters, rights, duties or obligations under or covered by any contract document (all foregoing hereinafter referred to as "Records") shall be open to inspection and subject to audit and/or reproduction by County's representative and/or agents or the County Clerk. County or County Clerk may also conduct verifications such as, but not limited to, counting employees at the job site, witnessing the distribution of payroll, >_ verifying payroll computations, overhead computations, observing vendor and supplier payments, miscellaneous allocations, special charges, verifying information and amounts through interviews cv and written confirmations with employees, Subcontractors, suppliers, and contractor's representatives. The County Clerk possesses the independent authority to conduct an audit of Records, assets, and activities relating to this Project. The right to audit provisions survives the termination of expiration of this Agreement. In addition, if PROVIDER is required to provide an audit as set forth in in Section 8(e) below, the audit shall be prepared by an independent certified public accountant (CPA) with a current license, in good standing with the Florida State Board of Accountancy. 7. PUBLIC ACCESS. The County and PROVIDER shall allow and permit reasonable access to, and inspection of, all documents, papers, letters or other materials in its possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the County and PROVIDER in conjunction with this Agreement; and the County shall have the right to unilaterally cancel this Agreement upon violation of this provision by PROVIDER. S. COMPLIANCE WITH COUNTY GUIDELINES. The PROVIDER must furnish to the County the following (items A-J must be provided prior to the payment of any invoices): U (a) IRS Letter of Determination and GUIDESTAR printout indicating current 501(c)(3) status; E (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; Contract-Guidance Care Center-Jail Program-FY20;page 2 Packet Pg.442 C.15.a (e) Unqualified audited financial statements from the most recent fiscal year for all organizations that expend $150,000 a year or more; if qualified, include a statement of deficiencies with corrective actions recommended/taken; audit shall be prepared by an independent certified public accountant (CPA) with a current license, in good standing with the Florida State Board of Accountancy. If the PROVIDER receives $100,000 or more in grant funding from the County: a. The CPA that prepares the audit must also be a member of the American Institute of Certified Public Accountants (AICPA); b. The CPA must maintain malpractice insurance covering the audit services provided and c. The County shall be considered an "intended recipient" of said audit. (f) Copy of a filed IRS Form 990 from most recent fiscal year with all attached schedules; (g) Organization's Corporate Bylaws, which must include the organization's mission, board and membership composition, and process for election of officers; (h) Organization's Policies and Procedures Manual which must include hiring policies for all staff, drug and alcohol free workplace provisions, and equal employment opportunity provisions; (i) Specific description or list of services to be provided under this contract with this grant (see Attachment C); (j) Annual Performance Report describing services rendered during the most recently completed grant period (to be furnished within 30 days after the contract end date.) The performance IL report shall include statistical information regarding the types and frequencies of services provided, a profile of clients (including residency) and numbers served, and outcomes achieved (see Attachment G); (k) Cooperation with County monitoring visits that the County may request during the contract year; and (1) Other reasonable reports and information related to compliance with applicable laws, contract provisions and the scope of services that the County may request during the contract year. RESPONSIBILITIES cv cv 9. SCOPE OF SERVICES. The PROVIDER, for the consideration named, covenants and agrees with the Board to substantially and satisfactorily perform and provide the services outlined in Attachment C to residents of Monroe County, Florida. 10. ATTORNEY'S FEES AND COSTS. The County and PROVIDER agree that in the event any cause of action or administrative proceeding is initiated or defended by any party relative to the enforcement or interpretation of this Agreement, the prevailing p g g party shall be entitled to � reasonable attorney's fees, court costs, investigative, and out-of-pocket expenses, as an award against the non-prevailing party, and shall include attorney's fees, courts costs, investigative, and out-of-pocket expenses in appellate proceedings. Mediation proceedings initiated and conducted pursuant to this Agreement shall be in accordance with the Florida Rules of Civil Procedure and usual and customary procedures required by the circuit court of Monroe County. 11. BINDING EFFECT. The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the benefit of the County and PROVIDER and their respective legal representatives, successors, and assigns. 12. CODE OF ETHICS. County agrees that officers and employees of the County recognize E 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. Contract-Guidance Care Center-Jail Program-FY20;page 3 Packet Pg.443 C.15.a 13. NO SOLICITATION/PAYMENT. The County and PROVIDER warrant that, in respect to itself, it has neither employed nor retained any company or person, other than a bona fide employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bona fide employee working solely for it, any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of the provision, the PROVIDER agrees that the County shall have the right to terminate this Agreement without liability and, at its discretion, to offset from monies owed, or otherwise recover, the full amount of such fee, commission, percentage, gift, or consideration. 14. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the PROVIDER is an independent contractor and not an employee, agent or instrumentality of the Board. No statement contained in this agreement shall be construed so as to find the PROVIDER or any of its employees, contractors, servants or agents to be employees of the Board. COMPLIANCE ISSUES 15. COMPLIANCE WITH LAW. In providing all services pursuant to this agreement, the PROVIDER shall abide by all statutes, ordinances, rules and regulations pertaining to or regulating the provision of such services, including those now in effect and hereinafter adopted. Any violation of said statutes, ordinances, rules and regulations shall constitute a material breach of this agreement and shall entitle the Board to terminate this contract immediately upon delivery of written notice of termination to the PROVIDER. 16. PROFESSIONAL RESPONSIBILITY AND LICENSING. The PROVIDER shall assure that all professionals have current and appropriate professional licenses and professional liability insurance coverage. Funding by the Board is contingent upon retention of appropriate local, state and/or federal certification and/or licensure of the PROVIDER'S program and staff. 17. NON-DISCRIMINATION. The COUNTY and PROVIDER agree that there will be no discrimination against any person, and it is expressly understood that upon a determination by a cv court of competent jurisdiction that discrimination has occurred, this Agreement automatically terminates without any further action on the part of any party, effective the date of the court order. 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 prohibits 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, 5 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 §§ 12101), as amended from time to time, relating to nondiscrimination in employment on the basis of disability; 10) Monroe County Code Chapter 14, E 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. Contract-Guidance Care Center-Jail Program-FY20;page 4 Packet Pg.444 C.15.a AMENDMENTS, CHANGES, AND DISPUTES 18. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the services and/or reimbursement of services shall be accomplished by an amendment, which must be approved in writing by the County. 19. ADJUDICATION OF DISPUTES OR DISAGREEMENTS. County and PROVIDER agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of the parties. The PROVIDER and County staff shall try to resolve the claim or dispute with meet and confer sessions to be commenced within 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, 161" Judicial Circuit, Monroe County, Florida. 20. COOPERATION. In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breach of this Agreement, County and PROVIDER agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement. County and PROVIDER specifically agree that no party to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. ASSURANCES 21. COVENANT OF NO INTEREST. County and PROVIDER covenant that neither presently has any interest, and shall not acquire any interest, which would conflict in any manner or degree with its performance under this Agreement, and that only interest of each is to perform and receive benefits as recited in this Agreement. 22. NO ASSIGNMENT. The PROVIDER shall not assign this agreement except in writing cv and with the prior written approval of the Board, which approval shall be subject to such conditions and provisions as the Board may deem necessary. This agreement shall be incorporated by reference into any assignment and any assignee shall comply with all of the provisions herein. Unless expressly provided for therein, such approval shall in no manner or event be deemed to impose any obligation upon the Board in addition to the total agreed upon reimbursement amount for the services of the PROVIDER. 23. NON-WAIVER OF IMMUNITY. Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the County and the PROVIDER in this Agreement and the acquisition of any commercial liability insurance coverage, self-insurance coverage, or local government liability insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall any contract entered into by the County be required to contain any provision 5 for waiver. 24. ATTESTATIONS. PROVIDER agrees to execute such documents as the County may reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug- Free Workplace Statement. 25. AUTHORITY. Each party represents and warrants to the other that the execution, E delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. Contract-Guidance Care Center-Jail Program-FY20;page 5 Packet Pg.445 C.15.a INDEMNITY ISSUES 26. INDEMNIFICATION AND HOLD HARMLESS. The PROVIDER covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners from any and all claims and causes of action for medical malpractice, medical negligence, bodily injury (including death), personal injury, and property damage (including property owned by Monroe County) and any other losses, damages, and expenses (including attorney's fees) which arise out of, in connection with, or by reason of services provided by the PROVIDER occasioned by the negligence, errors, or other wrongful act or omission of the PROVIDER'S employees, agents, or volunteers. 27. PRIVILEGES AND IMMUNITIES. All of the privileges and immunities from liability, exemptions from laws, ordinances, and rules and pensions and relief, disability, workers' compensation, and other benefits which apply to the activity of officers, agents, or employees of any public agents or employees of the County, when performing their respective functions under this Agreement within the territorial limits of the County shall apply to the same degree and extent to the performance of such functions and duties of such officers, agents, volunteers, or employees outside the territorial limits of the County. 28. NO PERSONAL LIABILITY. No covenant or agreement contained herein shall be deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe County in his or her individual capacity, and no member, officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to any personal liability or accountability by reason of the execution of this Agreement. 29. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non-Delegation of Constitutional or Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any participating entity from any obligation or responsibility imposed upon the entity by law except to the extent of actual and timely performance thereof by any participating entity, in which case the N 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 N constitution, state statute, and case law. 30. NON-RELIANCE BY NON-PARTIES. No person or entity shall be entitled to rely upon the terms of this Agreement to enforce or attempt to enforce any third-party claim or entitlement to or benefit of any service or program contemplated hereunder, and the County and the PROVIDER agree that neither the County nor the PROVIDER or any agent, officer, or employee of either shall have the authority to inform, counsel, or otherwise indicate that any particular individual or group of individuals, entity or entities, have entitlements or benefits under this Agreement separate and apart, inferior to, or superior to the community in general or for the purposes contemplated in this Agreement. GENERAL 31. EXECUTION IN COUNTERPARTS. This Agreement may be executed in any number of counterparts, each of which shall be regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement by signing any such counterpart. 32. NOTICE. Any notice required or permitted under this agreement shall be in writing E 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 Contract-Guidance Care Center-Jail Program-FY20;page 6 Packet Pg.446 C.15.a Key West, FL 33040 Key West, FL 33041 For PROVIDER Sharon Crippen, Senior Vice President 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: �s WestCare Foundation, Inc. Attn: Executive Vice President 1711 Whitney Mesa Drive Henderson, Nevada 89014 33. GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES. This Agreement shall be governed by and construed in accordance with the laws of the State of Florida applicable to contracts made and to be performed entirely in the State. In the event that any cause of action or administrative proceeding is instituted for the enforcement or interpretation of this Agreement, the County and PROVIDER agree that venue will lie in the appropriate court or before the appropriate administrative body in Monroe County, Florida. The County and PROVIDER agree that, in the event of conflicting interpretations of the terms or a term of this Agreement by or between any of them the issue shall be submitted to mediation prior to the institution of any other administrative or legal proceeding. cv 34. NON-WAIVER. Any waiver of any breach of covenants herein contained to be kept and performed by the PROVIDER shall not be deemed or considered as a continuing waiver and 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. cv cv 35. SEVERABILITY. If any term, covenant, condition or provision of this Agreement (or the application thereof to any circumstance or person) shall be declared invalid or unenforceable to any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant, condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent permitted by law unless the enforcement of the remaining terms, covenants, conditions and provisions of this Agreement would prevent the accomplishment of the original intent of this Agreement. The County and PROVIDER agree to reform the Agreement to replace any stricken provision with a valid provision that comes as close as possible to the intent of the stricken provision. a5 36. CLAIMS FOR FEDERAL OR STATE AID: PROVIDER and COUNTY agree that each shall be, and is, empowered to apply for, seek, and obtain federal and state funds to further the purpose of this Agreement. Any conditions imposed as a result of funding that effect the Scope of Services will be provided to each party. 37. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the parties hereto with respect to the subject matter hereof and supersedes any and all prior E agreements with respect to such subject matter between the PROVIDER and the Board. [THIS SPACE INTENTIONALLY LEFT BLANK WITH SIGNATORY PAGE TO FOLLOW] Contract-Guidance Care Center-Jail Program-FY20;page 7 Packet Pg.447 C.15.a IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as of the day and year first written above. (SEAL) BOARD OF COUNTY COMMISSIONERS ATTEST: KEVIN MADOK, CLERK OF MONROE COUNTY, FLORIDA t3 B _. BY _.......�._. ...... ....... Deputy Clerk Mayor/Chairman a Guidance/Care Center, Inc., a Florida 501(c)(3) not-for-profit corporation _ as (Federal ID No. "� -.m 2'_ W itn B wit n Director Z: Guidance/Care Center, Inc., a Florida 501(c)(3) not-for-profit corporation (n cv cv cv cv a Contract-Guidance Care Center-Jail Program-FY20;page 8 Packet Pg.448 C.15.a ATTACHMENT A EXPENSE REIMBURSEMENT REQUIREMENTS This document is intended to provide basic guidelines to Human Service and Community-Based Organizations, county travelers, and contractual parties who have reimbursable expenses associated with Monroe County business. These guidelines, as they relate to travel, are from the Monroe County Code of Ordinances and State laws and regulations. A cover letter (see Attachment B) summarizing the major line items on the reimbursable expense request needs to also contain the following notarized certified statement: 32 ° "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." E 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. IL 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. cv Data Processing, PC Time, etc. The vendor invoice is required for reimbursement. Inter-company allocations are not considered cv 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: a y p g � p 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. E 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. Contract-Guidance Care Center-Jail Program-FY20;page 9 Packet Pg.449 C.15.a For supplies or services ordered, a vendor invoice is required. Telefax, Fax, etc. A fax log is required. The log must define the sender, the intended recipient, the date, the number called, and the reason for sending the fax. Telephone Expenses A user log of pertinent information must be remitted including: the party called, the caller, the telephone number, the date, and the purpose of the call. Travel and Meal Expenses Travel expenses must be submitted on a State of Florida Voucher for Reimbursement of Travel Expenses. Travel reimbursement requests must be submitted and will be paid in accordance with Monroe County Code of Ordinances and State laws and regulations. Credit card statements are not acceptable documentation for reimbursement. If attending a conference or meeting, a copy of the agenda is needed. Airfare reimbursement requires the original passenger receipt portion of the airline ticket. A travel itinerary is appreciated to facilitate the audit trail. Auto rental reimbursement requires the vendor invoice. Fuel purchases should be documented with paid receipts. Taxis are not reimbursed if taken to arrive at a departure point: for example, taking a taxi from one's residence to the airport for a business trip is not reimbursable. Parking is considered a reimbursable travel expense at the destination. Airport parking during a business trip is not. IL 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. N N Meal reimbursement shall be at the rates established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. Meal guidelines state 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. a 0 U Contract-Guidance Care Center-Jail Program-FY20;page 10 Packet Pg.450 C.15.a 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 3 101 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) jX.XXX.XX N 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) TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) State of County of This instrument was acknowledged before me this day of (month), (year), by (name of officer or agent, title or officer or agent) of (name of entity). U Personally Known Produced Identification: Type of ID and Number on ID (Seal) Signature of Notary Name of Notary (Typed, Stamped or Printed) Notary Public, State of Contract-Guidance Care Center-Jail Program-FY20;page 11 Packet Pg.451 C.15.a ATTACHMENT C Specific description and list of services to be provided under this contract: Guidance/Care Center, Inc. will provide substance abuse services including psychosocial assessment, case management, individual therapy, group therapy, drug testing and vocational workshops to men and women in the Monroe County Detention Center. This program is also known as the Jail In-House Program (JIP). a a cv cv cv cv a Contract-Guidance Care Center-Jail Program-FY20;page 12 Packet Pg.452 C.15.a ATTACHMENT D PUBLIC E1ITITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list following a conviction for j public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a CONTRACTOR, supplier, subcontractor, or CONTRACTOR under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list." I have read the above and state that neither Respondent's name) nor any Affiliate has been placed on the convicted vendor list within the last 36 months. IL (Signature) " ® l ao Date: M..... _.. .a cv TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) State of County of � a This instrument was acknowledged before me this day of �°� " )� (month)„ �� (Fear), byo D( , "" f (name of officer or agent, title or officer or agent) t (namIII n ofLL e of entity). Personally Known Produced Identification: Type of ID and Number on ID ° (Seal) r 0 Notary Dubuc scars or Florida 9 Notary Maryanne L Johnson SI nature My commisaion GG 1753451@ - ;'td �o,,,dP Expires0l/15/2022 Name of Notary(Typed, Stamped or Printed) Notary Public, State of �i Contract-Guidance Care Center-Jail Program-FY20;page 13 Packet Pg.453 ATTACHMENT E SWORN STATEMENT UNDER ORDINANCE NO. 010-1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE (Company) r otherwise!had act on his/her behalf any former "—warrants that he/it has not employed, retained o 90 o County officer County offi cer or employee in violation of Section 2 of Ordi n 0For breaca 1 Ol-19 990, hrorany violation of this or employee in violation of Section 3 of Cr No. 010-1 and may also, E provision the County may, In its discretion, terminate this Agreement without liability 0 , r otherwise recover,the full amount 2 in its discretion,deduct from the Agreement or purchase price o y officer or or consideration paid to the former Count of any fee, commission, percentage, gift, IL employee." (Signature) cas Date: cv cv TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) State of County of 7 (month), (year), - This instrument was acknowledged before me this day of by (name of officer or ag ent, title or officer or agent) (name of entity), of Personally Known Produced Identification: Type of ID and Number on ID 0 (Seal) E Noitlary Public otsts of Flonda r Signa of Notary maryanne L Joh ison xplres o i I I IY2022 my commission GG 17 534 5 /y ZEE] , 4"ll? Name of Notary (Typed, Stamped or Printed) Notary Public, State of L V--el 2' / -V Contract-Guidance Care Center-Jail Program-FY20;page 14 1 Packet Pg.454 C.15.a ATTACHMENT F DRUG-FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: p� (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 avallable 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 IL 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 i plea of guilty or nolo cdntendere 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 ( ) days after such conviction. . Impose a sanction on or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employees community, or any employee who is so convicted. 6. Make a good faith effort to continue to maintain a drug-free workplace through , implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. (Signature) ® ® L Date. .... ... _. ._. c5 TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) State of County of This instrument was acknowledged before me this vl � day of ' . ' „ (month)„ _ � " (year)^ by t A (name of officer or agent, title or officer or agent) of r (name of entity). t , � Personally Known Produced Identification: Type of ID and Number on ID (Seal) . �y1w � Note Public State of FloridaFlonda g m commission oaa S � i t �T fed Stam e � � � Notary of Notar Maryanne L Johnson +. M Commission GG 175345 d or Printed) ExpiresName Notary(Typed, p i Notary Public, State of 4 1_21 .A, Contract-Guidance Care Center-Jail Program-FY20;page 15 Packet Pg.455 C.15.a ATTACHMENT G FY2020 Annual Performance Report (For year October 1, 2019—September 30, 2020) Agency Name ............................................................................................................................... .............................................................................................................................................................................................................................................................................................................................................................................. Point of Contact POC .........................................................................................(........................)........................................................................................................................................................................................................................................................................................................................................................................................................... �- Phone/Email ............................................................................................................................... .............................................................................................................................................................................................................................................................................................................................................................................. a 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 FY2020 Performance (i.e. successes, challenges, etc.): N CD Questions: 1. Please list services and client information below for the program/activities funded by the Monroe County award. CD N , (mw �s i�yl�00911111 �s a 2. What were the measurable outcomes (including numbers) accomplished in FY2020? Please base these outcomes on the services you identified in Question#1. 0 U 3. What number and percentage of your clients/participants were at or below the federal poverty level in FY2020; and/or 200%; and/or another standard used by your organization? 4. Were all the awarded funds used in FY2020? If not, please explain. 5. What is the number of FTEs working on the program(s) funded by the award in FY2020? Contract-Guidance Care Center-Jail Program-FY20;page 16 Packet Pg.456 C.15.a 6. Were the awarded funds used as match in FY2020? If so, please list matching sources. 7. What area of Monroe County did you serve in FY2020? 8. How many total FTEs in your organization? 9. Volunteers: hours of program service were contributed by volunteers in FY2020. �? 10. What was the CEO/Executive Director(or highest paid title) compensation in FY2020? (Please breakdown between salary and benefits.) a 11. What is your organization's fiscal year? For the following questions, please use the number as reported on your FY2020 IRS Form 990. If your FY2020 IRS Form 990 is not yet prepared, please provide an estimate for the following questions. 12. What were your organization's total expenses in FY2020? 13. What was your organization's total revenue in FY2020? cv cv 14. What was the organization's total in grants and contracts for FY2020? cv cv 15. What was the organization's total donations and in-kind (fundraising) in FY2020? 16. What percentage of your expenses are program service expenses' versus management and general expenses2 in FY2020 as reported on your IRS Form 990? a 0 U 1Program service expenses are defined as expenses needed to run your programs. 2Management and general expenses encompass expenses such as human resources,salaries of those not working directly with programs, legal services, accounting services, insurance expenses,office management,auditing, and other centralized services. Contract-Guidance Care Center-Jail Program-FY20;page 17 Packet Pg.457 -q co LOv T ci a m IL E to 0000 NCD O (D d' O M N L000 CO M 000000010. O CM O O 2 O 0CD NO LOh tt f. N LO 00 (ONOO 0 LO0 LO 00 O O O 00 M f- O U T M r 0 LO CO 00 (fl (O Cl) CA It 0D 0 0 CO tt O Ih r (p 0 r In O 7 -e O O 00 co N co M C- M N N r N (M r LL r V r V V V CO V Cl) N N N Up OOOON N 07 LO I " 00000 O O O N c} m U Y O coN O LO Cl) m N LO O LO C C O O O N M LO O LL 't(M r C LO 7 NN- q CO � r O 0 r Ln N Cl) (O m O 00 m �! (O 0 r h r V N Ln h LL ao r rn c CM N O O O O (D0 Fw LL O O O O O r OCto a) k 0 (OrO (O M 0 N000 01 OCOp 0m00 00 00 0 M C CO 00000 O 00 0) cc) E m LL 00 CN 00 to q (D q_ LOAL^ C\i (0 t LO CO O) O LL rn a- U N F- " r � V � N Z N LL r ° M CM Cl? O O O O r O w M (O m 0 Z a) to } wE � r y ai U Of ICD a i� " r f N � N N 0000�p CIJ V � 0 0 CO pMj r r Cl) 10 W O m 0 LL CD LO W N r 7 CO N O O LO O1 M M m L O a) LL' W 00 fA 0 (b r r r N n LO M O U Q fN N M N 00 r 0 r m N (6 U a � '5 r r } ."' w p LL Q U N Z N w 0 p 0 0 E co (D (D 00 m ❑ � (9 (o (o rn E T O O O r O 7 a C 00 � 000000 o c — e O O O O O O O L O (j .m OOOOO LO0LO r 0 00 O O N n V C- N O U O 'ct "tC LO O W CD C 't NO0M C- fJ 00 O CO (0 N (O --I- 7 st d r r LL a) CA co N C OI m n X o o a c U O c� N (D N N16 O fU L}L N C Y cm N ° m 3 y m ❑ LL' (D O a) a w � m � � � aN ° d (o 3 m c a) c O LL o� a) Im o N C � 0 Q cC� m c c v LO y O ❑ U C v N > LL N bN4 N (0 N O y 69 a) U U p) C y0 > '"7 Y N e od ,aY ) N d 2 O e C co $ E ° pp= _ _ a� Ln y a °o o (o E a�i a� _d ap 0 U ,D c N N M 7 U N O O ca N �" y Y (J (0 C � C1 ` w E r LL o > Q w a� a� m E >o o '� c °� ° c a aoi ` U H E . cw ws c c :° a � > > � F �' :° K p� � � �L o o 4 N f0 W C H p p O 10 V H U m C .2 W m LD V :� a E a $ a f0 J (`o rn-I (o ° -0 ~ C o � (n 2 d o m E a LL ° c lau) < a H 3 � (n ❑ I— w w t � UOaU 5 w ' v°i c 5 H m cnaU ❑ UW -itntn u 0 0 ai m AGREEMENT This Agreement is made and entered into this 16th day of October 2019, between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as "Board" or "County," and Guidance/Care Center, Inc., a Florida 501(c)(3) 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 matching funds pursuant to Section 394.76(9)(a), Florida Statutes, and in accordance with the contracts between the PROVIDER and South Florida Behavioral Health Network (ME225-10-27, P-04, and Amendment #1 to Contract No. 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 County shall reimburse the PROVIDER for the local match portion of the PROVIDER'S expenditures as billed by the PROVIDER, in consideration of substantially and satisfactorily performing Substance Abuse and Mental Health services for clients qualifying for such services under applicable state and federal regulations and eligibility determination procedures, for alcohol, substance abuse and mental health treatment. This cost shall not exceed a total reimbursement of EIGHT HUNDRED SIXTY-TWO THOUSAND, SIX HUNDRED SEVENTY-SIX AND NO/100 DOLLARS ($862,676.00) in fiscal year 2020. 3. TERM. This Agreement shall commence on October 1, 2019, and terminate September 30, 2020, unless earlier terminated pursuant to other provisions herein. 4. PAYMENT. Payment will be paid monthly as hereinafter set forth. 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. 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 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. 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. 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. To preserve client confidentiality required by law, copies of individual client bills and records shall not be Guidance Care Center-SAMH Contract FY20;page 1 1 available to the Board for reimbursement purposes but shall be made available only under controlled conditions to qualified auditors for audit purposes. S. AVAILABILITY OF FUNDS. The County reserves the right to withhold/reduce the funds to the Provider in the event that the Department of Children and Families eliminates/reduces the State contract funding provided for Services as set forth in the Prime Contract with the South Florida Behavior Health Network. 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. Funding under this agreement shall not be used to purchase capital assets. RECORDKEEPING 7. RECORDS AND RIGHT TO AUDIT. 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. Right to Audit. Availability of Records. The records of the parties to this Agreement relating to the Project, which shall include but not be limited to accounting records (hard copy, as well as computer readable data if it can be made available; general ledger entries detailing cash and if applicable trade discounts earned, insurance rebates and dividends; any other supporting evidence deemed necessary by County or the Monroe County Office of the Clerk of Court and Comptroller (hereinafter referred to as "County Clerk") to substantiate charges related to this agreement, and all other agreements, sources of information and matters that may in County's or the County Clerk's reasonable judgment have any bearing on or pertain to any matters, rights, duties or obligations under or covered by any contract document (all foregoing hereinafter referred to as "Records") shall be open to inspection and subject to audit and/or reproduction by County's representative and/or agents or the County Clerk. County or County Clerk may also conduct verifications such as, but not limited to, counting employees at the job site, witnessing the distribution of payroll, verifying payroll computations, overhead computations, observing vendor and supplier payments, miscellaneous allocations, special charges, verifying information and amounts through interviews and written confirmations with employees, Subcontractors, suppliers, and contractor's representatives. The County Clerk possesses the independent authority to conduct an audit of Records, assets, and activities relating to this Project. The right to audit provisions survives the termination of expiration of this Agreement. In addition, if PROVIDER is required to provide an audit as set forth in in Section 9(e) below, the audit shall be prepared by an independent certified public accountant (CPA) with a current license, in good standing with the Florida State Board of Accountancy. S. PUBLIC ACCESS. The County and PROVIDER shall allow and permit reasonable access to, and inspection of, all documents, papers, letters or other materials in its possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the Guidance Care Center-SAMH Contract FY20;page 2 2 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; (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 ME225-10-27 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 (ME225-10-27 and P-04); (1) Annual Performance Report describing services rendered during the most recently completed grant period (to be furnished within 30 days after the contract end date.) The performance report shall include statistical information regarding the types and frequencies of services provided, a profile of clients (including residency) and numbers served, and outcomes achieved; (m) Cooperation with County monitoring visits that the County may request during the contract year; and (n) Other reasonable reports and information related to compliance with applicable laws, contract provisions and the scope of services that the County may request during the contract year. 10. AUDIT. The Provider shall provide the County with an annual audit pursuant to Section 394.76(10), Florida Statutes, which separately reflects the funds received from the County and related expenditures of said funds during the 2018-2019 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, 2020. 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. Guidance Care Center-SAMH Contract FY20;page 3 3 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. 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 that there will be no discrimination against any person, and it is expressly understood that upon a determination by a court of competent jurisdiction that discrimination has occurred, this Agreement automatically terminates without any further action on the part of any party, effective the date of the court order. 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 prohibits 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 Guidance Care Center-SAMH Contract FY20;page 4 4 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 §§ 12101), 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. 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, 161" 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 Guidance Care Center-SAMH Contract FY20;page 5 5 insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall any contract entered into by the County be required to contain any provision for waiver. 26. ATTESTATIONS. PROVIDER agrees to execute such documents as the County may reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug- Free Workplace Statement. 27. AUTHORITY. Each party represents and warrants to the other that the execution, delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. INDEMNITY ISSUES 28. INDEMNIFICATION AND HOLD HARMLESS. The PROVIDER covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners from any and all claims 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 Guidance Care Center-SAMH Contract FY20;page 6 6 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 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. CLAIMS FOR FEDERAL OR STATE AID: PROVIDER and COUNTY agree that each shall be, and is, empowered to apply for, seek, and obtain federal and state funds to further the purpose of this Agreement. Any conditions imposed as a result of funding that effect the Scope of Services will be provided to each party. Guidance Care Center-SAMH Contract FY20;page 7 7 39. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the parties hereto with respect to the subject matter hereof and supersedes any and all prior agreements with respect to such subject matter between the PROVIDER and the Board. [THIS SPACE INTENTIONALLY LEFT BLANK WITH SIGNATORY PAGE TO FOLLOW] Guidance Care Center-SAMH Contract FY20;page 8 8 � � | IN WITNESS WHEREOF, the pnddae hereto have caused these presents to be executed as of � the day and year first written above. � BOARD OF COUNTY COMMISSIONERS (SEAL)ATTEST: KEVlNMADDK, CLERK OFMONROECOUNTy, FUORIDA Deputy Clerk Guidanca/CareCanter, Inc., a Florida 501(o)(3) not-for-profit corporation (F8d8r�| I[) N8 ) ` . � / Guidance Care ornte,nAM*Contract Fyuo page 9 ATTACHMENT A EXPENSE REIMBURSEMENT REQUIREMENTS This document is intended to provide basic guidelines to Human Service and Community-Based Organizations, county travelers, and contractual parties who have reimbursable expenses associated with Monroe County business. These guidelines, as they relate to travel, are from the Monroe County Code of Ordinances and State laws and regulations. A cover letter (see Attachment B) summarizing the major line items on the reimbursable expense request needs to also contain the following notarized certified statement: "I certify that the above checks have been submitted to the vendors as noted and that the attached expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this organization's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source." Invoices should be billed to the contracting agency. Third party payments will not be considered for reimbursement. Remember, the expense should be paid prior to requesting a reimbursement. Only current charges will be considered, no previous balances. Reimbursement requests will be monitored in accordance with the level of detail in the contract. This document should not be considered all-inclusive. The Clerk's Finance Department reserves the right to review reimbursement requests on an individual basis. Any questions regarding these guidelines should be directed to 305-292-3534. Data Processing, PC Time, etc. The vendor invoice is required for reimbursement. Inter-company allocations are not considered reimbursable expenditures unless appropriate payroll journals for the charging department are attached and certified. Payroll A certified statement verifying the accuracy and authenticity of the payroll expense is needed. If a Payroll Journal is provided, it should include: dates, employee name, salary or hourly rate, total hours worked, withholding information and paid payroll taxes, check number and check amount. If a Payroll Journal is not provided, the following information must be provided: pay period, check amount, check number, date, payee, and support for applicable paid payroll taxes. Postage, Overnight Deliveries, Courier, etc. A log of all postage expenses as they relate to the County contract is required for reimbursement. For overnight or express deliveries, the vendor invoice must be included. Rents, Leases, etc. A copy of the rental or lease agreement is required. Deposits and advance payments are not allowable expenses. Reproductions, Copies, etc. A log of copy expenses as they relate to the County contract is required for reimbursement. The log must define the date, number of copies made, source document, purpose, and recipient. A reasonable fee for copy expenses will be allowable. For vendor services, the vendor invoice and a sample of the finished product are required. Supplies, Services, etc. For supplies or services ordered, a vendor invoice is required. Guidance Care Center-SAMH Contract FY20;page 10 10 Telefax, Fax, etc. A fax log is required. The log must define the sender, the intended recipient, the date, the number called, and the reason for sending the fax. Telephone Expenses A user log of pertinent information must be remitted including: the party called, the caller, the telephone number, the date, and the purpose of the call. Travel and Meal Expenses Travel expenses must be submitted on a State of Florida Voucher for Reimbursement of Travel Expenses. Travel reimbursement requests must be submitted and will be paid in accordance with Monroe County Code of Ordinances and State laws and regulations. Credit card statements are not acceptable documentation for reimbursement. If attending a conference or meeting, a copy of the agenda is needed. Airfare reimbursement requires the original passenger receipt portion of the airline ticket. A travel itinerary is appreciated to facilitate the audit trail. Auto rental reimbursement requires the vendor invoice. Fuel purchases should be documented with paid receipts. Taxis are not reimbursed if taken to arrive at a departure point: for example, taking a taxi from one's residence to the airport for a business trip is not reimbursable. Parking is considered a reimbursable travel expense at the destination. Airport parking during a business trip is not. A detailed list of charges is required on the lodging invoice. Balance due must be zero. Room must be registered and paid for by traveler. The County will only reimburse the actual room and related bed tax. Room service, movies, and personal telephone calls are not allowable expenses. Mileage reimbursement shall be at the rate established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. An odometer reading must be included on the state travel voucher for vicinity travel. Mileage is not allowed from a residence or office to a point of departure. For example, driving from one's home to the airport for a business trip is not a reimbursable expense. Meal reimbursement shall be at the rates established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. Meal guidelines state that travel must begin prior to 6 a.m. for breakfast reimbursement, before noon and end after 2 p.m. for lunch reimbursement, and before 6 p.m. and end after 8 p.m. for dinner reimbursement. Non-allowable Expenses The following expenses are not allowable for reimbursement: capital outlay expenditures (unless specifically included in the contract), contributions, depreciation expenses (unless specifically included in the contract), entertainment expenses, fundraising, non-sufficient check charges, penalties and fines. Guidance Care Center-SAMH Contract FY20;page 11 11 ATTACHMENT B ORGANIZATION LETTERHEAD Monroe County Board of County Commissioners Finance Department 500 Whitehead Street Key West, FL 33040 Date The following is a summary of the expenses for (Organization name) for the time period of to Check # Payee Reason Amount 101 Company A Rent $ X,XXX.XX 102 Company B Utilities XXX.XX 104 Employee A P/R ending 05/14/01 XXX.XX 105 Employee B P/R ending 05/28/01 XXX.XX (A) 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) TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) State of County of This instrument was acknowledged before me this day of (month), (year), by (name of officer or agent, title or officer or agent) of (name of entity). Personally Known Produced Identification: Type of ID and Number on ID (Seal) Signature of Notary Name of Notary(Typed, Stamped or Printed) Notary Public, State of Guidance Care Center-SAMH Contract FY20;page 12 12 ATTACHMENT C Specific description and list of services to be provided under this contract: 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- 10-27, P-04 and Amendment #1 to Contract No. P-04). Guidance Care Center-SAMH Contract FY20;page 13 13 ATTACHMENT D Contractual Agreement Guidance/Care Center and South Florida Behavioral Health Network Contract Numbers: ME225-10-27, P-04 and Amendment #1 to Contract No. P-04 Guidance Care Center-SAMH Contract FY20;page 14 14 South Floricla ;,AeA0 Behavioral Health INetwor ,Inc, rev.07/O1/2019 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 Department of Children and Families ("DCF" or "Department")and SFBHN(ME),not in conflict with this Contract,shall be binding upon the Network Provider and the Network Provider agree s 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, 2019. It shall end at midnight, local time in Miami-Dade County, Florida on June 30, 2020, subject to the survival of terms of Section 50. 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 Ne twork 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, Standard Contract Guidance/Care Center, Inc. Page 1 of 13 Contract No.ME225-10-27 15 South Floricla ;,AeA0 Behavioral Health INetwor ,Inc, rev.07/O1/2019 Attachment Ill. All disclosure forms as required by the Certification Regarding Lobbying from must be completed and returned to the ME 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 Order12549. 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 this contract, at no additional cost to the ME. c. Upon demand,at no additional cost to the ME,the Network Provider will facilitate the duplication and transfer of any records or documents during the required retention period in Section 7.b. d. These records shall be made available at all reasonable times for inspection, review,copying,or audit by Federal, State,or other personnel duly authorized by the ME. e. At all reasonable times for as long as records are maintained, persons duly authorized by the ME, State, and Federal auditors, pursuant to 45 CFR,section 92.36(i)(10),shall be allowed full access to and the right to examine any of the Network Provider's contracts and related records and documents, regardless of the form in which kept. f. A financial and compliance audit shall be provided to the ME as specified in this contract and in Attachment II. Financial and Compliance 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 in all subcontracts and assignments. 8. Inspections and Corrective Action The Network Provider shall permit all persons who are duly authorized by the ME and the Department to inspect and copy any records, papers, documents, facilities, goods and services of the Network Provider which are relevant to this contract, the scope of review being conducted, and to interview any clients,employees and subcontractor employees of the Network Provider to assure the ME of the satisfactory performance of the terms and conditions of this contract. Following such review,the ME will deliver to the Network Provider a written re port of its findings, and may direct the development, by the Network Provider,of a corrective action plan where appropriate.The Network Provider hereby agrees to timely correct all deficiencies identified in the corrective action plan.This provision will not limit the ME's termination rights under Section 40. Failure to implement corrective action plans to the satisfaction of the ME, after receiving due notice, shall be grounds for contract termination. 9. Indemnification a. The Network Provider shall be fully liable for the actions of its agents, employees, partners, or subcontractors and shall fully indemnify, defend, and hold harmless the ME, State and the Florida Department of Children and Families (DCF), and its officers,agents, and employees, from suits, actions, damages, and costs of every name and description, including attorneys'fees, arising from or relating to any alleged act or omission by the Network Provider, its agents,employees, partners,or subcontractors, provided, however,that the Network Provider sha II not indemnify for that portion of any loss or damages caused by the negligent act or omission of the ME. Standard Contract Guidance/Care Center, Inc. Page 2 of 13 Contract No.ME225-10-27 16 South Florld'a ;,AeA0 Behavioral Health INetwwor ,Inc, rev.07/O1/2019 b.The Network Provider shall fully indemnify,defend and hold harmless the ME,the State and the DCF,from any suits,actions,damages, and costs of every name and description, including attorneys'fees, arising from or relating to violation of infringement of a trademark, copyright, patent, trade secret or intellectual property right, provided, however, that the foregoing obligation shall not apply to the ME's misuse or modification of Network Provider's products or a ME's operation or use of Network Provider's products in a manner not contemplated by the contract or the purchase order. If any product is the subject of an infringement suit or in the Network Provider's opinion is likely to become the subject of such a suit,the Network Provider may at its sole expense procure for the ME the right to continue using the product or modify it to become non-infringing. If the Network Provider is not reasonably able to modify or otherwise secure the ME the use,the ME shall not be liable for any royalties.The Network Provider's indemnification for violation or infringement of a trademark,copyright, patent,trade secret or intellectual property right shall encompass all such items used or accessed by the Network Provider, its officers, agents or subcontractors in the performance of this contract or delivered to the ME for the use of the ME, its employees,agents or contractors. c. The Network Provider shall protect, defend, and indemnify, including attorney's fees and cost, the ME for any and all claims and litigation (including litigation initiated by the ME) arising from or relating to Network Provider's claim that a document contains proprietary or trade secret information that is exempt from disclosure or the scope of the Network Provider's redaction, as provided for under Section 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 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 the terms of insurance,to include but not limited to,cancellation or modification to policy limits. b. To the fullest extent permitted by law, and not withstanding any other provision of this Contract, the Network Provider by signing this contract acknowledges the value of obtaining Cyber Liability insurance, has considered all of the risks,and assumes all of the risks and liability associated with not obtaining such insurance.The Network Provider will indemnify,defend,and hold the ME harmless from any and all claims, losses, liabilities, damages,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 II 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 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. Standard Contract Guidance/Care Center, Inc. Page 3 of 13 Contract No.ME225-10-27 17 South Florld'a ;,AeA0 Behavioral Health INetwor ,Inc, rev.07/O1/2019 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.or9. c.To the extent permitted by Florida Law,and in compliance with Section 9.of this Standard Contract,the Network Provider is responsible for all work performed and for all commodities produced pursuant to this contract whether actually furnished by the Network Provider or its subcontractors. Any subcontracts shall be evidenced by a written document. The Network Provider further agrees that the ME shall not be liable to the subcontractor in any way or for any reason.The Network Provider, at its expense,will defend the ME against such claims. d. The Network Provider shall make payments to any subcontractor within seven(7)working days after receipt of full or partial payments from the ME in accordance with section 287.0585, F.S., unless otherwise Stated in the contract between the Network Provider and subcontractor. Failure to pay within seven (7)working days will result in a penalty that shall be charged against the Network Provider and paid by the Network Provider to the subcontractor in the amount of one-half of one percent (.005) of the amount due per day from the expiration of the period allowed for payment.Such penalty shall be in addition to actual payments owed and shall not exceed fifteen (15%) percent of the outstanding balance due. e. The State of Florida shall at all times be entitled to assign or transfer, in whole or part, its rights, duties, or obligations under its contract with the ME to another governmental agency in the State of Florida or to a provider of the Department's selection, upon giving prior written notice to the ME. In the event the State of Florida approves transfer of the ME's obligations,the Network Provider remains responsible for all work performed and all expenses incurred in connection with the contract.This contract shall remain binding upon the successors in interest of the Network Provider, the ME and the Department. f. The Network Provider shall include, or cause to be included, in all subcontracts (at any tier) the substance of all clauses contained in this Standard Contract that mention or describe subcontract compliance. 