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Item C14 i } Xrr t"~ BOARD OF COUNTY COMMISSIONERS __1' '�;l • — Mayor David Rice,District 4 Mayor Pro Tem Kim Wigington, District 1,�� :. OUNTY o MON ROE �-� -��- • •. ��• _ Heather Carruthers, District 3 KEY WEST FLORIDA 33040 1 t' ' . y : .tic " SYlvia J. Murphy,District 5 (305)294-4641 ti :,, ^I'`i' — George Neugent, District 2 District 4 Office: 'ricr1,. 9400 Overseas Highway � ''k` 't -'t Florida Keys Marathon Airport Suite 210 Marathon, FL 33050 Ph: 305 289-6000 z,t00- Fx: 305 289-4610 " y �' Em: boccdis4@monroecounty-fl.gov ti . ? 3 -au? 0, fl I Interoffice Memorandum Date: October 15, 2012 To: Danny Kolhage, Clerk of the Court' From: Mayor David Rice,District 4 ': /1/4,7434,--- Re: Notice of Voting Conflict Per Florida Statute 112.3143, I hereby disclose by written memorandum that I will abstain from the vote on certain issues that are brought befoi e the Monroe County Board of Commissioners with entities, which I am involved with.: I will abstain from the vote on issues concerning the Guidance Care Center, Inc., a private, not-for-profit entity, which receives some of itsioperational funding from the County, as I am currently a member of the Board of Directors of the(Care Center. At the October 15, 2012 BOCC meeting, I will abstain from the vote on item(s). #C13—Approval of agreement with Guidance Care Center for , Baker Act transportation services and Transportation Disadvantage grant program match. ' #C14—Approval of agreement with Guidance Care Center for local match fisnding for Substance Abuse.arid Mental Health services for the period from October 1, 2012 through September 30, 2012. #C15—Approval of agreement with Guidance Care Center for the Jail Incarceration Program for the period from October 1, 2012 through September 30, 2012. , I BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: October 17, 2012 Division: OMB Bulk Item: x No — Department: Grants Staff Contact /Phone 4: Lisa Tennyson x 4444 AGENDA ITEM WORDING: Approval of agreement with Guidance Care Center for local match funding for Substance Abuse and Mental Health services for the period from October 1, 2012 through September 30, 2013. ITEM BACKGROUND: Monroe County is providing local match funding pursuant to FS 394,76, for Substance Abuse Mental Health (SAMH) services, inclusive of Baker Act services. This is a match for State funding for SAMH services, which is managed by Florida Department of Children and Families. DCF contracts with the South Florida Behavioral Health Network to provide substance abuse and mental health services in South Florida. SFBHN in turn contracts with the Guidance Care Center to provide SAMH services in Monroe County. A copy of the contract with SFBHN is attached. "Exhibit H" in that contract is a snapshot of the contract — it indicates the specific SAMH services that are funded, state funding for those services, and the local match requirement amount. (A copy of the exhibit is pulled out and is in front of contract for easy reference.) Monroe County's portion of local match amount reflects the match requirement after other local revenue sources and amounts are applied. (A copy of the contract between DCF and SFBHN is also attached.) PREVIOUS RELEVANT BOCC ACTION: The BOCC met in June 2012 to discuss Guidance Care Center's budget and finalized $570,792 as the local match amount required of Monroe County. Minutes from that meeting are attached. CONTRACT/AGREEMENT CHANGES: Guidance Care Center's funding was moved from FISAB item to a SAMH line item under the BOCC. STAFF RECOMMENDATIONS: Approval TOTAL COST: S 570,792 INDIRECT COST: BUDGETED: Yes X No DIFFERENTIAL OF LOCAL PREFERENCE: NA COST TO COUNTY: $570,792 SOURCE OF FUNDS: REVENUE PRODUCING: Yes No APPROVED BY: County Atty V DOCUMENTATION: Included DISPOSITION: Revised 7/09 X AM 8 NT PER MONTH Year 6C M, B/Pure asing _ Risk Management Not Required AGENDA ITEM 4 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract# Contract with: Effective [}ate: ]0\A}1/12 Expiration Date: 9/3{/]3| Contract Purpose/Description: Local match for state funding to Guidance Care Center for Substance Abuse Mental Health pursuant to FS 394.76. Contract Manager: Lisa Tennyson (Name) for BOCC meeting (Ext.) (Department) 4444 OMB/Grants ndaOead|ine: CONTRACT COSTS Total Dollar Value of Contract: $570,792 Current Year Portion: Budgeted?YesZ No Account Codes: 001-045902-53{I34} ------- Grant:______ County Match: Match: $_____ - - - - ADDITIONAL COSTS Estimated Ongoing Costs: $r For: (Not included in dollar value above) /eg. maintenance, utilities, janitorial, salaries, CONTRACT REVIEW Changes Date In Needed Division Director YesEJ NoEl O_ Risk Manage t K/!_k� Yes|lNon O.M.B./Pu4sing / YesFlNoF1 County Attorney VYesF-lNoFl Comments: umut-onnKev/sea9/lI/9b MCP#2 Date Out Reviewer ^/ Contract Exhibit H Indicating Local Match Amount Exhibit H FY 2012-2013 PXHIB rF Hs FUNDING DIII'AII.. 7 mii>rrAL * wAIJIR7 Buei4tet Fi10#Y 6091()546 - Aa&!It'v N/entsa I-Ioalth OCA ANKAW17 Budllet hhtity 60910506-CRliidren'S Mental Hexllth WA AMOI,INT 502004-FIYIFRC""=t++NCY STAII K,.IZATK)tN 5(130f11-{S4FRC:FNCY S`tAl3 B.I'LA`IRON <✓A-AI)UI:1 <<)NPvL MFNF.AT. FIIIAl:I'H (1006 t0) .... (:/A-CIII.)tRWN'S MRIVI'AI. HF:AI; I'H (10043$) ADs.MH £: it. tci F(()2'7(X)5)' AI, t ADAMHT t rand TF(O'2700.5)' cF 'Si C sl Rc..> v i (fXX),I 26)' 'T4TF A Fs's 1 g _.. _ 10N,264 r G.: —I R4vunu., ((XX)326)' (1 .,f)- 3)" A k� `.4 t i FGTF T tl XXI (261015) C:,nvi.s(.F,4.uW ruo, (fXX)3'26)' sMIF>t _ C t ai Rc---((X))326)' sN II-4C1 (:/A BAK1R A< Y SFRVICI:S 11006I 1) (./A-C Hi1 DRIN'S 13 AKIR ACT (104257) Cw.... t Ruva tu.. ((X))i26)"' ,\) ss I ,�+... i.(X)3,63) : Ccne +tt R4v-1 - ((XX)326)' ('L_SS F'nwrPencY Statiti—tion Total $ 1,112,903 F1net — '& Y St hi{iznti 't'otslt = $ 15,677 Un4axx1 nsatcd U>Sts S _22.581 U >ncert_ t d Unit, s 3.13s 502018-RI1)U()VFRY& RONN 1111PNCY 503013-It"C:OVERY& RON II,IFNC,:Y (;/A-ADU:7 CONING NINVI'AI, H1AIMH (1006 i(i) TA (;/A-CIIII,I)RISPS MENTAL JUI.,'FH (100435) A©\MH Tcg Fund FF (027( 5) ri RR`,i S ADA MH Ti—( Fun8/ TF (027005)' c:YZI2'i t S _ 153 TS2 f7.l.M Li" (0 7(X7ti) ARKS: .. C;4n.- I R� ((XX)? ()' (t F{.`.1 Ci1 R ((%X)? 6) AR `."g I )k8 >48 C><. ie I R t Cfi Icte.,i1 R,kof FlJ (((XH26) C;RfAG\11 A M t y t(XX)3"6)' M-ts.INJI FGTF MIAMI DADS Wr: 1 A tna Pro YR-1 (261015) ('%SD 1 At .. F'.. iic.<F ((027(6) AD F 1 1Gi tT tF. d 5 i It A Z7A N1Fi T t F .1 - FAC`{' \ l (C7 7IX)s) <`TAS 1'I' A i 2 z Gt n— l R t ((XX)i 6) �,1 yMA C,4 ii Ruv.„ iuu FA CI ♦ t ilX%)i"'67 t'tA }'> t GR-TV R .tor fit —nip To P—((XXH26)' 12,10 s -FMCaT'VIA-M^i cl Ad - in (26I015) 7NS'A7) FU`CF TLIu-XXl C261075) k.TG 13 ) a e t F( rF t i3F>T i a <;/A-PUR<._IIA413) RI2SII)tFN't1At, FC'i"F FOGC',F''I I i.n P sn H,,—I snwk. (261015) f;xoI4 "'s X)h 7 TRIArNtFNI SIRVIK IN (1027R0) (',).4(X M rt (0 7)i) MI-TSIh 3 _. s ., ... ..... p CTtfMCAID Lich MCAID MOE (((X)326)- G6z. tsi ANI emu1001)1n> 9t9 IA�_ t us (�2/R rch Ras Trutt —t M—li-tidS ((XX)326) 'tPK X'$ WT"FF"£ANF'f-ll)I(X)7) iS�h iA { _ .vi . .., .."' ((X 0326) Tc1 s}S«,rttt :nazut Tt—t F—W (122023) nRRSI Pil-.rii Cx.ua41'ixsst. Ili n.1 C'-(!1()15) — AK*p{St --. 7 (;/A-1SNIAI(';FN'l`PS YC1i MI,3>S PRO(;RAM (101350) Rc —'. ((XX):i26)' ;1 )2RS I I's T. 1 N.>n-TANF $ 1.295.120 F. (.tl Ni-=T`ANF $ 444)1(") Rccow ry �r R4si1 ncY '1 a[:.l1 = $ 1 75,120 I't--'Y V Re. ilicncy 'I"CttN{ _ $ 44/),000 Unwny>.-nsi>ted Units $"!i9,(Y24 Uneoirr(oenscitc;d Units $$ kii3,(N7O ADUTA-S MIN1'AL IBAL'IRi= $ 2,4023,023 "lY)'1'AI, CHII.I)RI.N'S MFNTAI. REAL'"-( 'S 45�5,677 S UIISTANUU ABUS E B! ci8ct F�ity 60910604 - Adni t' Solxv tanee Alxtxu OCA AM<>Ur-`F 04-CN Bulb:et FSrtity 6I)9 tt)604 -Chit<Men's Suttstrtrtcax Atxise OCA 60 i•005-I)F.1f)X 1FICAII<}N <'i)N7M'44dBN lAN<'F, A1II7:sI SVC:S (100618) 60200I-DI?ty609l4) ARE ANK)UN7' A DA MI -I T t F J'TF (f7Z70()S)"' to (';\AY 'ti' # <;/A-CHILD/AIN,)L S IRIStANt3i: All LIS T S VCS (100420) R— -- ((X)0326)-- 84, i59 ADA MH Trust l--1d TF(027(X).5)"' ( 1 .' "<:,,..: UThA's 102,2:34 'FSTF(122(Y23)*' Dhto ifi.,ation Total = $ 1116,643 i7N:#erxi kl4:lh.tn'I"otnl = I RI'VIN X; Ihlceun{xn�ntM U'ni is $ 37-Q9 Un4uxn{x. .wd Unit.5 (VA-C6 TAN -L.W Al U ABIJ.SfiS VCS 603002.-PRI;VWN'FI0N StRVICFS G-..'I) i,""UIISTAN(lu (iu .i=st Ruvo ({XX)i26)" (10061R) .- (WA-CHII..I)/AI)OI, SUBSFANCEABUSESVC.S(100420) A[?A h1H Tsiavt FCsncl PF f()27(X)5). w:«:x Af2G 15 PR�1'y ADAMHT t F d'I'F(027(X)s)"' PNI (s 5 F IT" 16'2 ._. G`v ut.1 R ((XX)'>2(',)"• G:nct a(Auv�,uu ((XX)326)" ,`:i",!(":; ,.£ f ...17Z262,. PreK-otion !! r I rt!! $ - U its S- I'e'elcnhewt S—i 4v'Fotal = X 603007-'I"Rl+A7'M1+N'T 8c AF"17 RC-ARI. CJ >tni).-ns.ito±xt Unit,, $ 34.452 C;/A <()N1M 41RIN 1ANLUABl,7,SLSYCS 602003-'I& AF'I'PUCARE' ADA MII I t F e.i I'F ((Y27(X)5) " (100618) (;/A-CHB�D/AIX)I ': UIIS FANCIEf.ABI iF:S VC,'4(100420) ((X X)i ^6 )" "` CE<7 5 `4 .2 t.93h ADAMH T t F tnel TF (0.�7IX);a)"*'' 7 t k f'S 4) 7I, 1 44 E `> f+4,S95 _ R.I.—I. C'. -n— l R. v t (O(X)326)*' ADAMHP I 1 [F(027W.S)'*"! ADA I-f r ,t C'E2') 1S ?7HC`. $ i6(p; TSTF(1.:.:023)" S A DANIH I F iX)32 (02?(X)5)'*' 7tiv _ OYeMTF {51(�()15)*'" iF FCS f (,3v- sal Rue.. e( (IXX74:26) f>M . _.. .. _ . .: A.DAMH Tntnt Fund TF (0270()5)"' `"t.IfV i . y 3'i'I f'(3 t £ WTTF TANF (4{)1(X)1) C.R7 )i(;entD 8P MOE((XX},32g)+� t`.rXCrt i5i'(D8 .. .. C.:n�r 1R uno ((XX)i?6)" F C,T H` FL A—, I R v (26101_5) F.11 FRh ADAM H Ti-, I Fund TF(027005)'*' >i ft.S .. t ( 67015) ' SS BG TF (6;S'J(X),Z) i t R I'C' ; - } F(711- <,,.. 'ue i tvrtarv..n Ttc-ut Pt- (2610]'S) 71I A t'lXi SBtX" a .. _. C:a c.t Rve cnuar ((XXd32f>y"* S h.t �� .... ...... ... M AI)AMH"4"sane Puncl 'T'F ((Y2'7(X1"`s)"""' TotaF N,- TA NF $ 31X0. 131 'I'resttrrwnt .k' Attercae-c 'Iiltx#i 39 T"tnl N—, TANF $ 'treatment ,)(Y,). 139 tTnc.>evpvnasit�et Units $ , $ 8J33,027 78.(Y27 tic Attsircarc 'Fetal = $ 3� )9,139 (,rty4c, mL)w;ns at4<i Llnits $ 6l.£i28 'tO'I'AL ADLR.7"S SUBS'FANCI+:.AB US I,= $ -76.776 TOTALCHILDRF]N'S SUIIS'LANCli ARUSE= .F 48 1.401 'FOTAI. ALL PRO-G RANTS — :$ 3,921,877 FUNDS NOT Rk'.f,1Li1RI N(i hIAT('H: 'lY)TAI. A1d. (' MI INSATF" UNTFS = UNC'S 784,3'7S 74,37S (;RAND'F(YI'AL OF PR<),(;RANDS & UNCK)MI INSA'FFR) I)NH'S = $ 4,706,252 2.2 ��.�..06. >tttt �t t t t,n Pt„���t ' TOTAL„ FUNDS REQUIRING MATCH= $$ 2,501.857)t.)F 57 Y+ _ ? 1 O.{XX} iLOCAL L MATCH REQUIRED _ 933.9Sz 375,970, ADDITIONAL... LOCAL, MATCH - .._._ _.._.J TC7F �I FUNDS NOT K1T UIRIN MATCH= Q G 5 1.120,020 v Mtvz71 CI++xlt Y Stl> „ '""-" GE2A ND TO"CAL[_OC'A L. MATCH= $ 9:�.....3.YLR? " 4t i c� It Pr E ,t<L't rcr. x tilt+u.k C _ {tt 1 Ais4' - tiF.SI'RIC'1-I<>N.4 AI'YX.Y Guidance Care Center, Inc, 102 Contract No. ME225-3-27 BOCC Minutes Indicating Approval of $570,792 to Guidance Care Center �u^:^'�" ) / ~ ` 122 MISCELLANEOUS Mayor Rice recognized Robert Reyes, Monroe Cnunty`xlobbyist with the firm Floridian Partners, LLC. Mr. Reyes addressed the commission. MISCELLANEOUS BULK APPROVALS ItemCl3 The Board discussed for consideration nfthe recommendation ofthe Climate Change Advisory Committee to evaluate and' lcmudanin-countymrd waste composting prugrum. Doug Gregory, Director of Extension Services discussed the matter. The Board ouqucyiod that a presentation be nondc at the July or August oomomnixuinncr^m noec(iug in order to decide if an RyPshould bc issued. COUNTY ADMINISTRATOR Item M7 USCG Auxiliary Phil Goodman updated the Board oothe upcoming Oil Spill So['etw Tro oi:g for Volunteers in the Florida Keys. The one day training is being offered [rcc of charge bvthe USCG, USCG }\uxi|iuryand Monroe Coun1y`uEmergency Management u1the following locations: June Z3nL2U|2,q:OOAM-Monroe County Emergency Operations Center, 2798 Overseas Hwy., Marathon. July 2LsL2O|2, 9:OO/\M-Murray Nelson Government and Cultural Cou(oc 10250 Overseas Hwy.. Key Largo. August |8(h,2O12,9:OO/lM-Harvey Government Center, 1200{uxuun/\ve., Key West. Mayor David Rice disclosed bcwould abstain from the vote outhe following item aabcCurrently serves naumember ufthe Board ufDirectors ofthe Guidance Care Center: Item &14 The Board discussed Monroe Cuuniy`uportion ofthe statutory local match requirement for Substance Abuse Mental Health services (FS 394.76) in the amount of $570,792 for F`f20i3 for the DCF-contracted provider of these services, Guidance Care Center, revising the previous amount of $312,527presented o1the May meeting. Roman (3aatoxi,County /\doninis(ra1or;TinuQouo,Budget & Finance Director; and Lisa Tennyson, Grants Administrator ~�-~ discussed the item. The following individuals addressed the Board: Frank Rubhho, Senior Vice President ofthe Guidance Clinic; A. B. Malay, representing the Guidance Care Center; and Sheriff Robert Peryacn. After discussion, motion was made byCommissioner Murphy and seconded byCommissioner Carruthers approving the minimum amount of$57U,792. Roll call vote was taken with the following results: / Commissioner Carruthers Yes Commissioner Murphy Yes 122 Mayor Pro Tern \Vigiogmn Yes Motion uucroJ, Mayor Rice abstaining. The Board continued discussion on the item. Danny L. Ko|boge, County Clerk addressed the cornmission and Suggested that the Guidance Clinic provide the Board with uschematic financial package. EMPLOYEE SERVICES (]| Herman Koch, Manager ofthe Promotions Program - Blue Cross Blue Shield discussed u partnership with the County regarding owodohc wellness program. Boman Gamtemi, County Administrator discussed the item and indicated that uhealth fair screening day imbeing o|uoucd for Monroe County cnop|oyccm as well as on incentive to attend the huu|(b fair allowing employees one day off inorder inaccordance with their Supervisor. DIVISION OF GROWTH MANAGEMENT Item 1i Mayte Santarnaria, Aumix(antDirector-Plmmiogmud Environmental Resources introduced John Abbott, Director of Environmental Sciences and Water Resources Planning Division, ofthe firm KciLh& Subnarsvvbn made upresentation ofthe United States Nuvy`a Atlantic Fleet Training and Testing Draft Environmental |cnpuot Stutcnuon( (QE|S) and the proposed operational alternatives within the Key West Range Complex which may impact the County. After discussion, motion was made by Commissioner Murphy and seconded by Commissioner Carruthers authorizing the Mayor to sign the County's comment letter on the I)E(S n/hiob will bcdrafted by Keith and Schnurs" P./\., and Tyson Sondb, Esq., /\iCP (Outside legal uouoac| for Monroe County). The following individual addressed the Board: Ron Cole. Motion carried unanimously. Item 13 Qkcb Jones, Senior Administrator - Marine Bcyoucocx discussed the National Marine \Yauk: Foundation's 0NMWfl anticipated 6xJwc/ and description ofservices for mobile pump out service inthe Keys. Motion was made byCommissioner y4uugtmKand seconded hy Cocuonimmioocr Carruthers approving the written artioipo1cdNMWF`u budget provided k` the Board during ioday`smeeting. Roll call vote vvuaunanimous. COMMISSIONERS' ITEMS Item K3 Mayor Rice provided the Board auupdate bzhis item concerning thcCuukunm Project at the Marathon Airport Terminal Facility. Ucro K4 The Board discussed Commissioner's Murph«`x item concerning uResolution for the waiver o[building permit fees inthe amount ofapproximately $13.125 (nconstruct 7 affordable housing units for project kuovvnuaMnuRE: #O055472O.O0U0OOand UV554720.0OO1OO,Mandalay 98|-|94,Key Largo PTSquare 3,for Uobi&dfor Humanity ofthe Upper Keys (U|1DK),requested byDirector Jack Niedbn|xki. Christine Hurley, Growth Management Director discussed the item. After discussion, motion was cuadc by Commissioner Murphy and seconded by Commissioner Carruthers (oadopt the fh||ov/iog Flcsn|u1iou. Motion carried unanimously. FY 2013 SAMH Contract AGREEMENT This Agreement is made and entered into this 17th day of October, 2012, between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as "Board" or "County," and Guidance/Care Center, hereinafter referred to as "PROVIDER." WHEREAS, the County participates in funding substance abuse and mental health (SAMH) services within the County pursuant to Section 394.76(9)(a), Florida Statutes; and WHEREAS, the PROVIDER is a not -for -profit corporation that provides SAMH services within Monroe County; and WHEREAS, it is a legitimate public purpose to provide substance abuse and mental health services for individuals, now, therefore, IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as follows: FUNDING 1. GRANT OFFER TO THE PROVIDER. The County hereby agrees to provide local match funding for State funding pursuant to Section 394.76(9)(a), Florida Statutes, and the contract between the PROVIDER and South Florida Behavioral Health Network (ME225-3-27) 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 exclusively. Contract ME225-3-27 references State contract KH-225; that contract is also attached herein (Attachment E). 2. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially and satisfactorily performing and carrying out the duties and obligations of the Board, shall reimburse the Provider for a local match portion of the Provider's expenditures for Substance Abuse and Mental Health services, as billed by the Provider, for clients qualifying for such services under applicable state and federal regulations and eligibility determination procedures, for substance abuse treatment. This cost shall not exceed a total reimbursement of FIVE HUNDRED SEVENTY THOUSAND SEVEN HUNDRED NINETY TWO AND NOj100 DOLLARS ($570,792.00) in fiscal year 2012-2013. 3. TERM. This Agreement shall commence on October 1, 2012, and terminate September 30, 2013, unless earlier terminated pursuant to other provisions herein. 4. PAYMENT. Payment will be paid monthly as hereinafter set forth. Baker Act and SAMH Billing Summary Forms, certified monthly financial and service load reports will be made available to the Board to validate the delivery of services under this contract. The monthly financial report is due in the office of the Clerk of the Board no later than the 15th day of the following month. After the Clerk of the Board pre -audits the certified report, the Board shall reimburse the Provider for its monthly expenses. However, the total of said monthly payments in the aggregate sum shall not exceed the total amount shown in Article 2, above, during the term of this agreement. To preserve client confidentiality required by law, copies of individual client bills and records shall not be available to the Board for reimbursement purposes but shall be made available only under controlled conditions to qualified auditors for audit purposes. The organization's final invoice must be received within sixty days after the termination date of this contract shown in Article 3 above. Payment will be made periodically, but no more frequently than monthly, as hereinafter set forth. Reimbursement requests will be submitted to the Board via the Clerk's Finance Office. The County shall only reimburse, subject to the funded amounts below, those reimbursable expenses Guidance Care Center-SAMH Contract; FY13; page 1 which are reviewed and approved as complying with Monroe County Code of Ordinances, State |avva and regulations and Attachment /\ - 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 letter, summarizing the expenses, with supporting documentation attached. The letter should contain a notarized certification statement. An example of reimbursement request cover letter is included as Attachment B. The onganization's final invoice must be received within thirty days after the termination date of this contract shown in Article 3 above. After the Clerk of the Board examines and approves the request for reimbursement, the Board shall reimburse the PROVIDER. However, the total of said reimbursement expense payments in the aggregate sum shall not exceed the total amount shown in Article 2, above, during the term Ofthis agreement. S. AVAILABILITY OF FUNDS. The County reserves the right to withhold/reduce the funds to the Provider in the event that the Department of Children and Families eliminates/reduces the State contract funding. If funds cannot be obtained or cannot be Continued at a level sufficient to a||ovv for continued reimbursement of expenditures for services specified herein, this agreement may be terminated immediately at the option of the Board by written notice of termination delivered to the PROVIDER. The Board shall not be obligated to pay for any services or goods provided by the PROVIDER after the PROVIDER has received written notice of termination, unless otherwise required by law. 6. CLAIMS FOR FEDERAL OR STATE AID. PROVIDER and County agree that each shall be, and is, empowered to apply for, seek, and obtain federal and state funds to further the purpose ofthis Agreement; provided that all applications, requests, grant proposals, and funding solicitations shall be approved by each party prior to submission. 7. PURCHASE OF PROPERTY. All property, whether real or personal, purchased with funds provided under this agreement, shall become the property of Monroe County and shall be accounted for pursuant to statutory requirements. RECORDKEEPING S. RECORDS. PROVIDER shall maintain all books, records, and documents directly pertinent to performance under this Agreement in accordance with generally accepted accounting principles consistently applied. Each party tothis Agreement ortheir 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. 9. PUBLIC ACCESS. The County and PROVIDER shall allow and permit reasonable access to, and inspection of, all documents, papers, letters or other materials in its possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the County and PROVIDER in conjunction with this Agreement; and the County shall have the right to unilaterally cancel this Agreement upon violation of this provision by PROVIDER. 10. COMPLIANCE WITH COUNTY GUIDELINES. The PROVIDER must furnish to the County the following (items A-M must be provided prior to the payment of any invoices): (a) IRS Letter ofDetermination and (5UI[}ESTAR printout indicating current 501(c)(3) status; Guidance Care [enter-8AMHContract; pM�page 2 (b) 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; (c) Evidence of annual election of Officers and Directors; (d) Unqualified audited financial statement from the most recent fiscal year for all organizations that expend $150,000 a year or more; if qualified, include a statement of deficiencies with corrective actions recommended/taken; (e) Copy of a filed IRS Form 990 from most recent fiscal year with all attached schedules; (f) Organization's Corporate Bylaws, which must include the organization's mission, board and membership composition, and process for election of officers; (g) 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; (h) Specific description or list of services to be provided under this contract with this grant (see Attachment C, per contract ME225-3-27); (i) Quarterly reports: a report for the preceding quarter which consists of a quarterly financial budget and expenditure report and a demographic report, and must be submitted within twenty (20) working days of the end of the reported quarter; (j) All legally required licenses; (k) Any updates throughout the fiscal year to the South Florida Behavioral Network contract with the Department of Children and Families (KH-225) and with Guidance/Care Center (ME225-3-27); (1) Current job descriptions for staff positions; (m) Match documentation; (n) Cooperation with County monitoring visits that the County may request during the contract year; and (o) Other reasonable reports and information related to compliance with applicable laws, contract provisions and the scope of services that the County may request during the contract year. 11. AUDIT. The Provider shall provide the County with an annual audit pursuant to Section 394.76(9)(a), Florida Statutes, which separately reflects the funds received from the County and related expenditures of said funds during the 2012-2013 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, 2014. RESPONSIBILITIES 12. SCOPE OF SERVICES. The PROVIDER, for the consideration named, covenants and agrees with the Board to substantially and satisfactorily perform and provide the services outlined in Attachment C to residents of Monroe County, Florida. 13. ATTORNEY'S FEES AND COSTS. The County and PROVIDER agree that in the event any cause of action or administrative proceeding is initiated or defended by any party relative to the enforcement or interpretation of this Agreement, the prevailing party shall be entitled to reasonable attorney's fees, court costs, investigative, and out-of-pocket expenses, as an award against the non -prevailing party, and shall include attorney's fees, courts costs, investigative, and out-of-pocket expenses in appellate proceedings. Mediation proceedings initiated and conducted pursuant to this Agreement shall be in accordance with the Florida Rules of Civil Procedure and usual and customary procedures required by the circuit court of Monroe County, 14. BINDING EFFECT. The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the benefit of the County and PROVIDER and their respective legal representatives, successors, and assigns. 15. 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, Guidance Care Center-SAMH Contract; FY13; page 3 solicitation or acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public position, conflicting employment or contractual relationship; and disclosure or use of certain information. 16. NO SOLICITATION/PAYMENT. The County and PROVIDER warrant that, in respect to itself, it has neither employed nor retained any company or person, other than a bona fide employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bona fide employee working solely for it, any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of the provision, the PROVIDER agrees that the County shall have the right to terminate this Agreement without liability and, at its discretion, to offset from monies owed, or otherwise recover, the full amount of such fee, commission, percentage, gift, or consideration. 17. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the PROVIDER is an independent contractor and not an employee of the Board. No statement contained in this agreement shall be construed so as to find the PROVIDER or any of its employees, contractors, servants or agents to be employees of the Board. COMPLIANCE ISSUES 18. COMPLIANCE WITH LAW. In providing all services pursuant to this agreement, the PROVIDER shall abide by all statutes, ordinances, rules and regulations pertaining to or regulating the provision of such services, including those now in effect and hereinafter adopted. Any violation of said statutes, ordinances, rules and regulations shall constitute a material breach of this agreement and shall entitle the Board to terminate this contract immediately upon delivery of written notice of termination to the PROVIDER. 19. PROFESSIONAL RESPONSIBILITY AND LICENSING. The PROVIDER shall assure that all professionals have current and appropriate professional licenses and professional liability insurance coverage. Funding by the Board is contingent upon retention of appropriate local, state and/or federal certification and/or licensure of the PROVIDER'S program and staff. 20. NON-DISCRIMINATION. County and PROVIDER agree that there will be no discrimination against any person, and it is expressly understood that upon a determination by a court of competent jurisdiction that discrimination has occurred, this Agreement automatically terminates without any further action on the part of any party, effective the date of the court order. County or PROVIDER agree to comply with all Federal and Florida statutes, and all local ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1) Title VI of the Civil Rights Act of 1964 (PL 88-352) which prohibits discrimination on the basis of race, color or national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC ss. 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; 3) Section 504 of the Rehabilitation Act of 1973, as amended (20 USC s. 794), which prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended (42 USC ss. 6101-6107) which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, ss. 523 and 527 (42 USC ss. 690dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC s. et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC s. 1201 Note), as maybe amended from time to time, relating to nondiscrimination on the basis of disability; 10) Any other nondiscrimination provisions in any Federal or state statutes which may apply to the parties to, or the subject matter of, this Agreement. Guidance Care Center-SAMH Contract; FY93; page 4 AMENDMENTS, CHANGES, AND DISPUTES 21. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the services and/or reimbursement of services shall be accomplished by an amendment, which must be approved in writing bythe County. 22. ADJUDICATION OF DISPUTES OR DISAGREEMENTS. County and PROVIDER agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of the pa/ties. If no resolution can be agreed upon within 30 days after the first meet and confer session, the issue or issues shall be discussed at a public meeting of the Board of County Commissioners. If the issue or issues are still not resolved to the satisfaction of the parties, then any party shall have the right to seek such relief or remedy as may be provided by this Agreement or by Florida law. 23. COOPERATION. In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breach of this Agreement, County and PROVIDER agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement. County and PROVIDER specifically agree that no party to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. ASSURANCES 24. COVENANT OF NO INTEREST. County and PROVIDER covenant that neither presently has any interest, and shall not acquire any interest, which would conflict in any manner or degree with its performance under this Agreement, and that only interest of each is to perform and receive benefits as recited in this Agreement. 25. NO ASSIGNMENT. The PROVIDER shall not assign this agreement except in writing and with the prior written approval of the Board, which approval shall be subject to such conditions and provisions as the Board may deem necessary. This agreement shall be incorporated by reference into any assignment and any assignee shall comply with all of the provisions herein. Unless expressly provided for therein, such approval shall in no manner or event be deemed to impose any obligation upon the Board in addition tothe total agreed upon reimbursement amount for the services of the PROVIDER. 26. NON -WAIVER OF IMMUNITY. Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the County and the PROVIDER in this Agreement and the acquisition of any commercial liability insurance coverage, self-insurance coverage, or local government liability insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall any contract entered into by the County be required to contain any provision for waiver. 27. ATTESTATIONS. PROVIDER agrees to execute such documents as the County may reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug - Free Workplace Statement. 28. AUTHORITY. Each party represents and warrants tothe other that the execution, delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. INDEMNITY ISSUES 29. INDEMNIFICATION AND HOLD HARMLESS. The PROVIDER covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners from any and all claims for bodily injury (including death), personal injury, and property damage (including Guidance Care Conter-3AMHContract; FM3;page 5 property owned by Monroe County) and any other losses, damages, and expenses (including ottonney'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 o/ the PROVIDER'S employees, agents/ or volunteers. 30. PRIVILEGES AND IMMUNITIES. All of the privileges and immunities from liability, exemptions from laws, ordinances, and rules and pensions and re|ief, disability, workers' compensation, and other benefits which apply to the activity of officers, agents, or employees of any public agents or employees of the County, when performing their respective functions under this Agreement within the territorial limits of the County shall apply to the same degree and extent to the performance of such functions and duties of such officers, agents, volunteers, or employees outside the territorial limits of the County. 31~ NO PERSONAL LIABILITY. No covenant or agreement contained herein shall be deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe County in his or her individual capacity, and no member, officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to any personal liability or accountability by reason of the execution of this Agreement. 32. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non -Delegation ofConstitutional or Statutory Duties. This Agreement is not intended to, nor shall itbeconstrued as, relieving any participating entity from any obligation orresponsibility imposed upon the entity by law except to the extent of actual and timely performance thereof by any participating entity, in which cage the performance may be offered in satisfaction of the obligation or responsibility. Further, this Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the constitutional or statutory duties of the County, except to the extent permitted by the Florida constitution, state statute, and case law. 33. NON -RELIANCE BY NON-PARTIES. No person or entity shall be entitled to rely upon the terms of this Agreement to enforce or attempt to enforce any third -party claim or entitlement to or benefit of any service or program contemplated hereunder, and the County and the PROVIDER agree that neither the County nor the PROVIDER or any agent, officer, or employee of either shall have the authority to inform, counsel, or otherwise indicate that any particular individual or group of individuals, entity or entities, have entitlements or benefits under this Agreement separate and apart, inferior to, or superior to the community in general orfor the purposes contemplated in this Agreement. 34. Execution in Counterparts. This Agreement may be executed in any number of counterparts, each of which shall be regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement bysigning any such counterpart. 35. NOTICE. Any notice required or permitted under this agreement shall be in writing and hand -delivered or mailed, postage pre -paid, by certified mail, return receipt requested, to the other party asfollows: Eor Board.' Grants Administrator and 1100B|rnonton Street Key West, FL33O4D For PROVIDER Frank Rabbito, Senior Vice President Guidance/CareCenter 1205 Fourth Street Monroe County Attorney PDBox 1036 Key West, FL33041 Guidance Care {ente,3AMHContract; Fv/3; page 6 Key West, FL 33040 36. GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES. This Agreement shall be governed by and construed in accordance with the laws of the State of Florida applicable to contracts made and to be performed entirely in the State. In the event that any cause of action or administrative proceeding is instituted for the enforcement or interpretation of this Agreement, the County and PROVIDER agree that venue will lie in the appropriate court or before the appropriate administrative body in Monroe County, The County and PROVIDER agree that, in the event of conflicting interpretations of the terms Or a term of this Agreement by or between any of them the issue shall be submitted to mediation prior to the institution of any other administrative or legal proceeding. 37. NON -WAIVER. Any waiver of any breach of covenants herein contained to be kept and performed by the PROVIDER shall not be deemed or considered as a continuing waiver and shall not operate to bar or prevent the Board from declaring a forfeiture for any succeeding breach, either of the same conditions or covenants or otherwise. 38. SEVERABILITY. If any term, covenant, condition or provision of this Agreement (or the application thereof to any circumstance or person) shall be declared invalid or unenforceable to any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant, condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent permitted by |avv unless the enforcement of the remaining terms, covenants, conditions and provisions of this Agreement would prevent the accomplishment of the original intent of this Agreement. The County and PROVIDER agree to reform the Agreement to replace any stricken provision with a valid provision that comes as close as possible to the intent of the stricken provision. 39. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the parties hereto with respect to the subject matter hereof and supersedes any and all prior agreements with respect to such subject matter between the PROVIDER and the Board. [THIS SPACE INTENTIONALLY LEFT BLANK WITH SIGNATORY PAGE TO FOLLOW] Guidance Care Qentep3AMHcontract; pM3;page 7 IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as of the day and year first written above. ATTEST: DANNY L. KOLHAGE, CLERK Deputy Clerk BOARD DFCOUNTY COMMISSIONERS DFMDNRDECOUNTY, FLORIDA By Guidance/Care Center 6 41 Director, Children &Rarni|ieS Guidance/Care Center iii! le-lig" Guidance Care Cemte,SAMHContrav pM3; page 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, asthey relate totravel, are from the Monroe County Code of Ordinances and State laws and regulations. Acover letter (see Attachment B) summarizing the major line items on the reimbursable expense request needs toalso 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'scontract 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 PaynoUJmurna| is provided, it should include: dates, employee name, salary orhourly rate, total hours worked, withholding information and paid payroll taxes, check number and check amount. If Payroll ]ourna| 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. Acopy ofthe rental orlease agreement is required. Deposits and advance payments are not allowable expenses. Reproductions, etc. A log of copy expenses as they relate to the County contract is required for reimbursement. The log must define the date, number ofcopies 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 CentepSAMHContract; pM3;page 9 Tellefax'Fax, etc. Afax 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 ofthe 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 besubmitted and will be paid in accordance with Monroe County [ode 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. Atrave| 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 tothe airport for a business trip is not reimbursable. Parking is considered reimbursable travel expense at the destination. Airport parking during business trip is not. Adetai|ed 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 beatthe 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 fora 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 ofthe Monroe County Code ofOrdinances. Meal guidelines state that travel must begin prior to 8 a.m. for breakfast reimbursement, before noon and end after 2 p.m. for lunch reimbursement, and before 6 p.m. and end after 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 CamCenter-SAMH Contract; FY13;page 10 ATTACHMENT B ORGANIZATION LETTERHEAD Monroe County Board ofCounty Commissioners Finance Department S00Whitehead Street Key West, FL]3O40 The following is a summary of the expenses for ( for the time period of to . Check # Payee 101 Company Rent $X,XXX.XX 102 Company Utilities XXX.XX 104 Employee P/Rending OS/14/01 XXX.XX 105 Employee B P/Rending 05/28/01 }XX^>X (A) Total (B) Total prior payments $X,XXX.XX (C) Total requested and paid (Af B) $X,XXX.XX ([}) Total contract amount $X,XXX.XX Balance ofcontract (O-C) I certify that the above checks have been submitted tothe vendors ao noted and that the expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this 0rganization'scontract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source. Chief Executive Officer Attachments (supporting documentation) Sworn tVand subscribed before me this who is personally known to me. day of Notary Stamp Guidance Care Caote+3AMHContract; FY13 paAa1/ ATTACHMENT C Services to be provided: (Insert a description of your organization including a list of the services that will be provided by your organization under this contract.) Local match Dortion of State -Funded Substance Abuse Mental Health Services, inclusive of Baker Act services, per Florida Statutes, and contract between Guidance Care Center and the South Florida Behavioral Health Network (ME225-3-27). Guidance Care Center-SAMH Contract; FY)3; page 12 PUBLIC ENTITY CRIME STATEMENT "A person oraffiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair ofa 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 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, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list." Guidance Care Center-SAMHContract; FY13;page /5 The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: (Name VfBusiness) 1. Publishes statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Informs employees about the dangers of drug abuse in the workplace, the business's 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 3. Gives each employee engaged in providing the commodities orcontractual services that are under bid a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notifies the employees that, as 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 no|o contendere to, any violation of Chapter 893 (Florida Statutes) or of any controlled substance |avv of the United States or any state, fora violation occurring in the workplace no later than five (5)days after such conviction. 5. Imposes sanction on, orrequire the satisfactory participation in adrug abuse assistance or rehabilitation program if such is available in the employee's community, or any employee who is so convicted. 6. Makes 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. STATE OF ct (Signature of Respondent) . Date PERSONALLY APPEARED BEFORE ME, the undersigned authority, who, after first being sworn by me, (name of individual signing) affixed his/her signature in the space provided above on this r~1�~day of 20['2 My commission expi CONS Guidance Care Center-GAMHContract; FM3;page /7 SWORN STATEMENT UNDER ORDINANCE NO. 1O-199O MONROE COUNTY, FLORIDA jg��"r— eO'Y�—OC 1-414:- warrants that he/it has not employed, retained or otherwise had act on his/its behalf any former County officer or employee in violation of Section 2 of Ordinance No. 10-1990 or any County officer oremployee in violation of Section 3 of Ordinance No. 10'1990. For breach or violation of this provision the County may, in its discretion, terminate this contract without liability and may also, in its discretion, deduct from the contract or purchase price, or otherwise recover, the full amount ofany fee, commission, percentage, gift, or consideration paid to the former County officer or employee. Date: STATE OF COUNTY OF PERSONALLY APPEARED BEFORE ME, the undersigned authority, who, after first being sworn by me, affixed his/her signature (name of individual signing) in the space provided above on this day of / _-__�_'. NOTARY POB�I� CONSTANCE A. My commission Bonded Thru Notary Public Underwriters Guidance Care Qenter-SAMHContract; FM3;page /0 ATTACHMENT D GCC's Contract with South Florida Behavioral Health Network Contract (ME225-3-27) Guidance Care Center-SAMH Contract,- FY13; page 13 �JSouth Florida Behavioral Health Network, Inc. www.sfbhn.org August 3, 2012 Marianne Benvenuti, Regional Controller Guidance/Care Center 3000 41" Street Ocean Marathon, Florida 33050 Dear Marianne; Enclosed please find the executed signature pages for the contracts between South Florida Behavioral Health Network, Inc. and Guidance/Care Center, Inc. contract number ME225-3-27 (main contract) and for the Emergency Contract. I have also enclosed an original copy of the Lobbying form (Attachment III) for both contracts and the SOAR Agreement for the main contract. I look forward to working with your agency during FY2012 — 2013, and feel free to contact me to facilitate aces pert4ining to your contract. Eve Kelly Contract Mana; (786) 507-7461 Enc. (5) STANDARD CONTRACT THIS CONTRACT iaentered into between the South Florida Behavioral Health Network, Inc., (GFBHN) hereinafter referred to as the "Managing Entity" (ME) and Guidance Care Center, Inc., hereinafter referred to as the "Network Provider." 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 ufSection 287.O58.Florida Statutes (F.Sj The Network Provider ahoU provide units of do\ivomb|oo, including neportn, findingo, and dnaftn, as specified in this contract, These deliverables must be received and accepted bythe contract manager and/or designee, in writing prior k/ 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, oratsuch lower rates an may be provided in this contract. Tnallow public access toall documents, pepem, letters, orother public records as defined in subsection 119.011(12). F.S. and as prescribed by subsection 119.07(1) F,G, made or received by the Network Provider in conjunction with this contract except that public moonda which are made confidential by law must beprotected from disclosure. |tiaexpressly understood that the Network Provider's failure \o comply with this provision ahuU constitute an immediate breach of uon\mo\ for which the ME may unilaterally terminate the Provisions of the Prime Contract All pmvisione, terms and oondNono, or amondmontn, addondum, changes or revisions applicable to the Network Provider made subsequent tothe initial execution ofthe Prime Contract, io.the Contract entered into between the DCFand SFBHN(k4E).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 isincorporated by vyforonoo in this Contract. In oaoo ufconflict with the pnmiaiono, terms and conditions of The phma Contract and this Contract, the pmvioiono, terms and conditions of this Contract will prevail, 4. Effective and Ending Dates This contract shall begin onJuly 1, 2012. It shall end at midnight, local time in Miami -Dade County, Florida on June 30, 2013.L 5. State of Florida Law This contract isexecuted and entered into inthe State cd Florida, and shall boconstrued, performed and enforced inall respects in accordance with Florida law, without regard to Florida provisions for conflict oflaws. Courts ofcompetent jurisdiction inFlorida shall have exclusive jurisdiction in any action regarding this contract and venue shall be the appropriate state court in Miami -Dade County, Florida. Federal Law a. Ifthis contract contains federal funds, the Network Provider shall comply with the provisions of federal law and regulations including but not limited to, 45 Code of Federal Regulations (CFR), Part 74, 45 CFR, Pad 92, and other applicable regulations. Lz U this contract contains over *100.000 of federal funds, the Network Provider ehuU comply with all applicable standavds, ondena, o, regulations issued under section 300 ofthe Clean Air Act, as amended (42 United States Code (U.S.Cj 7401 n1meqj. section 5O8ofthe Federal Water Pollution Control Act, anamended (33U.S.C. 1251 etnaqj. Executive Order 11738.aoamended and where applicable, and Environmental Protection Agency regulations (40CFR. Part 30). The Network Provider shall report any violations cfthe above iothe ME. o. No k*dend funds received in connection with this contract may be used by the Network Pnmidor, or agent acting for the Network Provider, or subcontractor to influence legislation or appropriations pending before the Congress or any State legislature. If this contract contains federal funding in oxooaa of $100.000. the Network Provider must, prior to contract nxocuhon, complete Guidance Care Center, Inc. I Contract mo.wE22s-3-2r the Certification Regarding Lobbying hxm. Attachment IL U a Disclosure of Lobbying Aobvhi»n form, Standard Form LLL' is nequied, it may obtained from the contract manager. All disclosure forms un required by the Certification Regarding Lobbying form must be completed and returned to the contract manager, prior to payment under this contract. d. Unauthorized aliens shall not be employed. The ME shall consider the employment of unauthorized aliens a violation of section 274A(e) of the Immigration and Nationality Act (8 U.S.C. 1324u)and section 101 of the Immigration Reform and Control Act of 1986. Such violation shall be cause for unilateral cancellation of this contract by the ME. Pursuant to Executive Orderl 1-2 signed on Januery4. 2011. the Network Pmvidor, and if applicable all subcontractors for work contemplated under this oontnao, shall use the E-Verify system established by the U.S. Department of Homeland Security to verify the employment eligibility of its employees and the subcontractors' employees performing under this contract. e.||this contract contains $1O.000ovmore offederal funds, the Network Provider shall comply with Executive Order 1124O.Equal Employment Oppnrtunhy, an amended by Executive Order 11375 and othom, and as supplemented in Department of Labor regulation 41 CFR. Part 0Oand 46CFR. Part92. if applicable. L Kthis contract contains federal funds and provides services 0ochildren uptmage 18.the Network Provider shall comply with the Pro- Children Act of1SO4(2OU�&C� 6081). Failure tocomply with the provisions ofthe law may result inthe imposition ofa civil monetary penalty of up to $1,000 for each violation or the imposition of an administrative compliance order on the responsible entity, or both, 7. Audits, Inspections, Investigations, Records and Retention a. The Network Provider shall establish and maintain books, records and documents (including electronic storage media) sufficient to reflect all income and expenditures of funds provided by the ME under this contract. 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 six (0) youm after completion cdthe contract or longer when required by law. In the event an audit is required bythis contract, records shall be retained fora minimum period of oix(6) years after the audit report is issued or until resolution of any audit findings or litigation based onthe terms cdthis contract, a(noadditional cost tothe ME. o. Upon demand, at no additional cost tothe ME. the Network Provider will facilitate the duplication and transfer of any records or documents during the required retention period inSection 7b. d. These records shall be made available at all reasonable times for innpoo1ion, mviow, oopying, or audit by Fodonai. State, or other personnel duly authorized bythe ME, o. At all reasonable times for as long as records are main<uinod, persons duly authorized by the k4E. State, and Federal audi\urm, pursuant to45 CFH. section 82.38(i)(10). shall be allowed full access toand the right to examine any ofthe 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 If. g. The Network Provider shall comply and cooperate immediately with any inspections, eviowa, investigationn, oraudits deemed necessary byThe Office of the Inspector General (section 2O.055.F.S.). h. The Network Provider shall include the aforementioned audit, inspections, investigations and record keeping requirements in all subcontracts and assignments. B. Monitoring bythe KdE The Network Provider shall permit all persons who are duly authorized by the ME to inspect and copy any rocorde, paperm, doouments, fooi|ihes, goods and oomi000 of the Network Provider which are relevant to this contract, and to interview any oUonto, employees and subcontractor employees of the Network Provider toassure the W1Eofthe satisfactory performance of the terms and conditions of this contract. Following such review, the ME will deliver to the Network Provider awritten report of its findings, and may direct the development, by the Network Pmvider, of 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 K8E^a termination rights tinder Section 4U. Failure to implement corrective action plans to the satisfaction of the ME, after receiving due notice, shall bagrounds for contract termination, g. Indemnification a. The Network Provider shall be fully liable for the actions of its agontn, omp|oy000, portnom, or subcontractors and shall fully indemnity, 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 ofevery name and description, including attorneys' fees, arising from or relating to any aiioQod act oromission by the Network Pmvidor, its agontn, omp|oyoeo, partnem, or subcontractors, pmvdod, however, that the Network Provider ohui\ not indemnify for that portion of any loss or damages proximately oouoad by the negligent act oromission cdthe ME. b. The Network Provider shall fully indemnify, defend and hold harmless the ME, the State and the DCF, from any suits, aodonn, domagea, and costs odevery name and description . including attorneys' feen, arising from orrelating Voviolation of infringement of atxadamaMk^ copyright, patent, \mdo secret or intellectual property hgh\, provided, however, that the foregoing obligation shall not apply to the ME'n misuse or modification of Network Provider's products or a K4E'n operation o, use of Network Provider's products |namanner not contemplated bythe contract orthe purchase order. \fany product inthe subject ofaninfringement suit or in the Network Provider's opinion inlikely tzbecome the subject of such anud. the Network Provider may ut its sole expense procure for the ME the right to continue using the product or modih/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 u trademadk, copyright patent, \xydo 000reg or in\oUoo\uu\ 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 &4E 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 trade secret information that is exempt from disclosure or the scope of the Network Provider's mdaction, as provided for under Section 34. d. The Network Provider shall not be liable for any cost, oxponna, or compromise incurred or made by the ME in any legal action without the Network Provider's prior written consent, which shall not be unreasonably withheld. The Network Provider's inability 8u evacuate liability or its evaluation of liability shall not excuse its duty \o 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 ioun agency orsubdivision of the Stato, its obligation \oindemnify, defend and hold hormiame the ME shall hetothe extent permitted by section 788.28. F.S. orother applicable |mw, and without waiving the limits of sovereign 10. Insurance 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) of it. By execution of this contract, un|oon it in a state agency or subdivision as defined by subsection 76820(2)' F.S.. the Network Provider accepts full responsibility for identifying and determining the type(a) and extent of liability insurance necessary to provide reasonable financial protections for the Network Provider and the clients to be served under this cun\nao1 The limits of coverage under each policy maintained by the Network Provider do not limit the Network Provider's liability and obligations under this contract. Upon the execution ofthis contract, the Network Provider shall furnish the ME written verification supporting both the determination and existence ofsuch insurance coverage. Such coverage may be provided by m self-insurance program established and operating under the |mwn of the State of Florida. The ME vanomeo the right to require additional insurance as specified in this contract. 11. Confidentiality ofClient Information The Network Provider shall not use or disclose any information concerning u recipient of oopvicon 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 orwhen authorized bylaw. 12. Assignments and Subcontracts a. The Network Provider ohoU 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 affectthe public interest; however, innoevent 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 oub|ioense, aao|gnmon\, 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 contractwithout prior written approval ofthe ME, which shall not beunreasonably withheld. b. The Network Provider shall ensure that all subcontract agreements for work contemplated under this contmc\, adhere to all of the requirements of the K4E's Prime Contract with the departmon1. KH225 and all the requirements ofthis contract. A copy of the contract KH225can bofound egthe K8E'owoboito.www.sfbhn.ong. o. To the extent permitted by Florida Law, and in compliance with Section A. ofthis Standard Contract, the Network Provider in responsible for all work performed and for all commodities produced pursuant \othis 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 K0Eagainst such claims. Guidance Care Center, Inc. 3 Contract No. Mszz5-3-z7 d. The Network Provider ohu\\ 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.8, 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 tothe subcontractor inthe amount of ono -half of one porzent(DO5) of the amount due per day from the expiration of the period oUm*od for payment. Such penalty shall be in addition to actual payments owed and shall not exceed fifteen (15%)percent of the outstanding balance due. a. 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 toanother governmental agency in the State of Florida, upon giving prior written notice tothe ME. In the *vent the Btoim of Florida approves transfer of the N1E'n obligations, the Network Provider remains responsible for all work performed and all expenses incurred inconnection with the contract. This contract shall remain binding upon the successors in interest ofeither the Network Provider orthe ME. I. The Network Provider shall include, or cause to be included, in all subcontracts (at any tier) the substance ofall clauses contained inthis Standard Contract that mention cxdescribe subcontract compliance. 13. Return of Funds a. The Network Provider shall return to the ME any overpayments due to unearned funds or funds disallowed that were disbursed to the Network Provider by the ME and any interest attributable to such funds pursuant to the \enno and conditions of this contract. In the event that the Network Provider or its independent auditor discovers that an overpayment has been made. the Network Provider shall repay said overpayment immediately without prior notification from the ME. In the event that the ME first discovers that an overpayment has been mudo, the contract manager ordesignee, on behalf ofthe YNE, will notify the Network Provider by letter ofsuch findings. Should repayment not bo made forthwith, the Network Provider will be charged interest on the outstanding balance after the [NE notification or Network Provider discovery. Payments made for such services subsequently determined bythe W1E to be in full compliance with the contract requirements shall be deemed overpayments. b. The funds paid tothe Network Provider are continually subject \o Roviow. Revision and Adjustment after evaluation of Utilization and Performance measures monitored byME. 14. Client Risk Prevention and Incident Reporting Mservices toclients 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 mbuee, neglect, or exploitation of a ohiid, aged pemon, or disabled adult to the Florida Abuse Hotline on the statewide toll -free telephone number (1-800'90ABUSE). An required by Chapters 89 and 415. F.S, this provision in binding upon both the Network Provider and its employees. 15. Civil Rights Requirements In accordance with Title VU ofthe Civil Rights Act of 1964. the Americans with Disabilities Act of 1990. or the Florida Civil Rights Act of 1892. asapplicable the Network Provider shall not discriminate against any employee (or applicant for employment) in the performance ofthis contract because of mce, ooior, veUgion, nox, national origin, d\nabi|i\y, ago, or marital status. Further, the Network Provider agrees not to discriminate against any applicant, client, or employee in service delivery or benefits in connection with any of its programs and activities in accordance with 45 CFR 80, 83, 84, 90, and 91, Title VI of the Civil Rights Actof1964.or the Florida Civil Rights Act of 1992. as applicable and CROP 60-18. These requirements shall apply to all oontoctom, subcontractors, subgrantees 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 Compliance ChookUst, CF Form 946 in accordance with CFOP 60-16 and 45 CFR 80. This is required of all Network Providers that have fifteen (15) or more employees. 