13. Return of Funds a. The Network Provider shall return to the ME any overpayments due to unearned funds or funds disallowed that were disbursed to the Network Provider by the ME and any interest attributable to such funds. 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 o r 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. 14. Client Risk Prevention and Incident Reporting a. If services to clients are to be provided under this contract,the Network Provider and any subcontractors shall, in accordance with the client risk prevention system, report those reportable situations listed in CFOP 215-6 in the manner prescribed in CFOP 215-6.The Network Provider shall immediately report any knowledge or reasonable suspicion of abuse, neglect,or exploitation of a child,aged person,or disabled adult to the Florida Abuse Hotline on the statewide toll-free telephone number(1-800-96ABUSE).As required by Chapters 39 and 415,F.S.,this provision is binding upon both the Network Provider and its employees. b. The ME monitors timely submissions of incident reports and may impose financial penalties as described in Section 39. Financial Penalties for Failure to Comply with Requirement for Corrective Action of this Standard Contract, paragraphs b.,c.,and d. 15. Civil Rights Requirements In accordance with Title VII of the Civil Rights Act of 1964,the Americans with Disabilities Act of 1990,or the Florida Civil Rights Act of 1992,as applicable the Network Provider shall not discriminate against any employee(or applicant for employment) in the performance of this contract because of race, color, religion, sex, national origin, disability, age, or marital status. Further, the Network Provider shall not to discriminate Standard Contract Guidance/Care Center, Inc. Page 4 of 13 Contract No.ME225-10-27 18 South Floricla ;,AeA0 Behavioral Health IfWetwor ,Inc, rev.07/O1/2019 against any applicant, client, or employee in service delivery or benefits in connection with any of its programs and activities in accordance with 45 CFR 80,83,84, 90,and 91,Title VI of the Civil Rights Act of 1964,or the Florida Civil Rights Act of 1992,as applicable and CFOP 60-16. These requirements shall apply to all contractors,subcontractors,sub-grantees or others with whom it arranges to provide services or benefits to clients or employees in connection with its programs and activities.The Network Provider shall complete the Civil Rights Certificate,CF Form 707 and the Civil Rights Compliance Checklist,CF Form 946 in accordance with CFOP 60-16 and 45 CFR 80. 16. Independent Capacity of the Contractor a.In performing its obligations under this contract,the Network Provider shall at all times be acting in the capacity of an independent contractor and not as an officer, employee, or agent of the ME or the State of Florida, except where the Network Provider is a State agency. Network Provider nor its agents, employees, subcontractors or assignees shall represent to others that it has the authority to bind the ME or the Department unless specifically authorized in writing to do so.This contract does not create any right to State retirement, leave benefits or any other benefits of State employees as a result of performing the duties or obligations of this contract. b.The Network Provider shall take such actions as may be necessary to ensure that each subcontractor of the Network Provider will be deemed to be an independent contractor and will not be considered or permitted to be an agent, servant,joint 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 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. and 287.134, 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 repl y on a contract with a public entity for the construction or the repair of a public building or public work; may not subm it bids, proposals,or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor,supplier, subcontractor,or consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in section 287.017, F.S.,for CATEGORY TWO for a period of thirty-six(36) months from the date of being placed on the convicted vendor list. This provision applies to the Network Provider and all their subcontractors. 22. Gratuities The Network Provider agrees that it will not offer to give or give any gift to any ME 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 Standard Contract Guidance/Care Center, Inc. Page 5 of 13 Contract No.ME225-10-27 19 South Florida ;,AeA0 Behavioral Health INetwwor ,Inc, rev.07/O1/2019 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 any interest in any intellectual property rights accruing under or in connection with the performance of this contract.It is specifically agreed that the Department shall have exclusive rights to all data processing software falling within the terms of section 119.084, F.S., which arises or is developed in the course of or as a result of work or services performed under this contract, or in any way connected herewith. Notwithstanding the foregoing provision,if the Network Provider is a university and a member of the State University System of Florida,then section 1004.23,F.S.,shall apply. 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,o r materials in any way involved in the work contemplated by this contract. For the purposes of this provision,the term "use"shall include use by the Network Provider during the term of this contract and use by the ME,agents,or contractors and the Department during the term of this contract and perpetually thereafter. c.All applicable subcontracts shall include a provision that the Federal awarding agency reserves all patent rights with respect to any discovery or invention that arises or is developed in the course of or under the subcontract. Notwithstanding the foregoing provision, if the Network Provider or one of its subcontractors is a university and a member of the State University of Florida,then section 1004.23, F.S.,shall apply, but the Department shall retain a perpetual, fully-paid, non-exclusive license for its use and the use of its contractors of any resulting patented, copyrighted or trademarked work products. 24. Real Property Any State funds provided for the purchase of or improvements to real property are contingent upon the Network Provider granting to the State a security interest in the property at least to the amount of the State funds provided for at least five(5)years from the date of purchase or the completion of the improvements or as further required by law.As a condition of receipt of State funding for this purpose,the Network Provider agrees that, if it disposes of the property before the Department's interest is vacated, the Network Provider will refund the proportionate share of the State's initial investment,as adjusted by depreciation. 25. Information Security Obligations a.An appropriately skilled individual shall be identified by the Network Provider to function as its Information Security Officer.The Information Security Officer shall act as the liaison to the ME's and the Department's security staff and will maintain an appropriate level of information security for the ME's and the Department's information systems or any client or other confidential information the Network Provider is collecting or using in the performance of this contract.An appropriate level of security includes approving and tracking all who request or have access,through the Network Provider's access,to ME or Department information systems or any client or other confidential information.The Information Security Officer will ensure that any access to the ME or Department information systems or any client or other confidential information is removed immediately upon such access no longer being required for Network Provider's performance under this contract. b.The Network Provider shall provide the latest DCF HIPAA and Security Awareness Training to its staff and subcontractors who have access to ME and Department 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 request or have access to ME or Department data system or information,, Incident Reporting and Analysis System (IRAS),Temporary Assistance for Needy Family(TANF), shall comply with,and be provided a copy of CFOP 50-2,and shall sign the DCF Security Agreement form CF 0114 annually or immediately upon hire and annually thereafter. The Network Provider shall maintain a copy of the signed DCF Security Agreement form CF 0114 in the personnel file. The Network Provider agrees to submit copies of each signed DCF Security Agreement form CF 0114 to the ME's Contract Manager and the ME's Vice President of IT and Data Anayltics upon request. A copy of CF 0114 may be obtained from the ME's 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. The Network Provider shall require the same of all subcontractors. f. The Network Provider agrees to notify the ME's Contract Manager as soon as possible, but no later than four(4) business days following the determination of any potential or actual unauthorized disclosure or access to ME or Department information systems or to any client or other confidential information. .The Network Provider shall require the same notification requirements of all subcontractors. Standard Contract Guidance/Care Center, Inc. Page 6 of 13 Contract No.ME225-10-27 20 South Floricla ;,AeA0 Behavioral Health INetwwor ,Inc, rev.07/O1/2019 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 Department data provided in section 501.171, 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 and the Department to avoid or mitigate potential injury to any person due to potential or actual unauthorized disclosure or access to the ME and Department information systems or to any client or other confidential information. 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 30,2020. 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,th e Network Provider shall,within thirty(30)days of the execution of this contract,submit to the contract manager an emergency preparedness plan which shall include provisions for records protection, alternative accommodations for clients in substitute care, alternate facilities for the 24 hour facilities in case those facilities are incapacitated by the disaster and the expectation for returning exceeds emergency sheltering capabilities and time allowances supplies, and a recovery plan that will allow the Network Provider to continue functioning in compliance with the executed contract in the event of an actual emergency. For the purpose of disaster planning,the term supervision includes the responsibility of the ME,or its contracted agents to ensure the safety, permanency and well-being of a child who is under the jurisdiction of a dependency court.Children may remain in their homes, be placed in a non-licensed relative/non-relative home,or be placed in a licensed foster care setting. b. The ME agrees to respond in writing within thirty(30) days of receipt of the plan accepting, rejecting, or requesting modifications. In the event of an emergency, the ME may exercise oversight authority over such Network Provider in order to assure implementation of agreed emergency relief provisions. c. An updated emergency preparedness plan shall be submitted by the Network Provider no later than 12 months following the acceptance of an original plan or acceptance of an updated plan.The ME agrees to respond in writing within 30 days of receipt of the updated plan,accepting, rejecting,or requesting modification to the plan. 30. Notification of Legal Action The Network Provider shall notify the ME of legal actions taken against them or potential actions such as lawsuits, related to services provided through this contract or that may impact the Network Provider's ability to deliver the contractual services, or adversely impact the ME.The ME's contract manager will be notified within ten (10) days of Network Provider becoming aware of such actions or from the day of the legal filing,whichever comes first. 31. 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 pe rsons 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/ Standard Contract Guidance/Care Center, Inc. Page 7 of 13 Contract No.ME225-10-27 21 South Florida ;,AeA0 Behavioral Health INetwwor ,Inc, rev.07/O1/2019 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 sped fically to redacted information,either confirming that the statutory and factual basis originally asserted remain unchanged or indicating any ch anges 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 propri etary or trade secret information are exempt from inspection and copying under Florida's Public Records Law. 33. Support to the Deaf or Hard-of-Hearing a.The Network Provider and its subcontractors,where direct services are provided, shall comply with section 504 of the Rehabilitation Act of 1973, 29 U.S.C.794, as implemented by 45 C.F.R. Part 84(hereinafter referred to as Section 504),the Americans with Disabilities Act of 1990, 42 U.S.C. 12131, as implemented by 28 C.F.R. Part 35 (hereinafter referred to as ADA), and the Children and Families Operating Instruction (CFOP)60-10,Chapter 4,entitled "Auxiliary Aids and Services for the Deaf or Hard-of-Hearing. b. If the Network Provider or any of its subcontractors employs fifteen (15)or more employees,the Network Provider shall designate a Single- Point-of-Contact 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 hops://fsl6.formsite.com/DCFTrainin /Monthly Summary Report/form loin.html by the 41h working day of the month,covering the previous month's reporting, and forward the confirmation of submission to the ME's Contract Manager. The name and contact information for the Network Provider's Single Point of Contact shall be furnished to the ME's Contract Manager within fourteen (14)calendar days of the effective date of this requirement. d.The network provider shall contractually require that its subcontractors comply with Section 504, the ADA, and CFOP 60-10, Chapter 4. A Single-Point-of-Contact shall be required for each subcontractor that employs fifteen(15)or more employees.This Single-Point-of-Contact will ensure effective communication with deaf or hard-of-hearing customers or companions in accordance with Section 504 and the ADA and coordinate activities and reports with the Network Provider's Single-Point-of-Contact. e. The Single-Point-of-Contact shall ensure that employees are aware of the requirements, roles & responsibilities, and contact points associated with compliance with Section 504, the ADA, and CFOP 60-10, Chapter 4. Further, employees of Network Providers and its subcontractors with 15 or more employees shall attest in writing that they are familiar with the requirements of Section 504, the ADA, and CFOP 60-10,Chapter 4.This attestation shall be maintained in the employee's personnel file. f. The Network Provider's Single-Point-of-Contact will ensure that conspicuous Notices which provide information about the availability of appropriate auxiliary aids and services at no-cost to the deaf or hard-of-hearing customers or companions are posted near where people enter or are admitted within the agent locations.Such Notices must be posted immediately by Network Providers and subcontractors. The approved Notice can be downloaded through the Internet at: _http://www.myflfamilies.com/service-programs/deaf-and-hard-hearing/providers g. The Network Provider and its subcontractors shall document the customer's or companion's preferred method of communication and any requested auxiliary aids/services provided in the customer's record. Documentation, with supporting justification, must also be made if any request was not honored.The Network Provider shall distribute Customer Feedback forms to customers or companions,and submission to the Department of Children and Families Office of Civil Rights. h. If customers or companions are referred to other agencies, the Network Provider must ensure that the receiving agency is notified of the customer's or companion's preferred method of communication and any auxiliary aids/service needs. Standard Contract Guidance/Care Center, Inc. Page 8 of 13 Contract No.ME225-10-27 22 South Floricia ;,AeA0 Behavioral Health Network,Inc, rev.07/O1/2019 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 $8,134,885.00, 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 $6,779,071.00, subject to the delivery and billing for services. The remaining amount of $1,355,814.00, 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 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 s ection 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.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 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. Standard Contract Guidance/Care Center, Inc. Page 9 of 13 Contract No.ME225-10-27 23 South Floricla ;,AeA0 Behavioral Health INetwwor ,Inc, rev.07/01/2019 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 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 sh all 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 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 writing to the other party unless a sooner time is mutually agreed upon in writing. Said notice shall be delivered by U.S. Postal Service or any expedited delivery service that provides verification of delivery or by hand delivery to the contract manager or the representative of the Network Provider responsible for administration of the program. This provision shall not limit the ME's ability to terminate this Contract for cause according to other provisions herein. b.In the event funds for payment pursuant to this Contract become unavailable,the ME may terminate this Contract upon no less than twenty- four(24) hour notice in writing to the Network Provider.Said notice shall be sent by U.S. Postal Service or any expedited delivery service that provides verification of delivery.The ME shall be the final authority as to the availability and adequacy of funds. In the event of termination of this contract,the Network Provider will be compensated for any work satisfactorily completed 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.Termi nation 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. Regardless of the amount of if this Contract, the ME must terminate this Contract immediately if at any time during the lifetime of this Contract,the Network Provider is:(1) found to have submitted a false certification under section 287.135,F.S.,or,(2)placed on the Scrutinized Companies with Activities in Sudan List or the or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, created pursuant to s.215.473, F.S.or(3)placed on the Scrutinized Companies with activities in the Iran Petroleum Energy Sector,or(4) placed on the the Scrutinized Companies that Boycott Israel List or is engaged in a boycott of Israel. 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 Standard Contract Guidance/Care Center, Inc. Page 10 of 13 Contract No.ME225-10-27 24 South Floricla ;,AeA0 Behavioral Health IN twwor ,Inc, rev.07/O1/2019 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 reach a mutually satisfactory resolution at the face-to-face meeting,the dispute resolution process in Section 42.c. shall be followed. In the event of a dispute regarding client eligibility and/or placement into the appropriate level of care, the dispute shall not preclude the Network Provider from providing the provision of services to eligible individuals until the dispute is resolved. c. If the representatives are unable to reach a mutually satisfactory resolution, either representative may request referral of the issue to the President/Chief Executive Officer of the respective parties. Upon referral to this next step,the President/Chief Executive Officer of the parties shall confer in an attempt to amicably resolve the issue. If the President/Chief Executive Officer of the parties cannot resolve the issue, the issue shall be presented at the discretion of the ME either to the Board of Directors Executive Committee and/or the ME's Board of Directors. Should the dispute not be resolved at the Board of Directors Executive Committee and/or the ME's full Board of Directors 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 actio n will be in Miami-Dade County, Florida.This provision shall not limit the parties' rights of termination under Section 40. 43. 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 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 subcontractorsswill 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.Employees assigned to the contract means all persons employed or assigned(including subcontractors)by the Network Provider or a subcontractor during the contract term to perform work pursuant to this contract within the United States and its territories. 44. 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 45. 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. 46. 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." 47. Human Subject Research:The Network Provider shall comply with the requirements of CFOP 215-8 for any activity under this contract involving human subject research within the scope of 45 CFR,Part 46,and 42 U.S.C.section 289,et seq.,and may not commence such activity until review and approval by the Department of Children and Families Human Protections Review Committee and a duly constituted Institutional Review Board. 48. Pride:Articles which are the subject of orare required to carry outthis Contract shall be purchased from Prison Rehabilitative Industries and Diversified Enterprises,Inc.,(PRIDE)identified under Chapter 946,F.S.,in the same manner and under the procedures set forth in subsections 946.515(2)and(4),F.S. For purposes of this Contract,the Network Provider shall be deemed to be substituted for the Department insofar as dealings with PRIDE.This clause is not applicable to subcontractors unless otherwise required by law.An abbreviated list of products/services available from PRIDE may be obtained by contacting PRIDE,(800)643-8459. Standard Contract Guidance/Care Center, Inc. Page 11 of 13 Contract No.ME225-10-27 25 South Florida ;,AeA0 Behavioral Health IfWe wwor ,Inc, rev.07/O1/2019 49. Recycled Products:The Network Provider shall procure any recycled products or materials,which are the subject of or are required to carry out this Contract,in accordance with the provisions of sections 403.7065,F.S. 50. 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. 51. 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 Maureen Dunleavy,Vice President 100 2nd Avenue South#901 WestCare/Guidance/Care Center,Inc. St.Petersburg,FL 30100 1205 Fourth Street Office number:727-490-6767 x 30111 Key West,FL 33040-3707 Mobile number:727-465-6083 Email: maureen.dunleavy@westcare.com Fax number:727-825-0573 Office:(305)434-7660 ext.31221 E-Mail: kristen.chaffee@westcare.com Cell:(305)896-5964 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. 52. All Terms and Conditions Included This contract and it attachments, I.II,III.IV&V and any exhibits referenced in said attachments,together with any documents incorporated by reference, including the ME prime contract(which can be found at http://www.sfbhn.org),contain all the terms and conditions agreed upon by the parties. There are no provisions,terms, conditions, or obligations other than those contained herein, and this contract shall supersede all previous communications, representations,or agreements,either verbal or written between the parties. If any term or provision of this contract is legally determined unlawful or unenforceable,the remainder of the contract shall remain in full force and effect and such term or provision shall be stricken. In the event of a conflict between the provisions of the documents, the documents shall be interpreted in the following order of precedence: a.Attachment I, Exhibits,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 Signature page follows Standard Contract Guidance/Care Center, Inc. Page 12 of 13 Contract No. ME225-10-27 26 Ida South Floe e ini t'al Health Network,Inc. rev.07/01/2019 BY SIGNING THIS CONTRACT,THE PARTIES AGREE THAT THEY HAVE READ AND AGREE TO THE ENTIRE CONTRACT,AS DESCRIBED IN SECTION 52. 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 BEHAV1 YI`IEALTH NETWORK,INC. SIGNE'" SIGNED eY: t BY „ NAME: Frank Rabbtio NAME: John J,w_comer M.D,,, TITLE: COO TITLE:Presides DATE: _— .. ... _..., DATE 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.ME225-10-27 27 South Florida ;'1:;OiAOO Behavioral Health INetwwork,Inc. 07/01/201 ATTACHMENT I 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) "Citrus Family Care Network" is the Southern Region's (Circuit 11 & 16) Lead Agency for Community Based Care provider under contract with the State of Florida Department of Children and Families for the child protection and child welfare system. (5) "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. (6) "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. (7) "Continuous Quality Improvement" is an ongoing, systematic process of internal and external improvements in service provision and administrative functions, taking into Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 1 of 65 Contract No.ME225-10-27 28 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 account both in process and end of process indicators, in order to meet the valid requirements of Individuals Served. (8) "Contract Manager" is the ME employee who is responsible for enforcing the compliance with administrative and programmatic terms and conditions of a contract. The Contract Manager is the primary point of contact through which all contracting information flows between the ME and the Network Provider. All actions related to the contract must be initiated by or coordinated with the Contract Manager. (9) "Co-occurring Disorder" is any combination of mental health and substance abuse in any individual, whether or not they have been already diagnosed. (10) "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. (11) "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. (12) "Cost Analysis" is the review of the proposed cost elements to determine if they are necessary, allowable, appropriate and reasonable. (13) "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. (14) "Department" means the State of Florida Department of Children and Families. (15) "Electronic Health Record (EHR)" is defined in s. 408.051(2)(a), F.S. Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 2 of 65 Contract No.ME225-10-27 29 South(Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 (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 genera lizability (replicated in different settings and with different populations over time) through research. The Department has established two option. For a list of approved registries used to identify, evaluate, and select EBP programs and strategies, refer to the Department's Guidance Document 1, Evidence Based Guidelines available at the following link: hops://www.myflfamilies.com/service-programs/samh/managing-entities/2019-contract- docs.shtm I (17) "FASAMS DCF Pamphlet 155-2" is the Department of Children & Families, Pamphlet 155- 2 - Mental Health and Substance Abuse Measurement and Data, version 13.0, 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: hops://www.myflfa m i l ies.com/service-programs/sa m h/155-2/pa m p h let-155-2-v13.shtm I (18) "Financial and Services Accountability Management System (FASAMS)" is the Department's information management and fiscal accounting system for providers of community substance abuse and mental health services. (19) "Forensic Mental Health Services" are services provided to individuals with mental illness pursuant to Chapter 916, Florida Statutes. (20) "HIPAA" is the acronym for Health Insurance Portability and Accountability Act and must 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. (21) "Individual(s) Served" (synonymous with 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). (22) "Knight Information Software (KIS)"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, must be utilized to upload consumer-related data as required by this contract. (23) "Lead Agency for Community-Based Care (CBC)" is an agency under contract with the Florida Department of Children and Families that provides care for children in the child protection and child welfare system. Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 3 of 65 Contract No.ME225-10-27 30 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 (24) "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. (25) "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. (26) "Mental Health Services" is defined pursuant to Chapter 394, F.S. (27) "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. (28) "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. (29) "Outcome for Individual Service Recipient" is a measure of the quantified result, impact, or benefit of services on the individual service recipient. (30) "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. (31) "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. Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 4 of 65 Contract No.ME225-10-27 31 South(Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 (32) "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. (33) "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. (34) "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: htt�s://www.myflfa m i I ies.com/service-prora ms/sa m h/ma nazi n -entities/2019-co ntract- docs.shtm I 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 must 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 must 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 Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 5 of 65 Contract No.ME225-10-27 32 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 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. (35) "Prime Contract" is the contract between the Department of Children and Families and the ME. (36) "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. (37) "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. (38) "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. (39) "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. (40) "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. (41) "Quality Improvement/Continuous Quality Improvement" is a management technique to assess and improve internal operations and network services. It focuses on organizational Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 6 of 65 Contract No.ME225-10-27 33 South Florida ;'1:;0iA00 Behavioral Health Network,Inc. 07/01/201 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. (42) "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.' (43) "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. (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) "Seclusion and Restraint Data System" referred to as SANDR, is the Department of Children and Families' web-based data system used to collect and report the frequency and types of seclusion and restraint events that involve persons served in state-contracted and non-state contracted community substance abuse and mental health programs, and state mental health treatment facilities. All facilities, as defined in section 394.455(10), F.S., are required to report each seclusion and restraint event to the Department of Children and Families in accordance with but not limited to Rule 65E-5.180, F.A.C. (47) "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 Providers. ' See hlWs://www.saiA-isa.gov/sites/defatilt/files/rosc_resotiree guide book. df accessed May,2018. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 7 of 65 Contract No.ME225-10-27 34 South Florida ;'1:;OiAOO Behavioral Health INetwwork,Inc. 07/01/201 (48) "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. (49) "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. (50) "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. (51) "Substance Abuse and Mental Health Information System (SAMHIS)" is the Department's web-based data system for reporting data such as but not limited to, Demographic, Temporary Assistance to Needing Families data, Seclusion and Restraint data by the Managing Entity and all Network Service Providers in accordance with this contract. (52) "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. (53) "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. (54) "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. (55) "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. (56) "Verifiable Service" is a service provision that is documented in compliance with the requirements contained in Rule 65E-14, F.A.C. (57) "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 Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 8 of 65 Contract No.ME225-10-27 35 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 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 consistent with the Prime Contract (ME's contract with the Department), which is incorporated herein by reference. The Network Provider must 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 must also serve as an opportunity for collaboration to continuously improve the quality of services. During the course of the contract period, the ME will require that the Network Provider participate in the process of improving co-occurring disorder service capability system wide, trauma informed care services and ensure the integration of behavioral health services and primary care services to all the consumers in care in coordination with a Federally Qualified Health Center or other medical facility as required by this Contract. The Network Provider must work in collaboration and must 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 must 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 Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 9 of 65 Contract No.ME225-10-27 36 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 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), or the latest revision thereof, herein incorporated by reference, and are as follows: (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 must maintain the following minimum programmatic requirements: (1) System of Care The individual-centered and family-focused system of care will: (a) Be driven by the needs and choices of the individuals served; (b) Promote family and personal self-determination and choice; (c) Be ethically,socially,and culturally responsive;and Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 10 of 65 Contract No.ME225-10-27 37 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 (d) Be dedicated to excellence and quality results. There is a commitment to improve access to care, promote service continuity, support efficient and effective delivery of services that utilize evidence-based practices, recovery-oriented and peer involved approaches in accordance with priorities established by the ME and the Department for substance abuse, mental health treatment and/or co-occurring disorders and, substance abuse prevention services. (2) Guiding Principles Guiding principles specify that services are as follows: (a) Inclusive - involve and engage families and consumers as full partners to participate in the planning and delivery of services; (b) Comprehensive - incorporating a broad array of service and supports (e.g. physical, emotional,clinical, social,educational and spiritual); (c) Individualized- meeting the individual's exceptional needs and strengths; (d) Community-based- provided in the least restrictive,clinically appropriate setting; (e) Coordinated-both at the system and service delivery levels to ensure that multiple services are provided and change as seamlessly as possible when 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 Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 11 of 65 Contract No.ME225-10-27 38 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 (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 must be justified in writing and submitted to the ME's Contract Manager for review and approval. (2) The Network Provider must serve the number of persons indicated in Exhibit D, Substance Abuse and Mental Health Required Outcomes/Outputs within the activities specified in Exhibit G, Covered Service Funding by OCA. Failure to meet the minimum numbers served may result in a corrective action and an imposed financial penalty as described in the Standard Contract. (3) The Network Provider must 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 must 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 must 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 must include the following: (a) Data Elements: I. Service Documentation-Group Sign in Sheet i. Recipient name and identification number or, if non-recipient, participant's name, address, and relation to recipient; ii. Staff name and identification number iii. Service date; iv. Start time V. Duration; vi. Covered Service; vii. Service (Brief description of type of group); vill. Group Indicator; and ix. Program (AMH, ASA, CMH, CSA) II. Audit Documentation-Recipient Service or Non-Recipient Chart: i. Recipient name and identification number or if non-recipient, participant's name, address, and relation to recipient; ii. Staff name and identification number Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 12 of 65 Contract No.ME225-10-27 39 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 iii. Service date iv. Clinical diagnosis; V. Start time; vi. Duration; and vii. Services (Group progress note) (5) The Network Provider must 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 must submit to the Managing Entities Contract Manager, by 08/01/2019, an attestation that all applicable Network Provider employees and subcontractors who have access to ME and Department information systems have completed the Security Agreement form as required in Paragraph 25. Information Security Obligations, of the Standard Contract. (6) For licensable services purchased by this Contract, the Network Provider must 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 must suspend payment for services delivered by the Network Provider under such license(s) until said license(s) is reinstated. (7) Network Providers serving persons with substance use disorders must use the American Society of Addiction Medicine (ASAM) to determine placement and level of care as required by FASAMS DCF Pamphlet 155-2. (8) If the Network Provider provides medication management services,the Network Provider must ensure that consumers discharged from state mental health treatment facilities will be maintained on the medication that was prescribed for them by the facility at discharge pursuant to s. 394.676, F.S. Maintenance includes performing required lab tests, providing the medication, and providing appropriate physician oversight. (9) By 08/01/2019, the Network Provider must submit to the ME's Contract Manager an updated disaster plan consistent with Paragraph 29., Emergency Preparedness, of the Standard Contract. (10) Should the ME conduct a mock emergency drill, the Network Provider must participate by activating their emergency/disaster plan and reporting on preparedness activities, response activities, and post-recovery activities. (11) By 08/01/2019, the Network Provider must submit to the ME's Contract Manager an Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 13 of 65 Contract No.ME225-10-27 40 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 updated Civil Rights Compliance Checklist (CF0946). (12) By 08/01/2019, the Network Provider must submit to the ME's Contract Manager an updated Civil Rights Certificate (CF707), signed a dated by the Network Provider's contract signer. (13) By 08/01/2019, the Network Provider must 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. 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 must post and provide copies of the grievance procedures to all consumers receiving services with funds provided for in this Contract. (14) By 08/01/2019, the Network Provider must 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 must 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, cultural and linguistic competence, integrated care, recovery-oriented system of care principles. (b) Individual records maintenance and compliance. (c) Staff development standards. (d) Service-environment safety and infection control standards. (e) Peer review and utilization management review procedures. (f) Incident reporting policies and procedures that include verification of corrective action and a provision that specifies that a person who files an incident report, in good faith, may not be subjected to any civil action by virtue of that incident report. Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 14 of 65 Contract No.ME225-10-27 41 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 (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.(21) below. (15) By 10/01/2019, the Network Provider must 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) The Network Provider shall operate under the principles of a Recovery Oriented System of Care (ROSC). ROSC principles promote a coordinated network of community- based services and supports that is person-centered, self-directed care, and builds on the strengths and resilience of individuals, families, and communities to achieve improved health, wellness, and quality of life. As such, the Network Provider should operate under a "no wrong door" model as defined in s. 394.4573, F.S., as well as the other guiding principles of ROSC. The network provider shall also participate in all implementation activities and Technical Assistance provided by DCF and the ME. (17) The Network Provider must 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. Network Providers that operate 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 must 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 must 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 illnesses or co-occurring Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 15 of 65 Contract No.ME225-10-27 42 South Florida ;'1:;0iA00 Behavioral Health INetwwork,Inc. 07/01/201 disorders who are homeless or at risk of homelessness., the Network Provider must adhere to the requirements of Exhibit AN, Supplemental Security Income/Social Security Disability Insurance(SSI/SSDI)Outreach,Access, and Recovery(SOAR). (19) Linkage and Referral Process (a) The Network Provider's policies and procedures must address the referral and linkage process which should include a "warm handoff" when referring consumers to all levels of services. This includes, but is not limited to, referrals within a Network Provider from one level of care to another, i.e. residential to outpatient; referrals outside of the Network Provider when a service is not offered by the Network Provider; and referrals to services upon discharge from the Network Provider, regardless if a planned or unplanned discharge. This also includes when a consumer presents at the Network Provider for a service; however, they are not actually admitted to the service for varying reasons. Such referral services include, but are not limited to, detoxification services, linkages with community programs such as housing, employment, parenting supports, and primary health care. (b) A warm handoff consists of the Network Provider coordinating and facilitating the consumer's admission to the next appropriate level of care by direct communication and follow-up with the receiving provider. These efforts must be documented and maintained in the consumer's clinical record and should include detailed information including dates, times, and names of people spoken to. (c) When a referral is made for a service at another provider with the expectation to return to the referring provider, i.e. detoxification, the referring Network Provider should initiate the warm handoff and maintain follow-up with the receiving provider to coordinate entry back to the referring Network Provider. This must be documented and maintained in the consumer's clinical record and should include detailed information including dates, times, names of people spoken to, and final disposition, i.e. date returned or justification when not returning. (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 must designate a Quality Assurance Officer/Compliance Officer who will be responsible for the continuous quality improvement program. Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 16 of 65 Contract No.ME225-10-27 43 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 The continuous quality Improvement program should objectively and systematically monitor and evaluate the appropriateness and quality of care to ensure that services are rendered consistent with prevailing professional standards and identify and resolve problems. (b) The quality improvement program must include at minimum: i. Activities to ensure that fraud, waste and abuse do not occur. ii. Composition of quality assurance review committees and subcommittees, purpose, scope, and objectives of the continuous quality assurance committee and each subcommittee, frequency of meetings, minutes of meetings, and documentation of meetings. iii. A framework for evaluating outcomes, including: 1. Output measures, such as capacities, technologies, and infrastructure that make up the system of care. 2. Process measures, such as administrative and clinical components of treatment. 3. Outcome measures pertaining to the outcomes of services; iv. A system of analyzing those factors which have an effect on performance; V. A system of reporting the results of continuous quality improvement reviews; and, vi. Best practice models for use in improving performance in those areas which are deficient. 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 Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 17 of 65 Contract No.ME225-10-27 44 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 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 at least two Integrated Healthcare Champions who will attend trainings and meetings. The names of the Integrated Healthcare Champions will be submitted upon request by ME staff. In the event of change in staff occur, the Network Provider must notify the ME's Contract Manager, in writing within ten (10) calendar days. ii. 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. iii. 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. iv. Participation in the regional Healthcare Integration Committee meetings to develop the processes and training germane to this initiative. Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 18 of 65 Contract No.ME225-10-27 45 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 V. Attendance of appropriate staff at the regional trainings regarding Integrated Healthcare, as requested by the ME staff. Participation in the trainings will be documented in the Continuous Quality Improvement Updates. (b) Trauma Informed Care Many individuals with behavioral health issues have experienced trauma that affects their development and adjustment. The ME and the Southern Region are committed to developing a 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 who will attend trainings and meetings. The names of the TIC Champions will be submitted upon request by ME staff. In the event of change in staff occur, the Network Provider must notify the ME's Contract Manager, in writing within ten (10) calendar days. ii. Participation in the regional TIC meetings to develop the process for identifying and responding to those affected by trauma. iii. Attendance at the regional trainings regarding TIC as applicable. Applicable trainings will be documented in the Continuous Quality Improvement Updates. iv. 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 who will attend trainings and meetings. The names of the CLC Champions will be submitted upon request by ME staff. In the event of change in staff occur, the Network Provider must notify the ME's Contract Manager, in writing within ten (10) calendar days. Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 19 of 65 Contract No.ME225-10-27 46 South Florida ;'1:;0iA00 Behavioral Health INetwwork,Inc. 07/01/201 ii. Participation in the regional CLC meetings. iii. Collaborate with the ME to identify and utilize the Network Provider's data to (1) identify sub-populations (i.e., racial, ethnic, Lesbian, Gay, Bisexual, Transgender, Questioning, Intersex, or Two-Spirited (LGBTQI-2S), minority groups) vulnerable to disparities and (2) implement strategies to decrease the differences in access, service use, and outcomes among sub-populations. These strategies should include the use of the enhanced National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care; iv. 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 individuals and families 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 Lead Agency for Community Based Care Provider 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 implement the Child Welfare Integration (CWI) initiative through a continuous quality improvement plan or component in the Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 20 of 65 Contract No.ME225-10-27 47 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 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 who will attend trainings and meetings. The names of the CWI Champions will be submitted upon request by ME staff. In the event of change in staff occur, the Network Provider must notify the ME's Contract Manager, in writing within ten (10) calendar days. 2. Participation in the CWI meetings to develop the process for identifying and responding to child-welfare involved families. 3. Attendance at the 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 the CBC or a CBC Network Provider is provided in a timely manner. The ME's Network Provider must 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) Accreditation Accreditation by an accrediting organization recognized by the Department, as required by Chapter 397, F.S., is a requirement for licensure renewal 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. The Network Provider must take appropriate steps to maintain its accreditation or become Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 21 of 65 Contract No.ME225-10-27 48 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 fully accredited by June 30, 2020, as required by this section, in order to promote best practices and the highest quality of care. The Network Provider must 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. (22) Continuous Quality Improvement Updates The Network Provider must 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; (b) Trauma Informed Care; (c) Cultural and Linguistic Competence; (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) Recovery-oriented system of care principles; (g) 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; (h) 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. (23) 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 Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 22 of 65 Contract No.ME225-10-27 49 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 394.4573(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 must be enrolled into Care Coordination services. Required Report(s): On a monthly basis, by the 51" calendar day following the month of service, the Network Provider must submit a Care Coordination Report on the template provided in Exhibit AC,to the ME's Contract Manager. (24) Transitional Voucher Project Pursuant to the Department's Guidance Document 29 — Transitional Voucher and the ME's Care Coordination Policy and Protocols, the Transitional Voucher Project provides care coordination and vouchers to purchase treatment and support services for adults transitioning from Florida Assertive Community Treatment (FACT) teams, acute crisis services, and institutional settings to independent community living. All Network Providers who serve individuals meeting the criteria above may participate in the Transitional Voucher Project. Transitional vouchers provide a participant with a monthly budget to be spent on allowable services pursuant to Rule 65E-14.021, F.A.C. This service is intended to support Care Coordination efforts outlined in the DCF Guidance Document 4—Care Coordination. Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 23 of 65 Contract No.ME225-10-27 50 South Florida ;'1:;0iA00 Behavioral Health INetwwork,Inc. 07/01/201 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. (25) Financial Audit Reports (a) The Network Provider must 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, must submit an attestation that the 941 has been filed timely and any taxes due have been paid timely to IRS. (c) The Network Provider must complete and submit the Department-approved Local Match Calculation Form as a supplemental report to the annual financial audit Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 24 of 65 Contract No.ME225-10-27 51 South Florida ;'1:;0iA00 Behavioral Health INetwwork,Inc. 07/01/201 reports as required by Attachment 11, 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: hops://www.myflfamilies.com/service-programs/samh/manain -entities/2019- contract-docs.shtml (26) The Network Provider must implement and maintain fiscal operational procedures. These must 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 must comply with the requirements in Section 7.,Audits, Inspections, Investigations, Records, and Retention. (27) The Network Provider must 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 must 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.myflorida.com/apes/vbs/adoc/F2551 ITN09H13GC1Addendum10 CFOP215$.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 must 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. (30) The Network Provider must meet with the ME's staff at regularly scheduled or specially called meetings when notified by the ME. (31) The Network Provider must ensure that individuals needing treatment services will receive services, depending on the severity of individual need, consistent with industry standards for distance and travel time, and as specified in the Coordination Care Plan & Utilization Management Manual, herein incorporated by reference. Non-compliance with timely access to care for services terms will result in a corrective action and may result in a financial penalty as specified in the Standard Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 25 of 65 Contract No.ME225-10-27 52 South Florida ;'1:;OiAOO Behavioral Health INetwwork,Inc. 07/01/201 Contract. (32) The Network Provider must immediately upon discovery inform the ME of conditions related to performance that may interrupt the continuity of service delivery or involve media coverage. (33) The Network Provider will promote personal self-determination and choice by: (a) Ensuring that the needs and preferences of consumers and their families drive treatment planning and service delivery, and that consumers and their families (with consent) are involved in all aspects of treatment(pre, during and post); (b) Engaging service recipients, family members, and advocates in the design, development, and evaluation of services; (c) Giving consumers a choice of provider and services,whenever possible; (d) Assessing and improving consumer satisfaction. (34) The Network Provider must ensure provision of services to consumers with special needs The Network Provider must 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 must 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 must provide early diagnosis and treatment intervention to enhance recovery and prevent hospitalization. (b) The Network Provider must work with the ME, the state, and other stakeholders to reduce the admissions and the length of stay for dependent children and adults with mental illness in residential treatment services. (35) Referrals and Case Management Services to Consumers Residing in Assisted Living Facilities with a Limited Mental Health License (a) It is unlawful to knowingly refer a person for residency to an unlicensed assisted living facility; to an assisted living facility the license of which is under denial or has been suspended or revoked; or to an assisted living facility that has a moratorium pursuant to part II of chapter 408. Referrals to unlicensed facilities are not lawful and subject to sanctions by the Agency of Health Care Administration (AHCA). Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 26 of 65 Contract No.ME225-10-27 53 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 (b) The Network Provider is directed to only refer consumers of mental health services to Assisted Living Facilities with a Limited Mental Health License. It is the referring Network Provider's responsibility to verify licensure. AHCA licenses can be verified at the following website: http://www.floridahealthfinder.gov/facilitylocator/FacilitySearch.aspx (c) In circumstances where the Network Provider determines that placement of particular individual in an Assisted Living Facilities with a Limited Mental Health License is unsuitable, the Network Provider must request a meeting with the appropriate ME staff to discuss alternative options. The request must 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 must 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 must be submitted in a secured, password protected, or encrypted format. (36) Develop and Disseminate Consumer Manual The Network Provider must assist the ME in developing and maintaining a manual for service recipients which includes information about access procedures, recipient rights and responsibilities (including grievance and appeal procedures). This information will be available for use by the consumers within each subcontractor location. (37) Work and Social Opportunities for Peer Specialists Nationwide, health systems have accepted peers as a valuable part of the workforce. A shift to a more person-centered approach, a focus on integrated health, and a demand for more workers have increased the role peer specialists play in Florida's mental health and substance abuse systems. In keeping with Florida's goal of increasing the number of peer specialists, the Network Provider is encouraged to 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. (38) Assist Stakeholder Involvement in Planning,Evaluation,and Service Delivery (a) At the ME's request, the Network Provider will assist the ME in engaging Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 27 of 65 Contract No.ME225-10-27 54 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 local stakeholders, per section 394.9082 F.S., in its support activities for the Department's local plans. (b) The Network Provider must work with the ME to provide performance, utilization, and other information for the Department's Substance Abuse and Mental Health Services Plan, and annual updates thereof, and to provide appropriate information for the Department's Long-Range Program Plan and its Annual Business Plan. (39) Develop,Maintain,and Improve Reporting The Network Provider must submit reports included in Exhibit C, Required Reports. In all cases, the delivery of reports, ad hoc or scheduled, must not be construed to mean acceptance of those reports. Acceptance, in writing, of required reports must constitute a separate act and must be approved by the ME's Contract Manager. The ME reserves the right to reject reports as incomplete,inadequate or unacceptable. (40) Consumer Satisfaction Survey The Network Provider must conduct satisfaction surveys of individuals served pursuant FASAMS DCF Pamphlet 155-2. The Network Provider must 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. (41) Department-Sponsored Surveys The Network Provider must participate in any Department-sponsored satisfaction surveys. (42) The Network Provider agrees to assist in the development and implementation of the Care Coordination and Utilization Management (UM) System and must 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 Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 28 of 65 Contract No.ME225-10-27 55 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 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. (43) Consumer Trust Funds(CTF) (a) The Network Provider must 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 1,2019. (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 must 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 must 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 must 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 must be maintained onsite and available for review by Department or ME staff, and must be submitted to the ME upon request. (e) The Network Provider must also maintain and submit documentation of all Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 29 of 65 Contract No.ME225-10-27 56 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 payment/fees received on behalf of SAMH consumers receiving Supplemental Security Income, Social Security Administration, Veterans Administration, Food Stamps, or other federal benefits upon request from the ME. b.Task Limits The Network Provider must 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 must ensure that services are performed in accordance with applicable rules, statutes, and licensing standards. 2. Staffing Requirements a. Staffing Levels (1) The Network Provider must 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 must 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 must 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 Sections 43 - 45. of the Standard Contract. (2) The Network Provider must 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 must provide employment screening for substance abuse personnel using the standards set forth in Chapter 397.4073, F.S., Background Checks for Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 30 of 65 Contract No.ME225-10-27 57 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 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 services or with adults who are developmentally disabled receiving services are subject to level 2 background screening as provided under chapter 435. A volunteer who assists on an intermittent basis for fewer than 40 hours per month and is under direct and constant supervision by persons who meet all personnel requirements of this chapter is exempt from fingerprinting and background check requirements." (4) Network Providers who have programs for children are required to meet the requirements of s. 39.001(2), (a) and (b) F.S which states the following: (a) "If the department contracts with a provider for any program for children, all personnel, including owners, operators, employees, and volunteers, in the facility must be of good moral character. A volunteer who assists on an intermittent basis for less than 10 hours per month need not be screened if a person who meets the screening requirement of this section is always present and has the volunteer within his or her line of sight." (b) "The department must 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 must 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. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 31 of 65 Contract No.ME225-10-27 58 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 (2) The ME has adopted the following definitions for vendors, subcontractors and/or independent contractors who are contracted by the Network Provider to do work contemplated under this contract: (a) Vendor: A person or company offering something for sale. (b) Subcontractor: A business to business relationship; contracting a business or person outside of one's own company to do work as part of a larger project. (c) Independent Contractor: a person who is in an independent trade, business, or profession in which they offer their services and/or expert advice to an individual or organization. The general rule is that an individual is an independent contractor if the payer has the right to control or direct only the result of the work and not what will be done and how it will be done. The earnings of a person who is working as an independent contractor are subject to Self-Employment Tax. (3) The United States Public Health Service Act, Sections 1931(a)(1)(E), and 1916 (a)(5), and Title 45 of the Code of Federal Regulations, Part 96.135(a)(5) prohibit States from expending Substance Abuse Prevention and Treatment Block Grant (SAPTBG) and Community Mental Health Services funds "To provide financial assistance to any entity other than a public or non-profit private entity". Ordinarily, the term "financial assistance" is used to describe a grant relationship as distinguished from a procurement relationship, typically funded by contract. While the above-referenced statute and regulations preclude States from providing grants to for-profit entities, procurement contracts may be entered into with for- profit entities. This is the latest interpretation from the United States Department of Health and Human Services Substance Abuse and Mental Health Services Administration (4/5/2009). [PHS Act, ss. 1931(a)(1)(E), and 1916 (a)(5), and 45 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, must 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 agreements Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 32 of 65 Contract No.ME225-10-27 59 South Florida ;'1:;OiAOO Behavioral Health INetwwork,Inc. 07/01/201 must 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 must include a detailed scope of work; term of the agreement, method of payment, clear and specific deliverables; and performance standards. (6) The Network Provider must maintain individual subcontractor files for each subcontractor and provide a copy of all subcontract's 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 must be available upon request by ME staff and at the time of monitoring. (8) The Network Provider must 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 must 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 in accordance with s. 287.133. F.S.; (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) has had a contract terminated by the Department or ME for failure to satisfactorily perform or for cause; (d) has failed to implement a corrective action plan approved by the ME, the department,orany other governmental entity,after having received due notice, or (e) is ineligible for contracting pursuant to the standards in s. 215.1473(2), F.S. (10) Regardless of the amount of the subcontract, the Network Provider must immediately terminate a subcontract for cause, if at any time during the lifetime of the agreement/subcontract, a person, entity, vendor, purchase orders or any like purchasing arrangements,is: (a) Found to have submitted a false certification under s. 287.135, F.S., (b) Placed on the Scrutinized Companies with Activities in Sudan List or (c) Placed on the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 33 of 65 Contract No.ME225-10-27 60 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 (d) Placed on the Scrutinized Companies that Boycott Israel List or is engaged in a boycott of Israel. (11) 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 must 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. (12) The Network Provider must monitor the performance of all subcontractors and perform follow up actions as necessary. The Network Provider must 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 must 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 must 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 must 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 must furnish all appropriate equipment necessary for the effective delivery of the services purchased. Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 34 of 65 Contract No.ME225-10-27 61 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 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 must 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 must deliver the services specified in and described in the Program Description submitted by the Network Provider in accordance with Exhibit G, Covered Services Funding by OCA and in Attachment IV, Scope of Work if prevention services are purchased through this contract. b. Records and Documentation The Network Provider must 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 must not be construed to mean or imply acceptance of those reports. It is specifically intended by the parties that acceptance of required reports must 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 must 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 must 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 must provide performance information or reports other than those required by this agreement at the request of the ME, the Southern Region's SAMH Regional Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 35 of 65 Contract No.ME225-10-27 62 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 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 must 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 must submit treatment data, as set out in subsection 394.74(3) (e), F.S. and FASAMS DCF Pamphlet 155-2. (6) The Network Provider is instructed to report the modifiers to procedure codes in compliance with the FASAMS DCF Pamphlet 155-2. (7) Service data must 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 4" of each month following the month of service into KIS, SAMHIS, FASAMS, PBPS maintained by Collaborative Planning Group Systems, Inc., or other data reporting system designated by the ME and/or the Department. If the 41"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 must submit prevention services data to PBPS, maintained by Collaborative Planning Group Systems, Inc., 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 must also: (a) To establish a unique client identifier for all individuals served, the Network Provider must submit the Demographic Data Set required by FASAMS DCF Pamphlet 155-2, 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 maintained by Collaborative Planning Group Systems, Inc., or other data reporting system designated by the ME, clearly documents all program participants, programs and strategies which occurred under this contract, if applicable; (c) Ensure that all data submitted to KIS, SAMHIS, FASAMS, 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 Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 36 of 65 Contract No.ME225-10-27 63 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 accepted and rejected. Based on this review, the Network Provider must make sure that the rejected records are corrected and resubmitted in KIS, SAMHIS, FASAMS, or other data reporting system designated by the ME. Only error-free data as processed by KIS will be accepted by the ME for monthly state reporting and payment validation; (e) Resubmit corrected records no later than the next monthly submission deadline. The failure to submit any data set or the Network Provider's total monthly submission per data set, which results in a rejection rate of 5% or higher of the number of monthly records submitted will require the Network Provider to submit a corrective action plan describing how and when the missing data will be submitted or how and when the rejected records will be corrected and resubmitted; and (f) In accordance with the provisions of section 402.73(1), F. S., and Rule 65-29.001, F.A.C., corrective action plans may be required for non-compliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed for failures to implement or to make acceptable progress on such corrective action plans. Failure to implement corrective action plans to the satisfaction of the ME and after receiving due notice, must 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 must 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 must 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, SAMHIS, and FASAMS, 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 must adhere to the ME's resolution. The Network Provider must submit all service related data for consumers funded in whole or in part by SAMH funds, local match, or Medicaid. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 37 of 65 Contract No.ME225-10-27 64 South Florida ;'1:;0iA00 Behavioral Health INetwwork,Inc. 07/01/201 b. Performance Measurement Terms FASAMS DCF Pamphlet 155-2, provides the data files and file layout requirements for collecting and reporting data on persons served in state-contracted community substance abuse and mental health Network Provider agencies. The 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 must collect information and submit performance data and individual consumer outcomes, to the ME data system in compliance with FASAMS DCF Pamphlet 155-2, requirements, or the latest revisions thereof. The specific methodologies for each performance measure may be found at the following website: Il��l:lC�^:ro°,�� v�v�.ir��y�ll�auir��iillii��aro,����ir���aro��ir�✓ii����_IC�ir�� irauir��^:ro�^:roauir��ll��:ll��-�'�IC�auir��lC�ll�ll��� :ll��-�' �✓.11 �.^:roll��ir��ll (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 must be followed. An eligibility dispute must not preclude the provision of services to Individuals Served, unless the dispute resolution process reverses the ME's determination. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 38 of 65 Contract No.ME225-10-27 65 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 (2) The Network Provider is responsible for the satisfactory performance of the tasks referenced in this contract. By executing this contract, the Network Provider recognizes its responsibility for the tasks, activities, and deliverables described herein and warrants that it has fully informed itself of all relevant factors affecting the accomplishment of the tasks, activities and deliverables and agrees to be fully accountable for the performance thereof whether performed by the Network Provider or its subcontractors. (3) The Network Provider agrees that services other than those set out in this contract will be provided only upon receipt of a written authorization from the ME's Contract Manager or an authorized ME staff member. The department through the ME has final authority to make any and all determinations that affect the health safety and well-being of the residents of the State of Florida. (4) The Network Provider must 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 must 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, SAMHIS, FASAMS, or other data reporting system designated by the ME. (6) The Network Provider must make available source documentation of units billed by Network Provider upon request from the ME staff.The Network Provider must 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 must monitor its compliance with block grant requirements and activities. (10) A Network Provider that receives block grant funding must comply with state or federal Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 39 of 65 Contract No.ME225-10-27 66 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 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 must be repaid to the Department upon discovery. (14) The Network Provider must make available to the ME and the Department all records pertaining to service delivery. These records must 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 must assist the ME and the Department in developing legislative budget requests based upon identified needs of the community. (16) The Network Provider must 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 must 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 must 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 must 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 must maintain in one place for easy accessibility and review by ME Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 40 of 65 Contract No.ME225-10-27 67 South Florida ;'1:;0iA00 Behavioral Health INetwwork,Inc. 07/01/201 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 must 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 must 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 must comply with all other applicable federal laws, state statutes and associated administrative rules as may be promulgated or amended. See Exhibit F, SAMH Programmatic State and Federal Laws, Rules,and Regulations, and ME policies and procedures. (23) Records relating solely to actions taken in carrying out the requirements of this contract and records obtained by the ME and/or the Department to determine a Network Provider's compliance with this section are confidential and exempt from s. 119.07(1) and s. 24(a), Access to Public Records and Meetings, Article. I, Constitution of the State of Florida. Such records are not admissible in any civil or administrative action except in disciplinary proceedings by the Department of Health or the appropriate regulatory board and are not part of the record of investigation and prosecution in disciplinary proceedings made available to the public by the Department of Health or the appropriate regulatory board. Meetings or portions of meetings of continuous quality improvement program committees that relate solely to actions taken pursuant to this section are exempt from s. 286.011.F.S. b. Coordination with other Providers/Entities (1) The Network Provider must develop, maintain,and improve care coordination and integrated care systems as follows: (a) Develop Initial Service Agreements (i) The Network Provider must 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. Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 41 of 65 Contract No.ME225-10-27 68 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 (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. 7. Managing Entity Responsibilities a. Managing Entity Obligations (a) The ME must only subcontract with entities that are fiscally sound, and that can adequately ensure the accountability of public funds. (b) The ME must 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 must 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 Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 42 of 65 Contract No.ME225-10-27 69 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 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 must 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 must work with the Department to redirect administrative cost savings into improved access to quality care, promotion of service continuity, required implementation of EBPs, the expansion of the services array, and necessary infrastructure development. It acknowledges the benefits to be realized, include improved access to quality care, promotion of service continuity, implementation of EBPs, improved performance and outcomes, expansion of the service array, and necessary infrastructure development. b. Monitoring Requirements (1) The ME will monitor the Network Provider in accordance with this contract and the ME's Contract Accountability Policies and Procedures which can be obtained from the designated ME Contract Manager and is incorporated herein by reference. The Network Provider must comply with any coordination or documentation required by the ME's monitor(s) to successfully evaluate the programs and must 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) must 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 must 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, Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 43 of 65 Contract No.ME225-10-27 70 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 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, must be grounds for contract termination in whole or in part. c. Training and Technical Assistance (1) The ME's contact manager, or designee, will provide training and technical assistance concerning the terms and conditions of this contract. (2) The ME will provide technical assistance and support to the Network Provider to ensure the continued integration of services and support for consumers, to include but not limited to, quality improvement activities to implement evidenced-based practice treatment protocols, the application of process improvement methods to improve the coordination of access and services that are culturally and linguistically appropriate. (3) The ME will provide technical assistance and support to the Network Provider for the 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 must 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 Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 44 of 65 Contract No.ME225-10-27 71 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 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 must be obtained according to the timeliness standards for the service in question. (3) Upon request, the ME will assist with the development and implementation of consumer admission, continued stay, discharge criteria specific to each level of care, diagnosis, presenting problems, and the establishment of review dates. (4) The ME will participate in the collaborative development and implementation of the working agreement with the Community Based Care and substance abuse and mental health Network Providers to ensure the integration of services and support within the community. The ME will support the development and implementation of the working agreement by providing an example of a policy working agreement, system of care information,data reporting requirements and technical assistance. (5) The ME has the right to review the Network Provider's policies, procedures, and plans. Once reviewed by the ME, the policies and procedures may be amended provided that they conform to state and federal laws, the state Administrative Code, and federal regulations. Substantive amendments to submitted policies, procedures and plans must 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 must follow in obtaining the required determination(s): (1) Whether the Network Provider is meeting the terms and conditions of this contract, to include the Standard Contract, Attachment I, any documents incorporated into any attachment by reference, Program Description, and any documents incorporated by herein by reference. (2) The ME reserves the exclusive right to make certain determinations in these specifications. The absence of the ME setting forth a specific reservation of rights does not mean that all other areas of this contract are subject to mutual agreement. The ME reserves the right to make exclusively any and all determinations that it deems are necessary to protect the best interests of the State of Florida and the health, safety, and welfare of the consumers who are served by the ME either directly or through any one of its contracted Network Providers. Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 45 of 65 Contract No.ME225-10-27 72 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 (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 G,Covered Service Funding by OCA Exhibit H, Funding Detail and Local Match Monthly Payment Request (Incorporated by reference and available from the MEs Contract Manager upon request) D. Special Provisions 1. The Network Provider is expected to maintain its administration cost to 10.00%or less for Fiscal Year 2019-2020 for SAMH services purchased under this contract. The cost savings must be reallocated to support the increase of direct services, improved access to quality care, promotion of service continuity, and the implementation and/or expansion in the use of evidence-based practices. The Network Provider's SAMH Projected Operating and Capital Budget must 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 must 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 manual is found in the FASAMS DCF Pamphlet 155-2 Chapter 8, Acute Care Data,dated 1/18/2019, or the latest revision thereof,and can be found at: s://www. yffa iies.co /service® rora s/sa /1 -2/ a S5-2-v13.shtml 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 must 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. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 46 of 65 Contract No.ME225-10-27 73 South Florida ;'1:;0iA00 Behavioral Health INetwwork,Inc. 07/01/201 4. Waitlist Data Entry: The Network Provider shall submit waitlist data information into KIS Express, or other similar data structure for services purchased by this Contract, to ensure compliance with several Block Grant regulations. Waiting lists records are created for individuals who have received an assessment and a recommended service but who are unable to receive recommended service. The Waiting List reporting manual is found in the FASAMS DCF Pamphlet 155-2 FASAMS Chapter 7, Waiting List, dated 1/18/2019, or the latest revision thereof,and can be found at: s://www. �ffa iies.co /service® rora s/sa /1 -2/ a 2-v13.shtml 5. 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 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 must submit a report on the template provided in Exhibit O, Weapons and Firearms Court Petitions Monthly Report, with information from the preceding month that includes the number of petitions filed, the names of the individuals that the petitions were filed for, and the dates that the petitions were filed. The report must be submitted electronically in a secured, password protected or encrypted format by the dates and to the individuals specified in Exhibit C, Required Reports. 6. Medication-Assisted Treatment Services Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 47 of 65 Contract No.ME225-10-27 74 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 a. The Network Provider must 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 must 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 must discuss medication-assisted treatment using FDA-approved medications including but not limited to disulfiram, and acamprosate products. d. The Network Provider must actively link individuals to medication-assisted treatment providers upon request e. Access to Services:The Network Provider must 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 must 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; ii. The Network Provider must 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 must 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 must 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. 7. 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 Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 48 of 65 Contract No.ME225-10-27 75 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 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 (HALM) and the Comprehensive Community Action Plan (CCAP). The Network Provider must 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, must 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. d. Based on consumer needs, the Network Provider must 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 must be justified in writing and submitted to the ME's Contract Manager for review and approval. 8. Intern Registration Requirements pursuant to section 491.0045, F.S. a. The Network Provider must 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 Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 49 of 65 Contract No.ME225-10-27 76 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 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. 9. Utilization Management Program: If the Network Provider contracts for services that are utilization managed by the ME, the Network Provider must assist the ME in the reporting and managing of the Substance Abuse and Mental Health Waiting List for all applicable levels of care. The Network Provider agrees to submit real-time data until an automated system is implemented. a. The Network Provider agrees to adhere to the utilization management protocols pursuant to the South Florida Behavioral Health Network Coordination of Care Plan Manual — FY 2017-18, or the latest revision thereof, herein incorporated by reference and available upon request from the Contract Manager. b. The Network Provider will have a data system in place that adequately supports the collection, tracking, and analysis of data necessary to perform utilization management activities, reviews of clinical/administrative performance related to levels of care, clinical outcomes, and 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 Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 50 of 65 Contract No.ME225-10-27 77 South Florida ;'1:;OiAOO Behavioral Health INetwwork,Inc. 07/01/201 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 must 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 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 must 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 Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 51 of 65 Contract No.ME225-10-27 78 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 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 must 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. 10. 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 must 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, must 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. (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 must 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 Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 52 of 65 Contract No.ME225-10-27 79 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 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 must 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. 11. Incident Reports a. The Network Provider must submit incident reports into the Incident Reporting and Analysis System (IRAS) on all reportable incidents per CFOP 215-6, within one (1) business day of the incident occurring. In the event an incident has an immediate impact on the health or safety of a consumer, has potential media impact, or involves employee-related incidents of criminal activity, the Network Provider must notify the ME Risk and Compliance Coordinator immediately upon discovery. Certain incidents may warrant additional follow-up by the ME. Follow-up may include on-site investigations or requests for additional information or documentation. When additional information or documentation is requested, the Network Provider will submit the information requested by the ME within 24 hours unless otherwise specified in the request. It is the responsibility of the Network Provider to maintain a monthly log listing all incidents occurring at the agency, including those submitted to the Office of the Inspector General and those not reportable in IRAS, with the following information: Consumer's initials, incident report tracking number from IRAS (if applicable), incident report category, date and time of incident, and follow-up action taken. b. All Network Providers (inpatient and outpatient) will report seclusion and restraint events in SAMHIS(SANDR) and in accordance with Rule 65E-5.180(7)(g), F.A.C. 12. 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 must report such incident as follows: 1) Reportable incidents that may involve an immediate or impending impact on the health or safety of a consumer must be Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 53 of 65 Contract No.ME225-10-27 80 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 immediately reported to the Contract Manager; and 2) Other reportable incidents must 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. 13. Contracted Mental Health Network Providers must 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 must 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. 14. Health, Safety, and Physical Environment Requirements for Substance Abuse and Mental Health Levels 1,2,and 3 Residential Treatment Facilities Unless abridged by a court of law, the rights of individuals who are admitted into a residential treatment facility must be assured. Each residential treatment facility must 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 must 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 must explain to the resident the conditions under which the articles may be used and must 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 must be reviewed weekly for effectiveness and continued need. 15. 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 Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 54 of 65 Contract No.ME225-10-27 81 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 394.4655, 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 must 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. 16. Service Provision Requirements for Substance Abuse Prevention and Treatment Block Grants, if applicable. a. As applicable, the Network Provider must 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 must 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 of substance use, must comply with 45 C.F.R. s. 96.125. d. Behavioral health services must 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 by Network Service Providers receiving SAPT Block Grant funding. If the clinically appropriate services cannot Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 55 of 65 Contract No.ME225-10-27 82 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 be provided for the pregnant woman, interim services, not later than forty(48) hours after the woman seeks treatment services, must 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), W- (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 must 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 must 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 must 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 FASAMS DCF Pamphlet 155-2, and in SAMHIS, as applicable, by the dates specified in Exhibit C, Required Reports. i. The Network Provider must meet the invoicing requirements outlined in Exhibit B, Method of Payment. j. In addition to the modifiers to procedure codes that are currently required to be utilized as per FASAMS DCF Pamphlet 155-2, and in SAMHIS, as applicable, 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. k. Only if such services are purchased through this contract is the Network Provider responsible for Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 56 of 65 Contract No.ME225-10-27 83 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 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. I. 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. m. The Network Provider must 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. n. The Network Provider must 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. o. 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. p. 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 Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 57 of 65 Contract No.ME225-10-27 84 South Florida ;'1:;0iA00 Behavioral Health INetwwork,Inc. 07/01/201 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 must 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. 21. Medicaid Enrollment Those Network Providers with SAMH contracts that meet Medicaid provider criteria and with funding in excess of $500,000 annually must enroll as a Medicaid provider. This process must 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 must obtain and use an NPI, a HIPAA standard unique health identifier for health care providers. b. An application for an NPI may be submitted online at https://nppes.cros.hhs.gov/NPPES/StaticForward.do?forward=static.npistart. c. Additional information can be obtained from one of the following websites: (1)The Florida Medicaid HIPAA located at: http://www.fdhc.state.fl.us/hipaa/index.shtml (2)The National Plan and Provider Enumeration System (NPPES) located at: https://nppes.cros.hhs.gov/NPPES/Welcome.do (3)The CMS NPI located at: http://www.cros.hhs.gov/NationalProvldentStand/ Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 58 of 65 Contract No.ME225-10-27 85 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 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 must 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 must not participate in any matter that would inure to their special gain, and must recuse themselves accordingly. Public funds may not be used for purposes of lobbying, or for political contributions, or for any expense related to such activities, pursuant to Paragraph 20. of the Standard Contract of this contract. The Network Provider understands that the ME contracts with the department, and as a subcontractor, recognizes that the department is a public agency which is mandated to conduct business in the sunshine, pursuant to section 286.011, F.S., and chapter 119, Florida Law, and that all issues relating to the business of the department, the ME and the Network Provider are public record and subject to full disclosure. The Network Provider understands that attempting to exercise undue influence on the ME, the department and its employees to allow deviation or variance from the terms of this contract other than a negotiated, publicly disclosed amendment, is prohibited by the State of Florida, pursuant to section 286.011, F.S. The Network Provider's conduct is subject to all state and federal laws governing the conduct of entities engaged in the business of providing services with government funds. 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 must not be used by the Network Provider to make loans to their employees, officers, directors and/or subcontractors. Violation of this provision must be considered a breach of contract and the termination of this contract must be in accordance with the Paragraph 40. of the Standard Contract. A loan is defined as Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 59 of 65 Contract No.ME225-10-27 86 South Florida ;'1:;0iA00 Behavioral Health IfNetwwork,Inc. 07/01/201 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 must 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. 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 must be immediately transferred to the Network Provider where it must 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 must 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 Network Provider. Business arrangements made between the Network Provider and its subcontractors must 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 must hold the Network Provider solely responsible for the use and condition of said property. Network Provider inventories must be conducted in accordance with CFOP 80-2. Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 60 of 65 Contract No.ME225-10-27 87 South Florida ;'1:;OiAOO Behavioral Health INetwwork,Inc. 07/01/201 (3)If any property is purchased by the provider with funds provided by this contract, the Network Provider must inventory all nonexpendable property including all computers. A copy of which must be submitted to the along with the expenditure report for the period in which it was purchased. At least annually, the provider must 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, must 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 must furnish a Closeout Inventory Form no later than 30 days before the completion or termination of this contract. The Closeout Inventory Form must include all nonexpendable property including all computers purchased by the Network Provider. The Closeout Inventory Form must 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 must 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 must be agreed upon by both the Network Provider and the ME and must 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 must 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 must 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 must 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 Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 61 of 65 Contract No.ME225-10-27 88 South Florida ;'1:;OiAOO Behavioral Health INetwwork,Inc. 07/01/201 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 must 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) must not be vested in the Network Provider. Subcontractors must 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 loss 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) a. In compliance with 45 C.F.R. s.164.504(e), the Network Provider must 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 must constitute a material breach of this Contract. 30. National Voter Registration Act (NVRA) of 1993 a. The Network Provider must 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 must 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 must 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 must 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 Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 62 of 65 Contract No.ME225-10-27 89 South(Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 paragraph f., below d. The Network Provider must 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.myflorida.com/elections/for-voters/voter-registration/national-voter-reistration- act 31. Special Insurance Provisions a. The Network Provider must 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 must 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 must be no less than $300,000 per occurrence with a minimal annual aggregate of no less than $1,000,000. d. The Managing Entity must 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, must 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 Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 63 of 65 Contract No.ME225-10-27 90 South Florida ;'1:;OiAOO Behavioral Health IfNetwwork,Inc. 07/01/201 of the performance of its duties under this contract, the Managing Entity must obtain and provide proof to the Department of comprehensive automobile liability insurance coverage. The limits of the Managing Entity's coverage must 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 must 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 must 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 must include medical malpractice liability and errors and omissions coverage, to cover the Managing Entity and all of its employees. The limits of the coverage must 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 must 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. L The ME and the Department must 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 must 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, must 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 must name the ME and the Department as an additional insured under the policy(ies). The Network Provider must 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. Attachment I HCO2 (a) Guidance/Care Center, Inc. Page 64 of 65 Contract No.ME225-10-27 91 South Florida ;'1:;0iA00 Behavioral Health INetwwork,Inc. 07/01/201 I. The requirements of this section must 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 must prevail and control. E. List of Exhibits The Network Provider agrees to comply with the requirements contained in 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 F, State and Federal Laws, Rules and Regulations 6. Exhibit G, Covered Service Funding by OCA 7. Exhibit H, Funding Detail & Local Match Plan 8. Exhibit I, Motivational Support (MSP) Provider Protocols 9. Exhibit K, SAMH Pre-Authorization Utilization Management Roster 10. Exhibit L,Assisted Living Facilities with Limited Mental Health License 11. Exhibit N, Special Provisions for the Indigent Drug Program 12. Exhibit O,Weapons and Firearms Court Petitions 13. Exhibit Q, Missing Children 14. Exhibit R, Child Welfare Quarterly Clinical Report 15. Exhibit V, Special Provisions for the Forensic Services Program 16. Exhibit X, Special Provisions for Projects for Assistance in Transition from Homelessness (PATH) Services 17. Exhibit Y, Special Provisions for TANF SAMH Guidelines and TANF SAMH Incidental Expenditures for Housing Assistance 18. Exhibit AA, Motivational Support Specialist 19. Exhibit AC, Care Coordination Report Narrative and Chart 20. Exhibit Al, Family Intensive Treatment Team - Scope of Work 21. Exhibit AJ, Community Action Team 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 2018-190 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 27. Exhibit AX, SAMHSA Emergency Response Grant (SERG) 28. AY, Mobile Response Team for Monroe County 29. Exhibit BB - State Opioid Response Discretionary Grant Services - MAT(MSSOR) Attachment 1 HCO2 (a) Guidance/Care Center, Inc. Page 65 of 65 Contract No. ME225-10-27 92 °vj uth Fllan irikla Beh aN kip iraall Ill to aallt➢n Nctnvo r➢c,1n ic. 0 7/b t/"2011t EXHIBIT A Individuals/Participants to be Served A. GENERAL DESCRIPTION The Network Provider must 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. INDIVIDUAL SERVED/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 FASAMS DCF Pamphlet 155-2. The Network Provider must comply with the Department's requirements for Individuals Served. FASAMS DCF Pamphlet 155-2 is available on the Department's website: hops://www.myflfamilies.com/service-programs/samh/fasams/documents.shtml and is incorporated herein by reference. 2. Behavioral Health services must 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 sections. 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 Exhibit A Guidance/Care Center, Inc. Page 1 of 3 Contract No.ME225-10-27 93 °vjuth Fllanu°ida Beharkiiraall III teaallt➢n Nctnvor➢c,1nic. 07/01/2011t substance abuse and mental health services by child protective investigators and also meet the target populations in subsections (a) or (b), above. Such priority must be limited to individuals that are not enrolled in Medicaid or another insurance program, or require services that are not paid by another payor source: (1) Parents or caregivers in need of adult mental health services pursuant to s. 394.674(1)(a)2., F.S., based upon the emotional crisis experienced from the potential removal of children; and (2) Parents or caregivers in need of adult substance abuse services pursuant to s. 394.674(1)(c)3., F.S., based on the risk to the children due to a substance 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; 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 ss. 394.4574 and 429.075, F.S.; h. Children referred for residential placement in compliance with Ch. 65E-9.008, F.A.C.; i. Inmates approaching the End of Sentence pursuant to Children and Families Operating Procedure (CFOP) 155-47, "Processing Referrals from the Department of Corrections," and j. In the event of a Presidential Major Disaster Declaration, Crisis Counseling Program (CCP) services must 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, must be provided to all persons meeting the criteria for admission, subject to the availability of beds and/or funds. C. INDIVIDUAL/PARTICIPANTS DETERMINATION 1. Determination for eligibility for services for individuals seeking and receiving services funded under this Contract is the responsibility of the Network Provider subject to the provision of Section C. 5, below. The Network Provider must 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 eligibility and override the determination of the Network Provider. When this occurs the Network Provider will immediately provide services to the individual until such time the individual 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 must an individual's county of residence be a factor that denies access to service. Authorized services must only be provided within the serviced area(s) outlined in Attachment 1, Section A.2.c.(2), subject to the availability of funds. Exhibit A Guidance/Care Center, Inc. Page 2 of 3 Contract No.ME225-10-27 94 °vjuth Fllanu°ida Beharkiiraall III teaallt➢n Nctnvor➢c,1nic. 07/01/2011t 3. In the event of a dispute regarding an individual's eligibility for services and/or placement into the appropriate level of care, the dispute must not preclude the Network Provider from providing the services to eligible individuals until the dispute is resolved. The dispute resolution process is described in Paragraph 42. of the Standard Contract. 