16. Independent Capacity ofthe Contractor a. In performing its obligations under this contract, the Network Provider ohuU at all hmoo be acting in the capacity of an independent contractor and not as an o#icor, omp|oyeo, or agent of the [NE or the State of Florida, except where the Network Provider is a state agency. Neither the Network Provider nor its agontu, employees, subcontractors or assignees shall represent to others that it has the authority to bind the ME unless specifically authorized in writing to do so. This contract does not create any right to state retirement, leave benefits or any other benefits of o\a\o employees as a result of performing the duties or obligations ofthis 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 orpermitted to be an agent, oonmn\. joint venturer, or partner of the ME or the State of Florida. The ME will not furnish services of support (e.g., office space, office supplies, telephone oemice, maungar|o\ or clerical support) to the Network Pmvidor, or its subcontractor or anoignoe, unless specifically agreed to by Guidance Care Center, Inc. 4 Contract No. Ma225-3-2 the N1Einthis contract. u. All deductions for social oeourity, withholding taxes, income taxes, contributions to unemployment compensation funds and all necessary insurance for the Network Provider, the Network Provider's u#icom, omp|nymoo, agento, subcontractors, or assignees shall bethe sole responsibility of the Network Provider. As required by section 286.25. F.S, if the Network Provider in u non -govern mental organization which sponsors a program financed wholly orin part by state fundn, including any funds obtained through this contract, it shall, in puNicizinQ, 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 ininwritten material, the words "South Florida Behavioral Health Network ^ and "State ofFlorida, Department ofChildren and Families" shall appear in a1least the same size letters ortype anthe name ofthe organization. 18. Publicity Without limitation, the Network Provider and its omployoon, agants, and epmoontabvoo will not. without the K4E'o prior written consent in each ins\ancn, use in advorhoing, publicity orany other promotional endeavor any ME or State mark, the name of the ME'norState mark, the name of the ME . the State, or any ME cxState affiliate orany officer oremployee of the ME or the State . or mpoesent, directly or indirectly, that any product or service provided by the Network Provider has been approved or endorsed bythe ME, orrefer \nthe 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 fifteen (15) days after the contractends oris 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 bythe ME. 20. Use of Funds for Lobbying Prohibited The Network Provider ahmU comply with the provisions of sections 11.002 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. Pursuant tmsection 287130. F.S., the following restrictions are placed on the ability of persons on the convicted vendor list or the discriminatory vendor list. When apemon or affiliate has been placed onthe convicted vendor list following uconviction for a public entity crime, or an entity uraffiliate has been placed on the discriminatory vendor list, such peroon, entity oraffiliate may not submit a bid, propooa|, or reply on aoontrac< to provide any goods orservices \o u public entity; may not submit o bid, ppopnau|, or reply on a contract with u public entity for the construction or the repair of u public building or public work; may not submit bide, poopooaia, or nepUoo on |eaoon of real property to u public entity; may not be awarded or perform work on a oontnsoor, oupp|i*r, suboontraotor, or consultant under a contract with any public entity; and may nottransact business with any public entity in excess ofthe 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 0othe Network Provider and all their subcontractors. 22. Gratuities The Network Provider agrees that it will not offer to give or give any gift toany ME employee. An part of the consideration for this contract, the parties intend that this provision will survive the contract for aperiod oftwo years. {naddition Voany other remedies available to the ME, any violation of this provision will result in referral of the Network Provider's name and description of the violation of this term to the Department of Management Services for the potential inclusion of the Network Provider's name onthe suspended vendors list for an appropriate period. The Network Provider will ensure that its nubcontu*ooro, if any, comply with these provisions, 23. Intellectual Property a. It is agreed that all intellectual property, inventions, written or electronically created materials, including manuals, presentations, U|mo, or other oopyrightab\o mutoriuio, arising in relation to Network Provider's performance under this contract, and the performance of all of its officers, agents and subcontractors in relation to this contract, are works for hire for the benefit of the ME, fully compensated for by the contract amount. and that neither the Network Provider nor any of its offiooro, agents nor subcontractors may claim any interest in any intellectual property rights accruing under orin connection with the performance of this contract, It iaspecifically agreed that the ME shall have exclusive rights toall data processing software failing within the terms of section 119.084. F.S., which arises oris developed inthe course uforaaa result ofwork cxservices performed under this contract, or in any way connected herewith. Notwithstanding the foregoing pnovuion, if the Network Provider is u university and m member ofthe State University System of Florida, then section 100423. F.S, uhd| apply. U. If the Network Provider uuma ordelivers tothe ME for its use or the use of its employees, agents orcontractors, any design, dovioe, or materials covered by |atteru, patent, or copyright, it in 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 inany way involved |nthe work contemplated bythis contract. o. All applicable subcontracts shall include u provision that the Fodom| awarding agency muomon all patent rights with respect to any discovery or invention that uhoon or is developed in the course of or under the subcontract. Notwithstanding the foregoing poovia|on, if the Network Provider or one of its subcontractors in a university and u member of the State University of Florida, then section 1004.23^ F.S., shall upp|y, but the [NE shall retain a poqpetuu|, fully -paid, non-exclusive license for its use and the use of its contractors of any resulting patentod, 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 K1E'n interest is vacated, the Network Provider will refund the proportionate share investment,ofthe mtw'n initial investment,ana�u��od 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 oheD act as the liaison to the K4E'u 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 |ovo| 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 ofemployment. c. The Network Provider shall provide the latest DCF security awareness training to its staff and subcontractors who have access to MEorDCF information. d All Network Provider employees who have access to ME or DCF information shall comply with, and be provided ucopy of contract manager and the Managing Entity's Director of Information Technology. A copy of CF 0114 may be obtained from the contractmanager. o. The Network Provider shall make every effort to protect and avoid unauthorized oe|oauo of any ponmnu| 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 unenoryptodporuonu| and confidential ME or DCF data will not be stored on unencrypted storage devices. The Network Provider shall require the same of all subcontractors. f. The Network Provider aQn*oa to notify the contract manager as soon as ponuiU|e, but no later than five (5) business days following the determination of any breach or potential breach of personal and confidential ME or DCF data. The Network Provider mhuU require the same notification requirements of all subcontractors. g. The Network Provider shall provide notice to affected parties no later than forty-five (45) days following the determination of any potential breach of personal or confidential ME or DCF data provided in section 817.5681, F.S. The Network Provider shall require the same notification requirements of all subcontractors. 26. Accreditation The ME is committed to ensuring provision of the highest quality services to the persons we serve. A000rdinQ|y, the ME has *npootg�nuthe�where accreditation iugonend�accepted n�gionwidoauaclear indicator ofquality uemioo the "ajohtyofthe K�E'u Network Providers will either bo uoovedited, have plan to meet national accreditation standards, or will �'' initiate a plan within areasonable period oftime. 27. Network Provider Employment Opportunities a. Agency for Workforce Innovation and Workforce Florida: The Network Provider understands that the DCF the Agency for Workforce Innovation, and Workforce Florida, Inc., have joir�� implemented an initiative to empower recipients in the Temporary Assistance to Needy Families Program to enter and remain in gainful employment. The ME encourages Network Provider participation with the Agency for Workforce Innovation and Workforce Florida. Guidance Care Center, Inc. 6 Contract No. ME2z�-27 b. TnanobioningYoung Adults: The Network Provider understands DCPuOpooat\on Full Employment initiative toassist 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 udultatnansidoning from the foster care system, 28. Health Insurance Portability and Accountability Act The Network Provider shall, where applicable, comply with the Health |nnununoo Portability and Accountability Act N2 U. & C 1320djos well esall regulations promulgated thereunder (45CFRParts 18O.102.and 164). 28. Emergency Preparedness o. If the tasks to be performed pursuant to this contract include the physical care or supervision of clients, the Network Provider shall, within thirty (DO)days ofthe execution ofthis contract, submit tothe contract manager anemergency preparedness plan which shall include provisions for moondn protectiun, alternative accommodations for clients in substitute oaoe, 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 urecovery 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 a000pting, nejecting, or requesting modifications. In the event ofan emergency, the MEmay exercise oversight authority over such Network Provider in order to assure implementation ofagreed emergency relief provisions. o. 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 ofLegal Action The Network Provider shall notify the ME of legal actions taken against them or potential actions such as lawsuits, related to uenxoea provided through this contract or that may impact the Network Provider's ability to deliver the contractual oem|cox, or adversely impact the ME. The K4E'ucontract manager will bonotified within ten (10)days ofNetwork Provider becoming aware nf such actions orfrom the day ofthe legal filing, whichever comes first. 31. Whistleblower's Act Requirements In accordance with subsection 112.3187(2)' F.S, the Network Provider and its subcontractors shall not retaliate against an employee for reporting violations of |ow, ru|o, or regulation that creates substantial and specific danger to the public's health, safety, o,welfare N an appropriate agency. Furthermore, agencies orindependent oontra�omuhaU not retaliate against any penmnwhodimc|omaainformo¢\on�ounuppmpri�geugonoyuUegingimproperuse ofgovernmental office, gross waste uffunds, —-� any other abuse urgross neglect ofduty onthe part ofan 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 |----General, Agency inspector General, the Florida Commission on Human Relations orthe Vh|o(|o-b|ower'u Hotline number at I` 8O0-543-5353. 32. Proprietary or Trade Secret Information a. Unless exempted by law, all public records are subject to public inspection and copying under Florida's Public Records Law Chapter 118, F.B. Any claim by Network Pm�dorofpmph��aryorten de seotoonhdenUa|hyfor any |nhxmabon contained in ` Network Provider's documents (neportu. deliverables orwork papers, etc., in paper orelectronic 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 todifferent portions ofthe protected information, the Network Provider shall include information ourve|uhng the nature of the claims tothe particular protected information. o. The ME, when required \ocomply with u public records request including documents submitted bythe Network Pmvidor, may require the Network Provider to expeditiously uubmhedu��ed copies ofdocuments marked as confidential or trade uoo'mt in accordance with Section 32. b. above. Accompanying the submission uhuU be an updated version of the justification under Section 32. b., correlated specifically to redacted infonnation, 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 Guidance Care Center, Inc. Contract No. mp22s�27 disclosure. The redacted copy must exclude or ob|dengm only those exact portions that are o|o8mod to be proprietary or trade secret. If the Network Provider fails to promptly submit u redacted copy, the ME inauthorized toproduce the records sought without any redaction ofproprietary ortrade 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 tothe Deaf orHuvd-of-Heahng n. The Network Provider and its aubnontmctom, where direct nomioen are pmvdod, shall comply with section 504 of the Rehabilitation Act of 1873. 29 U.S.C. 734, as implemented by45C.F.R. Part84 (hereinafter referred to as Section 504). the Americans with Disabilities Act of 1990. 42 U.S.C. 12131, as implemented by28C.F.R. Port3G (hereinafter referred to aeADA). and the Children and Families Operating Instruction (CFOP) 60-10, Chapter 4, entitled "Auxiliary Aids and Services for the Deaf or Hard -of -Hearing." b. If the Network Provider or any of its subcontractors employs fifteen (15) or more employees, the Network Provider shall designate a Single -Point -of- Contact (one per firm) to ensure effective communication with deaf or hard -of -hearing customers or companions in accordance with Section 504. the ADA. and CFOP 00-10. Chupter4. The name and contact information for the Network Provider's Single- Point -of -Contact shall be furnished to the ME'u Grant or Contract Manager within fourteen (14) calendar days ofthe effective date ofthis requirement. o. The Network Provider uhmU. within 30 days of the effective date of this requivemont, contractually require that its subcontractors comply with section 504. the ADA. and CFOP 00-10, Chapter 4. A Single -Point -of -Contact shall be required for each subcontractor that employs fifteen (15) or more employees. This Sing|m'Point-of-ContactwiU ensure effective communication with deaf orhand-of-heor|ngcustomers orcompanions in accordance with Section 504 and the ADAand coordinate activities and reports with the Network Provider's Sing|o-Pointof'Contmt. d. The Single -Point -of -Contact shall ensure that employees are aware of the requirements, m|ou & nsnponu|bUit\ou, 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. thm4DA. and CR}POO-1O. Chupter4. This attestation shall be maintained in the employee's personnel file. e. The Network Provider's Single -Point -of -Contact will ensure that conspicuous Notices which provide information about the availability of appropriate auxiliary aids and uom|oex 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: f.The Network Provider and its subcontractors shall document the customer's orcompanion's preferred method ofcommunication and any requested auxiliary aids/services provided in the customer's record. Dooumontation, with supporting justification, must also bemade |fany request was not honored. The Network Provider shall submit compliance reports monthly, by the 4th business day following the reporting month, to the K4E'u Grunt or Contract Manager. The Network Provider shall distribute Customer Feedback forma to customers or companions, and provide assistance in completing the forms an requested by the customer or companion. g� 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. h. The network provider's and its subcontractors' direct uomioe employees uhuU complete the Effective Communication Online (as requested of all Managing Entity employees) and sign the Attestation of Understanding. Direct service employees will also print their certificate of completion, attach it totheir Attestation of Undonstanding, and maintain them in their personnel file. 34. Contract Amount The ME ahcd| pay for contracted uepvioon according to the tomnn and conditions of this Contract in an amount not to exceed subject to the availability of funds and satisfactory performance of all terms by the Network Provider, Of the total Contract amount, the ME will be required to payX3L921,8773}0. subject to the delivery and billing for services. The remaining amount of J7A1,l75D0`roprementu "Uncompensated Units Reimbursement Fundo^, which the K4E, at its am|e discretion and subject 1othe availability of funds, may pay tothe 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 uamioeo 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 Log|n|okurm and the Contract between the ME and the DCF. Any costs orservices eligible tube paid for under any other contract or from any other source are not eligible for payment under this Contract. 35. Contract Payment The ME has ten (10) working days, subject to the availability offunds, to inspect and approve goods and sem|oon, unless the bid specifications, purchase ordor, or this contract opooUy otherwise. With the exception of payments to health care providers for hmupitu|, medkm|, orother health care uomicon, ifpayment iu not available within forty (40) duya, measured from the latter ofthe date a properly completed invoice in received by the ME or the goods or services are mneived, innpoctad, and mpp,ovad, o xopeoata interest penalty set by the Chief Financial Officer pursuant to section 55.03. F.S., will be due and payable in addition to the invoice amount. Payments to health care providers for hospital, medical, or other health care services, shall be made not more than thirty-five (35) days from the date eligibility for payment in determined. Financial penalties will be calculated at the daily interest rate of 03388%. Invoices returned to u Network Provider due to preparation errors will muuh in u 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 uhuU remain subject to the subsequent audit or review toconfirm contract compliance. 36. Financial Consequences for Network Provider's Failure toPerform Ifthe Network Provider fails tmmeet the minimum level of service or performance identified in this agreement, or that is customary for the industry, than the ME will apply financial consequences commensurate with the deficiency. Financial consequences may include but are not limited to refusing paymont, withholding payments until deficiency is cured, tendering only partial payments, imposition ofpenalties per Section 3S,and termination of contract and requisition ofservices form an alternate source. Any payment made in reliance onthe Network Provider's evidence of performance which evidence is subsequently determined tobe ervoneoua, will beimmediately due as an overpayment in accordance with Section 13. above, entitled "Return of Funds" tuthe extent ofsuch error. A Vendor Ombudsman has been established within the Department of Financial Gopvivoo, The duties ofthis office are found in section 215,422, F.S., which include disseminating information relative to prompt payment and assisting vendors in receiving their payments in a timely manner from a state agency. The Vendor Ombudsman may be contacted at (850) 413-5516. 38. Notice Any notice that is required under this contract shall be in wrhing, and sent by U.G. Postal Service orany expedited delivery xemioo that provides verification of delivery or by hand delivery. Said notice nhuU be sent to the representative of the Network Provider responsible for administration of the pmgram, to the designated address contained in this contract. 39. Financial Penalties for Failure to Comply with Requirement for Corrective Action a. In accordance with the provisions of section 402.73(1). F.S, and Rule 85-29.001. F.AC, corrective action plans may be required for nmnoomp|ianoo, nonperformonoe, or unacceptable pednnnanoo under this contract. Penalties may be imposed for failures to implement or to make acceptable progress on such corrective action plans. b. The increments of penalty imposition that shall apply, unless the ME determines that extenuating circumstances oxist, ahoU be based upon the severity of the nonoomp|iunoo, nonporformanoo, or unu000ptub|o performance that generated the need for corrective action plan. The penaUy, if impouod, uhu|| not exceed ton percent (10%) ofthe total contract payments during the period in which the corrective action plan has not been implemented or in which acceptable progress toward implementation has not been made, Noncompliance that iudetermined tohave a direct effect onclient health and safety shall result inthe imposition of a ten percent (10%) penalty ofthe 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. o. Noncompliance involving the provision of uomioo not having u direct effect on client health and safety shall result in the imposition of afive pevcont(5%) penalty. Noncompliance as result of unacceptable performance of administrative tasks shall result inthe imposition ufutwo percent (2%)penalty. d. 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 buterminated byeither party without cause upon noless than sixty (OO)calendar days' notice inwriting to the other party unless sooner time in mutually agreed upon in writing. Said notice shall bedelivered byU.S. Postal Service or any expedited delivery oomioe 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 W1E'u 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 |ona than twenty'hour(24} hour notice in whtingtothe Network Provider. Said notice shall be non1 by U.G. Postal Service or any expedited delivery uemioo that provides verification of delivery. The ME uhuU 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 Guidance Care Center, Inc. Contract No. Me2250-27 satisfactorily completed. o.(nthe 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 Gaturday. Sunday. and Holidays) notice in writing to the Network Provider after Network Provider's failure tofully cure such noncompliance within the time specified in awhtten notice of noncompliance issued by the ME specifying the nature of the noncompliance and the actions required to terminate the contract. The K4E'u failure to demand performance of any provision of this contract uhuU not be deemed a waiver of performance. The ME'awaiver of any one bnauoh of any provision of this contract uhuU not be doomed to be a waiver of any other breach and neither event shall be construed to he amodificcgion ofthe terms and conditions ofthis contract. The provisions herein du not limit the K8Ea right to remedies at law orin equity. Cl. Failure to have performed any contractual obligations with the ME in a manner satisfactory Vothe ME will bmasufficient cause for termination, To be terminated as u Network Provider under this provision, the Network Provider must have: (1) previously failed tosatisfactorily perform in acontract with the ME, been notified by the ME of the unsatisfactory performance, and failed to correct the unsatisfactory performance to the satisfaction of the [NE; or (2) had u contract terminated by the ME for cause. Termination shall be upon no less than twenty-four (24) hour notice in writing, 41. Renegotiations orModifications Modifications of provisions ofthis contract uhuU 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 W payment when these have been established through the appropriations process and subsequently included in the ME'm prime contract with the DCF. It is the sole responsibility of the managing entity to resolve differences with the Network Provider pertaining to this contract. The Network Provider and the managing entity agree tocooperate in resolving any differences in interpreting the contract. Within five (5) working days ofthe execution ofthis contract, each party shall designate one person to act auits representative for dispute resolution purp*soa, and uhuU notify the other party nfthe poruon'u name and business address and telephone number. Within five (5) working days from delivery to the designated representative of the other party of u written request for dispute nauo|mion. the representatives will conduct aface toface meeting to resolve the disagreement amicably. If the representatives are unable to much a mutually satisfactory rono|udon, either representative may request referral of the issue to the Executive Director of the respective parties. Upon referral to this second step, the Executive Directors ofthe parties shall confer in on attempt ioamicably resolve the issue, If the Executive Directors ofthe parties cannot resolve the issue, then |nthat event, the decision of the managing entity 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 o(termination under Section 40. 43. Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the |nyn 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 1.2O11). The Network Provider agrees to refrain from any of the prohibited business activities with the Governments of Sudan and Iran as described in a.218,473. F.S. Pursuant to uoo|on u287135(5). F.G, the ME may immediately terminate this contract for cause if the Network Provider isfound tohave submitted ufalse certification orif the Network Provider isplaced onthe Scrutinized Companies with Activities in Sudan List or the Scrutinized Companion with Activities in the Iran Petroleum Energy Sector List during the term of the contract. Guidance Care Center, Inc. 10 Contract No. Mo��27 44. Official Payee and Representatives (Names, Addresses, Telephone Numbers and E-Mail Addresses): a. The Provider name, as shown on page I of this Contract, and mailing address of the official payee to whom the payment shall be made is: Guidance Care Center, Inc. 3000 41 Street Ocean Marathon, Florida 33050 b. The name of the contact person and street address where the representative Provider's financial and administrative records are maintained is: Marianne Benvenuti 3 000 41 Street Ocean Marathon, Florida 33050 Tel: 305-434-9043 E-mail: Marianne.benvenutiCa)westeare.com c. The name, address, and telephone of the Contract Manager for the ME for this contract is: Evelyn Kelly South Florida Behavioral Health Network, Inc. 7205 Corporate Center Drive, Suite #200 Miami, Florida 33126 Tel: 786-507-7461 E-Mail: ekelly(a-)sfbhn.org d. The name, address, and telephone number of the representative of the Provider responsible for the administration of the program under this contract is: Frank Rabitto, Sr. Vice President 3050 Biscayne Boulevard, Suite 900 Miami, Florida 33137 E-mail: frubbito@wcstcarc.com Upon change of representatives (names, addresses, telephone numbers and e-mail addresses) by either party, notice shall be provided in writing to the other party and the notification attached to the originals of this contract. 45. All Terms and Conditions Included This contract and it attachments, 1. 11, 1111, IV, V and any exhibits referenced in said attachments, together with any documents incorporated by reference, including the ME prime contract KH225 (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, and other attachments, if any; b. Any documents incorporated into any attachment by reference; c. The Standard Contract; d. Any documents incorporated herein by reference BY SIGNING THIS CONTRACT, THE PARTIES AGREE THAT THEY HAVE READ AND AGREE TO THE ENTIRE CONTRACT, AS DESCRIBED IN SECTION 45. 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. PROVIDER-15. e Care Center. Inc. SIGNED BY: NAME: Frank Rabbito TITLE: Senior VicePre-sident - DATE: 1 1 qI Q_ U Federal Tax ID# (or SSN) 59-1458324 SOUTH FLORIDA BEHAVIORAL HEALTH NETWORK, INC. SIGNED BY: N E: hn W. Dow I F President & CEO DATE: Provider Fiscal Year Ending Date 06130 Guidance Care Center, Inc. 11 Contract No. ME225-3-27 ATTACHMENT I A. SERVICES TO BE PROVIDED 1. Definition of Terms a. Contract Terms Contract terms used in this document can be found in the Florida Department of Children and Families Glossary of Contract Terms, which is incorporated herein by reference, and can be obtained from the designated managing entity contract manager. b. Program/Service Specific Terms (1) "Accessible" — Children, families and community members should be helped to become knowledgeable about how to ask for and receive services that are timely, comprehensive and family -friendly without facing unreasonable barriers. (2) "Activity" is an educational process or procedure intended to stimulate learning. (3) "Adolescent" is a client who is receiving substance abuse treatment services who is between the ages of 12 and 17. (4) "Annual Action Plan" is an annual plan developed by the managing entity and approved by the department that contains the deliverables for the ten baseline functions and other requirements for the behavioral health services needs for the Southern Region. (5) "Approaches" are the methods used in dealing with or accomplishing a task or goal. (6)"Approved Regional Plan" is a plan established by the department in accordance with section 394.674, F.S. and section 394.675, F.S. and updated annually or as required. (7) "ASAM PPC-2R Florida Supplement" is the American Society of Addiction Medicine, Patient Placement Criteria for the Treatment of Substance Related Disorders, second edition - revised, July 1, 2001, or the latest revised edition thereof. (8) "Assessment Instrument" is a tool used for collection of detailed information concerning an individual's substance abuse, emotional and physical health, social roles, and other areas that may reflect the severity of the individual's abuse of alcohol or drugs, as a basis for identifying an appropriate treatment regimen. (9) "Attrition" is the loss of program participants during the course of the services due to voluntary dropout or other reasons. Higher rates of attrition can potentially threaten the validity of services and programming strategies. Attrition is one of the six criteria of Quality of Research in the National Registry of Evidence -based Program (NREPP) used to Evidence -based Programs and Practices. (10)"Available Appropriations" are State and other governmental funds allocated for mental health and substance abuse services including prevention and the associated local matching funds. (11)"Baseline" is the initial time point in service interventions just before the intervention or Guidance Care Center, Inc. 12 Contract No. ME225-3-27 07/01/2012 treatment begins. The information gathered at baseline is used to measure change in targeted outcomes over the course of the services. A2j"Beavioral Health Services" are mental health services and substance abuse prevention and treatment services as defined in chapters 394, 397 and 916, F.S. which are provided using state and federal funds. M3>~Caaua| Factors/Risk Factors" are research -based constructs that have been identified as being strongly related to, and influencing the occurrence and magnitude of, substance use and related risk behaviors and their subsequent consequences. These variables are the proximal focus of prevention strategies, changes in which are then expected to affect consumption and consequences. M4YC|ient" (synonymous with recipients of services/individual(s) served) is any individual who is receiving services in any substance abuse or mental health program whose ouot of care is poid, in part or in whole, by the Department, Medicaid, Medicaid oophated managed oana entities, or |uoa| match. Individuals who take pad in substance abuse prevention programs or services are referred to as participants. MG>"C|ient Fees" is compensation to the managing entity's contracted network providers for services rendered to the client, who has been authorized to receive services pursuant to this oontrao, from any uuunoe of funda, including city, oounty, atade, federal, private sources and client paid. <1G0"Clinical Assessment" iothe collection of behavioral heakh, emotional and physical reflect the individua|'o uvenyU health as a regimen. dotadedinformation concerning anindividuayo health, social m|eo, and other areas that may basis for identifying an appropriate treatment (17) "Clinical Pathways" is a method that charts relationships among project tasks illustrating the sequence and interdependence of tasks overtime. A "map" of pnehanad treatment/ intervention activities which outlines the types of information needed tomake decisions, the timelines for applying that informokiun, and what action needs to be taken by whom. They provide a way to monitor care "in naa| time." and are also designed to support resource management, clinical audits and financial management. MfU"Clinickan" is o substance abuse or mental health professional that provides one or more ofthe following services: assessment; individua], gvoup, orfamily counseling oen/ioea, or case management. (18)"Coalitiun" is ahxmo| arrangement for cooperation and collaboration among groups or sectors of a community in which each group retains its identity, but all agree to work together toward a common goal of building a safe, healthy, and drug free community. DECATrm (Co-occurring Disorders Educational Competency Assessment Too)" is a tool used toevaluate clinicians' training needs based on acompetency assessment to determine knmw|edge, akiUo, attitudes, and values relative to persons with co-occurring disorders. (Contract manager may delete if this is a prevention only contract) (21)iCommunity' isaspecific geographic mdomographic population. Geographic includes oourt|*u and municipalities. Demographic includes race, odlniohv, ago` gender or any combination thereof, (@2)"Comm unity -Based Services" are mental health and/or substance abuse services provided outside of a state mental facility or inpatient settings, such as psychiatric residential treatment facilities for children. (23) "Comm unity -Based Medicaid Administrative Claiming (CBMAC)" is the mechanism whereby states are eligible to claim federal Medicaid funds/reimbursement for qualifying Medicaid administrative activities. (24) "Community Conditions" is circumstances that underlie underage drinking mother substance abuse and /or alcohol -related problems identified by recognized community substance abuse coalitions in the needs assessment process during the development of Comprehensive Community Action Plans. (25)CommunityEvents" are generally, one-time activities that are conducted in response tVa request for the network provider to participate in a community event and are NOT a part of a program manual's Schedule of Activities and are NOT associated with a particular group of program participants within the data system. These events tend to be large (rallies), busy (community health fairx), or have no direct contact (billboards broadcast media). Therefore, the count of many individual activities is an estimate and may include some under age 18.The total reported here ioaduplicated count (26)"Comm unity-Foouaed" is the process of planning, management and decision- making to ensure resources are designed to build on the unique strengths and meet the specific needs ofthe local community. (27)''Community Prevention" are strategies and activities aimed at changing community conditions related to substance abuse. It is aimed at larger universal populations and oe|eoteduub'popu|atiune, does not track specific individuals and includes environmental strategies designed tuchange one urmore community conditions. (28)"Cummunity Substance Abuse Coalition" is community organizations recognized by the Department of Children and Families and SFBHN as organizations that convene representatives of community sectors and stakeholders that reflect the demographics and diversity of the community. The purpose of these organizations is to auueuu problems related to substance use or abuse in their community, develop and facilitate a000rdinated response tuthose problems, track and report on progress toward community goals and objectives, and build community capacity to implement evidence -based practices in planning and implementation. (29)''Community Preventiun" means strategies and activities aimed at changing community conditions related to substance abuse. It is aimed at larger universal populations and selected sub -populations, does not track specific individuals and includes environmental strategies designed tochange one ormore community conditions. <30\^'Cumprehenoivo Community Action P|on" means a plan developed bye |ooa|^ department recognized, community substance abuse coalition which is based on an assessment of substance abuse related epidemiology data and the resources needed to address identified needs. The plan includes goals to reduce the community's prioritized substance use problems and the approaches to take to achieve them. A community's data -driven strategic response tochange conditions and factors that underlie alcohol and other drug problems and related consequences. The plan includes two goals: Guidance Care Center, Inc. 14 Contract No. mE2z*a-27 07/01/2012 1) to achieve a long-term change in a substance abuse behavior pattern, and 2) to build community and organization capacity to effectively achieve the identified outcome. The plan defines short term and intermediate objectives for tracking progress toward goal achievement. (31) "COMPASSTM (Comorbidity Program Audit and Self -Survey for Behavioral Health Services)" is a tool that can be used by behavioral health care systems to assess program competencies in multiple areas that reflect the basic expectations of program performance for mental health services, substance abuse disorder services and integrated systems of care. (32) "Comprehensive Community Action Plan" is a plan developed by a local, department recognized, community substance abuse coalition which is based on an assessment of substance abuse related epidemiology data and the resources needed to address identified needs. The plan includes goals to reduce the community's prioritized substance use problems and the approaches to take to achieve them. (33) "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. (34)"Consequences" are the social, economic and health problems associated with the use of alcohol and illicit drugs. Any social, economic or health problem can be defined as a substance use problem if the use of alcohol, tobacco, or drugs increases the likelihood of the problem occurring. (35) "Consolidated Program Description" is the combination of all of the managing entity network providers' program descriptions and the managing entity program description. (36) "Consumer Price Index" is a measure of the average change in prices over time of goods and services purchased. (37)"Continuous Quality Improvement" is the systematic on -going process of improving performance, both in process and end of process indicators, in order to meet the individual service recipient's valid requirements. (38) "Continuum of Services" are recovery -oriented systems of care will offer a full array of services, including pretreatment, treatment, continuing care and support throughout recovery. Individuals will have a full range of stage -appropriate services from which to choose at any point in the recovery process. (39) "Contract Manager' is the managing entity 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 managing entity and the network provider. All actions related to the contract shall be initiated by or coordinated with the contract manager. Guidance Care Center, Inc. 15 Contract No. ME225-3-27 M (40) "Contributing Factors" are more specific dimensions or aspects of constructs which collectively can be used to measure the theory to which they are linked. (41)"Co-occurring Disorder' is any combination of mental health and substance abuse in any individual, whether or not they have been already diagnosed. (42) "Co-occurring disordered family' is a family where one member has one kind of problem, like a child with an emotional disturbance, and another member has another kind of problem, like a family member or caregiver with a substance abuse issue. (43) "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 be able to provide and/or coordinate appropriately matched, integrated services to the individuals and families with co-occurring disorders that are routinely presenting for care in that program. (44) "Core components" is the most essential and indispensable components of a service intervention (core intervention components) or the most essential and indispensable components of an implementation program (core implementation components). (45)"Cost Analysis" is the review of the proposed cost elements to determine if they are necessary, allowable, appropriate and reasonable. (46) "Cost Center" is a grouping of services that are similar in time, intensity and function where the average cost for service is generally the same, and are specified in the State Funding by Program and Activity which is incorporated herein by reference. See Rule 65E- 14.021, Florida Administrative Code (F.A.C.), and the Substance Abuse Recovery Support Services (Individual and Group),Clinical Supervision for Evidence -Based Practices, and the Children's System of Care Comprehensive Community Service Team are incorporated herein by reference and may be obtained from the contract manager. The description for the Adult System of Care Comprehensive Community Service Team, is specified in Section D, Special Provisions. (47) "Culturally Competent Services" means acknowledging and incorporating variances in normative acceptable behaviors, beliefs and values in determining and individual's mental wellness/illness and incorporating those variances into assessment and treatment that promotes recovery. (48) "Data Management" are activities that use data elements to track cost, utilization, quality of care and access to services within the network of providers. (49)"DCF PAM 155-2" is the Department of Children & Families, Pamphlet 155-2 - Mental Health and Substance Abuse Measurement and Data, effective July 2010 (10th edition, version 1),or the latest revised edition thereof, means a document promulgated by the department that contains required data -reporting elements for substance abuse and mental health services, and which can be found at: http://www.dcf.state.f1.us/programs/samh/pubs_reports.shtm1, and is incorporated herein by reference. (50) "Department" means the State of Florida Department of Children and Families. (51) "Direct Contact" for prevention services are activities conducted by a prevention services Guidance Care Center, Inc. 16 Contract No. ME225-3-27 specialist while in direct contact with a child or adult. These services may be provided in a one-to-one context, where the specialist is working with only one participant at a time or in a group context where the specialist is working directly with more than one participant (NOTE: This may include family members or other collateral contacts as indicated in the program manual). (52)"Direct Prevention" Level 1 Prevention Programs include persons participating in Universal and Selective programs in cost center 16. Level 1 Prevention Programs address subgroups of the general population that are at a higher risk of substance abuse than the general population. The mission is to provide individuals with the information and skills necessary to prevent the abuse of substances. This is an unduplicated count of participants. Level 2 Prevention Programs include persons participating in Indicated programs in cost center 16 and all programs in cost center 17. Level 2 Prevention Programs are designed to prevent the onset of substance abuse in individuals who do not meet the DSM-IV criteria for addiction but who are showing early danger signs in the form of multiple risk factors. The mission of Level 2 Prevention Programs is to identify individuals who are exhibiting early signs of substance abuse and other problem behaviors associated with substance abuse and to target them with special programs. This is an un-duplicated count of participants. (53)"Dissemination" is the targeted distribution of program information and materials to a specific audience. The intent is to spread knowledge about the program and encourage its use. (54)"Environmental Strategy' is a public health approach that strengthens policies and practices related to alcohol and other drug access, availability, promotion, enforcement and/or community norms. Grounded in the field of public health, which emphasizes the broader physical, social, cultural and institutional forces that contribute to the problems that coalitions address, environmental strategies offer well -accepted prevention approaches that coalitions use to change the context (environment) in which substance use and abuse occur. Environmental strategies incorporate prevention efforts aimed at changing or influencing community. (55)"Epidemiology data" are data relating to factors affecting the health and illness of populations that serve as the foundation and logic of interventions made in the interest of public health. (56) "Evaluation Plan" is a written document which will identify the outcomes that will be measured, data collection methods and instruments, and a plan for their collection. (57)"Evidence-Based Assessment Instruments" are assessment instruments that include, but are not limited to, one of the following for use in the completion of the Psychosocial Assessment with adolescents: the Global Appraisal of Individual Needs (GAIN); Adolescent Diagnostic Interview (ADI); the Mini -International Neuropsychiatric Interview (Mini -Kid) or other instruments designated by the Managing Entity. (58) "Evidence -Based" are those practices that are based on accepted practices in the profession and are supported by research, field recognition, or published practice Guidance Care Center, Inc. 17 Contract No. ME225-3-27 07/01/2012 guidelines. (59) "Family' is a target population of an evidence -based practice. Through this contract, any person or group that supports the individual receiving services. A fundamental social group in society typically consisting of one or two parents and their children or two or more people who share goals and values, have long-term commitments to one another, and reside usually in the same dwelling place. (60)"Family Intervention Specialists/Adult Intervention Specialists (FIS)" are individuals employed to provide adult behavioral health outreach, screening, intervention, and case management to families involved in the child welfare system and/or the Abuse Hotline. (61) "Family Intervention Specialist Services" 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. (62) "Fidelity' is the degree to which the evidence -based practice implemented adheres to the practice's implementation design. (63)"Fidelity of Implementation" is ideality of implementation occurs when implementers of a research -based program or intervention (e.g., teachers, clinicians, counselors) closely follow or adhere to the protocols and techniques that are defined as part of the intervention. For example, for a school -based prevention curriculum, fidelity could involve using the program for the proper grade levels and age groups, following the developer's recommendations for the number of sessions per week, sequencing multiple program components correctly, and conducting assessments and evaluations using the recommended or provided tools. (64)"Florida Department of Children and Families Strategic Intent" is the Secretary's Strategic Intent gives guidance and summarizes the department's major initiatives. This document provides the Secretary's intent on what the department and its partners must accomplish during a specific period of time. The Secretary's guidance drives the development of the department's Strategic Plan, which depicts how the department will achieve these initiatives, when they will be accomplished and the metrics used to measure progress. (65) "Florida System of Care (FSC)" is the Department's initiative to integrate substance abuse and mental health service structures to promote co-occurring disorder service capability throughout the system of care from the initial point of client contact at assessment through conclusion of services. (66) "Forensic Mental Health Services" are services provided to individuals with mental illness pursuant to Chapter 916, Florida Statutes. (67) "Global Assessment of Individual Needs (GAIN)" is one of the department approved evidenced -based assessment instrument. Information regarding this instrument can be obtained from the following website: http://www.chestnut.org/Ll/gain/ (68) "Governing Board" is the Commission, Board of Directors, Board of Trustees, Governing Body, etc. (69) "HIPAX is the acronym for Health Insurance Portability and Accountability Act (42 U.S.C. 1320d, and 45 CFR Parts 160, 162, and 164). (70) "Implementation" is the use of a prevention or service interventions in a specific community - Guidance Care Center, Inc. 18 Contract No. ME225-3-22 M � � based or other setting with a particular target audience. (71) "Incompetent to Proceed (ITP)" as defined in chapter 916 F.S., means unable to proceed at any material stage of a criminal proceeding, which shall include trial of the case, pretrial hearings involving questions of fact on which the defendant might be expected to testify, entry of a plea, proceedings for violation of probation or violation of community control, sentencing, and hearings on issues regarding a defendant's failure to comply with court orders or conditions or other matters in which the mental competence of the defendant is necessary for a just resolution of the issues being considered. (72) "Indicated" is one of the three categories (Universal, Selective, Indicated) developed by the Institute of Medicine to classify preventive interventions. Indicated prevention strategies focus on preventing the onset or development of problems in individuals who may be showing early signs but are not yet meeting identified levels of a particular disorder. (73) "Indicated Prevention" is education and other evidence -based practices conducted with groups of individuals to reduce personal risk factors or substance abuse or strengthen protective factors. (74)"Indigent Drug Program (IDP)" is the program that allows the Department of Children and Families to purchase medications for individuals who are indigent. (75) "Indirect Prevention" are strategies and activities aimed at changing community conditions related to substance abuse. It includes environmental strategies designed to change one or more community conditions. Indirect Prevention is aimed at larger universal populations and selected sub -populations and does not track specific individuals. Indirect Prevention seeks to impact community conditions through media, policies, policy enforcement, or other similar methods. Strategies utilized in Indirect Prevention may include education, information dissemination, alternatives, and environmental activities. Environmental strategies may also be known as "Environmental Prevention", "Environmental Programs", or "Environmental Practices." (76)"Intervention" is a strategy or approach intended to prevent an undesirable outcome (preventive intervention), promote a desirable outcome (promotion intervention) or alter the course of an existing condition (treatment intervention). (77) "KIT Solutions" is the entity that maintains the database called Performance Based Prevention System (PEPS). (78) "Knight Information Software Database (KIS)" is the managing entity's online data system which network providers are required to use to collect and report data and performance outcomes on clients served whose services are paid for, in part or in whole, by the managing entity's Substance Abuse and Mental Health (SAMH) contract, Medicaid, or local match. (79) "Local Match" are funds received from governing bodies of local government, including city commissions, county commissions, district school boards, special tax districts, private hospital funds, private gifts both individual and corporate, bequests and funds received from community drives or any other sources. See section 394.67(14), F.S. and 65E- 14.005, F.A.C. (80) "Managing Entity (ME)" means pursuant to section 394.9082(2)(d), F.S., a corporation that is organized in the State of Florida, is designated or filed as a non-profit Guidance Care Center, Inc. 19 Contract No. ME225-3-27 i ! i organization under section 501(c)(3) of the Internal Revenue Code, and is under contract to the Department to manage the day-to-day operational delivery of behavioral health services through an organized system of care. (81)"Mental health promotion" is an attempt to (a) encourage and increase protective factors and healthy behaviors that can help prevent the onset of a diagnosable mental disorder and (b) reduce risk factors that can lead to the development of a mental disorder. In this contract, mental health promotion is associated with substance abuse prevention strategies to promote wellness and reinforce protective factors that enhance wellbeing. (82) "Monitoring Subcontracts" is the process whereby the managing entity conducts a systematic organized review of a network provider's performance in order to give reasonable assurance that the network provider is complying with subcontract requirements, rules, regulations and laws applicable to contract performance. (83) "Network Provider" is an entity that Contracts with the Managing Entity and receives funding to provide services to clients; in this contract the network provider is synonymous with provider or subcontractor. (84) "Outcome" is a change in behavior, physiology, attitudes, or knowledge that can be quantified using standardized scales or assessment tools. In the context of NREPP, outcomes refer to measurable changes in the health of an individual or group of people that are attributable to the intervention. (85)"Outcome evaluation" is an evaluation to determine the extent to which an intervention affects its participants and the surrounding environments. Several important design issues must be considered, including how to best determine the results and how to best contrast what happens as a result of the intervention with what happens without the program. (86)`Overpayment" is for the purposes of this contract, the amount of money the department has paid the managing entity and/or the managing entity has paid the network provider for administrative expenses and/or program expense over and above what was properly earned for these expenses by the managing entity according to the approved line item budget. (87) "Participant" is any individual who takes part in targeted substance abuse prevention programs, activities or services which are paid, in part or in whole, by the Department through the ME. (88) "Payor class" means 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, and charity care. (89) "PBPS" is the Performance Based Prevention System that collects data related to community assessments and plans and substance abuse prevention programs and activities. The system can be accessed by contacting technical support at 1-888-600-4777 or https://kitprevention.kithost.net/. (90) "Performance Measures" are quantitative indicators, outcomes and outputs that are used by the Department to objectively measure performance and are used by the managing entity and network providers to improve services. Guidance Care Center, Inc. 20 Contract No. ME225-3-27 MITINOW (91) "Prevalence" is the count of all individuals affected by a disease/condition within a particular period of time, compared with the entire population of concern. (92) "Prevention" is a process involving strategies aimed at the individual or the environment which preclude, forestall, or impede the development of substance abuse problems and promote healthy development of individuals, families and communities. (93) "Programs" are a structured Schedule of Activities (by instructors and participants) designed so that participants will attain, so far as possible, certain educational and behavioral objectives. (94)"Program Planning Tool (PPT)" is the data collection module contained in the PEPS that collects a variety of program information. It is designed to assure substance abuse prevention contracts reflect best practices and level of effort, inform the Department's coalition and network provider support system, and set the stage for evaluating effectiveness in achieving community and program outcomes. (95) "Prevention Program Description (PPD)" is the report generated as a result of completing the PPT. The PPD contains the information required for a program description pursuant to Rule 65E-14.021, Florida Administrative Code (F.A.C.). (96) "Prevention Program" is a structured Schedule of Activities designed so that participants will attain so far as possible, certain educational, attitudinal, social and behavioral objectives. This is an unduplicated count of participants. (97) "Prevention Service" is a structured schedule of activities designed so that participants will attain certain educational, attitudinal, social, and behavioral objectives. Prevention services are focused on enhancing protective factors and resilience (strengths and assets) and reversing or reducing known risk factors (challenges). (98)"Prime Contract" is the contract between the Department of Children and Families and the Managing Entity. (99)"Program Description" is the document the network provider prepares and submits to the ME for approval prior to the start of the contract period, which provides a detailed description of the services to be provided under the contract pursuant to Rule 65E-14.021, F.A.C. It includes but is not limited to the network provider's organizational profile, a detailed description of each program and cost center funded in the contract, the geographic service area, service capacity, staffing information, and client and target population to be served. (100) "Projects for Assistance in Transition from Homelessness (PATH)" is a Federal grant to support homeless individuals with behavioral health needs. (101) "Promising Practices" is the use of practices that incorporate the best objective information available regarding effectiveness and acceptability. (102) "Prorated Share" is the total number of unpaid units or funds divided by the number of months remaining between the time the prorated share is calculated and the end date of the contract. (103) "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, Guidance Care Center, Inc. 21 Contract No. ME225-3-27 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. (104) "Provider Network" (subcontractor or network provider) refers to the direct service agencies that are under contract with a managing entity and that together constitute a comprehensive array of emergency, acute care, residential, outpatient, recovery support, and consumer support services or other services as designated by this contract. See section 394.9082, F.S. (105) "Psychosocial Assessment" is a series of evaluative measures designed to identify the behavioral and social factors involved in substance abuse and its symptoms, and in the determination of placement and the development of the treatment plan, as defined in Rule 65D-30,002, Florida Administrative Code (F.A.C.). (106) "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. (107) "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. (108) "Recovery' is an on -going process which enables a person with behavioral health issues to live a meaningful life in a community of his or her choice while striving to achieve his or her potential. This allows individuals to improve their health, wellness, and quality of life. (109) "Recovery Based" is process built upon overcoming the negative impact of substance abuse addiction or mental illness. A system of care provides treatment and supports that promote recovery and functioning in the community. (110) "Representative Payee" refers to an entity/individual who is legally authorized to receive Supplemental Security Income, Social Security Income, Veterans Administration benefits, or other federal benefits on behalf of an individual served. (111) "Resource Assessment" is a written inventory of current resources available to apply toward achieving a community long-term outcome and the identification of gaps in skills, materials, facilities, community readiness and other capacities necessary to successfully achieve a community long-term outcome. (112) "SAMH" stands for the Substance Abuse and Mental Health Programs within the Department. (113) "SAVE/VIS Program" is the U.S. Department of Homeland Security (DHS) administers Guidance Care Center, Inc. 22 Contract No. ME225-3-27 07/01/2012 the Systematic Alien Verification for Entitlements (SAVE) program. This program verifies immigration status and eligibility ofalien applicants for federal benefits. The alien status verification system under SAVE is entitled the Alien Status Verification Index (AGV|), as described at GO Federal Register 52694' 52697 (1995) administered by the Computer Sciences Corporation (CSC)aathe Verification Information System (V|8).The 8AVE/V|S Program can and may provide assistance in verifying eligibility in cases where a client does not possess sufficient documentation. (114) "Schedule ofActivities" isthe written instructional content, materials, resources, and processes inorder toattain educational objectives. (115) "Selective prevention" refers to strategies that are targeted to uubpopu|ationa identified as being at elevated risk for adisorder. (116) "Service Unita" means those units of measure specified in Rule 65E-14.021. F.A.C. and in the Substance Abuse Recovery Support Sorvi000, Adult Comprehensive Community Service Teams, Chi\dron'a Comprehensive Community Service Teams and Clinical Supervision for Evidence Based Practices exhibits. (117) ''SOAR'"stands for Supplemental Security Income/Social Security Disability Insurance (SSKSSD\) Outreach, A000ua and Recovery and is a technical assistance initiative. This strategy helps States and communities increase aooeaa to S8\ and 88D\ for people through training, technical assistance and strategic planning. (118) "Stakeholder" are individuals/groups with an interest in the provision of behavioral health services. M19A "State Designated Prevention Evaluation Contractor" is a comprehensive drug research center Contracted by the Department to evaluate prevention outcomes. (128) "Statewide Inpatient Psychiatric Programs (S|PP)" are residential inpatient facilities under contract with the Agency for Health Caro Administration under the Medicaid |K8D waiver for children under ago 18 to provide diagnostic and active treatment oon/ioea in a secure setting. (121) k: Prevention Framework (SPF[ is the SPF kaacommunity-based data driven approach tocommunity mobilization that employs ongoing assessment and evaluation to move communities toward their goals ofreducing substance abuse and its consequences. The Strategic Prevention Framework: 1) assess the conditions that underlie the onset and progression of substance abuse, including childhood and underage drinking; 2) oo\eot evidence -based practices to change those conditions and reduce substance- abuse related problems in the communities; and 3) build prevention capacity and infrastructure to sustain achievements. (122) "Strategies" is a plan of action or policy designed to achieve a major goal. (123) "Substance abuse" is u a pattern of chronic or harmful use of alooho, illicit or prescribed drugs that result in adverse physical, psychological, or social consequences. (124) "Substance Abuse and Mental Health Information System (SAMH|S)" is the Department's online data system which network providers are required to use tocollect and report data and performance outcomes onindividuals served whose services are paid for, in part or in whole, by the Department's Substance Abuse and Mental Health (8AK8H) contract, Medicaid, or local match. Instructions on how to access the system can be found in DCF PAM 155-2. (125) "Supplemental Program Activities" are Schedule of Activities that are made available to program participants in order to reinforce the participant's involvement in the program and the knowledge presented in the Schedule of Activities. (Direct Prevention only) NOTE: the nature and number of Supplemental Program Activities should not threaten the fidelity of program implementation. (126) "Sustainability" is the long-term survival and continued effectiveness of an intervention. (127) "System of Care" are behavioral health services that are coordinated and developed into an integrated network of services accessible and responsive to the needs of individuals served, their families, and community stakeholders. (128) "TANF Participant" is a person or family member of that person defined in 45 CFR Part 260.30 and section 414.1585 and subsection 414.0252(9), F.S. (129) "Targeted Prevention" are education and other evidenced -based practices conducted with groups of individuals to reduce personal risk factors or substance abuse or strengthen protective factors. (130) "Temporary Assistance to Needy Families (TANF)" are cash assistance for families, including any family receiving cash assistance payments or TANF diversion services from the state program pursuant to the provisions of section 414,045, F.S., and Part A of Title IV of the Social Security Act. (131) "Transformation" is a process that strives to change the form and function of the behavioral health services delivery system to better meet the needs of the individuals and families it is designed to serve. (132) "Unit Measurement" is used in billing the managing entity for services. The definition of each unit of measure can be found in Rule 65E-14.021, F.A.C. (133) "Universal prevention" are strategies that can be offered to the full population, based on the evidence that it is likely to provide some benefit to all (reduce the probability of disorder), which clearly outweighs the costs and risks of negative consequences. (134) "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. (135) "Verifiable Service" is a service provision that is documented in compliance with the requirements contained in Rule 65E-14.021, F.A.C. 2. General Description a. General Statement The services provided under this contract are community -based SAMH services for a consumer -centered and family -focused coordinated system of care. The contract requires a qualified, direct service, community -based network provider who will provide services for adults Guidance Care Center, Inc. 24 Contract No. ME225-3-27 and/or children with behavioral health issues as authorized �section ��9082,F.S,and in the yWE'scontract with the Department, which is incorporated herein by reference, and which are consistent with the Approved Regional Plan. The network provider shall work in partnership with the Managing Entity to better meet the needs of individuals with co-occurring substance abuse and mental health disorders. The partnership process will boopen, transparent, dynamic, fluid, and visible. The process shall also serve as on opportunity for collaboration to continuously improve the quality of services provided tothe residents of Florida. During the course ofthe contract period, the Managing Entity will require that the network provider participate in the process of improving co- occurring disorder service capability system wide. The network provider shall work in collaboration and aho\| assist, upon request of the managing entity, in fulfilling its contractual obligations pursuant tothe Prime Contract with the Department of Children and Families including but not limited to the following functions: (1) System ofCare Development and Management; (2) Utilization Management; (3) Quality Improvement; NU Data Collection, Reporting, and Analysis; (5) Financial Management; (G) Disaster Planning and Responsiveness b.Approved Annual Action Plan The ME will develop and opootiona|izo on annual action p|an, in partnership with the Department and network providers upon request by the managing entity. This action plan which is incorporated herein by reference, will be approved by the Department on an annual basis and may be modified by mutual agreement and approved/dated by the Managing Entity Executive Director and the approved Department Representative i.e.. the SAK4H Regional Director. A copy of any revisions to the approved annual action plan shall be provided tothe Department's contract manager. o. Authority Section 3S4.g082,F.8..and the Prime Contract provides the Managing Entity with the authority tocontract for these services. d. 