4. Participant eligibility (Direct Prevention) and target population eligibility (Community Prevention) must also be based upon the community action plan or on the relevant epidemiology data. 5. The Department, in accordance with state law, is exclusively responsible for defining Individuals Served for services provided through this Contract. In the event of a dispute, the determination made by the Department is final and binding on all parties. 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 its 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.ME225-10-27 95 °aaj�uth Fllanu°ida Beharkiiraall III teaallth Ncovoir➢c,Inic. 7/01/2011) EXHIBIT B METHOD OF PAYMENT 1. PAYMENT CLAUSES a. Fee-for-Service: This is a Fee-for-Service contract, paid in accordance with subsection 65E- 14.021(2), F.A.C. The unit prices for the covered services purchased under this contract are listed in Exhibit G, Covered Service Funding by OCA. The ME may 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 $8,134,885.00, 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 $6,779,071.00, subject to the delivery and appropriate billing for services. The remaining amount of $1,355,814.00 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 demonstrated by the Network Provider's service delivery and billing for those 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 Department. 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. Case Rate: This contract purchases FAMILY INTENSIVE TREATMENT TEAM services and is reimbursed by the ME using a Case Rate in accordance with subsection 65E-14.021(2), F.A.C. The ME shall pay the Network Provider for the delivery of services provided in accordance with the service delivery described in the approved Program Description, incorporated herein by reference, and terms and conditions of this contract for a total dollar amount not to exceed $633,188.00, subject to the availability of funds. The approved Case Rate is listed in Exhibit G, Covered Services Funding by OCA under OCA in OCA MS091. c. Case Rate: This contract purchases COMMUNITY ACTION TREATMENT TEAM services and is reimbursed by the ME using a Case Rate in accordance with subsection 65E-14.021(2), F.A.C. The ME shall pay the Network Provider for the delivery of services provided in accordance with the service delivery described in the approved Program Description, incorporated herein by reference, and terms and conditions of this contract for a total dollar amount not to exceed $750,000.00, subject to the availability of funds. The approved Case Rate is listed in Exhibit G, Covered Services Funding by OCA under OCA in OCA MHCAT. d. Case Rate: This contract purchases STATE OPIOID RESPONSE services and is reimbursed by the ME using a Case Rate in accordance with subsection 65E-14.021(2), F.A.C. The ME shall pay the Network Provider for the delivery of services provided in accordance with the service delivery described in the approved Program Description, incorporated herein by reference, and terms and conditions of this contract for a total dollar amount not to exceed$12,100.00,subject to the availability of funds. The approved Case Rate is listed in Exhibit G,Covered Services Funding by OCA under OCA in OCA MSSOR. Exhibit B Page 1 of 6 Guidance/Care Center, Inc. Contract No. ME225-10-27 96 °aaj�uth Fllanu°ida 13ch aN ki�iraall III teaallth Ncovoir➢c,Inic. 7/01/2011) 2. GROUP SERVICES 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 (15) individuals per group. Group size limitations outlined in the current Medicaid Handbook apply to Outpatient group services funded under this contract. 3. FLEXIBILITY Unless otherwise notified in writing by the ME, the Network Provider is authorized to use the funds within each Other Cost Accumulator ("OCA"), and for the approved covered services within that OCA as listed in Exhibit G, Covered Services Funding by OCA, with 100% flexibility without the need for an amendment to this contract. 4. LOCAL MATCH REQUIREMENT a. Pursuant to s. 394.76(3), Florida Statutes (F.S.), the Network Provider agrees to provide local matching funds in the amount of$1,114,255.00 as indicated in Exhibit H, Funding Detail and Local Match Plan. b. Should the Network Provider receive any funding from the "Uncompensated Units Reimbursement Funds", then the amount of Local Match Plan as it appears on Exhibit H, Funding Detail, will automatically change, utilizing the following formula: The additional match required on the uncompensated units=Uncompensated Substance Abuse Services X 16.67%+Uncompensated Mental Health Services that is not exempt from local match requirements X 33.33%. * *The following MH services are exempt from the local match requirement L 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. 5. CORRECTIVE ACTION PLANS 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 Exhibit B Page 2 of 6 Guidance/Care Center, Inc. Contract No. ME225-10-27 97 °aaj�uth Fllanu°ida 13ch arki�iraall III teaallth Ncovoir➢c,Inic. 7/01/2011) 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. 6. REDUCTION OR WITHOLDING OF FUNDS a. The ME may 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. b. 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. 7. CLOSURE OR SUSPENSION OF SERVICES 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. 8. PURCHASE OF ADDITONAL SERVICES The ME in its sole discretion and subject to funding availability, may purchase from any Network Provider prior to the end of the contract period any service units provided at any time during the term of the contract. 9. 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. 10. THIRD PARTY BILLING a. Department funds may not reimburse 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 publicly funded health benefits assistance program,when the services provided are covered by said program. b. Department funds may reimburse services provided to: i. Individuals who have lost coverage through Medicaid, or any other publicly funded health benefits assistance program coverage for any reason during the period of non-coverage; Exhibit B Page 3 of 6 Guidance/Care Center, Inc. Contract No. ME225-10-27 98 °aaj�uth Fllanu°ida 13ch arki�iraall III teaallth Ncovoir➢c,Inic. 7/01/2011) 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 publicly 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 shall ensure that Medicaid funds will be accounted for separately from funds for this Contract. This includes services such as Statewide Inpatient Psychiatric Program ("SIPP"), Florida Assertive Community Treatment ("FACT'), Community Action Treatment ("CAT"), Family Intensive Treatment ("FIT"), and Central Receiving Facilities. 11. PAYMENT FROM MEDICAID HEALTH MAINTENANCE ORGANIZATIONS, 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 commercial insurers such as worker's compensation, TRICARE, Medicare, Health Maintenance Organization, Managed Care Organizations, or other payers liable, to the extent that they are required by contract or law,to participate in the cost of providing services to a specific individual 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. 12. TEMPORARY ASSISTANCE TO NEEDY FAMILIES(TANF) BILLING, IF APPLICABLE 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, 2017 —September 30, 2020, 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: v�rv�rv�r.rrn flf rrnilir .c:urrn rruic:r- ru.:.r rrns ac:c:rnss r.�cac:� r�ol�ll: lf�l�ir.�r.�f I................ . .................................................. ....................................................................................... .................................................1................... ............................... ........................................ ............................./......................................................................1.................. 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. 13. INVOICE REQUIREMENTS a. The rates negotiated with any Network Provider may not exceed the rate as specified in in Exhibit Exhibit B Page 4 of 6 Guidance/Care Center, Inc. Contract No. ME225-10-27 99 °aaj�uth Fllanu°ida 13ch arki�iraall III teaallth Ncovoir➢c,Inic. 7/01/2011) 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. For Network Providers that receive block grant funding, the invoice shall include the minimum data elements to satisfy the Department's application and reporting requirements. d. A Network Provider that receives block grant funding shall, in its invoice, provide sufficient detail that captures, reports, and tests the validity of expenditures and service utilization. e. 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 Department. The invoice, Monthly Payment Request, is incorporated herein by reference and available upon request from the ME's Contract Manager. f. 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. g. 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. h. 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. i. 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. j. Invoices shall be submitted in detail sufficient for a proper pre-audit and post-audit. Exhibit B Page 5 of 6 Guidance/Care Center, Inc. Contract No. ME225-10-27 100 °aaj�uth Fllanu°ida 13ch arki�iraall III teaallth Ncovoir➢c,Inic. 7/01/2011) 14. 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. 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. 15. 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: 171:1::I.. r. f.l.u... ..cu.rr 0iui. iu. r. A.A........ ........................ .................................. .........................il::iir :.............Gji e 1:::orS1ate Ex.. c..r ......................n ............... ............. ......... .................... .............................................................................................................................. 16. 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 6 of 6 Guidance/Care Center, Inc. Contract No. ME225-10-27 101 °vjuth Fllanu°ida 13ch ariIciraall III teaallt➢n"Fctnvor➢c,1nic. 7/01/2011t Exhibit C Required Reports J q uiir ed t irirfs,,, owe oate ples, fiend tel: o „Within 10 calendar days „�,,,,,. Responset from 1 Electronic 1. ME Contract Manager Monitoring Reports the day the report is received Submission via E-mail) and Corrective Action 2. SFBHN staff member Plans issuing CAP External Quality Within 10 calendar days from 1(Electronic 1. ME Contract Manager Assurance Reviews, the day the report is received, Submission via E-mail) Monitoring Reports, or as requested by the 2. Director of Contract Surveys and Contract Manager Accountability Corrective Actions,as applicable Memorandum of Within 90 calendar days of 1(Electronic ME Contract Manager Understanding the effective date of the Submission via E-mail) (MOU)with a contract(for newly executed Federally Qualified MOU's); Health Center(FQHC) Within 30 calendar days for or renewed MOU's; Updates to Federally Qualified P&P for FQHC's shall be Health Centers are submitted within 30 calendar required to submit days of adoption policies and procedures that explain the access to primary care services to the medically underserved behavioral health client Sliding Fee Scale Prior to contract execution 1(Electronic ME Contract Manager [reflecting the Submission via E-mail) uniform schedule of discounts referenced in 65E-14.018(4)] Final FY 2019-2020 Submitted annually prior to 1(Electronic 1. ME Contract Manager (1) Projected Cost contract execution. Submit Submission via E-mail) Center Operating and updates within 30 calendar 2.VP of Finance Capital days of execution of an Budget, amendment to the contract (2) Budget Narrative, affecting the budget. (3) Network Providers Agency Service Capacity Report, (4)Cost Center Personnel Detail Report Exhibit C Page 1 of 19 Guidance/Care Center, Inc. Contract No.ME225-10-27 102 °vjuth Fllou°ida 13ch ariIciraall III teaallt➢n"Fctnvor➢c,1nic. 7/01/2011t Exhibit C Required Reports Program Description Annually, prior to contract 1(Electronic 1. ME Contract Manager (1)Organizational execution. Submit updates Submission via E-mail) Profile within 30 calendar days of 2.VP of Behavioral Health (2)Service Activity amendment Description (3)Supplemental Program Description Affidavit Regarding Annually prior to contract 1 ME Contract Manager Debarment execution,or as requested by the Contract Manager Incident Report Within 24 hours of Submission through Submission through IRAS occurrence, in IRAS accordance with CFOP 215-6 and reportable incidents defined CFOP 180-4 Mandatory Reporting Requirements to the Office of the Inspector General Acute Care Service Real-time data submission as Electronically KIS Express Acute Care Utilization Reporting mandated by subsection System for Public Receiving 394.9082(10), Florida Statutes Facilities, Detoxification and Addiction Receiving Facilities. Monthly Data Service data shall be Electronically KIS, PBPS,or other data Required by DCF submitted electronically, system designated by the ME FASAMS PAM 155-2 weekly, by 12:00 Noon every or the Department Wednesday. Final monthly shall be submitted electronically to the ME no later than the 4th of each month following the month of service ADA Client By the 4th business day 1(Electronic https://fsl6.formsite.com/D Communication following the Submission via E-mail) CFTraining/Monthly- Assessment Auxiliary reporting month Summary Aid Service Record Report/form login,html Monthly Summary Report (Applicable to agency's that employ Confirmation E-mail to the fifteen (15)or more ME Contract Manager employees) Exhibit C Page 2 of 19 Guidance/Care Center, Inc. Contract No.ME225-10-27 103 °vjuth Fllanu°ida 13ch ariIciraall III teaallt➢n"Fctnvor➢c,Inic. 7/01/2011t Exhibit C Required Reports Monthly Service Monthly, by the eighth (8th) 1 ME Sr.Accountant(Fiscal Invoice calendar day Department) after the month of service Invoice Review 1 As requested by SFBHN staff Supporting Submitted with the monthly Documentation invoice,as appropriate, and/or as requested by SFBHN staff Exhibit K, Pre- Monthly,with the monthly 1 1. ME Sr.Accountant(Fiscal Authorization invoice by the eighth (8th) Department) Utilization calendar day Management Roster after the month 2. ME ASOC Manager for Substance Abuse of service and Mental Health 3. ME CSOC Manager Residential Level II Services Exhibit AC, Monthly Monthly by the 5th calendar 1 ME Care Coordinator Care Coordination day after the month of service Report Narrative and Chart Final Invoice 1 ME Sr.Accountant(Fiscal By July 20 of each fiscal year Department) and/or 20 days after contract end date Designation of Within 5 working days of 1(Electronic ME Contact Manager Dispute Resolution contract execution Submission via E-mail) Officer Inventory Report 8/1/2019 ME Contract Manager 1(Electronic Submission via E-mail) Attestation of 8/1/2019 1(Electronic ME Contract Manager Network Provider's Submission via E-mail) Verification that all applicable employees and subcontractors with access to ME and/or DCF information systems have signed a DCF Security Agreement form CF0114, per the Attachment I and Standard Contract Exhibit C Page 3 of 19 Guidance/Care Center, Inc. Contract No.ME225-10-27 104 °vjuth Fllanu°ida BehariIciraall III teaallt➢n"Fctnvor➢c,1nic. 7/01/2011t Exhibit C Required Reports Emergency 8/1/2019 1(Electronic 1. ME Contract Manager Preparedness Plan Submission via E-mail) 2.QA/QI Risk&Compliance Manager Civil Rights 8/1/2019 1(Electronic ME Contract Manager Compliance Checklist Submission via E-mail) (CF0946) Civil Rights 8/1/2019 1(Electronic ME Contract Manager Certificate(CF707) Submission via E-mail) Client Trust Fund 8/1/2019 1(Electronic ME Contract Manager Letter Submission via E-mail) Quality 8/1/2019 1(Electronic 1. ME Contract Manager Assurance/Quality Submission via E-mail) Improvement Plan 2.QA/QI Risk&Compliance Manager Signed Florida 8/1/2019 1(Electronic ME Contract Manager Department of Submission via E-mail) Children and Families Employment Screening Affidavit that all required staff have been screened or Network Provider is awaiting the results of screening Grievance 8/1/2019 1(Electronic 1. ME Contract Manager Procedures Submission via E-mail) a)Clients(applicants 2.VP of CQI or recipient of services) b)Agency Staff Attestation signed by 10/1/2019 1(Electronic ME Contract Manager the CEO/Executive Submission via E-mail) Director indicating that all applicable staff funded by this Contract have received a copy of the fully executed Contract and will receive a copy of any amendments made to this Contract. Exhibit C Page 4 of 19 Guidance/Care Center, Inc. Contract No.ME225-10-27 105 °vjuth Fllanu°ida 13ch ariIciraall III teaallt➢n"Fctnvor➢c,1nic. 7/01/2011t Exhibit C Required Reports NVRA Voter July 5,2019 1(Electronic 1. ME Voter Registration Registration Agencies (Period: 04/01/19-06/30/19) Submission via E-mail) Activities Coordinator Quarterly Activities October 5,2019 Report Form (DS- (Period: 07/01/19-09/30/19) 2. ME Contract Manager DE131;effective January 5,2020 01/2012 or latest (Period: 10/01/19-12/31/19) revision thereof, if April 5,2020 applicable (Period: 01/01/20-03/31/20) July 5,2020 (Period: 04/01/20-06/30/20) Quarterly Financial October 31,2019 1(Electronic 1. ME VP of Finance Statements(Balance (Period: 07/01/19-09/30/19) Submission via E-mail) Sheet and Statement January 31,2020 2. ME Contract Manager of Activity) (Period: 10/01/19-12/31/19) April 30,2020 (Period: 01/01/20-03/31/20) July 31,2020 (Period: 04/01/20-06/30/20) Attestation indicating October 31,2019(Period: 1(Electronic ME Contract Manager the filing of Form 941 07/01/19-09/30/19)January Submission via E-mail) and payment of any 31,2020(Period: 10/01/19- taxes due to the IRS 12/31/19)April 30, have been paid. 2020(Period:01/01/20- 03/31/20)July 31, 2020(Period:04/01/20- 06/30/20) January 30,2020 1(Electronic 1. ME Contract Manager Continuous Quality (Period: 07/01/19-12/31/19) Submission via E-mail) Improvement July 30,2020 2.QA/QI Risk&Compliance Updates (Period: 01/01/20-06/30/20) Manager Year-Erd�itfancial F �Scrrterrltiresrk; rcfiidr' 1Equiritfg, uditserAtflmtil( n Due 180 days after the end of 1(Electronic 1. ME Contract Man ager Hager indicating that the Network Provider's fiscal Submission via E-mail) recipient expended year or within 30 days of the 2.VP of Finance less than$750,000 in recipient's receipt of the audit Federal Awards or in report,whichever occurs first, State Awards during directly to each of the the fiscal year following unless otherwise required by Florida Statutes The schedule shall be based on revenues and expenditures recorded during the state's fiscal year. Exhibit C Page 5 of 19 Guidance/Care Center, Inc. Contract No.ME225-10-27 106 °vjuth Fllou°ida 13ch ariIciraall III teaallt➢n"Fctnvor➢c,1nic. 7/01/2011t Exhibit C Required Reports Schedule of State Due 180 days after the end of 1(Electronic 1. ME Contract Manager Earnings the Network Provider's fiscal Submission via E-mail) 2.VP of Finance year or within 30 days of the recipient's receipt of the audit report,whichever occurs first, directly to each of the following unless otherwise required by Florida Statutes The schedule shall be based on revenues and expenditures recorded during the state's fiscal year. Projected Cost Due 180 days after the end of 1(Electronic 1. ME Contract Manager Center Operating and the Network Provider's fiscal Submission via E-mail) Capital Budget year or within 30 days of the 2.VP of Finance Actual Expenses& recipient's receipt of the audit Revenues Schedule report,whichever occurs first, directly to each of the following unless otherwise required by Florida Statutes The schedule shall be based on revenues and expenditures recorded during the state's fiscal year. Local Match Due 180 days after the end of 1(Electronic 1. ME Contract Manager Calculation Form- the Network Provider's fiscal Submission via E-mail) Template 9- year or within 30 days of the 2.VP of Finance Department of recipient's receipt of the audit Children and Families report,whichever occurs first, form,available at the directly to each of the following website: following unless otherwise required by Florida Statutes https://www.myfifa The schedule shall be based milies.com/service- on revenues and expenditures programs/samh/man recorded during the state's aging-entities/2019- fiscal year. contra ct-docs.shtmI Schedule of Bed-Day Due 180 days after the end of 1(Electronic 1. ME Contract Manager Availability Payments the Network Provider's fiscal Submission via E-mail) year or within 30 days of the 2.VP of Finance recipient's receipt of the audit report,whichever occurs first, directly to each of the following unless otherwise required by Florida Statutes The schedule shall be based on revenues and expenditures recorded during the state's fiscal year. Exhibit C Page 6 of 19 Guidance/Care Center, Inc. Contract No.ME225-10-27 107 °vjuth Fllanu°ida 13ch ariIciraall III teaallt➢n"Fctnvor➢c,1nic. 7/01/2011t Exhibit C Required Reports Agency Prepared Due 180 days after the end of 1(Electronic 1. ME Contract Manager Financial Statements the Network Provider's fiscal Submission via E-mail) (Balance Sheet and year or within 30 days of the 2.VP of Finance Statement of Activity recipient's receipt of the audit report,whichever occurs first, directly to each of the following unless otherwise required by Florida Statutes The schedule shall be based on revenues and expenditures recorded during the state's fiscal year. Year=Erin f ifiancial" artsDerrl ttiu srk:t rcf rid ' ; equir ng ui ats er'A aehrrieJII Due 180 days after the end of 1(Electronic 1. ME Contract Ma CorrespondenceHager from the Auditor the Network Provider's fiscal Submission via E-mail) showing proof of year or within 30 days of the 2.VP of Finance submission of the recipient's receipt of the audit Audit Report and report,whichever occurs first, Management Letter directly to each of the to the Network following unless otherwise Provider. required by Florida Statutes The schedule shall be based on revenues and expenditures recorded during the state's fiscal year. Management letter Due 180 days after the end of 1(Electronic 1. ME Contract Manager addressed to the the Network Provider's fiscal Submission via E-mail) Network Provider year or within 30 days of the 2.VP of Finance issued by the Auditor recipient's receipt of the audit report,whichever occurs first, directly to each of the following unless otherwise required by Florida Statutes The schedule shall be based on revenues and expenditures recorded during the state's fiscal year. Financial& Due 180 days after the end of 1(Electronic 1. ME Contract Manager Compliance Audit to the Network Provider's fiscal Submission via E-mail) include the necessary year or within 30 days of the 2.VP of Finance schedules per recipient's receipt of the audit Attachment II report,whichever occurs first, directly to each of the following unless otherwise required by Florida Statutes The schedule shall be based on revenues and expenditures recorded during the state's fiscal year. Exhibit C Page 7 of 19 Guidance/Care Center, Inc. Contract No.ME225-10-27 108 °vjuth Fllanu°ida 13ch ariIciraall III teaallt➢n"Fctnvor➢c,1nic. 7/01/2011t Exhibit C Required Reports Schedule of State Due 180 days after the end of 1(Electronic 1. ME Contract Manager Earnings the Network Provider's fiscal Submission via E-mail) 2.VP of Finance year or within 30 days of the recipient's receipt of the audit report,whichever occurs first, directly to each of the following unless otherwise required by Florida Statutes The schedule shall be based on revenues and expenditures recorded during the state's fiscal year. Schedule of Related Due 180 days after the end of 1(Electronic 1. ME Contract Manager Party Transaction the Network Provider's fiscal Submission via E-mail) Adjustments year or within 30 days of the 2.VP of Finance recipient's receipt of the audit report,whichever occurs first, directly to each of the following unless otherwise required by Florida Statutes The schedule shall be based on revenues and expenditures recorded during the state's fiscal year. Local Match Due 180 days after the end of 1(Electronic 1. ME Contract Manager Calculation Form- the Network Provider's fiscal Submission via E-mail) Template 9- year or within 30 days of the 2.VP of Finance Department of recipient's receipt of the audit Children and Families report,whichever occurs first, form,available at the directly to each of the following website: following unless otherwise required by Florida Statutes https://www.myfifa The schedule shall be based milies.com/service- on revenues and expenditures programs/samh/man recorded during the state's aging-entities/2019- fiscal year. contra ct-docs.shtmI Projected Cost Due 180 days after the end of 1(Electronic 1. ME Contract Manager Center Operating and the Network Provider's fiscal Submission via E-mail) Capital Budget year or within 30 days of the 2.VP of Finance Actual Expenses& recipient's receipt of the audit Revenues Schedule report,whichever occurs first, directly to each of the following unless otherwise required by Florida Statutes The schedule shall be based on revenues and expenditures recorded during the state's fiscal year. Exhibit C Page 8 of 19 Guidance/Care Center, Inc. Contract No.ME225-10-27 109 °vjuth Fllanu°ida 13ch ariIciraall III teaallt➢n"Fctnvor➢c,Inic. 7/01/2011t Exhibit C Required Reports Schedule of Bed-Day Due 180 days after the end of 1(Electronic 1. ME Contract Manager Availability Payments the Network Provider's fiscal Submission via E-mail) year or within 30 days of the 2.VP of Finance recipient's receipt of the audit report,whichever occurs first, directly to each of the following unless otherwise required by Florida Statutes The schedule shall be based on revenues and expenditures recorded during the state's fiscal year. u6taft,eAliu 61 Health Out ti fit r r n s;ll itla ti; eperrlEs... Outpatient Wait List Monthly by the 5th for the 1(Electronic 1. ME Adult System of Care Report Form- preceding month's services. Submission via E-mail) Manager Exhibit AK, Part I and Part 11 2. ME Children's System of Care Manager R s'Raqulred for Chit,r n's Nlenfa1 Health F murder ;as, ppli(cabl Crisis Per Exhibit S-Monthly Census One(1) Encrypted 1. ME Contract Ma Children's Hager Response Team Report by the 15th of every Electronic Submission (CCRT) month following the month of attachment to an 2. Children's System of Care service email to each Manager recipient "p©rts equired far'ff f exc`r I H Ith1Udt*t)rk;(f 11&)"id#r Alternative Services Within 15 calendar days after One(1) Encrypted 1. ME Contract Man ager Provision end of month Electronic Submission Documentation attachment to an 2. ME BNet Coordinator (Other than email to each Pharmaceuticals) recipient 3.Children's Mental Health State Program Office Alternative Services Within 15 calendar days after One(1) Encrypted 1. ME Contract Manager Provision end of month Electronic Submission Documentation attachment to an 2. ME BNet Coordinator (Pharmaceuticals email to each only) recipient 3.Children's Mental Health State Program Office Statement of September 1 following close One(1) Encrypted 1. ME Contract Manager Program Cost of the contract year(June 30) Electronic Submission 2. ME BNet Coordinator attachment to an 3. Children's Mental email to each Health State Program recipient Office F��grre�±d ttefrcfrti�`�c�rt��± i�ir�g F���latx�s;�rrd/�rr�"l`reathri�ht"�eciliti+�s,,,, Weapons and Within 15 calendar days after 1(Electronic 1. ME Contract Man ager Firearms Court end of month for the Submission via E-mail) Petitions Monthly preceding month's 2. ME Data Analyst Report, Exhibit O information -Only CSU and CMHC Exhibit C Page 9 of 19 Guidance/Care Center, Inc. Contract No.ME225-10-27 110 °vjuth F'Ilanu°ida BehariIciraall III teaallt➢n"Fctnvor➢c,1nic. 7/01/2011t Exhibit C Required Reports F p+c, s equir 46r'016j ft6hce iA'Trari"sxtitsh"fresco" restiXd;�r PATH Monthly Monthly, by the 5th calendar 1(Electronic 1. ME Contract Manager Report(generated day Submission via E-mail) from the HMIS after the month 2. ME Housing Coordinator system) of service PATH Monthly Monthly by the 10th calendar 1(Electronic 1. ME Contract Manager Enrollment Tracker day after the month of service Submission via E-mail) 2. ME Housing Coordinator Quarterly Summary No later than the 10th of the 1(Electronic https://www.pathpdx,or / Report month following the quarter Submission via E-mail) of services PATH Annual Data No later than November 17th 1(Electronic https://www.pathpdx,or / Report into the PATH Submission via E-mail) Data Exchange(PDX) data system Repe�rts Jequiree�fcr'Adult JNlntaf HeIthreS'usders,, sppliCbfe" Assisted Living October 5 2019 1(Electronic 1. ME Contract Manager Facility with a (Period: 07/01/19-09/30/19) Submission via E-mail) Limited Mental January 5,2020 2. ME Adult System of Care Health License Client (Period: 10/01/19-12/31/19) Manager Quarterly Report, per April 5,2020 Exhibit L (Period: 01/01/20-03/31/20) July 5,2020 (Period: 04/01/20-06/30/20) Repe�rtJ� uir�d'i"csr'i=fesri+d�";ass±art'r���esmmurrityTr��thrr�ftti{i=A 'j"1�ref�rsd+�s�s""""""""" Vacant Position Monthly by the 7th of each 1 Electronic Report per Section month following the month of Submission via E-mail) 1. ME Contract Manager II.H., Reports in service Exhibit AF 2. ME Adult System of Care Manager FACT Enhancement October 5,2019 1(Electronic Reconciliation Report (Period: 07/01/19-09/30/19) Submission via E-mail) 1. ME Contract Manager per Section II.H., January 5,2020 Reports in Exhibit AF (Period: 10/01/19-12/31/19) 2. ME Adult System of Care April 5,2020 Manager (Period: 01/01/20-03/31/20) July 5,2020 (Period: 04/01/20-06/30/20) Exhibit C Page 10 of 19 Guidance/Care Center, Inc. Contract No.ME225-10-27 111 °vjuth Fllou°ida 13ch ariIciraall III teaallt➢n"Fctnvor➢c,1nic. 7/01/2011t Exhibit C Required Reports Ad-Hoc Quarterly October 5,2019 1(Electronic Report per Section (Period: 07/01/19-09/30/19) Submission via E-mail) 1. ME Contract Manager II.H., Reports in January 5,2020 Exhibit AF (Period: 10/01/19-12/31/19) 2. ME Adult System of Care April 5,2020 Manager (Period: 01/01/20-03/31/20) July 5,2020 (Period: 04/01/20-06/30/20) Outcomes and October 5,2019 1(Electronic Output Performance (Period: 07/01/19-09/30/19) Submission via E-mail) 1. ME Contract Manager Measures Report, January 5,2020 per Section II.H., (Period: 10/01/19-12/31/19) 2. ME Adult System of Care Report in Exhibit AF April 5,2020 Manager (Period: 01/01/20-03/31/20) July 5,2020 (Period: 04/01/20-06/30/20) Rep©rtJ�equiri�d for lUli�rrir=dale�orensi�;�lt;�rr��tie(Nlt1FAC)`Pres��dei`s,,......... Daily Census Report Daily, by 10:00 am, 1(Electronic Monday-Friday Submission via E-mail) Regional Forensic Coordinator Monthly Program By the 15th of each month 1(Electronic 1. ME Contract Manager Quality Review following the month of Submission via E-mail) Tracking Report services 2. Regional Forensic Coordinator Monthly By the 15th of each month 1(Electronic 1. ME Contract Manager Performance following the month of Submission via E-mail) Measures Report services 2. Regional Forensic Coordinator F� �+c�r1Es �quir fc�r'�erre�si���rVis;J�rer�rXd;�rs,,,, Monthly Report for By 15th of each month 1 1. ME Forensic Coordinator Individuals on Conditional Release, 2. Mental Health if applicable Administrator Office Statewide Forensic Weekly 1 ME Forensic Coordinator Bed Census Report, if (Every Thursday by 5:00 pm) applicable Reports f�eiquired fcr'�orensi�IVliwlt'rdici�slit�ary Team PresVader""" Monthly Forensic By 10th of each month for the 1(Electronic 1. ME Contract Man ager Multidisciplinary preceding months'services Submission via E-mail) Team Report—DCF 2. Regional Forensic Template 25 Coordinator Monthly Vacant By 10th of each month for the 1(Electronic 1. ME Contract Manager Position(s) Reports preceding months'services Submission via E-mail) 2. Regional Forensic Coordinator Exhibit C Page 11 of 19 Guidance/Care Center, Inc. Contract No.ME225-10-27 112 °vjuth Fllanu°ida 13ch ariIciraall III teaallt➢n"Fctnvor➢c,1nic. 7/01/2011t Exhibit C Required Reports Monthly Court By 10th of each month for the 1(Electronic 1. ME Contract Manager Reports preceding months'services Submission via E-mail) 2. Regional Forensic Coordinator [fepo' S//equiirwed ldeltdnIDr�Ve �genci s......... „Enrollment/Member October (,,,,,,,,, g,,,,,,,,,,,,,,. 5,2019 1 Electronic ME Contract Manager ship Report (Period: 07/01/19-09/30/19) Submission via E-mail) January 5,2020 (Period: 10/01/19-12/31/19) April 5,2020 (Period: 01/01/20-03/31/20) July 5,2020 (Period: 04/01/20-06/30/20) Fbi rtilkii for ub tMi"uss' rwi s resA"rd rs (,,,,,,,,, . ............... Report for HIV Early January 5,2020 1 Electronic ME Contract Manager Intervention (Period: 07/01/19-12/31/19) Submission via E-mail) Services,SAPT Block July 5,2020 Grant Set Aside (Period: 01/01/20-06-30-20) Funded Services Only Annual Report for Upon Request 1(Electronic ME Contract Manager Evidenced-based Submission via E-mail) Injection Drug User Outreach Services, SAPT Block Grant Mandate, Designated Providers Only Annual Report for Upon Request 1(Electronic ME Contract Manager Pregnant Women Submission via E-mail) and Women with Dependent Children SAPT Block Grant Set Aside Funded Services Only Monthly Outcomes Due monthly, by the 4th of 1(Electronic 1. ME IT Office for Women's every month following the Submission via E-mail) Expansion Grant— month of service 2. ME Contract Manager Special Appropriation R,/ f Lre,,d'fc r Vitale` i3rc id Ff6gponse'[ iscrdi Monthly SOR Data Due monthly, by the 15th of 1(Electronic ME Contract Manager Collection Report- every month following the Submission via E-mail) State Opioid month of service Encrypted and Response Password Protected Discretionary Grant Services(SOR) Medication Assisted Treatment Services, OCA: MSSOR- Exhibit BB Exhibit C Page 12 of 19 Guidance/Care Center, Inc. Contract No.ME225-10-27 113 °vjuth Fllanu°ida 13ch ariIciraall III teaallt➢n"Fctnvor➢c,1nic. 7/01/2011t Exhibit C Required Reports Quarterly and Annual October 31,2019 1(Electronic 1. ME Contract Manager Expenditure Report (Period: 07/01/19-09/30/19) Submission via E-mail) (Exhibit BB) January 31,2020 2. VP of Finance (Period: 10/01/19-12/31/19) April 30,2020 (Period: 01/01/20-03/31/20) July 31,2020 (Period: 04/01/20-06/30/20) Annual Expenditure Report Due:7/15/2019 (Period: 07/01/19—06/30/20) tfepartsA quired#or ub tin&Abuse1 reuenlEicffr Serums rd"11 rs..............' .. Monthly Data Prevention service data shall Electronically PBPS,or other data system Required by DCF be submitted electronically to designated by the ME or the FASAMS PAM 155-2 PBPS no later than the 4th of Department each month following the month of service Monthly Data to the Monthly, by the 4th calendar Electronically DOES or any other format ME's contracted day after the month of service requested by BSRI evaluation entity- BSRI Monthly Service Monthly, by the eighth (8th) 1 ME Sr.Accountant(Fiscal Invoice calendar day after the month Department) of service Invoice Review 1 ME Sr.Accountant(Fiscal Supporting Submitted with the monthly Department) Documentation- invoice from PBPS in a jpeg format Monthly E-Mail Monthly, by the 4th calendar 1(Electronic 1. ME Director or Prevention Notification to the day after the month of service Submission via E-mail) Services ME Prevention Services Director and 2. ME Data Analyst ME Data Analyst verify 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. Refer to Scope of Work Attachment to the Contract for specifics Exhibit C Page 13 of 19 Guidance/Care Center, Inc. Contract No.ME225-10-27 114 °vjuth Fllou°ida 13ch ariIciraall III teaallt➢n"Fctnvor➢c,1nic. 7/01/2011t Exhibit C Required Reports Final Annual Site 8/31/2019 1(Electronic 1. ME Contract Manager Schedule Submission via E-mail) 2. ME Director of Prevention Services Memorandum of Within 30 calendar days of 1(Electronic 1. ME Contract Manager Understanding the effective date of the Submission via E-mail) (MOU)with a contract(for newly executed 2. ME Director or Prevention Community Coalition MOU's) Services OR Within 30 calendar days for renewed MOU's Submission of Refer to Scope of Work 1(Electronic 1. ME Contract Manager Participant Attachment to the Contract Submission via E-mail) Satisfaction Survey for specifics 2. ME Director or Prevention Services Reports f�eiquired fc�r'1�rw��ri�ri�r"�rri ParlEnersh��„�r`��1��rer�rXd;�r`s,,,, Monthly E-Mail Monthly, by the 4th calendar 1(Electronic 1. ME Director or Prevention Notification to the day after the month of service Submission via E-mail) Services ME Prevention Services Director and 2. ME Data Analyst ME Data Analyst verify 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. Refer to Scope of Work Attachment to the Contract for specifics Program Status 7/15/2020 1(Electronic 1. ME Contract Manager Report (Period: 07/01/2019- Submission via E-mail) 06/30/2020) 2. ME Director or Prevention Services Within 30 calendar days of 1(Electronic 1. ME Contract Manager Memorandum of the effective date of the Submission via E-mail) Understanding contract(for newly executed 2. ME Director or Prevention (MOU)with a MOU's) Services Community Coalition OR Within 30 calendar days for renewed MOU's Submission of Refer to Scope of Work 1(Electronic 1. ME Contract Manager Participant Attachment to the Contract Submission via E-mail) Satisfaction Survey- for specifics 2. ME Director or Prevention Services Final Annual Site 8/31/2019 1(Electronic 1. ME Contract Manager Schedule Submission via E-mail) 2. ME Director of Prevention Services Exhibit C Page 14 of 19 Guidance/Care Center, Inc. Contract No.ME225-10-27 115 °vjuth F'Ilanu°ida BehariIciraall III teaallt➢n"Fctnvor➢c,1nic. 7/01/2011t Exhibit C Required Reports Quarterly Financial October 31,2019 1(Electronic 1. ME Contract Manager Report of Program (Period: 07/01/19-09/30/19) Submission via E-mail) Expenses January 31,2020 2.VP of Finance (Period: 10/01/19-12/31/19) April 30,2020 (Period: 01/01/20-03/31/20) July 31,2020 (Period: 04/01/20-06/30/20) u�ticfh ��,,,. F� �+c�rts �quirfc�r'Etii�l+ `fri't'r'ty`fc�rt�r ��l�icfh ,,, MonthlyService Monthly by 20th calendar day 1(Electronic 1. ME Contract Manager Hager Report after the month of service Submission via E-mail) (Deliverables per 2. ME Director of Prevention Attachment IV,Scope Services of Work) Quarterly October 31,2019 1(Electronic 1. ME Contract Manager, Expenditure Report (Period: 07/01/19-09/30/19) Submission via E-mail) January 31,2020 2. ME VP of Finance,and (Period: 10/01/19-12/31/19) May 1,2020 3. ME Director of Prevention (Period: 01/01/20-03/31/20) Services July 31,2020 (Period: 04/01/20-06/30/20) F���+c�rts��quir fcir'1�rwef�rid�rs lfe+ i�ra�rg'S�+�cifi�,Aia�r�siari;�t'r�r�s Pof cted 7/10/2019 1(Electronic 1. ME Contract Ma Initial Projected Hager Return on Submission via E-mail) Investment-Per Exhibit AM Quarterly Updates on October 10,2019 1(Electronic 1. ME Contract Manager Return on (Period: 07/01/19-09/30/19) Submission via E-mail) Investment Report- January 10,2020 Per Exhibit AM (Period: 10/01/19-12/31/19) April 10,2020 (Period: 01/01/20-03/31/20) July 10,2020 (Period: 04/01/20-06/30/20) Ri ferrEthe Naurg to PrdgrAm/#icf'iid r Quarterly Services October 31 2019 1(Electronic ME Contract Manager Report (Period: 07/01/19-09/30/19) Submission via E-mail) January 31,2020 (Period: 10/01/19-12/31/19) May 1,2020 (Period: 01/01/20-03/31/20) July 31,2020 (Period: 04/01/20-06/30/20) Exhibit C Page 15 of 19 Guidance/Care Center, Inc. Contract No.ME225-10-27 116 °vjuth Fllou°ida 13ch ariIciraall III teaallt➢n"Fctnvor➢c,Inic. 7/01/2011t Exhibit C Required Reports Navigate Program October 31,2019 1(Electronic ME Contract Manager Quarterly (Period: 07/01/19-09/30/19) Submission via E-mail) Expenditure Report January 31,2020 (Period: 10/01/19-12/31/19) May 1,2020 (Period: 01/01/20-03/31/20) July 31,2020 (Period: 04/01/20-06/30/20) k rfs; oqulmdferrEirifcrmiaEicitr rrdFf; ferral ert� ;Orestexd/erii/,, Information and Due monthly, by the 30th of 1(Electronic ME Contract Manager Referrals Provider's every month following the Submission via E-mail) Network(Jewish month of service Community Services of South Florida, Inc.) Exhibit P-1, Information and Referral Monthly Progress Report FirFircrrsquir, +d ferr irifantiiiil �itl FFaIEhrcfgrm'>rcfrid ors Monthly Due monthly, by the 5th 1(Electronic 1. ME Contract Man ager Demographic Report, calendar day of the month. Submission via E-mail) 2.VP of Behavioral Health Exhibit AU, Infant Mental Health Services.The report shall be submitted in a secured, password protected or encrypted format. Quarterly Infant July 5,2019 1(Electronic 1. ME Contract Manager Mental Health- (Period: 04/01/19-06/30/19) Submission via E-Mail) 2.VP of Behavioral Health Narrative Milestones October 5,2019 Report on Client (Period: 07/01/19-09/30/19) Outcomes.The January 5,2020 report shall be (Period: 10/01/19-12/31/19) submitted in a April 5,2020 secured, password (Period: 01/01/20-03/31/20) protected or encrypted format. Rels©rtsiiequired for'the Forefisi 'Miitaf Healtherices;+resgrarn""' Appendix A, By the 10th of every month 1(Electronic ME Forensic Manager Conditional Release following the reporting month Submission via E-mail) Report Weekly Statewide Weekly by 12:00 Noon every 1(Electronic ME Forensic Manager Census Report Thursday Submission via E-mail) Exhibit C Page 16 of 19 Guidance/Care Center, Inc. Contract No.ME225-10-27 117 °vjuth F'Ilanu°ida 13ch ariIciraall III teaallt➢n"Fctnvor➢c,1nic. 7/01/2011t Exhibit C Required Reports Appendix B, Monthly By the 10th of every month 1(Electronic ME Forensic Manager Diversion Report following the reporting month Submission via E-mail) Quarterly SMHFT Due within thirty(30) 1(Electronic ME Forensic Manager Visit Report calendar days of date of the Submission via E-mail) visit Staffing Report January 5,2020 1(Electronic ME Forensic Manager (Period: 07/01/19-12/31/19) Submission via E-mail) July 5,2020 (Period: 01/01/20-06-30-20) F is rlEs qu r fc r tl e'Cct`ninuIn't cirr' r atmefi , e m"(C C,T arrif 1 rcfgr m„"" Weekly Census Weekly by 12:00 noon,every 1(Electronic Children's System of Care Report Monday Submission via E-mail) Manager Monthly shall be submitted Electronically KIS, FASAMS,or other data Monthly Data electronically to the ME no system designated by the ME Required by DCF later than the 4th of each or the Department FASAMS PAM 155-2 month following the month of service Appendix 1-Persons By the 8th calendar day of the 1(Electronic 1.Children's System of Care Served and month after the month of Submission via E-Mail) Manager Performance service 2.Contract Manager Measure Report Appendix 2- October 10,2019 1(Electronic 1.Children System of Care Quarterly (Period: 07/01/19-09/30/19) Submission via E-mail) Manager Supplemental Data January 10,2020 2.Contract Manager Report (Period: 10/01/19-12/31/19) April 10,2020 (Period: 01/01/20-03/31/20) July 10,2020 (Period: 04/01/20-06/30/20) Appendix 3-CAT Monthly, by the eighth (8th) 1 1. ME Sr.Accountant(Fiscal Team Monthly calendar day Department) Invoice after the month of service 2.Children's System of Care Manager Invoice Review Submitted with the monthly 1 1. ME Sr.Accountant(Fiscal Supporting invoice,as appropriate, Department) Documentation and/or as requested by SFBHN 2.Children's System of Care (incidental expenses) staff Manager R��+c�r1Es��quir fc�r'tl�e'M�bii t�es�c�rise`T�am�,,,, Monthly MRT Monthly by the 10th following 1(Electronic 1. ME Contract Manager Tracker the month of service Submission via E-mail) 2. ME Data Analysts -Encrypted, password protected Exhibit C Page 17 of 19 Guidance/Care Center, Inc. Contract No.ME225-10-27 118 °vjuth F'Ilanu°ida 13ch ariIciraall III teaallt➢n"Fctnvor➢c,1nic. 7/01/2011t Exhibit C Required Reports Outreach Activities October 15,2019 1(Electronic 1. ME Contract Manager Log (Period: 07/01/19-09/30/19) Submission via E-mail) 2. ME Data Analysts January 15,2020 (Period: 10/01/19-12/31/19) April 15,2020 (Period: 01/01/20-03/31/20) July 15,2020 (Period: 04/01/20-06/30/20) Iiscrrs; gwiri+dferrfernii `ris� Treethrreftt;( 1TJ: eratrctrdrs WeeklyChild Each Monday by close of 1(Electronic Child Welfare Integration- ration Welfare Program business following the week Submission via E-mail) Coordinator Active Cases Weekly of services(a week is defined Report(Appendix 1 as Tuesday-Monday) of Exhibit Al) Monthly Progress By the 15th day of the month 1(Electronic 1. Contract Manager Report(Reporting following the month of Submission via E-mail) 2.Child Welfare Integration Template 17 is services Coordinator available at: http://www.myflfami lies,com/service- programs/substance abuse/managing entities F(i rti/A4 rt d#er milf "te r0nd`5afety Oft' 'iircf r d ors WeeklyChild Each Monday by close of 1(Electronic Child Welfare Integration- ration Welfare Program business following the week Submission via E-mail) Coordinator Active Cases Weekly of services(a week is defined Report(Appendix 1 as Tuesday-Monday) of Exhibit Al) Monthly-Child By the 15th day of the month 1(Electronic Child Welfare Integration Welfare Monthly following the month of Submission via E-mail) Coordinator Tracker services Monthly-FERAS By the 8th day of the month 1(Electronic Child Welfare Integration Outreach Log following the month of Submission via E-mail) Coordinator services 1��frcrr�s;��quir,�dferrfi1�tti�iesrk;presriX�d+�r�s;��r�ing F�mrlii�� �ferr by,tl�e'1'�li�sti�r�t�rfh�l�uiaperrt�rfcrgr{ern„ „Monthly g ress Pro By the 15th day ,., of the month One(1) Password, Motivational Support Report(for following the month of protected and Specialist at the Motivational Behavioral Health services encrypted Electronic Support Program Network Treatment Network Submission Provider Providers refer to attachment to the Appendix 1 of assigned MSS Exhibit J) Exhibit C Page 18 of 19 Guidance/Care Center, Inc. Contract No.ME225-10-27 119 °vjuth Fllanu°ida 13ch ariIciraall III teaallt➢n Nctnvor➢c,1nic. 7/01/2011t Exhibit C Required Reports Motivational Support By the 10th day of the month One(1) Password, 1.Child Welfare Integration Program Tracker following the month of protected and Coordinator (Banyan Health services encrypted Electronic Systems, per Exhibit Submission 2. Data Analyst AA) Motivational Support Every Monday, by Close of One(1) Password, Child Welfare Integration Program Weekly Business following the week protected and Coordinator Caseload (Banyan of service encrypted Electronic Health Systems,per Submission Exhibit AA) �lrii�af�esnsultanterui±�e� ;(1�C ) CCS Tracker Every Monday, by Close of One(1) Password, Child Welfare Integr ation Business following the week protected and Coordinator of service encrypted Electronic Submission F Sar s quir d#err l tw srk res r j is r syll�din' reaeh ri s i o 1�re�tr�i��` J�ixneh,; hjWS Arid,,,,, thir,K# cedhnalii (CfA` 27rrd Mf� 1j,,,,,, Women's Special By the 8th day of the month One(1) Password, Data Analysts Appropriation Data following the month of protected and Reporting-Per services encrypted Electronic Exhibit AE Submission 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 Page 19 of 19 Guidance/Care Center, Inc. Contract No.ME225-10-27 120 So u I h 1lllm::^kfa ll dh::iuior: III NII111e:flllIh Net� flc, Ii1c. 7.1.2011) EXHIBIT D Substance Abuse &Mental Health Required Performance Outcomes&Outputs Network Provider Name: Guidance/Care Center, Inc. Contract#: ME225-10-27 Date: 7/1/2019 Amendment#: The Network Provider is directed to the Department's Guidance Document 24, Performance Measurement Manual for program guidance on the measures in Tables 1 & 2 below. To view the manual, click on the following link: tt s.//www.Myfifamilies.com/service®programs/sam /manaF& entities/20 9®contract- ocs.s tml 7"" � up, Adults Community Mental Health MH003 a. Average annual days worked for pay for adults with severe and persistent mental illness 40 MH703 b. Percent of adults with serious mental illness who are competitively employed 24/ MH742 c. Percent of adults with severe and persistent mental illnesses who live in stable housing 90% 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 30 days 15% 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 at the 94% time of discharge Children's Mental Health MHO12 a. Percent of school days seriously emotionally disturbed (SED)children attended 86% MH377 b. Percent of children with emotional disturbances(ED)who improve their level of 64% functioning MH378 c. Percent of children with serious emotional disturbances(SED)who improve their level of 65% 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 housing 93% environment MH780 f. Percent of children at risk of emotional disturbance(ED)who live in a stable housing 96% 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 versus 30 20% days prior to discharge SA752 c. Percent of children with substance abuse who live in a stable housing environment at the 93% time of discharge Exhibit D Guidance/Care Center, Inc. Page 1 of 2 Contract No.ME225-10-27 121 So uIii Fllo iida Bdhai iior�flII I1ie flIIii Net o llc, I i1 . 7.1.2011) Table 2 Network Service Provider Output Measures—Persons Served For Fiscal Year FY19-20 Service Category FY Target Residential Care 35 �a s Outpatient Care 1690 Crisis Care 350 4-1 73 State Hospital Discharges N/A Q Peer Support Services 0 Residential Care 0 c v � s N Outpatient Care 590 c v v = s Crisis Care 20 U a, Residential Care 0 Q Outpatient Care 360 v U Detoxification 200 4a Women's Specific Services 0 +� Injecting Drug Users 0 Q Peer Support Services 0 Residential Care 0 c 41 Outpatient Care 290 Detoxification 0 c °J **Refer to Attachment IV,Scope of Prevention Work for the numbers served.** s U Network Provider Compliance: Failure to meet the applicable standards established in Tables 1 and 2 shall be considered nonperformance pursuant to Standard Contract, Paragraph 36. Financial Consequences for Network Provider's Failure to Perform. Exhibit D Guidance/Care Center, Inc. Page 2 of 2 Contract No.ME225-10-27 122 SmuthRmh�a Bmhamimna� H aRh ��wmMk. |nC' evism�T/1 2819 EXHIBIT 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: F2'1 Federal Authority F24.1 Block Grants Regarding Mental Health and Substance Abuse F24.1.1 Block Grants for Community Mental Health Services 42U.G.C. 00. 3OOx' ntseq. F24.1.2 Block Grants for Prevention and Treatment of Substance Abuse 42U.G.C. 00. 300x'21 ntonq. 45CFR Part 90' Subpart L F24.2 Department of Health And Human Services,General Administration, Block Grants 45CFR Part. 90 F24.3 Charitable Choice Regulations Applicable to Substance Abuse Block Grant and PATH Grant 42CFR Part 54 F24.4 Confidentiality Of Substance Use Disorder Patient Records 42CFRPart 2 F24.5 Security and Privacy 45CFR Part 104 F24.8 Supplemental Security Income for the Aged, Blind and Disabled 2OCFR Part 410 F24.7 Temporary Assistance to Needy Families(TANF) 42U.G.C. 00. 001 019 45CFR' Part 200 F24.8 Projects for Assistance in Transition from Homelessness(PATH) 42U.G.C. 00. 290oc-21 —29Oon'35 F24.9 Equal Opportunity for Individuals with Disabilities (Americans with Disabilities Act of 1990) 42U.G.C. 00. 12101 12213 F24.10 Prevention of Trafficking(Trafficking Victims Protection Act of2OOO) 22U.G.C. o. 7104 2CFR Part 175 F24.11 Governmentwide Requirements for Drug-Free Workplace(Financial Assistance) 2CFR Part 182 2CFR Part 382 Exhibit Page & nf4 oumanno/oamoonter. Inc. Contract No.ME225'10'27 123 F2-1.12 Maintenance of Effort 45 CFR Part 263 F2-2 Florida Statutes F2-2.1 Child Welfare and Community Based Care Ch. 39, F.S. Proceedings Relating to Children Ch. 402, F.S. Health and Human Services: Miscellaneous Provisions F2-2.2 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 F2-2.3 Developmental Disabilities Ch. 393, F.S. Developmental Disabilities F2-2.4 Adult Protective Services Ch. 415, F.S. Adult Protective Services F2-2.5 Forensics Ch. 916, F.S. Mentally III And Intellectually Disabled 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. Use of detention; prohibitions F2-2.6 State Administrative Procedures and Services Ch. 119, F.S. Public Records Ch. 120, F.S. Administrative Procedures Act Exhibit F Page 2 of 4 Guidance/Care Center, Inc. Contract No.ME225-10-27 124 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 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 orjudicial branch compliance S. 216.181(16)(b), F.S. Advanced funds for program startup or contracted services F2-3 Florida Administrative Code F2-3.1 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 F2-3.2 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 F2-3.3 Financial Penalties Ch. 65-29, F.A.C. Penalties on Service Providers F24 MISCELLANEOUS F24.1 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 Exhibit F Page 3 of 4 Guidance/Care Center, Inc. Contract No.ME225-10-27 125 CFOP 215-6 Incident Reporting and Analysis System (IRAS) F24.2 Standards applicable to Cost Principles,Audits, Financial Assistance and Administrative Requirements S. 215.425, F.S. Extra Compensation Claims prohibited; bonuses; severance pay S. 215.97, F.S. Florida Single Audit Act S. 215.971, F.S. Agreements funded with federal or state assistance Ch. 65I-42, F.A.C. Travel Expenses Comptroller's Memorandum No. 03(1999-2000) Florida Single Audit Act Implementation CFO's Memorandum No. 03 (2014-2015) Compliance Requirements for Agreements 2 CFR, Part 180 Office of Management and Budget Guidelines to Agencies on Government Wide Debarment and Suspension (Non-procurement), 2 CFR, 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 CFR, Part 300.1 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 CFR Part 200 45 CFR, Part 75 Uniform Administration Requirements, Cost Principles,and Audit Requirements for HHS Awards F24.3 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.ME225-10-27 126 . . . . . . . . . . . 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W > C �,^ `c ce C a`i Gl a=i c W U G o « •> c '� Ca E c =-o ° v c a> > > > > > ° ? o 6 o ° ° c v j ° ° ° .o a E ° o � F x `o c x = '> d U E ° s c °23 a ° °4^ c c s. .