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 popu|ation(o)indicated in Exhibit A, Clients and Participants tmbe Sorxed, and in accordance with the tasks outlined in Section B.1a., of this contract. Services shall also be delivered atthe locations specified in, and inaccordance with the Program Description, as required by Rule 65E-14.021. F.A.C. which is herein incorporated by referonoe, and maintained in the ME's contract manager's file. (2) Services are tobedelivered inthe following oountv(ioa): Miami -Dade County ___A___Monroe County Guidance Care Center, Inc. 25 Contract No. mE2a�3-z 07/01/2012 e. Major Program Goals (1) The intent of the Substance Abuse and Mental Health Programs are to reduce or prevent substance abuse and promote and improve the mental health of the residents of the state by making behavioral health services available through a community -based system of care. (2) It is the goal of the Managing Entity and network provider to improve accountability, ensure quality of care through best practice models and seek to ensure delivery of behavioral health services across the provider network and across systems resulting in systematic access to a full continuum of care for all children, adolescents and adults who enter the publicly -funded behavioral health services systems. (3) It is the goal to improve co-occurring capability and expertise in all programs. (4) The intent of substance abuse prevention is to promote and improve the behavioral health of Florida's Southern Region communities by assisting the Managing Entity in strategically applying substance abuse prevention programs, and environmental strategies that are relevant to community needs as defined in a Department approved Comprehensive Community Action Plan. Once approved the plan can be obtained at: https://kitservices2.kithost.net/. f. Minimum Programmatic Requirements The network provider shall maintain the following minimum programmatic requirements: (1) System Of Care The consumer -centered and family -focused system of care will: (a) Be driven by the needs and choices of the customers; (b) Promote family and personal self-determination and choice; (c) Be ethically, socially, and culturally responsible; and (d) Be dedicated to excellence and quality results. There is a commitment to expand clinical treatment to include the behavioral health Transformation Initiative, evidence -based practices and recovery support services in accordance with priorities established by the Managing Entity and the Department for substance abuse, mental health treatment and/or co-occurring disorders, substance abuse and mental health treatment capacity, children and families, criminal and juvenile justice, HIV and hepatitis. (2) Guiding Principles Guiding principles specify that services are as follows: (a) Inclusive - involve and engage families and consumers as full partners to participate in the planning and delivery of services; (b) Comprehensive - incorporating a broad array of service and supports (e.g. physical, emotional, clinical, social, educational and spiritual); Guidance Care Center, Inc. 26 Contract No. ME225-3-27 b1 |ndividudized-meotingthe individua[aexceptional needs and strengths; (d) Community -based -provdedinthek*au restrictive, clinically appropriate setting; (e) Coordinated -both at the system and service delivery levels to ensure that multiple services are provided and change aoseam |oao|yaepossible when warranted, and U8 Cultural and linguistic competence. 3. Clients hpbe Served See Exhibit A, Clients and Participants tobe Served. B. MANNER OF SERVICE PROVISION 1. Service Tasks The following tasks must be completed for each fiscal year covered in the contract period. a. Task List (1) Based on client needs, the network provider agrees to provide appropriate services from the list of approved program a/aotivitieadescribed in ExhibitG. State Funding by Program and Activity and the description ofsuch services specified in the Program Description as required byRule GGE-14.U21. F.A.C. (2) The network provider shall serve the number of persons indicated in Exhibit D, Substance Abuse and Mental Health Required Outcomes/Outputs within the activities specified in ExhibitG. State Funding by Program and Activity. (3) The network provider shall comply with the provisions of Exhibit 1, Substance Abuse Family Intervention Services and the revised Family Intervention Guidelines, incorporated herein by reference. All Family Intervention Specialist positions will be identified by the network provider upon request bythe managing entity. NQ The network provider shall adhere to group size limitations not to exceed fifteen (15) individuals per group for any clinical therapy service provided. In addition to other programmatic documentation nequirementa, service documentation toevidence group activates shall include the following: (a) Data Elements: i Service Documentation -Group Sign inSheet I. Recipient name and identification number; ii. Staff name and identification number iii. Service dab*; iv. Start time V. Duration' vi Cost Center; vil. Brief description oftype ufgroup; viH. Program (AMH' ASA. CMH, CSA) Guidance Care Center, Inc. 27 Contract No. ms22s�-2/ U. Audit Doc umentation-Recipient Service cvNon-Recipient Chart: i Recipient name and identification number or if non-naopient, participant's namo, addveao, and relation to recipient; iT. Staff name and identification number Ill. Service date (v. Duration; and V. Group progress note (5)The network provider shall develop and implement policies so that all applicable providers' employees abide by the terms and conditions of Section 25.^ Information Security Obligations, ofthe Standard Contract. The network provider shall submit tothe Managing Entities Contract menager, bvU8/U1/2U12. verification that all network provider employees and subcontractors who have access to managing entity and Department information systems have completed the Security Agreement form as identified in Section 25. Information Security Obligations, of the Standard Contract. (6) For licensable services, the network provider shall have and maintain correctand current Department of Children and Families and Agencyfor 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 managing entity may cease payment for services delivered by the network provider under such license(s) until said Uoenne(n)are reinstated bythe Department ufChildren and Families. (7) By the network provider shall submit tothe K8E'ocontract manager and implement a Quality Assurance Plan that details how the network provider will ensure and document that quality services are being provided to the clients oerved, which is herein incorporated by reference. The network provider shall submit: updates as amended of the Quality Assurance Plan within 20daya of adoption. (8) Bv[8/01/1�2establish aQuality Improvement Plan, which is herein incorporated by reference, of quality improvement activities for fiscal year 2012-2013 to improve performance. The network provider shall submit amendments to the Quality Improvement Plan, and quarterly reports on the implementation ufplan tothe managing entity's contract manager. (9) By the network provider shall submit tothe K8E'acontract manager grievance procedures, which include an appeal process with the managing entity, 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 managing entity about contracted services. (10)Tho network provider shall use the GA|N. the approved utilization management assessment tool for substance abuse, if substance abuse services are purchased through this contract. The Managing Entity in conjunction with the Department may specify an alternate assessment tool that may replace the current tool. Consumer placement criteria specific to mental health services will be developed by the managing entity and approved by the Southern Region SAMH Program Office. Standardized tools and assessments approved by the Department through the @Emust boused todetermine placement and level ofcare. (111) If the network provider provides medication management services, the network provider shall Guidance Care Center, Inc. 28 Contract No. Ms225�-27 � f � ensure that clients discharged from state mental health treatment facilities will be maintained on the medication that was prescribed for them by the facility at discharge pursuant to s. 394.676, F.S. Maintenance includes performing required lab tests, providing the medication, and providing appropriate physician oversight. (12)By 08/01/2012, the network provider shall submit to the ME's contract manager a disaster plan consistent with Section 29., Emergency Preparedness, of the Standard Contract. (13)Qn an annual basis, within thirty (30) days of the beginning of hurricane season, the network provider's emergency/disaster plan will be updated and activated upon notification of a disaster from the ME. The managing entity will conduct post disaster assessments of damage incurred by network providers. (14) By 08/01/2012, the network provider shall submit to the ME's contract manager a completed Civil Rights Compliance Questionnaire. (15) Comprehensive Continuous Integrated System of Care (CCISC): The network provider will participate in the Comprehensive Continuous Integrated System of Care (CCISC) Initiative.. CCISC participation will be considered in the allocation of lapse and/or new funding, subject the availability of funds. Lapse funds and new funds will be allocated in accordance with network providers' participation in the CCISC initiative. (16) The network provider shall coordinate services for persons with co-occurring disorders. (a) During the course of the contract period, the network provider shall design services based on the recognition of the needs of individuals and families with co-occurring disorders in the population served, and participate with the ME in a quality improvement process to improve co- occurring disorder service capability in all programs. (b)The network provider shall develop and operate a system of care to ensure the provision of appropriate services in the least restrictive setting for adults and children with substance abuse, mental health and/or co-occurring disorders. Those services are needed in order to provide a seamless Comprehensive Continuous Integrated System of Care (CCISC) for this population that will increase access to services and improve outcomes in the most cost effective manner. (c)The network provider shall implement a "no wrong door" model by developing a process for assessing, referring and/or treating clients with co-occurring disorders to increase access of persons identified as co-occurring to provide services for both disorders regardless of the initial point of contact. As used in conjunction with the CCISC model, "no wrong door' (See http://www.kenminkoff.com/ccisc.html ) requires that systems develop policies and procedures that mandate a welcoming approach to individuals with co-occurring psychiatric and substance disorders in all system programs, eliminate arbitrary barriers to initial evaluation and engagement, and specify mechanisms for helping each client (regardless of presentation and motivation) to get connected to a suitable program as quickly as possible. Guidance Care Center, Inc. 29 Contract No. ME225-3-27 (17)Bv the network provider shall submit Lothe W1E'a contract manager copies of its "no wrong door" policies and procedures as required by the CC|SC Initiative. The policies and procedures must address the referral and linkage process of clients to local community providers for services not offered by the network provider. The network provider is responsible for tracking and ensuring that the proper linkages are made. N8\The network provider shall submit to the managing entity a 6-month follow-up report on their implementation of the co-occurring action plans. (19) The network provider shall perform the following tasks related to the co-occurring disorder service capability initiative: b6 Develop and submit tothe managing entity for approval anaction Lplan Lfor assessing and nahahngo|ion\awithoo-000uningdioondonabylulma(Lofeaohyearofthouontruo term that details: An overview of the network provider's co-occurring disorder service capabilities with regard to service structure (assessment, stabilization, treatment, support, and other sen/|mea); H. Networking capacities with local network providers inthe community for persons with co- occurring disorders; Ui. Strategiesand activities todevelop orimprove co-occurring disorder service h. Scope ofservices and programs tobeincluded inthe process; and V. Timeframes for reviewing co-occurring disorder service capability within each network provider program. (h) Complete network provider co-occurring disorder service capability as directed by the managing entity using theCOMPASS (c) Following evaluation of each program using the COMPASS, evaluate clinicians' co- occurring disorder service capabilities as directed by the managing entity using the Develop and submit tothe managing entity a summary rel2ort byJune n«mofeach year that details: The types ofnetwork provider involvement instate and local co-occurring planning ii The number oftimes the COMPASS was used and the composition ofthe focus group(s) for each use; iii. Brief narrative detailing the findings from the COMPASS, the action steps developed, and progress made for each action step; Guidance Care Center, Inc. 30 Contract No. ms22s�-2/ k/. The number ofclinicians evaluated using the CODECAT; V. Brief narrative detailing the findings from the CODECAT and action steps developed to enhance clinicians'co-occurring attitudes, knowledge, values and skills; and vi Overall progress toward co-occurring disorder service capability development in accordance with timeframes specified in the action plan. (2NAny network provider that attains orthat already has attained co-occurring disorder service capability mustdemonstrate prior use of the COMPASS and [ODECATassessment tools as part of their overall process to improve co-occurring disorder service capabilities, and must: hASubmit to the managing entityiorapproval acompliance report byJune 30th of each year inlieu ufrepeating the administration ofthe COMPASS and CODECAT assessment tools. The compliance report must provide detail onwhen and how the assessment tools were used and the program (s) and staff participating in the evaluations. The COMPASS and COUECATassessment tools can befound at: (b) The network provider must provide copies of training guidelines or curricula and co- occurring policies to demonstrate attainment of co-occurring disorder service capability. This compliance report and related documents shall be accepted, upon approval from the managing entity, in lieu of the annual requirement for an action plan; and (c) Submit a summary report by June 30th each year that describes through brief narrative, any changes to the co-occurring disorder service structure including new programs, training, orchanges inpolicy and procedures. (21)The network provider shall evaluate co-occurring disorder service capabilities within their agency and their clinical staff. Prevalence data shall becollected using the K|S. The network provider shall include the number of co-occurring individuals from the previous fiscal year in their annual action plans. Speoifimd|y, prevalence data will be collected via the Substance Abuse Outcomes Admiaaion, Mental Health Outcomes Admission, and Detoxification Outcome forms which may be obtained from the ME's contract manager upon request. (22)Tho network provider should be engaged in performance improvement activities to improve its ability to recognize accurate prevalence of co-occurring disorders in its data system. (23)Trmma|nforme Care (TIC) 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 eayatem of care that meets their needs. Network providers will be implementing the Trauma Informed Care initiative through the following: acontinuous quality improvement plan or component in the existing agency wide continuous quality improvement plan that delineates participation in the TIC initiative. As part ofthe plan orcomponent ufthe plan must include the following: Guidance Care Center, Inc. 31 Contract No. mso2s-3-2r (a) Identification of at least two TIC Champions at the beginning of each contract term. If any changes occur to the existing champions notice must go to the Contract Manager, Director of CQI and Compliance and Director of Behavioral Health Services; (b) Participation in the regional Trauma Informed Care meetings to develop the process for identifying and responding to those affected by trauma. (c) Attendance at the regional trainings regarding Trauma Informed Care as applicable. Applicable trainings will be documented in agency action plan. (d) Completion and submission of an agency -wide self -assessment using the Trauma assessment tool as identified by the Department and SFBHN by December 34th of each year. (e) Development and submission of a TIC Evidence of Commitment plan that includes the below along with incorporated results of the self -assessment tool by January 15th of each year: i. An overview of the network provider's TIC capabilities with regard to service structure (assessment, stabilization, treatment, support, and other services); ii. Networking capacities with local providers in the community for persons with trauma; iii. Strategies and activities to develop or improve TIC service capability; iv. Scope of services and programs to be included in the process; and v. Timeframes for reviewing TIC capability within each network provider program. (f) Participation in all TIC related activities to ensure staff and agency become competent in all areas of trauma informed care. (g) Implementation Trauma Informed Care throughout the agency will be documented in quarterly QA/QI Reports. (24)The network provider will participate in the SOAR initiative to include the submission of SOAR web -based data as outlined in the Working Agreement for SSI/SSDI Outreach, Access, and Recovery (SOAR) Initiative Community Provider Agency found on Attachment IV, of this contract. (25)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:/lwww.dcf.state.fl.us/newslhumanresearchpolic se�htrnl. 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. (26)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 Guidance Care Center, Inc. 32 Contract No. ME225-3-27 to 45 CFR 96.136. (27)The network provider shall execute a Memorandum of Understanding (MOU) with the appropriate Federally Qualified Health Center within ninety (90) days of the effective date of this contract. The MOU shall be submitted to the ME's Contract Manager on or before September 14 of each fiscal year. The MOU provides for integration of primary care services to the medically underserved. A network provider designated as a Federally Qualified Health Center is exempt from this requirement. (28) The network provider will demonstrate efforts to initiate and support local county implementation of the Medicaid Substance Abuse Local Match Program in order to expand community service capacity through draw down of Federal funding. (29)The network provider shall maintain in one place for easy accessibility and review by the ME's 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 managing entity operating procedures. (30) 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. (31) The network provider shall meet with the ME's staff at regularly scheduled or specially called meetings when notified by the ME. (32) The network provider shall assist the managing entity in the reporting and managing of the Substance Abuse and Mental Health Waiting List for all levels of care. (33)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 Managing Entity policies and procedures. (34) The network provider shall meet the standards for timely access to care along the lines of those required by ME, accrediting bodies and the Medicaid prepaid plans as identified below: L Immediate/Crisis: seen immediately for life behavioral health life threatening emergencies ii. Within 24 hours of initial contact for non -life threatening emergencies; iii. Within 48 hours for urgent care; iv. The offer of an appointment for routine care within 7 business days. Non-compliance with timely access to care for services terms will result in a corrective action. Guidance Care Center, Inc. 33 Contract No. ME225-3-27 (35)Thenetwork provider will promote personal self-determination and choice by: 1. 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); ii. Engaging service recipionta, bumih/ membera, and advocates in the doaign, development, and evaluation ufservices; iii. Giving consumers achoice ofprovider and services, whenever possible; iv. Assessing and improving consumer satisfaction. (36)The network provider shall develop and aoauno the delivery of services based on Evidence -Based Practices/Promising Practices Guidelines in accordance with the approved Program Description. (37)The network provider shall ensure access to services that meet linguistic and cultural needs of recipients. (38)The network provider agrees to provide sign language, translation, and interpretive services required to meet the communication needs of aemioo recipients, including English, Spanish and Creole. Services will meet the cultural needs and preferences of the covered populations. (39) The network provider aaoun*a to engage in recruitment to maintain as much as possible staff with the ethnic and racial composition of the clients served. (40) K not already aoonadited, the network provider shall take appropriate steps to obtain/maintain national accreditation during state fiscal year 2012-2013 in order to promote best practices and the highest quality of care. The network provider shall provide the K4Ewith their full accreditation and licensing nopoda upon request. Providers whose contract or annual service reimbursement amount exceeds $86.000 but is |oaa than $350.000end serve more than three unrelated persons, must comply with the CARF Standards for Unaccredited Providers. (4N)The network provider mhm|| ensure provision of services to clients with special needs The network provider shall ensure the coordination of specialty services including employability skills training and |inkage, victimization and trauma aervicea, infant mental health services, the e|dedy, and services tofamilies in recovery. The network provider shall also ensure the availability of appropriate services to consumers with special needs such as those who are b|ind, deaf or hard of heering, developmentally disabled, physically handicap, criminally involved, or forensic clients. The managing entity reserves the right to modify this list aothe needs ofthe consumers change. The network provider shall provide early diagnosis and treatment intervention to enhance recovery and prevent hospitalization. The network provider agrees tocomply with provisions of EoHibbJ, Assisted Living Facilities With mLimited Mental Health Licemoa, if services tosuch Guidance Care Center, Inc. 34 Contract No. Ms225�-27 residents are offered. id. The network providershall work with the ME, the state, and other stakeholders to n*duoo the admissions and the length of stay for dependent children and adults with mental illness in residential treatment services. (42) 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 procedunea, recipient rights and responsibilities (including grievance and appeal procedures). This information will beavailable for use bythe consumers within each subcontractor location. (43) Work and Social Opportunities The network providerwill employ Peer Services Coordinators todevelop work and social opportunities for clients and make recommendations to the ME and subcontractors for a conaumerdrkmnayotem. (44)Ammist Stakeholder Involvement inPlanning, Evaluation, and Service Delivery Participate in Planning: At the ME's nequest, the network provider will assist the managing entity in engaging local stakeholders, per section 394.9082 F.S., in its support activities for the Department's local plans and in the development of its Annual Action Plan. (45)Develop, Maintain and Improve Reporting The network provider shall submit reports included in Exhibit C, Required Reports. In all cases, the delivery of reports, ad hoc or scheduled, shall not be construed to mean acceptance /f Uhua* reports. Aoo*ptanoe, in writing, of required reports shall constitute a separate act and shall be approved by the managing entity's contract manager. The managing entity reserves the right to reject reports as inoomp|ete, inadequate or unacceptable. (46) The network provider shall provide prevention services as outlined in 65D-30,013, F.A.C., and in accordance with this oontrao, the program description and Attachment V. Prevention Services. (47)The prevention services network provider shall ensure that a PPT is contained in the Performance Based Prevention System. The "fina|" PPTahal| beprinted from PBPS and sent to the managing entity's contract manager for approval within 30 days of contract execution. The managing entity shall review and approve the Prevention Program Tool (48)The network provider shall ensure that Prevention Program Coordinators and any other personnel responsible for entering data into the Prevention data system, including subcontractors who upload data from their own system, must register and complete training onuse ofthe PPTatleast annually. network provider contracted for HIV Early Intervention Services will designate a representative to participate in the bma| Department of Health H|\VA|DS planning body's meetings. The network provider shall ensure participation in a minimum of 50% of the Guidance Care Center, Inc. 35 Contract No. Mszz*a-2r i M meetings involving community service partners. (50)Network providers shall collaborate with the local community substance abuse coalitions (where available) to help develop and support capacity to address community substance abuse needs. Activities shall be specified in the Prevention Activities Exhibit, which is incorporated herein by reference, and as specified in the approved annual action plan. (51) Based on the most recent local community anti -drug coalitions' action plan or the most recent county Substance Abuse epidemiology data, the network provider agrees to administer and deliver appropriate evidence -based strategies and approaches as specified in the Program Description required by Rule 65E-14.021, F.A.C., and is on file in the ME contract manager's file and incorporated herein by reference. (52) Client Satisfaction Survey The network providers shall conduct client satisfaction surveys as per DCF PAM 155-2. Failing to provide the required number of satisfaction surveys will result in a corrective action. (53) Forensic Service 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 have been committed or may be at risk of commitment to the Department of Children and Families, 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, the Forensic Mental Health Services Exhibit and established forensic performance measures. (a) All individuals referred for admission to short-term residential treatment facility (SPIT) by the ME's SAMH Forensic Coordinator and/or Forensic Specialists shall be granted an on -site face-to-face interview with 72 hours of referral. Written findings and recommendations must be completed and submitted to the referral source and the regional forensic coordinator. (b) All individuals referred for admission to a residential treatment facility by the ME's SAMH Forensic Coordinator and/or Forensic Specialists will be granted an on -site face- to-face interview within a minimum of 72 hours of referral, if individuals reside within Miami -Dade, Monroe and Broward County. For individuals who are referred for admission and who live outside of the above referenced counties, the network provider shall coordinate the interview date for the client with the Forensic Specialist and/or ME's SAMH Forensic Coordinator. The network provider must submit written findings and recommendations to the referral source and the ME's SAMH Forensic Coordinator within 48 hours of client interview. (c) The community case manager will coordinate services and provide the court with routine progress reports as required by the conditional release order Rule 65E- 15.051(14), F.A.C. The Forensic Specialist may accompany the case manager to all court hearings regarding individuals on conditional release. (d) The community case manager will consult with the Forensic Specialist regarding any apparent conditional release violation. Network Provider staff will be responsible for Guidance Care Center, Inc. 36 Contract No. ME225-3-27 notifying the court and the Forensic Specialist of any conditional release violations via affidavit or sworn statement per s. 916.17(2), F.S. (e) The network provider will not return individuals on conditional release to court prior to consultation with the ME's Forensic Coordinator and/or assigned Forensic Specialist, except in cases of physical aggression by the individual in question. (f) Programs must provide services in English, Spanish and Creole. (g) 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. The network provider will ensure that individuals on conditional release order are monitored in accordance with the requirements of Rule 65E-15. F.A.C., Continuity of Care Case Management and the court order to ensure compliance with the order and department rules. ii. The network provider will ensure the committing court is immediately notified by phone and in writing of any deviations from the conditional release order. The network provider will ensure the ME SAMH Forensic Coordinator is copied on written correspondence to the court. iiii. The network provider will ensure the review of required monthly monitoring reports in order to intervene in problematic situations, to provide alternative treatment modalities when necessary, and to identify trends and issues that illustrate opportunities for improvement in service delivery. The network provider will bring the aforementioned situations, trends and issues to the immediate attention of the ME SAMH Forensic Coordinator. IV. The network provider will ensure the distribution of copies of conditional release orders and modifications to the agency providing mental health and substance abuse services to the individual and to the SAMH Regional and Headquarters Office in Tallahassee. (h) Utilization Management The network provider shall facilitate the Forensic Specialists' requirement to manage the residential treatment beds funded by community forensic dollars in Circuit 11 and the statewide community forensic beds located in Circuits 11 & 17. This includes a short - term residential treatment facility and residential level 2 beds. The network provider will be responsible for managing the appropriate utilization of community forensic residential treatment beds. (54) Projects for Assistance in Transition from Homelessness (PATH) (a) The network provider shall submit an annual PATH application to the Mental Health Program Office as requested. (b) The network provider shall provide support services for individuals who have a serious mental illness and/or substance abuse and are homeless or at imminent risk of becoming homeless. (c) The network provider shall implement services and provide deliverables as set forth and described in each approved and signed Local Intended Use Application which is Guidance Care Center, Inc. 37 Contract No. ME225-3-27 07/01/2012 a requirement of the PATH grant application. (d) Eligible PATH local matching funds must be expended in the provision of PATH eligible services to PATH eligible persons. The expenditures must match the types of services outlined in the Local Intended Use Plan. The formula to be followed is cited in Section 524 of the Public Health Services Act, as amended by Public Law 101-645. (e) The network provider will complete PATH activities as follows: (i) Submit Annual Data Report to SAMHSA (ii) Submit the Annual reapplication for the PATH Grant (55)Children's Mental Health Services, including services for Severely Emotionally Disturbed Children, Emotionally Disturbed Children and their Families (i) The key strategic objectives and strategies that support the department's mission and direct the provision of services to Florida's residents are detailed in the Substance Abuse and Mental Health Services Plan 2010-2013, which is incorporated herein by reference. They represent the primary focus of the Substance Abuse and Mental Health programs, and it is expected that the network provider will ensure adherence to them, including but not limited to the following: (a) Ensure that families and youth are full partners in the development and implementation of individual recovery plans and have a prominent voice in designing supports and services. (b) Prioritize services and supports for children who are involved with the child welfare and juvenile justice systems. Within these priority groups, children birth to five years of age, youth transitioning to adulthood and children at risk of residential treatment are the focus of specific activities and initiatives. System transformation is the driving force for current and future activities, with an emphasis on evidence based practices that are culturally competent, focused on prevention, early identification and intervention, and family -centered. (c) Ensure that services and supports for children, youth, and families are sensitive to the impact of trauma, and are designed to address treatment issues and minimize system elements that might produce further trauma. (d) Address the critical need for better information, planning, and assistance for eligible children transitioning into the adult mental health system. (e) Develop coordinated systems of care for children that provide services and supports that promote recovery and resiliency by being: (i) Community -based (ii) Culturally competent (iii) Strength -based (iv) Evidenced -based practices for children and adolescents - including Multi -systemic Therapy for children and youth with or at risk of juvenile justice involvement, Therapeutic Foster Care, Family Support and Education, Cognitive Behavioral Therapy for Guidance Care Center, Inc. 38 Contract No. ME225-3-27 07/01/2012 traumatic a\nsoo, Dyadic Therapy for infants and toddlero, and the Wraparound Approach. A6 Individualized, child focused, and family directed. (vi) Inclusive of early intervention with the child and family. (vii) Coordinated across agencies and time lines U0 The managing entity will agree to ensure that its subcontractors provide o full continuum of services to address the needs of Severely Emotionally Disturbed Children, Emotionally Disturbed Children and their Families. These services must include but not belimited to: (i) Dyadic Therapy for children under 5, (iU Behavior Analysis services for children with behavior problems, (i|8Life skills and VVeUnaoa Recovery Action Plan services to children transitioning to the adult system. The network provider ahed| perform oemkzao in accordance with app|\cab|e, rules, nhau\ea. licensing standards and policies and procedures. Services shall only bmprovided in the Southern Region (Miami -Dade and Monroe Counties), with the exception of clients residing in state hospitals, or Short -Term Residential Treatment programs that are Southern Region clients, o/ by exception with approval by the department through the ME. The network provider agrees to abide by the approved Program Oeaoription, 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 /f the ME. If app|ioab(e, the network pnovidar, with managing entity written approva|, may unbundle K4mdioa| Services from the Substance Abuse Residential Levels U, |(L and (V cost centers for clients with co-occurring disorders, unbundle Psychological Evaluations from theChUdnen'o Mental Health Residential Lmvm|a ( and ||, and unbundle Psychological Evaluations from the Chi(dnen'aSubstance Abuse Residential Levels ||. |||. and |Vcost centers. The network provider shall ensure that services are performed in accordance with applicable rules, statutes, and licensing standards. 2. Staffing Requirements a. Staffing Levels M1 The network provider shall maintain staffing levels in compliance with applicable rules, statutes, licensing standards and policies and procedures. See Exhibit F, Minimum Service Requirements. (2) The network provider nhe|| engage in recruitment to maintain as much as possible staff with the ethnic and racial composition of the clients served. b. Professional Qualifications /1\ The network provider shall comply with applicable rules, statutes, requirements, and standards Guidance Care Center, Inc. 39 Contract No. mE2uS-a-2r 07/01/2012 with regard toprofessional qua|ificationa. See Exhibit F, Minimum Service Requirements. (2) The network provider shall provide employment screening for all mental health personnel and all ownera, dinso\oro' and chief financial officers of service network providers using the standards for Level || screening set forth in Chapter 435, and o. 408.809 F.S., except as otherwise specified in n. 884.4572(1)(b)-(o). F.S. For the purposes of this contract, "Mental health personnel" includes all program directors, professional oUnioians, 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. Addihona(|y, the network provider shall provide employment screening for substance abuse personnel using the standards set forth inChapter 3A7.F.S. This includes all owners, directors, and chief financial officers of service network providers and all service network provider personnel who have direct contact with children receiving services or with adults who are developmentally disabled receiving services. c. Staffing Changes The network provider shall notify the ME'a 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. Additionally, the network provider will notify the ME'o 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 all aervioea, subject tothe provisions of, but not limited to, Section 12. of the Standard Contract. Written requests by the network provider to subcontract for the provision of services under this mznireot will be routed through the ME'a 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 ofsubcontracting shall not in any way relieve the provider of any responsibility for the contractual obligations of this contract. (2) The network provider shall implement and maintain procedures for subcontractprocurement, development, performance, and management that comply with state and federal m|es, regulation, and/or Managing Entity policies and prooedureo, in addition to identifying the managing entity's pre' approval process for approving the network providers act of subcontracting. (3) The network provider shall maintain individual subcontractor files for each subcontractor and provide copy of all subcontracts prior tothe execution of those subcontracts and any amendments tothe managing entity's contract manager. (4) The network provider shall not subcontract for substance abuse/mental health services with any person or entity which: (a) is banod, suspended, or otherwise prohibited from doing business with any government enhty, or has been barnsd, ouapended, or otherwise prohibited from doing business with any government entity within the last 5years; (b) is under investigation or indictment for criminal oonduo\, 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 |aa\ 5 yeara, with any litigation, Guidance Care Center, Inc. 40 Contract No. me22sa-27 07/01/2012 regardless ofwhether aaa plaintiff ordefendant, which might pose aconflict 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 ooUofao\ork/ perform or for cause; or, (e) failed to implement acorrective action plan approved to the satisfaction of the managing entity, the department, and other governmental entities, after having received due notice. (5) All subcontract agreements shall adopt the applicable terms and conditions ofthe network provider's contract with the ME, which ioincorporated herein byreference. Subcontract agreements shall include adetailed scope of work; clear and specific deliverables; and performance standards. The subcontractors will be required to follow the network provider's and the W1E'o Policies and Procedures, and Contract, which is incorporated herein byreference and may befound onthe K4E'owebahowww.ofbhnorg. (6) Unless the Department agrees to an alternative payment method an authorized in section 394.9082. F.S, and prior to entering into any subcontract, or an amendment which modifies the previously negotiated unit ooa\ rate or adds additional cost centers, the network provider shall conduct a cost analysis for said subcontract, in accordance with Rule 65E-14.021, F.A.C.. Acoot analysis iothe review of the proposed cost elements to determine if they are necessary, a||owab(e, appropriate and reasonable. Subcontractors will be required to comply with Rule 65E-14.021, F.A.C., Unit Cost Method of Payment' including but not limited to, cost centers, unit meoaunemmnto, deaorip\iona, program areas, data elements, maximum unit cost natea, required fiscal reporta, program deaorip\ion, setting unit cost radea, payment for services including allowable and unallowable units and requests for payments. (7) The United States Public Health Service Act, Sections 1831(a)(1)(E)'and 1816(a)(5).and Title 45 of the Code of Federal Regulations, Part88]35(a)(5) prohibit States from expanding 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 uuubtunoe^ is used to describe agrant relationship aadistinguished from aprocurement relationship, typically funded bycontract. While the above -referenced statute and regulations preclude States from providing grants tofor-profit entities, procurement contracts may be entered into with for -profit entities. This is the latest interpretation from the United S\edos Department of Health and Human Services Substance Abuse and Mental Health Smn/ioaa Administration (4/5/2009). [PHGAo\. aa. 1931(a)(1)(E). and 1816(a)(5). and45 CFR, Part 96.135(a)(5)] Additional guidance for contracting SAPTBGfunds can beobtained |nthe SAK4H Funding Restrictions Guide ekthe following webaite: (8) The network provider shall monitor the performance of all subcontractors and perform follow up actions as necessary. The network provider shall notify the managing entity within 48 hours of conditions related to subcontractor performance that could impair continued service delivery. 3. Service Location and Equipment a. Service Delivery Location The location ofservices will beaaspecified inthe approved Program Description required byRule 85E- 14.O21(0)(d)1.d.(U(). F.A.C. b. Service Times (1) A continuum of services shall be provided on the days and times as specified inthe approved Program Description. Guidance Care Center, Inc. 41 Contract No. ms22s�-2r (2) The network provider ahsd| notify the yWE'a contract manager, in writing, at least ten (1[) calendar days prior to any changes in days and times where services are being provided pursuant to Rule G5E-14.O21(8)(d)5,F.A.C. u' Changes |nLocation The network provider shall notify the ME'o contract manager, in writing. at least ten(1{) calendar days prior toany changes in location where services are being provided pursuant to Ru|eG5E- 14.O21(8)(d)d(U|), 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 anynon'axpendable property with funds under this oontraot, the network provider will ensure compliance with the Tangible Property Requirements, Department operating Policies and Procedures as outlined in CFOP40'5. CFOP8O-2. Rule 65E'14. F.A.C, which are incorporated herein by reference and may be obtained from the K4E`n contract manager. The provider shall submit an inventory report, as specified in Exhibit0, Network Provider Inventory List and bythe date(o) listed in Exh1bitC, Required Reports. 4. De|h*amoblem a. Services The network provider shall deliver the services specified in and described in the Program Description submitted by the network provider and an set forth in Exhibit G, State Funding by Program and b. Records And Documentation The network provider shall protect confidential records from disclosure and protectclient confidentiality in accordance with oa.3Q7.5O1(7),3S4.455(3),394.4S15,and 414.285.F.S.,and also the Health Insurance Portability and Accountability Act (HIPAA), and any other applicable State, and Federal laws, rules, and Where this contract requires the delivery of reports to the managing entity, mere receipt by the managing entity 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 separate act in writing. The managing entity reserves the right to reject reports as incomplete, inadequate, or unacceptable according tothe parameters set forth in the resulting contract. The managing entity, at its option, may allow additional time within which the network provider may remedy the objections noted by the managing entity or the managing entity may, after having given the network provider a reasonable opportunity to comply with the report requirmmento, declare this agreement to be in default. (1) The network provider shall submit to the ME financial and programmatic reports specified kl Exhibit C, Required Reports, by the dates specified. (2) The network provider shall ensure that its audit report will include the standard schedules that are outlined in Rule 65E-14.003, F.A.C. Guidance Care Center, Inc. 42 Contract No. mE2o5-a-2/ (3) All ohi|dnen'o mental health network providers shall complete a typed quarterly progress neport, as specified in Exhibit M, Child Welfare Quarterly Clinical RepoML, that is filed in the medical record. The network provider is required to provide Children and Families or Community Based (]are wVrkarn, immediately upon nequeot, with the most recent quarterly written report detailing the pnzOreoo, current status and therapeutic needs ofthe named child. NA The network provider ahsU| submit treatment data, as set out in subsection 394.74C3) (e), F.S. (5) In addition to the modifiers to procedure codes that are currently required to be utilized as per DCF PAK815G-2.Appendix 2.the network provider iodirected toutilize the following modifiers required for services funded bythe following sources, where applicable: Panel Approved Code Short Description 10 27CHV-Children |V 11 27H|\-(VDrug Usage 12 27VVOK8-Gen/kmatoWomen 15 CFBAS-CommunityForensic Beds 18 GX018-PATH (6) Service Provision Requirements for Substance Abuse Prevention and Treatment Block Grants (a) The network provider agrees to comply with the data submission requirements outlined in DCF PAM 155-2 and with the funding restrictions outlined in "SAMH OCA's And Funding Restrictions" which can befound at: hKp://mwvv.dof.sXate.f|.uo/oroAnams/aemh/non\rautingMona.mhtm| and which are incorporated herein by reference. For services (b)inaddition to the modifiers toprocedure codes that are currently required tobeutilized aaper DCF PAM 155-2. Appendix 2, the network provider in directed to utilize the following modifiers required for Block Grant funds, where applicable: Panel Approved Code Short Description 10 27CHV(Chi|dnan(V 11 27H|V'|VDrug Usage 12 27WOM-Services to Women (c) The network provider agrees to comply with applicable data submission requirements outlined in Exhibit C.Required Reports. This exhibit lists required annual reports for GAPTBGset-aside funded pregnant women and women with dependent children services, SAPTBG set -aside funded HIV Early Intervention Programs, and the SAPTBG for Evidenced -based Outreach Services to Injection Drug Users. (d) 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. (e) 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 Exhib|tG, State Funding by Program and Activity. Guidance Care Center, Inc. 43 Contract No. ms2zs'a'zr AA 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 \o45CFR9G.13S. (7) Data for services shall be submitted electronically tothe ME by the 8th of each month into the Knight Information Software database (K|S). |naddition, the network providerwiUaubmitdataonprevantionao\ivhieointhe Performance Based Prevention System (PBPS) by the 8th of each month following the month of service. The network provider shall also: (a) Ensure that the data submitted clearly documents all client admissions and discharges which occurred under this contract; (b) Ensure that all data submitted to the K|S is consistent with the data maintained in the network provider's o(ien\o files; (c)Review the managing entity's File Upload History screen in SAWS to determine the number of records eocepted, updated and rejected. Based on this navevv, the network provider shall download any associated error files to determine which client records were rejected and to make sure that the rejected records are corrected and resubmitted in the KIS; (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 net, which results in a rejection rate of 10% or higher of the number of monthly records submitted will require the network provider to submit a corrective action plan describing how and when the missing data will be submitted or how and when the rejected records will be corrected and resubmitted; and (e) In accordance with the provisions of section 402.73(1). F. G, and Rule 65-29.001. F.A.C., corrective action plans may be required for non-oompUanoe, nonpedormanoe, or unacceptable performance under this contract. Penalties may be imposed for failures to implement orto make acceptable progress on such corrective action plans. Failure to implement corrective action plans tothe satisfaction of the Managing Entity and after receiving due notice, shall be grounds for contract termination. (8) In addition to utilizing the modifiers to procedure codes for block grant funds identified in paragraph 4J6) (b) obove, the network provider, upon request by the Managing Entity or the Department, shall submit information regarding the amount and number of services paid for by the Community Mental Health Services Block Grant and/or the Substance Abuse Prevention and Treatment Block Grant. /8> A facility designated as a public receiving or treatment facility under this contract shall report the following Payor Class data to the ME, unless such data are currently being submitted into K|G. Public receiving or treatment facilities that do not submit data into K|G, ahuU report these data annually as specified in Exhibit C. Required Repods, even if such data are currently being submitted to the Agency for Health Care Administration: (a) Number oflicensed beds available bypayorclass; (b) Number ufcontract days bypaynrclass; (c) Number of persons served (unduplicated) in program by payor class and diagnoses; (d) Number ofutilized bed days bypayorclass; (e) Average length ofstay bypayorclass; and (f) Total revenues bypayorclass. (10)Thenetwork provider shall obtain the format and directions for submitting payorC(aoo data from the managing entity. (11)Tha network provider shall submit Payor Class data to the managing entity no later than 90 days following the end of the facility's fiscal year. 5. Performance Specifications m. Performance Measures (1)The network provider shall meet the performance standards and required outcomes anspecified in Exhibit D. Substance Abuse and Mental Health Required Performance (2) The network provider agrees that the Knight Information Software (KiS) Data System and SAW1H(S 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 Managing Entity. Any conflicts will be clarified by the Managing Entity and the network provider shall adhere to the Managing En\i\\/o resolution. The network provider shall submit all service related data for clients funded in whole orin part bySAMHfunds, local match, orMedicaid. (3) The network provider agrees that the Performance Based Prevention System (PBPG) will be the source for all data used to determine compliance with substance abuse prevention related performance standards and outcomes in Exhibit D. Substance Abuse and Mental Health Required Performance Outcomes/Outputs or other data system mpooihmd by the Managing Entity. The network provider shall submit all service related data for clients funded, inwhole orinpart, byGAK4Hfunds. WA The network provider shall ensure that the Prevention Program Coordinator and any other personnel responsible for directly entering data into the Prevention data system register for data entry training on PBPG and complete online or face-to-face training within thirty (30) days of hi/a, and annually thereafter. The network providers nhn|| maintain the certificate of attendance for all participants for all trainingo.This does not apply to network providers who have their own data system and upload data toPBPS. (5) In addition to the performance standards and required outcomes specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs, the network provider shall meet requirements set forth in Section D. 10. Special Prpvisionm, Performance Measures for Continuous Quality Improvement Programs, and Attachment V^ Prevention Services. b. Performance Measurement Terms [CFPAM1GG-2provides the definitions of the data elements used for various performance measures which are quantitative indicators, outoomoa, and outputs used by the managing entity to objectively measure a network provider's perfonnanoe, and contains policies and procedures for submitting the required data. KIT Solutions maintains the pnzoedunua for submitting the required prevention data into PBPS. o. Performance Evaluation Methodology Guidance Care Center, Inc. 45 Contract No.xxezzs-3-27 (1) The network provider shall collect information and submit performancedata and individual client outcomes, to the managing entity data system in compliance with DCF PAM 155-2 requirements. The specific methodologies for each performance measure may be found at the following (2) The network provider isexpected tohave the capability to engage inorganized performance improvement activities, and to be able to participate in partnership with the department and ME in performance improvement projects that are no|a1od to system wide transformation and improvement ofservices for individuals and families. (3) By execution of this contract the network providerhereby acknowledges and agrees that its performance under the contract must meet the standards set forth above and will bebound by the conditions set forth inthis contract. Kthe network provider fails tomeet these standards, the ME, at its exclusive option, may allow a reasonable pohod, not \oexceed six (S) months, for the network provider to correct podonnanoo 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 ie/m)nuio the contract. The ME has the eo|o authority to determine whether there are extenuating ormitigating circumstances. (4) The ME will monitor the standards and outcomes specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes/Outputs, in Section D. YQ. Performance Measures for Continuous Quality Improvement Programs, and in Attachment V. Prevention Servicoa, during the contract poriod, to determine if the network provider is achieving the |eme\m that are specified. QG> Performance data information may be found on the department's vvob'beaud performance Dashboard at: . Additional prevention data information may be found on the Exhibit D Report which is transmitted to the ME Director of Prevention Services monthly. G. Network Provider Responsibilities a. Network Provider Unique Activities NThe network provider isresponsible for the satisfactory performance of the tasks referenced inf 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 accountablefor the performance thereof whether performed bythe network provider or its subcontractors. (2)The network provider agrees that services other than those set out in this contract will be provided only upon receipt of awrit\on authorization from the managing entity's contract manager or on authorized managing entity staff member. The department through the managing onthy, has final authority tomake any and all determinations that affect the health safety and well-being of the residents of the State of Florida. (3) The network provider shall ensure that the invoices submitted to the ME reconcile with the amount of funding and services specified in this contract, as well as the network provider's agency audit report and client information system. N0The network provider shall comply with all other applicable federal laws, state statutes and associated administrative rules asmay bopromulgated mamended. See Exhibit F.Minimum Service Requirements. 07/01/2012 (5) Pursuant tns. 394.74(3)(o). F.S, the network provider shall maintain data on the performance standards specified hn Exhibit D.Substance Abuse and Mental Health Required Perfprrnmmom Outcomes and Outputs, for the types of services provided under this contract and maintain data specified in Attachment V, Prevention Services, for the types of prevention strategies under this contract. The network provider shall submit such data tothe MEupon request. (G)Anetwork 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 11 of Pad B of Title X|X of the Public Health Service Act, o. 42 U.S.C. 300x-21 e1aeq. (as approved September 22, 2000) and the Health and Human Services (HHS) Block Grant regulations (45 CFR Port 9G). (7) A network provider that receives funding from the SAPTBG certifies compliance with all of the requirements of the Substance Abuse and Mental Health Services Administration (SAMHSA) Charitable Choice provisions and the implementing regulations of 42 CFR54a. (8) The network provider shall be engaged in performance improvement activities to improve its ability to recognize accurate prevalence of co-occurring disorders in its data system. (9)Krequired by 45 CFRParts 160,162,m164; the following provisions shall apply [45CFR 164504(e)(2)0(U: (a) The network provider hereby agrees not to use or disclose protected health information (PHI) except as permitted or required by this contract, o\aA* or federal law. <b\ The network provider agrees to use appropriate safeguards, secure methods, and security measures to prevent use or disclosure of PHI other than as provided for by this contract or applicable law. This applies toall manual and electronic data. (c) The network provider agrees to report to the Department any use or disclosure of the information not provided for by this contract or applicable law. (d) The network provider hereby assures the Department and the Managing Entity that if any PHI received from the Department or the Managing Entity, or received by the network provider on the Department's or the Managing Entity's behalf, is furnished to network provider's subcontractors or agents in the performance of tasks required by this contract, that those subcontractors or agents must first have agreed to the same restrictions and conditions that apply tothe network provider with respect tosuch information. (e) The network provider agrees tomake PHI available in accordance with 45C.F.R. 164.524. (f) The network provider agrees to make PHI available for amendment and to incorporate any amendments tnPHI in accordance with 4GC.F.R. 164.520. (g) The network provider agrees to make available the information required to provide an accounting ofdisclosures inaccordance with 4GC.F.R.1S4.528. (h) The network provider agrees to make its internal practices, books and records relating to the use and disclosure of PHI received from the Department or the Managing Entity or created or received bythe network provider onbehalf ofthe Department orthe Managing Entity available for purposes of determining the network provider's compliance with these assurances. (i) The network provider agrees that at the termination of this contract, if feasible and where not inconsistent with other provisions of this contract concerning record rotention, it will return or Guidance Care Center, Inc. 47 Contract No. nxsoz5-s'o destroy all PHI received from the Department or Managing Entity or received by the network provider on behalf of the department that the network provider still maintains regardless of form. |fnot feasible, the protections ofthis contract are hereby extended tothat PHI which may then be used only for such purposes as make the return or destruction infeasible. (j) A violation or breach of any of these assurances shall constitute a material breach of this (11O)The network provider shall provide performanceinformation urreports other than those required bythis agreement a1the request ofthe ME, the Southern Rogion'oSAMHRegional Director, or their designee. For requests that are complex and difficult to address, all parties will develop and implement a mutually viable work plan, (111) The network provider shall cooperate with the ME and the Department when investigations are conducted regarding regulatory complaint ofthe network provider. (12) The network provider shall make available and communicate all plans, policies, procedures, and manuals tothe ME staff, network provider staff, and toclients/stakeholders if applicable. (13) 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 byclient, ^ and have the ability to provide an audit trail. Maximize all potential sources of revenue to increase oervi000, and institute efficiencies that will consolidate infrastructure and management functions inorder tomaximize funding, (14) The network provider will have a data system in place that adequately supports the collection, tracking, and analysis ofdata necessary to perform utilization management activities, reviews of clinical/administrative performance related to levels of care, clinical outcomes, and adherence to ohn|oa\/adminiatrativoatandarda. (15) The network provider shall make available to the ME all evaluations, assessments, surveys, monitoring or other reports and any corrective action plans, pertaining to outside licensure, accreditation, or other reviews conducted by funding entities or others and received from such other entities within ten (1U)days ofreceipt bynetwork provider. (16) The network provider shall maintain human resource policies and procedures that provide safeguards toensure 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 ME of the same. (17)The network provider shall assist the yNEand the Department indeveloping legislative budget requests based upon identified needs ofthe community. (118) The network provider shall make available source documentation of units billed by network provider upon request from the K8Estaff. (19) Client Trust Funds ([|TF) (a) The network provider shall submit a letter to the contract manager certifying that they either are or are not the representative payee for Supplemental Security Income, Social Security Administration, Veterans Administration, orother federal benefits on behalf of aclient within thirty (30)days cfcontract/amendment execution orbyJuly 15thcfeach fiscal year. (b) If the network provider is the representative payee for Supplemental Security Income, Social Security Administration, Veterans Adminiatration, orother federal benefits on behalf ofthe client, the network provider shall comply with the applicable federal laws including the 97KFAM establishment and management of individual client trust accounts (20 CFR 416 and 31 CFR 240). (Circuits may delete paragraphs (b)—(d) if not applicable.) (c) Any network provider assuming responsibility for administration of the personal property and/or funds of clients shall follow the Department's Accounting Procedures Manual 7 APM, 6, Volume 7, incorporated herein by reference. Department or the ME personnel or their designees upon request may review all records relating to this section. Any shortages of client funds that are attributable to the network provider shall be repaid, plus applicable interest, within one (1) week of the determination. (d) All reports specified in the Department's Accounting Procedures Manual 7 APM, 6, Volume 7 shall be maintained onsite and available for review by Department or ME staff, and shall be submitted to the ME upon request. (e) The network provider shall also maintain and submit documentation of all payment/fees received on behalf of SAMH clients receiving Supplemental Security Income, Social Security Administration, Veterans Administration, or other federal benefits upon request from the ME. (20) The network provider agrees to comply with Exhibit N, Missing Children, if the network provider is providing services to children where the care of the child is assigned to the Department or network provider. (21) Upon request, the ME will assist with the development and implementation of client admission, continued stay, discharge criteria specific to each level of care, diagnosis, presenting problems, and the establishment of review dates. b. Coordination with other Providers/Entities (1) The network provider shall develop, maintain, and improve care coordination and integrated care systems as follows: I. Develop Initial Service Agreements (a) The network provider shall fulfill their designated role in implementing and/or maintaining a system of care in support of the cooperative agreements with the judicial system and the criminal justice system which define strategies and alternatives for diverting persons from the criminal justice system and address the provision of appropriate services to persons with substance abuse, mental health and/or co- occurring disorders who are involved with the criminal justice system, as specified in the approved annual action plan. These agreements address the provision of appropriate services to persons who have behavioral health problems and leave the criminal justice system. (b) 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. (c) The network provider may be required to develop and implement cooperative agreements with other external stakeholders as described in the approved Annual Guidance Care Center, Inc. 49 Contract No. ME225-3-27 07/01/2012 Action Plan. (d)The network provider shall execute amemorandum of understanding with the local community substance abuse coalitions \ohelp develop and support capacity Vo address community substance abuse needs. (2) Plan for Care Coordination (a) The network provider agrees to coordinate services with other providers and state entities rendering services to children, adults, and families as the need is identified by either the K8E. the Department or as defined in the approved annual action plan. /b> When indicated by the K8E, the network provider will ensure that substance abuse and/or mental health services are available to clients served by the Protective Investigators to support the principle of keeping children in the home whenever possible. (c) The network provider will make efforts to initiate and support local county implementation of the Medicaid Substance Abuse Local Match Program in order to expand community service capacity through draw down of Federal funding. (3)The failure of other providers or entities does not m|imm the network provider of any accountability for tasks or aoni000 that the network provider is obligated to perform pursuant to this contract. c. Minimum Service Requirements See Exhibit F, Minimum Service Requirements. 7. Managing Entity Responsibilities a. Managing Entity Obligations (1) The managing entity will provide administrative and programmatic oversight \o ensure that network providers comply with all consumer -related aemiooa and other requirements of this (2) The network provider agrees that the managing entity is solely responsible for the oversight of the network provider and enforcement of all tonno and conditions of this contract. Any and all enquiries and/or iaauoa arising under this contract are to be brought solely and directly to the managing entity for consideration and resolution between the network provider and the managing entity. In any event, the managing entity's decision on all issues is final and solely subject to the managing entity's appeal process and legal rights of the network provider. (3) The managing entity is responsible for the administration, management, and oversight, and through subcontracts, the provision of behavioral health oorviooe in Miami -Dade and Monroe counties as stipulated in the Primo Contrao\, and in this contract. Prevention services designed to preclude the development and/or exacerbation of substance abuse problems and mental health disorders by addressing risk factors with adults, children and families and in the community at large are a part of the behavioral health services. Guidance Care Center, Inc. 50 Contract No. Ms22s-3-z M M M (4) The managing entity shall monitor and take action when necessary so that services which meet the standards defined herein will be provided throughout the contract period. (5) The ME will ensure that subcontractors use the GAIN, when appropriate, as the behavioral health assessment and placement tool for ages 12 and up in the Southern Region, or as otherwise specified in the approved annual action plan. b. Monitoring Requirements (1) The ME will monitor the network provider in accordance with this contract and the managing entity's Contract Monitoring Operating 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 managing entity's evaluator(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) The ME will monitor the network provider on its performance of all tasks and special provisions of the contract. (3) The ME will provide a written report to the network provider within thirty (30) calendar days 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 managing entity, if there is a threat to health, life, safety or well-being of clients, the ME may require immediate corrective action or take such other action as the ME deems appropriate. Failure to implement corrective action plans to the satisfaction of the Managing Entity and after receiving due notice, shall be grounds for contract termination. c. Training and Technical Assistance (1) The ME's contact manager, or designee, will provide training and technical assistance concerning the terms and conditions of this contract. (2)The ME will provide technical assistance and support to the network provider to ensure the continued integration of services and support for clients, to include but not limited to, quality improvement activities to implement evidenced -based practice treatment protocols, the application of process improvement methods to improve the coordination of access and services that are culturally and linguistically appropriate. (3) The managing entity 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 and in Attachment V, Substance Abuse Prevention Services. In addition, the ME may convene cross -organizational training and assistance to help non -accredited network providers become accredited. (4)The managing entity implements a training program for its staff and the network provider staff. The trainings assure that staff receives externally mandated and internal training. The managing entity 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 Guidance Care Center, Inc. 51 Contract No. ME225-3-27 service compliance with criteria and practice guidelines, such as retrospective reviews to ensure the level of placement of oUonta is appropriate. The managing entity will take corrective action to neaokm situations in which the subcontracted network provider is not following the guidelines or working to help the system moot its utilization goals, (2)Authorize Services (a)The ME shall conduct authorization and reauthorizations for applicable levels of care as described in the approved Annual Action Plan in order to ensure hmok/ nooeoa to behavioral health oen/ioea and eliminate the wait lists. The authorization pr0000aoa (i) Tkne|in000 standards for authorization review must adhere totimelines standards referenced in Section 191.11.m-(35) for the services provided and departmonta, statutory, and judicial regulations orrequirements. UUProcesoes for making the criteria on which decisions are made available to practitioners, including any standardized tools and aaaooamonta for use in determining placement and/or level of care. (iii)Pruvsiona 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 ofthe covered population believes that he or she has been treated impropedy, whereas an appeal iaarequest toreview a]udgmont.) The second opinion shall boobtained according tnthe timeliness standards for the service inquestion. (3) The ME will participate in the collaborative development and implementation of the working agreement with the Community Based Caro and substance abuse and mental health network providers to onauno the integration of aomiooa 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 agroemont, system of oan* information, data reporting requirements and technical assistance. NA The ME has the right to review the network provider's po|icioo, pn000dureo, and plans. Once reviewed by the managing entity, the policies and procedures may be amended provided that they conform to state and federal \mwo, the state Administrative Code, and federal regulations. Substantive amendments to submitted policies, procedures and plans shall boprovided tothe ME. (5)The managing entity may request supporting documentation and review source documentation of units billed to the managing entity. e. Managing Entity Determinations Through the Department, the ME has exclusive authority to make the following doA*nnina1km(a) and to set the procedures that the network provider shall follow in obtaining the required determination(s) Whether the network provider is mooting the terms and conditions of this oontnuo, to include the Standard Contract, Attachment |, any documents incorporated into any attachment by nsf*nanoe, Program Description, and any documents incorporated by herein by reference. C. Method of Payment Exhibit B, Method cdPayment Guidance Care Center, Inc. 52 Contract No. msoos-3-27 Exhibit E-1 Substance Abuse and Mental Health Services Monthly Request for Non-TANFPayment /Advama Exhibit G^ State Funding by Program and Activity Exhibit H,Funding Detail and Local Match D. Special Provisions 1. The network provider ioexpected toreduce its administration cost to13%mless for Fiscal Year 2D12-2O13for SAK4Hservices purchased under this contract. The cost savings shall bereallocated to support the increase ofdirect services. The network provider's Projected Cost Center Operating and Capital Budget shall evidence the reduction and redistribution of the cost savings. 2. The network provider shall adhere tothe do|ivenub|oo as set forth in AttmohnnentV, Substance Abuse Prevention Services. 3. Renewals For prevention services awarded through the SFBHN Solicitation #003. Prevention Invitation to Negotiate, Prevention of Substance Abuse and Related Consequenoes, this contract may be renewed annually for period not to exceed three (3) years with a projected end date of June 30, 2015, subject to the availability offunds, Renewals for two (2) years and three (3) shall be made by mutual agreement and ahoU becontingent upon satisfactory performance, monitoring and evaluations as determined by SFBHN,subject tothe availability nffunds. Any renewal shall beinwriting, 4. Utilization Management Program The network provider agrees to: (a) Utilize a transmittal nystem, which may be a computerized management information aystem, for submitting/receiving and recording information and documentation required as pad of the Substance Abuse Utilization Management Program. (b) Request and receive an authorization number from the managing entity for all clients requiring admission into asubstance abuse service prior to the client being admitted to the program for (c)[omplete all required assessment components outlined in the SAUM Manual for all children/adolescent clients requiring substance abuse treatment services. The information will be submitted to the managing entity prior to the authorization request. (d) Participate and cooperate in the centralized waiting list in accordance with the waiting list policies and procedures outlined in the SALIM Manual. (e)Provide to the managing entity Treatment Plans within 30 days ofadmission, Treatment Plan reviews vvW1in 14 days, and a discharge summary within 5 days of discharge for all High- Risk/High Users as defined in the SAUM Manual. Treatment Plans and Discharge Summaries will comply with the requirements set forth inRule S5D-3U.F.A.C. 5. Waiting List and Interim Services In the event that waiting lists dovolop, the network provider will md\abonube with the Managing Entity and community partners, to develop and implement procedures for managing the substance abuse and mental health waiting |in\ for all applicable |ovo|a of oune including provision of interim services. The authorization ufservices are specified in Section B. 7. Managing Entity Responsibilities. Guidance Care Center, Inc. 53 contract No,msaos-3-27 G. Prio=awthmrioedotiemtm RomtcrAdult0' ChUdmyn'aSubatmnoe Abuse Residential Level t @ Level II. The network provider shall submit arequest for reimbursement onthe approved KAEinvoices found on Exhibit E-1 of this contract.. A listing of all prior -authorized o|ion\a served ino|uding, client name, client I.D. number, authorization number, and service period must be provided to support the invoice. This information must be submitted on Exhibit P. Pre- Authorization Residential Utilization Manauement Roster, of this contract and attached to the approved Managing Entity's invoice, Exhibit E'1 as a prerequisite for payment. The network provider shall maintain back-up documentation for step-down services for aperiod ofsix (S) years from the expiration date ufthe contract per Section 7. of the Standard Contract. 7. Utilization Management Program (Adult & Children SAMHWAN) (a) The Managing Entity will comply with and implement the policies and procedures of the District 11 Utilization Management Prooram, detailed in the 'Substance Abuse Utilization Management (SAUK4) Policies and Procedures Manua|, January 2004-updatod Edition' (or latest revised edition thereof). The network provider will comply with the policies and procedures of the District |\ Utilization Management Program, detailed in the 'Substance Abuse Utilization Management (SAUK4) Policies and Procedures Manual, January 2004-updahad Edition' (or latest revised edition \henoof).The network provider will offer clients a multi- level continuum of care services for treatment of substance abuse. Each level of care has the following duration or length of stay: Cost Center Maximum Service Period Residential Level | & U Children (No more than 8 months) Residential Level \&\| Adults (No more than G1 days orNomore than 9Ddays for clients Identified as "high risk" by the Managing Entity) Residential Level U Families in Transition Program: Families & Pregnant Woman (No more than Gmonths) Residential Level IV Adults and Children (No more than 3months) Day/Night Adults and Children (No more than 3months) Outpatient Adults and Children (No more than Smonths) (b) The network provider shall obtain written authorization from the ME prior to providing Residential Level | 8 || services. A written authorization will also be requin*d, prior to the expiration of the initial length of stay, in order to extend Residential Level \ & \| aon/i000. The request for an extension must be justified in accordance with GAIN criteria and in accordance with the SAUKA Policies and Procedures Manual. (c) Case management services maybe provided to clients receiving residential services as a separate service pursuant to other Vonno and conditions in this contract. Post- residential d|anto may continue to receive case management services only if they are receiving outpatient orday-night services. (d) When aclient has been provided residential services aoanon-Managing Entity funded client (e.g. paid by inouranoo), that stay is subtracted from the prescribed length of stay should the client become eligible toreceive network providopfundodservices. (e) The managing entity will be responsible for managing the utilization of residential treatment beds funded by community forensic dollars in Qvouh 11 and the statewide community forensic beds located inthe Southern Region. This includes a short -term residential treatment facility Guidance Care Center, Inc. 54 Contract No. Mso�3-zr 07/01/2012 and residential level 2 beds. The managing entity will be responsible for managing the appropriate utilization of community forensic residential treatment beds. 8. Adult System of Care Comprehensive Community Service Teams Case Management (CCST) (1) Adult System of Care Comprehensive Community Service Team (CCST) services must continue to provide Adult Mental Health Case Management Services as defined by the Continuity of Care Guidelines for Geo Care, Inc./South Florida State Hospital (on file at the Southern Region SAMH Program Office). Additionally, CCST must provide appropriate Adult Mental Health services to CCST clients with the availability to increase or decrease intensity and frequency of similar services, as needed. Programs must provide services in English, Spanish, and Creole as required by the population served. (2) Description Comprehensive Community Service Team (CCST) services take place in either an outpatient or community -based setting and provide consumers with mental illness and/or substance use disorders assistance in identifying goals and making choices to promote resiliency and facilitate recovery, For consumers with mental health and/or substance abuse problems, recovery is the personal process of overcoming the negative impact of a psychiatric and/or substance abuse/use despite its continued presence. CCST services are intended to restore the individual's function and participation in the community. The services are designed to assist and guide consumers in reconnecting with society and rebuilding skills in identified roles in their environment. The focus is on the individual's strengths and resources as well as their readiness and phase of recovery. A team approach for delivery of services will be used to guide and support the consumer's served with development of a recovery plan focusing on the areas of individual and family living, learning, working and socialization. The expectation is that therapeutic services and supports will be determined based on the clinical needs of the consumer. Therefore, not every consumer will require involvement of all members of the team. The type(s) and intensity of clinical services and supports will be determined by the consumer and is based upon a full clinical assessment. (3) CCST should prioritize the following populations: (a) Persons who are being admitted to, or discharged from, a state treatment facility or are awaiting admission to or discharge from a state treatment facility; (b) Persons who are in a state treatment facility regardless of admission date; (c) Persons who are at -risk of institutionalization or incarceration for mental health reasons; (d) Persons who have had one or more admissions to a crisis stabilization unit (CSU), short- term residential facility (SRT), or inpatient psychiatric unit; (e) Persons who reside or have been discharged from a mental health residential treatment facility; (f) Persons who are at -risk or have been adjudicated as incompetent to proceed or not guilty by reason of insanity due to their mental illness and are being released to the community under a conditional release plan; (g) Persons who are experiencing long-term or serious acute episodes of mental impairment that may put them at -risk of requiring more intensive services (4) CCST Team Composition The treatment approach must be delivered by staff working in a Multi -Disciplinary Team. At a minimum the Multi -Disciplinary Team must consist of: (a) A CCST Supervisor — 1 FTE (b) Two Part-time Peer Specialists — 0.5 FTE each (c) A Care Coordinator/Targeted Case Manager —1 FTE (d) A Therapist/Clinician —1 FTE Guidance Care Center, Inc. 55 Contract No. ME225-3-27 (e) Vocation aKEmploymonVHouoingManager —1 FTE Members of the team can be added to include a Psychiatrist etc. based on the needs of the consumer. All members of the team must meet at least monthly and staff must be trained and competent inutilizing evidence -based practices, recovery concepts and language. The consumer's voice and choice should be seen throughout, starting with a recovery -based self -assessment tool and continuing with statements of needs, goal -setting and decision -making, The Peer Specialist(s) must be working towards a certification by the Florida Certification Board and must be a true peer; which means that the peer specialist is also (or has been) a consumer of public or private mental health or substance abuse services. A Peer Specialist provides peer mentoring to consumers. They also assist consumers by teaching them how to navigate the mental health and substance abuse service system to achieve resiliency and recovery. In order to provide the full complement and quality of services and supports offered through the CCST, each team must maintain afuA| staffing pattern as specified in the approved program description, incorporated herein by reference, which aligns with the allocation of contracted dollars, Howover, failure tomaintain afu|| complement of staff may result in the reallocation of contracted dollars. While SFBHN understands that staff turnover io common in the social service |nduatry, it is the responsibility of the provider to ensure that all positions are filled within six weeks of the position becoming available. In addition, a full complement of staff allows the provider to receive maximum reimbursement for services provided. Additionally, given that CCST is reimbursed based on staff availability, any position(s) that remains vacant for extended periods of time will negatively impact the provider's ability to draw down allocated funds. It is expected that temporary staff trained in the services delivery model and implemented evidence -based practices will be re -assigned to vacant position(s) to ensure that the full array of services and supports are provided to all consumers. (5) System of Care Values The system of care values including those listed below must be embedded within all aspects of the (a) Consumer -Centered (b) Family Driven Care (c) Cultural and Linguistic Competence (d) Individualized (e) Evidmnoe'Baaedpraoti000 U8 Streamlining and expediting access toservices (g) Continuous Quality Assurance (h) Collaborative (I) Community -Based (j) Integrated Services (h) Trauma -Informed Care (1) Trauma -Specific Caro Documentation (6) There must be evidence that staff are aware of consumer's needs and documentation in the service record that identified needs are addressed by the CCST and the person receiving services. Staff must assist consumers with obtaining benefits (insurance, Social Security and income). Documentation in the service record must reflect efforts, progress and barriers to individualized goals and treatment objectives, including school performance. Documentation is necessary to identify changes in services, supports and continuity of those services and supports (i.e., treatment plan updates indicating new/revised/achieved goals), A crisis plan must be developed with the consumer and contained within the case record, Guidance Care Center, Inc. 56 Contract No. wso2s-3-27 There must be evidence that supports were offered to the consumer receiving services. Supports are necessary in self -managing wellness via activities such as, but not limited to, education, supportive counseling, or skills training. The consumer needs to be aware and involved in appropriate self-help or support groups. Evidence is required that the people receiving services actively takes part in achieving his/her service goal(s) and chooses the people who are involved in their recovery (as in Wellness Recovery Action Plan "WRAP Plans" Crisis Management tools). These persons could be family members, friends or significant others, CCST staff, or other Peer support. There should be evidence that the CCST staff partners with the consumer, assisting and building confidence in their decision -making ability. Furthermore, documentation must reflect the use of natural supports and the Peer Specialist must document all contact with the consumer. (7) Data Requirements Data submission to SFBHN is required for all services provided under the CCST cost center. These services must be submitted as directed by SFBHN. All service data must be entered every month in keeping with contractual requirements. (8) Services Array Services and supports provided includes but is not limited to Assessment, Case Management, Intensive Case Management, Outpatient, In-home/On-Site, Intervention, Information and Referral, Prevention, Prevention/Intervention, Outreach and other transition, and Therapeutic Recreational Activities (non-traditional support services) as identified on the treatment plan and outlined in the policy governing the use of flexible funding. The above listed services are reimbursed in a bundled staff hour rate and may not be contracted for separately. Incidental Expenses may be utilized as specified in Rule 65E-14.021(2)j, F.A.C., for persons served through CCST to purchase medications and other enhancement and support services not included in this bundled rate that are in concert with the individual's treatment plan. (9) Minimum Training Requirements (a) Motivational Interviewing. - All clinicians/therapist assigned to the CCST team are encourage to complete the Motivational Interviewing training within one year of employment with the CCST team. (b) Wellness Recovery Action Planning (WRAP) - All CCST team members are required to complete the initial three day WRAP training and utilize the strategies with all consumers enrolled in CCST. This training must be completed within six months of joining the CCST team. The WRAP facilitator five day training is available to all CCST team members but is not a required training. (c) SSI/SSDI, Outreach, Access and Recovery (SOAR) training - Targeted Case Managers/Care Coordinators, and Peer Specialists are required to attend this training. This training must be completed within six months of joining the CCST team. (d) Peer Specialist Training— All Peer Specialists are required to complete the Peer Specialist training as outlined by the Florida Certification Board within six months of employment with the CCST team and attempt certification within one year of employment with the CCST team. (e) Person to Person Training — All case managers seeking to become Care Coordinators must complete and acquire the Person to Person certification within 90 days. (f) Other Best Practices as approved by SFBHN — The CCST team can utilize other evidence -based practices approved by SFBHN. However, all evidence -based practices Guidance Care Center, Inc. 57 Contract No. ME225-3-27 utilized by the provider must beimplemented with fidelity checks to ensure that the model is being correctly utilized. M0AProgramnm: Adult Mental Health & Substance Abuse (a) Unit of Measure: Staff Hour (b) Maximum unit cost rate: $ 37.86 (c) Data Elements: Service Documentation —CCSTDuty Roster (Exhibit L) (i) Staff name and identification number (i8 Service Date UiBHoumoohadu|edtovvorh—Beginning&EndingTime (iv)Cost Center (v) Program (v|) Signature of Supervisor (d) AuditDooumontation—ThneSheet (|) Staff name and identification number (i0DoAo (iH) HouroVVorkod—Beginning & Ending Time (iv) Program /v\ Cost Center (vi) Signature of Supervisor (e) Some ofthe additional elements SBNNwill be reviewing include the following: (8 Number of consumers linked to Medicaid and tracking the length of time for approvalof benefits (SOAR Data submission) (H) Type oftherapeutic services provided (iH) The frequency ofeach therapeutic service (iv) Number of consumers receiving Evidence -Based Practices (EBP) and which EBPs are used (v) Staff produotivity, which iathe amount of direct care hours provided monthly (vi) Fidelity to the treatment model utilized (11)Adult CCST Caseload CCGTprovides therapeutic services and supports \oconsumers with varyingand complex needs. Therefore, it is anticipated that caseloads will vary widely in intensity and types of services and support provided to consumers. While some cases may involve one therapeutic session per week others may warrant significantly more clinical services in order to address the changing and complex needs ofthe consumer. For that reason, a\least anaverage of6O.10% ofeach member ofthe CC8Tteem'otime must bospent providing direct care services. For purposes of determining staff productivity, provision of a group only counts for one hour of staff productivity per hour of group. For example, staff productivity is not measured by counting a separate hour ofproductivity for each consumer inthe group. |\ioexpected that only one staff member will be providing each group. For purposes ofdetermining staff productivity, provision ofugroup only counts for one hour ofstaff productivity per hour ofgroup. For example, staff productivity ionot measured bycounting a separate hour cfproductivity for each consumer inthe group. |tiaexpected that only one staff member will be providing each group. In order to track that group size limitations and staff productivity levels are being met, the documentation requirements listed in Seo\ionB. 1.a.(3)aro Guidance Care Center, Inc. 58 Contract No. mc2zs'o'27 required for CC8Tgroup h1addition tothe duty roster and time sheet service and audit documentation requirements for CCSTIndividual. (12) Invoicing Requirements The network provider shall ensure that the monthly billing and the data submitted into K|S support the GO.18%direct care services requirement as stated above. Failure toadhere tuthis requirement may cause the K4Etowithhold payment until such requirement iamet, 8. Continuous Quality Improvement Programs (1) Each aen/ioo network provider must maintain a continuous quality improvement program to objectively and systematically monitor and evaluate the appropriateness and quality ofcare, to ensure that services are rendered consistent with prevailing professional standards, and to identify and resolve problems. Addidona||y, the program must support activities \oensure that fraud, waste and abuse donot occur. (2) For each service network provider, awhtton plan must be developed with acopy made available upon request tothe managing entity which addresses the minimum guidelines for the nmtvvurh provider's continuous quality improvement program, including, but not limited to: (a) Individual oan* and services standards to include transfers and n*h*mals, co-occurring supportive services, and trauma informed services. (b) Individual records maintenance and compliance. (o) 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 may not be subjected toany civil action by virtue of that incident report. (g) Fraud, waste, abuse and other potential wrongdoing auditing, monitorinq, and namodiskionpr000durea. (3) The continuous quality improvement program is the responsibility ofthe director and is subject to review and approval by the governing board of the service network provider. (4) Each director shall designate a person who is an employee of or under contract with the service network provider as the network provider's continuous quality improvement manager. (5) The quality improvement program must also: (a) Composition of quality assurance review committees and subcommittees, purpose, ouopa, and objectives of the continuous quality assurance committee and each auboommittoo, frequency of mootingo, minutes of meetings, and documentation of meetings. (b) Provide aframework for evaluating outcomes, including: (i) Output measures, such as capacities, toohno|ogieo, and infrastructure that make up the system of care. Guidance Care Center, Inc. 59 Contract No. mE22s-s'z7 (iUProcess measures, such aaadministrative and clinical components odtreatment. (i|\)Outcome measures pertaining tothe outcomes ofservices; (c) Provide for usystem of analyzing those factors which have an effect on performance; (d) Provide for asystem of reporting the n*ouKo of continuous quality improvement reviews; (e) Incorporate best practice models for use in improving performance in those areas which are deficient. (f) For agencies utilizing seclusion and restraint procedures and aa required by law (65E 5.180), establishment and utilization ofuSeclusion and Restraint Oversight Committee responsible for the timely review of each use of seclusion and restraint to include: (i) Circumstances that lead to the event. (ii)Ncture of the de-escalation efforts and alternatives to seclusion and restraint are (III) Staff response to the incident. (iv) Ways to effectively support the person's constructive coping in the future and avoid the need for future seclusion and restraint. (6) The ME may a0000a all oonioo network provider records and policies necessary to determine compliance with this section. Records relating solely toactions taken in carrying out this section and records obtained by the managing entity to determine a network provider's compliance with this section are confidential and exempt from o. 119I7`(1) and o. 24(a). Art. | of the State Constitution. Such records are not admissible in any civil or administrative action oxoop\ in disciplinary proceedings by the Department of Health or the appropriate regulatory board, and are not pad 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 o/ portions of meetings of continuous quality improvement program committees that relate solely to actions taken pursuant tothis section are exempt from o.286.{11. 10.Performance Measures for Continuous Quality Improvement Programs The network provider shall track byprogram, asapplicable, the following performance measures and report it quarterly within the QA/QI plan reports by the dates specified in Exhibit C, Required Reports: (1) Mental Health Services (Admission typo): Cost Centers 03- Crisis Stabilization Unit 20- Residential Level 3 08- In Home/ On -Site 34- FACT 12- Medical Services (psychiatric) 39-Short-term Residential Treatment Guidance Care Center, Inc. 60 Contract No. Mc22s�-2/ 07/01/2012 (a) Average number of calendar days between a request for service and the date of the initially scheduled face-to-face appointment, tracked by assessment, counseling/psychotherapy and psychiatric appointments. (b) Percent of clients who do not appear for their initial appointment tracked by assessments, counseling/psychotherapy and psychiatric appointments. (c) Percent of appointments cancelled by the client tracked for all initial appointments for assessments, counseling/psychotherapy and psychiatric services. (d) Percent of appointments cancelled by the staff for all initial appointments for assessments, counseling/psychotherapy and psychiatric services. (e) Medication error percentage, as documented during the reporting period including: wrong medication, wrong dose or wrong time of administration as reported in inpatient/CSU and residential settings. (2) Substance Abuse Services (Admission type): Cost Centers 01-Assessment 21-Residential Level 4 06 Day/Night 24-Detoxification 08- In Home/On-Site 35- Outpatient Group 12- Medical Services (psychiatric) 44- CCST Individual 14-Out atient Individual 45- CCST Grou 18- Residential Level 1 19- Residential Level 2 20- Residential Level 3 (a) Average number of calendar days between a request for services and the date of the initially scheduled face-to-face appointment, tracked by assessment and counseling services. (b) Percent of persons who do not appear for their initial appointments tracked by assessments and counseling services. (c) Percent of appointments cancelled by the client for initial appointment for assessments and counseling. (d) Percent of appointments cancelled by the staff, tracked by initial appointment, counseling/psychotherapy and psychiatric appointments. (e) Medication error percentage, as documented during the reporting period including: wrong medication, wrong dose or wrong time of administration as reported in JARF/Detox and residential settings. 11. 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. Guidance Care Center, Inc. 61 Contract No. ME225-3-27 Inthe event en incident has an immediate impact onthe health orsafety ofaconsumer, has potential media impau, or involves employee -related incidents of criminal activity, the network provider must notify the ME Risk and Compliance Coordinator aasoon as possible, but not to exceed 24hours. Certain incidents may warrant additional follow-up by the ME. Follow-up may include on -site investigations or requests for additional information. When additional information is roquosted, each network provider will submit the information requested by the ME within 24hours un|moo other specified of receiving the requests. It is the responsibility of the network provider to maintain a monthly log listing all incidents occurring at the agency, including those submitted tothe Office ofthe Inspector General and those not reportable in |RA8' with the following information: Consumer's initia|o, incident report tracking number from |HAS (if app|ioab|o), incident report category, date and time ofincident, 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. 12.Mandatory Reporting Requirements �A The network provider and any subcontractor mua comply with and inh�it s the ' - following mandatory reporting requirements. Each employee ofthe network provider, and of any subcontractor, providing services inconnection with this contract who has any knowledge of areportable incident shall report such incident aafollows: (1) Reportable incidents that may involve an immediate or impending impact on the health or safety of a client shall be immediately reported to the contract manager; and (2) Other reportable incidents shall be reported to the ME and Department's Office of Inspector General bycompleting sNotification/Investigation Request (form CF1Q34)and emai|ing the request tothe {}#ioo of Inspector General atig_oomp|ainto@d/f.atatejiva. The network provider and subcontractor may also mail the completed form to the Office of Inspector General, 1317VVinovvood Bou|ovard, Building 6` 2nd Floor, Ta||ahaaoee, Florida, 323S9-O70O;orvia fax at(850)488-1428. (b) Areportable incident iodefined inChildren and Families OperatingProcedures CFOP18O~4 (CFOP 180-4) Mandatory Reporting Requirements to The Office of The Inspector General, which can be obtained from the contract manager. 13.Option for Increased Services The network provider acknowledges and agrees that the contract may be amended to include additional, negotiated, services aodeemed necessary bythe managing entity, Additional services can only be increased if the network provider demonstrates competence in the provision of contractual services and meets whatever criteria ia established by the managing entity from time to time. The managing entity in its sole discretion shall determine at what time and to which network provider and what amounts are tobogiven tonetwork providers for additional services. 14. Sliding Fee Scale The K8Erequires the network provider\ocomply with the provisions ofRule G5E-14.018`F�iC.Acopy of the network provider's sliding fee scale that reflects the uniform schedule of discounts referenced in Guidance Care Center, Inc 62 Contract No. Ms225-3-27 Rule 85E'14.018(4)^ F.A.C. shall be furnished tothe managing entity within thirk/C90\ days of contract execution. 15. 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 totransport clients. The network provider agrees to comply with the provisions of Children and Families Operating Procedures 40-50 (CFC}P 40'5) Acquisition of Vehicles For Transporting Disadvantaged Clients if public funds provided under this contract will be used to purchase vohio|oa which will be used totransport consumers. (Contract managers delete if not 18'Agreements with Health Maintenance Organ izationm/Mmne@edCare Organizations hd The network provider shall notify the managing entity's contract manegor, in writing, prior to entering into a contract for the provision of substance abuse and mental health services with e health maintenance organization or other managed care organization that is mapitehad by Medicaid to provide substance abuse and/or mental health services or an agent of any such health maintenance organization orother managed care organization. (b) Copies of the contract shall befurnished tothe managing entity's contract manager within thirty (30) days of execution. (a) Those network providers with SAMH contracts in excess of $500,000 annually and rendering substance abuse services shall enroll uaaMedicaid provider. This process shall beinitiated within ninety (90) days of contract execution. Awaivor of the ninety (BO) day requirement may be granted, in writing, by the Department's Director of Substance Abuse, through the ME. (b) All network providers whose contracts are $500'00mmore annually, and enrolled as Medicaid provider shall participate and ensure its subcontracted Medicaid providers whose contracts are $500,000 or more annually participate in Department sponsored training, conduct required sampling, and conduct quality assurance and administrative activities necessary to recover federal matching funds on behalf of the Department, as part of the Community Based Medicaid Administrative Claiming (CB;WAC) program. ThoCBK8AC program allows participating network providers to claim reimbursement for administrative activities performed vvhi|o providing eligible Federal Medicaid Title X|X services. (c)Participation inthe C0NACprogram bySubstance Abuse and Mental Health providers who are enrolled aoMedicaid providers with contract amounts less than $60O.0O0annually, and who have the technological capability toparticipate a|ootronioaUyiooptionai 18. National Provider Identifier (NP|) (a) All network providers shall obtain and use an NPI, a HIPAA standard unique health identifier for health care providers. (b) Aoapplication for anNP|may besubmitted online at https-//nppea.omm,hha.muv/NpPES/StQ1ioFonwand.dO?fonmund=mtadic.np|otart. (c] Additional information can beobtained from one ofthe following woboiteo: Guidance Care Center, Inc. 63 Contract No. ME225-3-2/ (1\ The Florida Medicaid HIPAA located at: }dhc.otateJD.ua/hipee/index.ahtm| The National Plan and Provider Enumeration System (NPPES) located at: (2) QA ,cms.hho. 19. Indigent Drug Program (a) The network provider shall ensure that all funds allocated for use of purchasing psychotropic medications, or medications used to treat addictions, or medications accessed through line of credit from the Indigent Drug Program (IDP) are used for individuals who meet any of the following criteria: (1) Have anannual income that ioa\orbelow 150%ofthe Federal Poverty Income Guidelines, as published annually in the Federal Register. (2) Have no liable third -party insurance or other source of psychotropic medications available, nor isthe individual aparticipant in aprogram where poyohotropicmedications are paid for byany other funding source. (3) Ifthe individual has third party insurance for psychotropicmedications but has temporarily been denied benefits for these medications, they may receive IDP medications until such time as eligibility has been reestablished. (b) The network provider shall actively participate in manufacturer's patient assistance programs for medications needed by a significant portion of clients served by the network provider. (c) The network provider shall participate inanyrogiona]tnainingoventomadeavolab|ebythne Department. The network provider shall also participate inanytraningeventomadeavai|ab|eby the Florida Louis DoLa Pade Florida Mental Health Institute of the University of South Florida's Medicaid Drug Therapy Management System Program for Behavioral Health which iaposted on the following website: tllp-.//flmedicaidbh.fmhi.usf.edu/. b8 The network provider shall for purposes of auditing and/or monitoring, retain and make available upon request acopy of the license and the permit issued inaccordance with the requirements specified in s. 499.012(l)(d), F.S. 28.Ethical Conduct The network provider understands that performance under this contract involves the expenditure of public funds from both the state and fodons| governments, and that the acceptance of such funds obligates the network provider to perform its oorvi000 in accordance with the very highest standards of ethical conduct. No omp|oyoo, director, offiuor, agent of the network provider oho|| engage in any buoineas, financial or legal relationships that undermine the public truat, whether the conduct is unethical, or lends itself to the appearance of ethical impropriety. Network providers' dirootoro, officers or employees shall not participate in any matter that would inure totheir special gain, and shall reouoa themselves accordingly. Public funds may not be used for purposes of lobbying, or for political coniribut|onm, or for any expense related to such activities, pursuant to Section 20. of the Standard Contract ofthis contract, The network provider understands that the managing entity contracts with the department, and as a ouboontrau\or, recognizes that the department is e 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 ioauoa relating tothe business of the department, the managing entity and the Guidance Care Center, Inc. 64 Contract No. Ma22sa-27 network provider are public record and subject to full disclosure. The network provider understands that attempting to exercise undue influence on the managing entity, 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 |avvo governing the conduct of entities engaged in the business ofproviding services togovernment. 21. Liability Insurance Coverage The network provider shall notify the managing entity'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. 22' Information Technology Resources If opp||oab|e, the network providers must receive written approval from the managing entity prior to purchasing any Information Technology H000uroo (|TH)oon\raot funds. The Contract Manager is responsible for serving as the liaison between the network provider and the managing entity during the completion ofthe process as instructed by the Contract Manager. The network provider will not be reimbursed for any |TR purchases made prior toobtaining the managing entity's written approval. 33. Programmatic, Fiscal Qk 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, Program/Cost Center Actual Expenses and Revenues Sohodu|o, Projected Coot Center Operating and Capital Budget, Agency Capacity Report and Personnel Detail Reoord, are herein incorporated by reference for programmatio, contractual and fiscal assurances ofservice provision These referenced contractual documents will be part of the contract manager's file. Documents incorporated by reference in this contract are available inthe managing entity contract manager's file. 24. Employee Loans Funds provided by the ME to the network provider under this contract oho|| not be used by the network provider to make loans to their omp|oy000, officers, directors and/or subcontractors. Violation of this provision shall be considered abreach ofcontract and the termination ofthis contract shall be in accordance with the Section 48. of the Standard Contract. A|oan is defined as any advancement of money for which the repayment period extends beyond the next scheduled pay period. 25. Travel The network provider's internal procedures will assure that: travel voucher Form DFS-AA-15,State cd Florida Voucher for Reimbursement of Traveling Expenses, incorporated heroin 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 |odging, tolls and funea, 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�081. F.S. governing payments for traveling expenses. CF{}P 40-1 (Official Travel of State Employees and Non -Employees) provides further explanation, o|arihoation, 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 trave|, travel destination, purpose of travel, hours of Guidance Care Center, Inc. 65 Contract No. Ms225�27 departure and odurn, per them or meals a]|owanoo, map mileage, incidental expenses, signature of payee and payee's supervisor. 