� _JJJJd' Wx W C7 0 0 0� z - o ° ° ° c ° _ E O_ o o a c . ^ ^ c c c a s u F - v o c c - ° ° ° cq G G .> .o 0� 0� _ o 0 0 0 F F.. W m U N U v v ° c c c c a F 33 33 °� o W a F U j a rt o > > = = ° ° ° ° � a a a F o o a c " = F s s s� 0 0 0 0 0 ° ° U o 0 o E F E E E s F F > > o Z o Q Q m 'a r� ai ai U � Nv� v� FrQQ � CQz. 2o' 20' a.� UUUct� � 0.L. Q QQ mmmU �p �F O O O O O --i 7 --i -. --i M -- -- '-' C I CAI N C I C I CAI N C I ➢ � — ^' EXHIBIT H-FUNDING DETAIL July 2019 Provider: Guidance/Care Center,Inc. Contract#: ME225-10-27 Amendment# ADULT MENTAL HEALTH CHILDREN MENTAL HEALTH OCA DESCRIPTION NLNA OCA AMOUNT OCA DESCRIPTION NENA OC A AMOUNT Residential Services MH001 $ 228,629 '.. Residential Services MHO01 $ Non-Residential Services MH001 $ 915,082 Non-Residential Services MH001 $ 47Q000 Crisis and Baker Act Services MII018 $ 1,130,503 Crisis and Baker Act Services MHO 18 $ 15,677 Community Forensic Program MH077 $ 16Q000 Special Appropriation-ICFH MHOCN $ FACT Team MHOT1 $ Purchased Residential Treatment(PATS) MH071 $ Indigent Drug Program MII076 $ SQ564 Community Action Treatment(CAT)Team MHC A I $ 75Q000 Proviso Allocation-Citrus MI 094 $ Mobile Crisis Team MHMC I $ 636,471 PATH Grant MHOPG $ 165,000 $ TANF Services MII0 1 P3 $ $ Early Intervention-Psychotic Disorders MII026 $ $ Forensic Hospital Multidisciplinary Team MII0III $ $ For Profit Sub-Recipeint-Key West HMA MHSI P $ $ Supported Employment Services MIB;SAP $ 75 000 $ Miami-Dade County Homeless Trust MII010 IOS Pilot Project MII021 $ $ MDC-Central Receiving Facility MDC R& $ $ Care Coordination MIIOC N $ 54,669 Care Coordination M1I0C N $ Carry Forward MIIOC I $ Carry Forward MHOC I $ Mobile Crisis Team MIIMC 1 $ MH Florida Hurricane-SERG M1I1LII $ 125,000 TOTAL ADULT MENTAL HEALTH= $ 2,904,447 TOTAL CHILDREN MENTAL HEALTH= $ 1,872,148 ADULT SUBSTANCE ABUSE CHILDREN SUBSTANCE ABUSE OCA DESCRIPTION NLNI OCA AMOUNT OCA DESCRIPTION NENI OCA AMOUNT Residential Services MS003 $ Residential Services MS003 $ Non-Residential Services MSOI I $ 271,791 Non-Residential Services MSOI I $ 253,773 Detox Services MS021 $ 486,643 Detox Services MS021 $ HIV Services MS023 $ HIV Services MS07 7 $ Prevention Services MS027 $ Prevention Services MS027 $ 199,063 Women's Services MS027 $ Prevention Partnership Grant MSOPP $ Pregnant Women Project MS081 $ TANF Services MSO I B $ FIT Team MS091 $ 633,188 Proviso Allocation-Here's Help MS903 $ ,e. TANF Services MSO I B $ Here's Help Opioid Training MS91 $ Proviso Allocation-New Hope CORPS MS908 $ Functional Family Therapy-EBA MS911 $ Targeted Response-Opioid Crisis MSOPII $ SOR-Prevention MSSOP $ 39,887 Opioid Crisis MAT MSOPM $ $ Here's Help Opioid Training MS91"1 $ $ Community Based Services MSCBS $ 83,333 $ MDC-Central Receiving Facility MDC R& $ $ Care Coordination MSOC N $ 22,698 Care Coordination MSOC N $ Carry Forward MSOC I $ Carry Forward MSOC I $ SOR-MAT MSSOIL $ 12,100 SOR-Prevention MSSOP $ TOTAL ADULT SUBSTANCE ABUSE_ $ 1,509,753 TOTAL CHILDREN SUBSTANCE ABUSE_ $ 492,723 FUNDS NOT REQUIRING MATCH: Drug Abuse Services $ 739,841 TOTAL ALL PROGRAMS= $ 6,779,071 Prevention $ 199,063 UNCOMPENSATED UNITS= $ 1,355,814 Deinstitutionalization Project $ 573,266 TOTAL= $ 8,134,885 CMH Program $ 1,872,148 SOR Grant $ 51,987 TOTAL FUNDS REQUIRING MATCH= $ 3,342,766 TOTAL FUNDS NOT REQUIRING MATCH $ 3,436,305 LOCAL MATCH REQUIRED= $ 1,114,255 NOTES FY 2018-19 Adjustments '8/24/18 $750,000 is added to fund the CAT Team ofMonroe County(Procured). 10/17/18 The following allocations are for Care Coordination: $23,878 in MHOCF(MHOCN)-non-recurring,$12,295 in MSOCF(MHOCN)-non-recurring, $52,961 in MHOCN-non-recurring and$22,698 in MHOCN-recurring. $60,499 is added to MSOPM for opioid MAT services,non-recuuring and another$50,000 in MSCBS for MAT services,recurring. $44,619 is added to MH076 for IDP (cash)for the purchase ofinedications-incidental covered services-recurring. '11/26/18 $425,000 is added to MHMCT to fund the Mobile Crisis Team operations awarded in accordance with the ITN. $375,000 is added to MHFLH to for the SERG services,$125,000 will be available for the 1st Quarter of next STY. '1/15/19 $12,100 is allocated in OCA MSSOR for the SOR services to be paid on a Case rate basis(bundled rate per client=$1,008.33/month). $39,887 is added to MSSOP for SOR Prevention services. '2/28/19 $1,708 is added to MHOCN for additional services,recurring. $40,000 is added to MHOPG for additional PATH services. FY 2019-20 Adjustments: '3/6/19 All the carry Forward funds are withdrawn as those were 1-time only allocations. $40,000 is reduced from MHAPG due to 1-time only allocation. All MSOPM funds are reuduced as the grant ended in FY 2018-19. $33,333 added to MSCBS to annualize the MSCBS funding allocation. $211,471 is added to MHMCT to annualize the Mobile Crisis Team funding allocation. '5/16/19 Path Funding is adjusted to$165,000 annual allocation. 6/25/19$75,000 is added to MHEMP for supportive employment at Personal Growth Clubhouse. 7/1/2019 The Central Receiving Facility funding allocated to GCC are as follows: $100,000-MSO11 and$300,000-MS021. Guidance/Care Center, Inc. Exhibit Contract No.ME225-10-27 Paye ofI LOCAL MATCH PLAN July 2019 Guidance/Care Center,Inc. ME225-10-27 REQUIRED MATCH: S 1,114,255 /. IIIIIIII IIIIIIIIIIIIIIIIIIIll COST CENTERS RATE UNITS MATCH UNITS MATCH UNITS MATCH UNITS MATCH 01 Assessment S 77.09 583.73 $ 45,000 02 Case Management S 90.84 715.54 $ 65,000 03 Crisis Stabilization S 376.29 531.50 $ 200,000 04 Crisis Support/Emergency S 47.39 06 Day/Night $ 07 Dro-In/SelfHel Centers $ 08 In-HOme/On-Site S 93.34 1,146.35 $ 107,000 11 Intervention-Individual S 78.16 42 Intervention-Group S 19.54 12 Medical Services S 484.75 206.29 $ 100,000 13 Medication-Assisted Treatment S 19.44 14 Ou adenf-Individual S 67.49 35 Ou atient-Grou S 16.87 15 Outreach S 44.03 18 Residential Level I S 280.64 712.66 $ 200,000 Residential Level I new SIPP rate $ 19 Residential Level II $ 20 Residential Level III $ 21 Residential Level IV $ 24 Substance Abuse Detox S 251.15 1,581.74 $ 397,255 25 Supported Em to vent $ 26 Supportive Housing $ 27 TASC $ 28 Incidental Expenses S 1.00 29 Aftercare-Individual $ 43 Aftercare-Group $ 30 1 Information&Referral $ 34 FACT Team $ 36 Room&Board Level I $ 37 Room&Board Level II $ 38 Room&Board Level III S 115.25 39 Short-term Residential Treatment $ 40 Clubhouse Services S 50.69 44 CCST-Individual $ 45 CCST-Grou $ 46 Recover Su ort-Individual $ 47 Recovery Support-Grou $ 48 Prevention-Indicated S 69.70 49 Prevention-Selective S 95.54 50 Prevention-Universal Direct S 68.59 51 Prevention-Universal Indirect $ 52 AO-Forensic Multidisciplinary Team $ 53 Al-BNET $ 54 A2-FIT Team S 1,250.00 55 A5-First Episode Team $ 56 A7-Federal Project Grant $ 57 B3-Cost Reimbursement $ 58 B 4-CAT Team $ 59 B5-FACT Team $ 60 B6-Provider Proviso Projects $ 61 CO-Other Bundled Projects $ MATCH ALLOCATION: $ 607,000 $ $ 507,255 $ GRAND TOTAL: I S 1,114,255 Guidance/Care Center, Inc. Local Match Plan Contract No. ME225-10-27 Page 1 of 1 132 °vjuth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,1nic. 07/51/11t EXHIBIT I Motivational Support Program (MSP) Treatment Provider Protocols I. POLICY: It is the policy of South Florida Behavioral Health Network (SFBHN) to establish protocols for treatment providers that receive referrals and/or provide services to 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 MSP Protocols for the Southern Region (Miami-Dade and Monroe Counties) are incorporated herein by reference and 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: hops://www.myflfamilies.com/service-programs/samh/manain -entities/2019-contract-docs.shtml IV. DEFINITIONS: 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 the lead Community Based Care ("CBC") agency, 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. Exhibit I Guidance/Care Center, Inc. Page 1 of 6 Contract No.ME225-10-27 133 °vjuth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,1nic. 07/51/11t 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 the lead CBC 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 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 former Child Welfare Community Based Care (CBC) Lead Agency for the Southern Region. k. CITRUS FAMILY CARE NETWORK ("CFCN")-The Department of Children and Family Services Child Welfare Community Based Care (CBC) Lead Agency for the Southern Region. I. 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. m. 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.) . Individuals who are certified are permitted to serve in the capacity of a qualified professional, but only within the scope of their certification. Exhibit I Guidance/Care Center, Inc. Page 2 of 6 Contract No.ME225-10-27 134 °vjuth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,1nic. 07/51/11t n. SCREENING —The first step needed to identify if there is a substance use or mental health disorder potentially impacting parenting protective capacity and the safety of the child. It is a process to determine the possibility that a behavioral health disorder may be present and to identify indicators when one suspects the presence of a disorder. o. 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. Referral to MSP Criterion:The identified danger threat level determines the urgency of the referral to MSP. Refer to the Motivational Support Program Protocols, incorporated by reference herein. 1. Urgent Referral Case MSP will offer an immediate response and contact family/caregiver within 24 hours for cases that are considered urgent at the CPI level, following a consultation with CPI Supervisor (CPIS) or with the Behavioral Health Clinical Consultant(CCS). Referral Source: A CPI Supervisor (CPIS), a Program Administrator (PA); or a Behavioral Health Clinical Consultant(CCS)who has screened the case history or who has triaged a case during a pre- commencement or post commencement consultation. 2. Semi-Urgent Case MSP will offer a response and contact family/ caregiver within 48 hours for cases that are considered "SEMI- urgent" at the CPI level,following a consultation with CPI Supervisor or with the Behavioral Health Clinical Consultant (CCS). The DCF Opioid Grant Behavioral Health Consultant can also make a recommendation for MSP involvement. If a recommendation has been made by the CCS or CPIS for an MSP referral to be submitted, the CPIS or CCS is to follow-up to ensure that the MSP referral has been completed. Referral Source: A CPI Supervisor (CPIS), a Program Administrator (PA); or a Behavioral Health Clinical Consultant (CCS) who has screened the case history or who has triaged a case during a pre-commencement or post commencement consultation. 3. CBC Referrals MSP will offer a response and contact family/ caregiver within 72 hours. These referrals are initiated during the later stages of the CPI investigation. Referral Source: The CBC Intake staff, at end of investigation, when CPI is closing and or transferring case to the Full Case Management Agency(FCMA.) Exhibit I Guidance/Care Center, Inc. Page 3 of 6 Contract No.ME225-10-27 135 °vjuth Fllanu°ida Beharkiiraall III teaallt➢n Nctnvor➢c,1nic. 07/51/11t VI. PROCEDURES 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 Network Provider for behavioral health treatment. A. Referrals and Communication between the parties 1. The MSP case manager or Motivational Support Specialist ("MSS") will submit referral to treatment provider. 2. The treatment provider will ensure that an initial appointment takes place within seven (7) business days of the receipt of referral from MSS, regardless of the consumer's ability to pay. 3. The treatment provider will ensure that the consumer was financially assessed utilizing the sliding fee scale as specified in the SFBHN main contract with the network provider. 4. The treatment provider will submit a Monthly Progress Report to the MSS on the 151" of every month following enrollment in the template provided in Exhibit J. 5. The treatment provider shall notify the MSS, within 24 hours of the event, via email or documented phone call, when a referred consumer presents with any crucial issues such as non- compliance with appointments, positive urinalysis, and/or lack of progress issues. 6. The treatment provider must notify the MSS and submit a Discharge Summary to the MSS upon completion of behavioral health treatment. 7. The Network Provider will coordinate with the MSS, and/or the DCF Protective Investigators (PI), and/or the CBC lead agency, Intensive Family Preservation Services ("IFPS"), Full Case Management Agencies ("FCMA") Providers to participate in staffing's as required. B. Substance Abuse Treatment Assessment 1. The treatment provider will complete and transfer the assessment tool to the MSS within twenty (20) calendar days of admission into outpatient substance abuse treatment. 2. The provider will complete and transfer the assessment tool to the MSS within five (5) calendar days of admission into residential substance abuse treatment. C. Mental Health Treatment Assessment 1. The treatment provider will complete a Bio-psychosocial assessment, upon completion of the intake process.This determines the type and frequency of services that the consumer needs. In addition, the treatment provider will submit the completed Bio- psychosocial assessment to the MSS within one (1) business day of its completion. Exhibit I Guidance/Care Center, Inc. Page 4 of 6 Contract No.ME225-10-27 136 °vjuth Fllanu°ida Beharkiiraall III teaallt➢n Nctnvor➢c,1nic. 07/51/11t 2. The treatment provider must link the consumer to recommended services based on the needs identified in the Bio-psychosocial assessment and notify the MSS, within one (1) business day,via email. a. The email will contain all information deemed necessary by the treatment provider including but not limited to type of service, initial service date,therapist name and contact information. b. The treatment provider will utilize the assistance of the MSS, who will engage SFBHN for residential placement assistance, if necessary. 3. The MSS will then upload the Bio-Psychosocial Assessment and add the treatment recommendations into FSFN. In instances when the treatment provider is unable to clinically meet the consumer's needs,the treatment provider will link the individual (within two (2) business days) to another behavioral health provider that is able to meet his/her treatment needs.The referring treatment provider will staff the case with the MSS and the Child Welfare Integration Coordinator at the ME and provide clinical justification for the transfer of case, prior to the transfer. The referring treatment provider will notify the MSS within one (1) business day of the transfer. All reports and documentation submitted to the MSS will be uploaded to Florida Safe Families Network ("FSFN") and will be used to inform decision making by the primary worker assigned to the child welfare case. D. 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 bythe MSS 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 in FSFN until the case has been closed. Should the consumer be court involved, drug screenings will be conducted at the intervals required by the courts. E. Documentation: Monthly treatment summaries will be submitted to the MSS by until such time as the case is closed with MSP.The MSP Monthly Treatment Summary Form found in Appendix 1 of this Exhibit. 1. The form must be submitted at the required intervals as specified above. 2. It must be completely filled out including: individual served demographic information, diagnostic information, progress in treatment, and urinalysis results (if applicable). 3. The form must be signed and dated by the treating clinician. Exhibit I Guidance/Care Center, Inc. Page 5 of 6 Contract No.ME225-10-27 137 °vjuth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,1nic. 07/51/11t Appendix 1 Motivational Support Program Monthly Progress Report Initial ❑ Monthly ❑ Network Provider(Agency Name): Date: Client Name: Social Security Number: DOB: ICD 10 Code DSM 5 Diagnosis Progress in Treatment (to include compliance with sessions, resistance): Frequency of UA Testing: Urinalysis Results: I, (Print Therapist Name), hereby attest that I will submit this completed form to the Motivational Support Program Specialist every 151"calendar day after the month of service. Therapist Signature and Title: Date: Exhibit I Guidance/Care Center, Inc. Page 6 of 6 Contract No.ME225-10-27 138 N w.i O C � H N N 2 LLI � Q O c O' O d U O ' d Z � J d t d � U 06 d P6. A E- X �+ O W LV O U co O Z w N U 0 A z dcm o o Ei O U w.i r d x y U °South Lllanu°ida Beh ar6ai�iraall 1111caallt➢n Nctnvor➢c,1nic. 07/01/20111 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 must: 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 must 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 must 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 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 must 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. The resident's declination must also be filed in the mental health residents case record maintained by the Network Provider. 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. Exhibit L Guidance/Care Center, Inc. Page 1 of 3 Contract No.ME225-10-27 140 °vjuth Lllanu°ida Beh ar6ai�iraall 1111caallt➢n Nctnvor➢c,1nic. 07/01/20111 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 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 must 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 must assist the mental health resident in carrying out the activities identified in the individual's community living support plan. 10) Each case manager must 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 must 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 must submit an ALF-LMHL Consumer Report the required format as shown in Table 1. below. The ALF-LMHL Consumer Report must 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.ME225-10-27 141 ........................................................................................................................................................................................................................................................................................................................................................... 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Q J U J _ LL J � Q N _ U U � U E � Z J LL J Q °aaj�uth Fllanu°ida 13ch arki�iraall III teaallth Ncovoir➢c,Inic. 7/1/2011) EXHIBIT N Indigent Psychiatric Medication Program, known as the Indigent Drug Program (IDP) The Network Provider shall follow the guidelines established by the Florida Department of Children and Families defined in Incorporated Document 13, Indigent Drug Program, dated July 1, 2019, or the latest revision thereof, and ensure that all funds allocated for use of purchasing psychotropic medications, or medications used to treat addictions, or medications accessed through line of credit from the Indigent Psychiatric Medication Program, known as the Indigent Drug Program (IDP) are used for eligible individuals. 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 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 agencies that participate in the IDP can use to order medications. 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 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 beta blockers, anticonvulsants, cognition enhancers, and opiate blockers. Exhibit N Page 1 of 9 Guidance/Care Center, Inc. Contract No. ME225-10-27 143 °aaj�uth Fllanu°ida Beharkiiraall III teaallth Ncovoir➢c,Inic. 7/1/2011) 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 individual. 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 Responsibilities 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 Managing Entity. 3.1.2. Each July, provide a list of approved IDP providers to the Department's Office of Substance Abuse and Mental Health (SAMH) and provide updates when there are changes. 3.1.3. Report bulk purchases into FASAMS. 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 Chapter 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 denied benefits for these medications, they may receive IDP medications until such time as coverage or eligibility is reestablished. Exhibit N Page 2 of 9 Guidance/Care Center, Inc. Contract No. ME225-10-27 144 °aaj�uth Fllanu°ida Beharkiiraall III teaallth Ncovoir➢c,tnic. 7/1/2011) 3.2.1.2. Provide information to individuals and staff working with IDP individuals regarding adverse effects, side effects, possible allergic reactions, 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 Managing Entity 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: 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.If 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; 3.2.1.9. Review updated video presentations for medication guidelines or read the adult medication guidelines available through the Florida Mental Health Institute (FMHI) of Exhibit N Page 3 of 9 Guidance/Care Center, Inc. Contract No. ME225-10-27 145 °aaj�uth Fllanu°ida 13ch arki�iraall III teaallth Ncovoir➢c,Inic. 7/1/2011) the University of South Florida's Medicaid Drug Therapy Management Program for Behavioral Health,found at http://flmedicaidbh.fmhi.usf.edu/. 3.2.1.10. Review and validate the IDP/FSH Warehouse monthly statements. 3.2.1.11. Address emergency situations, including but not limited to: 3.2.1.11.1. Order additional psychiatric medications from either the IDP/FSH Warehouse or a pharmacy of their choice (for urgent needs); and 3.2.1.11.2. Pay dispensing fees to IDP Dispensing Unit for individuals who cannot afford them. 3.2.1.12. Implement medication receiving, storage, and administrative procedures that meet the current State approved prescribing instructions pursuant to s. 465.035, F.S.; and 3.2.1.13. 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. 3.3.3. Provide monthly statements to the Managing Entity 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. Exhibit N Page 4 of 9 Guidance/Care Center, Inc. Contract No. ME225-10-27 146 °aaj�uth Fllanu°ida 13ch arki�iraall III teaallth Ncovoir➢c,Inic. 7/1/2011) 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 (SAMH) The Office of 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) 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 Page 5 of 9 Guidance/Care Center, Inc. Contract No. ME225-10-27 147 °^ou lh Florida Behaananirant Ifea lfli .fie oii,k,tuna°.. 7/1/2011f Appendix 1 SIGNATURE AUTHORIZATION FORM a Ron DeSantis State of Florida Department of Children and Families Governor Chad Poppell k ANV rvy,� Secretary MY LFAm1LJE5.00M 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 hate 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. "� mr>7samaw� ✓..,Pay=ro- 2012 F ACCREDITED GOVERNOR'S STERLING AWARD RECIPIENT Exhibit N Page 6 of 9 Guidance/Care Center, Inc. Contract No. ME225-10-27 148 °vjuth Fllou°ida Beh aNiloiraall III teaallt➢a Nct voir➢c,IIfic, 7/1/2011t Appendix 2 SUPPLY REQUISITION SUPPLY INVENTORY MANAGEMENT SYSTEM Supply Requisition Supply Use Only To Be Completed By Requester 11.Alction 2.11C 5 Expansion 6.Other Cost 3.Organizational Code 4.Sub Code Fe� Comde O t Accumulators 7.Grant 8.Grant 9.External Gen-eral Ledger 10 Agency Requistion Year Unique Number No 11.Stock Number 12 Quantity Unit Price Total Price 13.Unit of Issue 14.Description $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $000 ..1..0aI Remarks: 15.Requestor's Signature 16.Date 17.Signature of Approval 18.Date 19.Requestor's Telephone Number(SubCom,if available) Filled By Date Received By Date Exhibit N Page 7 of 9 Guidance/Care Center, Inc. Contract No. ME225-10-27 149 Soufllh Florida Bellhakimiral licalfli .Ce1aAoii,k,I ii ii c, 7/1/20 11) Appendix 3 ISSUE DOCUMENT TO CONFIRM EXAMPLE ISSUE DOCUMENT DELIVER 'TO FROM : DP - INDIGENT DRUG PROGRAM UNIT OF OBJECT PXSED BACK "Nvr TOTAL LOC COD�E STOCK NUMBER ISSUE CODE QUEST ISUORDER PRICE 6505-001-06945 N11 1 344002 30 3 0 0 36,9867 1 H)()60 (1IA1J)01[,I 1\fl,,Al0rIX5 NIX'400045-0254 6505-005-1399 BF 344002 1() G0 0 6.,'l 6,1 1nw+.Vla T,JIRTAZAIIINE; 15-kIGTAB(R1NIFIRON) ,40,11 11,NDC#00052-0105-30 6505-00 1-,9 9�-8, B 1 344002 a 3 1 W 5 7 63,85 472,92 PFRIN t13NAZIINI3°4-MG 'I'AB(I RU,AFON) 1100/f1ll N DC`r44)0 1 7,-kIf,8-60,Fi%k 1 6505-002-01 17-4 B 1 344002 1 11 0 1301,S178 PERPI IENAZINE. 16-M(i IA B(I R11 ,I&I,)NO V00/13 I I NIX 400�72-3670--60,11W 6505-005-IS 194 11 64402 I0 10 43,2302 413,,�,50 ZIIIR AS IDON I`:80-NR u,("A I'S I(A�01)(),N)60 111,R ho I 11,1,,'N DC.:00049-3990-60 6505-005-1 8 16-0 t3l 344002 6 6 0 36 9200 2 1 1 Z IIRASIDONI�':20-NUJ�CARS(GEODON)60 111 X 114)ITI-L N'D 00049-0)110 60 6565-004 -21,119­4 111 8 8 0 W 19,044 93,09 14 .)UUI IAPI NE FU klARA FL AR:G SEROQW11A )MH NIG I-ABS,601,W)Tf tA: 6505-005-2344.9 By 344002 4 4 0 805 q)_'100 3212,49 Ot TI IAIIONll'IA TNIARAI F XR,SF ROQI,[: ,X R 200 N461 TABS;60/131 6505-00 1-0 171-4 B F 34 100 2, 8 8 Q 2�0758 240 61 \/I-'Nl,AFAXIN'F,4 SP1 150-N,16 XR CAP(I"FFTV)k� I00)'Bll N141, 40008-08,16411 SH - CONFIRM SUPPLIES SHIPPED DURING PHYSICAL INVENTORY OR SYSTEM DOWN-TIM Exhibit IN Page 8 of 9 Guidance/Care Center, Inc. Contract No. ME225-10-27 150 Soufllh Florida Bellhakimiral licalfli e o 'k,I ii ii c, 7/l/20 11) Appendix 4 ISSUE DOCUMENT TO REVERSE EXAMPLE ISSUE DOCUMENT DELIVER TO FROM : DP - INDIGENT DRUG PROGRAM LODC CODE STOCK NUI ER UNIT OF OBJECT REQUEST ISSUED BACK UNIT TOTAL ISSUE CODE ORDER PRICE 6505-001-0694-5 %1'1 344001 30 '30 0 36,9867 11 G09,60 11 A,1,()N R I DA I,DECA NOA 1-1?: 100 Wil/%l I (I I A L DOL� I N4 IJA N1 IIX5 N[)C 400045-02 54 6505-005-1399..•Y 1311' 344002 1() 1 6-11 164 16 MIRI-AZAPINE: 15-W I� TAB(RENIFRON)WD'IL NDC'400052-0105-30 6505-001-3939-8 B 1' 3440102 3 3 01 15T6395 1729 11E.101 IENAZINE:4-NIC5 T,,kB(TRILAFON) 1100,/B'l 1,NX4001 72-3668-60,BW 1 6505-002-01 174 Bl 344002 1 1 0 150 5378 150 5 t PFRPHEN,IkZINE 1Cm-M61AB(TRILAI'ON) 100/1311 NDC,'W172-3670-60,13W 6505-005-1819-4 BT 344002 10 10 0 43,2502 4)150 1 /]PRASIDONE:80-NIG,CAB(GEODON)61)IIER B(l)'111F Nl)('�00049-3990-60 6505-005-1816-0 B 1 344002 6 0 36.9200 22 L52 ZIPRASIDONE: 20-MC'i,CAPS(GEODON)60,lll,,,,R BOTTLE NDC' 00049-3960-60 65015-005-2338-4 ICI" 144002 9 8 C9 1,038.6544 8309,24 QLjl-',I IANNE FLIMARATE XW(SER04,1UEL)300,N4(3 ]"ABS,60,1BOTTLF 6505-005-2344-9 BT 344002 4 4 0 805,6200 3212148 QUETWINE 1-111`'a1ARATE XR.'5ER0Q(lEll XR;200 VIG JAIM 60/B I. 65050)11-0 171-4 Wil 144002 8 9 IN 25.0758 200,61 VENL,,AFAXlNE-",I11"W E 50-MG XR(",0 0,11"FlAOR) I 00jBI 1,,NT)(1",t0)008-08l6- SH - CONFIRM SUPPLIES, SHIPPED DURING PHYSICAL 4 INVENTORY OR SYSTEM DOWN-TIME Guidance/Care Center, Inc. Exhibit N Contract No. ME225-10-27 Pagle 9 of 9 51 § ( 7 / _ § \ } ƒ 7 / k ` 0 § CL / cu C) \ cu m 2 LL } e 0 # » ƒ 0 § § _ 0 z ) 0 CL e a 2 I M k ° 2 # e / k 0 y m Q / e / cu LU � to 2 \ ° k z § 2 � \ \ Q e C } a § u / R 2 0 E \ E z u Of z « LU « e \ ° � ± _ § # 2 { « \ ® L - \ ƒ \ e > } = a o 2 k 2 E \ \ G § LU e c \ 2 3 E k a f \ 2 { \ � � k 3 j \ \ \ /a / °vjuth Fllanu°ida Beharkiiraall III teaallt➢n Nctnvor➢c,1nic. 7/01/2011t EXHIBIT Missing Children The Network Provider agrees that when services are provided to children who are adjudicated dependent, where the care of the child is assigned to the Department or Network Provider, that 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" will be adhered to. 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 that when services are provided to children in the community that are not adjudicated dependent, that it will 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. Pip-tR{f 4 Contract No.ME225-10-27 Page 9 of 9 153 °vjuth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,1nic. 7/01/2011t 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.ME225-10-27 154 °vjuth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,1nic. 7/01/2011t (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.ME225-10-27 155 °vjuth Fllanu°ida Beharkiiraall III teaallt➢n Nctnvor➢c,1nic. 7/01/2011t 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.ME225-10-27 156 Swudb �b ��m �ubm�lwcml�umbb� I o . 0�0� 20�� Exhibit Child Welfare Quarterly Clinical Report -Adult The Network Provider shall complete the clinical report below and shall file it in the medical record of the adult. The Network Provider is required to provide to the Department or the Community-Based Care workers, immediately upon request,with the most recent quarterly clinical report. BEHAVIORAL HEALTH PROVIDER INFORMATION Provider Name: Date of Report: Provider Type: Treatment Start Therapist Name: Title/Credentials: Phone Number: Email Address: ADULT INFORMATION Client Name: Date of Birth: Current Address: Age: Medicaid#: Social Security#: Gender at Birth: Malel Femal Gender Preference: Malel Femalel Neutrall Prefer not to Answer Currently Employed: Part or Full Time: TREATMENT SUMMARY ICD-10 Code: DSM-5 Diagnosis: 1. 2. 3. Service Type: #Missed Sessions I Date of Admission: Last Service Date: #Scheduled Sessions 2. 3. Summaryof Treatment Progress:Provide a description Of therapeutic treatment intetntions including treatment modality,child and family compliance with treatment interventions and sessions, progress toward therapeutic treatment goals, any critical incidents or barriers to treatment progress, and treatment recommendations. Reporting Period: Outline of Services Received Outside your Agency. Exhibit -Adult Page 1of2 Guidance/Care Center, Inc. Contract No.ME225'10-27 157 Swudb �b ��m �ubm�lwcml�umbb� I o . 0�0� 20�� Exhibit Child Welfare Quarterly Clinical Report -Adult The Network Provider shall complete the clinical report below and shall file it in the medical record of the adult. The Network Provider is required to provide to the Department or the Community-Based Care workers, immediately upon request,with the most recent quarterly clinical report. CURRENT MEDICATION* Prescribing Psychiatrist Name: Phone: Prescribing Medical Doctor Name: Phone: Medication Name: Dosage: Range: Date Prescribed: 2. 3. *Type ox Medications Denoted: Psychiatric Meu|mat|ons~RMeu|mx~M. TREATMENT TEAM MEMBERS (Gi0natures) My signature confirms that this treatment plan was jointly developed by the recipient and the treatment team. In addidon, the treatment plan is consistent with the identified needs, stren0ths, abi|ides, and preferences of the recipient. Therapist Signature Date Print Name Supervisor Signature Date Print Name Exhibit -Adult Page 2of2 oumanno/oamoonter. Inc. Contract No.ME225'10'27 158 Swudb �b ��m �ubm�lwcml�umbb� I o . 0�0� 20�� Exhibit Child Welfare Quarterly C|inicm| Report -ChUd The Network Provider shall complete the clinical report below and shall file it in the medical record of the adult.The Network Provider is required to provide to the Department or the Community-Based Care workers,immediately upon request,with the most recent quarterly clinical report. BEHAVIORAL HEALTH PROVIDER INFORMATION Provider Name: Date of Report: Provider Type: Treatment Start Therapist Name: Title/Credentials: Phone Number: Email Address: CHILD INFORMATION Client Name: Date of Birth: Current Address: Age: Medicaid#: Social Security#: Gender at Birth: Malel Female Gender Preference: Malel Femalel Neutrall Prefer not to Answer School Name: Grade: Yes/No TREATMENT SUMMARY ICD-10 Code: DSM-5 Diagnosis: 1. 2. 3. Service Type: #Missed Sessions I Date of Admission: Last Service Date: #Scheduled Sessions 2. 3. Summaryof Treatment Progress:Provide a description of therapeutic treatment interventions including treatment modality,child and family compliance with treatment interventions and sessions, progress toward therapeutic treatment goals, any critical incidents or barriers to treatment progress, and treatment recommendations. Reporting Period: Outline of Services Received Outside your Agency. Exhibit -Child Page 1of2 Guidance/Care Center, Inc. Contract No.ME225'10-27 159 Swudb �b ��m �ubm�lwcml�umbb� I o . 0�0� 20�� Exhibit Child Welfare Quarterly C|inicm| Report -ChUd The Network Provider shall complete the clinical report below and shall file it in the medical record of the adult.The Network Provider is required to provide to the Department or the Community-Based Care workers,immediately upon request,with the most recent quarterly clinical report. CURRENT MEDICATION* Prescribing Psychiatrist Name: Phone: Prescribing Medical Doctor Name: Phone: Medication Name: Dosage: Range: Date Prescribed: 2. 3. *Type ox Medications Denoted: Psychiatric Meu|mat|ons~RMeu|mx~M. TREATMENT TEAM MEMBERS (Gi0natures) My signature confirms that this treatment plan was jointly developed by the recipient and the treatment team. In addidon, the treatment plan is consistent with the identified needs, stren0ths, abi|ides, and preferences of the recipient. Therapist Signature Date Print Name Supervisor Signature Date Print Name Exhibit -Child Page 2of2 oumanno/oamoonter. Inc. Contract No.ME225'10'27 160 °vjuth Fllanu°ida Beharkiiraall III teaallt➢n Nctnvor➢c,1nic. 7.1.2011t 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 Forensic Specialists must 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 Network Provider must discuss any denial of services with the Forensic Team prior to responding to the referral source.The Forensic Team must discuss denials of services with the ME's designated 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 must coordinate the interview date for the client with the Forensic Specialist and if necessary involve the ME's designated Forensic Coordinator. The Network Provider must submit written findings and recommendations to the referral source within 48 hours of client interview. The Forensic Team must discuss any denial of services with the ME's designated 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 Forensic Specialist. The Forensic Team, when appropriate, should discuss Exhibit V Guidance/Care Center, Inc. Page 1 of 4 Contract No.ME225-10-27 161 °vjuth Fllanu°ida Beharkiiraall III teaallt➢n Nctnvor➢c,1nic. 7.1.2011t proposed violations with the ME's Forensic Coordinator, except in cases of physical aggression by the individual in question. (f) Programs must provide services in English, Spanish and Creole. (g) Diversion- The Network Provider will be responsible for the provision of services and the monitoring of individuals charged with felonies in the Miami-Dade and Monroe County Jails who are at risk of commitment to the Department of Children and Families, but who may be diverted to the community by the Forensic Team. i. The Network Provider will facilitate and coordinate the provision of mental health treatment, competency restoration training, residential care or housing with supervision, medical and auxiliary services if appropriate, case management and monitoring of individuals who are being diverted from commitment to the Department of Children and Families, pursuant to chapter 916, F. S. H. 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. H. 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. Exhibit V Guidance/Care Center, Inc. Page 2 of 4 Contract No.ME225-10-27 162 °vjuth Fllanu°ida Beharkiiraall III teaallt➢n Nctnvor➢c,1nic. 7.1.2011t (i) Conditional Release Monitoring —The Network Provider will ensure that individuals on conditional release order in Dade and Monroe Counties, including individuals transferred into the counties from other circuits are monitored. i. The Network Provider will ensure that individuals on conditional release order are monitored in accordance with the court order to ensure compliance with the order and department rules. 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 must facilitate the Forensic Specialists' requirement to manage the residential treatment beds funded by community forensic dollars in the Southern Region. (k) 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 in need of forensic mental health services placed by the Forensic Team/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 must may only be use for forensic individuals. The Network Provider agrees that the ME's decision for placement is final and binding on all parties. The Network Provider must submit weekly census reports by the dates and times specified in Exhibit C, Required Reports, and to the individuals identified. Exhibit V Guidance/Care Center, Inc. Page 3 of 4 Contract No.ME225-10-27 163 °vjuth Fllanu°ida 13ch ariIai�iraall III teaallt➢n Nctnvor➢c,1nic. 7.1.2011t 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 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 may only be be used for forensic individuals.The Network Provider agrees that the ME's decision for placement is final and binding on all parties. The Network Provider must 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 may only be used for forensic individuals. The Network Provider agrees that the ME's decision for placement is final and binding on all parties. The Network Provider must 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.ME225-10-27 164 °vjuth Fllanu°ida Beharkiiraall III teaallt➢n Nctnvor➢c,1nic. 7.1.2011t 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 must: a. Submit an annual application packet which includes a budget and an Intended Use Plan (IUP) for Managing Entity and Department review and approval no later than March I" The Department will provide a budget and IUP template. The IUP must cover needs and services for the following PATH Fiscal Year(8/1—7/31). Providers should include how the PATH services align with the priorities of the local Continuum of Care (CoC) plan, when appropriate. b. Establish a service plan for all PATH-enrolled individuals which is reviewed every three months and includes: i. Community mental health services; ii. Coordination and referrals for needed services such as shelter, daily living activities, personal and benefits planning, transportation, habilitation and rehabilitation services, prevocational and employment services, and permanent housing; and iii. Assistance obtaining income and income support services, Supplemental Nutrition Assistance Program (SNAP) benefits, and Supplemental Security Income/Social Security Disability Insurance (SSI/SSDI). c. Maintain individual medical records for each PATH participant containing an intake form, a determination of eligibility for PATH-funded services,a service plan,and progress notes. d. Enter quarterly summary information about PATH programs and services into the PATH Data Exchange (PDX) at hops://www.pathpdx.or / no later than the 10th of the month following the quarter of services. e. Submit an annual report no later than November 171" via the PDX at hops://www.pat h pdx.o r�/. f. Train designated staff on SOAR using the SOAR Online Course, available at: https://soarworks.prainc.com/course/ssissdi-outreach-access-and-recovery-soar-online- trainin . g. Enter SSI/SSDI application data into the SOAR Online Application Tracking(OAT)database at soartrack.prainc.com/, in accordance with Managing Entity Contract Guidance 9, and in Exhibit AN, SOAR of this Contract. Exhibit X Guidance/Care Center, Inc. Page 1 of 4 Contract No.ME225-10-27 165 °vjuth Fllanu°ida Beharkiiraall III teaallt➢n Nctnvor➢c,1nic. 7.1.2011t h. 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 participants. Match-funded expenditures must align with the services identified in the local IUP budget. L Employ policies and procedures that ensure priority use of other available funding sources for services (i.e., Medicaid). j. Include consideration of continuity of care needs specifically for people experiencing homelessness in disaster response plans. PATH providers shall assess, at least annually, and amend as appropriate, their disaster response plan to ensure it continues to meet the service needs of the target population. k. Participate and collect consumer data in the Homeless Management Information System (HMIS) and establish plans for new hire training and continued training. III. The Managing Entity will: a. Review instructions and participate in training(s) on data entry into the WebBGAS data system and annually check for any changes that may have been updated since prior years. b. Review and become familiar with the Funding Opportunity Announcement (FOA) requirements for the Grant Fiscal Year.The FOA is accessible through the Resource page in PDX. c. Check each PATH provider IUP and budget for accuracy, completeness, and adherence to the reporting requirements and submit to the State PATH Contact (SPC) no later than March 15th. d. Upload PATH application documents and enter the data for each provider into WebBGAS once approved by the SPC. e. Ensure budget costs charged to the grant are allowable as authorized under 45 CFR § 75.403, and that housing expenses do not exceed the maximum 20 percent allowable per section 522(h) (42 U.S. Code § 290cc-22). f. Review and approve the PATH provider's annual report in PDX prior to submitting for SPC for approval. Review and approval include verification of PATH funds received and matching funds used in support of PATH. g. Designate a lead staff responsible for managing, regularly reviewing and ensuring accurate data input by PATH provider's in PDX. h. Monitor the PATH provider's progress toward annual targets in IUPs and Behavioral Health Disparity Impact Statement (DIS) as reported in the quarterly and monthly PATH reports. L Develop and implement a quality improvement plan for the use of program data on access, use,and outcomes to support efforts to decrease the differences in access to, use, and outcomes of service activities. The plan shall align with the goals of the DIS and be submitted to the Department no later than January 31st. j. Assist PATH providers in collaborating with local resources to link people with safe, affordable housing. Exhibit X Guidance/Care Center, Inc. Page 2 of 4 Contract No.ME225-10-27 166 °vjuth Fllanu°ida Beharkiiraall III teaallt➢n Nctnvor➢c,1nic. 7.1.2011t k. Inform the SPC within three business days of any significant program changes or anticipated changes. If determined to be necessary by the SPC, a request detailing the planned revisions and justification must be submitted. Implementation of any significant changes are contingent upon Department approval. An example of a significant change includes, but is not limited, to the following: a corrective action issue, adding new or withdrawing of a PATH provider, or changes in funding allocation. I. Use Section 4 and Appendix F in the most current SPC Welcome Manual when conducting site visits.The manual will be provided by the Department. IV. Best Practice Considerations: PATH Enrollment In order to establish consistency across PATH programs it is recommended that the PATH Enrollment checklist below is used when enrolling PATH participants. V. PATH Enrollment Checklist Enrollment: PATH enrollment implies that there is the intent to provide services for an individual other than those provided in the outreach setting.The term enrolled means that there is a mutual intent for the services to begin. PATH enrollment is when: 1) The individual has been determined to be PATH eligible, 2) The individual and the PATH Provider have reached a point of engagement where there is a mutual agreement that services will be provided, and 3) The PATH Provider has started an individual file or record for the individual that includes, at a minimum: a. Basic demographic information needed for reporting, b. Documentation by the Provider of the determination of PATH eligibility, c. Documentation by the Provider of the mutual agreement for the provision of services, d. Documentation of services provided, and e. Service plan if the PATH enrollee is receiving case management services. has been determined eligible for PATH (Name of Person Served) enrollment based on meeting the following criteria: ❑ He/she has a mental health diagnosis of OR ❑ There is an informed presumption that the individual has a serious mental illness because: Exhibit X Guidance/Care Center, Inc. Page 3 of 4 Contract No.ME225-10-27 167 °vjuth Fllanu°ida Beharkiiraall III teaallt➢n Nctnvor➢c,1nic. 7.1.2011t ❑ He/she is experiencing or displaying symptoms of mental illness and is experiencing difficulty in functioning as a result of these symptoms that indicates severity, ❑ He/she has shared or has a known history of engagement with mental health services, ❑ He/she has symptoms and functioning that indicates there is a history of or expected tenure of significant mental health concerns AND ❑ He/she lacks any housing, OR ❑ His/her primary residence during the night is a supervised public or private facility that provides temporary living accommodations, OR ❑ He/she is a resident in temporary or transitional housing that caries time limits, OR ❑ He/she is in a doubled-up living arrangement where his/her name is not on the lease, OR ❑ He/she is living in a condemned building without a place to move, OR ❑ He/she is in arrears in rent/utility payments, OR ❑ He/she has received an eviction notice without a place to move, OR ❑ He/she is being discharged from a health care or criminal justice institution without a place to live, OR ❑ He/she is living in substandard conditions that could result in homelessness due to local code enforcement, police action, voluntary action by the person, or inducements by service providers to go to alternatives like short-term shelters whose residents are considered to be homeless. Vl. Monthly Reporting Requirements 1. By the 51"of each month following the month of services,the Network Provider will submit to the individuals identified in Exhibit C,Required Reports, a monthly report containing the information submitted into the Homeless Management Information System (HMIS), and any other report(s) requested by the ME staff. 2. By the 101" of each month following the month of services, the Network Provider will submit to the individuals identified in Exhibit C, Required Reports, the monthly PATH Enrollment Tracker, incorporated herein by reference, in the template provided by the ME to the ME's Housing Coordinator. The PATH Enrollment Tracker must be submitted in a secure, password protected, encrypted format. Exhibit X Guidance/Care Center, Inc. Page 4 of 4 Contract No.ME225-10-27 168 °vjuth Fllanu°ida Beharkiiraall III teaallt➢n Nctnvor➢c,1nic. 7.1.2 11) EXHIBIT Y Temporary Assistance for Needy Families(TANF) State Plan and TANF SAMH Incidental Expenditures for Housing Assistance I. Temporary Assistance to Needy Families(TANF) The network provider agrees to comply with the provisions of the Florida Department of Children and Families Temporary Assistance for Needy Families State Renewal Plan ("TANF State Plan") for the period between October 1, 2017 — September 30, 2020, or the latest revision thereof, incorporated herein by reference, for any TANF services provided under this contract. The TANF State Plan may be obtained by clicking on the following link: hops://www.myflfamilies.com/service-programs/access/does/TANF-Plan.pdf II. TANF SAMH Incidental Expenditures for Housing Assistance a) The TANF SAMH incidental cost center may be used for temporary housing assistance to remove barriers (i.e., lack of affordable housing, public housing waiting list, homelessness, etc.)to treatment that are identified as challenges in the client's recovery process. Accessing the incidental cost center for temporary housing assistance should be used as a resource necessary to stabilize and maintain TANF eligible family members receiving treatment services when the provider has exhausted and documented in client's case file, all other available resources. The uses of these funds are short-term and temporary in nature and should not exceed four (4) consecutive months of temporary housing assistance for each family per fiscal year. The expenditure of SAMH TANF incidental funds will be reflected in the incidental cost center on the monthly invoice. This information must be monitored by the Managing Entity to ensure that the funds expended do not exceed the four (4) month time period. The cost per day for housing assistance may not exceed $50.00 per day. b) Services to be Provided Services provided to families resulting from the use of the temporary housing assistance incidental expenditure will consist of direct and indirect client contact and will include but not be limited to: case management, aftercare, intervention, and prevention services. Additionally, documentation of the above services must clearly show improved outcomes towards economic self-sufficiency and permanent housing. All documentation must be clearly identified in the client's case record for monitoring purposes. c) Documentation of the incidental expenses should include: • Client Name • Number of Days (24 hours) per month in rental housing unit (Census Log) Exhibit Y Guidance/Care Center, Inc. Page 1 of 2 Contract No.ME225-10-27 169 �vjuth Flom��haN I(ji'all III I calth Ncovork, I nic. 7].20 11) * The goa|(s)for 3AMHTANF * Description of treatment services received each month * Rental Receipt * Approving authority signature with date Exhibit Guidance/Care Center, Inc. Page Z»fZ Contract No.ME225'10-27 170 °aaj�uth Fllanu°ida Beharkiiraall III teaallth Ncovoir➢c,Inic. 07/01/2011) 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 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 the lead Community Based Care ("CBC") agency, 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 6 Contract No. ME225-10-27 171 °aaj�uth Fllanu°ida Beharkiiraall III teaallth Ncovoir➢c,Inic. 07/01/2011) g. INTENSIVE FAMILY PRESERVATION SERVICES: Agencies under contract with the lead CBC 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. CITRUS FAMILY CARE NETWORK ("CFCN")-The Department of Children and Family Services Child Welfare Lead Community Based Care(CBC)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 —The first step needed to identify if there is a substance use or mental health disorder potentially impacting parenting protective capacity and the safety of the child. It is a process to determine the possibility that a behavioral health disorder may be present and to identify indicators when one suspects the presence of a disorder. 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 6 Contract No. ME225-10-27 172 °aaj�uth Fllanu°ida Beharkiiraall III teaallth Ncovoir➢c,Inic. 07/01/2011) 5. PROFESSIONAL QUALIFICATIONS a. This contract provides 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. 6. FUNCTIONS A brief description of the duties of the MSP Screening processes are below, however,the Network Provider is referred to the approved Motivational Support Program Protocols, incorporated by reference herein, for a detailed description of the screening and referral process. a. The MSS, upon receipt of referral, will secure an SFBHN Consent to Release Information from the consumer and will attach this consent as part of the referral packet to the behavioral health provider. If the consumer refuses to sign the Consent to Release Information to MSS, then FSFN will be updated to indicate such. b. If the case is found not to have any behavioral indicators, MSS will enter a SAMH note in FSFN indicating the result of the assessment and upload the ME approved screening tool. The progress should be rated as "adequate". c. The MSS will utilize a screening tool to determine the need for behavioral health services for all referrals. The MSS will determine if there has been a screening completed within the previous 90 days and ascertain if another screening 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. 7. DATA REPORTING REQUIREMENTS Data shall be submitted electronically to the ME by the 4th of each month following the month of service into KIS, SAMHIS, FASAMS or other data reporting system designated by the ME. MSS shall enter data using an MSS Staff ID as defined in FASAMS DCF Pamphlet 155-2 and by the dates specified in Exhibit C, Required Reports. The MSS shall also utilize FSFN to regularly update the consumers' progress within the timeframes specified in the Motivational Support Program Protocols, incorporated by reference herein. Exhibit AA Guidance/Care Center, Inc. Page 3 of 6 Contract No. ME225-10-27 173 °aaj�uth Fllanu°ida Beharkiiraall III teaallth Ncovoir➢c,Inic. 07/01/2011) 8. TRAINING a. 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. b. The MSS must participate in all ME required trainings including but not limited to all technical assistance, Child Welfare Champions Trainings, FSFN Training, etc. 9. 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. 10. INCIDENTAL FUND REQUEST FORM a. The incidental fund request must contain, at a minimum, the information below: i. Name of the MSS accessing funds; H. Funds spent on behalf of(client name); Exhibit AA Guidance/Care Center, Inc. Page 4 of 6 Contract No. ME225-10-27 174 °aaj�uth Fllanu°ida Beharkiiraall III teaallth Ncovoir➢c,Inic. 07/01/2011) 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. 