20 Incidental Funds for Adult Mental Health (a) The network provider agrees to use incidental funds allocated under this contract for housing, medication and other emergency expenses for indigent o|ionta. (b) The network provider agrees to keep in the clients' file a record of all client expenses charged against the funds. (u) The network provider shall keep a record to log all incidental funds expenditures as specified in Exhibit 0, Incidental Expense Fund Invoice and Expenditure Log for Adult Mental Health. (d) The network provider shall submit as back to the monthly invoice an expenditure report as specified inExhibit 0.Incidental Expense Fund Invoice and Expenditure Log for Adult Mental Health. (e) The ME reserves the right to reduce the contract amount by the incidental funds projected surplus. 27. Evidence Based Prevention All network providers rendering substance abuse prevention services are required to use an evidence based prevention program. Network provider agencies involved inthe validation process for prevention programs must notify the circuit SAMH Program Office of progress annually. 2IProperty and Title tpVehicles a. Property (1) Nonexpondable property is defined as tangible personal property of a nonconsumable nature that has an acquisition value orcost of $1,000or more per unit and an expected useful life of at least one year, and hardback covered bound books that are not circulated to students orthe general public, the value orcost ofwhich io$2GOormore. Hardback books with e 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 veh|o|oa include any automobi|o, truok, airplane, boat or other mobile equipment used for transporting persons orcargo. (2)When state property will boassigned toaprovider for use in performance ofacontract, the title for that property or vehicle shall be immediately transferred to the provider vvhone it shall remain until this contract is terminated or until other disposition instructions are furnished by the K4E'o 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 wahio|o is assigned to and accepted by the provider. Business arrangements made between the provider and its subcontractors shall not permit the transfer oftitle ofstate property to subcontractors. VVhi|o 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 CFDP8O-2. (3) K any property is purchased by the provider with funds provided by this contract, the provider shall inventory all nonexpendable property including all computers. Acopy ofwhich shall be submitted to the along with the expenditure report for the period inwhich dwas purchased. At least annually, the provider shall submit a complete inventory of all such property to the ME whether new purchases have been made ornot. (4) The inventory (see Exhibit K[, Network Provider Inventory List) shall ino|ude, at e 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 oep|ie| aaamta)` if a group, record the number and description of the components making up the group, name, make, ormanufacturer, serial numbor(o),ifany, and if anautomobile, the V|Nand 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 ofthe contract period. The provider cannot dispose ofany property that reverts tothe ME ordepartment without the contract manager's approval. The provider shall furnish aCloseout Inventory Form nolater than 30daye before the completion ortermination ofthis contract. The Closeout Inventory Form shall include all nonexpendable property including all computers purchased by the provider. The Closeout Inventory Form shall oontain, at aminimum, 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 ofthe inventory. |fthe original acquisition cost ofaproperty item io not available at the time of inventory, an estimated value shall be agreed upon by both the provider and the K8E and shall beused inplace ofthe 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 tothe ME upon completion or termination of this contract. When property transfers from the provider to the ME, the provider shall be responsible for paying for the title transfer. (8) If the provider oep|a000 or disposes of property purchased by the provider pursuant to this contuact, the provider is required to provide accurate and complete information pertaining to replacement or disposition of the property as required on the provider's annual inventory. (9) The provider hereby agrees to indemnify the ME and the department against any claim orloss arising out of the operations of any motor vehicle purchased by or transferred to the provider pursuant tothis contract. (10) Afonna| contract amendment is required prior to the purchase of any property item not specifically listed inthe approved contract budget. b.Title boVehicles U> Title (ownership) to, and possession of, all vohio|oo acquired with funds from this contract shall bevested inthe K4Eupon completion nrtermination ofthe contract. The provider will retain custody and control during the contract period, including extensions and renewals. (2)Dui the term of this contract, title tovehicles furnished by the state macquired at the direction ofthe state (using state orfederal funds) shall not bovested klthe provider. Subcontractors shall not boassigned ortranuh*nodtb|etothooevoh|nleo. 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 29. Verification pfEmployment Status ( 1. Employment Eligibility Verification (a) Definitions. As used in this clause - "Employee assigned to the contract" means all persons employed during the contract term by the provider/grantee to perform work pursuant to this contract within the United States and its territories, and all persons (including subcontractors) assigned by the provider/grantee to perform work pursuant hothe contract/grant with the department. "Subconir4oy'means any contract entered into byasubcontractor to furnish supplies or services for performance of a prime contract or a subcontract. It includes but is not limited to purchase orders, and changes and modifications to purchase orders. "Subcontractor' means any supplier, distributor, vendor, or firm that furnishes supplies or services to or for aprime provider oranother subcontractor. (b)Enrollment and verification requirements. (1)The provider/grantee shall - 0Enroll, Enroll aoa in the E-Vorifyprogram within 30calendar days of contract award; UA Verify all new/ employees. Within SO calendar days of enrollment in the E- Verify pnuqnum, begin to use E-Verify to initiate verification of employment eligibility. All new employees assigned by the provider/grantee/subcontractor to perform work pursuant iothe contract with the D{}F shall be verified amemployment eligible within 3business days after the date odhire; and (2) The provider/grantee shall oomp|y, for the period of performance of this contract, with the requirement ofthe E'Vorifyprogram enrollment. (U The Department of Homeland Security (DHS) or the Social Security Administration (SSA) may terminate the provider's/grantee's enrollment and deny access to the E-Verify system inaccordance with the terms of the enrollment. In such oaoo, the provider/grantee will be referred to a UHS or SSA suspension ordebarment official. (ii) During the period between termination of the enrollment and a decision by the suspension or debarment official whether to suspend or debar, the provide nbrantoo is excused from its obligations under paragraph (b) of this clause. If the suspension or debarment official determines not to suspend or debar the provider/grantee, then the provide r/g rantee must reenroll in E-Verify. (c) Web site. Information on registration for and use of the E-Verify program can be obtained via the Internet at the Department ofHomeland Security Web site: . (d) Individuals previously verified. The provider/grantee is not required by this clause toperform additional employment verification using E-Verify for any employee whose employment eligibility was previously verified by the provider/grantee through the E-Verifyprogram. (e) Individuals performing work prior tothe £- verify requirement. Employees assigned tnand performing work pursuant to this contract prior to February 04, 201 1do not require employment Guidance Care Center, Inc. 68 Contract No. Ma225�2 eligibility verification through E-verify. (f) Evidence of the use of the E-Verify system will be maintained in the employee's personnel file. (g) Subcontracts. The provider/grantee shall include the requirements of this clause, including this paragraph (g) (appropriately modified for identification of the parties), in each subcontract." E. List of Exhibits The following exhibits, or the latest revisions thereof, are incorporated in and made a part of the contract. 1. Exhibit A, Clients and Participants to be Served 2. Exhibit B, Method of Payment 3. Exhibit C, Required Reports 4. Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes and Outputs 5. Exhibit E-11, Substance Abuse and Mental Health Monthly Request for Non-TANF Payment/Advance 6. Exhibit F, Minimum Service Requirements 7. Exhibit G, State Funding by Program and Activity 8. Exhibit H, Funding Detail & Local Match Plan 9. Exhibit 1, Substance Abuse Family Intervention Specialist Services 10. Exhibit J, Assisted Living Facilities With a Limited Mental Health License 11. Exhibit K, Network Provider Inventory List 12. Exhibit L, CCST Duty Roster 13. Exhibit M, Child Welfare Quarterly Clinical Report 14. Exhibit N, Missing Children 15. Exhibit 0, Incidental Fund Invoice and Expenditure Log for Adult Mental Health 16. Exhibit P, Pre- Authorization Residential Utilization Management Roster Guidance Care Center, Inc. 69 Contract No. ME225-3-27 EXHIBIT A CLIENTS AND PARTICIPANTS TO BE SERVED A. General Description Client Non-specific Performance Contract SAMH Services Program The network provider shall furnish services funded by this contract to the target population(s) checked below: I Non -Prevention I Prevention I ZAdult Mental Health -Forensic Involvement j E] Adult at Substance Abuse ZAdult Mental Health -Severe & Persistent Mental Illness ❑ Children's at Substance Abuse Adult Mental Health -Serious & Acute Episodes of Mental Illness ❑ Community Prevention -Adult at SA Adult Mental Health -Mental Health Problems Community Prevention- Children at SA Children's Mental Health -Emotional Disturbances F-1 Children's Mental Health -At Risk of Emotional Disturbances Children's Mental Health -Serious Emotional Disturbances Adult Substance Abuse Children's Substance Abuse (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. (2) Crisis stabilization, substance abuse detoxification, and addiction receiving facility services shall be provided to all persons meeting the criteria for admission subject to the availability of beds and/or funds. C. Client and Participant Determination (1) Determination of client eligibility is exclusively the responsibility of the network provider. (2) 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 department for more units than are specified in Exhibit G, State Funding by Program and Activity, or for more units than can be purchased with the amount of funds Guidance Care Center, Inc. 70 Contract No. ME225-3-27 specified in Exhibit G, State Funding by Program and Activity. (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) Services provided under this contract are limited by the availability of funds. The network provider may not authorize or incur indebtedness on behalf of the Managing Entity or the Department. Guidance Care Center, Inc. 71 Contract No. ME225-3-27 Exhibit B Method of Payment 1' PaymentClausem a. This is afixed price (unit cost) contract. The unit prices are listed onExhibit G,State Funding byProgram and Activity. The MEshall pay the network provider for the delivery of service units provided in accordance with the terms and conditions of this contractfor atotal dollar amount not toexceed , subject tothe availability offunds and satisfactory performance of all terms by the network provider. Of the total Contract amount, the K8Ewill borequired topay ,oubjoot tothe delivery and billing for services. The remaining amount of $784,375.00 represents "Uncompensated Units F7einbu:aennentFunds�'. which the PWE, at its sole discretion and subject tothe availability of funds, may pay tothe network provider, in vvho|o or in part, or not at all, for Exemplary Performance bythe network provider. Exemplary Performance will be determined by the network provider delivering and billing for services in excess of those units of service the ME will be required to pay. The ME's obligation to pay under this Contract is contingent upon an annual appropriation by the Legislature and the Contract between the ME and the DCF. Any costs or services eligible to be paid for under any other contract or from any other source are not eligible for payment under this Contract. b. Aftercare, intervention, Outpatient, and Recovery Support Services (Substance Abuse) are eligible for special group rates. Group services shall bobilled onthe basis ofacontact hour, at 25% of the contract's established rate for the individual services for the same costcenter. Excluding Outpatient, total hourly reimbursement for group services shall not exceed the charges for fifteen individuals per group. Group size limitations outlined inthe current Medicaid Handbook apply to Outpatient group services funded under this contract. c' Pursuant to s. 394.76(3), Florida Statutes (F.S.), the provider agrees to provide local matching funds inthe amount of $933,952.00 aoindicated inExhibit H.Funding Detail and Local Match. Should the network provider n*ooivo any funding from the Units Reimbursement Funds", then the amount of Local Match 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 K1ontd Health Sorv|000 that is not exempt from local match requirements X33.33%° The MH services are exempt from local match requirement i. Case Management Intensive Case Management Residential Services I -IV Supported Housing/Living Supported Employment Short Term Residential Treatment (not exempt if funded by Baker Act funds or operated byapublic receiving facility) FACT Teams ii. CMHPrograms U0043 &1O278 that are not grant Guidance Care Center, Inc. 72 Contract No. ME225-3-z d. In accordance with the provisions of s. 402.73/1\. F.S, and Rule 85-29.001. Florida Administrative Code (F.A. C.), corrective action plans may be required for noncompliance, nonperformance, munacceptable performance under this contract. Penalties may be imposed for failures toimplement nrtomake acceptable progress on such corrective action plans. e. The managing entity shall reduce mwithhold funds pursuant tnRule G5-29.0O1,F.A.C..hthe network provider fails tocomply with the terms ofthe contract and/or fails tusubmit client reports and/or data as required in DCF PAM 155-2, Rule 65E-1 4, F.A.C. and by the due dates listed on Exhibit C, Required Reports, t The managing entity's decision to reduce or withhold funds will be submitted to the provider in writing. The written notice will specify the manner in which the provider has failed to comply with the terms of the contract. When, and if, compliance is achieved, the withheld funds will bedisbursed tothe provider. g. If the Provider closes or suspends the provision of services funded by this contract, the provider agrees tonotify the managing entity inwriting thirty 00calendar days prior totheir intent toclose, suspend orend oenioo(o). |fthe provider fails tonotify the managing entity, the provider hereby agrees not to request payment for services provided inprior months ifthe 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 cost center as given on Exhibit G, State Funding by Program and Activity ortwenty-five percent (25%) of the prorated share ofthe amount of funding as specified on ExhibitG, State Funding by Program and Activity. h. The managing entity in its sole discretion and subject to funding availability, may purchase from any provider prior tothe end cf the contract period any service units provided atany time during the term ofthe contract. 2. MyFloridaMarketPlace Transaction Fee This contract is exempt from the MyFloridaMarketP lace Transaction Fee in accordance with Rule 3. Additional Release o4Funds At its sole discretion, the ME may approve the release of more than the monthly prorated amount when the network provider submits awritten request justifying the release ofadditional funds, if funds are available and services have been provided. 4, Medicaid Billing m. The Department is always the payorof last resort. The ME and the network provider specifically agree that the Department, through the ME is never a liable third party for Medicaid eligible oon/i000 provided to individuals that meet the eligibility criteria for Medicaid. Authorized network provider oorvi000 shall be reimbursed in the following order of precedence: Any liable first, second, and/or third party payom'then |i K4odicaid, pursuant to o. 408810` F.S., if the individual meets the o|iQdbi|Ky criteria for Medicaid, and the service ioMedicaid eligible, then iii' The Department through the ME (only if none ofthe above are available or eligible for payment). Guidance Care Center, Inc. 73 Contract No. Ms225-3-27 h. The network provider shall identify and report Medicaid earnings separate from all other fees; V. Medicaid earnings cannot be used as local match; vi' The network provider shall ensure that Medicaid payments are accounted for in compliance with federal regulations; Vill. In no event shall both Medicaid and the ME be billed for the same service; b. The network provider operating a residential treatment hsoi|itv licensed as a ohska stabilization unh, detoxification facility, short-term neoidonhe| treatment facility, residential treatment facility Levels 1 or2' ortherapeutic group home that is greater than 16 beds is not permitted to bill or knowingly aomaoo Medicaid Fee For -Service programs for any services for individuals eligible for Medicaid while in these facilities; and c. The network provider operating a ohi|dren'a residential treatment center of greater than 16 beds is not permitted to bill orknowingly access Medicaid Foe -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. d' 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; and e. The network provider agrees to oaaiai individuals eligible for Medicaid covered by a Medicaid oapitated entity who need and request assistance to obtain covered mental health services that the treating provider considers to be medically necessary. This assistance shall include assisting clients in appealing adonia| of services. 5. Payments from Medicaid Health Maintenance Organizations, Prepaid Mental Health Plans, orProvider Services Networks. Unless waived in Section Provisions) of this contract, the provider agrees that payments from a health maintenance organization, prepaid mental health plan, or provider services network will be considered to be "third party payer' contractual fees as defined in Rule 65E-14.001(2)(z).F.A.C. Services which are covered bythe ouboapitekedcontracts and provided (opersons covered bythese contracts must not bobilled tothe department. 6. Invoice Requirements a. The rates neqotiated with any network provider may not exceed the model rat* as specified in Rule 65E-14, F.A.C. b. Network providers are required to comply with Rule 65E-14.021' Unit Cost Method of Paymont, including but not limited to, cost oontom^ unit meaounements, d000riptionx, program areas, data o|omonto, maximum unit cost rates, required fiscal reports, program d000ripL|on, setting unit cost ra1oo, payment for oen/ioeo including allowable and unallowable units and requests for payments. If agreed upon with the KxEand the Department, other payment methods may bopermitted. c. The network provider shall request payment monthly through submission of a properly completed invoice, Exhibit E-11, Substance Abuse and Mental Health Monthly Request for Npn-TANFPayment within twelve (12) days following the end ofthe month for which payment iobeing requested for the delivery ofservice dL The network provider shall submit amonthly Incidental Expense Fund Invoice and Expenditure Log for Adult Mental Hmsbh, Exhibit 0.tothe ME'o Contract Manager 07/01/2012 and by the dates specified in Exhibit C, Required Reports. The report oheU| identify by client, the category ofthe expense (pursuant to Rule 65E-14.021(7)^ F.A.C]. the program, month of service and amount billed per category. 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 twelve (12) days following the end ofthe month. f. The network provider's final invoice must reconcile actual service units provided during the contract period with the amount paidbvthe ME. The provider shall submit their fiscal year final invoice to the ME within fifteen (15) days after the end of each state fiscal year in the contract period. g. Pursuant toS5E-14.021(10)(b)6b,F.A.[|.,the yoar-to-datanumber ofunits ofservice reported on a request for payment orany associated workohootoha|| not exceed the total number of units reported and accepted in the ME'o data system pursuant to Rule GGE- h. Pursuant toG5E-14.O21(10)(a)2,F.A.C,any costs orservice units paid for under any other contract or from any other source are not eligible for payment. The network provider must subtract all units which are billable toMedicaid, and all units for SAMH client services paid from other sources, including Social Security,Medicare paymentS, and funds eligible for local matching which include patient fees from first, second, and third -party payers, from each monthly request for payment. For services provided based on bed -day availability, the provider must report any payments received from all other sources on the "Schedule of Bed -Day Availability' at the end of the fiscal year and refund any overpayment. I. Invoices shall be submitted in detail sufficient for a proper pre -audit and 7. Supporting Documentation au The network provider agrees tomaintain and submit tothe ME, if applicable, service documentation for each service billed tothe K1Epursuant tothis contract. Properserv�e documentation for each SAMHcost center isoutlined inRule 65E-/4L2/(7),F.A.C.'in Section D..Special Provisions for Adult System of Care Comprehensive Community Service Teams services, Exhibit 0,Incidental Expense Fund Invoice and Expenditure Log for Adult Mental Health. b. The provider shall maintain documentation tosupport all units billed tothe ME and units subtracted for SAMHclient services oneach monthly request for payment. o. The network provider shall ensure that all oorvi000 provided are entered into the K|S data system designated bythe managing entity. d. The ME, Department and the Stato'o Chief Financial Officer reserve the right to request supporting documentation at any time after actual units have been delivered. & Funding Sweeps The network provider agrees that at the sole discretion of the ME and at such time and upon terms, conditions orcriteria set by the managing entity, a review of the funding utilization rate or pattern of the provider may bo conducted by the ME. Based upon such roview, if it is determined that the ro&a of utilization may result in a lapse of funds, then in that event the ME may amend the network 07/01/2012 provider's total amount offunding bvreducing same inorder toprevent the potential lapse. The ME will ouhh/ the network provider in writing of the reduction prior to amending the total amount of funding. The K8E'mLapse Policy is incorporated herein byreference. Guidance Care Center, Inc. 76 Contract No. me22s�-2r BZM= Exhibit C Required Reports Response to Monitoring Reports and Corrective Action Within 10 days from the day the report is FBHN Contract Plans received. 1 Manager Sliding Fee Scale (reflecting the uniform schedule of Within 30 days after the beginning of each 1 FBHN Contract discounts referenced in 65E-14.018(4)] fiscal year. Manager Final FY 2012-2013 (1) Network Providers Agency Service Capacity Report, (2) Projected Cost Center Operating and Capital Budget (If applicable), Within 30 days after Contract execution or SFBHN Contract (3) Cost Center Personnel Detail upon request of the Contract Manager Manager Report (if applicable), & (4) Program Description. Monthly Data Required by DCF PAM 155-2 Within 8 days after end of month Electronic SFBHN MIS Office Submission Incident Report Within 24 hours of occurrence 1 IRAS Audit Schedules for Network Providers (for client non-specific unit cost performance contracts) Due 180 days after the end of the fiscal year Schedule of State Earnings or 45 days upon completion of audit, 1 SFBHN Contract Manager whichever comes first. Due 180 days after the end of the fiscal year Schedule of Related Party Transaction Adjustments or 45 days upon completion of audit, I SFBHN Contract Manager whichever comes first, Program/Cost Center Actual Expenses & Revenues Due 180 days after the end of the fiscal year SFBHN Contract Schedule or 45 days upon completion of audit, 1 Manager whichever comes first. Due 180 days after the end of the fiscal year Schedule of Bed -Day Availability Payments or 45 days upon completion of audit, 1 SFBHN Contract Manager whichever comes first. 180 days after the end of the managing Financial & Compliance Audit per Attachment 11 entity's fiscal year or 45 days after its 1 FBHN Contract completion, whichever comes first. Manager (See Attachment 11) Reports Required for Substance Abuse Providers SFBHN Contract Annual Report for HIV Early Intervention Services, Manager & SAPT Block Grant Set Aside Funded Services Only Upon Request p 1 Substance Abuse Program Office Annual Report for Evidenced -based injection Drug User SFBHN Contract Outreach Services, SAPT Block Grant Mandate, 1 Manager & Designated Providers Only Upon Request pq Substance Abuse Program Office Annual Report for Pregnant Women and Women With SFBHN Contract Dependent Children SAPT Block Grant Set Aside Upon Request 1 Manager & Funded Services Only Substance Abuse I Program Office Guidance Care Center, Inc. 77 Contract No. ME225-3-27 Required Reports Due Date of end to: I I I Copies IS I Service Invoice Review Supporting Documentation ion Services Report printed from PBPS Activities Report Final Invoice Wait List (until departments automated system is operational) Provider's Grievance Procedures Provider Informed Consent Forms Provider's Emergency Preparedness Plan Provider's Civil Rights Compliance Questionnaire Provider's Security Agreements, per Standard Contract Affidavit Regarding Debarment Inventory Report "No Wrong Door' Policy and Procedure Quality Improvement Plan uarterly Report on implementation of Quality Improvement Plan lity Assurance Plan rterly Report on the Implementation of Quality trance Plan Monthly, by the 12th after the month of service 1 1 As requested by the contract manager Submitted with the monthly invoice October 12, 2012 January 12, 2013 April 12, 2013 June 15,2013 By July 15 of each fiscal year and/or 15 days after contract end date Monthly by the 15 th after the month of service Within 30 days of contract execution. Submit updates as amended within 30 days of execution of the amendment Within 30 days of contract execution Within 30 days of contract execution Within 30 days of contract execution Within 30 days of contract execution Annually, prior to contract execution, or as requested by the contract I manager. Within 30 days of contract execution August 1, 2012 August 1, 2012 October 15, 2012 January 15, 2013 April 15, 2013 July 15, 2013 August 1, 2012 1 October 15, 2012 1 January 15, 2013 April 15, 2013 July 15, 2013 FBHN Contract anager FBHN Contract anager ME Contract Contract HN Contract FBHN Contract anager FBHN Contract anager FBHN Contract anager FBHN Contract anager FBHN Contract anager FBHN Contract anager FBHN Contract anager FBHN Contract anager FBHN Contract HN Contract N Contract Guidance Care Center, Inc. 78 Contract No. ME225-3-27 i i ! Co-occurring Action Plans 06130/2013 1 SFBHN Contract Manager ODECAT 06130/2013 1 SFBHN Contract Manager COMPASS Follow-up Self -Assessment for all Network 06/30/2013 SFBHN Contract Providers 1 Manager Cooperative Agreements Within 30 days of execution of the 1SFBHN Contract agreements Manager ANF SAMH Program Logs and Service Data As per the contract and/or as requested by 1 FBHN TANF the contract manager Supervisor DA Client Communication Assessment Auxiliary Aid by the 4th business day following the SFBHN Contract Service Record Monthly Summary Report reporting month 1 Manager External Quality Assurance Reviews, Monitoring As per the contract and/or as requested by SFBHN Contract Reports, Surveys & Corrective Action Plans the contract manager Manager Client Trust Fund Letter August 1, 2012 1 FBHN ContractManager Children's Mental Health hildren's Mental Health Quarterly clinical reports on all dependent children Per the contract and Exhibit S. 1 opy in chart hildren"s Mental Health Quarterly clinical reports on all As per the contract and/or as requested by community children the contract manager 1 opy in chart Adult Mental Health Incidental Expense Fund Invoice and Expenditure Log for p p g Monthly by the of each month following the 1 SFBHN Contract Manager and ME Adult Mental Health (Exhibit O} month month of service stem of Care Per PATH Grant PATH Annual Data Report to SAMHSA Per PATH Grant Application Instructions 1 pplication Instructions PATH Annual Reports Drafts to be submitted to managing entity for Contract Manager, Southern Region SAMH Program Office, g g ME System of DCF Central Office in Tallahassee in April or 1and Care Staff May of each fiscal year as requested Forensic Services Forensic Monthly Report for Individuals on Conditional Release By 15th of each month eamCoordinat 1 Guidance Care Center, Inc. 79 Contract No. ME225-3-27 Exhibit D MENTAL HEALTH & SUBSTANCE ABUSE REQUIRED OUTCOMES/OUTPUTS (Part 1) Provider Name: Guidance Care Center, Inc. Contract #: ME225-3-27 Date: 07/01/2012 Revision #: NA 1. Mental Health Contracted Services A. Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH, Medicaid and Local Match) Numbers to Be Served 1. Adult Mental Health a. Adults with Severe and Persistent Mental Illness (SPMI) (MOO] 6)/(MHO 16) 1,200 b. Adults with Serious and Acute Episodes of Mental Illness (M05301)/(MH5301) 40 c. Adults with Mental Health Problems (M05302)/(MH5302) 250 d. Adults with Forensic Involvement (MOO I 8)/(MHO 18) 4 2. Children's Mental Health a. Children with Serious Emotional Disturbances (SED) (M003 1)/(MH03 1) 150 b. Children with Emotional Disturbances (ED) (M0032)/(MHO32) 225 c. Children at -risk of Emotional Disturbances (M0033)/(MHO33) 0 Minimum Contract B. Required Performance Outcome Standards for Each Target Population Standard 1. Adult Mental Health - Adults with Severe and Persistent Mental Illness a. Percent of adults with severe and persistent mental illnesses who live in stable housing environment will be at least (M0742)/MH742) 93% b. Average annual number of days (post admission assessments) worked for pay 30 for adults with severe and persistent mental illness will be at least (M0003)/(MHO03) 2. Adult Mental Health - Adults in Mental Health Crisis, including Adults with Serious and Acute Episodes of Mental Illness and Adults with Mental Health Problems a. Percent of adults in mental health crisis who live in stable housing environment will be at least (M0744)/MH744) 90% 3. Adult Mental Health - Adults with Serious Mental Illness (SPMl, MH Crisis, Forensic) a. Percent Of adults with serious mental illness who are competitively employed will be at least (M0703)/MH703) 15% 4. Adult Mental Health - Forensic Involvement a. Percent of adults in forensic involvement who live in stable housing environment will be at least (M0743)/MH743) 70% 5. Children Mental Health - Seriously Emotionally Disturbed a. Percent of children who live in stable housing environment will be at least (,M0779)/(MH779) 95% Guidance Care Center, Inc. 80 Contract No. ME225-3-27 b. Percent of children who improve their level of functioning will be at least (M037S)/MH378) 65% c. Percent of school days seriously emotionally disturbed children attended will be at least (MOO I 2)/(MH404) 86% 6. Children Mental Health - Emotionally Disturbed a. Percent of children who live in stable housing environment will be at least (M0778)/(MH778) 95% b. Percent of children who improve their level of functioning will be at least (M0377)/(MR377) 64% 7. Children Mental Health - At -Risk of Emotional Disturbance a. Percent of children who live in stable housing environment will be at least (M0780)/(MH780) 90% C. Required Internal Measures 1. Data Submission Outcomes for Mental Health a. Percent of persons receiving state -contracted mental health service event records which have matching mental health initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) 95% (M0759) Guidance Care Center, Inc. 81 Contract No. ME225-3-27 Exhibit D MENTAL HEALTH & SUBSTANCE ABUSE REQUIRED OUTCOMES/OUTPUTS (Part 11) 11. Substance Abuse Contracted Services A. Required Performance Output Standards for Each Target Population Minimum (including all clients paid for by SAMH, Medicaid and Local Match) Numbers to Be Served 1. Adults with Substance Abuse Problems a. Number of Adults Served (M0063)/(SA063) 415 2. Children with Substance Abuse Problems a. Number of Children Served (M0052)/(SA052) 3. Adult At -Risk of Substance Abuse Problems - (NonGAA) a. Number of adults participating in Prevention Services (M0785)/(SA785) b. Number of adults participating in Level I Prevention Programs (M0767)/(SA767) c. Number of adults participating in Level 2 Prevention Programs (M0768)/(SA768) d. Number of adults participating in Level I Prevention Programs who complete 75 percent of the program's schedule of activities (M0769)/(SA769) e. Number of adults participating in Level 2 Prevention Programs who complete 75 percent of the program's schedule of activities (M0770)/(SA770) 4. Children At -Risk of Substance Abuse Problems - (Baseline-NonGAA) a. Number of children participating in Prevention Services (M0762)/(SA762) b. Number of children participating in Level I Prevention Programs (M076 1)/(SA76 1) c. Number of children participating in Level 2 Prevention Prograins(M0695)/(SA695) d. Number of children participating in Level I Prevention Programs who complete 85 percent of the program's schedule of activities (M0763)/(SA763) e. Number of children participating in Level 2 Prevention Programs who complete 85 percent of the program's schedule of activities (M0764)(SA764) B. Required Performance Outcome Standards for Each Target Population 1. Adults with Substance Abuse Problems a. Percent of adults who successfully complete substance abuse treatment set -vices will be at least (M0755)/SA755) b. Percent change in clients who are employed from admission to discharge will be at least (M0753)/SA405) c. Percent of adults who live in a stable housing environment at the time of discharge will be at least (M0756)/SA756) d. Percent change in the number of adults arrested 30 days prior to admission versus 30 days prior to discharge (M0754/SA754) 2. Adult At -Risk of Substance Abuse Problems - (Baseline -Non GAA) a. Percent of adults participating in Level I Prevention Programs who complete 85 percent of the program's schedule of activities will be at least (N1077 ])/(SA77 1) Guidance Care Center, Inc. 82 176 25,309 NA NA NA NA 5,000 1,123 50 954 42 Minimum Contract Standard 50% 20% 80% 35 50% Contract No. ME225-3-27 b. Percent of adults participating in Level 2 prevention Programs who complete 85 percent of the program's schedule of activities will be at least (M0772)/(SA772) 3. Children with Substance Abuse Problems a. Percent of children who successfully complete substance abuse treatment services will be at least (SA725)/(SA755) b. Percent of children who live in a stable housing environment will be at least (M0752)/SA752) c. Percent change in the number of children arrested 30 days prior to admission versus 30 days prior to discharge will be at least (M075 l/SA75 1) 50% 55% 85% 20% 4. Children At -Risk of Substance Abuse Problems - (Baseline -Non GAA) a. Percent of children participating in Level I Prevention Programs who complete 75 percent of the program's schedule of activities will be at least 50% (M0765)/(SA765) b. Percent of children participating in Level 2 Prevention Programs who complete 85 percent of the program's schedule of activities wil I be at least 50% (M0766)/(SA766) 5. Data Submission for Prevention Program Tool (baseline - Non GAA) a. Percent of approved Prevention Descriptions completed within 30 days 50% of contract execution. C. Required Internal Measures 1. Data Submission Outcomes for Substance Abuse a. Percent of persons receiving state -contracted substance abuse service event records which have matching Substance abuse initial (purpose 1) 95% admission records in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0758) Guidance Care Center, Inc. 83 Contract No. ME225-3-27 Exhibi F T MENTAL HEALTH .N-TANP MONTHLY PA.YMEN"T DVANCE REQUEST TANF F+xrt43log YTR TotA YTG ^iAMM NWI-. oitfoton00 (YTO 00f NpY4.1'I NP t..-N4 f", tho : E')sq t. No",. T'ANP PIAO 101 Unp.10 AkY[Jun£ Do. t:tt$t G:-to, U111TO Pmd ro, sxtjoot £f+A C O'k, '.. CPntar f on, tno. 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I v`Tf1 intoMat I YTP fU"tta i YID AOVAOr I r l-Vs A,1.�a I Guidance Care Center, Inc. 84 Contract No. ME225-3-27 07/01/2012 Exhibit E a. AGENCY NAME: CLIENT NON-SPECIFIC PERFORMANCE CONTRACT WORKSHEET FOR REQUEST FOR PAYMENT b.CONTRACT No.: Adult Mental Health c.FRObt T0: F0rCt btcente B DE on the basisD A PROGRAAh - -- ut_tttt,,,OffCiiS 0 & J MUS14401 e FEDERAL ID #: BE> than.andColumnE MUST NOTbe �g.VENDOR f3 (If different than Fed ID): < then, (0 I ofunds reported to the `h.ADDRESS (Number, City, State, Zp): MHSA Data Warehouse Non-TANF- Units & Eamin s TANF -Units &Eamin YTD Total Units YTD Local to Enrolled YTD Billable Match Units to YTD Total Non- YTD Total Non- YTD Total TANF YTD Total Clients & Non- Medicaid Units Enrolled Clients YTD Total Units TANF Units TANF $ Amount Units Eligible to TANF $ Amount Contracted Ghent -Specific to Enrolled & Non -Client- Eligible to be Eligible to be for Eligible be Billed to for Eligible ACTMTY Rate Units Clients Specific Units Billed to SAMH Billed to SAMH Units SAMH Units Cost Center D{E+F) (CxH) (CxJ) AlB CI D E 1 F G H I J K Emergency Stabit¢ation - 502004 Crisis Stabilization (No TANF) $0.00 0.00000 0.00000 0,00000 0.00000 0.00000' $0.00 Crisis Support/Emergency $0.00 0,00000 0.00000 0.00000' 0.00000 0.00000, $0.00 0.00000 $0.00 inpatient (No TANF) $0.00 0.00000 0.00000 0.00000, 0.00000 0.00000, $0.00 Recovery & Resiliency Services - 502018 Residential Level i $0.00 0.00000 0.00000 0.00000 0,00000 0.00000' $0.00 0,00000 $0.00 Residential Level I - Enhanced Rates $0,00 0.00000 0.00000 0,00000 0.00000 0.00000' $0.00 0.00000 $0.00 Reside tat Level It $0,00 0.00000 0.00000 0.00000 0.00000 0.00000 , $0.00 0.00000 $0.00 Residential Level IN $0.00 0.00000 0.00000 0.00000 0.00000 0.00000, $0.00 0.00000 $0.00 Residential Level N $0,00 0.00000 0.00000 0.000DO 0,00000 0.00000' $0,00 0.00000 $0.00 Room & Board w/Supervision Lev 1 $0,00 0,00000 O.00000 0.00000 0.00000 0.00000 , $0.00 0.00000 $0.00 Room & Board w/Supervtion Lev H $0.00 0.00000 0.00000 0.000D0' 0,00000 0.00000' $0.00 0.00000 $0.00 Room & Board wlSupervisiu Lev III $0.00 0.00000 0.00000 0.00000 0.00000 0.00000, $0,00 0.00000 KOO ,Short-term Residential Treatment KOO 0,00000 0.00000 0.000DO' 0.00000 0.00000, $0.00 0.00000 $0,00 Case Management $0.00 OD0000 0.00000 0.00000 OD0000 0.00000, $0.00 0.00000 $&00 Intensive Case Management $0,00 0,00000 0.00000 0.00060' 0.00000 0.00000 , $0.00 0.00000 $0.00 'Assessment $0,00 0.00000 0.00000 0,00000 OD0000 0,00000, $0.00 0.00000 $0.00 jDay Care $0.00 0.00000 0.00000 O.000DO' 0.00000 0.00000' $0.00 0.00000 $0.00 Day/Night $0,00 0.00000 0.00000 0.00000 0.00000 0,00000, $0.00 OD0000 $0.00 Intervention - Indviduai $O.00 0.00000 0.00000 0.00000, 0.00000 0,00000, $0.00 0.00000 $0.00 Intervention - Group $0.00 0.00000 0.00000 0.00000, 0.00000 0.00000, $0.00 0.00000 $0.00 Medical Services (No TANF) $0.00 0.00000 0.00000 0,00000, 0.00000 0.00000, $0.00 Outpatient - Individual $0.00 0,00000 0.00000 0.00000, 0.00000 0.00000, $0.00 0,00000 $0.00 Outpatient - Group $0,00 0.00000 0.00000 0.00000, OD0000 0.00000, KOO 0.00000 $0.00 Sheltered Employment (No TANF) $0.00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00; Drop-InlSetf-HelpCenters(NoTANF) $0.00 0.00000 0.00000 0,00000, 0.00000 0,00000, $O.00i In -Hone and On Site $0.00 0.00000 O.wo 0.00000, 0.00000 0.00000' $0 00 O.00O i $0.00 Outreach ,Prevention $0.00 0.00000 0.00000 0,00000, 0.00000 0.00000, $0A0 0.00000 $0.00 $0.00 0,00000 0,00000 0.00000, 0.00000 0.00000, $0.00 0.00000 $0.00 Respite Services $0.00 0.00000 0.00000 0.00000, 0.00000 0.00000, $0.00: 0.00000 $0.00 Supported Employment $0.00 0.00000 0.00000 0.00000, 0.00000 0.00000, $0.00; 0,00000 $0.00 Supportive Housi%Uvmg $0,00 0.00000 0.00000 0.00000, 0,00000 OD0000 ' $0.00i 0.00000 $0.00 Aftercare - Individual $0.00 0.00000 0,00000 0.00000, 0.00000 0.O000' $o.00' 0.00000 $0.00 Aftercare - Aftercare -Group $0.00 0.00000 0.00000 0.00000, OD0000 0.00000' KOO 0,00000 $0.00 Information & Referral (No TANF) $0.00 0.00000 0.00000 0.00000, 0.00000 0.00000' $0,00 Health Clubhouse Services $0.00 0.00000 0,00000 0.00000, 0,00000 0.00000, $0,00 0.00000 KOO Recovery & Resiliency - FACT Teams-502018 Fact Team (No TANF) KOO 0.00000 0.00000 OD0000 0.00000 0.00000, $0.00 Recovery & Resiliency CCST - 502018 CCST-Individual KOO 0.00000 0.00000 0.00000 OD0000 0.00000, $0.00 0.00000 $0,00 CCST - Group $0.00 OD0000 0,00000 0.00000 0,00000 0.00000' $0.00 0.00000 $0,00 Recovery & Resiliency -Incidental Expenses $0.00 Incidental Expenses 1 $0,00 0,00000 0,00000 0.00000 0,00000 0,00000, $0,00 0,00000 $0.00 Guidance Care Center, Inc. 85 Contract No. ME225-3-27 04 1 Exhibit E CHK..oRE:W S L*NTAL HEALTH U00,rANF r'j0NTHL.`f PAYMENVADVANCE REQUEST ..._-,.-....,._...,._,u.. .. _.a._.....e........ 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L-Raxnoxsprt nB pi As4vancm $1,00 Y"fb SP{toroat VTO [s4t9lki t YTO F t 004, h Y"Tft Advaol esxerr.aa me, aw Ad et'x 3 _tar ,my 6 C.emfy Mae abz 0.t P. bt, 4;eseBTe aew.S {n YPte ?sa .'P"nR t'a'cai9Y CAta3 A+mLer-C3is rb r^DtdS .aesd -TCc y#'-dc Bexrr*rs^a of c`,ba a�w[naj'9 cunt: HeCtrvsaa tfi. ME. Ax.3Hs+S+.Ysxao?g @ . M^p.4;o t9 +ak ;A[P fBMef€ d ae^ *�, rsXi[xe n! sxti ,ra cM6 m det. Eta. L+tRa'l'&lnkse`e Twd is Ole tde¢ xi!"t1+ 1 a» ace s.t4. rr, . motiLh °ilk sx5rcaxAce, p.. frt - 1:6A{}.11tiY 1 Date {€L4Y£*pGi„+ R.btmft*ofv-V 'ti c"��iSfkf.Ma#J e�MN:4"?;a @+; t24�'LeF :K 0,t# #rxd tT03rsttSYB arrout Appaaxzu d, Guidance Care Center, Inc. 86 Contract No. ME225-3-27 07/01/2012 Exhibit E a. AGENCY NAME: CLIENT NONSPECIFIC PERFORMANCE CONTRACT ----.- b. CONTRACT No.: WORKSHEET FOR REQUEST FOR PAYME For cost centers paid for on the basis of Ic. FROM: TO: Children's Mental Health urflitzadofl,Coluaws D & J MUST NOTRE s ;d PROGRAM: Than, and Coliumis E ► USTNUT be < their e FEDERAL ID #: the # of taiks mponad to the WTSA Date, g. VENDOR ID (If different than Fed ID): Warehouse h. ADDRESS (Number, City, State, Zip): Non-TANF- Units & Earnings TANF- n! arnings ACTMTY Cost Center Contracted Rate YTD Total Units to Enrolled Clients & Non -Client- Specific Units YTD Local Match Units YTD Billable to Enrolled YTD Total Medicaid Clients & Units Units to Non -Client- Eligible to Enrolled Specific be Billed to Clients Units SAMH D E+ YTD Total Non-TANF YTD Total Units Eligible Non-TANF $ to be Billed to Amount for SAMH Eligible Units (CxH) YTD Total YTD Total TANF Units TANF $ Eligible to Amount for be Billed to Eligible SAMH Units (CXJ A I B C D E F G H i J K Emergency Stabilization - 503001 Crisis Stabilization (No TANF) $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 Crisis Support/Emergency $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.001 0.00 $0.00 Inpatient (No TANF) $0.00 0.00000 0.00000 0.00000 0,00000 0.00000 $0,00 Recovery & Resiliency Srvs - 503013 Residential Level $0,00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00' $0.00 Residential LevelI- Enhanced Rates $0.00 0.00000 0,00000 0,00000 0.00000 0.00000' $0.00 0.00' $0.00 Residential Level II $0.00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00; 0.00' $0.00 Residential Level III $0.00 0.00000 0.00000 0,00000 0.00000 0.00000' $0.00 0.00' $0.00 Residential Level N $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 0.00' $0.00 Room & Board w&pervision Lev 1 $0.00 0.00000 0.00000 0.00000 0,00000 0.00000' $0.00 0.00' $0.00 Room & Board w/Supervision Lev ti $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 0.00' $0.00 Room & Board w&pervision Lev 111 $0,00 0,00000 0.00000 0.00000 0.00000 0.00000' $0.00 0.00' $0,00 Case Management $0.00 0.00000 0.00000 0.00000 0.00000 0.00000' $0.00 a00' $0.00 Intensive Case Management $0.00 0.00000 0.00000 0.00000 0,00000 0.00000' $0.00 0.00' $0.00 Assessment $0.00 0.00000 0.00000 a00000' 0.00000 0.00000' $0.00 0.00' $0.00 Day Care $0.00 0,00000 0.00000 0.00000' 0.00000 0.00000' $0.00 0.00' $0.00 DaylNight $0,00 0.00000 0.00000 0.00000' &00000 0.00000' $0.00 0.00' $0,00 intervention - Individual $0.00 0,00000 0.00000 0.00000' 0.00000 0.00000' $0.00 0.00' $0.00 Intervention -Group $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 0.00' $0.00 Medical Services (No TANF) $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 Outpatient -Individual $0.00 0.00000 0,00000 0.00000' 0.00000 0.00000' $0,00 0.00' $0.00 Outpatient - Group $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 0.00' $0.00 In -Home and On Site $0.00 0,00000 0.00000 0.00000' a00000 0.00000' $0.00 0.00' $0.00 Outreach $0.00 0.00000 0.00000 0,00000 0.00000 0.00000' $0.00 0.00' $0.00 Prevention $0.00 0.00000 0.00000 0.00000' 0.00000 a00000' $0.00 0.00' $0.00 PreventionYhtervertion Day $0DO 0.00000 0.00000 0.00000' 0,00000 0.00000' $0.00 0.00' $0.00 Respite Services $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 0.00' $0.00 Supported Empbyni nt $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 0.00' $0.00 Supportive Housing/Living $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 no, $0.00 Aftercare - Individual $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 a00' $0.00 Aftercare - Group $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 0.00' $0.00 Information & Referral (No TANF) $0.00 0.00000 0.00000 0.00000' 0.00000 a00000' $0.00; 00 Mental Health Clubhouse Services $0.00 0.00000 0.00000 0.00000' 0.00000 a00000 $0.00 0.00' $0 00 Recovery & Resiliency Comprehensive - Community Service Team-503013 CCST-Individual $0.00 0.00000 0.00000 0.00000' 0.00000 0.00000' $0.00 0.00' $0.00 CCST-Group $0.00 0.00000 0.00000 0.00000 0,00000 0.00000 $0.00 0.00' $0,00 Recovery & Resiliency -Incidental Expenses 0.00000 0,00000 0.00000' u0000 0,00000 $0.001 0,00' Guidance Care Center, Inc. 87 Contract No. ME225-3-27 i �i '-M EXHIESFT E 2 ADULT SUBSTANCE ABUSE TA14F MONTHLY f PAYMENT ADVANCE REQUEST Fuvel"'q(,tve't Y@'o'T 013t YTo SA,Ae Drt€erom# : Aaa4TAttt t"MM fa the A,owty f h gatkt TRt€'I $ TMW Pa:d for {YT0 V nPa of : Amx uNt Due caa@ centex pmd Ntf 1"lata 'yM" �ixxesx+xt IN.— fY}e:.aar1# Pt-6 zM. q.R—'b t,,$[ara:, trite C O%t C'A'. so that thewwtof C c W, 2 , ' W U - eaCh A.can ,r ra + 5ths zNe Ee v%ew of ' - a 'A `1 ,:L t"I " <l ' Xi ' G,e e Y 'x 3 4'.)',3 See XX', <A "K AX 1100 hX, xx x 'K t:°ur.Y. r'r +rasfia:;tt .'.f x, a..k x"x, : S4 !?{k s€,"i. €3 Yr,..?..X Y;;d X ', t t M, "t 0 C XX, Xx X;€,x. 000 : : $000 1XXx x x x d4>°E".. e...?' `t ,s s.CA.., �t : ;^, iiR) ,9At +ii' i' XXI 5:{?`, .'; k. e f5.."a &. vT tqi x.t Yet <'"'n"P,d Rue,f XX.x X„'XX „i 06 : : 4$000 .X X.XXXX x Xr ",X x,axvsa :yxt�t,is= xxx"l.Yxx iU2o +eg60 ;e,tXXXXX A�";X<rxra i,F,A=,vta€ ,x::x x.'A:t.X so 00 $000 ,:a„AY'A:w, ;x. .r.3 oaf: : : :. 9,,. Gem ava'ti'.e .per"'"' t.Ce lx xxxxx'*=::a`; I:1 a'° S100A At:>3„ XXx;. Rec su.p 'Ceevp xX.XXXIXX V)00 so'oo x X x XX<x.X T rtat" ens A AStema t, Total n,' SU.i7is WOO $0,00 S0100 $0,00 esveen?aon+2d?t€A .,e'x :pX pretvrsr€Noo 10141 tri?v'ler, A~`+.A..,,X. a`.t.0 Sltx,t *"Ari,xXXX ancklental E xponws ToW,, Sta,(10 $0,00 $0,00 $0,00 $0,00 TOTAL. S0.00 WOO $0.00 SAM $100 SAM xr a.^x+.. xsrex:ze;;,s xA.esrr-, '- MH us!,p w. ram+- =hasrti ovaot=X* LLess Recoup" E0,00 %RTT -C RTWR,ATlONA,APPROVAL € eMt,Me.,4,,'e" ,0-a�m Me;.ndmar,r.:arn"s'GYrthAageprs;fexne€l°a:zrx'3,A4tnI ate€spartMs' ...,.rr'sxentA'lrferR)vo,ME ^ *'t t''."c' bN V"It m$ ,YA rt d-maw',a G,k"; c and s ,r .¢. ¢S$i`tr, ita RaG A-edt.._tJ.FP.'�if+�dt, to rbe tt F ir4 tt* comact. Dalp r r aat { sx etr�st,t FT�rtea�� r sg Se rArehr: t2 att et v 0K,O R eax',ry axes. Date 4sttu°zd lselvices Date MspecuA and Appmved� S0 Za`'0 it. S2 20 0 t£C 00,11, S11 0E0 ) 000100 Sii kr` 00,0000 Eil Se 00 i €t€3S`tt' 0 S�tJC „ S=a 00 t? i s Ofoo a' v t Sal..00 0.3{�0,tAZ,t't't .,..v .."14?v" w'x0.00 tt;;Itt+300 YTV sutecawt i 4YTO antereAt I 'YTD Ynarade I YTD A vame Guidance Care Center, Inc. 88 Contract No. ME225-3-27 07/01/2012 Exhibit E a AGENCY NAME, CLIENT NON-SPECIFIC PERFORMANCE CONTRACT WORKSHEET FOR RECAJEST FOR PAYMENT For cos coo mrs paW for on the b. CONTRACT No, Adult Substance Abuse basis of utrdindon, Uurnns C & c. FROMt. TO: J h1UST14OT8E> than, and d PROGRAM f Column E MST NOT be qc ihan, e FEDERAL iD #t ; the of u nirs reported to die g, VENDOR 0 (If dffe(90 than Fed 10): MH SA Data: Warehouse K ADDRESS (Number, City; State, Zip): _. -, .�,,. -, - _ Non-TANF- Units &Earnings TANF-Units & Earnings YTO Total YTO Local Units to Match Units YTO Total Enrolled YTO Billable to Enrolled YTO Total Non-TANF YTO Total YTO Total Clients & Medicaid Gents & Units Units YTO Total Non TANF Units TANF $ Non -Client- Units to Non-Ckent- E higibie to Eligible to TANF $ E6gibte to Amount for Contracted Specific Enrolled Specific be Bilked to be Billed to Amountfor be Billed to Eligible ACTIVITY Rate Units Clients Units SAMH SAMM Eligible Units SAMN Units CostCemer O-(E+F) (CXH) (CXJ) A I B C 0 E F G H I J K Treatment & Aftercare - 603007 Assessment $0.00 0.00000 0,00000 0,00000 0.00000 0,00000 $0,00 0.00000 KOO Case hlanactwent S0 00 000000 0.00000 0.00000 0.00000 0.00000 $0,00 000000 S0.00 Crs6 Support'Emergency $0.00 0,00000 0,00000 0.00000 0,00000 0,00000 $0,00 0.00000 $0,00 Day Care S0,00 0.00000 000000 0.00000 0,00000 000000 S0.00 0.00000 S0.00 0a t{gf i $0.00 0.00000 0,00000 0,00000 0,W000 0.0000o $Ho 0,00000 $0,00 kr-Hme & On Site S0.00 0.00000 0.0GO00 0.00000 0.00000 000000 S0.00 0,00000 $0,00 Intensive Case ftranagerrrent $0.00 0,00000 0.00000 0.00000 0,00000 0,00000 $0.00 0,00000 %00 �rrt 1tcn-lndroi,ia So 00 000000 0.00000 o.o0000 O 00000 000000 %00 000000 $0 00 Intawntion - Group $0,00 0.00000 0,00000 0.00000 0,00000 0.00000 $0.00 0100000 $0,00 r;WicN Services (NoTAN F) SO.00 0,00000 0.00000 0.00000 0.00000 0,00000 soo0r hiethad,ne Mactenance (No TANF) $0.00 0.00000 0,00000 0,00000 0,00000 0,00000 $0,00 f O�patent- ind,ndu4 $0.00 0,00000 0.00000 0.00000 0.00000 0.00000 $000 0,00000 $0.00 Outpatient- Graup $0,00 0.00000 OD0000 0,00000 0,00000 0,00000 SO.00 0.00000 $0,00 Wreach S0.00 0.00000 000000 0.00000 0.00000 0.00000 $0,00 000000 $000 Res identialLevel 1 $0.00 0,00000 0,00000 0,00000 0,00000 0,00000 $0,00 0,00000 $0,00 Res>dental €.evei I - Enixii.ed Rees S0.00 0,00000 0,00000 0,00000 0.00000 0.00000 SO.00 O,O0000 $0,00 Resdentait.e+eili $0.00 0,00wo 0.00000 0.00000 OA000o 0.00000 $0,00 0.00000 $0.00 Res ;dental Level M S000 0.00000 0,00000 O.00OOO 0.00000 000000 S0,00 000000 $0.00 Resdentiai t.avei iV $0.00 0.00000 0,00000 0,00000 0,00000 0,00000 $0,00 0.00000 KOO RespteSeroces SO.00 000000_ 0,00000 0.00000 0,00000 0.00000 S0.00 0,00000 $0,00 Supported Emplcym at $0.00 0,00000 0,00000 0,00000 000000 0,00000 $0.00 0.00000 $0.00 Supp(mr,i,HcL6ng`trvrcrg S0,00 0,00000 0-00000 0.00000 0.00000 0-00000 50.00 0-00000 S0.00 TASC $0.00 0.00000 0,00000 0.00000 0.0000o 0.00000 WOO 0,00000 KOO Altercate - InvrvrduN S0.00 0.00000 0.00000 0.00000 000000 0.00000 $0.00 0,00000 S0.00 Aftercare-G(oup $0.00 0.00000 0.00000 0,00000 0,00000 0,00000 $0.00 0.00000 $0,00 Roam & Scafd wiSupe(visrcn;.ev i 50.00 0,00000 0.00000 0.00000 0.00000 0.00000 So 00 000000 $0,00 Room & Bwd w/Supervision Lev it $0.00 OD0000 0.00000 0,00000 0,00000 0.00000 $H0 000000 $0,00 Roorn & @mod A-Suparnsion t.ev if 50.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0,00000 S0.00 Recov&ySuppoR- Irdvidual $0,00 0.00000 0.00000 0,00000 0,00000 0,00000 S0.00 0,00000 $0,00 Ra-cr,ervSuppxors -Gr $0,00 0.00000 000000 000000 0,00000 0.0000o S0.00 0.00000 $0,00 jinfordi1ian & Referral (No TANF) $0,00 U0000_ 0.00000 0,00000 0,00000 0,00000 $o.00; 1 Detoxification - 603005 El Substance Abuse 0etax(No TANF) KOO 0,00000 0.00000 0,00000 0,00000 0.00000 %001 OtApatent "a(a6catio n (No TANF) $0,00 0,00000 0A0000 0,00000 0,00000 H0000 $0.00 Prevention-603006 f Prewntion $0.00 0,00000 OD0000 0,00000 0.00000 O.00000 $0.00 O.o0000 $0.00 informaton & Re err8 (No TANF) $0.00 0.00000 0.00000 0,00000 0.00000 0.00000 $0.00 FACT Teams - mwxx IFact Tewt (No TAN F) $0.00 0.00000 0,00000 0,00000 0,00000 0,00000 $0.00� Incidental Expenses ncrdentd Eqenses So 00 000000 0.00OOo 0.00000 0.00000 0.00000 50.04 0,00000 0.00 Guidance Care Center, Inc. 89 Contract No. ME225-3-27 07/01/2012 Exhibit E e. �e11C.N`I,e n. c a No. a. `� ortt�+t mrn,�-a+ana T2 ezcr+w[r41 CHILDREN SUBSTANCE ABU SE NO[FTFWF MONTHLY PAYMENT1AOVA14CE REQUEST f. v6 eto ORS t�}611PlrenI t non Fao all: p. AGGR[�.S (twmoer. C>n. 3tata, an3- T �P ART t-t RM NO tsp-M.0 Hon-� -0 Tor., Y10 SAMH Non- 6l It- X. p to _s_"W ♦ lu»>unt Out Co�E CeMaf wofg0iT-T / TANF 7u tng EttQfb€sNon� L,e for III.TANF3eafn.d TANF.Vdfor tY 0Unpslo eRml ngs E f0_d) U"t A *to UMte pefd for t"S W-th A AN Iy O my �' Enfrr •nd adJun4 mo Cart r or Acvvny uny rentare tram €toot. 2 - coi �) 1 Cal 5 ao crret 5-got EM' COSs OdOi monid[s :rw loth for (aof,0 AC TfVTY=Gnat GSR01rs ifiame%n 6I (CAI,l of FJrirgre� Y4a16-aoF d) ratr ipinE BAOn COttvi I. t'�i'ts@hf t;OfT GOl6 h n1eR Aa'RMGiRr-IF(SSS�T-- *neeeeloene nt Xx:«X' s000 3000 Ki:?SX:< 5400 OP0000 C oat Mansytmt t xX XX XXX 3660 5000 XXXXXXX 90.60 000000 0 na:a SuEpurrt,n ®r�eoof nX.XY, XXX 5300 $000 XhXX.Y KX a000 0.00000 payCare .XXXXXX X $0.00 $000 XXXXXXX $000 0.00000 �a�et; �y*• :tiX XI"K;K $00R SO W ::.X kx X,< 50.00 O WII00 m ayamt � 01 sllo XXXXXXX $000 $0.00 XXXXXXX so CIO 000000 mreoemt ,O?x XR 0000 $0 OQ XXXXXXX $000 00Lt000 mtan-tnttoo-mahvnua[ XXXXXXX $0.00 $000 i(XXXXX X $000 0.LX000 1^irtnanuoa XX"IX7�:X 5000 000 XTX V,�X 'SO 0C 000000 nl max l'AaMGrre XXXXXXX Scoo $000 XXXXxx� $0.00 0.00000 [=+tRaaama t✓a�oranance XXXXX$A soQQ 5000 <.n1AX".E $000 000000 a m0auent•motw9ual XXXXXXX $000 $000 XXXXXXX $0.00 0.W000 'U:pxtanc-:3rossp X X , X , X $000 $0 G0 Y:XXX'KX,X SO 00 000000 Gutrotcn XXXXXXX $0.00 $000 XXXXXXX S0.00 0.00000 w aamvot�al tea:-¢z� XI ::iX �SQ.00 SD OQ ;t Y'.iXx,x:v� 50.00 O1?0000 R Qaaennal t�evel -e nnanceu Race XXXXXXX $000 $0.00 XXXXXXX $000 000060 n ax3aanual r.a�sl 9 XX X,XA YX SO 00 $0 00 .XXX XXX t>0 00 6 C10000 Raexreoersi �a�rl Nt XXXXXXX $000 50.00 XXXXXXX SO Q0 000000 R .ansannal X X X X XX.l so 00 $O On XXX xxXX $0(W 000000 11 aepze 3ar.w`Re XXXXXXX $000 5000 XXXXXXX 30.00 0.00000 �ssccantaeml:w,+rer; .'c XXX xi; 5000 50W .:i'ti Xxxx 5000 000000 $oPPNrf�t nawl,�ryCNrp XXXXXXX $000 $0.00 XX XXXX>-. 5000 000000 T-mac "<�, $000 $000 �XaXxx T0.00 000000 rttfuan - �rtatwdcrxi XY, XXXXX 30 00 10.00 XXXXXXX $000 000000 .cer�a>a-G�suA ft oom a 9aara :<x NJ-XXX XXXXXXX 50 C)o $000 50 rX $0.00 '.X;(k XXX XXXXXXX 9Ct.00 $000 0-00(PM) 000000 P �nm aeaaru .v'i �cersa�ow .av-u ;';, X,X?Ck SQ QO SO Qq T<XX.XkXX. Sp 04 tr09040 Room A GFaard wSopervs�tsn Lev a XXXXXXX S0.00 $0 co RX.KXXXX 50.00 0.00000 a acavl,r-r s:.t><en-m0;_u4A� YXX1"XXx $0.00 $000 X%7(XXXX $000 6.00000 P+It-'r}9vyyan-�q >:+:L:(;t7:X $O OQ 5000 XXX, 'XXAX S000 000000 IR fO({rL ailOR h fS Trsst++sM 3. An��af's TpNt � $Q.00 $0�R0 $H9 OAQ f0.00 gtoxtilOsiMn - "03003 9ucatance �.coas CtNx XXXXXXX 3000 $0.00 XXXXXXX $000 Q.00000 oveFarkneDataWn�ytbn ­xxx ,S"�; X $0.00 0.W000 a adoxUlcatron Tang � � £� per_ � q� Yf� ¢� SO.O4! �.00 9p..M.0 No.�-�YTD Tat.f YTO SARtH NON DlRsrnn<� prUl'RWp Share ArYVunt 0.0 C-1, Csntfr ih of Non-TAIif p AM t -e AAMi N G a Co Zmueo; TAMP fUnOtng L evol for fie EllgVw. NOT TANF f e$meo 7A F p.lo tar (YTa Unpalo a ArM nga a amr g.) (0-0) UM Rate VMicpMll Dor tray wrtth ronv tty O my ad)est dtr Cost For Muff lty only GentseA from C ot.S - n,at n Gogsl 11111y 10l1 OCR T 'M (COI. t Of L. !SUndli E f frN tgYf! NN nt vP ttiw & Or !fV 1 2x 3b a 5 9 T e 'i Prix "On- 03004 _.._....,._.r�,..e.e.�.._.�_.._._m..,�,.�.�,. ._._.. ....��._...._....��m........��- ,_.._�...�.-e_._.�....�_ p �evtnWn XXXXXXX $000 $000 XXXXXXX $0.00 000000 m +cnn anon e. xaarrral XXXXXXX so.00 5U 00 X:<XXXXX U 00 000000 Prs tw r.4wr $0.00 $0.00 $0.00 $0-00 30.Oo ACT T _ - xx><xxx �Facc Team XXtiXX:�XX 90.00 $000 ..a XXXXXx 1000 Q00000 f ACT Tofae� f6,00 $%l.tw 36f:Q 30A0 i8.00 naidental eapsn»n tin GbNMai Expeneae 5006 000000 Irtotoer0.st E xpenwt TOLN - I OTAL. $0.00 $0.00 WOO $0.00 So,00 $0.00 UN... ttat coruaaor requr, as aro dm MBE Apprav�ea pu,rnert �a eareaa of q p,.Wad shone h. Les! Roo wprllent of In tor{w Retcattupn>afnf dAdv sneY m T YTO M161401t YTD MIA -al: YTn Funds YTO /HY sno! 'Fat"ff URi FSr Ff¢v. _ Y6f➢- crge ZT0[me uie S6.OA TO.QO so 00 SO.00 PMT�-IUN OtNG QMTRMUT{ON a mrent .aavan ae .^, +r11z�n0*rCe�F .>arr ELs�t o;ca !h�lttrosr �._-__ __,.:':a0e a -.♦ srs f! xlsetargil 000 SO 00 TQTAL AMQUIlT Af I. TOTAL At VIUfIT OFtrtE PAYMENT 50.00 PART3- CERTWICATIOf1A APPROVAL �� -� m. t cartYv iha abav�s M t+s scclaats and Fn aortar+lert w4fh SSrs aoenc is rtcorxks andwtth ttn term of tNs apancva COMraCi ia`tit ftse ME. A'sdm,nazy t oemfy,"t as Ck dvmugapMc an ssrria eve d- nau been auEzn, "O zo he WE to a«wf0a vain ttre cvrmarz. 