11. REQUIRED REPORTS a. The MSP Tracker, incorporated herein by reference, is due monthly by the 101"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. b. The MSP Weekly Caseload Summary, found in Appendix 1 of this Exhibit, is to be submitted each Monday, by COB, following the week of service. It will be e-mailed to the Child Welfare Integration Coordinator at the ME.The Caseload Summary is to include the week ending date as the Monday of submission (a week is detailed as Tuesday to Monday). All data included in the Summary must be reflective of data up to the date and time of submission.The Caseload Summary must include the current pending screenings and currently enrolled consumers assigned to each MSS.The name of each MSS must be included in the caseload summary. Exhibit AA Guidance/Care Center, Inc. Page 5 of 6 Contract No. ME225-10-27 175 °vjuth Floilda BehaN I(ji'all III I calth Ncovork, I nic. 07/0 1/20 11) APPENDIX I MSP WEEKLY CASELOAD SUMMARY V, 1 1111 Ul MR�,791 moffIffis Exhibit AA Guidance/Care Center, Inc. Page 6 of 6 Contract No. ME225-10-27 176 °vjut➢n Fllanu°id a Behark�iraall Illteaallt➢n Nctnvor➢r,tnic. 07/01/2011t Exhibit AC DCF Template 21 Monthly Care Coordination Report-Narrative Region of Service: Circuits: Managing Entity: Report Period: MonthNear This report serves to track the progress of care coordination activities statewide. Please do not repeat information, if you answered a question in previous months and nothing has changed, mark"No Changes". If applicable, describe a success story: ❑ N/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 ❑ LOCUS ❑ Other: How many 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.): El 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 Describe SOAR activities: ❑ Are SOAR applications reported in OAT Exhibit AC Page 1 of 2 Guidance/Care Center, Inc. Contract No.ME225-10-27 177 For this reporting period, how many SOAR applications are: Pending Approved Not Eligible Reasons for ineligibility(i.e., immigration status) How many individuals who are homeless or at risk of homelessness were housed? List types of housing resources utilized (i.e., 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 2 Guidance/Care Center, Inc. Contract No.ME225-10-27 178 O O L6 C14 C14 LLI Z > s. IL LLI T: L; L-1 S. �E3 Z Z 2 2 rL m m rL rz °vj uth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,1nic. 7/1/2011t 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, 2019, or the latest revision thereof, which is incorporated by reference, and available at the following link: hops://www.myflfamilies.com/service-programs/samh/manain -entities/2019-contract-docs.shtml 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. Provide immediate access to substance abuse and co-occurring mental health treatment services for parents in the child welfare system with early engagement strategies,such as at case initiation or case transfer; 5. Identify fami ly-d riven pathways to recovery and promote sustained recovery through involvement in recovery-oriented services and supports; 6. Promote increased engagement and retention in treatment; 7. Facilitate program completion; and 8. 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; Exhibit Al Page 1 of 10 Guidance/Care Center, Inc. Contract No.ME225-10-27 180 °vjuth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,1nic. 7/1/2011t b. Develop a safe, nurturing and stable living situation for these children as rapidly and responsibly as possible; c. Provide information to inform the safety plan; ongoing Family Functioning Assessments, and any other relevant status updates; 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 publiclyfunded 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. Meet criteria fora 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; b. For children in out of home care, the family must have a child welfare case management plan with the permanency goal of reunification, or a concurrent case plan that includes reunification as a permanency goal; and c. 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. Exhibit Al Page 2 of 10 Guidance/Care Center, Inc. Contract No.ME225-10-27 181 °vjuth Fllanu°ida Beharkiiraall III teaallt➢n Nctnvor➢c,1nic. 7/1/2011t 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. a. Any Biopsychosocial Assessment of an eligible parent that is completed within 30 calendar days prior to receiving FIT services may be accepted by the FIT Team Provider. Otherwise, a new Biopsychosocial Assessment shall be completed. b. In instances where an eligible parent is readmitted to the same provider for services within 180 calendar days of discharge, a Biopsychosocial Assessment update shall be conducted, if clinically indicated. Information to be included in the update shall be determined by the qualified professional.A new Biopsychosocial Assessment shall be completed of an eligible parent who is readmitted for FIT services more than 180 calendar days after discharge. c. The Biopsychosocial Assessment shall be updated annually for eligible parents who are in continuous treatment for longer than one year. 4. Provide FIT services within two (2) business days of completing the initial ASAM and Biopsychosocial Assessment. Completion of the treatment plan with the family may be the first service. 5. Document and report the most current and appropriate substance use disorder and mental health disorder diagnosis codes, to the highest level of specificity that supports treatment, on the Monthly Progress Report. 6. Complete the Daily Living Activities (DLA-20) Alcohol-Drug Functional 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 sixty (60) calendar days of initial completion, and continue to be administered at 60-day intervals throughout the course of FIT services. A final DLA- 20 shall be administered at discharge 7. 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 aid in the assessment of parenting capacity and family functioning; and c. Any other assessments as designated by the Department. 8. Complete an initial Adverse Childhood Experience (ACE) Questionnaire 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 ACES score. This may be completed sooner if clinically appropriate. 9. Within thirty (30) calendar days of enrollment, ensure the FIT Team's treatment plan and case management plan guide the provision of services. The FIT Team's treatment plan and case management plan is to be developed with the participation of the family receiving services and reviewed or revised with the familyto address changes in circumstances impacting treatment.The Exhibit Al Page 3 of 10 Guidance/Care Center, Inc. Contract No.ME225-10-27 182 °vjuth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,1nic. 7/1/2011t case management plan is to be completed with the participation of the family receiving services, other professionals and natural supports chosen by the family and reviewed or revised with the family to address changes in circumstances impacting treatment. The FIT Team's treatment plan or case management plan shall: a. Identify how support services will be provided to the enrolled parent(s); b. Identify how support will be provided to parents to address the child's therapeutic, medical, and educational needs; c. Align with the child welfare case plan by enhancing caregiver protective capacity and/or support conditions for return. If the child welfare case plan has not been developed at the time of the development of the FITTeam's treatment plan or case management plan,they shall be revised upon completion of the child welfare case plan; d. Establish a goal to address the coordination of clinical services received by the child(ren), to align with the parents' clinical services, in the case management plan; and e. Have a mix of formal and community support interventions to address needs identified by the family. 10. 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 in the Florida Safe Families Network(FSFN). 11. The FIT Team Provider will provide updates to the child welfare case manager,to include ongoing assessments of caregiver protective capacities and conditions for return,when indicated.The FIT Team Provider, Managing Entities, and Community Based Care Lead Agency will establish a process to promote concurrent planning throughout the case until it has been determined that: 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. 12. 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, a process should be established to facilitate communication occurs 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; Exhibit Al Page 4 of 10 Guidance/Care Center, Inc. Contract No.ME225-10-27 183 °vjuth Fllanu°ida Beharkiiraall III teaallt➢n Nctnvor➢c,1nic. 7/1/2011t 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. 13. A process should be established to ensure communication occurs between the FIT Team Provider and the child welfare case manager regarding the status of the family at the time of discharge. A FIT services Discharge Summary will be completed no later than ten (10) business days after discharge from all FIT services.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 goal of the FIT Team's treatment plan and case management plan, including the goal of coordinating clinical services to the children. 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; 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. Exhibit Al Page 5 of 10 Guidance/Care Center, Inc. Contract No.ME225-10-27 184 °vjuth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,1nic. 7/1/2011t 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 family when appropriate; and c. Relapse prevention skill development and engagement in the recovery community. 11. Care coordination, as reflected in the FIT Team's case management plan, include 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 FIT Team's case management 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.All Incidental Expense services must be document 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 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 Exhibit Al Page 6 of 10 Guidance/Care Center, Inc. Contract No.ME225-10-27 185 °vjuth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,1nic. 7/1/2011t 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 and 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 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 - A Recovery Peer Specialist certified by the Florida Certification Board; or an individual who has direct personal experience living in recovery from substance abuse and mental health conditions for at least 2 years with a minimum of one year work experience as a peer. If not certified by Florida Certification Board, 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. Required Reports Exhibit Al Page 7 of 10 Guidance/Care Center, Inc. Contract No.ME225-10-27 186 °vjuth Fllanu°ida 13ch ariIai�iraall III teaallt➢n Nctnvor➢c,1nic. 7/1/2011t 1. Child Welfare Program Active Cases Weekly Report This report is to be submitted each Monday by Close of Business. It will be emailed to the Child Welfare Integration Coordinator at the ME.The Active Cases Weekly Report is to include the week ending date as the Monday of submission(a week is detailed as Tuesday to Monday).All data included in the Report must be reflective of data up to the date and time of submission. This report must include the current consumers pending intake and currently enrolled consumers assigned to each program. The Network Provider shall use the reporting template provided in Appendix 1 of this Exhibit Al. 2. Monthly Progress Report The Network Provider shall submit FIT data, using Template 17—FIT Reporting Template, by the 151"day of the month following service delivery. Note:Reporting Template 17 is accessible by clicking on the following link: htt�s://www.myflfamilies.com/service-programs/samh/manain -entities/2019-contract-docs.shtml Note: To access the template click on FY19-20 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 Network Provider is responsible for meeting the following performance measures and methodologies: 1. At discharge, 90% percent of parents served will be living in a stable housing environment: 2. 80% percent of parents served will improve their level of functioning, as measured by the Daily Living Activities (DLA-20) Functional Assessment. a. Measure of improvement is based on change in the average score of the DLA-20. Improvement is based on the change between results from the initial score to the last recorded score. Exhibit Al Page 8 of 10 Guidance/Care Center, Inc. Contract No.ME225-10-27 187 °vjuth Fllanu°ida Beharkiiraall III teaallt➢n Nctnvor➢c,1nic. 7/1/2011t b. The numerator is the sum of the number of parents who completed FIT services during the reporting period with an overall functioning score that is higher than the last recorded score. c. The denominator is the sum of the number of parents who completed the DLA-20 and had more than one score 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% percent of parents served will improve their level of functioning, as measured by the Adult Adolescent Parenting Inventory(AAPI-2)Assessment. a. Measure of improvement is based on the change between results in the AAPI-2 Form A (pretest)to Form B (posttest). b. The numerator is the sum of the number of parents discharged during the reporting period with an overall functioning score that is higher on Form B than Form A. c. The denominator is the sum of the total number of parents with assessment results for both Form A and Form B within the reporting period. 4. 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: 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 fifteen (15) days. c. The percentage of parents who receive assessments within fifteen(15)days of enrollment during the reporting period should be equal to or greater than 85%. 5. The FIT Team Provider will initiate therapeutic services for 90%of parents within two (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 therapeutic services within two (2) business days 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 therapeutic services within two (2) business days of completion of their initial assessments during the reporting period should be equal to or greater than 90%. Exhibit Al Page 9 of 10 Guidance/Care Center, Inc. Contract No.ME225-10-27 188 °vjuth Floilda BehaN kirall III I calth Ncovork, I nic. 7/1/20 11) APPENDIX I Child Welfare Programs Active Cases Weekly Report REPORTING PERIOD: Family Intensive Treatment Team (FITT) Exhibit Al Page 10 of 10 Guidance/Care Center, Inc. Contract No.ME225-10-27 189 Saaaairth 11olliiddl IDtehauN Doha l Ilea lthi Nlar4:woirh,Mc. 07/01/2019 EXHIBIT AJ Community Action Treatment(CAT)Team The Network Provider must 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 must 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 DCF Guidance Document 32, dated July 1, 2019 or the latest revision thereof.The DCF Guidance Document 32 can be found at the following link: hops://www.myflfamilies.com/service-programs/samh/manain -entities/2019-contract- docs.shtm I Note: Click on FY19-20 ME Templates and click on Guidance Document 32—Community Action Treatment(CAT) Team 2. Data Submission: The Network Provider must submit data, in accordance with the most recent version of the PAM 155-2, and in compliance with Section C-1.4 of the Managing Entity contract. The Network Provider must submit electronically to the ME by the 4th of each month following the month of service in the Managing Entity's designated data system. 3. The Network Provider must submit Appendix 1 - Persons Served and Performance Measure Report,Appendix 2-Quarterly Supplemental Data Report, and Appendix 3—Monthly CAT Team Invoice,to the individuals identified in Exhibit C, Required Reports, in accordance with the following schedule: o Appendix 1 — Monthly submission to the Managing Entity no later than the 81" of the month following services. o Appendix 2 — Quarterly submission to the Managing Entity 101" of the month following the end of each state Fiscal Year Quarter. o Appendix 3 — Monthly submission to the Managing Entity no later than the 81" of the month following services. 4. The Network Provider must participate in all CAT program conference calls, meetings or other oversight events scheduled by the Department and/or the Managing Entity; Exhibit AJ Page 1 of 17 Guidance/Care Center, Inc. Contract No.ME225-10-27 190 Saaaairth 11olliiddl IDtehauN Doha l Ilea lthi Nlar4:woirh,Mc. 07/01/2019 5. The Network Provider must submit a 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; 6. The Network Provider must service a minimum service target of thirty-five (35)children per month. o The Managing Entity may request Department approval for an alternative target for a specific Network Service Provider,taking into consideration a Network Service Provider's program-specific staffing capacity, historical funding utilization, estimated community needs, or unique geographic and demographic factors of the service location. 7. The Network Provider must be applied a financial consequence in the event that the Network Service Provider does not meet the monthly minimum service target. Financial consequences must be established at a $2,000 reduction of the monthly invoice amount for each individual served less than the monthly service target. 8. 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 subsidies, pharmaceuticals,and other incidentals that can demonstrate support of individual's treatment plan or other allowable uses. a. The Network Provider must 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. b. Request for Use of Incidental Expenses Funds: Incidental Expenditures must 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. 9. 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. 10. Eligible Other Cost Accumulator (OCA) and Covered Services: The OCA for the CAT Team Program is: MHCAT The Covered Services allowed forthe CATTeam 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. Exhibit AJ Page 2 of 17 Guidance/Care Center, Inc. Contract No.ME225-10-27 191 Saaaairth 11olliiddl IDtehauN Doha l Ilea lthi Nlar4:woirh,Mc. 07/01/2019 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. III. Eligibility The following participation criteria are established in proviso and must 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. 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,to include the following staff: Exhibit AJ Page 3 of 17 Guidance/Care Center, Inc. Contract No.ME225-10-27 192 South ➢Flaroui ddl Behm Doha l Ilea lthi Nlar4:woirh,Mc. 07/01/2019 1. A full-time Team Leader, 2. Mental Health Clinicians, 3. A Psychiatrist or Advanced Registered Nurse Practitioner(part-time), 4. A Registered or Licensed Practical Nurse (part-time), 5. A Case Manager, 6. Therapeutic Mentors, and 7. Support Staff The Network Provider must have these staff as part of the team; however, the number of staff and the functions they perform may vary by team in response to local needs and as approved by the Managing Entity.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, 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:lltipstars.org/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 Exhibit AJ Page 4 of 17 Guidance/Care Center, Inc. Contract No.ME225-10-27 193 Saaaairth ➢Flaroui ddl IDtehauN Doha l Ilea lthi Nlar4:woirh,Mc. 07/01/2019 4. Strengthening Family Support for Young People:Tip sheet for strengthening family support. http://www.pathways rtc.pdx.ed u 5. Positive Youth Development (PYD), Resilience and Recovery: Actively focuses on building strengthens and enhancing healthy development. http://www.pathways rtc.pdx.edu 6. Section 394.491, F.S. —Guiding principles for the child and adolescent mental health treatment and support system. http://www.le .state.fl.us/statutes/index.cfm?App mode=Display Statute&Search Stringy= U RL=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. https://www.youthmovenational.org/mission-and-vision 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. Network Service Providers 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, Network Service Providers should support the young person to enhance and develop relationships and supports within their family and community, guided by their preferences. VI. Coordination With Other Key Entities It is important for Network Service Providers 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). Network Service Providers 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 must 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. Network Service Providers must document efforts to identify and coordinate with the other key entities in the case notes. Exhibit AJ Page 5 of 17 Guidance/Care Center, Inc. Contract No.ME225-10-27 194 Saaaairth 11olliiddl IDtehauN Doha l Ilea lthi Nlar4:woirh,Mc. 07/01/2019 VII. Screening and Assessment Within 45 days of an individual's admission to services,the Network Service Provider must 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. Network Service Providers are 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, Network Service Providers are 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.org/assessment-tools/assessment-rati nos/ 2. The REACH Institute offers a listing of mental health screening tools, assessments and tool kits. GLAD-PC Toolkit and 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.interation.samhsa. ov/clinical-practice/screening-tools • SAMHSA Co-occurring Center for Excellence—Integrated Screening and Assessment http://media.samhsa.�ov/co-occurring/topics/screening-and- assessment/i ndex.aspx • 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 Exhibit AJ Page 6 of 17 Guidance/Care Center, Inc. Contract No.ME225-10-27 195 South ➢Fataroudddl Behm Doiramt Ilea lthi Nlar4:woirh,Ma:. 07/01/2019 independent living skills in eight areas that takes about 30 minutes to complete online and provides instant results. http://lifeskills.casey.orL 5. Youth Efficacy/Empowerment Scale and Youth Participation in Planning Scale-Portland Research and Training Center(Pathways RTC): http://www.pathwaysrtc.pdx.edu Vill. Treatment Planning Process The treatment planning process serves to identify short-term objectives to build long-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. Network Service Providers are 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/prof-3-amp 2. Family and Youth Participation in Clinical Decision Making. American Academy of Child and Adolescent Psychiatry. http://www.aacap.or /aacap/Policy Statements/2009/Family and Youth Participation in Cli nical Decision Makin .aspx IX. Plan of Care 1. Initial Plan of Care Within 30 days of an individual's admission to services,the Network Service Provider must complete an Initial Plan of Care to guide the provision of services by the CAT team. Services and supports by the See,,httg://www.aacap.oro/aacan/Policv State men ts/2009/Family and_Youth_Participation in_Clinical_Decision_Makinq.aspx Exhibit AJ Page 7 of 17 Guidance/Care Center, Inc. Contract No.ME225-10-27 196 Saaaairth 11olliiddl IDtehauN Doha l Ilea lthi Nlar4:woirh,Mc. 07/01/2019 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 Service 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 must: • 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 Service Provider must 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 Service Provider will implement the updated Initial Plan of Care as the Master Plan of Care. The Network Service Provide 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 must: • 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 Service Provider must 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 Service Provider must 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.oreon. ov/oha/amh/wraparound/does/wraparound-approach-soc.pdf Exhibit AJ Page 8 of 17 Guidance/Care Center, Inc. Contract No.ME225-10-27 197 South 11olliiddl Beh�auN Doiramt Ileamtdhi Nlar4:woirh:,inc. 07/01/2019 2. Achieve My Plan (AMP): Youth participation in planning — provides tools, tip sheets for professionals and youth https://www.pathwaysrtc.pdx.edu/p3c-achieve-my-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: htt ps://www.pat hways rtc.pdx.ed u 4. Community-based Approaches for Supporting Positive Development in Youth and Young Adults: RTC Pathways http://www.pathways rtc.pdx.edu 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. ' 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. Network Service Providers are 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. Network Service Providers are 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. Network Service Providers are 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. 2Chapter 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?Aon mode=Display_Statute&Search String=&URL=0300-0399/0394/Sections/0394.491.html 3Transition Youth with Serious Mental Illness:_http://www.apa.op/about/gr/issues/cyf/transition-youth.pdf Exhibit AJ Page 9 of 17 Guidance/Care Center, Inc. Contract No.ME225-10-27 198 South 11olliddlBehaN DoiralV lealtWNletwair4Mc. 07/0 1/2019 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 toadulthood. 2. HH3: Office of Adolescent Health: Research, resources and training for providers, fact sheets, grant opportunities: 4. RTC Pathways -Youth Peer Support XL 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 Service 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. Network Service Providers are 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 tothe adult mental health and other systems, as appropriate; and 6. Includes anaftercare 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 individua|'o discharge from services, the Provider must complete a Discharge Summary containing the following items, at 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. ExhibitAJ Page 1Oof17 Guidance/Care Center, Inc. Contract No.ME225'10-27 199 Saaaairth 11olliiddl IDtehauN Doha l Ilea lthi Nlar4:woirh,Mc. 07/01/2019 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 subsidies, pharmaceuticals, and other incidentals that can demonstrate support of individual's treatment plan or other allowable uses. Network Service Providers must follow state purchasing guidelines and any established process for review and approval; however, Network Service Providers are encouraged to be creative in using these funds within the limits of what is allowable and to consult the Managing Entity 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 must 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 Managing Entity must include the following performance measures in each subcontract for CAT services: 1. School Attendance Individuals receiving services must 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- Exhibit AJ Page 11 of 17 Guidance/Care Center, Inc. Contract No.ME225-10-27 200 Saaaairth ➢Flaroui ddl IDtehauN Doha l Ilea lthi Nlar4:woirh,Mc. 07/01/2019 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) Effective once the Network Service Provider discharges a minimum of 10 individuals each fiscal year, 80% of individuals receiving services must 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. Administrative Discharges When completing CFARS for Administrative Discharge and the client may not have been seen, the Provider should go by the last face to face contact with the individual to determine their scores. If the client was opened and never seen again for any services, the Provider would have to put in the original scores as their discharge scores. 4. Living in a Community Setting Individuals served will spend a minimum of 90%of days living in a community 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. Exhibit AJ Page 12 of 17 Guidance/Care Center, Inc. Contract No.ME225-10-27 201 Saaaairth 11olliiddl IDtehauN Doha l Ilea lthi Nlar4:woirh,Mc. 07/01/2019 • 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. 5. North Carolina Family Assessment Scale for General Services and Reunification (NCFAS-G+R) Effective once the Provider discharges a minimum of 10 individuals each fiscal year, 80% of individuals and families receiving services must 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. 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. Exhibit AJ Page 13 of 17 Guidance/Care Center, Inc. Contract No.ME225-10-27 202 Saaaairth 11olliiddl IDtehauN Doha l Ilea lthi Nlar4:woirh,Mc. 07/01/2019 APPENDIX 1 PERSONS SERVED AND PERFORMANCE MEASURE REPORT ... ... Provide... ... ... .... . CAT PROGRAM r Name ... .... Contract.. �. ... .... . .. Number ... ... Rep 9 . ... ... . .. Reporting Period From 4 To L Reporting Requirement Target This Period Q ua This rter to Year to Dat e Date DELIVERABLE Number of Persons Served Section D-2 Min _ per 1st Month= 10 month 2nd Month= 20 31d Month= 25 Thereafter=35 o d o d o d C C R C C R C C R MINIMUM PERFORMANCE MEASURES—Section XV d E d d e 2 e 2 e 2 d d � d d � d d z o a z o a z o a School Attendance 80% Improved Level o CFARS f .. .. ... Functioo ning, based upon 80% FARS Living in a Community Setting 900 Improved Family Functioning, based on Child 80% 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 N ... ... . Name and Title (please print) Signature Date Exhibit AJ Page 14 of 17 Guidance/Care Center, Inc. Contract No.ME225-10-27 203 Saaaairth 11olliiddl IDtehauN Doha l Ilea lthi Nlar4:woirh,Mc. 07/01/2019 APPENDIX 2 QUARTERLY SUPPLEMENTAL DATA REPORT Pro idery ,�,�,. � CAT PROGRAM Name Contract # �Reporting From ... .. To .. Period .... .� .. m, .. m, .. m, ..... . .,o �....,, �. ..... ... ........, ........, ................,. Individuals Diverted from Out of Home Placement At admission,number of participants at At admission, risk of out of home placement due to number of Total Total Discharge Options Child Residential Juvenile participants not This Welfare mental justice at risk of out of Quarter Year to Date involvement health treatment commitment home placement .. ��� Number of discharges removed from the home due to child welfare involvement ' ����� Number off discharges admitted to a residential mental health treatment center ber off' s ......... Num dicharges committed to juvenile justice placement .... Number of discharges living in the community Totals Use the space below to provide any discussion of details affecting the delivery of services and supplemental data. (Optional) Gainful Activity for Individuals Not Enrolled,in School or a Vocational Program Required Reporting Total 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. Number of these individuals that engaged in at least one gainful activity during the reporting period. L Use the space below to provide examples of the gainful activities these individuals engaged n reporting period. ag in during the p ortig ..,.. .... ..,.. .... ." 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 15 of 17 Guidance/Care Center, Inc. Contract No.ME225-10-27 204 Saaaairth ➢Flaroui ddl IDtehauN Doha l Ilea lthi Nlar4:woirh,Mc. 07/01/2019 Appendix 2 Guidance The following guidelines must 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. Exhibit AJ Page 16 of 17 Guidance/Care Center, Inc. Contract No.ME225-10-27 205 Saaaairth 11olliiddl IDtehauNDoiraml Ileamldti Nlar4:woirh,Mc. 07/01/2019 APPENDIX 3 CAT TEAM MONTHLY INVOICE PROVIDER NAME CONTRACT NO. FEDERAL ID# VENDOR ID (if different from Federal ID#) ADDRESS INVOICE NUMER INVOICE PERIOD INVOICE AMOUNT TOTAL AMOUNT OF PREVIOUS TOTAL CONTRACT AMOUNT CONTRACT BALANCE AFTER Service Unit Description One month of CAT services provided to a minimum of 35 eligible individuals in accordance with Contract Sections Appendix-1 and Appendix-2 Fixed Fee Amount Requested Supporting Documentation Appendix 1 for the month of: Submitted 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 ME. Additionally, I certify that all client demographic and service event data have been submitted to the ME in accordance with the terms and conditions of this contract. Authorized Signature Authorized Name and Title Date Submitted For ME Finance Department use only: Date Invoice Received: Date Goods/Services Received: Date Inspected and Approved: Description Financial Consequences Applied? Reduction Amount Yes No Approved Payment Amount Approved By: BE: EO: Payment Funding Codes: CAT: OCA: Exhibit AJ Page 17 of 17 Guidance/Care Center, Inc. Contract No.ME225-10-27 206 r- N O ic, O a N L6 O c w u N � W U C`� N N O O LL L.. .tiM L.. c N x N c ° 'E N `w > Y nr O E r € c". Yw, ° 3 ° 3 U otS z 0r '. 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Z V;';p R 06 O y y w w w w y y w N�if l q N lu lllllll�:, `w N c `w N i.. `w N LL Q y Q y Q y CIr Q y O ILILN ILILN ILILN F w ,PC)LII N F zz C CI'IIII'I 0 IILIIIIIII Z V�L"N N II"N N ILILN N N 2 �ilJlll y •R N '7Z ail' N •R N '7Z w II.II%N R II'.„�"I' CUTII'.,,,"I' R I.'........ R F ) Z. C'� ILI��I�N Q � Q � ICII�: .iN, 0 Ilk:: 0 ...,p 0 II.II.N, 0 rn � .N w •.� w u::N w F to in C��:II u ^'°Y: U v w d d d d Y Y w Q O 00 w 0 E E E E : ry 7 7 7 7 x Z Z Z Z cn "' a 7 Z 2 m LL y w otf otj otj otj otj = Q C C C C C m } E E E E E cn U Z w w w w w Q Q u Q u Q u Q u Q u r- > O N N N N N LL 2N2 N N N N 22cn cn `w 2 N ` N ` N ` N ` F m S•,`,1� co CO co :�:o�� CO F N LL ;:IN N LL N LL N LL ILILN N LL v) A II';';If: A 2 R R R III^p R R II..."I' 0 m 41 S•1� ILILN ""N ..N 7 C�IINII��ILN Of "CIIC: pf IC'�If: R II.II.N R '��. mu) > > > > > Q S•;y� Q IPC"N Q C:ICC; Q C.I: Q II�,II,�N Q w II,II;,N C:VIIII ILI N, ILI N, Li w C r III �,ll.p C J II"c) O O Ill,i"H O II1C) O IL) O a. IIN D y D y V1';N D y i�;��„ D y jj,�':�� 0 r 'R ",;�' y .R Ip... N 'R ILILN N 'R .... y •R 0 11�3 a a s a II.I N, III � LL O 11) u'Ir: w U w 0 0 0 0 0 0> °' op v v v v v O oN U R N R N R N R N R N Z a r a r a r a r a r C o a w U a = U U Z Z Z Z Z w ,� E 0 i�; li °aaj�uth Fllanu°ida 13ch arki�iraall III teaallth Ncovoir➢c,Inic. 7/1/2011) EXHIBIT AM Return on Investment—Special Project Return on Investment for FY 2019-20 I. Pursuant to the FY 2019-20 General Appropriations Act, the Network Provider has been awarded funding to provide the following services: Provider: Guidance/Care Center, Inc. A. Specific Appropriation Line Item#370—Family Intensive Treatment Amount: $633,188.00 Designated as follows: Miami-Dade County: $483,871.00 Monroe County:$149,317.00 B. Specific Appropriation Line Item#368-Supported Employment Amount: $75,000.00 Contract Manager: Elba Taveras i. From the funds in Specific Appropriation 370, 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. ii. From the funds in Specific Appropriation 368, the non-recurring sum is to provide for supported employment services for individuals with mental health disorders at Personal Growth Center. II. The Network Provider shall: 1. By July 10, 2019 provides an initial projected estimate of positive return on investment the state may receive by providing the funding, and, Exhibit AM Page 1 of 2 Guidance/Care Center, Inc. Contract No. ME225-10-27 209 °South Fllanu°ida Beharkiiraall III teaallt➢n Nctnvor➢c,1nic. 7/1/2011t 2. No later than 10 days after the completion of each fiscal quarter, provide a report documenting the actual return on investment the state has received as a result of this funded project. The Network Provider shall describe the methodology by which the return of investment was determined. A return on investment can vary and can include increased jobs and revenue to the state; reduced recidivism or involvement in the juvenile justice system; improved health care costs, quality, and access; or improvements to water quality. Actual returns by fiscal year should be included if state funding was previously received, as well as projected positive returns based on current fiscal year funding. The Network Provider shall submit the reports to the ME's Contract Manager by the dates specified in Exhibit C, Required Reports. Exhibit AM Page 2 of 2 Guidance/Care Center, Inc. Contract No.ME225-10-27 210 Smith Il lloiddo 111ollhavo or all II Iloolltlh Network,Il ic,, 7 01/2010 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 Case Manager(s) also referred to as SOAR Processor(s): The Network Provider must have specifically identified Case Manager(s)trained in and utilizing the SOAR Model who will process SOAR applications for the target population receiving services under this contract that have been screened and determined to be eligible for SOAR benefits. The required screening tool is the"Identifying SOAR Applicant"form developed by DCF and SFBHN dated October 2018, or the latest revision thereof. 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-training 2. Assign a staff member responsible for data submission quality control. 3. 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. 4. Eligibility Screening: Screening for SOAR eligibility must be conducted during the intake or admissions process. Upon determination that a consumer meets SOAR eligibility, the screener must refer the consumer to the designated SOAR Trained Processor utilizing the"Identifying SOAR Applicant"form. 5. 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. Exhibit AN Page 1 of 4 Guidance/Care Center, Inc. Contract No.ME225-10-27 211 Smith Il lloiddo 111ollhavo or all II Iloolltlh Network,Il ic,, 7 01/2010 6. Reconsiderations/Appeals: If applicable, the SOAR Processor must complete the reconsideration/appeal process for those applications which may be denied upon initial review 7. Data Requirement (OAT System): The SOAR Processor must register and start entering information into the OAT system once the protective filing date is determined. They should not wait for the application decision to be made before they enter data into the OAT system. The SOAR Processor(s) must input all of the data into the OAT System before the end of the month 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:hops://soartrack.prainc.com/loin.php 8. Training: New SOAR Processor(s) must 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. All SOAR Processors must attend a Live SOAR Online Course Review Session once to obtain status as Southern Region certified SOAR Processor, after completion of the SOAR Online Course. These sessions will be held on a quarterly basis and scheduled by the ME. SOAR processors need only attend once to obtain their certification. For those newly trained SOAR Processors through the SOAR Online Course,attendance to the Live SOAR Online Course Review Session should be completed within six (6) months. For those that have already completed the SOAR Online Course, attendance to the Live SOAR Online Course Review Session must be completed by the second quarter of the fiscal year(October—December) 9. The Network Provider is responsible for notifying the ME regarding the training status of their Case Manager/SOAR Processor. 10. The SOAR Processor(s) must attend scheduled or specially called meetings when notified by the ME. These include SOAR group technical assistance trainings and SOAR related trainings. 11. Individual Record Reviews: The Network Provider must conduct a sampling of file/record reviews on a quarterly basis to see if individuals paid for by SAMH dollars would be eligible for SOAR. a. The provider will complete five individual record reviews from various programs within their agency. b. The provider will also complete file/record reviews for five indigent individuals identified by the SFBHN Housing Coordinator as receiving transitional vouchers (TRV) during the quarter. Individuals placed in TRV funded shelter beds will be excluded from reviews as will recurring TRV requests. Only new TRV requests as of 7/1/18 will be eligible for review. Exhibit AN Page 2 of 4 Guidance/Care Center, Inc. Contract No.ME225-10-27 212 Smith Il lloiddo 111ollhavo or all II Iloolltlh Network,Il ic,, 7 01/2019 c. Within fifteen days after each quarter, the network provider is required to submit a report of the sampling results to SFBHN. The report requires the individual's identifying information (name, DOB, SS#), the date of SOAR eligibility screening, admission date, a copy of the completed screening tool (SFBHN version of Identifying SOAR Applicants, October 2018), documentation of the referral (if appropriate)to the SOAR Processor, and the completed/submitted SOAR application data entered into OAT. These instructions are on the Identifying SOAR Applicants, October 2018 document. 12. Performance Outcomes &Outputs:The Network Provider must meet the standards and required outcomes specified below: a. Maintain a minimum completion rate of 75%of applications completed and submitted within 60 days of the Protective Filing Date, defined as the time when an applicant first contacts the Social Security Administration indicating an intent to file for SSI/SSDI; b. At a minimum, the Network Provider must 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 Sections I and II shall be considered non-performance pursuant to Standard Contract, Paragraph 36. Financial Consequences for Network Provider's Failure to Perform. II. MANAGING ENTITY RESPONSIBILITES 1. The ME must 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: hops://www.myflfamilies.com/service-programs/samh/manain -entities/2019-contract- docs.shtm I Note: To access the form click on FY19-20 ME Templates and click on Guidance 9—Supplemental Security Income/Social Security Disability Insurance (SSI/SSDI) Outreach, Access, and Recovery (SOAR). 2. The ME must ensure that the Network Provider implements the SOAR process. 3. The ME must monitor the Network Provider's performance on all tasks identified in this Exhibit and issue corrective actions if deemed necessary. 4. The ME shall provide training and technical assistance when requested by the Network Provider. Exhibit AN Page 3 of 4 Guidance/Care Center, Inc. Contract No.ME225-10-27 213 Smith Il lloiddo 111ollhavo or all II Iloolltlh Network,Il ic,, 7 01/2010 5. The SFBHN SOAR Coordinator and the identified System of Care staff will collect and review the sampling of the SOAR screening tools and develop a tracker for success indicator analysis. 6. Reports generated by the SFBHN SOAR Coordinator on the success indicator will be reviewed at each quarterly SOAR Steering Committee meeting. Exhibit AN Page 4 of 4 Guidance/Care Center, Inc. Contract No.ME225-10-27 214 °vjuth Fllanu°id a Beharkiiraall III Ic allt➢n Nctnvor➢c,1nic. 7/1/2011t 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 life and ability to function in the community as meaningfully and independently as possible. It identifies goals and objectives and 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 Exhibit AP Page 1 of 6 Guidance/Care Center, Inc. Contract No.ME225-10-27 215 °vjuth Fllanu°id a Beharkiiraall III Ic allt➢n Nctnvor➢c,1nic. 7/1/2011t manager shall be responsible for the overall completion of the assessment, but shall work with the client and consult with relevant professionals where specific expertise is needed. 2. The case management assessment shall consider information from the following sources: a. Client's assessment of his or her personal situation; b. Input from the family, friends or significant others. Such input shall be sought with the consent of the client; 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; L 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. Exhibit AP Page 2 of 6 Guidance/Care Center, Inc. Contract No.ME225-10-27 216 °vjuth Fllanu°id a Beharkiiraall III Ic allt➢n Nctnvor➢c,1nic. 7/1/2011t 6. A home visit is to be made prior to the completion of the Assessment, unless the case manager's supervisor deems such a visit unsafe to the case manager or such a visit is denied by the client. In such instances where a home visit does not occur: a. The reasons for the failure to make such a visit will be documented in the case record and signed by the case manager and the case manager supervisor. b. Subsequent visitations and the suitability of the housing shall be considerations addressed in the service plan. 7. Subsequent written case management assessments shall be completed and an updated Service Plan developed at a minimum of every 6 months, or when the client changes residence, enters or is discharged from a state treatment facility or at other times when the client's situation changes significantly. (b) Service Planning 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 must be 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. Exhibit AP Page 3 of 6 Guidance/Care Center, Inc. Contract No.ME225-10-27 217 °vjuth Fllanu°id a Beharkiiraall III Ic allt➢n Nctnvor➢c,1nic. 7/1/2011t 6. The client shall be provided a copy of the Service Plan, and this shall be documented in the record. With the approval of the client, others involved in its development or implementation shall be provided with a copy of the service plan. (c) Linkage and Brokerage The case manager shall ensure that the Service Plan is implemented through a variety of linkage and brokerage activities designed to procure specified services,treatment and resources for the client. 1. Such activities include verbal or written referrals, telephone calls, meetings, assistance with making appointments and completing applications, assistance at interviews and hearings, transportation and supportive counseling. 2. The case manager shall convene a 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 resource 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. Exhibit AP Page 4 of 6 Guidance/Care Center, Inc. Contract No.ME225-10-27 218 °vjuth Fllanu°id a 13ch arki�iraall III Ic allt➢n Nctnvor➢c,1nic. 7/1/2011t (3) Case managers may utilize contingency funds provided by the department in accordance with circuit procedures. These shall be used to provide for unmet resource needs of clients when other resources are not available or in combination with other resources. (4) For clients residing in the community, the case manager shall make a home visit or field visit within the client's natural environment at a minimum of every other month, unless the case manager's supervisor deems such visits unsafe to the case manager or the client declines such visitation during the planning process. In such instances where home visits are not to occur: (a) The reason for the failure to make such a visit will be documented in the case record signed by the case manager and case manager supervisor, (b) Subsequent visitations and the suitability of the housing shall be considerations in the service plan. (5) When a client misses an appointment related to the service plan or is absent from a treatment program without notification, the case manager shall attempt to contact the client either by telephone or face-to-face meeting within twenty-four hours. If initial attempts to contact the client are unsuccessful, the case manager shall make additional efforts by telephone, face-to-face meetings, or correspondence. Upon contacting the client, the case manager shall explore the reasons for the absence or the missed appointment and shall work with the client to resolve any issues inhibiting the effective implementation of the plan. Such efforts and their results shall be documented in the case record. (6) Case Management Record. 1. An individualized case record for each client shall be maintained. 2. A clearly identifiable portion of the agency's record shall be devoted to case management. This portion shall contain the demographic information and items specified in subsection 65E-4.014(3)b., F.A.C. 3. The case record shall be maintained in accordance with Rule 65E-4.014, F.A.C. 4. In addition to items specified in Rule 65E-4.014, F.A.C., the record shall contain: (a) The name of the current assigned case manager. (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 Exhibit AP Page 5 of 6 Guidance/Care Center, Inc. Contract No.ME225-10-27 219 °South Fllanu°id a Beharkiiraall III Ic allt➢n Nctnvor➢c,1nic. 7/1/2011t 7. Documentation of missed appointments, follow-up, and an explanation of why the appointments were missed 8. Documentation for the need and lack of availability of any goods or services for which contingency funds are requested (f) Advocacy efforts as specified above. (7) Case load. The mental health case manager's caseload shall not exceed 40 consumers at any given time. (8) Case managers shall at 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.ME225-10-27 220 °vjuth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,1nic. 7/1/2011t 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 must function as a no-wrong-door model that responds to individual needs and integrates services among various providers. The Network Provider must 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 must 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, must 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.ME225-10-27 221 °vjuth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,1nic. 7/1/2011t 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 must 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 twenty-four hours seven days per week, 365 days per year. 3. Screening Tools: The Network Provider must utilize 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.ME225-10-27 222 °vjuth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,1nic. 7/1/2011t • 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. 100% of persons who walk into the CRF requesting screening (non-acute) services must 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.ME225-10-27 223 °vjuth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,1nic. 7/1/2011t 3. 