54aNAm,ro matt For ME Contract Mnitseter t only. N QaAeiti .a Rw-*d: bateGo WSaavfoee Received; Date I l petted and Apf r od, Guidance Care Center, Inc. 90 Contract No. ME225-3-27 07/01/2012 Exhibit E 'a. AGENCY NAME CLIENT NON-SPECIFIC PERFORMANCE CONTRACT �b. WORKSHEET FOR REQUEST FOR PAYMENT I For cost centers as for on the CONTRACT No Children's Substance Abuse of utilization, Columns 0 & J c. FROM TO: MUST NOT BE > than. and Column d PROGRAM E MUST NOT be < than, the # of FEDERAL ID #: g. VENDOR 10 (If different than Fed ID): units reported to the MHSA Data h, ADDRESS (Number, City, State, Zp): Warehouse L-,--. - -- Non-TANF- Units & Earnings TANF -Units & Earnin s YTD Total YTD Local Units to Match Units YTD Total Enrolled YTD Billable to Enrolled YTD Total Non-TANF YTD Total YTD Total Clients & Medicaid Clients & Units Units YTD Total Non TANF Units TANF$ Non -Client- Units to Non -Client- Eligible to Eligible to TANF $ Eligible to Arnountfor Contracted Specific Enrolled Specific be Billed to be Billed to Amount for be Billed to Eligible ACTIVITY Rate Units clients Units SAMH SAMH Eligible Units SAMH Units Cost Center D-(E+F) (CxH) (Cxi) 8 C D E F G H I I J K Assessment $0.00 0.00000 0.00000 0.00000 H0000, HOW $0,00 H0000 $0 0 iCase i Management Koo 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 .Crisis Supportitmergency Koo H0000 0.00000 H0000 0,00000, n0000 $0.00 0.00000 $0.00 Day Care $Ho H0000 0.00000 0,00000 0.00000 0.00000 Wool 0,00000 $0.00 Day/Night $0,00 0.00000 H0000 0.00000 0.00000 0.00000 $0.00 0,00000 $0.00 In -Horne & On Site $0.00 0.00000 0.00000 H0000 0.00000 0.00000 $0.00 0.00000 $0.00 'Intensive Case Management $0.00 0+00000 H0000 H0000 000000, 0.00000 $Ho 0.00000 $0.00 Intervention - Individual $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 H0000 $0.00 Intervention - Group Koo 0.00000 0.00000 0,00000 0.00000 0.00000 $0,00 0,00000 $0.00 Medical Services (No TANF) $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 Methadone Maintenance (No TANF) $0.00 0.00000 0.00000 0.00000 0.00000 , n0000 $0.00 Outpatient - Individual $0,00 0.00000 HOW() 0.00000 H0000, 0.00000 $o-oo� n0000 $o-Go Outpatient - Group $0+00 H0000 0.00000 0.00000 0.00000, n0000 Koo 0.00000 $0,00 reac $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 Residential Level 1 $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 Koo 000000 Koo �Outreach Residential Level I - Enhanced Rates $0.00 0,00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 ,Residential Level 11 $0.00 0.00000 0,00000 H0000 0.00000 0.00000 $0.00 0.00000 $0,00 lResidential Level 11 $0.00 0.00000 0.00000 0.00000 0.00000 ' 0.00000 $0.00 0.00000 $Ho Residential Level N $0.00 0.00000 0.00000 0.00000 0.00000, n0000 $0.00 00000 $0,00 Respite Services $0.00 0.00000 0.00000 HOW 0.00000 0.00000 $0.00 0.00000 $0.00 Supported Employment $0.00 0.00000 0,00000 0.00000 0-00000, 0.00000 $0,00 000000 $0.00 Supportive Housing/Living $0.00 H0000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 Woo TASC $0.00 0.00000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 Aftercare - Individual $0.00 0.00000 H0000 0,00000 0.00000 ' 0.00000 $0,00 0,00000 $0.00 'Aftercare- Group $0.00 0.00000 0.00000 0.00000 00000, 0.00000 $0.00 0.00000 $0,00 Room & Board w/Supef* ion Lev 1 $0.00 0.00000 0.00000 0.00000 0,00000 0.00000 $0.00 0.00000 $0.00 Room & Board w/Supervision Lev 11 $0.00 0.00000 0.00000 0.00000 0.00000 0,00000 $0.00 0r00000 Koo Room & Board w/Supervision Lev It $0.00 H0000 0.00000 0.00000 0.00000 0.00000 $0.00 0.00000 $0.00 Recovery Support - Individual $0.00 H0000 H0000 H000c 0.00000 0.00000 $0.00 0,00000 $0.00 Recovery Support - Group $0.00 0.00000 0.00000 0.0000 0.00000 0.00000 Koo 0.00000 $0.00 Information & Referral (No TANF) $0.00 0.00000 0,00000 0,000010 0Z000 0.00000 $0.00 Detoxification - 602001 !Substance Abuse Detox (No TANF) $0.00 0,00000 0,00000 0.00000 H0000 0.00000 $0,00 (Outpatient Outpatient Detoxification (No TANF) $0.00 0.00000 0,00000 00000 0,00000 0,00000 $0,00 Prevention - 602002 Prevention $0.00 0.00000 0.00000 0.00000 oZ000 0.00000 $0.00 0.00000 $0.00 PreventionAntervention - Day $0.00 0,00000 0,00000 0.00000 0.00000 0.00000 Woo 0.00000 Woo Information & Referral (No TANF) $0.00 0.00000 0,00000 0.00000 0.00000 0.00000 Koo Incidental Expenses - incidental Expenses $0,00 0X000 0.00000 0,00000 0,00000, 0.00000 Wool 0,00000 $0.00, Guidance Care Center, Inc. 91 Contract No. ME225-3-27 Exhibit F Minimum Service Requirements The provider and its subcontractors shall be knowledgeable of and fully comply with all applicable state and federal laws, rules and regulations, as amended from time to time, that affect the subject areas of the contract. Authorities include but are not limited to the following: 1. PROGRAMMATIC AUTHORITY (FEDERAL) A. Mental Health 42 U.S.C. 300x to 300x-9 (Block Grant for community Mental Health Services) http,//www4.law,cornelI.edu/uscode/42/ch6AschXVIIoB.htmI B. Substance Abuse Prevention and Treatment Block Grant (SAPTBG) 42 U.S.C. 290kk, et seq.(Limitation on use of funds for certain purposes) htt e42/usc sec 42 0000029 0-- kk000-,html 42 U.S.C. 300x-21 to 300x-35 and 300x-51 to 300x-66(SA Treatment& Prevention Block Grants) http://www4,law.cornell , edu/uscode/html/uscode42/usc sup 01 42 10 6 A 20 XVII 30 Q 40 ii.html 42 CFR, Part 54 (Charitable choice) http://www.access.gpo.gov/nara/cfr/waisidx 03/42cfr54 03,html 45 CFR 96.120 — 137 (SA Treatment & Prevention Block Grants) /45cfr96 03.html Restrictions on expenditures of SAPTBG 45 CFR 96.135 htto'Hwww,access.aDo.gov/nara/cfr/waisidx 01/45cfr96 01,html C. Substance Abuse -Confidentiality 42 CFR, Part 2 bllp,,//w�ww,ac�cess,ia•,�ov/g�.arq_4 fr/waisidx 03/42cfr2 03,html D. Health Insurance Portability and Accountability Act (HIPAA) 1 45 CFR 164 /45cfr164 03.ht] Guidance Care Center, Inc. 92 Contract No. ME225-3-27 E. Social Security Income for the Aged, Blind and Disabled 20 CFR 416 htjp�//www. access. qpo . qov/nara/cf r/waisidx 03/20cfr416 03.ht] F. Endorsement and Payment of Checks Drawn on the United States Treasury 31 CFR 240 relating to SSA /31cfr240 03.html G. Temporary Assistance to Needy Families (TANF) Part A, Title IV of the Social Security Act 45 CFR, Part 260 httjL//www. access. q r/waisidx 03/45cfr260 03.ht] Section 414.1585, F.S. e&Search String=&URL=0400-0499/0414/Sections/0414.1585,htmI H. Positive Alternatives to Homelessness (PATH) Public Health Services Act, Title V, Part C, Section 521, as amended 42 U.S.C. 290cc-21 et. seq. htto://www.law.corneI1.edu/uscode/htm1/uscode42/usc sup 01 42 10 6A 20 111 -A 30 C.html Stewart B. McKinney Homeless Assistance Amendments Act of 1990, Public Law 10 1 -645 h tto:Hwww4.law.cornell.edu/usc-c it et externals i` t e= ubL&tar et-101 -645 42 CFR, Part 54 hjVL/�www.acc�.qp ov/na.ra/cfr/waisidx 03/42cfr54 03.ht] --Q2,q - 1. Americans with Disabilities Act of 1990 42 U.S.C. 12101 et seq. http://www,law,cornell.edu/uscode/html/uscode42/usc sec 42 00012101 ---- 000- ,html II. FLORIDA STATUTES All State of Florida Statutes can be found at the following website: I)ttr):Hwww. lea.state.fl.us/statutes/index.cfm?Mode=ViewStatutes Su bm e nu=1 Guidance Care Center, Inc. 93 Contract No. ME225-3-27 mg�� A. Child Welfare and Community Based Care Chapter 39, F.S. Proceedings Relating to Children Chapter 119, F.S. Public Records Chapter 402, F.S. Health and Human Services; Miscellaneous Provisions Chapter 435, F.S. Employment Screening Chapter 490, F.S. Psychological Services Chapter 491, F.S. Clinical, Counseling and Psychotherapy services Chapter 1002, F.S. Student and Parental Rights and Educational Choices Section 402.3057, F.S. Persons not required to be refingerprinted or rescreened Section 414.295, F.S. Temporary Cash Assistance; Public Records Exemptions B. Substance Abuse and Mental Health Services Chapter 381, F.S. Chapter 386, F.S. Chapter 395, F.S. Chapter 394, F.S. Chapter 397, F.S. Chapter 400, F.S. Chapter 435, F.S. Chapter 458, F.S. Chapter 459, F.S. Chapter 464, F.S. Chapter 465, F.S. Chapter 490, F.S. Chapter 491, F.S. Chapter 499, F.S. Chapter 553, F.S. Chapter 893, F.S. Section 409.906(8), F.S. C. Developmental Disabilities Chapter 393, F.S. D. Adult Protective Services Chapter 415, F.S. E. Forensics Chapter, F.S.916, F.S. Chapter 985, F.S. Section 985.19, F.S. Public Health General Provisions Particular Conditions Affecting Public Health Hospital Licensing and Regulation Mental Health Substance Abuse Services Nursing Home and Related Health Care Facilities Employment Screening Medical Practice Osteopathic Medicine Nursing Pharmacy Psychological Services Clinical, Counseling and Psychotherapy Services Drug, Cosmetic and Household Products Building Construction Standards Drug Abuse Prevention and Control Optional Medicaid — Community Mental Health Services Developmental Disabilities Adult Protective Services Mentally Deficient and Mentally III Defendants. Juvenile Justice; Interstate Compact on Juveniles Incompetency in Juvenile Delinquency Cases Guidance Care Center, Inc. 94 Contract No. ME225-3-27 37MYME Section 985.24, F.S. Interstate Compact on Juveniles; Use of detention; prohibitions; F. Florida Assertive Community Treatment (FACT) General Appropriations Act • G. State Administrative Procedures and Services Chapter 120, F.S. Chapter 287, F.S. Chapter 815, F.S. Section 112.061, F.S. Section 112.3185, F.S. Section 215.422, F.S. Section 216.181(16)(b), F.S. Administrative Procedures Act Procurement of Personal Property and Services Computer - Related Crimes Per them and Travel Expenses* Additional Standards for State Agency Employees Payments, Warrants & Invoices; Processing Times Advanced funds invested in interest bearing accounts *Travel Expenses are specified in the DFS Reference Guide for State Expenditures hitto 1/www.m flo rid acfo . com/aadi r/ref ere nce%5 Fg uide/ref e rence- guide.htm A. Child Welfare and Community Based Care All references to F.A.C. may be found at the following website: httr)S://www.flrules.org/default.asp Rule 65C-12, F.A.C. Emergency Shelter Care Rule 65C-13, F.A.C. Substitute Care of Children Rule 65C-14, F.A.C. Group Care Rule 65C-15, F.A.C. Child Placing Agencies B. Substance Abuse and Mental Health Services Rule 65C-12, F.A.C. Emergency Shelter Care Rule 65D-30, F.A.C. Substance Abuse Services Office Rule 65EA F.A.C. Community Mental Health Regulation Rule 65E-5, F.A.C. Mental Health Act Regulation Rule 65E-10, F.A.C. Psychotic and Emotionally Disturbed Children Purchase of Residential Services Rules Rule 65E-12, F.A.C. Public Mental Health, Crisis Stabilization Units, Short Term Residential Treatment Programs Rule 65E-14, F.A.C. Community Substance Abuse and Mental Health Services - Financial Rules Rule 65E-15, F.A.C. Continuity of Care Case Management Rule 65E-20, F.A.C. Forensic Client Services Act Regulation Guidance Care Center, Inc. 95 Contract No. ME225-3-27 C. Financial Penalties Rule 65-29, F.A.C. Penalties on Service Providers Reduction/withholding of funds Rule 65-29.001, F.A.C. Financial Penalties for a Provider's Failure to Comply With a Requirement for Corrective Action IV. MISCELLANEOUS A. Department of Children and Families Operating Procedures CFOP 155-10, Services for Children with Mental Health & Any Co-occurring Substance Abuse Treatment Needs In Out of Home Care Placements us/admin/publications/policies/15-10.pdf CFOP 215-6, Incident Reporting and Client Risk Prevention B. Federal Cost Principles OMB Circular A-21, Cost Principles for Educational Institutions 2004 OMB Circular A-87, Cost Principles for State, Local and Indian Tribal Governments 2004 OMB Circular Al 02, Grants and Cooperative Agreements with State and Local Governments httiD://www,whitehouse.ciov/omb/circulars a102 OMB Circular A-1 22, Cost Principles for Non-profit Organizations 2004 OMB Circular A-1 33, Audits of States, Local Governments and Non -Profit Organizations htt /assets/a133/a133 revised 200 Z.Rdf Section 215.97, F.S., Florida Single Audit Act htt ://www,lea.state,fl,u,s/statutes/index.cfm?App._mode=Disr)lav Statute&Search Strina=&URL=0200-0299/0215/Sections/0215,97.htmI Guidance Care Center, Inc. 96 Contract No. ME225-3-27 Comptrollers Memorandum #03 (1999-2000): Florida Single Audit Act Implementation 03.htm D. Administrative Requirements 45 CFR, Part 74 - Uniform Administration Requirements for Awards and Subawards to Institutions of Higher Education, Hospitals, other Non -Profit Organizations and Other Commercial Organizations /45cfr74 06,htmI 45 CFR, Part 92 - Uniform Administration Requirements (State and Local Governments)\ /45cfr92 06.html OMB Circular Al 10, Uniform Administrative Requirements for Grants and Other Agreements htt ://www.whitehouse.aov/omb/circulars/allO/allO.html E. Data Collection and Reporting Requirements Rule 65E-14.022, F.A.C. �&LwaLejkakk'as' Section 397.321(3)(c), F.S., Data collection & dissemination system htto:flwww. leg.state.fI.us/Statutes/index.cfm?A mode=Display Statute&Searc h Strinci=&URL=0300-0399/0397/Sections/0397.321.htmI Section 394.74(3)(e), F.S., Data Submission htti)://www.le•.5tatE�.fl.Us/Statutes/index.cfm?A ,-moDisplgy.5tatute&Searc h Strina=&URL=0300-0399/0394/Sections/0394.74,htmI Section 394.77, F.S., Uniform management information, accounting, and reporting systems for providers. ute&Searc h Strina=&URL=0300-0399/0394/Sections/0394.77.titmI CFP 155-2, Mental Health and Substance Abuse Data Measurement Handbook htti)://www.dcf.state.f1.us/i)roarams/samh/pubs reports.shlml Guidance Care Center, Inc. 97 Contract No. ME225-3-27 07/01/2012 Exhibit G FXhilit G: STATE FINDING BY PROGRAM & ACrlvrl'Y Fiscal Year 2012.13 (enter, Inc. ((X) " _. ------- _. _........_ Contract Adult Mental Health Children Mental Health Activity t Cost Center TANF$ Unit TANF$ Unfit X = Yes Rate X = Yes Rate 1 2 3----^^�-^^^�� 4 5 6 7 0 2' Emergency Stabilization . L 03. CnsisStabtivatiun (NoTANF) f `not. bed day . „�. $323.77 -- 04. Oisis Support(Entergency `� 17 Unit: siul'fhour c', e-iyr" t $43 17 ;,-: 7, t,+'( $43 ...-.,......_ ....-t ()9. inpatientw tNoTANFI l npa24hr day :overy & Resiliency 01. Assessment Unit: contact hour 02. Case Management Una:dircct staff hour Q5. Day Care Unit: 4hr day 06, Day/Night Unit' a-hr day 07. Drop-In/Self Help Centers (No-TANT) Unit: facility day 08. In -Vane and On S Ite Unit: drect doff hour 10. Intensive Case Management Unit: direct staff hour It. Intervention - Individual Unit: direct staff hour 12. M1tedical Services (No TANF} Unit: contact hour 14. Outpatient - Individual Unit: contact hour 15, Outreach Unit: non -direct staff hour I6. Prevention Unit:non-direct staffhour IT Prevention intervention -Day I;nit:4hr day 18. Residential level I Unit:'_4hrday 19, Residential Leven lI Unit: 24hr day 20. Residential Level III Una. 24hrday 21. Residential Level IV Unit: 24hr day 22. Respite Services Gnin contact hour 3. Sheltered Fmpiryment (NoTANF) Unit: 4hr day 25. Supported Employment Unit direct staff hour 26. SupportiveHousmWl-iving (mitt direct staff hour 29. Aftercare - Individual Unit: direct stuff hour 30. Information and Referral (No TANF) Unit: staffhour 35. Outpatient- Group Unit: contact hour 36. Room and Board w/Supervision Level I Unit:24-hr day 37, Room and Board v,/Supervision Level it Unit: 24hrday 38. Room and Board YdSupervisiotLevel Ili Unit: 24hr day 39, Shon-tetmResidentialTmatn-ent Unit: lied -Day Non-TANF= $1.11111O3 Total FinergencyStabilization= $1,112,903 Uncompensated (hits $222581 r ,_..._,..._..,., ee......... __t " . N �. r , 390.47 _. $265.1 t i t $88; 25 , Non-TANF= $15,677 Total Finergency Stabilization = $15,677 Uncompensaterituits= $3.135 . 40.45 MOM I "$390A7 _1 $91'09..��.. Isom i im "�., .... ......_�i AWAMM }' $631.211 " .. $22.77 .�.. Guidance Care Center, Inc. 98 Contract No. ME225-3-27 07/01/2012 Activity! Coat Center 1 40. `Mental Health Clubhouse Services Unit: Clubhouse staffhour 42. Intervention - Group Unit: contact hour 43. After are - Group Unit: contact hour :overy & Resiliency - FACT Team 34, FACTTeant; (NoTANE) Unit: statthour :overy & Resiliency - CCST 44. CCST-Individual Unit: StaffHour :overy & res II iency - COST - FA.C.E.S. 44. CCST-individual Unit: StaffHour :overt' & Resiliency - Community Forensic 19. Residential Level R Unit: 24-hr day 39, Short-term Residential Treatment Unit: Bed -Day :overy & Resiliency - Incidental Expenses 28. Incidental Expenses: General Unit: each $50 spent 28. Incidental Expenses: CCST - FA C.ES. Unit: each $50 spent 28. Incidental Expenses: Forensic Unit: each $50 ; pent Exhibit G Adult Mend TANF$ Unit X = Yes Rate 2 4 Non-TANF= JS�F.rifi�1 TANF=i Total Recovery & Resiliency = $556A89 Uncompensated Units= $111,378 FACT = Total FACT = $0,00 Uncompensated Units = Non-TANF= 7714�a31 TANF t Total CCST Services = $714,331 Uncompensated Units= $142,866 02018�M ...... ! t i 1 .. Non-TANF= $23,9()0 TANF Total ncidental Expenses = $23,900 Uncompensated Units = $4,780 Total Non-TANF= $2,408,023 Total TAM SO{ Total Mental Health Funds = $26108,023 Children's Mental TANF$ Unit X = Yes Rate } v $1,5.49.._1 $15.80 Non-TANF= $440.000 TANF Total Recovery & Resiliency = $440,000 Uncompensated Units = $88,000 503Lt 1 �tN�� ... _ ..� Non-TANF= TANF=' WjMfff= Total CCSTServices = $0 Uncompensated Units = All-1 Uncompensated Units = Non-TANF= $0 Total Incidental Expenses = $0 Uncompensated Units = SO Total Non-TANF= $455,677 Total TANF= Total Nlental Health Funds = $455,677 Guidance Care Center, Inc. 99 Contract No. ME225-3-27 07/01/2012 Exhibit G Activity/Cost Center I Adult Substance Abuse TANF$ Chit X = Yes Rate 2 3 4 Children's Substance Abuse TANF$ Unit X = Yes Rate 5 6 7 Detoxification 3 II 24. Substance Abuse Detopfication (No TANF) .. Unit:hed-daY $204.94 32. Outpatient Deloxification (No TANF) Unit:4-hrdaY t i Total Non-TANF= 186,643 Total Non-TANF= Total Detoxification = $186,643 Total Detoxification = $0 Uncompensated Units = $37,329 Uncompensated bits =t Prevention 30 9 6022 16. Prevention Unit: non -direct staffhour$43 20 _ IT Prevention/Intervention - Day Un tti hrday 30. Information and Refetnl (No TANF) Unit: staff hour h Total Non-TANF= Total Non-TANF= $172,262 Total Prevention =. $0 Total Prevention =$172,262 Uncompensated Chits = Uncompensated Chits = $34,452 Treatment and Aftercare 601t10 E 'm 3 01. Assessment Unit: contact hour �. __. 79 ' $....47 _ . $79.47 ,__ 02 nt a8Unit:direct Unit: staffhour i ._._1 t �. $60 .45 04. Crisis Support/Emergency Unit: staffhour _ . $4317 05, Day Cam. _ Unit:4-hrday 06. Day/Night } F Unit: 4-brday }} 08. In -Home & On Site Unit: direct staffhour _ t ___.x t $70.11 _._._. I �_._ ___.� $70,11 ,_ _. _.... 10. Intensive Case Management ��i�f Unit direct staffhour)ar���mom I I . Intervention - Individual Unit: direct staffhour F._......_,..,._....r...� ._ _--.., _.ew ...,_.._ $6195 � 12. Medical Services (No TANF) Unit contact hour i., , ,•i „ $39047 �`'' �{ $3904' 13. Methadone Maintenance (No TANF) Unit: dosage 14. Outpatient - Individual Uuit: contact hour $9. 1.09 .' $91.09 15. Outreach Unit: non -direct staffhour E $43.20 i $43.20 _ 18. Residentiallevell Unit: 24-hrday 19. Residential Level Un it: 24-hr day M Residential Level Ill Unit: 24-hr day v._ ..M ...._., .. 21. Residential Levelly Ut it:24-hr day ' 22, Respite Services Unit: contact hour _i 25, Supported ErTloyment Unit: direct staffhour 26. Supportive Housinglliving Unit: direct staff hour 27. TASC Unit: direct staffhour $59.22 $59.22_ i 29. Aftercare Unit: direct staffhour 63.21 Guidance Care Center, Inc. 100 Contract No. ME225-3-27 07/01/2012 Activity / Cost Center 1 35. Outpatient - Group Unit: Contact Hour 36. Roomand Board w/Supervision Level I Unit: 24-hr day 37. Roomand Board w/Supervision Level II Unit: 24-hr day 38. Roomand Board w/Supervision Level III Unit: 24-hr day 42. Intervention - Group Unit: Contact hour 43. Aftercare - Group Unit: contact hour 46. Recovery Support - Individual Unit: direct staff hour 47. Recovery Support - Group Unit: contact hour 48. Clinical Supervision for Evidence -Based Practices Unit: contact hour ,atment & After - CCST 44. CCST-Individual Unit: Staff Hour Incidental &penes 28. Incidental EVenses (init: each $50spent Exhibit G Adult Substance Abuse TANF$ Unit X = Yes Rate 2 3 Children's Substance Abuse TANF$ Unit X = Yes Rate 4 5 6 7 Total Non-TANF = $345,979 Total Non-TANF = $309,139 Total TANF=j $0 Total TANF Total Treatment & Aftercare = $345,979 Total Treatment & Aftercare = $309,139 UncompensatedUnits = $69,1% Uncompensated Units = $61,828 w. -_ M.._ Non-TANF = TANF Total CCST Services = $0 UncompensatedUnits = $0 f $50.00 Total Non-TANF = $44,154 f_._. .___ _.. Total TANF Total Incidental bq)enses = $44,154 Total Non-TANF = $576,776 Total TANF __. Total Substance Abuse Funds =� $576,776 Non-TANF = Total Non-TANF= $0 Total TANF = f $0 Total Incidental Expenses = $0 Total Non-TANF = $48 1,401 Total TANF=i�� _ Total Substance Abuse Funds = $481,401 Guidance Care Center, Inc. 101 Contract No. ME225-3-27 Exhibit H I ly 20122 '201 1 VNI1114 rf t]: FUNDING DEFAll, ­'NA­fo'­ ( . .......... - - -------- --------#�f' ME1253 27 R­ . ..... *f: MVIVVAL 13­lget Entity 60910506 - A(k.lt'. NU-.td 14-Ath OCA AN40UN'F lltidgc-t Entity 609105416 - Childr­'S N4enttd MWth 0k,A AA,K)UN'l' 502004-F]MVJRGJ1TS( A, Sr UARIVIZATION 503001 STAH11,1ZATION (WA-AlWAA'CONINt MUNI'Al, fillAVI'll (100610) (;/A-(-'l NHWFAI, 1111AIA41 (100435) ADA NSl11,­1 1, i t U (0270)5)* ADA Ml I T,­1 Fund UF (02:7(X)-'5)' C€ I z R"­­_ (000326)'" I '$ 108,264 __1 R.,­­ (0(0326)* t F:"S I s 15,677 FSTF (l22()23)- AI F.UFF Titl. XXT (261015) ;,9Q')l R ... 000i26)' I'M f l'N Cl-al R­­­ ((XX)326)' wl <WA-RAKU1R A('l'S[7IVl(,TN (10061 1) HAKPU AUT (104217) d R"­­", tx)()326) AI:'>S I 'S I JXA 634 G--al R­­­ ((XX)32(W 'I STF (122023)- j A 1 lz�903 15,677 Un ... min lsate,d Untts $ 222-581 Unit, 3,115 502018-RUX'OVERV& I".NHAENCY _I 5#E4()l Rj.Slljj.N(1y WA -Al> TA CONINJ, MENTAl , I (100610) (WA-C1111A RVIN'S N1lWl'Al,lWAl,'l'll (1004J5) ADANTIJ l'-,t Fund FFi027(X)5) ^iP'WI I 7 ADAMH F-, 1 -1 ((l27(X)5)- s 153,7,52, O&AITF (0:17")7) A RR�' '� 1, R Xil 6)- I 28K _'48 R""­" ((003,26) A URI s 1,038,348 G1 Re," I'l, - A( Rt, k c, I ED (000326) 1 'A F' I I I G R/ A OA PE Fa,ar Nli­­} ((X)0126)' FCJ I F N4 I A N41 DA DF, W, ap Around I Px,, YR- 1 (261015) Z\RVIV I (,R/ .......... F­­­ TA-1, A,1,0, S­ ((XX)326) o' ;i ) s 160,(XX) f�"J­ka C3t1-1 F"­ Fund(261015) t R 111S ADAT,111 T-,­l I `,­d FACT Ad -in (027(X)5) G�.­­l R-m- ((XX)326) "I''NIA G­­­f R­­­ FA(I'Ad-in ((X))326) I 1A CR-JVR..stol h ...... ITo P-((XX)326)"` Q 'm I FOFF FNKjPTTA TVI­U­id Ad -in (261015) FTJ*TF - I'a 1. XXT (261015) 10c" I ICT1,F FOCKUD 1261015) 1 (WA-PURCIIASU33 R11SIDUIVIIAL ,',Uf F<XXXIF ...... (261(115) 'X).827 VWES, (102790) >&NITU (02-7005) (WMCAID & No� MCAIL) MOE (000326)- "1 "N'� I --al l"v- .... � (0003 16) '�Nll 1A,' GiR/TN­h R., T­­­­ M-Awaid S­ ((XX)326 1111K I S W'V_l F I A�'T��'('4010)1) ("',­ ,d 11- (O(X) i �6) Tob..... S,1 I 1u .... �­ F,­d (122023) V_J_j 4,,­ T,,­ Fuu1 261015) MIS i GIA-IN1111GENTI'S Y( A I MUDS PROGRAM (1411354)) ((X)'032(')' A PJRS I s 5,945 N,,.l-TANF $ 1,295,120 1',­,JN­, FANF 44(),(X X) R'­_'y & R,,,i ,,_y'F1't.l=_i 14-o-y & R­M'­yT"t.l 440-1100 ll Lh'il' $ 259,024 t'h­ ....glWns utud U-1, $ l'O'l'Al,AllUl,T'S Ml,1N'l'AL All,AE'Ftl=_j. 2,408,02.4 'I'O'EAL C1111,I)RUTWS NIUNI'Al, 11EALT11 SUBS'FANCE All USE Budget 1416ty 60910604 - Adult's SWtan. Al-e OCA ANIOUNT H-k-t 11.0ty 60910604 - t'hil,h-W., Sul.tari­ At- OCA ANIOUNT 602001 -lWF0XlFllCA'Flf)N/ARl1 (WA-k'OMN (100618) SUHS7'ANC11, Alit NESVCS (100420) ADAMH Tevnt F-IJ VU(02700S)"I m 84, 3,"'i9z ADAMH X"", R-n", ((XX)326)11 I, t x. 'q $' 102,284 7 Cx.tlelal Revenue. (000326)' I'STF ( 122023)-, S 11"l-in-61-Towl 186,643 Un­).q_­­t­lUnits $ 37, 129 Unit" 60300f, -l'lWVl,7Vl'K)N S FRVR_TN 602002-PREV PN130N SPUVICIN (WA-COMM SUBSTANCE ABUSESVCS (100618) SUBSTANCEABINESWN (100420) ((XM)126)" Pg^:4"I 1; i AT AMF1 T,,,,l F,­dTF (027(X)5)1"s ALIAMIJ l'u-1 F,­d 1 F'(027005)"' PRVAS G--al R­­­ ((X)0326)­ C.­­l R-n- (0(X)326)-11 'Pj< S-i-, Total = S 1-r-nfl- se -ices 'Vot'd 1-72,262 llnco y­­­d IT"il. k �tvdUnit, 14,452 603007-TREAUNTUNT& AFFERCARE 602003-THEATNRNT.S. A11Flnf,'ARE HSTAN S -( O (WANINT UCE All I NESV(N (100420) A I )A N111 j_"_ Y__l FF(027(X)5)11' R I'A S S 1211938 ADAM, r,__l Fm,d I'F(02-7005)" tier at Rw�e.rruc )(326)- 1 S' 64,595 Ck� ­­1 R­­­ ((X)0_l26)11 U, $ ' 109,139 0&' m P T 'I's, I't '(l 22023)­ ADA1011 1� 11V $ 3,6(Xi i O&,MTF (51f-A)15)" I A I,)AMFI Tae.t Fun d Y/7005)... :i`\v( %N) A DA Mf I T­,, 1--ITF (02-,(X)5)' 2 tClf% W T-1 ETA NF (401 ")1 f-A 44)1(X)I) WTI G--al R.-n- ((XX)326)" (iR 1-bg"', D"'g, 11.. MOE (000326). t'P , Al' A DA M I I T-, I Fund TE (027(X)5)... f,'(;T F FL A-, R­ (261015) 1 IA I R6 SSBG'rF 1639(XY2) i ("t 'FF M-i ­110 Ad,, W 0 I:S) "CIA (114 C' , Ff " S-1111 F-al P­ (261015) "PiAs ADAN411 V­,f 1�­,d l_F(027(X)5)­1 'Point N.... I'ANF 390- 133 T'­') Non TANF S 4�1' 1 0) Tr-t-t & Aft ---Total = Fre.t--t & After-we'l,"tal 309,139 ,,_ -w--l-I Un61, s 78,027 U-1, 6 1,8 7Is VOTALAI)IIIA"S S(JBSTANk'EABtNE= $ 576,776 TOTAX.C1111,I)RUN'S SUVISTANCE Alit Nil- 481,401 ")TAU ALL Plit)(;HANIS 3,921,877 'l'()'l'Aj' Al't, I JNC0Nll'U7-4SA'lTJ) t 1NV1 S 7 FUNDS NOT RIXA IRINC-iMA T('11: (;RAN DTOTA L OFI-ROCRANIN is UNCONIPENT SA1,J) UNUFS 4.706,252 L�­g Al-- S-­i ... $ 534,050 FOTAL FUNDS REQ1 BRING M A VC] I $ 2,8M,857 .. p alilk ."'J'et 2 1 (m X)( 1,0CALMATCH 'U-,QUIREF>= $ I 9J3,952 Ft,,am S 375,970 ADDITIONAL LOCAL.MA T'('l I NIVI Ill"'k (; r()rA[,,FUNDS NOTREC-)UIRING, MATCH 1,120,020 (iRAND TCyCA7. LOCAL MATCH 9331952 ­0 1­,I BI-k ill SUR11 Guidance Care Center, Inc. 102 Contract No. ME225-3-27 07/01/2012 Exhibit H L(X'AL Ni A R'll PIA':' C k,,-t N i- 'NIE2253-27 I),,,, 1/112012 CAkSA" TT:'�'� 1 WS NA 0'"0 CSA Total S 91 A43.1K1 T..) M-h Tol A NUI,h % v. T,,,,,l Mulch k Cove Madry(ement T,� I Nl,�,,h T,,(,t MulchS,3()()I)o u. T-,l Match Ruic Y h, R,,,c $ h. R- h, If- 1, N-h-d R-h,-d U-, R-h-d C,6k Stwll-d- I (A'L, SfaH1i>Wluo 3, Ca,6 S.HII.,fi- 3, CH,6 St'""""' T,,,A Minch r5 n. T,,,,.l NI-h Mulch 1, R,f, If Rule 1, N,h-,d , Unl1, D-h-d 7, c. U-, P-h,-d nla c. Uw, P..),a-d (',Mu S,pp,Vhmrg-y I C,W, S.ppwt/FkmrR,,wy 4 C,Wk S.ppvb-g-Y 4. COIL, S pp"),�-,-y T,I,A M,,,h (A) , T(,,,) M-h 's T-I %i,,I,h -NI -h I, - Rlj,,iI, h, If- I, R- Unna P-h-,,J , , U-, P-h-d Je c. lhlns P-h-,d Ik" ( - 1, MY C- 5, 1 �) C- �S, D.Y C- T,,: -,t %t.a, 1, T,,I.11 NI-11 15 T,-] MulchTotal kLa,h b, R,t, N,h-,j PoM-d i. ''-,' 6. DyNight 6, INy-Night 6 Dy-Night Tl T,,d M-1 T, �i \C,,,h " s h. Rule. p""l,-d ljnl, Purchased P-h-d 0, thu,,a P-,h,-d 1. pWs� "WPU.- -mg,c-t- I. 7 D�Wsdf�wljpc-- 7 lf�­ WS'Of4klp C-- F": at M"', f', I " I 'I'S S r,,1A Mulch T,,:�l M-1 R," f. s R, I N-h-,d , , Nu �/,, U-, Fl-h-d S. I- 1.w()n-Sf. S111i" 9 k"%- -d0n,SI. X. E.-Ii- -,!OHi* S-i- -10-SI4 S-k- ed T,,wl KI,-h t v. Total M,ldf RateRa- pl-l-d U,- P-h-,d U., P-h'-d ivn a Unit. P-h,-d IJe InpWent 9 kpol"t 9. I.P.0-t 9 fnp-d-i T,,:,0 rs 0,,c Urns Pl-h-,d ��h, Unitst, P-h,-1 fhv UfUnitsR-b�-d --------- 17 10, 1. -ile Cerro Aw m-t 10, - C- Nh-mt 1. -17 Cm, Nk-w-t 10, IW-iw CaveNl-g-t F,,tvi Mx 1, (,A TM,fh T(71 I M-h V., To,,d Nl,,k,h R a, b. R- -S h R,- S h. Rx. n/, e. lln ua P-h,-d d. " Units R-4-d It W.-d- 11. Lnter,entlon I I kit-wntim a. , T,:.�IW-h - "_Total M-1, R:, b. %", P-h,,-i U� P_h ... d U,fil, P-h-d iJu Uulfs Pothered 12. aklf 12 Nklt S-4- 12. NJ,4eW Services 12 WII S-i- a. T-d M-1, S n. T(,, ol Nl,,,h Nlal,h R- f S b R',, i s 30732 a. llnity P-A,-d W, U,,f, FN,,b,,,d Na - a U,Puirhwd 13 13 Nkthadafe NVttawlne Ntwa - 'N1.4 M,l,h ToA M-1, s I, Rawb� Ruf, $ 6. If- S P-l""'d , Units N,,h-d nf,h-d O.tpfl-t - lk.110dw 14 O.tpd-t - IdAfk.J 14 Ou4,fftW,t - kft I Owp-b- " 'idw o. Tidal N1,10, i.T111A N11111A f(MMAX) u. Tulin M!"I'l, R, fc I R- I S b. R,- h, R- Ih,f, P-h-d Nei a Is Ix P-h,-d lj,,lf, P-h-,d iN 31 . U,d,, P-h-,d 15. (W-h 15 0--h 0 0--h TIT,,lf hJ­h T,,1A M,,f,lf 1,147,04 1--d- 16, 1R-.life 16, Pre, .d N1,1,h To of Sleld, s u. Tot I kl-h s r",'I NUl't, s IN, t 0 00 h. gale S h R,l,, S h, R- R,,f. P-O""'d c. Units N,h,-d c, I ln,I, pl-h-,d U,If, Pl-h-,,d 1998 17, P--ti-tow-fim Do, Wy 17 I-rtwntkdhw-d- - My 17 Prtwnfl,,Wln(,-tlm Dy u. T-0 NI.-h S a. T,-I NI,f,h F-d MI,h 5 a. r,-i m,.,h h. R,t, s h R- s h, R,- h R- L;,,,, Rlrehnrd o/,, , u-, P-h-I -S Ullifl P-h,-d 18 Rl`kk.I`iw I -I I Is, Wkt.fiw I -I I IS Reid,.1141 I -I I W' Id-dW [.,I I r, .,iNL-L 7111A Mlldl Total Match a. Total NLIlLh s h, 161, h, R- S ml, P-1,-,d Un,f, P-h-d 1. Ulf- pl-h,-d 19 K-id-dW I.,[ If 19 R-id-thd I -I B 19 if nid-flW 1-111 19, R-i&&W 1-1 H M,f,h I R, S b. R.ac S b R- 1, Ihou P-Ltl-d 1, 1 Pl-h-d 20 R,,'id-thil I -I M 2" R-id-fij I.," IU 20, R-id,.IIW I -I III - [I M kl,-h a. T,,A rtuich s T,,1AM-1, S e. T"I'd ll,,I,h h. Ralc S h, Rune - - - - - - - - - - - U, c U i1, Ruch used , U Porch used Guidance Care Center, Inc. 103 Contract No. ME225-3-27 07/01/2012 Exhibit H 21. RevldentiW 1-j R 21 Revid-dW 1-1 IV 21, Resldentlt i-I tV 21. Reskk dw 1-i IV T lal Mo:ch r5 - T IIMacch r5. - .'r T :IM l h �S - b. H-la r. i.r rtx P-h,-i c/n v. U ,i,, Rlrcha.ud n!u �, Unuv Pua h:wal t!d c. Uh,,l, P-h-d uta '1 Revptte SerHe<9 ? Revpik Ser4cev Re pte S-Alcev 22. Reslite Serdcev v. Tntvl Match -S . Tolnl Match fx - _T ldhfulch rS a_Totai MatchC _ h. Hvtc S h. R.tti s b. R r- 4 h. Rol, = S . Unn. PlrchaYcA c! c. lluits Porchaeul n/u . Ow, Rltch;-d Wn c •. Urlts P-h,,,W n/a I 21_,Shdf-d tko,; vneal - i, Shel4red FSolio -t i.T hd' -d Fk pk y-M 23,T hel M 45uplmrotM a Tolvl Match r S - Tutnl \latch ,. _ r5 . _ ... , * S _... .... _- h' f -.. ... S .. , h. Rnte S b. Rate S - b. Rutc S h. Rxe - c. l.o ns Rnchv.ad c/a c. Unit.. N'hoscd :Va c. Un[lc Purchased n/u c_ Uaity pl-haecd -� hl I 2A_SaMtance Aluve lRtodflcatlrn .. 24. Sutwnnce Aluve lklndftcadm 24.SuMtmce Ahav<IRtodHeetlm 24. SuNfetwv. Ahree lktatlBcatbn a Total ht:Uch -c .Totxihfaich S - aTotal htacch _ S If $OOW a. Total Match r5 _ Rutc S h. Rate S - b Ralc s- .• • a9 b. Rafe S '. Uuis Ptrc h.u�.d c/u c. Unn.. R:rchnsa] T P-h-,l -Wii.44 c. Uniln Nu hasod n1u Supinrted F'nyid)ment _ ..... 25, Snpprkd Fmlirwmenl 25. Supprted FirrlimmeM 25, S,pprkd t1 ,,i Tnent a_Totul Mitch S u. Tornl Mbrch S - TotalAFicir r-...__ _, ._. 5 _..... a, T,,aXh(vtch r ...._._..._- S _ R,rlc - ti - h. Raly S b. Role S b. Rate $ . thins Pun�h,,,d r,/u C. L`ntis Puch-d n/v c, Uuus Pumh-d n/a c. Udits Ptrchaeal :f/a 3A S.PjwtdWadny/ljA.g 'f<uvl � ^6. 5upp.Mdli-inq/Ildnq 6,Su Ikntvi l4A IA+rR'rl ryI/ nR 26. Soo dFhnn`Inq/11Ainq a, Mulch �5 - a Torol Minch S -. Total Match rS .. _ - a. TotAMYfwch r .. .... ..... $ .. b_ Kvtc = ff - h. R- i S - h. R.ac ., S b_ ft.:tc S R-h-d n/u c, Unrcs P,-hu..vd n/a c. Unite Purchoscxl n/o c. Untie l)-h.-d t2(a 27. I'A,SI Tui.il rS ... 27. "FASC rS 27. TASC _ ..- '_7, TASC . Mritch - 1. Toivl Mnich - v Tolai hfnich 1S.. a, Tidal Match rS .._ :. Nvto s S b. R.ftc 5 b. Rule S - h_ Pi- , S c- Uunn Plrv-h,ued nh: c. llnns Pl ch,-d tJu c. Uuif,v Pln;h'-'d Ua c. Unlfc R-haecd n/u 2n_ bddetal F-14- 2R, NdhntW F:gemes 28, W&Md F7tpenses 29 I-W-W Fxpemes a_ Total Match � S - u. Totvi Match i S - a. Torul Match S d. Total Match � $ b. Ro:e ` S h_ P,ue S - h. Ruic S - h. Ru c $ . mils Rtrchv..ut n/- . t,nan Rtrvhv.sad nh U-' Purchased n/u c. U its Pin hosW u!a >9. Aftercare _....... 29. Aft-- 19, Aftercare 29_ Aft- :. Total Malch 5 - a. Total hfatch i S u. Torul Math S $ . Rate S h. Ruts S b. R'!u [ S b. Poac S Unit, PtrcF-d n/ Gnus Puch-d n/a U ifs Purchased A c. Ihrtta R:rcha.oel n/a lO. Infmrnntlm and Rekrral 31).filfi- dim and RekrrM 7f1 hdroetlm and Rekmul .70,lnftr wand ReferrN v. TotvlMmuh . 5 u_ Total Minch S- - ._ Tnal Mulch _ . 5 n. Total Match $ h. Rafe 5 . Units Renha ul u/a c. l;nit.v P:rclnuwl n/a Una.s Rachosed Na c. U "is Purchased o/u It R--d 11. Revered 31. R-" 3l. Rener.ed 32. Outpaknt Ikmdtil'atlm Q, Oldputlenl l)etodficMim 32. Outpntlent lleludfkatim 32 Oagetlent UekMflcadm „lal March S -,T nl Match S.. Tolul Mnich t ff _ --u. Total Match f S b R<r c S c_ (ntrts Pulrhusul n/ Um" Puch-d n/u c. Utl, Parch,-i n/a e. t, it.s pure h-1 n[a 13. Revered 13_ It --d 33. Res -d 13. Reserved 34. FAC1 1'- ... _ . 34 FA( --FT- 34 FACTTeam 34. FA(TTenm Tot ulMn[ch S - u. Total Match S - a. Tot-vi Mulch . S _ - v. Tt.tul Match i$ - h Ratc S h. Ru1c lv:il. Purrh:u.cd n! . Uniry Rltthucui n/o U its Psch-d n!a c. U11111 Pl-h-d nla �35 Outpdknt-tkmp 'a, .. 35. Outp fi-l-G mp - 35,O Wd-t-(imp 35. OWpuWM-(rmp Tc,lal h(ttch C A Total Ivfa;ch i , T tal M:dch 5 YI,(WOO a. To u) hf.nch g m. Rule $ b Rdc $ b. Rue �. Units PircliuxW n!- Urns Ruch.i.d n/u U i"Pl-hu.sal I ii7 iH c, U:nv Nu h,.cd Ani1hJ perdviq 'ftRi IrAell R-&Rurdtth SuperNn lib 1-11 .,, tb P &Baud With SuprM hn 1z 11 36 P-&Rfwd�hth Supertitik.1 ell ta,:I M&H - T - .'C -IA7roch t - n-Total Mulch S _. .....__... _ h. Stvtc R.te S b_ Stntc [Lau S - h. Sl-[ ft t- Sl ote Ratc S e. ittwn or Unns Pun hasad n!v ,:. Hoare or Unus Rrrltawd n/a Helre or Util.s Ptrchased ✓a c. fh,nro orU is Prehauvl n/a 1. Raw>tn&Hurdwith Superdvimlztel❑ 37 Ram& Hardwth SuprtaNlm 1r 111 37, Rend& Bead with Jufxravla. Le.NB 3]_ W.am&Band with Superdsim lc.el0 r_ Total,\d�lrh - 4 T �lal Mauch S e. Tui;J Mulch 5 u. Total Match S b. S[nlc Rnc - S b SII 21c S b. Sul,Ra S - h. SI RI:c 5 . Hf�raerUtts Pu'h"ced n! �. Hoare or Una, Purchased n/a Henn. t rU,it, Ptnh,, . .1 r/x c. lio:rs ec(Iu'ty Ptn-h-d n/a tk Ram&Bard w,hl p i,,n 1, _ _ - R ram Hurd wlWS im lzre110 uperAie iM Roan&Boartl with Su cis IB per imlreel 3S- Rann& Hmrd with SupevAsim 1-1IH T,rud M v Tot:fSlotch S - Toivi Mulch S. a. Total Mulch 1 � a_ T IA N1i h - S h S h. Stale R;ie S h_ SI-1 Ru S - b. 5 t R.t S e Hu lrs or Urn, R:n hn.evi n;u e. Hof rs or th tl.s P:rch:ucd :✓a . H un orl=oily P-h,-d Ja c_ lfoun "'U"" R aha'ai tits i9 Stxt-term ReshkndW rr,"nt - 19. Short-term Residentlal Treatment-_, .. -: 39TS' tttrlm Revidentlal'IYer�neot hdrt-termh Reskkutial Treatment u. Txul Mnch s 65Ttilq .'r fat Mai�-h S 1 ._-.. i9r _.... h Rate Rase .i R e t 6. R�ac § l§t f,. Rrrchn. d 291 AI �. 1, ilia Pl-haxevt n/a �. U ue Ruchuszd nlu c. lJnete P"'l I Nu 40. Mrnotl Health Clulb- Serekev 'Co 41. MentM Heath C7uHawe tierNcev 411. Metal IkMih (,I.bh uve S"k" 41_ Mettal Ikalih C'IuHa­ SerHces -:. al Mnich c IA,17A�a. Tut d Match =3.- _ u_7aai Match _ b. k:� h. R la r S _ '. Un is Pu rch-d }22 14 _ ll eR.s Purchased n/a b. R is <. U. ns R-hased S b. W l • 5 tJn c. [- s Rtrcl nFed n/e 44 c(sr 41, Cr - atgrehemlee U>.rmutnBv SerAice "Fetmr(CCI TI 41. ((�W htmiw Cd njt s, rAke T-W( S 1) 41_ ct rmlreheavleeUmmtniry SerHce w-R :_Total Math $ _ 197,t%Id,pl a Total Minch S a. Total Match 5 _ a. Tor;d Match S b Rxlc I h, Rvw '. g - h. Rine = S h_ Rale S Pt "seal 03 Guidance Care Center, Inc. 104 Contract No. ME225-3-27 SUBSTANCE ABUSE FAMILY INTERVENTION SPECIALIST SERVICES HEF09229M Family Intervention Specialists (FIS) are intended to reduce the incidence of child abuse and neglect resulting from parent(s)' or caregiver(s)' substance abuse and to improve outcomes for substance involved families in the child welfare system. The FIS positions are specifically appropriated by the legislature as a line -item budget. FIS services are performed in compliance with Rule 65D-30, Florida Administrative Code (F.A.C.). a. AFTERCARE - Structured services provided to individuals who have completed an episode of treatment and who are in need of continued observation and support to maintain recovery. b. CASE MANAGEMENT - A process which is used by a network provider to ensure that clients receive services appropriate to their needs and includes linking clients to services and monitoring the delivery and effectiveness of those services. c. CHILD WELFARE - Services provided directly or under contract with the Florida Department of Children and Families' Family Safety Program Office. d. DEPARTMENT - The Department of Children and Family Services, created pursuant to Section 20.19, Florida Statues (F.S.). e. INTERVENTION - Includes activities and strategies that are used to prevent or impede the development or progression of substance abuse problems. f. INTERVENTION PLAN - A written plan of goals and objectives to be achieved by a client who is involved in intervention services. g. QUALIFIED PROFESSIONAL - A physician licensed under Chapter 458 or 459, F.S., a practitioner licensed under Chapter 490 or 491, F.S., or a person who is certified through a department -recognized certification process as provided for in ss. 397.311(24), 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. Guidance Care Center, Inc. 105 Contract No. ME225-3-27 h. SCREENING - A process involving a brief review to determine the person's appropriateness and eligibility for substance abuse services and the possible level of service. I. 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. a. Services will be provided to the residents of Monroe County and will be performed at the locations of Key West, Marathon, and Key Largo or in the field (i.e. client's home, community service center, etc.). b. FIS services should be located in a place where they will be easily available and accessible to child welfare personnel. FIS locations must be licensed for Intervention: General Intervention and Intervention: Case Management as required by Rule 65D-30, F.A.C. 5. SERVICES &TIMES FIS provide adult substance abuse outreach, screening, intervention, and case management. FIS do not provide direct treatment services. Services will be provided, at a minimum, Monday through Friday, with flexible hours to meet the needs of clients. a. This contract provides for two (2) Family Intervention Specialist(s). b. These must be specific staff positions identified as a FIS or FIS supervisor. c. Staff shall preferably hold the appropriate clinical license or certification. The minimum qualifications 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 substance abuse and child abuse/neglect knowledge and experience. All FIS services are to be provided under the supervision of a qualified professional, as required by Rule 65D-30, F.A.C. 7. CLIENT ELIGIBILITY Services may be provided to pare nt(s)/caregive r(s) referred by child welfare or a dependency court in which substance abuse is suspected during the initial child abuse/neglect investigation, or at any point during child protective supervision or out - Guidance Care Center, Inc. 106 Contract No. ME225-3-27 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 substance abuse prevention or treatment services, as well as children in relative placements. a. A referral shall be made when the dependency court or a child welfare worker suspects that pare nt(s)'/caregive r(s)' alcohol and/or drug abuse may be contributing factors in a situation where a child's safety or well-being is at risk. Priority referrals are those children at risk for immediate removal or when children have been removed. b. The FIS shall attempt contact with the client within three (3) working days from receipt of the complete referral package. A phone contact or face-to-face visit is acceptable for the initial contact. During this contact, the FIS will conduct a screening or set an appointment to conduct a screening. c. The network provider is responsible for determining what constitutes a complete referral package and conveying the requirements for a complete referral package to the referral agents. Each FIS shall maintain a caseload with a maximum of thirty-five (35) families. A family includes all members of the family who are in need of substance abuse services. Caseload size shall be based on the severity, case management needs, and resources available to support the FIS. Once the FIS case load has reached capacity, the referrals shall continue to be screened and referred to an appropriate treatment provider. i a. The FIS shall conduct a comprehensive screening, using the department's "FIS Screen for Mental Health, Substance Abuse, and Co -Occurring Instrument", or a screening instrument approved by the department. Additional circuit screening tools may be used. If appropriate, a toxicology chemical dependency screening may be completed to identify the nature and extent of the substance use and to determine the most appropriate substance abuse referral source. b. The screening shall be completed within ten (10) working days from the date of the receipt of the referral package. Guidance Care Center, Inc. 107 Contract No. ME225-3-27 lJoHMOWN 11. FIS REFERRAL OF CLIENT TO SERVICES a. If the client or a client's family member is in need of services, the FIS shall refer and schedule an appointment within 48 hours for the client to be seen within seven (7) working days after completion of the screening with the most appropriate local provider for an assessment and subsequent services. b. Upon completion of the client referral, the FIS shall provide a summary to the referral agent/child welfare worker. FIS can provide the summary to the referral agent/child welfare worker through electronic transmissions. The FIS must use appropriate safeguards to prevent use or disclosure of protected health information. c, The primary referrals may be to substance abuse treatment providers for more in-depth evaluation and substance abuse treatment, if needed. Other referrals may include referrals for mental health screenings, assessments or treatment, referrals for medical or physical problems, other social or assistance services, legal, educational, housing, vocational, or employment services. d. Referrals shall be based upon the client's needs, available community resources, and financial considerations. e. Each FIS shall maintain a directory of treatment resources, eligibility criteria, and referral procedures for available prevention and treatment resources in each community. The network provider agrees to mutually define, with child welfare, the role of the FIS positions within the system of care. The FIS will establish and maintain a working relationship with Our Kids, DCF, SFBHN, and all DCF licensed providers within the community(ies). 12.CASE PLANNING a. The FIS are responsible for developing the substance abuse intervention plan as required by Rule 65D-30, F.A.C. The FIS are required to provide a copy of the intervention plan to the child welfare worker for incorporation into the child welfare case plan. b. The FIS are responsible for reviewing and updating the substance abuse intervention plan as required by Rule 65D-30, F.A.C. An updated intervention plan is also required when there is a major change of status regarding the client's participation in substance abuse treatment. The FIS are required to provide a copy of the updated intervention plan to the child welfare worker for incorporation into the child welfare case plan. 13.CASE MANAGEMENT The FIS shall perform continued case management related to the substance Guidance Care Center, Inc. 108 Contract No. ME225-3-27 abuse portion of the plan. This will continue throughout the duration of the client's participation in substance abuse services. FIS should make contact, preferably face-to-face, at least monthly with the client. This may include participation in formal staffing or informal contact. Case management activities shall include: I. Monitoring client's condition and progress in treatment; 11. Linking clients to services as dictated by their needs; and 111. Facilitating client's participation in treatment by removing barriers. a, The FIS shall provide a monthly written status report throughout the duration of the open substance abuse case to the child welfare worker, indicating treatment progress and alerting the child welfare worker to any barriers or other concerns. A written report is also required when there is a major change of status regarding the client's participation, and at the close of the case. b. The FIS shall participate in staffing of the family's progress as requested by the child welfare worker or the substance abuse provider. The FIS will facilitate a staffing of the family's progress when there is a major change of status regarding the client's participation in substance abuse treatment. Although face-to-face staffing is preferred, interested parties may participate through telephone conferencing. c. The FIS are required to remain informed regarding the status of the child welfare case plan. 15. DEPENDENCY COURT LIAISON a. The FIS shall provide liaison services to the dependency court and inter- agency communication regarding the status and progress of clients in the FIS caseload who are in substance abuse treatment. In accordance with 42CFR 2.61, FIS, in consultation with the substance abuse treatment provider, shall assist child welfare staff in making recommendations to the court regarding family reunification. b. The FIS shall appear in court under any of the following circumstances: I. Clinical case staffing of the client indicates the need for the FIS; 11. The court issues a subpoena to the FIS; 111. The department or a child welfare agency provides a request to the FIS in writing, requesting client court representation; or IV. Upon request of an attorney representing the department. c. If the court requests a written status report in lieu of court appearance, the Guidance Care Center, Inc. 109 Contract No. ME225-3-27 FIS shall provide said report to the department's Legal Counsel for filing with the court. Client/family requests for an FIS to appear on their behalf will be taken into consideration. 16. LENGTH OF SERVICE & DISCHARGE a. FIS services shall be provided to an eligible client receiving substance abuse treatment or substance abuse aftercare treatment to ensure linkage with and support for the child welfare case plan. The network provider may continue to provide FIS services to clients in active substance abuse treatment, or in substance abuse aftercare after the child welfare case is closed. b. The client may be discharged from FIS services upon any of the following: I. Substance abuse treatment is completed; 11. The case is closed by the child welfare agency; 111. The client refuses to participate in the program; or IV. The client is incarcerated, or moves to another geographic area. c. Decisions about when to close a case or keep it open should be made by the FIS in consultation with the substance abuse provider, child welfare worker, and/or the court. Case records must be consistent with requirements of Chapter 65D-30, F.A.C. Refer to the FIS revised guidelines for a specific description of required records. The revised FIS guidelines can be obtained from the department's contract manager. Data shall be maintained by the network provider and submitted to the state Substance Abuse Program Office as required by CFP 155-2. FIS shall enter data using an FIS Staff ID as defined in CFP 155-2. Data will also be submitted to the circuit office as per Exhibit C. The network provider agrees to allocate training dollars per FIS position to participate in the FIS statewide meetings when they occur, any training provided by the DCF Substance Abuse Program Office specifically for FIS, or to attend a work related conference. Guidance Care Center, Inc. 110 Contract No. ME225-3-27 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 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 FIS, and the contract manager. The department's contract manager 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 department's contract manager, which details year-to-date expenditures and the balance of the FIS incidental funds, along with the corresponding incidental fund request form(s). The expenditure of FIS 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 FIS funding for this contract is $100,000.00. This includes $0.00 that the network provider agrees to make available for Incidentals funds. a. The incidental fund request must contain, at a minimum, the information below: I. Name of the FIS accessing funds; 11. Funds spent on behalf of (client name); 111. Referral type (protective investigation/supervision); IV. Date of request; V. Description of Goods/Services requested; VI. How the purchase is related directly to the FIS intervention plan; VII. Goal/Reason for purchase amount requested; and VIII. FIS and approving authority signature with date. Guidance Care Center, Inc. 111 Contract No. ME225-3-27 Assisted Living Facilities with Limited Mental Health License Network providers that enter into a cooperative agreement with an Assisted Living Facility -Limited Mental Health (ALF-LMH) that are also responsible for providing case management services to mental health residents inthe ALF-LK4Hshall: 1) 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 individual who is supervised by one of these professionals, to establish that all residents are appropriate to reside in the ALF. A copy of that documentation shall be provided to the ALF administrator no later than 30 days following admission. 2) Ensure that case managers are assigned toall AUF-UNHresidents who meet criteria aaamental health resident. |ithe resident declines case management, case managers must attempt toengage the person for a period not less than 30 days and document efforts in the ALF records, |fthe mental health resident continues todecline services, they must be encouraged todoaninwriting, unless that ioalso refused. Documentation of a resident's declination of case management services and stated reason for declination must bemaintained incase records at thoALF-Lk8H. 3) Ensure that individuals living inALF-UNHand meeting the definition ofamental 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. 4) 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-LKxH. 5) 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 after-hours emergency access; transportation provision; and services and activities available at the ALF-LMH. The ALF-LK4H administrators must also be given contact information for the Department's Circuit Substance Abuse Mental Health Program Office and the managing entity, auappropriate. The cooperative agreement must contain a provision requiring the provider to maintain afile for each ALF- LK8Hclient with copies nfall required documentation. A||ALF-LK8H client records must baavailable for production bythe network provider for monitoring purposes. G) Ensure that the Cooperative Agreementkyannually updated between the provider and the ALF-LMH Administrator. 7) 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-LMH administrator of the facility infaoa-to-faoemeetings. Ataminimum, meetings will beheld for initial plan development and annual updates to the plan. More frequent meetings shall be held as necessary to resolve concerns expressed by the resident, case manager, or ALF-LMH Administrator. The plan should be individualized and should include information about support services and special needs. 8) Report all concerns related to health and safety violations toappropriate officialuat the Agency for Health Care Administration and the Department's Abuse Hotline. Exhibit K, Network Provider Inventory List ------------- �Nl IZ iE (X tH E Uj (D S� Y� C) � Q tH CL Contract No. ME225-3-27 fflN� EXIHIBIT L CCST DUTY ROSTER CCST DUTY ROSTER FOR THE WEEK OF: *PROGRAM: AMH /CMH /ASA /CSA (circle one) COST CENTER: 44. CCST— Individual / 45. CCST -Group *Funding Source: Non-TANIF /TANIF (circle one) **.* Remember to exclude Holidays (unless staff is scheduled to work, CCST STAFF NAME/ID # Part Time or Full Time Does this staff work in any other cost center or program? Hours / Scheduled to Work MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY Beginning & Ending Time Beginning & Ending Time Beginning & Ending Time Beginning & Ending Time Beginning & Ending Time Beginning & Ending Time Beginning & Ending Time L 2. 3. 4, 5. 6. 7. 8. 9. 10. SIGNATURE OF SUPERVISOR: Date: Note: * Fill out a separate Duty Roster for each program and funding sources combination. Guidance Care Center, Inc. 114 Contract No. ME225-3-27 CHILD WELFARE QUARTERLY CLINICAL REPORT Date of Report: Name of Person Completing Report: Title: Child's Name: DOB: DOA: School: Grade: School Placement: School Performance: Full Case Management Agency: Full Case Manager's Name: Phone#: Cell#: Relevant Incidents: Type of Service(s): Frequency: Location: Presenting Problern(s): Treatment Plan Goals/ Progress: "Attach copy of most current Treatment Plan or Treatment Plan Review DSM IV Diagnosis (Current): Axis 1: Axis 11: Axis [11: Axis IV: CGAS: Psychotropic Medications: Y/N If yes: Name of Psychiatrist: Was Medication treatment Plan completed? Y/N If yes, date of court approval: Current medication and dosage: Previous medication, if applicable: Rational for current medication: Date that. child started taking the medication: Child's Treatment Summary/Therapeutic Recommendations: Therapist Signature Supervisor Signature Guidance Care Center, Inc. 115 Contract No. ME225-3-27 EXHIBIT N MISSING CHILDREN The network provider agrees when services are for children who are adjudicated dependent where the care of the child is assigned to the department or network provider, to follow the procedures outlined in Rule 65C-30.019, F.A.C. and Rule 65C- 29.013, F.A.C. and in Children and Families Operating Procedure (CFOP) 175-85, entitled "Prevention, Reporting, and Services to Missing Children". The network provider will perform the departmental functions as described in Rule 65C-30.019, F.A.C. and CFOP 175-85 which correspond to the functional role of this contract. The network provider also agrees when services for children are community based and the child involved is not adjudicated dependent, to comply with all licensing and contracting requirements. 1. Definitions a. Designee - a person, contractual network provider or other agency or entity named by the department. b. Exigent Circumstances - situations that require immediate actions, such as the child is under the age of thirteen, believed to be out of the zone of safety for their age and development, mentally incapacitated, in a life threatening situation, in the company of others who could endanger their welfare or is absent under circumstance inconsistent with established behaviors. c. FDLE-MCIC - Florida Department of Law Enforcement -Missing Children's Information Center. d. Family Services Counselor - a professional position responsible for case management for children placements. The term includes Department of Children and Families staff and staff working for an agency named as a designee. e. Missing Child - a person who is under the age of 18 years; whose location has not been determined; is currently placed in an out -of -home care setting; court order in -home placement; or is the subject of an active abuse investigation in which the child has been sheltered, would have been sheltered if their location had become known, or who was in the physical custody of the department or a network provider when they went missing; and who has been or will be reported as missing to a law enforcement agency. Rff=- a 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. Guidance Care Center, Inc. 116 Contract No. ME225-3-27 c. The network provider agrees to instruct caregivers, including relative and non -relative caregivers, and all other staff that might be required to report a child as missing to local law enforcement to immediately undertake the following activities, as applicable, and document all actions and activities related to any efforts made to report and/or locate any child who is determined to be missing from their care or supervision: d. If exigent circumstances exist, the caregiver, family services counselor, or until the family services counselor is engaged, the network provider employee, who has identified that a child is missing from their care or supervision shall immediately call local law enforcement as soon as a determination has been made that a child is missing and they shall request that the responding office: (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; Guidance Care Center, Inc. 117 Contract No. ME225-3-27 (b) The law enforcement missing child case number if one was issued by local law enforcement; (C) A copy of the law enforcement report when one is made available; (d) Detailed information on the child's overall state of mind and behavior prior to the child going missing; (e) Detailed description of what the child was last seen wearing; (f) Detailed information on possible locations that the child might be going to; and (g) Detailed information on any individuals that the child might be traveling with. e. If exigent circumstances do not exist, the caregiver , family services counselor, or other network provider staff will within the first four (4) hours of learning that a child might be missing check to see what, if any, of the child's personal belongings are missing or if the child left a note; and, the caregiver , family services counselor, or other staff (if the family services counselor is not yet engaged), will: (1) Contact the following persons as appropriate to ascertain if the child has been seen, or has given any indications that may explain the child's missing status: (a) School/child's teachers and school resource officer; (b) The child's relatives/parents, both local and non -local, if appropriate, and the caregiver has the means for such contact; (c) Any friends or places that the child generally frequents, the local runaway shelter, if there is one in the community; and, (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. a. 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.a., above. Guidance Care Center, Inc. 118 Contract No. ME225-3-27 b. If at any time, the child is located or returns to the caregivers home after law enforcement has been notified of the missing child case, all law enforcement agencies and other agencies that were notified of the missing child episode must be contacted immediately by the caregiver, family services counselor, or other network provider employee who made the report. If at any time new information is obtained on a possible location of the missing child, the caregiver, family services counselor, or any other employee of the network provider shall immediately contact all law enforcement agencies and other agencies that were notified of the missing child episode as to the possible location of the child. If the Family Services Counselor has been engaged, the network provider shall also inform them and the legal guardian of the new information once law enforcement has been notified. c. All of the department's documentation related to the missing child episode shall be completed and entered into the department's approved missing child reporting system within one working day of the family services counselor, on -call staff, or Community Based Care (CBC) Child Location Specialist learning of a missing child episode regardless of whether local law enforcement has issued a missing child report number. This includes the uploading of a recent high quality photograph of the child into the department's approved missing child reporting system. If local law enforcement has refused to issue a missing child report a dummy local law enforcement case number of 00000 and the name of the local law agency that refused to issue the missing child report shall be used to complete and enter the missing child episode into the department's approved missing child reporting system. Guidance Care Center, Inc. 119 Contract No. ME225-3-27 07/01/2012 EXHIBIT O INCIDENTAL EXPENSE FUND INVOICE AND EXPENDITURE LOG FOR ADULT MENTAL HEALTH Incidental Expense Fund Invoice and Expenditure Log for Adult Mental Health Reporting Month: Network Provider: Contract No. Cost Center: Amount Allocated: Amount Remaining: Recipient Name & ID # Program Civil or Forensic Description of Expenses Requisition Date Status (Date request approved/pending/denied) Staff name & Title Amount Check # & Disbursement Date Total Amount for Housing $ Total Amount for Medication $ Total Amount for Emergency Expenses $ Totm $ Guidance Care Center, Inc. 120 Contract No. ME225-3-27 37KYAM WA 0117-H IN SAMH PRE -AUTHORIZATION RESIDENTIAL UTILIZATION MANAGEMENT ROSTER (1) Provider Name and Address: (2) Contract No: (3) SANIH Program: (4) Invoice Period: (5) Page ------ of __ (6) Client Count (7) Authorization Number (8) Client Name (Last, First) (9) Social Security Number (10) Placement Authorization No. (11) Service Period (12) Cost Center (13) Unit Rate (1,4) No. of Units of Services Rendered (15)'Fotal Service Cost (Col, 13 x 14) 1. 2, 3 4. 5. 6. 7 8. 9. 10, 12. 13. 14, 15. 16. 17. 18. 19. 