100% of persons determined by the screening process to need outpatient services must 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 41"Street Ocean Marathon, FL 33050 (305)434-7660 F. FUNDING: The Network Provider's allocation to operate the CRF is found in Exhibit H, Funding Detail. G. METHOD OF PAYMENT: The CRF must 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 must 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, must 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 juvenilejustice 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. I. REPORTING REQUIRMENTS Exhibit AS Page 4 of 5 Guidance/Care Center, Inc. Contract No.ME225-10-27 224 °vjuth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,1nic. 7/1/2011t 1. Service Data: Service Data into KIS or any data system designated by the ME and must 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 301"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 must meet with the ME's staff at regularly scheduled or specially called meetings and/or trainings when notified by the ME. Exhibit AS Page 5 of 5 Guidance/Care Center, Inc. Contract No.ME225-10-27 225 °vjuth Fllanu°ida Beharkiiraall III teaallt➢n Nctnvor➢c,1nic. 7/1/2011t EXHIBIT AX SAMHSA Emergency Response Grant(SERG) 2017 Hurricane Irma I. OVERVIEW Guidance/Care Center ("Network Provider") will expand client-specific and non-client specific behavioral health services in Monroe County, Florida. to address ongoing unmet needs generated by the Hurricane Irma of 2017. II. SERVICE ARRAY AND SERVICE STRATEGY A. The Network Provider will provide short-term substance abuse and mental health treatment, and prevention treatments; coupled with expanded outreach, crisis counseling, information and referral,suicide preventions services, case management services and supportive housing/living;to address ongoing disaster trauma recovery needs of adults and children in the Florida Keys. B. Services will be provided at the frequency, level and intensity best associated with the individual or family's treatment needs, as determined by the Network Provider's existing clinical intake eligibility and assessment protocols.The list of covered services allowed for this program are listed in Exhibit G,Covered Service by OCA. C. To address the unmet non-client specific needs in Monroe County, the Network Provider will partner with primary health partners and the county health department to provide a suicide prevention public education and messaging campaign. III. TARGET POPULATION The general target populations will be any persons eligible for publicly-funded community behavioral health services pursuant to Chapter 394 or 397, F.S. Generally speaking, populations eligible for client- specific services include adults with a severe and persistent mental illness, including adults in crisis; children with or at-risk of an emotional disturbance; adults and children with a substance use disorder; children at-risk for initiating drug use; and adults or children with co-occurring mental illness and substance use disorders. Outreach, information and referral, public education, prevention and related non-client specific services may also be available to the communities-at-large or to targeted population subgroups. In Monroe County, eligibility for client-specific services will also include a discernible connection to Hurricane Irma impact on the individual or family receiving grant-funded services. Exhibit AX Page 1 of 2 Guidance/Care Center, Inc. Contract No.ME225-10-27 226 °vjuth Fllanu°ida Beharkiiraall III teaallt➢n Nctnvor➢c,1nic. 7/1/2011t IV. OUTCOMES AND PROGRESS MEASUREMENT—REQUIRED REPORTS A. Service Data: Service Data shall be submitted monthly by the 41" of every month following the month of service into the ME's designated data system and shall comply with the requirements of the Department of Children & Families, Pamphlet 155-2 - Mental Health and Substance Abuse Measurement and Data, version 13.0, or the latest revised edition thereof. Service data for this program shall be reported under OCA MHFLH. B. Outcome Measures: Client-specific covered services will be tracked against the Department's legislatively-approved array of Network Provider outcome measures, presented in Exhibit D, Substance Abuse &Mental Health Required Performance Outcomes&Outputs. C. Ad Hoc Reports:The Network Provider agrees to submit any ad-hoc and/or additional reports as determined necessary by the ME, and/or the Florida Department of Children and Families. V. MEETINGS: 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. VI. Term of Funding: October 1, 2018 through September 30, 2019 Exhibit AX Page 2 of 2 Guidance/Care Center, Inc. Contract No.ME225-10-27 227 �,'Io flh II I11olid a, Belha)iioir 111 11vallfilh Sxl[[v�orll 1111Lw. 7/0 11./ 011.1) Exhibit AY Mobile Response Team for Monroe County I. OVERVIEW Guidance/Care Center("Network Provider") is funded to operate a Mobile Response Team for Monroe in compliance with the Florida Department of Children and Families Substance Abuse & Mental Health Mobile Reponse Team Framwork("DCF MRT Framework"),dated 8/29/2018 or the latest revision thereof, incorporated herein by reference. II. GOALS The primary goals of the MRTs is to lessen trauma, divert from emergency departments or juvenile/criminal justice, and prevent unnecessary psychiatric hospitalizations. MRTs must be designed to be accessible in the community at any time. If inpatient services are needed, MRTs facilitate that connection. MRTs must be effective in connecting people with the community mental health system who had not accessed treatment and services before. III. TARGET POPULATION The target population of focus for the MRT per the DCF MRT Framework are children,youth, and young adults ages twenty-five (25) and under, however,the team must serve others experiencing a behavioral or mental health crisis. IV. SERVICE ARRAY MRTs provide on-demand crisis intervention services in any setting in which a behavioral health crisis is occurring, including homes, schools and emergency rooms. MRTs are multi-disciplinary teams of behavioral health professionals and paraprofessionals with specialized crisis intervention and operations training. Mobile response services are available 24/7 with the ability to respond within 60 minutes to new requests. MRT staff are expected to triage calls in order to determine the level of severity and prioritize calls that meet the clinical threshold required for an in-person response. MRTs must include access to a board-certified or board-eligible psychiatrist or psychiatric nurse practitioner. Best practice suggests these professionals play a vital role to stabilize the crisis until the individual is connected to a behavioral health services provider for ongoing services, if necessary. For example, these professionals can provide: Phone consultation to the team within 15 minutes or shortly after a request from an MRT, and Face-to-face or telehealth appointments with the individual within 48 hours of a request if the individual has no existing behavioral health services provider. Exhibit AY Page 1 of 3 Guidance/Care Center, Inc. Contract No.ME225-10-27 228 �,'Io flh II I11olid a, Belha)iioir 111 11vallfilh Sxl[[v�orll 1111Lw. 7/0 11./ 011.1) Services include evaluation and assessment,development of safety or crisis plans, providing or facilitating stabilization services, supportive crisis counseling, education, development of coping skills, linkage to appropriate resources and connecting those individuals who need more intensive mental health and substance abuse services.They facilitate "warm handoffs"to community services, and other supports. Once this occurs, it is expected that either the crisis has resolved naturally, the individual is connected to a community-based provider who will engage the individual in services,or the individual was assisted with admission to a designated receiving facility. MRTs will need to establish protocols for working with existing care coordination teams for individuals who are not already connected to behavioral health services, for those that are eligible. To meet community needs, MEs and their partners will develop the delivery system and process for MRT response. MRTs are designed to provide immediate intervention to attempt to stabilize the individual's condition safely in situations that do not require an immediate public safety response, prevent unnecessary hospitalizations, manage appropriate levels of risk and provide timely access to assessment and evaluation in a wide array of settings. Intervention is warranted when a crisis significantly interferes with the ability to function and is severe enough to place the individual at a risk of disruption of services or living environment. The clinical threshold for crisis may include aggressive behaviors; suicide attempts/ideation; drug and alcohol overdose or abuse; or disruptive symptoms related to thought, mood and anxiety disorders (e.g., panic, hopelessness, anger, depression), escalating behavior(s) and,without immediate intervention, the individual is likely to require a higher intensity of services. It may also present as an overt change in functioning or be prompted by traumatic life events. Mobile Response Teams must coordinate in- person services with law enforcement to provide additional safety,when appropriate and necessary. The MRT provider will need to be well connected to the local behavioral health system of care. This includes being familiar with the community resources, services, and supports available to the individuals they serve. When the crisis assessment indicates a need for additional services, MRTs need to be positioned to facilitate a warm handoff to the right service at the right time. This can range from case management to Community Action Treatment teams and anything in between. MRT providers will need to be connected to local multi-disciplinary/family service planning teams as they are able to assist in identifying supports and service planning for the family. Telehealth is an important asset for increasing the capacity of MRTs especially in rural areas, geographically large counties, or urban areas where congested traffic patterns make meeting the 60- minute response time a challenge. Telehealth can be used to provide direct services to individuals via video-teleconferencing systems, mobile phones, and remote monitoring. It can also be used to provide assessments and follow-up consultation as well as initial triage to determine if an in-person visit is needed to respond to the crisis call. At minimum, the Mobile Response Team must be available for administrative business Monday through Friday between 9:00 a.m. and 5:00 p.m., local time, and available 24 hours per day, 7 days per week for referral response. On-call services must be available nightly between 10PM and 7AM. A 24 hour per day, 7 days per week Crisis Hotline staffed by a trained and qualified specialist, must be available as the primary referral portal for Mobile Response Team services. Exhibit AY Page 2 of 3 Guidance/Care Center, Inc. Contract No.ME225-10-27 229 �,'Io flh II I11olid a, Belha)iioir 111 11vallfilh Sxl[[v�orll 1111Lw. 7/0 11./ 011.1) Mobile Response Team services may be provided up to a 72-hour period after the initial contact, during which the mobile response team providers deliver immediate and direct clinical intervention, either in person or telephonically. Mobile Response Team services may include ongoing coordination during the 72-hour period following the crisis assessment and stabilization intervention to facilitate "warm hand- offs"to community services, and other follow-up supports. V. SERVICE DATA Service Data: Service Data must be submitted monthly by the 41"of every month following the month of service into the ME's designated data system and must comply with the requirements of the Department of Children & Families, Pamphlet 155-2 - Mental Health and Substance Abuse Measurement and Data, version 13.0, or the latest revised edition thereof. VI. REPORTING REQUIREMENTS 1. Monthly MRT Tracker:The Network Provider must submit MRT Monthly Tracker using template provided by the ME by the 101" of every month for data from the previous month. The Network Provider will submit the monthly tracker to the individuals listed in Exhibit C, Required Reports. 2. Outreach Activities Log: -The Network Provider must submit a quarterly log of formal outreach activities (such as trainings, education and networking) to increase community awareness about MRT and behavioral health needs. This log will include at a minimum the date, time, duration, # of individuals trained and#of staff that participated.The Outreach Log must be submitted by the dates and to the individuals specified in Exhibit C, Required Reports. 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 and/or Monroe County. VII. MEETINGS/TRAININGS 1. The Network Provider will ensure that its staff is properly trained on MRT model, goals and objectives, evidence-based practices and screenings. 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 AY Page 3 of 3 Guidance/Care Center, Inc. Contract No.ME225-10-27 230 Saaaairth ➢Flaroui ddl Behm Doha l Ilea lthi Nlar4:woirh,Mc. 07/01/2019 EXHIBIT BB State Opioid Response Discretionary Grant Services Medication Assisted Treatment Services OCA: MSSOR A. OVERVIEW The Network Provider is contracted to provide Medication-assisted treatment (MAT) services for the treatment of opioid use disorder associated with the State Opioid Response (SOR) Grant awarded by the Substance Abuse and Mental Health Services Administration. B. CLIENT ELIGIBILITY Eligibility includes individuals who are indigent, uninsured, or underinsured and misuse opioids, have an opioid use disorder, or experience an opioid overdose. The following individuals should be given preference in admissions in the following order: 1. Pregnant women; 2. Injection drug users; 3. Caretakers involved with child welfare; 4. Caretakers of children ages 0-5; and 5. Individuals re-entering the community from incarceration. C. ALLOWABLE COVERED SERVICES The following covered services described in Ch.65E-14.021, F.A.C.,are allowable uses of these funds when provided to individuals in conjunction with methadone, buprenorphine, or oral naltrexone maintenance. These funds may also be used to support individuals receiving VIVITROL, except for Assessment, Medical Services and Medication-Assisted Treatment, as this will be paid through the Florida Alcohol and Drug Abuse Association. Aftercare Assessment Case Management Crisis Support/Emergency Day Care Day Treatment Incidental Expenses Outreach (to identify and Medication-Assisted (excluding direct payments link individuals with Treatment (only to participants) opioid use disorders to methadone, MAT providers) buprenorphine, or oral naltrexone maintenance) Medical Services Outpatient In-Home and On-Site Recovery Support Supported Employment Supportive Housing/Living Inpatient Detoxification Residential Levels I and II Outpatient Detoxification Inpatient and outpatient detoxification must be accompanied by injectable extended-release naltrexone (Vivitrol). Residential services may only be used to stabilize and treat eligible individuals during transition to medication-assisted treatment.When determining level of care, individuals must be assessed using the ASAM dimension spectrum criteria to determine appropriate care level followed by documentation justifying placement. Level of care should be reevaluated at least every 5 days for inpatient detoxification placements and every 14 days for residential treatment placements. Exhibit BB Page 1 of 3 Guidance/Care Center, Inc. Contract No.ME225-10-27 231 Saaaairth 11olliiddl IDtehauN Doha l Ilea lthi Nlar4:woirh,Mc. 07/01/2019 D. LICENSES For licensable services to be provided with the SOR funds, 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 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. E. SERVICE DATA REPORTING REQUIREMENTS Service data shall be submitted monthly into the ME's designated data system and shall comply with the requirements of the FASAMS DCF Pamphlet 155-2. F. PROGRAMMATIC DATA COLLECTION AND REPORTING REQUIREMENTS 1. The Network Provider will be required to collect data via face-to-face interviews at six data collection points (intake, 3 months post-intake, 6 months post-intake, discharge, 3-months post- discharge, and 6-months post-discharge) using the Government Performance and Results Modernization Act (GPRA) data collection tools, herein incorporated by reference. Follow up interviews MUST be completed within four(4)weeks of the follow-up date. EX: If a 6-month follow up is due on 5/15, the interview MUST take place between 4/17 and 6/12 Network Providers are expected to achieve a 3-month follow-up rate of 80% and a 6-month follow-up rate of 80%. The Department is currently working with a vendor to provide the tools online; however, there may be paper collection until the electronic record system is available. Training on the electronic record system will be provided by the Department. Note: If an individual is terminated from treatment (non-completion discharge from treatment episode) and the individual then returns to re-enroll in a new SOR funded treatment episode, a new GPRA timeline must be started. EX: An individual is terminated "Left on own against staff advice with satisfactory progress" at 4 months post intake with a GPRA at Intake and 3-month post intake follow- up having been completed. Individual re-enrolls 2 months later. A new GPRA at intake MUST be completed and continued on a new GPRA timeline. Separate data collection will be required for Emergency Department Bridge programs. This data will include: Hospital intake, Peer collection at discharge, peer collection at 30 days follow-up post discharge, peer collection at 60 days follow-up post discharge, and peer collection at 90 days follow-up post discharge. The Department is currently working with on a system to provide the tools online; however, there may be excel template collection until the electronic record system is available.Training on the electronic record system will be provided by the Department. Exhibit BB Page 2 of 3 Guidance/Care Center, Inc. Contract No.ME225-10-27 232 Saaaairth 11olliiddl IDtehauN Doha l Ilea lthi Nlar4:woirh,Mc. 07/01/2019 2. The Network Provider will maintain all required data on paper and upon availability of an electronic record system will enter all data collected to date and any new data collected as instructed by the ME. 3. The Network Provider shall provide additional reporting pertaining to the services and activities rendered should the Department or ME determine this to be necessary. G. RESTRICTIONS Funds may not be used by any Network Provider that denies any eligible individual access to their program because of their use of FDA-approved medications for the treatment of substance use disorders, namely methadone and buprenorphine. In all cases, MAT must be permitted to be continued for as long as the prescriber determines that the medication is clinically beneficial. Network Providers must assure that individuals will not be compelled to no longer use MAT as part of the conditions of any programming if stopping is inconsistent with a licensed prescriber's recommendation or valid prescription. In addition, State Opioid Response funds may not be used for the following purposes: 1. Make direct payments to individuals to enter treatment or continue to participate in prevention or treatment services. 2. To pay for construction or purchase of structures. 3. To pay the salary of an individual at a rate in excess of$189,600. 4. To supplant(or replace) current funding of existing services. H. MONTHLY SOR DATA COLLECTION REPORT The Network Provider shall submit a monthly SOR Data Collection report in the template provided by the ME. The template may be requested from the ME's Contract Manager. The report shall be submitted to the ME's Contract Manager by the 15r" of each month with the preceding months services information.The report must be submitted electronically encrypted and password protected. I. QUARTERLY AND ANNUAL EXPENDITURE REPORT The Network Provider shall submit a quarterly expenditure report by the dates and to the individuals identified in Exhibit C, Required Reports, in a template provided by the ME. Any funds paid to the Network Provider in excess of the amount to which the Network Provider is entitled under the terms and conditions of this Contract must be refunded to the ME. J. METHOD OF PAYMENT The ME has established a case rate for the use of the SOR funding, refer to Exhibit G,Covered Services Funding by OCA. The use of the SOR funds shall be driven by consumer need and support the achievements identified in the plan and treatment goals. The Network Provider is granted flexibility for the use of the funds within the OCA MSSOR for the covered services listed in Section C.,Allowable Covered Services, above. Exhibit BB Page 3 of 3 Guidance/Care Center, Inc. Contract No.ME225-10-27 233 & - \ \ § j u 2 70- \ ) � � \ / \ ( � _ 2 / 0 \ 2 a & c « C \ D k 0 / � � \ E k z Cu @ a Cu cr Cu M � \ m 3 f » « > / ƒ / Q 2 = �LLI N > \ w 3 % / 42, % � 2 ) k Cu 3CL � u � o § \ C3 Cu q / k \ \ 2 E a \ \ C a z _ > o = c \ f % / E ( E / CD \ 2 / / / \ c \ \ \ \ z u x » G 7 q \ ± / - _ « = o a \ : E @ ® e ° 7 g - - x § \ e \ E / C ( o \ ^ \ \ 2 Cu t » { x J g = } i $ { 5 5 A j \ e { C E _ Ca 5 z = c c - - 2 \ # ± c 2C g z : > 2 = c 2 \ e U \ - g e b a = c § _ [ _ / { { { { _ \ . : e u k / - c / 2 / 2 \ » » / c c • £ 3 G / \ > § > > 2 _ ° ± ± = 7 2 & t \ \ J / / 3 3 - \ / / \ - = 7 7 ƒ } } \ J \ South Florida ;'1:;0iA00 Behavioral Health INetwor ,Inc, T 1 2019 ATTACHMENT 11 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.ME225-10-27 235 South Florida ;'1:;0iA00 Behavioral Health INetwor ,Inc. T 1 2019 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.ME225-10-27 236 South(Florida ;'1:;0iA00 Behavioral Health INetwwor ,Inc. T01.2019 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: htIpj1harvester.census.Eov/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:faudEen_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 Attachment II Page 3 of 4 Guidance/Care Center, Inc. Contract No.ME225-10-27 237 South Florida ;'1:;0iA00 Behavioral Health IfWetwor ,Inc, 1".11L2019 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 II Page 4 of 4 Guidance/Care Center, Inc. Contract No.ME225-10-27 238 So utl I"toirfida %A0 Behavioral Health,Network,Inc. ATTACHMENT III CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS,GRANTS,LOANS AND COOPERATIVE AGREEMENTS The undersigned certifies,to the best of his or her knowledge and belief,that: (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or an employee of any agency, a member of congress, an officer or employee of congress, or an employee ofa member of congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with this federal contract,grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form- LLL,"Disclosure Form to Report Lobbying,"in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans and cooperative agreements)and that all sub-recipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure. ry P Signature Date Frank Rabbito ME225-10-27 Name of Authorized Individual Application or Contract Number The Guidance Care Center Name of Organization ................................."..........._._................. ......... ................................................................................_........ 3000 41 st Street Ocean. Marathon, FL 33050 Address of Or gani.ga—ni..zat..a'_t ion—...............-...._._... _ _..—..... m........------------ .. � m._.m .......... CF 1123, PDF 03/96 Attachment III Guidance/Care Center,Inc. Page I of 1 Contract No.ME225-10-27 239 South Florida Behavioral Health Network,Inc. Attachment IV SCOPE OF WORK NAME OF PROVIDER: Guidance/Care Center NAME OF PREVENTION PROGRAM: Power of Prevention AMOUNT OF CONTRACT AWARD: 199,063.00 "Regular" Prevention Services Prevention Partnership Grant TYPE OF FUNDING: (PPG) X COST ALLOCATED TO: (check both Children's Substance Abuse Adult Substance Abuse if approved for both covered services) X Section I. DESCRIPTION OF SERVICES AND STRATEGIES FOR SERVICE DELIVERY The Guidance/Care Center's Prevention program, POP for Power of Prevention, consists of (3) evidence-based practices: An Apple A Day© (K-4), Project SUCCESS Prevention Education Series (PES) (Middle School), and Teen Intervene (Middle School) of which address the specific long-term outcomes identified in the CCAP for Monroe County. This year GCC is working with the Monroe School District to implement the Project SUCCESS Prevention Education Series in the Middle Schools. This expansion was the result of holding focus groups with 9th graders who had completed the series. The most common recommendation coming from those students was to implement the curriculum in the middle schools. 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 Day© 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. Project SUCCESS PES uses education to teach students about the —challenges of adolescence, how different substances affect emotional and physical development, the Attachment IV Scope of Work Page 1 of 14 Guidance/Care Center, Inc. Contract No.ME225-10-27 240 risks associated with substance use and experimentation, how relationships with friends and family can impact substance use as well as how substance use can impact relationships, and stress management, relaxation and refusal skills. 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 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 —An Apple A Day and Project SUCCESS provide 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—All (3) programs identify youth who need further services and referrals to those services. INFORMATION DISSEMINATION - through the Prevention programs offered, Health Fairs, Coalition Collaboration and the various agencies, youth in the community and community members will become more aware of the risks of underage drinking and drug use. f An Apple A Day© (AAAD) Selective Education 500 Elementary An Apple A Day© (AAAD) Indicated Problem ID & Referral 40 un duplicated An Apple A Da AAAD Selective Alternatives 25 Project SUCCESS PES Selective Education 100 Project SUCCESS PES Indicated Problem ID & Referral 20 unduplicated Project SUCCESS PES Selective Alternatives 25 Teen Intervene Indicated Education 20 Teen Intervene Indicated Problem ID & Referral 4 unduplicated Health Fairs Universal Direct Information 300 Dissemination Capacity Building Universal Direct Information 150 Dissemination (50) To Be Parents of AAAD Coalition Collaboration Universal Indirect Information 200 Dissemination Attachment IV Scope of Work Page 2 of 14 Guidance/Care Center, Inc. Contract No.ME225-10-27 241 Section II. TARGET POPULATION — RISK AND PROTECTIVE FACTORS 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 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, 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. 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 vs/ 10 1 a max//, � I / 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 25 sites Selective --- Problem ID & Referral - An Apple A Day© — Elementary 40 School participants who need further services. Identify & refer to services Selective --- Project SUCCESS PES — Middle School based participants 100 Selective --- Alternatives --- Project SUCCESS PES —Community sites 25 Attachment IV Scope of Work Page 3 of 14 Guidance/Care Center, Inc. Contract No.ME225-10-27 242 Selective --- Problem ID & Referral — Project SUCCESS PES — Middle 10 School participants who need further services. Identify & refer to services 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 300 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- 200 All Ages TARGET POPULATION — RISK AND PROTECTIVE FACTORS An Apple A Day© Perceptions of Harm, Favorable Attitudes, Social 1 & 2 Skills, Literacy Skills, Clear Boundaries and Rules, Family Bonds, Resiliency Project SUCCESS PES 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* ISO 0/00m.I M W1 =�l Key Largo Middle School 104801 Overseas Hwy Key Largo 33037 X Plantation Key Middle School 100 Lake Rd Tavernier 33070 X Ocean Studies Charter 92295 Overseas Hwy Tavernier 33070 X Treasure Village Montessori 86731 Overseas Hwy Islamorada 33036 X Stanley Switlik Middle School 3400 Overseas Hwy Marathon 33050 X Sugarloaf School 255 Crane Blvd Sugarloaf 33042 X Gerald Adams Elementary 5855 W College Rd Key West 33040 X Poinciana Elementary 1407 Kennedy Dr. Key West 33040 X Si sbee Charter School 939 Felton Rd Key West 33040 X Horace O'Bryant School 1105 Leon Street Key West 33040 X May Sands Montessori School 1400 United Street Key West 33040 X Attachment IV Scope of Work Page 4 of 14 Guidance/Care Center, Inc. Contract No.ME225-10-27 243 Marathon Middle School 350 Sombrero Rd Key West 33040 X Community Partner Sites Monroe County 33040 X 33050 33037 TOTAL NUMBER TO BE SERVED 1,374 *Changes in sites/locations of services must adhere to contractual requirement procedures. Section IV. MAJOR REFERRAL SOURCES W,ell /, i Monroe County Schools —Teachers, Principals and School Counselors Department of Juvenile Justice Self-Referral Social Service Agencies Community Centers Section V. PERFORMANCE MEASURES Quantit Performance Measures VON f 1 100% of 500 will An Apple A Day© 500 0 0 (8-10) AAAD receive services, Selective Sessions for 85% will complete each 500 AAAD and 85% of participants completers or 425 30 to 60 will improve from Minutes each pre to post 100% of 100 will Project SUCCESS PES 100 0 0 (6-8) PES receive services, Selective Sessions for 85% will complete each 100 ALC and 85% of participants completers or 85 60 Minutes will improve from each pre to post Teen Intervene — 100% of 20 will Teen Intervene 20 0 0 (3) Sessions receive services, Indicated for each 20 85% will complete participants the program and Attachment IV Scope of Work Page 5 of 14 Guidance/Care Center, Inc. Contract No.ME225-10-27 244 60 Minutes 85% of completers each or 17 participants will improve from pre to post test in the minimum of 3 sessions (3 sessions are one cohort 100% of 300 participants will Health Fairs 25 275 0 4 Events receive information Universal at the Health Fairs, Direct 85% or 255 participants be 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) Average number of sessions attended (Participant Retention) Number of participants improved An Apple A Day© Participant attendance log . Each session 85% of 500 (425) will improve based on the pre/post Pre-and Post-surveys from each . At beginning and end of each outcomes as measured by participant cohort the approved SFBHN tool. Average of(6) sessions Participant Satisfaction Survey from e At end of each cohort required attendance for 8 each participant week course and (8) sessions for 10 week course. Average number of sessions attended (Participant Retention) Number of participants improved Project SUCCESS PES Participant attendance log . Each session 85% of 100 (85) will improve based on the pre/post Pre-and Post-surveys from each . At beginning and end of each outcomes as measured by participant cohort the approved SFBHN tool. Attachment IV Scope of Work Page 6 of 14 Guidance/Care Center, Inc. Contract No.ME225-10-27 245 Average of(4) sessions for 6 Participant Satisfaction Survey from At end of each cohort week course & (6) for 8 week each participant course. Average number of sessions attended (Participant Retention) Number of participants improved Teen Intervene— 100% of 20 will receive services and 85% Participant attendance log Each session or 17 will complete the program. 85% of completers Pre and Post surveys from each At beginning and end of each will improve from pre to post participant cohort test in the minimum of 3 sessions (3 sessions are one Alcohol Timeline Follow-back (TLFB) . At end of each cohort cohort) completed at baseline and exit from treatment Participant Satisfaction Surveys . At end of each cohort # and % of participants 85% of participants who completed satisfied with services program(s) will complete the provided satisfaction survey and 85% will be . At the end of each cohort satisfied based on the Satisfaction Survey Observation of service Curriculum fidelity checklist (3) Three times per year in delivery/ Fidelity checklist Supervisor/Observer report coordination with the Evaluation Team —with identified needs and changes to be reported to SFBHN in the Quarterly Report Documentation of structured Supervisory Tool/Checklist and During regular supervisory supervision Notes sessions for each staff and not less than one time per month. (Per the Rule, "Supervisor Instructions" # and % of staff with 100% of staff with necessary Attendance at prevention training necessary training training/certification every quarter. Every prevention / certification (as required by staff member must participate in at all entities and EBP) a minimum, 8 hours of training per quarter. # and % of staff working 100% of staff working towards By October 2019 or one month toward achieving certification achieving certification by attending after hire of one new staff, all staff in the State of Florida in SFBHN and other training consistent not certified, will be working Prevention Certification with FCB's criteria towards State of Florida FCB Prevention Certification Attachment IV Scope of Work Page 7 of 14 Guidance/Care Center, Inc. Contract No.ME225-10-27 246 VI. TASK LIST An Apple A Day© 500 35% (175) 75% (375) 85% of participants served will have a matched pre-post test Project 100 35% (35) 75% (75) 85% of participants served with SUCCESS PES 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 300 0% (0) 50% (150) 100% of individuals receive materials and/or information Capacity Building 150 35% (53) 75% (112) 100% of individuals receive materials and/or information Problem 64 35% 75% 100% of individuals will receive Identification and screening, information, services, Referral and referral/linkage to services Activity Title: An Apple A Day© Prevention Education Series 500 (K-4th 30 to 60 85% Activity Description: (K-4) students will participate in either grade) minute the 8 or 10 week Prevention Education Curriculum based on Students sessions. 8 class time restrictions. to 10 times Frequency: one session per week. Intensity. 8 to 10 sessions based on class time restrictions. Duration: 30 to 60 minutes based on class time restrictions. Activity Title: Project SUCCESS PES Prevention Education Series 100 (6th or 45 to 50 85% Activity Description: 6th or 7th graders will participate in a 7th) grade) minute (4) topic Prevention Education Curriculum. Students sessions. 6 Frequency: one session per week. to 8 times. Intensity. 6 to 8 sessions, based on class time restrictions. Duration: 45 to 50 minutes. Attachment IV Scope of Work Page 8 of 14 Guidance/Care Center, Inc. Contract No.ME225-10-27 247 Activity Title: Teen Intervene Activity Description: Students will participate in (3) one- 20 Middle 45 to 50 85% on-one sessions. School minute Frequency: one session per week Students sessions. 3 Intensity: (3) sessions times. Duration: 45 to 50 minutes. Activity Title: Pre/Post Testing Activity Description:All Participants will be pre and post 500 AAAD 30 to 50 85% tested for the knowledge, beliefs, attitudes and use of minute participant substances using age-appropriate assessment instruments. 100 Project sessions pre/post tests Frequency:Twice SUCCESS matched and Intensity: Once before first session and once at completion meet of last session. 20 Teen outcomes Duration: 30— 50 minutes. Intervene Activity Title: Satisfaction Survey Activity Description:All Participants will complete 500 AAAD 30 to 50 85% satisfaction surveys using age-appropriate assessment minute participant instrument. 100 Project sessions satisfaction Frequency:At completion of last session. SUCCESS Intensity: One session. Duration: 30— 50 minutes. 20 Teen Intervene Section VII. EVIDENCE BASED PROGRAMS (EBP) i An Apple A Da AAAD SAMSHA approved, NREPP Project SUCCESS Prevention Education Series (PES) SAMSHA approved, NREPP TEEN INTERVENE SAMSHA approved, NREPP Section VIII. EVALUATION OUTCOME MEASURES Attachment IV Scope of Work Page 9 of 14 Guidance/Care Center, Inc. Contract No.ME225-10-27 248 Evaluation of the effectiveness of all Prevention services described shall take place with BSRI. GCC/POP will do the following: Address the underage drinking goal from the Monroe County CCAP and common outcomes related to substance and other alcohol use and will measure them using the Monroe County FYSAS, and Alcohol Time Line Follow Back. POP will use results from previous years' FYSAS as the baseline and utilize more results by 2017 during course of this project to define meaningful improvement and gauge POP participant outcomes as they relate to the overall goals of the CCAP. Adhere to the Fidelity requirements of each program. Any problem areas in the classrooms or in the groups, will be discussed and addressed at weekly Supervision meetings. The effectiveness of all programs will be evaluated through the pre and post surveys and client satisfaction surveys. Random observations will be done by Prevention Coordinator and Research Assistant. All activities for Prevention will be consistent with the agency's Quality Assurance/Quality Improvement Plan. Activity Logs will be maintained for all Prevention activities and client charts will be maintained for Indicated Prevention Activities. Coordinate with the Evaluation Team regularly, attend meetings, and submit the required documentation. An Apple A Day© 500 85% of program 85% of program 2 visits by May completers completers 31 improve' demonstrate satisfaction with program services Project SUCCESS 100 85% of program 85% of program 2 visits by May PES completers completers 31 improve demonstrate satisfaction with program services TEEN INTERVENE 20 85% of program 85% of program N/A completers will completers improve demonstrate satisfaction with program services HEALTH FAIRS 300 100% of N/A N/A individuals receive materials and/or information Attachment IV Scope of Work Page 10 of 14 Guidance/Care Center, Inc. Contract No.ME225-10-27 249 Capacity Building 150 100% of NA NA individuals receive materials and/or information Problem Identification 64 100% of Linkages and NA and Referral individuals services for the receive individuals and families t Improvement will be measured by BSRI outcomes reporting Section IX. CAPACITY BUILDING lira//% N 2le MINMOVES / W, 74!ffll, GCC currently receives support from the PPG Grant for school based youth development programs. They are in all (3) high schools full-time using the EBP Project SUCCESS. 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 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. GCC also knows that The Florida Keys Children's Shelter has programs in the sites we are in; they provide the EBP All Stars. GCC will begin scheduling meetings to build capacity and cross-learn more about their programs to best develop a coordination plan documented in PBPS. 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 is our area of focus for all sites. Will attend MCC meetings and coordinate activities that serve Monroe County parents, school personnel and community stakeholders. Will help coordinate and participate in MCC community events such as "No One's House Parent Information", "Know The Law" campaigns and disseminate their "Be Above Bullying" campaign in our An Apple A Day program. 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. Attachment IV Scope of Work Page 11 of 14 Guidance/Care Center, Inc. Contract No.ME225-10-27 250 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 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. Attachment IV Scope of Work Page 12 of 14 Guidance/Care Center, Inc. Contract No.ME225-10-27 251 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 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 Attachment IV Scope of Work Page 13 of 14 Guidance/Care Center, Inc. Contract No.ME225-10-27 252 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 14 of 14 Guidance/Care Center, Inc. Contract No.ME225-10-27 253 So th Florida Etehaviorall Health(Network,Inc. Attachment V SCOPE OF WORK NAME OF PROVIDER: Guidance/Care Center NAME OF PREVENTION PROGRAM: Project SUCCESS AMOUNT OF CONTRACT AWARD: $39,887.00 TYPE OF FUNDING: State Opioid Response Prevention 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 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 11 to 13 who have experimented with alcohol, are showing early danger signs and multiple risk factors for substance abuse and who attend Horace O'Bryant Middle School. 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. Prevention Warriors is a group of middle school students who have volunteered to promote Prevention Services and Activities school wide. They work under the supervision and direction of the Project SUCCESS counselor. 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. Attachment V Scope of Work Page 1 of 12 Guidance/Care Center, Inc. Contract No. ME225-10-27 254 School wide activities Universal Information and 600 Dissemination 7th grade PES Selective Education 200 Student Assistance Selective Problem ID and referral 200 One on One Indicated Education 20 Prevention Warriors Selective Alternatives 45 Section II. TARGET POPULATION — RISK AND PROTECTIVE FACTORS 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 Horace O'Bryant Middle School in Key West. School wide activities are universal in nature while PES, Student Assistance 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, Teen Intervene will be available in middle schools, Project SUCCESS will be provided at HOB Middle School, and The Project SUCCESS PES will be offered to schools for the 6th or 7th grade. 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 Attachment V Scope of Work Page 2 of 12 Guidance/Care Center, Inc. Contract No. ME225-10-27 255 Community Norms Self-regulation Protective factors: Prosocial opportunities/activities Positive peer influence Skill/competency Healthy behaviors Increased knowledge/awareness Self-Esteem Positive family communications Community values F/m/m/m/ wo 00" M/W� 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, 600 mental health and substance use awareness for example). 7th grade Prevention Education Series is a Selective prevention strategy which 200 consists of 4 topics taught in 4 to 8 sessions to all 7th graders enrolled in the school Student Assistance is a Selective prevention strategy in which students who are 200 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 20 3 individual prevention sessions as need. Prevention Warriors consists of middle school students working under the direction of the HOB Middle School Prevention Counselor to promote the goals 45 of Prevention within the school TARGET POPULATION — RISK AND PROTECTIVE FACTORS 1- School wide activities Favorable attitudes towards ATOD 1 & 2 Perceptions of harm Prosocial opportunities/activities Positive peer influence, Healthy behaviors Increased knowledge/awareness Attachment V Scope of Work Page 3 of 12 Guidance/Care Center, Inc. Contract No. ME225-10-27 256 711 Grade Prevention Education Favorable attitudes towards ATOD 1 & 2 Perceptions of harm Self-regulation Skill/competency Healthy behaviors Increased knowledge/awareness 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 Prevention Warriors 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 Attachment V Scope of Work Page 4 of 12 Guidance/Care Center, Inc. Contract No. ME225-10-27 257 Section III. SITE LOCATIONS AND INFORMATION* N Ell lgs I I im" A 019, INN' I Alow I=//1122/11-1/1/1111" o rwio /r/RE; =��l W/23 / r Horace O'Bryant Middle 1105 Leon St, Key 1 Key West 33040 X School Total number to be served 600 *Changes in sites/locations of services must adhere to contractual requirement procedures. Section IV. MAJOR REFERRAL SOURCES 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) 85% of 200 PES participants Pre/post tests and attendance records Measured at the beginning and end of will complete pre/posts and each cohort will attend minimally 85% of classes 85 %of 245 youth will increase Project SUCCESS pre and post tests Collected immediately prior to the 1 st their attitudes and beliefs related For PES and Prevention Warriors session and immediately following the to risk of harm associated with last session underage drinking Collected immediately prior to the 1 st 85 %of 245 youth will have no Project SUCCESS pre and post tests session and immediately following the or a decrease in past 30 day For PES and Prevention Warriors last session alcohol use by curriculum completion Collected immediately prior to the 1 st 85 %of 245 youth will decrease Project SUCCESS pre and post tests session and immediately following the favorable attitudes toward For PES and Prevention Warriors last session alcohol and drug use #and %of youth/participants 90 % Satisfaction Survey Measured at the end of each program satisfied with services provided cohort Attachment V Scope of Work Page 5 of 12 Guidance/Care Center, Inc. Contract No. ME225-10-27 258 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 50°�° the time of contract monitoring. Certification Board Quantit Performance Measures / / Prevention Education Series 200 6 to 8 85% Selective Project SUCCESS Of scheduled sessions School Wide Activities 600 9 90% Universal Individual Sessions 20 1-3 85% Indicated Sessions, with justificatio n if different Attachment V Scope of Work Page 6 of 12 Guidance/Care Center, Inc. Contract No. ME225-10-27 259 7th grade PES 200 85%of program 90%or program 1 completers will completers will show decreased demonstrate favorable satisfaction with attitudes, and program services increased perceptions of harm, and increased prosocial skills. Prevention Warriors 45 85%of program 90%or program 1 completers will completers will show decreased demonstrate favorable satisfaction with attitudes, and program services increased perceptions of harm, and increased prosocial skills. VI. TASK LIST Activity Title: Intake/Assessment 20 45-60 mins. 85% Activity Description: Participants who become enrolled in indicated prevention will complete a detailed intake of service needs Frequency: Once, upon enrollment in the program Intensity. One session Duration: 45 -60 mins. Activity Title: Project SUCCESS Prevention Education Series 200 85%of 85% Curriculum scheduled Activity Description:. 7th graders will participate in a 4 topic sessions ( 6 Prevention Education Curriculum -8) Frequency: one time per week For 45-60 Intensity. 6-8 sessions, based on class time restrictions mins. Duration: 45 to 50 mins. Activity Title: Pre- and Post-testing 200 45 to 60 min. 85 % Activity Description:. All 7th grade PES participants will be sessions pre and post tested for the knowledge, beliefs, attitudes and use of substances Fre uenc .Twice Attachment V Scope of Work Page 7 of 12 Guidance/Care Center, Inc. Contract No. ME225-10-27 260 Intensity: once before first session, once at completion of last session Duration: 45 to 50 mins. Activity Title: Prevention Warriors 45 45 to 50 min. 85% Activity Description:. Middle school students who sessions volunteer to serve as Prevention advocates will work with PS counselor to promote prevention activities school wide Frequency: One session per month Intensity. Duration: 45 to 50 mins. Section VII. EVIDENCE BASED PROGRAMS (EBP) i Project SUCCESS SAMHSA approved, NREPP Section Vill. EVALUATION Outcome Measures (Include fidelity measures, satisfaction survey information, supervision, training, Staffing, and other required information pertaining to quality) 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. Attachment V Scope of Work Page 8 of 12 Guidance/Care Center, Inc. Contract No. ME225-10-27 261 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 Section XI. CAPACITY BUILDING 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 hold conversations to ensure awareness of each other's Prevention Activities and to 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 Attachment V Scope of Work Page 9 of 12 Guidance/Care Center, Inc. Contract No. ME225-10-27 262 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 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. Attachment V Scope of Work Page 10 of 12 Guidance/Care Center, Inc. Contract No. ME225-10-27 263 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 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 Attachment V Scope of Work Page 11 of 12 Guidance/Care Center, Inc. Contract No. ME225-10-27 264 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 V Scope of Work Page 12 of 12 Guidance/Care Center, Inc. Contract No. ME225-10-27 265 South Floricla ;,AeA0 Behavioral Health INetwor ,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 0 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 Ne twork Provider, or subcontractor to influence legislation or appropriations pending before the Congress or any State legislature.If this Contract contains Federal funding in excess of$100,000, the Network Provider must, prior to contract execution, complete the Certification Regarding Lobbying form, Attachment Ill. 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-4 266 South Floricla ;,AeA0 Behavioral Health INetuvor ,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 Order12549. 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 this contract, at no additional cost to the ME. c. Upon demand,at no additional cost to the ME,the Network Provider will facilitate the duplication and transfer of any records or documents during the required retention period in Section 7.b. d. These records shall be made available at all reasonable times for inspection, review,copying,or audit by Federal, State,or other personnel duly authorized by the ME. e. At all reasonable times for as long as records are maintained, persons duly authorized by the ME,State, and Federal auditors, pursuant to 45 CFR,section 92.36(i)(10),shall be allowed full access to and the right to examine any of the Network Provider's contracts and related records and documents, regardless of the form in which kept. f. A financial and compliance audit shall be provided to the ME as specified in this contract and in Attachment II, Financial and Compliance 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 under Section 40. Failure to implement corrective action plans to the satisfaction of the ME, after receiving due notice, shall be grounds for contract termination. 9. Indemnification a. The Network Provider shall be fully liable for the actions of its agents, employees, partners, or subcontractors and shall fully indemnify, defend, and hold harmless the ME, State and the Florida Department of Children and Families (DCF), and its officers,agents, and employees, from suits, actions, damages, and costs of every name and description, including attorneys'fees, arising from or relating to any alleged act or omission by the Network Provider, its agents,employees, partners,or subcontractors, provided, however,that the Network Provider 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. P-4 267 South Florld'a ;,AeA0 Behavioral Health IfWotwor ,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 manner not contemplated by the contract or the purchase order. If any product is the subject of an infringement suit or in the Network Provider's opinion is likely to become the subject of such a suit,the Network Provider may at its sole expense procure for the ME the right to continue using the product or modify it to become non-infringing. If the Network Provider is not reasonably able to modify or otherwise secure the ME the use,the ME shall not be liable for any royalties.The Network Provider's indemnification for violation or infringement of a trademark,copyright, patent,trade secret or intellectual property right shall encompass all such items used or accessed by the Network Provider, its officers, agents or subcontractors in the performance of this contract or delivered to the ME for the use of the ME, its employees,agents or contractors. c. The Network Provider shall protect, defend, and indemnify, including attorney's fees and cost, the ME for any and all claims and litigation (including litigation initiated by the ME) arising from or relating to Network Provider's claim that a document contains proprietary or trade secret information that is exempt from disclosure or the scope of the Network Provider's redaction, as provided for under Section 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 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 the terms of insurance,to include but not limited to,cancellation or modification to policy limits. b. To the fullest extent permitted by law, and not withstanding any other provision of this Contract, the Network Provider by signing this contract acknowledges the value of obtaining Cyber Liability insurance, has considered all of the risks,and assumes all of the risks and liability associated with not obtaining such insurance.The Network Provider will indemnify,defend,and hold the ME harmless from any and all claims, losses, liabilities, damages,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 II 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-4 268 South Floricla ;,AeA0 Behavioral Health INetuvor ,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 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.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 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 Utilization 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 accordance with the client risk prevention system, report those reportable situations listed in CFOP 215-6 in the manner prescribed in CFOP 215-6 or circuit or region operating procedures.The Network Provider shall immediately report any knowledge or reasonable suspicion of abuse, neglect, or exploitation of a child, aged person, or disabled adult to the Florida Abuse Hotline on the Statewide toll-free telephone number (1-800-96ABUSE). As required by Chapters 39 and 415, F.S.,this provision is binding upon both the Network Provider and its employees. b. The ME monitors timely submissions of incident reports and may impose financial penalties as described in Section 39. Financial Penalties for Failure to Comply with Requirement for Corrective Action of this Standard Contract, paragraphs b.,c.,and d. Standard Contract Guidance/Care Center, Inc. Page 4 of 13 Contract No. P-4 269 South Floricla ;,AeA0 Behavioral Health IfWetuvor ,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 contract. c. All deductions for social security, withholding taxes, income taxes, contributions to unemployment compensation funds and all necessary insurance for the Network Provider, the Network Provider's officers, employees, agents, subcontractors, or assignees shall be the sole responsibility of the Network Provider. 17. Sponsorship As required by section 286.25, F.S., if the Network Provider is a non-governmental organization which sponsors a program financed wholly or in part by State funds, including any funds obtained through this Contract, it shall, in publicizing,advertising,or describing the sponsorship of the program State: "Sponsored by (Network Provider's Name), Inc., South Florida Behavioral Health Network, and the State of Florida, Department of Children and Families". If the sponsorship reference is in written material,the words"South Florida Behavioral Health Network " and "State of Florida, Department of Children and Families" shall appear in at least the same size letters or type as the name of the organization. 18. Publicity Without limitation, the Network Provider and its employees, agents, and representatives will not, without the ME's prior written consent in each instance, use in advertising, publicity or any other promotional endeavor any ME or State mark,the name of the ME's or State mark,the name of the ME,the State, or any ME or State affiliate or any officer or employee of the ME or the State, or represent, directly or indirectly, that any product or service provided by the Network Provider has been approved or endorsed by the ME, or refer to the existence of this Contract in press releases,advertising or materials distributed to the Network Provider's prospective customers. 19. Final Invoice The final invoice for payment shall be submitted to the ME no more than twenty (20) days, per the requirements stipulated in the Method of Payment section of this Contract, after the contract ends or is terminated. If the Network Provider fails to do so, all rights to payment are forfeited and the ME will not honor any requests submitted after the aforesaid time period.Any payment due under the terms of this contract may be withheld until all reports due from the Network Provider and necessary adjustments thereto, have been approved by the ME. 20. Use of Funds for Lobbying Prohibited The Network Provider shall comply with the provisions of sections 11.062 and 216.347, F.S.,which prohibit the expenditure of contract funds for the purpose of lobbying the Legislature,judicial branch,or a State agency. 21. Public Entity Crime Pursuant to section 287.133,F.S.,the following restrictions are placed on the ability of persons on the convicted vendor li st orthe 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 publ is 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; Standard Contract Guidance/Care Center, Inc. Page 5 of 13 Contract No. P-4 270 South Florida ;,AeA0 Behavioral Health INetwwor ,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 contract and perpetually thereafter. c.All applicable subcontracts shall include a provision that the Federal awarding agency reserves all patent rights with respect to any discovery or invention that arises or is developed in the course of or under the subcontract. Notwithstanding the foregoing provision, if the Network Provider or one of its subcontractors is a university and a member of the State University of Florida,then section 1004.23, F.S.,shall apply, but the Department shall retain a perpetual, fully-paid, non-exclusive license for its use and the use of its contractors of any resulting patented, copyrighted or trademarked work products. 24. Real Property Any State funds provided for the purchase of or improvements to real property are contingent upon the Network Provider granting to the State a security interest in the property at least to the amount of the State funds provided for at least five(5)years from the date of purchase or the completion of the improvements or as further required by law.As a condition of receipt of State funding for this purpose,the Network Provider agrees that, if it disposes of the property before the Department's interest is vacated, the Network Provider will refund the proportionate share of the State's initial investment,as adjusted by depreciation. 