20. Totals Provider's Authorized Representative I CERTIFY THAT THE ABOVE IS ACCURATE AND CORRECT Provider's Signature Name (Print or Type) Date Tittle Guidance Care Center, Inc. 121 Contract No. ME225-3-27 ATTACMKNENTU The administration of resources awarded by the Managing Entity to the network provider may be subject to audits as described in this attachment. |naddition toreviews of audits conducted inaccordance with OMB Circular A-133and Section 215.S7, F3, as revised. the Managing Entity may monitor orconduct oversight reviews to evaluate compliance with contract, management and programmatic requirements. Such monitoring orother oversight procedures may include, but not be limited to, on -site visits by Managing Entity staff, limited scope audits as defined by OMB Cirou\arA-133, as revised, or other procedures. By entering into this uBroement, the recipient agrees to comply and cooperate with any monitoring procedures deemed appropriate by the managing entity. In the event the Managing Entity determines that a limited scope audit of the recipient is appropriate, the recipient agrees to comply with any additional instructions provided by the Managing Entity regarding such audit. The recipient further agrees tocomply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the department's inspector general, the state's Chief Financial Officer orthe Auditor General. PART 1: FEDERAL REQUIREMENTS This part iaapplicable Kthe recipient ivaState orlocal government oranon-profit organization ao defined in OMB CiroulanAr133' as revised. In the event the recipient expends $500,000 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 OMB Circular A-133,aorevised. |ndetermining the Federal awards expended during its fiscal year, the recipient shall consider all sources of Federal awards, including Federal resources received from the Managing Entity. The determination of amounts of Federal awards expended should be in accordance with guidelines established byOMB Circular A-133.aurevised. Anaudit ofthe recipient conducted by the Auditor General in accordance with the provisions of OMB Circular A-1 33, as revised, will meet the requirements of this part. In connection with the above audit requirements, the recipient shall fulfill the requirements relative toeuditee responsibilities as provided in Subpart C ofOMB Circular A'133' as revised. The schedule ufexpenditures should disclose the expenditures bycontract number for each contract with the Managing Entity 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 Managing Entity shall be fully disclosed in the audit report package with reference to the specific contract number. Single Audit Information for Recipients ofRecovery Act Funds: (a) To maximize the transparency and accountability of funds authorized under the American Recovery and Reinvestment Act of 2009 (Pub. L. 111-5) (Recovery Act) as required by Congress and in accordance with 2CFR21G.21 "Uniform Administrative Requirements for Grants and Agreements" and OMB Circular A_1O2 Common Rules provisions, recipients agree tomaintain records that identify adequately the source and application of Recovery Act funds. OMB Circular A-1 02 is available at http:Hwww.whitohouoegov/omb/oirou|aru/a102/a1U2.htm|. (b) For recipients covered by the Single Audit Act Amendments of 1996 and OMB Circular A-1 33, "Audits of States, Local Governments, and Non -Profit 0rganizotionu." recipients agree to separately identify the expenditures for Federal awards under the Recovery Act on the Schedule of Expenditures of Federal Guidance Care Center, Inc. 122 Contract No. ME225-3-27 Awards(SEFA) and the Data Collection Form (Srequired by OMB Circular A-133. OMB Circular A_133isavailable e1httpxYwww.whitehouuo.Qov/omb/oncu|aru/a133/a133.htmiThis shall be accomplished by identifying expenditures for Federal awards made under the Recovery Actseparately on the SEFA, and as separate rows under Item 9 of Part III on the SF —SAC by CFDA number, and inclusion of the prefix "ARRA-" in identifying the name of the Federal program on the SEFA and emthe first characters in Item 0d of Part \\\ on the SF —SAC. (c) Recipients agree to separately identify to each subrecipient, and document at the time of subaward and at the time of disbursement of funds, the Federal award number, CFDA number, and amount of Recovery Act funds. When arecipient awards Recovery Act funds for anexisting program, the information furnished to subreo}pientashall distinguish the nubavvards ofincremental Recovery Act funds from regular oubawardounder the existing program. (d)Recipients agree to require theiruubrecipients to include on their SBAinformation to specifically identify Recovery Act funding similar to the requirements for the recipient SEFA described above. This information is needed to allow the recipient to properly monitor subrecipient expenditure of ARRA funds as well as oversight by the Federal awarding agencies, Offices of Inspector General and the Government Accountability Office. PART 1k STATE REQUIREMENTS This part is applicable if the recipient is a nonstate entity as defined by Section 215.97(2), Florida |nthe event the recipient expends $GOO.00Oormore instate financial assistance during its fiscal year, the recipient must have aState single mproject-specific audit conducted in accordance with Section 215.97, Florida Statutes; applicable rules of the Department of Financial Services; and Chapters 10.550 (lVoo\ governmental entities) or 10.650 (nonprofit and for -profit organizations), Rules of the Auditor General. In determining the state financial assistance expended during its fiscal year, the recipient shall consider all sources ofstate financial assistance, including state financial assistance received from the Managing Entity, other state agencies, and other nonutateentities. 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 1O.5GOor1O£G0.Rules o(the Auditor General, The schedule ofexpenditures should disclose the expenditures bvcontract number for each contract with the Managing Entity ineffect 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 Managing Entity shall be fully disclosed in the audit report package with reference to the specific contract number. PART III: REPORT SUBMISSION Any reports, management letters, orother information required to be submitted to the ManagingEntity pursuant to this agreement shall be submitted within 180 days after the end of the networkprovider'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 byFlorida Statutes: A. Managing Entity Contract for this contract (1 electronic copy and management letter, if iasued) Guidance Care Center, Inc. 123 Contract No. ms22s�z B. Reporting packages for audits conducted in accordance with OMB Circular A-1 33, as revised, and required byPart I of this agreement shall be submitted, when required by Section .320(d), OMB Circular A'133,aorevised, byoronbehalf ofthe recipient directly tothe Federal Audit Clearinghouse using the Federal Audit Clearinghouse's Internet Data Entry System at: and other Federal agencies and pass -through entities in accordance with Sections .320(e) and (f), OMB Circular A-133. as revised. C. Copies of reporting packages required byPart Uof this agreement shall besubmitted byoronbehalf of the recipient directly \mthe following address: Auditor General Local Government Audits/342 Claude Pepper Building, Room 4U1 111 West Madison Street Tallahassee, Florida 32398-14GU Email address: f @aud.utate]|.uu Network providers, when submitting audit report packages to the Managing Entity for audits done in accordance with OMB Circular A-1 33 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 network provider must be indicated in correspondence submitted to the Managing Entity in accordance with Chapter 1O.G5D(3)orChapter 10.G57(2).Rules ofthe Auditor General. PART IV: RECORD RETENTION The recipient shall retain sufficient records demonstrating its compliance with the terms of this agreement for period of six years from the date the audit report is issued and shall allow the Managing Entity 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 Managing Entity or its designee, Chief Financial Officer or Auditor General upon request for a period of three years from the date the audit report iaissued, unless extended inwriting bythe managing entity. Guidance Care Center, Inc. 124 Contract No. xxEzzs-3-27 07/01/2012 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 of a 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 subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans and cooperative agreements) and that all subrecipients 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 such failure. Signaturl 7/9/12 Date FRANK RABBITO Name of Authorized Individual GUIDANCE CARE CENTER, INC. Name of Organization Address of OrganizaTfon ME225-3-27 Application or Contract Number Guidance Care Center, Inc. 125 Contract No. ME225-3-27 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 ofcongress, anofficer oremployee ofcongress, oranemployee of a 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, orcooperative agreement. (2) If any funds other than federal appropriated funds have been paid mwill bepaid to any person for influencing or attempting to influence an officer or employee of any agency, amember o/ 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 toReport Lobbying.'`inaccordance with its instructions. (3) The undersigned uha|requheUlatthmlanouaQeofthksoartificoOonbaindudedinthe8w@rd documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification isamaterial representation of fact upon which reliance was placed when this transaction was made cventered into. Submission ofthis certification ivaprerequisite for making ur entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification uhu|| be subject to a civil penalty of not less than $10.000 and not more than $1OO.OD0for each such failure. Signature FRANK RABBITO Name of Authorized Individual GUIDANCE CARE CENTER, INC. Name of Organization Address of Organization K4E225-3-27 Application or Contract Number Guidance Care Center, Inc, 125 Contract No. Ms225a-27 07101/2012 Attachment IV Working Agreement for SSI/SSDI Outreach, Access, and Recovery (SOAR) Initiative Community Provider Agency The Commumty Pro WderAgency shag ha ve dewguated SOAR trained staff who agree to do the Mowing- 1 , Contact the identified Social Security Administration (SSA) liaison according to the Community Provider Agency zip code and create an individualized application submission► procedure that will be utilized for all initial SOAR applications, The procedure should include the agreed upon preferred method of communication with the SSA liaison and how the protective filing date will be established for each claim. 2. Submit claims for SOAR applicants as soon as possibte but within two weeks of the notification, at the latest. I Complete and submit a SSA 1696 Appointment of Representative form that will list the name of the Individual and the agency that witl serve as the SOAR claimant's representative. This form will be submitted with the application. 4. Follow up on any additional needed non -medical information for SSA within two working days of notification of the need for information. This follow-up will either provide the documentation needed or notify SSA of the steps being taken to obtain the notification. 5, Receive notification from the SSA claims representative once the claim has cleared the non-Inedicat process and has been sent to the Division of Disability Determinations (DD/D). This notification will take place within 24 hours of sending the Balm to the ODD. 6. Obtain all existing medical information and submit it to the DDD, once the application for SS1/SSDI is completed. 7. Contact the ODD office within one week of notification of the claim having gone to the ODD to determine who the disability adjudicator is and make contact by phone with that adjudicator, notifying him/her of working with a SOAR claimant, confirming the authorized representative status, and informing the examiner of the records being collected. & Maintain contact with the DDD adjudicator as appropriate, to check on the status of the claim and to continue to submit information. 9. Submit all existing medical information and additional evaluation information to the ODD within 30 calendar days of the submission of the application to the DDD by SSA. 10, Submit the medical summary report to the DDD within 30 calendar days as well. 11. Collect data regarding SOAR applications and submit don an ongoing basis, via the Policy Research Associates! (PRA) web -based data entry program. Frank C. Rabbito, Sr. VP 1 (Print Name) Signature Guidance/Care Center, Inc. Community Provider Agency 7M12 Guidance Care Center, Inc. 126 Contract No. ME225-3-77 07/01/2012 Attachment V Prevention Services DESCRIPTION OF SERVICES ( Include overall intention of program, outline of program activities,, target population to be served, implementation of E8P, and partners if applicable): The Guidance/Care Center's (G/CC) program consists of three evidenced -based practices and an environmental strategy to address the specific long-term outcome identified in the CCAP for Monroe County: Goal 1: Reduce the Monroe County prevalence rate of past 30-day alcohol use among youth. Goal 2: Increase youths' attitudes and beliefs about the risk of harm of underage drinking The long term goal is to reduce DUI crashes countywide amongst 18-20 year olds by 10% in 2015 by reducing parent acceptance and approval of behavior and increasing the perception of harm and risk in youth. TARGET POPULATION OR PARTICIPANTS (Include numbers in tables and a narrative description of participant characteristics below): Level 1 and Level 2 Number of Participants Youth living in Monroe County 1,123 Teens living in Monroe County 50 Environmental Strategy: "Parents Who Host, Lose the Most" 60,619 Description of participants to be served (describe criteria for program enrollment eligibility, geographic areas/neighborhoods or schools to be served, risk factors, as well as any other significant demographics information; if serving children with disabilities, include type of disabilities): Male and female youth ages 10-17 years and their parents who reside in Monroe County. Services will be provided at all three high schools, the alternative high school, three middle schools and two elementary schools. The TGFDV Program will be available to all 10'h graders attending any one of the three Monroe County High Schools, as well as youth attending the alternative school or living at Florida Keys Children's Shelter in Tavernier. The TGFD Program will be available to 61h and 7th graders attending Big Pine Academy, 7th and 81h graders attending Key Largo Middle School, and Plantation Key Middle School, and 5 h graders attending Stanley Switlik School and 6 h graders at Marathon Middle School. - It # fl Site Name Street Address City Zip Code I Children/ Parents Other Youth Key West High School 2100 Flagler Ave Key West 3304 ?92 0 0 Coral Shores High School 89901 Old Highway Tavernier 33070 182 0 0. Key t.ar-,,o Middle St:ho of 104801 Overseas Highway Key Largo 33037 196 0 0 Plantation Key Middle School 10Lake Ad, Tavernier 3.3050 120 0 0. Stanley Switlik School 3400 Overseas Highway Marathon i 1050 75 0 0 Marathon Middle High School 350 Sombrero Rd. Marathon 3.1050 190 0 0 Florida Keys Children's Shelter 173 High Point Rd. Tavernier 3 3070 40 0 0 Big Pine Academy 30220 Overseas Highway Big Pine 3 304i3 28 0 i Guidance Care Center, Inc. 127 Contract No. ME225-3-27 PERFORMANCE MEASURES Quantity Activities/Service Name & Description (Include # Children/ # # # Required % To Meet ActivitV frequency, intensity, & duration of sessions, as well as the Youth Patents Others Sessions Required Level (I number of cycles expected to be offered and tentative or 2) schedule) Too Good For Drugs Too Good For Violence 1,123 0 0 10 sessions 85% 1 Total = 1,123 served from July 1, 2012 through June 30, for 2013 50 0 0 1 85% 1 Teen Intervene 50 served from July 1, 2012 through June, 30, 2013 assessment 3 sessions for 1.5 5,000 20,109 5,000 hours each 822 50% NA Environmental Strategy — Parents Who Host, Lose The Most Environ Public education, Social Marketing, Media Advocacy mental 40A) Public Service Announcements on radio and cinema Strategy 10 press releases 1 kickoff event 1 rnedia campaign 10 presentations in the community 20 campaign posters in windows of local businesses 20 stickers posted in businesses that sell and serve alcohol that you must be 21 to purchase or use throughout the county Posters and other information regarding serving to those without ID will be available to vendors at the over 650 festivals in Monroe County each year serving alcohol Quantitv Performance Mpa.,;tjrt-% ActivitVI Service Name and # of participants to, Required # of sessions for %of participants Description receive service participants to achieve results to meet required Goal 1. Reduce the Monroe County prevalence rate of past 30-day alcohol use among youth. Goal 2: Increase youths' attitudes and beliefs about the risk of harm of underage drinking Too Good For Drugs Too Good For 1,123 12 sessions 85% = 955 Violence Participants Teen Intervene 50 1 assessment and 85% = 43 3 sessions for 1.5hours each participants Goal 1. Reduce the Monroe County prevalence rate of past 30-day alcohol use among youth, Goal-2: Increase youths' attitudes and beliefs about the risk of harm of underage drinking Environmental Strategy 60,619 822 50— %=30,309 Guidance Care Center, Inc. 128 Contract No. ME225-3-27 07/01/2012 Parents Who Host Lose the Most I I I participants Quality Description of the required program Quality measures. Quality Measure Measurement and Reporting Toot Timing Average number of sessions attended 85% of 1,123 participants or 955 will • At the end of each cohort of (Participant Retention) complete Too Good For Violence Too group sessions Good For Drugs post test and a minimum of 12 sessions • Ten (10) by September 30, 85% of 50 or 43 participants complete 2012, an additional 10 by the Teen Intervene sessions — a January 15, 2013, for a total minimum of 3 sessions of 20; an additional 10 by Measure: (Survey and Logs) March 2013 for a total of 30; and additional 20 by May 31, 2013 for a total of 50 youth. # and % of youth satisfied with services 90% • At the end of each TGFD V provided Satisfaction survey sessions for youth in TGFDV • At the end of each Teen Intervene session —or by June 15, 2013 for youth in Teen Intervene Observation of service delivery/ Fidelity Curriculum fidelity checklist One time for each cohort (school) checklist in September and March Documentation of structured supervision Supervisory Tool/Checklist and Notes During regular supervisory sessions for each staff and not less than one time per month # and % of staff with necessary 100% At the time of contract training/certification monitoring Participant Outcomes Outcome Data urce Mea urernent Timing Associated Activity 1,123 youth will receive the 1. Data entered into the At admission into Staff trained; Program TGFDV/TGFD curricula annually PBPS system & The GCC program timelines developed; database Database set-up; 2. Client enrollment forms At end of sessions TGFCV/TGFD 3. Pre/post surveys sessions facilitated; Data collected and entered in database; Data analyzed; Program improvement activities Outputs: 10 of 12 sessions 50 youth will receive Teen 1. Data entered into the At admission into the Prior to delivery of 1' Intervene annually PBPS system & GCC program session database 2. Client enrollment forms At end of sessions youth Sessions delivered will complete a post Survey administered survey Guldance Care Center, Inc. 129 Contract No. ME225-3-27 07/01/2012 95% of the youth will complete 1. Attendance records 1. Youth sign attendance Youth sign the at least the required 10 sessions 2. Service deliver data records for each session attendance record at of TGFDV/TGFD curricula entered into GCC database 2. Staff enter service the beginning of each delivery data daily session 3. Post surveys Post surveys administered at the end administered and data of the sessions collected and analyzed 85% of the high school students 1. Attendance records 1. Youth sign attendance Youth sign the will complete at least the 3 2. Data entered into GCC records at each session attendance record at required sessions of Teen database 2. Staff enter service the beginning of each Intervene delivery data daily/based session on services rendered 3. Post surveys Post surveys administered at the end administered and data of the sessions collected and analyzed 85% of the youth will improve TG FDV/TG ED pre/post tests Collected immediately During the first/last their attitudes and beliefs prior to the 1" session sessions of the related to risk of harm of and immediately curriculum; for youth underage drinking following the last session only completing the required 10 sessions, the research assistant will contact/meet with youth to collect the -- post test 85% of the youth will report no Timeline follow back Collected immediately Youth will complete alcohol use in past 30-day by prior to the 1" session the surveys; for youth curriculum completion and immediately only completing the following the last session required 3 sessions, the research assistant will contact/meet with youth to collect the post test. Data will be analyzed and reported. Staff shall enter 100% of data PEPS and/or SFBHN data Monthly Research and requested into the PEPS and/or systems Evaluation does a SFBHN systems monthly audit of information in the system compared to hard copy The agency shall submit 90% of Data submission reports Monthly Staff will review data the data on schedule completed following submission process Increased collaboration with the Increase by 2015 the Sept. 1, 2012-June Increased DUI arrests State Attorney's Office, conviction rate from 26% to 30,2013 by Law Enforcement & campaign materials targeting 36%, promote Parents Who Monthly reporting form Increased prosecution parents, increase/sustain ESP's, Host Campaign from SAO by SAO of DUI cases by and increase Law Enforcement 100/0. capacity for Saturation Patrols in MOU's with SAO, GCC, the Lower, Middle and Upper Monroe coalition and Keys HSA, All to attend monthly Monroe Increased enforcement County Coalition / rosecution of arents Monitor alive 2 artier Meetin s to increase Guidance Care Center, Inc. 130 Contract No. ME225-3-27 providing alcohol enforcement/ monitor targeted/monthly collaboration. prosecutions Monthly meeting with SAO to monitor Increased Saturation prosecution activity Patrols/arrests in Lower, Middle Key West Police, Monroe Sept. 1, 2012-June and time expended to and Upper Keys County Sheriff 30,2012 log data. HSA(if funded by PPG) Increase arrests by Key West to monitor Police by 20 - enforceme nts/ Monroe For Monroe Co. Sheriff by 10 County Coalition to Lower Keys, by 12 Middle Keys, Monitor prosecutions. and by 22 Upper Keys Data collected monthly by reporting forms and analyzed by Committee named by Coalition( to be determined) Monitor # of increased arrests by Key West Police and for Monroe Co. Sheriff through HSA (if funded by PPG) and share report with the Coalition at monthly meetings. EVIDENCE BASED PROGRAMS (EBP) All strategies funded by South Florida Behavioral Health Network should deliver high quality, evidence -based practices that are strength -based, child/youth/family centered, accessible, respectful of diversity and mindful of community context and connections, or constitute best practices that have been approved by South Florida Behavioral Health Network because, when performed with fidelity, they should deliver analogously high quality services. Listed are the evidence -based programs that will be used during activities/service delivery. Evidence Based Program Designating Agency Strength of Evidence Too Good for Drugs and Violence (TGFDV), Too Good for Drugs (TGFD) SAMSHA approved, NREPP Option I "Teen Intervene SAMSHA approved, NREPP Option 1 Parents Who Host, Lose the Most I Promising Practice with research to support it I Option 2 TASK LIST Activities Year I Activities/service Name & Description # & Type of ESP % to Participants Recommended Meetthis Sessions or Outcome Hours Activity Title: Too Good For Violence/Too Good For Drugs 1,123 youth 1 hour for 12 85% Activity Des"tion: Participants will be recruited from designated schools sessions and will receive a pretest assessment of their risk and protective factors. The Curriculum will be administered once per week for 12 sessions and the posttest will be administered at the end of the sessions Guidance Care Center, Inc. 131 Contract No. ME225-3-27 ELEqLELM One time upon program entry. Intensity: 10-12 sessions I Duration: 1 hour per session. Activity Title: Teen Intervene Curriculum so 3 sessions 85% Activity Description: Participants will be required to attend 90 minute 1,5 hour per sessions session Frequency., One time per week Intensitv: Three sessions Duration: One 90 minute session Activity Title: Parents Who Host, Lose the Most 60,619 422 50% Activity Description:. Participants will be reached by ads, radio and cinema PSA's, mailings, community meetings, posters placed at local businesses Frequency: PSA's 44 week Intensity: 3x1dayfora days per week Duration: 30 seconds each Activity Title: Parents Who Host, Lose the Most 15-20 10 sessions 85% Activity Description: Community Meetings parents, Frequent 1x monthly Sept 2012-June 2013 teachers,cit Intensitw, .10 meetings y&,county Duration: 60 minute meetings personnel, business leaders, community members A(�kyjjTitle: Parents Who Host, Lose the Most 50 mailings Mailings =36 100% L)escr.iption.% Mailings & Poster placement each Cycle hrs/Cycle - Y 6x Mailings, Poster placement 1x cycle 1, Ix cycle2 fL!L(Lt'±?nr & Intensit to key Posters =40 Duration: 0 r-nonths contacts in Hrs. community for outreach support, 20 Poster/Stick er Placements at local businesses. Guidance Care Center, Inc. 132 Contract No. ME225-3-27 ATTACHMENT E Contract Between Florida Department of Children and Families and South Florida Behavioral Health Network Contract (KH-225) Guidance Care Center-SAMH Contract; FY13; page 14 Contract No. K11225 ('FDA No. 23.22 FLORIDA DEPARTMENTOF CHILDREN AND FAMILIES STANDARD CON'rRAICT Client 0 Non -Client F1 TIIIS CONTRACT is entered into between the Florida Department ot'Children and Families, hereinafter referred to as the "department" and South Florida Behavioral Health Network Inc hereinafter referred to as the "provider", 1. THE PROVIDER AGREES: A. Contract Document I o provide services in accordance with the terms and conditions specified in this contract including all attachments and exhibits, which constitute the contract document. B. Requirements of Section 287.058, Florida Statutes (F.S.) Me 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 contract manager in writing prior to payment. The 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 1 12061, 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 provider in conjunction with this contract except that public records which are made confidential by law must be protected from disclosure. It is expressly understood that the provider's failure to comply with this provision shall Constitute an immediate breach of contract for which the department may unilaterally terminate the contract. C. Governing Law, lurisdiction and Venue 1. State of Florida Law ThIS COLAMCt is executed and entered into in the State of Florida, and shall be construed, performed and enforced in Lill respects in accordance with Florida law, without regard to Florida provisions for conflict of laws. Courts of competent jurisdiction in Florida shall have exclusive jurisdiction in any action regarding this contract and venue shall he as provided in PUR 1000. (see Section l.13[3) 1 Federal Law a. If this contract contains federal hands, the provider shall comply with the provisions ot'45 Code of Federal Regulations (CFR), Part 74, 45 CFR, Part 92, and other applicable regulations, b If this contract contains over $100,000 of federal funds, the provider shall comply with all applicable standards, orders, or regulations issued Linder section 306 ofthe Clean Air Act, as amended (42 United States Code (U.S,C.) 7401 et seq.)', section 508 of the Federal Water Pollution Control Act, as amended (33 U,S C 1251 etseq.). Executive Order 11738, as amended and where applicable, and Environmental Protection Agency regulations (40 CFR, Part 30). The provider shall report any violations of the above to the department, c. No federal funds received in connection with this contract may be used by the provider, or agent acting for the provider, or subcontractor to influence legislation Or appropriations pending before the Congress or any State legislature. If this contract contains federal funding in excess of$] 00,000, the provider must, prior to contract execution, complete the Certification Regarding Lobbying form, Attachment Lt. If a Disclosure oflobbyingActivities form, Standard Form LLI., is required, it may he obtained from the contract manager, All disclosure forms as required by the Certification Regarding Lobbying form must be completed and returned to the contract manager, prior to payment Linder this contract. d. Unauthorized aliens shall not be employed. 1-he department shall consider the employment of unauthorized aliens a violation of section 274A(e) of the Immigration and Nationality Act (S U.S.C.. 1324 a) and section 101 of the Immigration Reform and Control Act Of 1986. Such violation shall be cause for unilateral cancellation of this contract by the department, e. If this contract contains $10,000 or more of federal fluids, the provider shall comply with LXeCUfiVC Order 11246, FqUal Employment Opportunity, as anlended by Executive Order 11375 and others, and as supplemented in Department of labor regulation 41 CFR, Parthl) and 45 CF`R, Part 92, ifatip'licabic, t" If this contract contains federal funds and provides services to children Lip to age 18, the provider shall comply with the Pro -Children Act of 1994 (20 1 �.S,G 6081) Failure to comply with the provisions of the law may result in the imposition of civil monetary penalty of tip to $1,000 for each violation or the unpositton of an administrative compliance order on the responsible entity, or both. D. Audits, Inspections, Investigations, Records and Retention I The provider shall establish and maintain hooks, records and documents (including electronic storage media) SUffiCICIll 10 reflect all income and eXpeoduLUCS of funds provided by the department under this contract. 2. 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 provider for a period of six (6) years after completion of the contract or longer when required by law. fit the event an audit is required by this contract, records shall be retained for a minimum period of six (6) 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 department. 3. t Jpon demand, at no additional cost to the department, the provider will facilitate the duplication and transfer of any records or documents during the required retention period in Section 1, paragraph D. 2. 4 FhQse records shall be made available at all reasonable times for inspection, review, copying, or audit by Federal, State, or other personnel duty authorized by the department, (T Standard Contract 06/20 10 1 Contract # K11225 At all reasonable times for its long as records are maintained, persons duty authorized by the department and Federal auditors, pursuant to 45 CFR, section 92 36(1)(10), shall be allowed full access to and the right to examine any ol'the provider's contracts and related records and documents, regardless ofthe form in which kept, 6. A financial and compliance audit shall be provided to the department as specified in this contract and in Attachment III The provider shall comply and cooperate immediately with any inspections, reviews, investigations, or audits deemed necessary by The Office ofthe Inspector General (section 20 055, F,S), E. Monitoring by the Department The provider shall permit all persons who are duty authorized by the department to inspect and copy any records, papers, documents, facilities, goods and services ofthe provider which are relevant to this contract, and to interview any clients, employees and Subcontractor employees ofthe provider to assure the department ofthe satisfactory performance ofthe terms and conditions of this contract. Following such review, the department will deliver to the provider a Witten report of its findings, and request for development, by v the provider, of a corrective action plan where appropriate. The provider hereby agrees to timely correct all deficiencies identified in the corrective action plan. F. Indemnification I The provider shall be fully liable for the actions of its agents, employees, partners. or Subcontractors and shall fully indemnify, defend, and hold harmless the department and its officers, agents, and employees, from Suits, actions, damages, and costs ofevery name and description, including attorneys' fees, ansiniz, from or relating to any alleged act or omission by the provider, its agents, employees, partners, or subcontractors, provided, however, that the provider shall not indemnify for that portion of any loss or damages proximately caused by the negligent act or emission ofthe department. 2. Fuilher, the provider shall, without exception, indemnity and save harmless the department and its employees from any liability of any nature or kind whatsoever, including attorneys fees, costs and expenses, arising Out of, relating to or involving any claim associated with any trademark, copyrighted, pateriled, or unpatented invention, process, trade secret or intellectual property right, information technology used or accessed by the provider, or article manufactured or used by the provider, its officers, agents or subcontractors in the performance ol'this contract or delivered to the department for the use Of the department, its employees, agents or contractors. The provider may, at its option and expense, procure for the department, its employees, agents or contractors, the right to continue Use of, replace, or modify the product or article to render it non -infringing. If the provider is not reasonably able to modify or otherwise secure the department the right to continue using the product or article, the provider shall remove the product and refund the department the amounts paid in excess of a reasonable rental for past use. However, the department shall not be liable for any royalties. The provider has no liability when such claim is solely and exclusively due to the department's alteration ofthe product or article or the department's Misuse or modification ofthe provider's products or the department's operation or use of vendor's products in a manner not contemplated by this contract. I tie provider shall provide prompt written notification to the department of any claim of copyright, patent or other infringement arising from the performance Of this contract, 3. Further, the provider shall protect, defend, and indemnify, including attorneys' fees and costs, the department for any and all claims and litigation (including litigation initiated by the department) arising from or relating to provider's claim that a document contains proprietary or trade secret Information that is exempt from disclosure or the scope ofthe provider's redaction, as provided for under Section LET, 4 flie provider's Inability to evaluate liability or its evaluation of liability shall not excuse its duty to defend and indemnify alter receipt of notice. Only an adjudication or -judgment after the highest appeal is exhausted finding the department negligent shall excuse the provider of performance Linder this ' provision, in which case the department shall have no obligation to reimburse the provider for the cost oftheir defense, If the Provider is an agency or subdivision ofthe State, its obligation to indemnify, defend and hold harmless the department shall be to the extent permitted by law and without waiving the limits of sovereign immunity. G. Insurance Continuous adequate liability insurance coverage shall be maintained by the provider during the existence of this contract and any renewal(s) and extension(s) of it By execution of this contract, unless it is a state agency or subdivision as defined by subsection 768.28(2). F.S., the provider accepts full responsibility for Identity ting and determining the type(s) and extent of liability insurance necessary to provide reasonable financial protections for the provider and the clients to be served under this contract, the limits ot'coverage Linder each policy maintained by the provider do not lit -nit the provider's liability and obligations tinder this contract. Upon the execution of this contract, the provider shall furnish the department written verification Supporting both the determination and existence ot'such insurance coverage. Such coverage may he provided by a selluISUrance program established and operating Linder the laws ofthe State of Florida. The department reserves the right to require additional insurance as specified in this contract, 11. Confidentiality of Client information The provider shall not use or disclose any information concerning a recipient of services Linder this contract for any Purpose prohibited by state or federal law or regulations except with the written consent of person legally authorized to give that consent or when authorized by law. ' Assignments and Subcontracts 1. The provider shall not assign the responsibility for this contract to another part, y without prior written approval Of time departalent, upon the department's sole determination that such assignment will not adversely affect the public interest; however, in no event may 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 provider's duties hereunder. Any sublicense, assignment, or transfer otherwise occurring without prior approval ofthe department shall be null and void, The provider shall not subcontract for any ol'the work contemplated under this contract without prior written approval ofthe department, which shall not be unreasonably withheld, 2, 10 the extent permitted by Florida Law, and in compliance with Section I.F. of this Standard Contract, the provider is responsible for all work performed and f'or all commodities produced pursuant to this contract whether actually furnished by the provider or its subcontractors. Any Subcontracts shall be evidenced by a written document.The provider further agrees that the department shall not be liable to the subcontractor in any way or for any reason The provider, at its expense, will defend the department against such claims, CF Standard Contract 00/20 10 2 Contract # Kt1225 3 The provider shall make payments to any subcontractor within seven (7) working days after receipt of full or partial payments from the department in accordance with section 287.0585, F.S,, unless otherwise stated in the contract between the provider and subcontractor Failure to pay within seven (7) working days will result in I penalty that shall be charged against the provider and paid by the provider to the subcontractor in the arnount of one-half of one percent (,005) o fthe 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. Fhe State of Florida shall at all times be entitled to assign or transfer, in whole or part, its rights, duties, or obligations under this contract to another governmental agency in the State of Florida, upon giving prior written notice to the provider. In the event the State of Florida approves transfer of the provider's obligations, the 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 ofeither the provider or the department, 5. The provider shall include, or cause to be included, in all subcontracts (at any tier) the substance ofall clauses contained in this Standard Contract that mention or describe subcontract compliance, J. Return of Funds The provider shall return to the department any overpayments due to Unearned funds or funds disallowed that were disbursed to the provider by the department and any interest attributable to Such funds pursuant to the terms and conditions ofthis contract. In the event that the provider or its independent auditor discovers that an overpayment has been made, the provider shall repay said overpayment immediately without prior notification from the department. In the event that the department first discovers all overpayment has been made, the contract manager, on behalfof the department, will notify the provider by letter of such findings, Should repayment not be made forthwith, The provider will be charged interest at the lawful rate of interest on the outstanding balance after department notification or provider discovery. K. Client Risk Prevention and Incident Reporting 1. If services to clients are to be provided under this contract, the provider and any Subcontractors shall, in accordance with the client risk prevention system, report those [reportable situations listed in CFOP 2 15-6 in the manner prescribed in CFOP 2 15-6 or circuit or region operating procedures. 2. Fhe 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 I lotline on the statewide toll -free telephone number ( I-800-96ABUSE), As required by Chapters 39 and 415, F.S,, this provision is binding upon both the provider and its employees. L. Purchasing I , Articles 'which are the subject ofor are required to carry out this contract shall be purchased from Prison Rehabilitative Industries and Diversified Enterlirises, Inc., (PRIDE) identified Linder Chapter 946, F.S., in the same manner and under the procedures set forth in subsections 946,515(2)and (4), F,S, 'rot, purposes of this contract, the 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. 2, Me 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, and 287,045, F.S. M. Civil Rights Requirements I , In accordance with ]'tile 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 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 provider agrees not to discriminate against any applicant, client, or employee in service delivery or benefits its in connection with any of its programs and activities in accordance with 45 CFR 80, 93, 84, 90, and 91, Title VI of 1he Civil Rights Act of 1904, or the Florida Civil Rights Act of 1992, as applicable and CFOP 60-16. These requirements shall apply to all contractors, subcontractors, SUbgrantees or others with whom it arranges to provide services or benefits to clients or employees in connection with its programs and activities, Complete the Civil Rights Compliance Checklist, CF' Form 946 in accordance with CFOP 60-16 and 45 CFR 80. This is required ofall providers that have filleen (15) or more employees. Subcontractors who are on the discriminatory vendor list may not transact business with any public entity, in accordance with the provisions of287, 134, V S, N . Independent Capacity of the Contractor I In performing its obligations tinder this contract, the provider shall at all firries be acting in the capacity of an independent contractor and not as all officer, employee, yee, or agent of the State of Florida, except where the provider is a state agency. Neither the provider nor its agents, employees, subcontractors or assignees shall represent to others that it has the authority to bind the department unless specifically authorized in writing to do so. 2. Mrs contract does not create any right to state retirement, leave benefits or any other benefits of state employees as a result ofperformingthe duties, or obligations of this contract. 3. I'lic provider shall take such actions as may be necessary to ensure that each subcontractor of the provider will be deemed to be an independent contractor and will not be considered or permitted to be an agent, servant, joint venturer, or partner of the State of Florida. 4 r Fhe department will not fumish services of support (e.g,, office space, office supplies, telephone service, secretarial or clerical -support) to the provider, or Its subcontractor or assignee, unless specifically agreed to by the department in this contract, 5 All deductions for social Security, withholding taxes, income taxes, contributions to unemployment compensation funds and all necessary insurance for the provider, the provider's officers, employees, agents, subcontractors, or assignees shall be the sole responsibility of the provider. CF Standard Contract 0612010 3 Contract# K11225 O. Sponsorship As required by section 286.25, VS,, if the 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 (provider's name) and the Spite of Florida, Department ol'Children and Families". If the sponsorship reference is in written material, the words "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, 11. Publicity Without limitation, the provider and its employees, agents, and representatives will not, without prior departmental written consent in each instance, use in advertising, Publicity or any other promotional endeavor any State mark, the name of the State's mark, the name of the State or any State affiliate or any officer or employee of the State, or represent, directly or indirectly, that any product or service provided by the provider has been approved or endorsed by the State, or refer to the existence of this contract in press releases, advertising or materials distributed to the provider's prospective customers, Q. Final Invoice The final mvoice for payment shall be submitted to the department no more than 31 days after the contract ends or is terminated. If the provider fails to do so, all rights to payment are forfeited and the department will not honor any requests submitted after the aforesaid time period. Any payment due Linder the terms ofthis contract may be withheld until all reports due front the provider and necessary adjustments thereto, have been approved by the department. R. Use of Funds for Lobbying Prohibited The provider shall comply with the provisions of sections 11.062 and 2 16,347, F.S., which prohibit the expenditure of contract funds for the purpose of lobbying the I egislature, Judicral branch, or a state agency. S. Public Entity Crime PursUant to section 28TI 33, F.S., the following restrictions are placed on the ability of persons convicted ofpublic entity crimes to transact business with the department. When a person or affiliate has been placed on the convicted vendor list following a conviction for a public entity crime, he/she may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or the repair of public building or public work, may not submit bids, proposals, or replies on leases of real property to a public entity; rinay, not be awarded or perform work as a contractor, supplier, subcontractor, or consultant tinder 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 ofthirty-six (36) months from the date of being placed on the convicted vendor list T. Gratuities I I -lie provider agrees that it will not offer to give or give any gill to any 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 department, any violation ofthis provision will result in referral of the provider's name and description ofthe violation ofthis term to the Department of Management Services for the potential inclusion of the provider's name on the suspended vendors list for air appropriate period. The provider will ensure that its subcontractors, ifany, comply with these provisions. U. Patents, Copyrights, and Royalties 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 provider's performance tinder this contract, and the performance ofall 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 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 ofthis 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 ot'work or services performed Linder this contract, or in anyway connected herewith. Notwithstanding the foregoing provision, if the provider is a university and a member of the State University System ofFlorida, then section lOO4.23,F,S,,shall apply. 1 If the provider use.,' or delivers to the department for or 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 toy,altics Or costs arising from the use of'such design, device, or materials in any way involved in the work contemplated by this contract, 3. 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 rs developed in file Course of or Linder the subcontract. V. Construction or Renovation of Facilities Using State Funds Any state funds provided for the purchase of or improvements to real property are contingent upon the 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 former required by law. As a condition of'receipt of state funding for this purpose, the provider agrees that, if it disposes of the property before the department's interest is vacated, the provider will refund the proportionate share of the states initial investment, as adjusted by depreciation, W. Information Security Obligations I An appropriately skilled individual shall be identified by the provider to function as its Data Security Officer. The Data Security Officer shall act as the liaison to the department's Security stalfand will maintain an appropriate level of data Security for the information the provider is Collecting Or Using in the performance of this contract. An appropriate level of security includes approving and tracking all provider employees that request or have access to any departmental data system or information. The Data Security Officer will ensure that user access to the data system or information has been removed from all terminated provider employees. 2. Me provider shall provide the latest departmental Security awareness training to its staff and subcontractors who have access to departmental information. CF Standard Contract 00/2010 4 Contract# K11225 3 All provider employees who have access to departmental information shall comply with, and be provided a copy of CFOP 50-2, and shall sign the DCF SectiiityAgreement form CF0114annually. A copy ofCF 0114 may be obtained from the contract roariager, 4, '1 lie 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 CF0P 50-2. If encryption of these devices is not possible, then the provider shall assure that Unericrypted personal and confidential departmental data will not be stored on unencrypted storage devices. The provider shall require the same of all subcontractors. 5. The provider agrees to notify the contract manager as soon as possible, but no later than five (5) business days following the determination of any breach or potential breach of personal and confidential departmental data. The provider shall require the same notification requirements of all subcontractors 6. T'he provider shall provide notice to at , fected parties no later than 45 days following the determination of any potential breach of personal or confidential departmental data provided in section 817 5681, F.S. The provider shall require the same notification requirements of all subcontractors, X. Accreditation Me department is committed to ensuring provision of the highest quality services to the persons we serve. Accordingly, the department has expectations that where accreditation is generally accepted nationwide as a clear indicator of quality service, the majority of the department's providers will either be accredited, have a plan to meet national accreditation standards, or will initiate a plan within a reasonable period of time. Y. Provider Employment Opportunities Agency for Workforce Innovation and Workforce Florida: The provider understands that the department, the Agency for Workforce Innovation, and Workforce Florida, Inc., have jointly implemented an initiative to empower recipients in theTemporary Assistance to Needy Families Program to enter and remain in gainful employment. The department encourages provider participation with the Agency for Workforce Innovation and Workforce Florida. 2, Transitioning Young Adults: The provider understands the department's Operation Full Employment initiative to assist voting adults aging Out of the dependency system. The department encourages provider participation with the local Community -Based Care Lead Agency Independent [,,lying Program to offer gainful employment to Youth in foster care and Young adults transitioning from the foster care system. Z. Health insurance Portability and Accountability Act The provider shall, where applicable, comply with the Health Insurance Portability and Accountability Act (42 U. S. C. I 320d.) as well as all regulations promulgated thereunder (45 CFR Parts 160, 102, and 164). AA. Emergency Preparedness I , If the tasks to be performed pursuant to this contract include the physical care or supervision of clients, the provider shall, within 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, Supplies, and a recovery plan that will allow the 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 department, or its contracted agents to ensure the safety, permanency and well-being of child who is tinder the jurisdiction of 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, 2. The department agrees to respond in writing within 30 days of receipt ofthe plan accepting, rejecting, or requesting modifications. In the event of an emergency, the department may exercise oversight authority over Such provider in order to assure implementation of agreed emergency relief provisions. 3. An updated emergency preparedness plan shall be Submitted by the provider no later than 12 months following the acceptance of an original plan or acceptance of an updated plan. The department agrees to respond in writing within 30 days of receipt of the updated plan, accepting, rejecting, or requesting modification to the plan. 135. ITIR (Purchasing) 1000 Form I'lle PUR 1000 Form is hereby incorporated by reference, In the event of any conflict between the PUR 1000 Form, and any terms or conditions of this contract (including the department's Standard Contract), the terms or conditions of this contract shall take precedence over the PUR 1000 Form. However, if the conflicting terms or conditions in the PUR 1000 Form are required by any section of the Florida Statutes, the terms or conditions contained in the PUR 1000 Form shall take precedence CC. Notification of Legal Action Me provider shall notify the department of legal actions taken against them or potential actions such as lawsuits, related to services provided through this contract or that may impact the provider's ability to deliver the contractual services, or adversely impact the department. The department's contract manager will be notified within 10 days of provider becoming aware of such actions or from the day of the legal filing, whichever conics first. DD. Whistleblower's Act Requirements In accordance with subsection 1123 187(2), F S_ the provider and its subcontractors shall not retaliate against all 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 V person who discloses information to an appropriate agency alleging improper use ot'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 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, CF Standard Contract 00/20 10 5 Contract # K11225 EK Proprietary or'frade Secret Information 1. Unless exempted by law, all public records are Subject to public inspection and copying under Florida's PUbIlC Records Law, Chapter 119, F.S.Any claim by provider of proprietary or trade secret confidentiality for any information contained in provider's documents (reports, deliverables or vvorkpapers, 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 paragraph 2 below. 2, '1 lie provider Must Clearly I abel 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 ofthe information from public disclosure. II'different exemptions are claimed to be applicable to different portions ofthe protected information, the provider shall include information correlating the nature ofthe claims to the particular protected information. 3. the department. when required to comply With a public records request including documents submitted by the provider, may require the provider to expeditiously Submit redacted copies of documents marked as confidential or trade secret in accordance with paragraph 2 above. Accompanying the submission shall be air updated version ofthe -justification tinder paragraph 2, correlated specifically to redacted information. The redacted copy must exclude or obliterate only those exact portions that are claimed to be proprietary or trade secret. If the provider falls to promptly submit a redacted copy and UpdatedJUStifiCatiOn in accordance with this paragraph, the department is authorized to produce the records sought without any redaction of proprietary or trade secret information. 4, fhe department is not obligated to agree with the provider's claim of exemption on the basis of proprietary or trade secret confidentiality and the provider ,,hall be responsible for defending its claim that each and every portion ofthe redactions of proprietary or trade secret information are exempt from inspection and copying Under Florida's Public Records Law. FF. Support to the Deaf or I lard-of-Illearing The provider and its subcontractors, where direct services are provided, shall comply with section 504 ofthe Rehabilitation Act of 1973, 29 U.S.C. 794, as implemented by 45 C.P.R. Part 84 (hereinafter referred to as Section 504). the Americans with Disabilities Act of 1990, 42 U,SC, 12131, as implemented by 28 C,t,,R, Part .15 (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 Flard-ofllearing." I If the provider or any Of its Subcontractors employs 15 or more employees, the provider shall designate a Single -Point -of -Contact (one per firm) to ensure effective Communication with deaf or hard -of -hearing Customers or companions in accordance with Section 504, the ADA, and CF`OP 60- 10, Chapter 4, The name and contact information for the provider's Single -Point -of -Contact shall be furnished to the department's Grant or Contract Manager within 14 calendar days ofthe effective date of this requirement, 2. Fhe provider shall, within 30 days ofthe effective date of this requirement, contractually require that its subcontractors comply with section 504, the ADA, and (TOP 60- 10, Chapter 4. A Single-Point-of-Contactshall be required for each Subcontractor that employs 15 or more employees. This Single - Poi nt-of Contact will ensure effective COull-IlUniCatiOn with deaf or hard -of -hearing Customers or companions in accordance with Section 504 and the ADA and coordinate activities and reports with the provider's Single -Point -of -Contact. 3 The Single: Point -of -Contact shall ensure that employees are aware ofthe requirements, roles & responsibilities, and contact points associated with o Cmpliance with Section 504, the ADA, and CFOP 60-10, Chapter 4. Further, employees of 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. 4. The 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 IOCa10011S. Such Notices must be posted immediately by providers and Subcontractors. The approved Notice can be downloaded through the Internet at fittp.//%vww.dcfstate.fl.tis/zidniinlig/civilriglits,slitinI 5. The 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 piowder shall submit compliance reports monthly, by the 5" business day following the reporting month, to the department's Grant or Contract Manager, The provider shall distribute Customer Feedback forms to Customers or companions, and provide assistance in completing the forms as requested by the customer or companion. 6. if customers or companions are referred to other agencies, the provider must ensure that the receiving agency is notified ofthe customer's or companion's preferred method of communication and any auxiliary aids/service needs, 11. VIIE DEPARTMENT AGREES: A. Contract Amount The department shall pay for contracted services according to the terms and conditions of this contract ofan amount not to exceed $362,976,259.00 or the rate schedule, subject to the availability of funds. The State of Florida's performance and obligation to pay Linder this contract is contingent upon all annual appropriation by the Legisdature. Any costs Or services paid for Linder any other contract or from any other source are not eligible for payment under this contract. 14. Contract Payment Pursuant to section 215,422 F S_ the department has five (5) working days to inspect and approve goods and services, unless the bid specifications, Purchase order, or this contract specify otherwise With the exception of payments to healthcare providers for hospital, medical, or other health care services, if payment is not available within lorry (40) days, measured from the latter ofthe date a properly completed invoice is received by the department or the goods or services tire received, inspected, and approved, a separate interest penalty set by the Chief Financial Officer pursuant to section 55,03, FS., will be due and payable in addition to the invoice aniount, payments to health care providers for hospital, medical, or other health care services, shall be made not more than thirty-five (35) days from the date eligibility for payment is determined. Financial penalties will be Calculated at the daily interest rate of.03333%, Invoices returned to it 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 provider requests payment, CF Standard Contract 00/20 10 6 Contract K11225 C. Vendor Ondbodsinan A Vendor Ombudsman has been established within the Department of Financial Services, The duties ofthis office are found in section 215,422, F.S., which include disseminating information relative to Prompt payment and assisting vendors in receiving their payments in a timely manner from a state agency. The Vendor Ombudsman may be contacted at (850) 413-55 16, D. 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 provider responsible for administration of the program, to the designated address contained in this contract Ill. 