25. Information Security Obligations a. An appropriately skilled individual shall be identified by the Network Provider to function as its Data Security Officer. The Data Security Officer shall act as the liaison to the ME's security staff and will maintain an appropriate level of data security for the information the Network Provider is collecting or using in the performance of this contract.An appropriate level of security includes approving and tracking all Network Provider employees that request or have access to any ME or DCF data system or information. b.The Data Security Officer will ensure that user access to the data system or information has been removed from all terminated Network Provider employees immediately upon termination of employment. c.The Network Provider shall provide the latest DCF HIPAA and Security Awareness Training to its staff and subcontractors who have access to ME and DCF data system, information and/or who have access to Protected Health Information regardless of format (e.g. electronic,written, audio, video or still image recording) or function. Security and HIPAA requirements extend to non-clinical or non-administrative personnel if such persons can access Protected Health Information.The Network Provider shall ensure that proof of training is maintained in each employee file. d. All Network Provider employees who have access to ME or DCF data system or information, including but not limited to access to KIS, or any data system designated by the ME, Substance Abuse and Mental Health Information System (SAMHIS), Incident Reporting and Analysis System (IRAS),Temporary Assistance for Needy Family(TANF), shall comply with, and be provided a copy of CFOP 50-2, and shall sign the DCF Security Agreement form CF 0114 annually or immediately upon hire and annually thereafter. The Network Provider shall maintain a copy of Standard Contract Guidance/Care Center, Inc. Page 6 of 13 Contract No. P-4 271 South Floricla ;,AeA0 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 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 acceptance of an original plan or acceptance of an updated plan.The ME agrees to respond in writing within 30 days of receipt of the updated plan,accepting, rejecting,or requesting modification to the plan. 30. Notification of Legal Action The Network Provider shall notify the ME of legal actions taken against them or potential actions such as lawsuits, related to services provided through this contract or that may impact the Network Provider's ability to deliver the contractual services, or adversely impact the ME.The ME's contract manager will be notified within ten (10) days of Network Provider becoming aware of such actions or from the day of the legal Standard Contract Guidance/Care Center, Inc. Page 7 of 13 Contract No. P-4 272 South Floricla ;,AeA0 Behavioral Health INetwwor ,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 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: hops://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 sped fically 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 tho se exact portions that are claimed to be proprietary or trade secret. If the Network Provider fails to promptly submit a redacted copy,the ME is authorized to produce the records sought without any redaction of proprietary or trade secret information. d. The Network Provider shall be responsible for defending its claim that each and every portion of the redactions of proprietary or trade secret information are exempt from inspection and copying under Florida's Public Records Law. 33. Support to the Deaf or Hard-of-Hearing a.The Network Provider and its subcontractors,where direct services are provided, shall comply with section 504 of the Rehabilitation Act of 1973, 29 U.S.C.794, as implemented by 45 C.F.R. Part 84(hereinafter referred to as Section 504),the Americans with Disabilities Act of 1990, 42 U.S.C. 12131, as implemented by 28 C.F.R. Part 35 (hereinafter referred to as ADA), and the Children and Families Operating Instruction (CFOP)60-10,Chapter 4,entitled "Auxiliary Aids and Services for the Deaf or Hard-of-Hearing. b. If the Network Provider or any of its subcontractors employs fifteen (15)or more employees,the Network Provider shall designate a Single- Point-of-Contact 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 hops://fsl6.formsite.com/DCFTrainin /Monthly Summary Report/form loin.html by the 41h 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-4 273 South Floricla ;,AeA0 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.myflfamilies.com/service-programs/deaf-and-hard-hearing/providers g. The Network Provider and its subcontractors shall document the customer's or companion's preferred method of communication and any requested auxiliary aids/services provided in the customer's record. Documentation, with supporting justification, must also be made if any request was not honored.The Network Provider shall distribute Customer Feedback forms to customers or companions,and submission to the Department of Children and Families Office of Civil Rights. h. If customers or companions are referred to other agencies, the Network Provider must ensure that the receiving agency is notified of the customer's or companion's preferred method of communication and any auxiliary aids/service needs. i. The network provider's and its subcontractors' direct service employees shall complete the online training 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 $450,000.00, subject to the delivery and billing for services. The remaining amount of 0.00 represents "Uncompensated Units Reimbursement Funds", which the ME, at its sole discretion and subject to the availability of funds, may pay to the Network Provider, in whole or in part, or not at all, for Exemplary Performance by the Network Provider. Exemplary Performance will be determined by the Network Provider delivering and billing for services in excess of those units of service the ME will be required to pay.Should the network provider receive any funding from the "Uncompensated Units Reimbursement Funds", then the amount of Local Match as it appears on Exhibit 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 Standard Contract Guidance/Care Center, Inc. Page 9 of 13 Contract No. P-4 274 South Floricla ;,AeA0 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 s ection 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.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 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 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 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 sh all 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 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 delivery service that provides verification of delivery.The ME shall be the final authority as to the availability and adequacy of funds. In the event of termination of this contract,the Network Provider will be compensated for any work satisfactorily completed through the date of termination. c. In the event the Network Provider fails to fully comply with the terms and conditions of this contract, the ME may terminate upon no less than twenty-four (24) hours, excluding Saturday, Sunday, and Holidays, notice in writing to the Network Provider after Network Provider's failure to fully cure such noncompliance within the time specified in a written notice of noncompliance issued by the ME specifying the nature of the noncompliance and the actions required to terminate the contract. The ME's failure to demand performance of any provision of this 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-4 275 South Floricla ;,AeA0 Behavioral Health INetwwor ,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 Israel 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 contract, each party shall designate a Dispute Resolution Officer with the requisite authority to act as its representative for dispute resolution purposes,and provide that information to the other party. b. Within five (5)working days from delivery to the Dispute Resolution Officer of the other party of a written request for dispute resolution, the representatives will conduct a face-to-face meeting to resolve the disagreement amicably. If the parties are not able to meet within the five (5) working days due to scheduling difficulties, the meeting shall occur as mutually agreed to by the parties, but no later than ten (10) working days from the date of receipt of the written request for dispute resolution. If the representatives are unable to reach a mutually satisfactory resolution at the face-to-face meeting,the dispute resolution process in Section 42.c. shall be followed. In the event of a dispute regarding client eligibility and/or placement into the appropriate level of care, the dispute shall not preclude the Network Provider from providing the provision of services to eligible individuals until the dispute is resolved. c. If the representatives are unable to reach a mutually satisfactory resolution, either representative may request referral of the issue to the President/Chief Executive Officer of the respective parties. Upon referral to this next step,the President/Chief Executive Officer of the parties shall confer in an attempt to amicably resolve the issue. If the President/Chief Executive Officer of the parties cannot resolve the issue, the issue shall be presented at the discretion of the ME either to the Board of Directors Executive Committee and/or the ME's Board of Directors. Should the dispute not be resolved at the Board of Directors Executive Committee and/or the ME's full Board of Directors 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 1,2011). The Network Provider agrees to refrain from any of the prohibited business activities with the Governments of Sudan and Iran as described in s.215.473,F.S. Pursuant to section s.287.135(5),F.S.,the ME shall immediately terminate this contract for cause if the Network Provider is found to have submitted a false certification or if the Network Provider is placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List during the term of the contract. 44. 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-4 276 South Floricia ;,AeA0 Behavioral Health IfWetwwor ,Inc, rev.07/19/2018 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; 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-4 277 I' South Florida ttehamriiora) stealth etiiivoork,Illlrc.o 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,1 IL III&IV and any exhibits referenced in said attachments,together with any documents incorporated by reference,including the ME prime contract(which can be found at http://www.sfbhn.org),contain all the terms and conditions agreed upon by the parties. There are no provisions,terms,conditions,or obligations other than those contained herein, and this contract shall supersede all previous communications,representations,or agreements,either verbal or written between the parties. If any term or provision of this contract is legally determined unlawful or unenforceable,the remainder of the contract shall remain in full force and effect and such term or provision shall be stricken. In the event of a conflict between the provisions of the documents,the documents shall be interpreted in the following order of precedence: a.Attachment I,Exhibits,the Business Associate Agreement,and other attachments,if any; b.Any documents incorporated into any Exhibit or Attachment by reference; c.The Standard Contract; d.Any documents incorporated herein by reference BY SIGNING THIS CONTRACT,THE PARTIES AGREE THAT THEY HAVE READ AND AGREE TO THE ENTIRE CONTRACT,AS DESCRIBED IN SECTION 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. SIGG SIGf ' _A_.. BY: BY: ...... ........ NAME:Sharon Crippen NAME: Stephen Zuckerman TITLE:Sr.Vice President TITLE:Interim 2E0 DATE. ��.... DATE: 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.P-4 278 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 ATTACHMENT I 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-4 279 South(Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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.myflfamilies.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 (f) Page 2 of 52 Guidance/Care Center, Inc. Contract No. P-4 280 South(Florida ;'1:;0iA00 Behavioral Health IfWetwwor ,Inc, I ffective° 7/01,/201.8 (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 genera lizability (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/mana�in�-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-4 281 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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-4 282 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 (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-4 283 South Florida ;'1:;OiAOO �����m�a| Health�NetworA^Inc. Effective� 7/O1/2O18 ianaging- 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 Ru|e6SD'3U.U13, F.A.C.: information dissemination, education, alternatives orproblem identification and referral services. (b) Universal Indirect Prevention Universal indirect services support popu|ation-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 Ru|e6SD'3U.U13, 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 ofdeveloping 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 ofadisorder. Examples include programs offered tochildren exposed to risk factors, such as parental divorce, parental mental illness, death of 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 o. 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)"PrimeContract" is the contract between the Department ofChildren and Families and the ME. Attachment|H02N Page 6of52 Guidance/Care Center, Inc. Contract No. P'4 284 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 (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-4 285 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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 ' See htlps://www.samhsa.gov/sites/defaiilt/files/rosc_resotirce guide book. df accessed May,2018. Attachment I HCO2 (f) Page 8 of 52 Guidance/Care Center, Inc. Contract No. P-4 286 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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 forfamilies,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-4 287 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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-4 288 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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 (HALM)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-4 289 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 (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-4 290 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 (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 HCO2 (f) Page 13 of 52 Guidance/Care Center, Inc. Contract No. P-4 291 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 • 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 worktogetherto 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-4 292 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 (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-4 293 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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: i. Activities to ensure that fraud, waste and abuse do not occur. ii. Composition of quality assurance review committees and subcommittees, purpose,scope,and objectives of the continuous quality assurance committee and each subcommittee, frequency of meetings, minutes of meetings, and documentation of meetings. iii. A framework for evaluating outcomes, including: 1. Output measures, such as capacities, technologies, and infrastructure that make up the system of care. 2. Process measures, such as administrative and components of the services. 3. Outcome measures pertaining to the outcomes of services; Attachment I HCO2 (f) Page 16 of 52 Guidance/Care Center, Inc. Contract No. P-4 294 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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-4 295 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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-4 296 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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-4 297 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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-4 298 South(Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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: http://www.myflfamilies.com/service-programs/substance-abuse/licensors-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-4 299 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 (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-4 300 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 (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: hops://eds.myflfamilies.com/DCFFormslnternet/Search/DCFFormSearch.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.myflfamilies.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-4 301 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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-$.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-4 302 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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 HCO2 (f) Page 25 of 52 Guidance/Care Center, Inc. Contract No. P-4 303 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 (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-4 304 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 (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 exemptfrom 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. P-4 305 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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-4 306 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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 I HCO2 (f) Page 29 of 52 Guidance/Care Center, Inc. Contract No. P-4 307 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 (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-4 308 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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-4 309 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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-4 310 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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 maybe 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 HCO2 (f) Page 33 of 52 Guidance/Care Center, Inc. Contract No. P-4 311 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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.myflfamilies.com/service-programs/substance-abuse/pamphlet-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-4 312 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 (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 11 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-4 313 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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-4 314 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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. (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 HCO2 (f) Page 37 of 52 Guidance/Care Center, Inc. Contract No. P-4 315 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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)lf 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-4 316 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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-4 317 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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 HCO2 (f) Page 40 of 52 Guidance/Care Center, Inc. Contract No. P-4 318 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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-4 319 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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-4 320 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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), W-(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 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 Attachment I HCO2 (f) Page 43 of 52 Guidance/Care Center, Inc. Contract No. P-4 321 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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-4 322 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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 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. 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 (f) Page 45 of 52 Guidance/Care Center, Inc. Contract No. P-4 323 South Florida ;'1:;0iA00 �����m�a| Health�NetworA^Inc. Effective� 7/O1/2O18 (1) The Florida Medicaid HIPAA located at: http://vvwvv.fdhc.stateƒ|.us/hipaa/index.shtm| (2) The National Plan and Provider Enumeration System (NPPES) located at: https://nppeszms.hhs.gov/NPPES/VVe|come.do (3) http://wvvvvzms.hhs.8ov/Nationa|Prov|dentStand/ 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 ZU. 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.3, 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 a||ovx 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 sectionZO6.U11, F.3. 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 (|TR)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 |TR purchases made prior to obtaining the ME's written approval. 16. Programmatic,Fiscal 8k 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|H02N Page 46of52 Guidance/Care Center, Inc. Contract No. P'4 324 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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-4 325 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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-4 326 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 (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 indemnifythe 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 indemnifythe ME or the department against any claim or loss arising out of the operations of any motor vehicle purchased by or transferred to the provider pursuant to this contract. 19. Health Insurance Portability and Accountability Act(HIPAA) a. In compliance with 45 CFR s.164.504(e),the Network Provider shall comply with the provisions of the Business Associate Agreement, incorporated herein by reference to this Contract, governing the safeguarding, use and disclosure of Protected Health Information created, received, maintained, or transmitted by the Network Provider or its subcontractors incidental to Network Provider's performance of this Contract. b. A violation or breach of any of the assurances as stipulated in the Business Associate Agreement shall constitute a material breach of this contract. 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 Registration Activities Coordinator and provide the contact information of the Coordinator by the date and to the individual(s) identified in Exhibit C-1, Required Reports. 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-4 327 South(Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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/national-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-4 328 South Florida ;'1:;OiAOO Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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. L 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-4 329 South Florida ;'1:;0iA00 Behavioral Health Network,Inc, I ffective° 7/01,/201.8 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-1, Required Reports for Prevention Providers 4. Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs S. 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-4 330 °vjuth Fllanirikla @ e➢nsaNki�iraall III teaallt➢n Network,Inic. 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.myflfamilies.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-4 331 °vjuth Fllanu°ida Beharki�iraall III teaallt➢n Network,Inic. (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-4 332 °vjuth Fllanu°ida Beharki�iraall III teaallt➢n Network,Inic. 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-4 333 °vjuth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,Inic. 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-4 334 °vjuth Fllanu°ida 13ch aN ki�iraall III teaallt➢n Nctnvor➢c,tnic. Reimbursement Funds", then the amount of Local Match Plan as it appears on Exhibit H, Funding Detail, will automatically change, utilizing the following formula: The additional match required on the uncompensated units= Uncompensated Substance Abuse Services X 16.67%+Uncompensated Mental Health Services that is not exempt from local match requirements X 33.33%. * *The following MH services are exempt from the local match requirement i. Deinstitutionalization Projects Case Management Intensive Case Management Residential Services I-IV Supported Housing/Living Short Term Residential Treatment(not exempt if funded by Baker Act funds or operated by a public receiving facility) FACT Teams ii. CMH Programs (100435 Category & 102780 (PRTS) Category) that are not grant funded. 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. P-4 335 °vjuth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,Inic. 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. P-4 336 °vjuth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,Inic. 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 Page 4 of 6 Guidance/Care Center, Inc. Contract No. P-4 337 °vjuth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,Inic. 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. P-4 338 °vjuth Fllanu°ida 13ch arki�iraall III teaallt➢n Nctnvor➢c,Inic. 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.myfloridacfo.com/aadir/reference guide Reference Guide For State Expenditu res. df 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 6 of 6 Guidance/Care Center, Inc. Contract No. P-4 339 South Florida Behavioral Health Network,IInc. Exhibit C-1 Required Reports 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 calendar days of execution of an (2)Budget Narrative, amendment to the contract affecting the E-mail) 2,VP of Finance (3)Network Providers Agency Service Capacity Report, budget. (4)Cost Center Personnel Detail Report Program Description Annually,prior to contract execution. 1 (Electronic Submission via 1.ME Contract Manager (1)Organizational Profile Submit updates within 30 calendar days of E-mail) (2)Service Activity Description amendment 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 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 2.QA/QI Risk&Compliance Risk&Compliance Manager Manager Exhibit C-1 Guidance/Care Center, Inc. Page 1 of 7 Contract No. P-4 340 South Florida Behavioral Health Network,IInc. Within 24 hours of occurrence,in accordance with CFOP 215-6 and Incident Report reportable incidents defined CFOP 180-4 Submission through IRAS Submission through IRAS Mandatory Reporting Requirements to the Office of the Inspector General ADA Client Communication Assessment Kitt s, ,(,Fs;1E3..:Fc],rl,rlsi,tc=,,,ro.L.r.7,t,;fTr,,i;,n Auxiliary Aid Service Record Monthly Summary nx/V antl,�l,y 5uinin ,ry Report By the 4th business day following the 1 (Electronic Submission via ft( )ort form lop,,m Irtrnl (Applicable to agency's that employ fifteen(15) reporting month E-mail) or more employees) Confirmation E-mail to the ME Contract Manager By July 20 of each fiscal year and/or 20 ME Final Invoice days 1 Sr.Accountant(Fiscal De after contract end date Department) Designation of Dispute Resolution Officer Within 5 working days of contract 1 (Electronic Submission via ME Contact Manager execution E-mail) Inventory Report 8/1/2018 1 (Electronic Submission via ME Contract Manager E-mail) 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) Security Agreement form CF 0114,per the Attachment I and 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(CF0946) 8/1/2018 1 (Electronic Submission via ME Contract Manager E-mail) Civil Rights Certificate(CF707) 8/1/2018 1 (Electronic Submission via ME Contract Manager E-mail) 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-4 341 South Florida Behavioral Health Network,IInc. 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 will receive 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 the following initiative: 1.ME Contract Manager 1.Integration of Behavioral Health and Primary 3/1/2019 1 2.QA/QI Risk&Compliance 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-4 342 South Elorlda Behavloral Health Network,IInc. 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 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 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 state's fiscal year. Due 180 days after the end of the Network Provider's fiscal year or within 30 days of the recipient's receipt of the audit report, Projected Cost Center Operating and Capital whichever occurs first,directly to each of Budget 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 state's fiscal year. e n ti ties/2018-con tract-d ocs 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 state's fiscal year. Due 180 days after the end of the Network Provider's fiscal year or within 30 days of the recipient's receipt of the audit report, whichever occurs first,directly to each of 1. ME Contract Manager 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 state's fiscal year. Year-End Financial Reports for Network Provider's Requiring Audits Per Attachment II Exhibit C-1 Guidance/Care Center, Inc. Page 4 of 7 Contract No. P-4 343 South EloHda BehaWoiral Health Network,IInc. 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 state's fiscal year. Due 180 days after the end of the Network Provider's fiscal year or within 30 days of the recipient's receipt of the audit report, whichever occurs first,directly to each of 1. ME Contract Manager 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 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 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 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, 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 state's 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. ME Contract Manager 1 (Electronic Submission via 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 state's fiscal year. Exhibit C-1 Guidance/Care Center, Inc. Page 5 of 7 Contract No. P-4 344 South EloHda BehaWoral Health Network,IInc. 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, 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 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 state's 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-4 345 South Florida Behavioral Health Network,IInc. 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 1. ME Director or Prevention has been checked and is correct and complete 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 /�ufur Co Suopu of Work AHauhm meth o fru Cori raO far spuuificr 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 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) 1. ME Contract Manager January 31,2019 (Period:10/01/18-12/31/18) 1 (Electronic Submission via 2. ME Director or Prevention Financial Report April 30,2019 (Period:01/01/19-03/31/19) E-mail) Services 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-4 346 So u I ii Rorkfa Bdmiior: II I ieflI�I ii Net oflc, I i1c. ii ei.7.1.2 018 EXHIBIT D Substance Abuse & Mental Health Required Performance Outcomes & Outputs Provider Name: Guidance/Care Center,Inc. Contract P-04 Date: 7/1/2018 Revision N 12"Em 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% I 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 I 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 I of 2 Contract No. P-4 347 So uIii Horiida Bdhai iior�flII I1ie flIIii Net o llc, Ii1 . Rei.7.1.2 018 Table 2 Network Service Provider Output Measures—Persons Served For Fiscal Year FY18-19 Service Category FY Target Residential Care N/A s Outpatient Care N/A � Crisis Care N/A 41 73 x State Hospital Discharges N/A Q Peer Support Services N/A Residential Care N/A 41 c v � s Outpatient Care N/A c v v = s Crisis Care N/A U a, Residential Care N/A Q Outpatient Care N/A v U Detoxification N/A 4a Women's Specific Services N/A +� Injecting Drug Users N/A Q Peer Support Services Residential Care N/A c 41 Outpatient Care N/A N Detoxification N/A c Q °J **Refer to Attachment IV,Scope of Prevention Work for the numbers served.** s U Network Provider Compliance: Failure to meet the applicable standards established in Tables 1 and 2 shall be considered nonperformance pursuant to Standard Contract, Paragraph 36. Financial Consequences for Network Provider's Failure to Perform. Exhibit D Guidance/Care Center, Inc. Page 2 of 2 Contract No. P-4 348 °vjuth Floilda Behar I(ji'all III I calth Ncovork, I Tic. 7/1/20 18 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-4 349 SmuthRmh�a Bmhamimna� H aRh ��wmMk. |nC' evism�T/1 2817 Exhibit F SAMH PROGRAMMATIC STATE AND FEDERAL LAWS, RULES, AND REGULATIONS The Network Provider and its subcontractors shall comply with all applicable state and federal laws, rules and regulations,as amended from time to time, that affect the subject areas of the contract. Authorities include but are not limited to the following: F-1 Federal Authority F'11 Block Grants Regarding Mental Health and Substance Abuse B4.1.1 Block Grants for Community Mental Health Services 42U.G.C. 00. 3OOx' ntseq. B4.1.2 Block Grants for Prevention and Treatment of Substance Abuse 42U.G.C. 00. 300x'21 ntonq. 45C.F.R. Part 90' Subpart L F4.2 Department of Health And Human Services,General Administration, Block Grants 45C.F.R. Part. 90 F4.3 Charitable Choice Regulations Applicable to Substance Abuse Block Grant and PATH Grant 42 C.F.R. Pnrt54 F4.4 Confidentiality Of Substance Use Disorder Patient Records 42C.F.R. Part 2 F4.5 Security and Privacy 45C.F.R. Part 104 F4.8 Supplemental Security Income for the Aged, Blind and Disabled 2OC.F.R. Part 410 F4.7 Temporary Assistance to Needy Families(TANF) 42U.G.C. 00. 001 019 45C.F.R.' Part 200 F4.8 Projects for Assistance in Transition from Homelessness(PATH) 42U.G.C. 00. 290oc-21 —29Oon'35 F4.9 Equal Opportunity for Individuals with Disabilities (Americans with Disabilities Act of 1990) 42U.G.C. 00. 12101 12213 F4.10 Prevention of Trafficking(Trafficking Victims Protection Act of2OOO) 22U.G.C. o. 7104 2C.F.R. Pnrt175 F'2 Florida Statutes F'2.1 Child Welfare and Community Booed Core Ch. 39' F.G. Proceedings Relating to Children Exhibit Page & of4 Guidance/Care Center, Inc. Contract No. P4 350 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-4 351 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. P-4 352 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. P-4 353 v a 0 z U C 0 U 0 N �r a 0 d v3 U O ro a, C7 z Q z Z w � w C7 � aLn G1 O F ro x w M W N N N N O 7 kn kn kn O kn 7 z Q z wvj v3 v3 v3 v3 c � zQ a x r .. .. .. "C ° °' CG ""s* U o Qa > > > L g m a�i �° o > > > o o o ° o 0 0 0 at c c c c 0 o o C7 o ° ° a a o ° °' °' o U o 0 0 0 o o a ° ¢� �iUUUa aOLOLOLOLv 7 �r 0.r ii :II- V .i ':d I I .� `• I 'I ':I V ,• V V V "V "IV" 7 7 � � ,., � v a 0 z U O C O U N a, a� 0 d U C, mil ro C7 z Q z w w w j o a N Ln M Gl w P. 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C'oi UUUa aOLOLOL OLv 7 "I V d� 'I '�I V V d V d V d� 00 kn 7 �r 0.r ii :II- V .i ':d `• ':I V ,• V V V "V "IV" 7 7 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 NENV OCR. AMOUNT OCA DESCRIPTION NENV OCR. AMOUNT Residential Services 1\1II001 $ Residential Services 1\411001 $ Non-Residential Services MII009 $ Non-Residential Services 1\411009 $ Crisis and Baker Act Services MII018 $ Crisis and Baker Act Services 1\411018 $ Community Forensic Program MII072 $ Special Appropriation-ICFH MIIOBN $ FACT Team MI1073 $ Purchased Residential Treatment(PRTS) 1\411071 $ Indigent Drug Program MI1076 $ Community Action Treatment(CAT)Team MIICAT $ Proviso Allocation-Citrus MII09I $ $ PATH Grant MHOPt $ $ TANF Services MII01I3 $ $ Early Intervention-Psychotic Disorders MII026 $ $ Forensic Hospital Multidisciplinary Team MIIOIII $ $ For Profit Sub-Recipeint-Key West HMA MHSFP $ $ Supported Employment Services MI II MP $ $ Miami-Dade County Homeless Trust MII01 O $ $ IOS Pilot Project MII021 $ $ MDC-Central Receiving Facility MDC RI .$ .$ Care Coordination MIJOCN Care Coordination MHOCN$ $ .www_wwwwwwwwwwwww w.. Carry Forward MHOC I $ Carry Forward MIIOCF $ TOTAL ADULT MENTAL HEALTH= $ TOTAL CHILDREN MENTAL HEALTH= $ ADULT SUBSTANCE ABUSE CHILDREN SUBSTANCE ABUSE OCA DESCRIPTION NENV OCR. AMOUNT OCA DESCRIPTION NENV OCR. AMOUNT Residential Services MS003 $ Residential Services MS003 $ Non-Residential Services MS011 $ Non-Residential Services MSOl 1 $ Detox Services MS021 $ Detox Services MS021 $ HIV Services M`s023 $ 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 M`s0 B $ Here's Help Opioid Training MS913 $ Proviso Allocation-New Hope CORPS MS908 $ $ Targeted Response-Opioid Crisis MsOPII $ $ Opioid Crisis MAT MSOPyQ $ $ Here's Help Opioid Training M`s913 $ $ MDC-Central Receiving Facility MDC RI' $ $ Care Coordination M`sOCN $ Care Coordination MSOCN $ Carry Forward M`sOC I .$ Carry Forward MSOCF $ TOTAL ADULT SUBSTANCE ABUSE_ $ TOTAL CHILDREN SUBSTANCE ABUSE 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 Contract No. P-4 Pagidef 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 NENV OCR. AMOUNT OCA DESCRIPTION NENV OCR. AMOUNT Residential Services 1\1II001 $ Residential Services 1\411001 $ Non-Residential Services MII009 $ Non-Residential Services 1\411009 $ Crisis and Baker Act Services MII018 $ Crisis and Baker Act Services 1\411018 $ Community Forensic Program MII072 $ Special Appropriation-ICFH MIIOBN $ FACT Team MI1073 $ Purchased Residential Treatment(PRTS) 1\411071 $ Indigent Drug Program MI1076 $ Community Action Treatment(CAT)Team MIICAT $ Proviso Allocation-Citrus MII09I $ $ PATH Grant MHOPt $ $ TANF Services MII01I3 $ $ Early Intervention-Psychotic Disorders MII026 $ $ Forensic Hospital Multidisciplinary Team MIIOIII $ $ For Profit Sub-Recipeint-Key West HMA MII`sFP $ $ Supported Employment Services MI II MP $ $ Miami-Dade County Homeless Trust MII01 O $ $ IOS Pilot Project MII021 $ $ MDC-Central Receiving Facility MDC RI .$ .$ Care Coordination MIJOCN Care Coordination MHOCN$ $ .www_wwwwwwwwwwwww w.. Carry Forward MHOC I $ Carry Forward MIIOCF $ TOTAL ADULT MENTAL HEALTH= $ TOTAL CHILDREN MENTAL HEALTH= $ ADULT SUBSTANCE ABUSE CHILDREN SUBSTANCE ABUSE OCA DESCRIPTION NENV OCR. AMOUNT OCA DESCRIPTION NENV OCR. AMOUNT Residential Services MS003 $ Residential Services MS003 $ Non-Residential Services MS011 $ Non-Residential Services MSOl 1 $ Detox Services MS021 $ Detox Services MS021 $ HIV Services M`s023 $ 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 M`s0 B $ Here's Help Opioid Training MS913 $ Proviso Allocation-New Hope CORPS MS908 $ $ Targeted Response-Opioid Crisis MsOPII $ $ Opioid Crisis MAT MSOPyQ $ $ Here's Help Opioid Training M`s913 $ $ MDC-Central Receiving Facility MDC RF $ $ Care Coordination M`sOCN $ Care Coordination MSOCN $ Carry Forward M`sOC I .$ Carry Forward MSOCF $ TOTAL ADULT SUBSTANCE ABUSE_ $ TOTAL CHILDREN SUBSTANCE ABUSE 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 Contract No. P-4 Pagido f 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 NENV OCR. AMOUNT OCA DESCRIPTION NENV OCR. AMOUNT Residential Services 1\1II001 $ Residential Services 1\411001 $ Non-Residential Services MII009 $ Non-Residential Services 1\411009 $ Crisis and Baker Act Services MII018 $ Crisis and Baker Act Services 1\411018 $ Community Forensic Program MII072 $ Special Appropriation-ICFH MIIOBN $ FACT Team MI1073 $ Purchased Residential Treatment(PRTS) 1\411071 $ Indigent Drug Program MI1076 $ Community Action Treatment(CAT)Team MIICAT $ Proviso Allocation-Citrus MII09I $ $ PATH Grant MHOPt $ $ TANF Services MII01I3 $ $ Early Intervention-Psychotic Disorders MII026 $ $ Forensic Hospital Multidisciplinary Team MIIOIII $ $ For Profit Sub-Recipeint-Key West HMA MHSFP $ $ Supported Employment Services MI II MP $ $ Miami-Dade County Homeless Trust MII01 O $ $ IOS Pilot Project MII021 $ $ MDC-Central Receiving Facility MDC RI .$ .$ Care Coordination MIJOCN Care Coordination MHOCN$ $ .www_wwwwwwwwwwwww w.. Carry Forward MHOC I $ Carry Forward MIIOCF $ TOTAL ADULT MENTAL HEALTH= $ TOTAL CHILDREN MENTAL HEALTH= $ ADULT SUBSTANCE ABUSE CHILDREN SUBSTANCE ABUSE OCA DESCRIPTION NENV OCR. AMOUNT OCA DESCRIPTION NENV OCR. AMOUNT Residential Services MS003 $ Residential Services MS003 $ Non-Residential Services MS011 $ Non-Residential Services MSOl 1 $ Detox Services MS021 $ Detox Services MS021 $ HIV Services M`s023 $ 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 M`s0 B $ Here's Help Opioid Training MS913 $ Proviso Allocation-New Hope CORPS MS908 $ $ Targeted Response-Opioid Crisis MsOPII $ $ Opioid Crisis MAT MSOPyQ $ $ Here's Help Opioid Training M`s913 $ $ MDC-Central Receiving Facility MDC RI' $ $ Care Coordination M`sOCN $ Care Coordination MSOCN $ Carry Forward M`sOC I .$ Carry Forward MSOCF $ TOTAL ADULT SUBSTANCE ABUSE_ $ TOTAL CHILDREN SUBSTANCE ABUSE 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 Contract No. P-4 Page$f 1 LO 0 N ti U � F a z° 69 U O O O 0 U O l� 69 CZ Q 69 F Z F Q 69 F � w F O a Q � O F� 69 Z Q 6R 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 6R 6R 6R 6R 6R O x � Q —fj F v F 0 w zct QQ ct cz CZ m m O 'ID lT 00 O\ O •-• U` 7 7 7 7 7kn � co O N _T 7 z 0 N ti U � F a z° 69 U O l� 69 CZ Q 69 F Z F Q 69 F � w Q � 0 F� 69 Z Q 6R 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 6R 6R 6R 6R 6R 0 x � Q —fj F v F 0 w zct QQ ct cz 7-2 N U O O O d d d d p d V V Ci Si Si Si --� N M 7 � r 00 �--�. N N M 7 � � 00 O\ O --� 7 � � r 00 O\ M O 7 � r 00 O\ O �D l� 00 O\ O •-• U` CZ N _T 7 0 N 0 N ti U � F a z° 69 U O l� 69 fn Q 69 F Z F Q 69 F � w F O a Q � 0 F� 69 Z M Q F M Q 6R 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 69 6R 6R 6R 6R 6R 0 x � Q w z QQ 72ct A Z F" F� o —Ct 't o e e W o a fj N U O O O O N d d d d O O d O V V Ci Si Si Si N a N N CZ CZ cz co O x ,N ,N Y Y Y m m m m V� y y OCZ ct 0 0 0 p U U d d d d M O 7 �c r 00 O\ O �D l� 00 O\ O •-• U` M N N N N N N 7 M M M M M M 7 7 7 7 7 t O N O N _T 7 South Florida ;'1:;0iA00 Behavioral Health INetwor ,Inc, T 1 201 ATTACHMENT 11 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-4 372 South Florida ;'1:;0iA00 Behavioral Health INetwor ,Inc. T 1 201 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-4 373 South(Florida ;'1:;0iA00 Behavioral Health INetwwor ,Inc. T01.201 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: htIpj1harvester.census.Eov/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:faudEen_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 Attachment II Page 3 of 4 Guidance/Care Center, Inc. Contract No. P-4 374 South Florida ;'1:;0iA00 Behavioral Health IfWetwor ,Inc, 1".11L201 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 II Page 4 of 4 Guidance/Care Center, Inc. Contract No. P-4 375 South Florlda Behavioral Health Network,Inc. ATTACHMENT III CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS,GRANTS,LOANS AND COOPERATIVE AGREEMENTS The undersigned certifies,to the best of his or her knowledge and belief,that: (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or an employee of any agency, a member of congress, an officer or employee of congress, or an employee ofe member of congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract,grant,loan,or cooperative agreement. (2) If any funds other than federal appropriated'funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with this federal contract,grant,loan,or cooperative agreement,the undersigned shall complete and submit Standard Form- LLL,"Disclosure Form to Report Lobbying,"in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans and cooperative agreements)and that all sub-recipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352,Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than$10,000 and not more than$100,000 for each such failure. Signature r ...._..._ .�...__......_ g Date Sharon Crippen P-4 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 I of I Contract No.P-4 376 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 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 Pag(P7of 13 f / 1 /1 MI School wide activities Universal Information 2,500 Dissemination 9tn 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 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 Page3 %f 13 Positive peer influence Skill/competency Healthy behaviors Increased knowledge/awareness 21, �o / ff"M111, o 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). 9th grade Prevention Education Series is a Selective prevention strategy which 450 consists of 4 topics taught in 4 to 8 sessions to all 9tn 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 /- 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 Page 3%f 13 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* /I Inin i i111 "go ' teu 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 Page3�gf13 Section IV. MAJOR REFERRAL SOURCES 3 �� 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) 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 post tests Collected immediately prior to the 1 st 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 1 st 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 1 st 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 50% the time of contract monitoring. Certification Board Guidance/Care Center, Inc. Attachment IV Contract No. P-4 Scope of Work PagAbf 13 Quantity Performance Measures /r / 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 4-8 85% Selective N ewco 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 PagA;f 13 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 Page3�;f 13 VI. TASK LIST 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 meeting Intensity:one session 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:. 9tn graders will participate in a 4 topic sessions ( 6 g p p p� pre/post tests Prevention Education Curriculum -8) matched and Frequency: one time per week For 45-60 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 PagA f 13 Section VII. EVIDENCE BASED PROGRAMS (EBP) i Project SUCCESS SAMHSA approved, NREPP Section Vill. EVALUATION Outcome Measures (Include fidelity measures, satisfaction survey information, supervision, training, Staffing, and other required information pertaining to quality) 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. 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 Page§%f 13 Section IX. CAPACITY BUILDING GCC currently receives funding from SFBHN Regular Prevention which supports An Apple A Day serving K through 4 th 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 (M E'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 Page3lUof 13 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 PagA7of 13 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 Page3lVof 13 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 PageWof 13 Amendment#1 Contract No.P-04 07/1/2019 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. P-04. PREAMBLE:This amendment revises contract language and adds Attachment V,Scope of Work for Fiscal Year 19-20. As a result,this amendment revises the Standard Contract;Attachment I; Exhibit C, Required Reports; and adds Attachment V,Prevention Scope of Work,Fiscal Year 19-20 as follows: 1. Page 13 of 13,Standard Contract,Section 51, is hereby amended as follows: 51. All Terms and Conditions Included This contract and its attachments, 1, 11, 111, IV, & V and any exhibits referenced in said attachments, together with any documents incorporated by reference, including the ME prime contract (which can be found at http://www.sfbhn.org), contain all the terms and conditions agreed upon by the parties. There are no provisions,terms, conditions, or obligations other than those contained herein, and this contract shall supersede all previous communications, representations, or agreements, either verbal or written between the parties. If any term or provision of this contract is legally determined unlawful or unenforceable, the remainder of the contract shall remain in full force and effect and such term or provision shall be stricken. In the event of a conflict between the provisions of the documents, the documents shall be interpreted in the following order of precedence: a.Attachment 1,Exhibits,the Business Associate Agreement,and other attachments, if any; b.Any documents incorporated into any Exhibit or Attachment by reference; c.The Standard Contract; d.Any documents incorporated herein by reference 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. SIGNED m SIGNED BY: y::j C- BY: NAME: Frank Rabbito NAME: John W.Dow TITLE: COO i TITLE:President and CEO DATE:, ! Ijig_ DATE: Federal Tax ID#(or SSN)59-1458324 Network Provider Fiscal Year Ending Date 6 30 2. The replacement of Page 13 of the Standard Contract does not affect the original execution of this Contract. The original signatures are on file. Page 1 of 2 390 Amendment#1 Contract No.P-04 07/1/2019 3. Pages 1-52, Attachment 1, are hereby deleted in their entirety and Pages 1-52, Revised Attachment I, are inserted in lieu thereof and attached hereto. 4. Pages 1-7, Exhibit C-1, Required Reports are hereby deleted in their entirety and Pages 1-19, Exhibit C,Required Reports, are inserted in lieu thereof and attached hereto. S. Pages 1-8, Attachment V, Prevention Scope of Work, Fiscal Year 19-20, are hereby added and attached hereto. This amendment shall begin on July 1,2019. 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. 1N WITNESS THEREOF, the parties hereto have caused this eighty-nine (89) page amendment to be executed by their officials'thereunto duly authorized. GUIDANCE/CARE CENTER,INC. SOUTH FLORIDA BEHAVIORAL HEALTH NETWORK,INC. SIGNED - SIGNED BY: BY: NAME: Frank Rabbito NAME: John Newcomer, M.D. TITLE: COO TITLE: President and CEO DATE: 1 DATE: FEDERAL Tax ID#(or SSN):59-1458324 Network Provider Fiscal Year Ending Date 6 30 Page 2 of 2 391 ATTACHMENT E PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list l orlservic coto anviction public for public entity crime may not submit a bid on a contract to provide any goods entity, may not submit a bid on a contract with a public entity ty for the constructions u publor repair may of a Y public building or public work, may not submit bids on lelierssubcont actor, or CONTRACTOR under not be awarded or perform work as a CONTRACTOR, supplier,b public entity in excess of a contract with any public entity, and may not transact business with any P period of 36 months I the threshold amount provided in Section 287.017, for CATEGORY TWO fora from the date of being placed on the convicted vendor list." - C44(Respondent's name) nor I have read the above and state that neither any Affiliate has been placed on the convicted vendor list withiP�tt-3 6 months. (Signature) Date w _....m TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) s a State of County of of � � (month), � � (Year) This instrument was acl owledged before me this day - by � ,� " (41° r (name of officer or agent, title or officer or agent) of ( 1, 1 ` " '„(name of entity). Q -'f Personally Known Produced Identification: Type of ID and Number on ID (Seal) Notary Public state of igl' ire of Notar Maryanne L Johnson h ly Co,Mmi son CEO 175345 ro� J O �r e xpiVe s 01512022 ame o Notary(Typed, Stamped or Printed) Notary Public, State of-��I f�" - Guidance Care Center-SAMH Contract FY20;page 15 392 ATTACHMENT F SWORN STATEMENT UNDER ORDINANCE NO. 010-1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE e?- (Company) "...warrants that he/it has not employed, retained or otherwise d act gtontg his/her 0 or any if any ntyformer er County officer or employee in violation of 'Section 2 of Ordinance 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 wi heur cove the fuY t liability and may amountin its discretion, deduct from the Agreement or purchaseprice, of any fee, commission, percentage, gift, or consideration paid to the former County officer or employee." (Signature) Date i TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) State of 11 County of This instrument was acknowledged before me this "day of 1,141,16 )(month), ' ,O- (Year), 4yl, yt ) ( (name of officer or agent, title or officer or agent) of °� b (name of entity). Personally Known Produced Identification: Type of ID and Number on ID (Seal) y Notary Public state or Florir ture o Nota ' Al Maryanne L Johnson'y My Commission GG 17534d ` �tExpires 01115l2022 of N tart'(Typed, Stamped or Printed) Notary Public, State of n .. Guidance Care Center-SAMH Contract FY20;page 16 393 ATTACHMENT G DRUG-FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: &LAAU.4--�0Z.- 1CCeC_ (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 ernployees 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, certify that this firm complies fully with the above requirements. (Signature Date: TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) State of County of This instrument was acknowledged before me this d 4a) (month), (year), ay of by I (name of officer or agent, title or officer or agent) of I _.,ku.(name of entity). 61 Personally Known Produced Identification: Type of ID and Number on ID lo ory Public State of Florida (Seal) '0 NOL 11"' , Maryanne L Johnson L Jo i i at Notary, Gr.1 75 5 my commission GG 175345 11 si'0 Expires 0111W2022 Notary(Typed, Stamped or Printed) �E1yapq`11.0a1M1"` Name Notary Public, State of Guidance Care Center-SAMH Contract FY20;page 17 394 ATTACHMENT H FY2020 Annual Performance Report (For year October 1, 2019—September 30, 2020) Agency Name ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ Point of Contact 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 FY2020 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. ji I t 2. What were the measurable outcomes (including numbers) accomplished in FY2020? 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 FY2020; and/or 200%; and/or another standard used by your organization? 4. Were all the awarded funds used in FY2020? If not, please explain. 5. What is the number of FTEs working on the program(s) funded by the award in FY2020? Guidance Care Center-SAMH Contract FY20;page 18 395 6. Were the awarded funds used as match in FY2020? If so, please list matching sources. 7. What area of Monroe County did you serve in FY2020? 8. How many total FTEs in your organization? 9. Volunteers: hours of program service were contributed by volunteers in FY2020. 10. What was the CEO/Executive Director (or highest paid title) compensation in FY2020? (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 FY2020 IRS Form 990. If your FY2020 IRS Form 990 is not yet prepared, please provide an estimate for the following questions. 12. What were your organization's total expenses in FY2020? 13. What was your organization's total revenue in FY2020? 14. What was the organization's total in grants and contracts for FY2020? 15. What was the organization's total donations and in-kind (fundraising) in FY2020? 16. What percentage of your expenses are program service expenses' versus management and general expenses2 in FY2020 as reported on your IRS Form 990? 1Program service expenses are defined as expenses needed to run your programs. 2Management and general expenses encompass expenses such as 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 FY20;page 19 396