'Fill," PROVIDER AND DEPARTMENT muru,icll-U AGREE: A. Effective and Ending Dates This contract shall begin on October I. 2010, or on the date on which the contract has been signed by the last party required to sign it, whichever is I ater, It shall end at midnight, local time in Miami Dade County, Florida, on September 30, 2015. B. Financial Penalties for Failures to Comply with Requirement for Corrective Actions I In accordance with the provisions of section 402.73(1), F.S., and Rule 65-29,00 1, F.A.0 , corrective action plans may be required for noncompliance, nonperformance, or unacceptable performance Linder this contract. Penalties may be imposed for failures to implement or to make acceptable Progress on such corrective action plans. 2, [lie increments of penalty y imposition that shall apply, unless the department 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. Ate penalty, if imposed, shall not exceed ten percent (10%) of the total contract payments during the period in which the corrective action plan has not been implemented or in which acceptable progress toward implementation has not been made. Noncompliance that is determined to have a direct effect on client health and safety shall result in the imposition of 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. 3. Noncompliance involving the provision of service not having a direct effect on client health and safety shall result in the imposition of five percent (5°14) penalty, Noncompliance as a result of unacceptable performance of administrative tasks shall result in the imposition of two percent (2%) penalty, 4 The deadline for payment shall be as stated in the Order imposing the financial penalties. In the event of nonpayment the department may deduct the amount of the penalty from invoices submitted by the provider. C. Fernaination I , 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 provider responsible for administration of the program, 2. In the event funds for payment pursuant to this contract become unavailable, the department may terminate this contract upon no less than twenty-four (24) hours notice in writing to the provider. Said notice shall be sent by U.S. Postal Service or any expedited delivery service that provides verification of deli\Tfy. The department shall be the final authority as to the availability and adequacy of funds. In the event ofterminationofthis contract, the provider will be compensated for any work satisfactorily completed. 3. This contract may be terminated for the provider's non-performance upon no less than twenty-four (24) hours notice in writing to the provider. If applicable, the department may employ the default provisions in Rule 60A- 1,006(3), F.A.C. The department's failure to demand performance of any provision ofthis contract shall not be deemed a waiver of such performance. The department's waiver of any one breach of any provision ofthis contract shall not be deenied to be a waiver of any other breach and neither event shall be construed to be a modification of the terms and conditions ofthis contract fhe provisions herein do not limit the department's right to remedies at law or in equity. 4 Failure to have performed any contractual obligations with the department in a manner satisfactory to the department will be a sufficient cause for termination. To be terminated as a provider Linder this provision, the provider must have: ( I ) previously failed to satisfactorily perform in a contract with the department, been notified by the department of the unsatisfactory performance, and failed to correct the Unsatisfactory performance to the satisfaction of the department, or (2) had a contract terminated by the department for cause. 1). 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 identified in the department's operating budget. Cl` Standard Contiact 06/2010 7 Conuact # K11225 (Ajh,crjj j,ayc Alleff Representatives (Nantes, Addvosc'*. 'I'VIPPI1011C Numbers. iAtKi C-0101 Addt'OUSt: I Tile pl-ovaicv nanw, as 0)owli on t}agv' I coilttacU and Inaillov 3, 1 fie morle, ailkircs" fe'lcillum1c 11villtvr atilt V-Imoi adklr",oithe c(alwict flljmq't'r ltirc of, thc k4ficial jlayex it, whom (ti(,, payinctit shall he madc is liar trw &Ttartment for tlws l:onmict e" mic: somb vioviklzt b0l;4vioral Hcalth Nc(wofk- lo,;, . ...... v ss: 140 Soltb Nixie lb"h—V S"ite `04 Addrs as401 NW Avertuc StliW N-82t,� `state Ft Zip ( o4e�13 1,13 City: Miami sultc: F1 Zip Code: Phone, 3il't-377-7650 11holic. 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Fhcu aw no provisvw", WrIll," c"adirlons, orobtipatiow,, oilicr ffilin those Qoolamcd lx"rem' vuxt tht""onlract sJuill "uper"'cdc all pf;viow, of ajlavcf;wms' eltht-r tvvbal w, wriacil belwcm the parms, If ant, lVil'o (41 Pr(Wtsion cal` this ckimrac( I, li'v3fly lictcrillitwd unbwl'14 ol, the tvilmilldef, oftii,, coainwt shAl lvilmin m tali t'ovtx and cticct and �'mh teml ot provision 'h')jI I'K' '11 iQkctl. Rv siggling this vootrav'C the purtiv% agree that sbc�k h1tvc read asitt itgmc to the votiry runtram as, describcd io Paragraph (it. '. alIovc IN WVUNE'sl^ 'I'VIVREOF, 6w paille", ilt"Icto hav"' cattsej jjji; llJqb pw,c conmict to he exc"'kiwd by Ilwil antdtcrrakrncrs offkialls duly audocuek"d, FLORIDA OF (411111,11IMEN AND F8MII,IE', South Florida Behavioral Health Network, im, f sittjmtorc� Prifif"I'y1le N a Itiv: Ville: J"Xo'.uovk� Dilel:ior—faf — Dattic matte S'1'A'fC AGENC8 29 1)1(;l t FL'Alliz com".: Ft-deral Lix ID # (or S'SN)' �9 �13'45099 Provider Vkcal Yvar FAId4lit Pate. Dirvvtor APPROVU) kS TO FORM AND tFwM SUFFICJENCV . . . . ...... . . .. 4sIC fUAid Cl, '""uiodwtt ( mir"40 06 ;(rla+ k "Oti'Ad ,` M122� 10/01/2010 Managing Entity ATTACHMENT I A. SERVICES TO BE PROVIDED 1. Definition of Terms a. Contract Terms Contract terms used in this document can be found in the Florida Department of Children and Families Glossary of Contract Terms, which is incorporated herein by reference. b. Program/Service Specific Terms (1) "Accessible" — Children, families and community members should be helped to become knowledgeable about how to ask for and receive services that are timely, comprehensive and family -friendly without facing unreasonable barriers. (2) "Activity" means an educational process or procedure intended to stimulate learning. (3) "Annual Action Plan" means an annual plan developed by the managing entity and approved by the department that contains the deliverables for the ten baseline functions and other requirements for the behavioral health services needs for the Southern Region. (4) "Approaches" mean the methods used in dealing with or accomplishing a task or goal. (5) "Approved Regional Plan" means a plan established by the department in accordance with section 394.674, F.S. and section 394.675, F.S. and updated annually or as required. (6) "ASAM PPC-2R Florida Supplement" means the American Society of Addiction Medicine, Patient Placement Criteria for the Treatment of Substance Related Disorders, second edition - revised, July 1, 2001, or the latest revised edition thereof. (7) "Assessment Instrument" means a tool used for collection of detailed information concerning an individual's substance abuse, emotional and physical health, social roles, and other areas that may reflect the severity of the individual's abuse of alcohol or drugs, as a basis for identifying an appropriate treatment regimen. (8) "Available Appropriations" means State and other governmental funds allocated for mental health and substance abuse services including prevention and the associated local matching funds. South Florida Behavioral Health Network, Inc. 9 KH225 W111KIWI Managing Entity (9) Behavioral Health Services" means mental health services and substance abuse prevention and treatment services as defined in chapters 394, 397 and 916, F.S. which are provided using state and federal funds. (10) "CFP 155-2 Department of Children & Families, Pamphlet 155-2 - Mental Health and Substance Abuse Measurement and Data, effective September 2008 (9th edition, version 1)", or the latest revised edition thereof means a document promulgated by the department that contains required data -reporting elements for substance abuse and mental health services, hereafter referred to as "CFP 155-2", and which can be found at: http://www.def.state.fi.us/mentalhealth/publications/index.shtmi, and is incorporated herein by reference. (11) "Client Fees" means compensation to the managing entity's contracted network providers for services rendered to the client, who has been authorized to receive services pursuant to this contract, from any source of funds, including city, county, state, federal, private sources and client paid. (12) "Clinical Assessment" means the collection of detailed information concerning an individual's behavioral health, emotional and physical health, social roles, and other areas that may reflect the individual's overall health as a basis for identifying an appropriate treatment regimen. (13) "Clinician" means a substance abuse or mental health professional that provides one or more of the following services: assessment; individual, group, or family counseling services; or case management. (14) "CODECATTM (Co-occurring Disorders Educational Competency Assessment Tool)" means a tool used to evaluate clinicians' training needs based on a competency assessment to determine knowledge, skills, attitudes, and values relative to persons with co-occurring disorders. (15) Comprehensive Community Action Plan" means a plan developed by a local, department recognized, community substance abuse coalition which is based on an assessment of substance abuse related epidemiology data and the resources needed to address identified needs. The plan includes goals to reduce the community's prioritized substance use problems and the approaches to take to achieve them. (16) "Community -Based Services" means behavioral health services provided outside of a state facility. South Florida Behavioral Health Network, Inc. 10 KH225 10/01/2010 Managing Entity (17) "Community -Focused" means the process of planning, management and decision -making to ensure resources are designed to build on the unique strengths and meet the specific needs of the local community. (18) "Community Prevention" means strategies and activities aimed at changing community conditions related to substance abuse. It includes environmental strategies designed to change one or more community conditions. Community prevention is aimed at larger universal populations and selected sub -populations and does not track specific individuals. (19) "COMPASSTM (Comorbidity Program Audit and Self -Survey for Behavioral Health Services)" means a tool that can be used by behavioral health care systems to assess program competencies in multiple areas that reflect the basic expectations of program performance for mental health services, substance abuse disorder services and integrated systems of care. (20) "Comprehensive Continuous Integrated System of Care (CCISC)" means the model for improving service system wide to individuals with co-occurring psychiatric and substance disorders. "Comprehensive, Continuous, Integrated System of Care (CCISC) model" means 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, (21) Consolidated Program Description" means the combination of all of the managing entity network providers' program descriptions and the managing entity program description. (22) "Continuous Quality Improvement" means continuous internal improvements in service provision and administrative functions. These include the systematic ongoing process of improving performance, both in process and end of process indicators. (23) "Continuum of Services" Recovery -oriented systems of care will offer a full array of services, including pretreatment, treatment, continuing care and support throughout recovery. Individuals will have a full range of stage -appropriate services from which to choose at any point in the recovery process. South Florida Behavioral Health Network, Inc. 11 KH225 10/01/2010 (24) "Contract Manager" means the department 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 department and the provider. All actions related to the contract shall be initiated by or coordinated with the contract manager. (25) "Co-occurring Disorder" means any combination of mental health and substance abuse in any individual, whether or not they have been already diagnosed. Families impacted by co-occurring disorders are characterized by a family where one member has one kind of problem, like a child with an emotional disturbance, and another member has another kind of problem, like a family member or caregiver with a substance abuse issue. (26) "Co-occurring Disorder Service Capability" means the ability of any program to coordinate every aspect of its program infrastructure (policies, procedures, practices, documentation, and/or staff competencies), within its existing resources, to be able to provide and/or coordinate appropriately matched, integrated services to the individuals and families with co-occurring disorders that are routinely presenting for care in that program. (27) "Cost Analysis" means the review of the proposed cost elements to determine if they are necessary, allowable, appropriate and reasonable. (28) "Cost Center" means a grouping of services that is similar in time, intensity and function where the average cost for service is generally the same, and are specified in the State Funding by Program and Activity which is incorporated herein by reference. See Rule 65E- 14.021(7), Florida Administrative Code (F.A.C.), and the Substance Abuse Recovery Support Services (Individual and Group), Comprehensive Community Service Teams, and Clinical Supervision for Evidence -Based Practices (which are incorporated herein by reference) for a complete listing of services that comprise the cost centers. The Children's Mental Health Comprehensive Community Service Team (CCST) cost center is described in Exhibit H, Children's Mental Health Community Service Team. (29) "Data Management" means activities that use data elements to track cost, utilization, quality of care and access to services within the network of providers. "CFP 155-2 Department of Children & Families, Pamphlet 155-2 - Mental Health and Substance Abuse Measurement and Data, effective September 2008 (9th edition, version 1)", or the latest revised edition thereof means a document promulgated by the department that contains required data -reporting elements for substance abuse and mental health services, hereafter referred to as "CFP 155-2", and which can be found at: South Florida Behavioral Health Network, Inc. 12 KH225 10/01/2010 Managing Entity http://www,dcf.state.fl,us/mentalhealth/pubIicatioiis/index,shtml, and is incorporated herein by reference. (30) "Epidemiology data" means data relating to factors affecting the health and illness of populations that serve as the foundation and logic of interventions made in the interest of public health. (31) "Evidence -Based Practices" means those practices that are based on accepted practices in the profession and are supported by research, field recognition, or published practice guidelines. (32) "Family Intervention Specialists/Adult Intervention Specialists (FIS)" means individuals employed to provide adult behavioral health outreach, screening, intervention, and case management to families involved in the child welfare system and/or the Abuse Hotline. (33) "Family Intervention Specialist Services" means 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. (34) "Florida Department of Children and Families Strategic Intent" means the Secretary's Strategic Intent gives guidance and summarizes the department's major initiatives. This document provides the Secretary's intent on what the department and its partners must accomplish during a specific period of time. The Secretary's guidance drives the development of the department's Strategic Plan, which depicts how the department will achieve these initiatives, when they will be accomplished and the metrics used to measure progress. (35) "Forensic Mental Health Services" means Forensic Mental Health Services provide services to individuals with mental illness pursuant to Chapter 916, Florida Statutes. (36) "Global Assessment of Individual Needs (GAIN)" means one of the department approved evidenced -based assessment instrument. Information regarding this instrument can be obtained from the following website: Ott /kwwv.chestnt.or �11/ a�in/ (37) "Governing Board" means the Commission, Board of Directors, Board of Trustees, Governing Body, etc, (38) "HIPAA" is the acronym for Health Insurance Portability and Accountability Act. (39) "Incompetent to Proceed (ITP)" as defined in chapter 916 F.S., means unable to proceed at any material stage of a criminal South Florida Behavioral Health Network, Inc. 13 KH225 Managing Entity proceeding, which shall include trial of the case, pretrial hearings involving questions of fact on which the defendant might be expected to testify, entry of a plea, proceedings for violation of probation or violation of community control, sentencing, and hearings on issues regarding a defendant's failure to comply with court orders or conditions or other matters in which the mental competence of the defendant is necessary for a just resolution of the issues being considered. (40) "Indigent Drug Program (IDP)" means the program that allows the Department of Children and Families to purchase medications for individuals who are indigent. (41) "Individual(s)Served" is (synonymous with recipients, individual(s), and persons who are receiving services, also synonymous with client/consumer) — Any individual who is receiving services in any substance abuse treatment or prevention program or mental health treatment program whose cost of care is paid, in part or in whole, by the department, Medicaid, Medicaid capitated managed care entities, or local match. (42) "Juvenile Incompetent to Proceed (JITP)" means a "child" or "juvenile" or "youth" as defined in chapter 985, F.S., as any unmarried person under the age of 18 who has not been emancipated by order of the court and who has been found or alleged to be dependent, in need of services, or from a family in need of services; or any married or unmarried person who is charged with a violation of law occurring prior to the time that person reached the age of 18 years. (43) "KIT Solutions" means the entity that maintains the database called Performance Based Prevention System (PEPS). (44) "Local Match" means funds received from governing bodies of local government, including city commissions, county commissions, district school boards, special tax districts, private hospital funds, private gifts both individual and corporate, bequests and funds received from community drives or any other sources. See section 394.67(14), F.S. and 65E-14.005, F.A.C. (45) "Managing Entity (ME)" means pursuant to section 394.9082(2)(d), F.S., a corporation that is organized in the State of Florida, is designated or filed as a non-profit organization under section 501(c)(3) of the Internal Revenue Code, and is under contract to the department to manage the day-to-day operational delivery of behavioral health services through an organized system of care. (46) "Monitoring Subcontracts" is the process entity conducts a systematic organized review performance in order to give reasonable assi South Florida Behavioral Health Network, Inc. 14 whereby the managing of a network provider's trance that the network f� Managing Entity provider is complying with subcontract requirements, rules, regulations and laws applicable to contract performance. (47) "Overpayment" means for the purposes of this contract, the amount of money the department has paid the managing entity for administrative expenses and/or program expense over and above what was properly earned for these expenses by the managing entity according to the approved line item budget. (48) "Participant" means any individual who takes part in targeted substance abuse prevention programs, activities or services which are paid, in part or in whole, by the department. (49) "Payor class" means 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, and charity care. (50) "P13PS" means the Performance Based Prevention System that collects data related to Substance Abuse Prevention programs and activities. The system can be accessed by contacting technical support at 1-888-600-4777 or (51) "Performance Measures" means quantitative indicators, outcomes and outputs that are used by the department to objectively measure performance and are used by the managing entity and network providers to improve services. (52) "Prevalence" means the count of all individuals affected by a disease/condition within a particular period of time, compared with the entire population of concern. (53) "Prevention" means a process involving strategies aimed at the individual or the environment which preclude, forestall, or impede the development of substance abuse problems and promote healthy development of individuals, families and communities. (54) "Prevention Program Description (PPD)" means the report generated by the PPT that contains the information required for a program description pursuant to Rule 65E-14.021, Florida Administrative Code (F.A.C.). (55) "Program Planning Tool (PPT)" means the data collection module contained in the Performance Based Prevention System that collects a variety of program information. It is designed to assure substance abuse prevention contracts reflect best practices and level of effort, inform the department's provider support system, and set the stage for determining effectiveness in achieving prevention outcomes, South Florida Behavioral Health Network, Inc. 15 KH225 ff1X11R RUS Managing Entity (56) "Program" means a structured Schedule of Activities designed so that participants will attain so far as possible, certain educational, attitudinal, social and behavioral objectives. This is an unduplicated count of participants. (57) "Program Description" means the document the provider prepares and submits to the department for approval prior to the start of the contract period, which provides a detailed description of the services to be provided under the contract pursuant to Rule 65E-14.021, F.A.C. It includes but is not limited to the provider's organizational profile, a detailed description of each program and cost center funded in the contract, the geographic service area, service capacity, staffing information, and client and target population to be served. (58) "Projects for Assistance in Transition from Homelessness (PATH)" means the Federal grant to support homeless individuals with behavioral health needs. (59) Promising Practices" means the use of practices that incorporate the best objective information available regarding effectiveness and acceptability. (60) "Prorated Share" means the total number of unpaid units or funds divided by the number of months remaining between the time the prorated share is calculated and the end date of the contract. (61) "Protected Health Information" (PHI) means 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. (62) "Provider Network" (subcontractor or network provider) means the direct service agencies that are under contract with a managing entity and that together constitute a comprehensive array of emergency, acute care, residential, outpatient, recovery support, and consumer support services or other services as designated by this contract. See section 394.9082, F.S. (63) "Quality Improvement/Continuous Quality Improvement" means 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 South Florida Behavioral Health Network, Inc. 16 KH225 I Managing Entity 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. (64) "Readiness Assessment" means a formalized process to determine the operational capacity of a managing entity to satisfactorily perform required duties. (65) "Recovery" means an on -going process which enables a person with behavioral health issues to live a meaningful life in a community of his or her choice while striving to achieve his or her potential. This allows individuals to improve their health, wellness, and quality of life. (66) "Recovery Based" is based upon a personal process of overcoming the negative impact of substance abuse addiction or mental illness. A system of care provides treatment and supports that promote recovery and functioning in the community. (67) Representative Payee" means an entity/individual who is legally authorized to receive Supplemental Security Income, Social Security Income, Veterans Administration benefits, or other federal benefits on behalf of an individual served. (68) "SAMH" means the Substance Abuse and Mental Health Programs within the department. (69) "Schedule of Activities" means the defined instructional content, materials, resources, and processes in order to attain educational objectives. (70) "Service Units" means those units of measure specified in Rule 65E- 14.021(7), F.A.C. and in Substance Abuse Recovery Support Services, Comprehensive Community Service Teams, and Clinical Supervision for Evidence Based Practices. (71) "SOAR" stands for "SSI/SSDI Outreach, Access and Recovery" and is a technical assistance initiative. This strategy helps States and communities increase access to SSI and SSDI for people through training, technical assistance and strategic planning. (72) "Stakeholder" means individuals/groups with an interest in the provision of behavioral health services. (73) "Statewide Inpatient Psychiatric Programs (SIPP)" means residential inpatient facilities under contract with the Agency for Health Care Administration under the Medicaid IMID waiver for children under age 18 to provide diagnostic and active treatment services in a secure setting. South Florida Behavioral Health Network, Inc. 17 KH225 ONDIRZOOP, Managing Entity (74) "Substance Abuse and Mental Health Information System (SAMHIS)" means the department's online data system which providers are required to use to collect and report data and performance outcomes on persons served whose services are paid for, in part or in whole, by the department's Substance Abuse and Mental Health (SAMH) contract, Medicaid, or local match. Instructions on how to access the system can be found in CFP 155-2. (75) "System of Care" means behavioral health services that are coordinated and developed into an integrated network of services accessible and responsive to the needs of individuals served, their families, and community stakeholders. (76) "TANF Participant" means a person or family member of that person defined in 45 CFR Part 260.30 and section 414.1585 and subsection 414.0252(9), F.S. (77) "Targeted Prevention" means prevention programs or other Schedule of Activities conducted with individuals or groups of individuals to educate them on personal prevention concepts and skills and consists of prevention programs or curricula. (78) "Temporary Assistance to Needy Families (TANF)" means cash assistance for families, including any family receiving cash assistance payments or TANF diversion services from the state program pursuant to the provisions of section 414.045, F.S., and Part A of Title IV of the Social Security Act. (79) "Transformation" means a process that strives to change the form and function of the behavioral health services delivery system to better meet the needs of the individuals and families it is designed to serve. (80) "Utilization Management" means 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. 2. General Description a. General Statement This contract is for the purchase of the administration, management, and oversight of a consumer -centered and family -focused comprehensive coordinated system of care by a managing entity. The contract requires the managing entity to subcontract with qualified, direct service, community -based network providers who will provide services for adults and children with behavioral health issues as authorized in section 394.9082, F.S. and which are consistent with the Approved Regional Plan. South Florida Behavioral Health Network, Inc. 18 KH225 liplemilts] Managing Entity The managing entity will provide administrative and programmatic oversight to ensure that network providers comply with all consumer -related services and other requirements of this contract. b. Approved Annual Action Plan 'The managing entity will develop and operationalize an annual action plan in partnership with the department, which is incorporated herein by reference. This action plan will be approved by the department on an annual basis and may be modified by mutual agreement and approved/dated by the managing entity Executive Director and the approved department Representative i.e., the Southern Region SAMH Program Supervisor. A copy of any revisions to the approved annual action plan shall be provided to the department's contract manager. c. Baseline Functions There are ten (10) baseline functions that the Managing Entity must provide. Performance on these functions will be provided in the Approved Annual Action Plan. The deliverables are outlined in the Annual Action Plan. These functions are as follows: (1) Function 1. System of Care Development and Management Behavioral health services that are coordinated and developed into an integrated network of services accessible and responsive to individuals in need of substance abuse and mental health services, families, and community stakeholders. To accomplish this, managing entities support the application of evidence based practices through contracting requirements, program development and design, training, quality improvement activities, and the development of mechanisms for care management and service coordination. (2) Function 2. Utilization Management Systems to ensure cost-effective and clinically appropriate utilization of treatment services. For the purposes of this contract, the specific goals of utilization management include the elimination/management of wait lists, the maximum utilization of treatment resources, and the delivery of clinically appropriate services. Utilization management systems will 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. 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 managing entity will develop an automated utilization management system that includes treatment authorization and management reports for the system of care as outlined in the approved annual action plan. South Florida Behavioral Health Network, Inc. 19 KH225 MODW1101 Managing Entity (3) Function 3. Network/Subcontract Management The process whereby the managing entity conducts a systematic organized review of a subcontractor's operations and service provision in order to give reasonable assurance that the subcontractor is complying with subcontract requirements, rules, regulations and laws applicable to the subcontractor's contract performance. For the purposes of this contract network management includes processes by which accountability for performance and quality of services from subcontractors will be ensured. (4) Function 4. Quality Improvement A series of management techniques and processes used to assess and improve internal managing entity operations and network services. Quality improvement focuses on organizational systems of network members' performance and seeks to continuously improve quality of services provided. The managing entity will establish a clearly delineated quality improvement program that provides for the meaningful involvement of managing entity staff members, subcontractor organizations, and individuals served and other stakeholders. (5) Function 5. Technical Assistance/Training The managing entity will provide technical assistance and training in two broad areas. First, they will provide training and technical assistance to help subcontractors perform network -functions, such as invoice submission and participation in network quality improvement activities. The second area is training and technical assistance to help subcontractors implement quality of care including the implementation of evidence -based practices, such as the application of process improvement methods to improve coordination and access, the use of evidence -based treatment protocols, and providing services that are culturally and linguistically appropriate. The managing entity will provide the technical assistance and training directly or arrange for the provision of technical assistance or training in the most fiscally responsible manner. (6) Function S. Data Collection, Reporting, and Analysis The managing entity will manage activities that use data elements to track cost, utilization, quality of care, access to services, and individuals served outcomes within the network of subcontractors. The managing entity will describe the implementation of the electronic health records (EHR) for the subcontractors in the approved annual action plan. (7) Function 7. Financial Management Financial management activities include the following elements: (a) Negotiating and developing administrative costs and service rates within the parameters established by the department; (b) Developing contracts that allocate funds according to department utilization targets and reallocating funds according to shifts in utilization patterns, all funds are allocated in accordance with the approved operating South Florida Behavioral Health Network, Inc. 20 KH225 10/01/2010 Managing Entity budget and approved annual action plan, incorporated herein by reference. Paying invoices in a timely manner and verifying the accuracy of the invoices submitted by subcontractors. The managing entity will pay subcontractors within 15 working days of receiving a valid invoice, based upon or subject to the availability of funds. (c) Managing contracted funds according to State and Federal requirements; (d) Complying with Local Match requirements. (e) Securing, managing and leveraging other sources of funding, Resource maximization to include pursuit of third party payments prior to the billing of SAMH funding; (f) The managing entity will pursue additional sources of revenue particularly grant applications in accordance with the approved annual action plan; (g) Achieving efficiencies by consolidating subcontractor operational functions; (h) Reinvesting efficiencies into the system of care or infrastructure development designed to continuously improve the quality of services and maximize capacity in partnership with department staff; and (i) Redirecting service dollars from restrictive care settings (as defined in the approved annual action plan) to community -based recovery services, (8) Function 8. Planning The managing entity will be the source of performance, utilization, and other network information used by the department in formulating its plans, including the Annual Action Plan. The managing entity's approved annual action plan, subject to the approval of the department, is the vehicle for identifying the network's goals, objectives, and improvements. The managing entity will participate in departmental planning processes at the State, regional, and circuit levels as appropriate. (9) Function 9. Board Development and Governance The managing entity will maintain a governing body that is representative of the community and that includes individuals served and family members, relevant community stakeholders and organizations, and subcontractors of behavioral health services. (10) Function 10. Disaster Planning and Responsiveness Includes working collaboratively with the department and taking direction from department staff for any disaster -related preparedness, response activities, and the Regional Disaster Plans and/or as specified in the approved annual action plan. South Florida Behavioral Health Network, Inc. 21 KH225 10/0112010 Managing Entity d. Minimum Programmatic Requirements The managing entity, either individually or through the management and oversight of services provided by subcontractors, shall maintain the following minimum programmatic requirements: (1) System Of Care The consumer -centered and family -focused comprehensive coordinated system of care will: (a) Be driven by the needs and choices of the customers; (b) Promote family and personal self-determination and choice; (c) 'Be ethically, socially, and culturally responsible; and (d) Be dedicated to excellence and quality results. There is a commitment to expand clinical treatment to include the Behavioral Health Transformation Initiative, evidence -based practices and recovery support services for the full continuum of care based on priorities established by the department for substance abuse, mental health treatment and/or co-occurring disorders, substance abuse and mental health treatment capacity, children and families, criminal and juvenile justice, HIV and hepatitis. (2) Guiding Principles Guiding principles specify that services are as follows: (a) Inclusive - involve and engage families and consumers as full partners to participate in the planning and delivery of services; (b) Comprehensive - incorporating a broad array of service and supports (e.g. physical, emotional, clinical, social, educational and spiritual); (c) Individualized - meeting the individual's exceptional needs and strengths; (d) Community -based - provided in the least restrictive, clinically appropriate setting; and (e) Coordinated - both at the system and service delivery levels to ensure that multiple services are provided and change as seamlessly as possible when warranted. (f) Cultural and linguistic competence. South Florida Behavioral Health Network, Inc. 22 KH225 Managing Entity e. Programmatic Authority Sections 20.19, 39.001(2), 39.001(4), 394.457(3), 394.74, 394.9082, 397.305(2) and 397.321(5), 916, F.S, provide the department with the authority to contract for these services. f. Scope Of Service The following scope of service applies to each fiscal year of this five (5) year contract and any renewal or extension: The managing entity is responsible for the administration, management, and oversight, and through sub -contracts, the provision of behavioral health services in Miami -Dade and Monroe counties as stipulated in this contract. Prevention services designed to preclude the development and/or exacerbation of substance abuse problems and mental health disorders by addressing risk factors with children and families and in the community at large are a part of the behavioral health services. g. Major Program Goals (1) The primary goal of the Substance Abuse and Mental Health Programs is to reduce or prevent substance abuse and promote and improve the mental health of the citizens of the state by making behavioral health services available through a community -based system of care. (2) It is the goal of the managing entity to improve accountability, ensure quality of care through best practice models and seek to ensure delivery of Behavioral Health Services across the provider network and across systems resulting in systematic access to a full continuum of care for all children, adolescents and adults who enter the publicly -funded behavioral health services systems. (3) Construct a system of care design that will facilitate and improve co- occurring capability and expertise in all programs and for all service network providers. (4) Promote and improve the behavioral health of Florida's Southern Region communities by strategically applying substance prevention programs, activities and services available as part of the community -based system action plan. 3. Clients to be Served a. Client General Description South Florida Behavioral Health Network, Inc. 23 KH225 Managing Entity Pursuant to section 394.9082(7)(b), F.S., the managing entity shall ensure that services funded by the contract are furnished to eligible adults and children with or at risk of developing behavioral health disorders . ® Adult Mental Health — Forensic Involvement Z Adult Mental Health — Severe and Persistent Mental Illness ® Adult Mental Health — Serious and Acute Episodes of Mental Illness ® Adult Mental Health — Mental Health Problems Z Children's Mental Health — Seriously Emotionally Disturbed Z Children's Mental Health — Emotionally Disturbed ® Children's Mental Health — At Risk of Emotional Disturbance ® Adults with Substance Abuse Problems ® Children with Substance Abuse Problems Z Adults at Risk of Substance Abuse Problems ® Children at Risk of Substance Abuse Problems (1) The managing entity shall ensure that all persons meeting the target population descriptions in paragraph A.3.a. above, and as described in CFP 155-2, receive services through its subcontractors based on the availability of resources. However, department funding shall be targeted for the medically indigent. A detailed description of each target population is contained in CFP 155-2. (2) The managing entity shall ensure that substance abuse detoxification and addiction receiving facility services are provided to all persons meeting the criteria for admission, subject to the availability of funds. (3) Mental Health Crisis: The managing entity shall ensure that all crisis services are provided for both children and adults meeting criteria pursuant to chapter 394, F.S.; Rule 65E-5, F.A.C.; and Rule 65E-12, F.A.C. This includes but is not limited to, mobile crisis services and inpatient hospitalization at receiving facilities and crisis stabilization units. c. Client Determination The department is exclusively responsible for defining client eligibility for services provided through this contract. The managing entity shall apply this definition to persons on a case -by -case basis, and the managing entity may delegate the client eligibility determinations to the network providers. The department reserves the right to make final determinations of client eligibility. If the managing entity disputes the department's determination regarding eligibility of a client, dispute resolution, as described on in Section D.2. shall be implemented. Services shall be provided to the client unless and until the dispute resolution process reverses the department's determination. South Florida Behavioral Health Network, Inc. 24 KH225 Managing Entity The managing entity shall work with the Southern Region to coordinate admissions and discharges from state forensic hospitals and residential treatment centers. d. Client Contract Limits (1) The managing entity is not authorized to receive funding from the department for more dollars than are allocated. (2) The managing entity shall ensure that funds provided in this contract will not be used to serve persons outside the target population(s) specified in Section A.3.a. and A.3.b. above. (3) Services provided under this contract are limited by the availability of funds, with the exception of Section A.3.b(3) above. The managing entity may not authorize or incur indebtedness on behalf of the department. 1. Service Tasks a. Task List The following tasks shall be completed for each fiscal year of the contract unless otherwise noted: (1) Develop, Maintain, and Improve the Provider Network The managing entity shall develop and maintain a network of qualified, direct service, community -based providers to provide services for adults and children with behavioral health and/or co-occurring disorders as authorized in section 394.9082, F.S. This network shall deliver all services in accordance with the Consolidated Program Description on file in the department contract manager's file. The managing entity shall continue to assess the adequacy of the network and modify the network as indicated by department plans and requirements, consumer and stakeholder needs and preferences, data analysis and best practice findings scientific findings, and improvement opportunities identified in the managing entity approved annual action plan based upon the most current Florida Department of Children and Families Strategic Intent 2008-2010, or the latest revision thereof, and through quality management processes. The exact array of services, the required features of particular services, priorities for service development and improvement, and service coordination efforts are made at the Regional level within the broader framework of Department of Children and Families (DCF) priorities and policies. Each year, the department, with the assistance of the local regional planning councils, will identify the service requirements that the managing entity will address in its approved annual action plan. The managing entity will develop the network according to the general values and features described in this contract and the specific dimensions that follow: South Florida Behavioral Health Network, Inc. 25 KH225 ff#7fjjVX#Kj� Managing Entity (a) Ensure Timely Access to Care for Services The standards for timely access to care are along the lines of those required by managing entity accrediting bodies and the Medicaid prepaid plans: (i) Immediate/Crisis: seen immediately for life behavioral health life threatening emergencies (ii) Within 24 hours of initial contact for non -life threatening emergencies; (iii) Within 48 hours for urgent care; (iv) The offer of an appointment for routine care within 7 business days. The managing entity shall monitor compliance with the timely access standard, and if a pattern of noncompliance develops with any network provider, the managing entity will take corrective action and monitor the results of corrective action. Please refer to approved annual action plan for deliverables. (b) Ensure Geographic Access to Services Aspects of geographic access include drive times, the location of services on public transportation routes, and proximity to other services and locations often used by members of the covered population. Standards for acceptable geographic access are: (i) Thirty (30) mile drive for outpatient services in Miami -Dade County and fifty (50) mile drive within Monroe County; (ii) Sixty (60) mile drive for inpatient and residential services in Miami - Dade County and one hundred twenty (120) mile drive for Monroe County; (iii) Services located on available public transportation routes where public transportation is available. As with the timeliness standards, these standards define acceptable performance that when not achieved trigger corrective action, consistent with the approved annual action plan. (c) Promote Family and Personal Self -Determination The managing entity will promote personal self-determination and choice by: (i) Providing oversight so that the needs and preferences of consumers and their families drive treatment planning and service delivery, and South Florida Behavioral Health Network, Inc. 26 KH225 Managing Entity that consumers and their families (with consent) are involved in all aspects of treatment (pre, during and post); (ii) Engaging service recipients, family members, and advocates in the design, development, and evaluation of services; (iiii) Giving consumers a choice of provider and services, whenever possible; (iv) Assessing and improving consumer satisfaction. (d) Develop and Assure the Delivery of Services Based on Evidence - Based Practices/Promising Practices Guidelines The managing entity shall identify specific services provided by the network and service features in the managing entity's department -approved annual action plan. These include such service features as evidence -based practices (EBPs) and promising practice guidelines, as specified in the approved annual action plan, endorsed by expert panels. The managing entity shall assure that the service requirements are identified in subcontracts and that the services are provided according to service guidelines (see Section 13.a(2)). (e) Ensure Access to Services that Meet Linguistic and Cultural Needs of Recipients The managing entity shall assure that the network provides sign language, translation, and interpretive services required to meet the communication needs of service recipients, including English, Spanish and Creole. Services will meet the cultural needs and preferences of the covered populations. The managing entity shall identify, through the approved annual action plan, specific service characteristics that will include features designed to meet the needs and preferences of cultural groups. In addition, the managing entity will address in its approved annual action plan, improving the ability of the network to provide services that meet the cultural needs, languages and preferences of the covered populations. The managing entity shall provide processes so that the contracted network providers engage in recruitment to maintain as much as possible staff with the ethnic and racial composition of the clients served. (f) Facilitate National Accreditation of Network Providers The department intends that most of the services it purchases through managing entities be delivered by nationally accredited provider organizations. To that end, the managing entity will subcontract with organizations that are accredited, or working towards accreditation, in order to promote best practices and the highest quality of care, as specified in the approved annual action plan. However, national accreditation might not be South Florida Behavioral Health Network, Inc. 27 KH225 fflYIERM Managing Entity realistic or useful for some smaller niche providers of such important services as recovery support services, and consumer operated services. Consequently, the department may grant exceptions to the requirement for accreditation on a case -by -case basis. (g) Coordinate Services for Persons with Co-occurring Disorders The managing entity shall develop and operate a system of care to ensure the provision of appropriate services in the least restrictive setting for adults and children with substance abuse, mental health and/or co-occurring disorders. Those services are needed in order to provide a seamless Comprehensive Continuous Integrated System of Care (CCISC) for this population that will increase access to services and improve outcomes in the most cost effective manner. The managing entity shall implement a "no wrong door" model by developing a process for assessing and referring clients with co-occurring disorders to increase access of persons identified as co- occurring to provide services for both disorders regardless of the initial point of contact. As used in conjunction with the CCISC model, "no wrong door" (See http://www.kenminkoff.com/ccisc.html ) requires that systems develop policies and procedures that mandate a welcoming approach to individuals with co-occurring psychiatric and substance disorders in all system programs, eliminate arbitrary barriers to initial evaluation and engagement, and specify mechanisms for helping each client (regardless of presentation and motivation) to get connected to a suitable program as quickly as possible. The managing entity must collect and review Required Reports as identified in Exhibit G and as identified in the Annual Action Plan submit these reports to the department's contract manager and the SAMH Program Office in Tallahassee. (h) Ensure Provision of Services to Clients with Special Needs The managing entity shall ensure the coordination of specialty services including employability skills training and linkage, victimization and trauma services, infant mental health services, the elderly, and services to families in recovery. The managing entity shall also ensure the availability of appropriate services to consumers with special needs such as those who are blind, deaf or hard of hearing, developmentally disabled, physically handicap, criminally involved, or forensic clients. The department reserves the right to modify this list as the needs of the consumers change. (i) Providing early diagnosis and treatment intervention to enhance recovery and prevent hospitalization (ii) Promote specialized behavioral health services to residents of assisted living facilities. (iii) The managing entity shall work with the state and other stakeholders to reduce the admissions and the length of stay for dependent South Florida Behavioral Health Network, Inc. 28 KH225 10/01/2010 Managing Entity children and adults with mental illness in residential treatment services. (2) Develop, Maintain, and Improve Contract Management and Provider Relations The managing entity will rely on national accreditation and State licensing to deal with the network providers' compliance with the rules and regulations covered by accreditation and licensing requirements. The managing entity will focus its contract management and oversight activities on the contract requirements. Network providers will be required to provide the managing entity with their full accreditation and licensing reports upon request. (a) Establish Contract Management Procedures The managing entity shall develop and implement procedures for subcontract procurement, development, performance, and management that meet contract management and provider relations requirements and establish a process to regularly update contract procedure directives as specified in the in the approved annual action plan. The managing entity shall submit a copy of the procedures and any updates to the department's contract manager for department approval. (b) Establish a Process for Approving Subcontracted Organizations and Terminating Contracts The managing entity's formal processes for approving subcontracting organizations and terminating contracts shall include: (i) Responding to provider organization inquiries (ii) Formal applications, reviews, and approvals as well as onsite visits, primary verifications of licensing and accreditation status, receipt of liability insurance documents, and, for non -accredited providers, verifications that the organization's credentialing process meet the requirements outlined in this task list (iii) A grievance or appeal procedure to the managing entity's governing body or highest ranking local officer for adverse decisions (iv) Contract termination The managing entity shall not terminate a subcontract agreement between a network provider and the managing entity without prior written approval from the department. To the extent possible, the managing entity will confer with the department regarding any potential termination of contracts as soon as identified. The managing entity shall submit to the department's Contract Manager, a written request for approval at least 15 fifteen days prior to the South Florida Behavioral Health Network, Inc. 29 KH225 Managing Entity intended notification of the network provider of termination of a subcontract between a network provider and the managing entity. This request for approval shall include evidence of due diligence on the part of the managing entity to address the performance deficiencies of the network provider, including, but not limited to, provision of technical assistance and the implementation of Corrective Action Plans. (v) The specific make-up of the network, including the organizations identified to provide services, is subject to the prior written approval of the department. (c) Develop Terms of Subcontracts with Subcontracted Organizations The managing entity shall enter into subcontract agreements with network providers for the provision of substance abuse, mental health and/or co- occurring, and prevention services which adopt the applicable terms of the managing entity's contract KH225 with the department and abide by all terms of the department's standard contract. The managing entity will develop contracts with subcontracted organizations that include: (i) A Detailed Scope of Work with Clear and Specific Deliverables [a] Service delivery requirements, features, and improvements as specified in the Consolidated Program Description and approved annual action plan, including the staffing levels and qualifications needed for particular services [b] Access to care, coordination of care, and service integration requirements [c] Requirements for the involvement of consumers and other stakeholders [d] Recipient eligibility requirements [e] Client rights and grievance procedures [f] Performance outcomes and outputs (ii) Performance Standards and Administrative Requirements [a] Detailed documentation requirements [b] Requirements that subcontractors meet Substance Abuse Prevention and Treatment Block Grant (SAPTBG) and Community Mental Health Services Block Grant (CMHSBG) requirements applicable to their organizations and services along with a listing of these requirements South Florida Behavioral Health Network, Inc. 30 KH225 ffordmalwe Managing Entity [c] Reporting, service, and administrative requirements from the department, federal block grants and other funding streams [d] Liability insurance requirements [e] Accreditation and licensing requirements, and, for non - accredited providers, the additional credentialing requirements presented in this task list. Also, a requirement that subcontracted providers provide the managing entity with their full accreditation and licensing reports upon request [f] Agreements to participate in network training events [g] Agreements to follow the procedures outlined in the network's provider manual, as specified in the approved annual action plan, or similar document which outlines network procedures and policies [h] Requirements for security agreements (incorporated herein by reference) [i] Requirements for emergency plans (iii) Monitoring and Sanctions for Non -Performance [a] Programmatic and fiscal monitoring requirements, including requirements to allow the department to review client, programmatic, and fiscal records [b] Sanctions for non-performance and processes for problem correction [c] Agreement to participate in managing entity and the department quality assurance and quality management activities, including peer reviews, critical incident reporting, and evaluations, including reviews of client and administrative records, and to comply with contract management requirements [d] The process for contract termination, including the transfer or continued treatment of recipients (iv) Fiscal Requirements [a] Funding activity levels and rates for each cost center will be negotiated in accordance with rule and statute. [b] Sliding fee scale amounts and procedures South Florida Behavioral Health Network, Inc. 31 KH225 Managing Entity [c] Financial management, billing and invoice verification requirements [d] Innovations leading to the reduction of administrative costs as specified in the approved annual action plan (d) Conduct Contract Monitoring The managing entity shall monitor the performance of all subcontractors and perform follow up actions as necessary. The managing entity shall notify the department verbally within 24 hours and in writing within 48 hours of conditions related to subcontractor performance that could impair continued service delivery and/or include a health and safety violation. The managing entity shall monitor subcontracts, according to the departments operating procedure 75-8, Contract Monitoring, using a systematic review of the subcontracted organization's compliance with their subcontract requirements. Contract monitoring may include desk audits and onsite reviews. Onsite reviews will occur at least annually, for high risk network providers, with more frequent visits triggered by patterns of compliance problems. Within 30 days of contract execution, and by July 30th of each subsequent fiscal year of the contract, the managing entity shall develop and distribute a monitoring schedule to network providers. The managing entity shall submit a copy of the monitoring schedule and any revisions to the monitoring schedule to the department's contract manager and to the SAMH Program Office. The managing entity shall submit copies of the monitoring reports, including any requests for corrective action plans, to the contract manager within 30 calendar days of the completed contract monitoring exit conference with the network provider. Copies of corrective action plans received from subcontractors shall be forwarded to the contract manager and to the SAMH Program Office within 30 days of receipt. While contract monitoring addresses compliance with all requirements, the managing entity's reviews shall focus on the subcontracted providers' compliance with section 13.1.a(2)(c) above particularly: (i) Federal Substance Abuse Prevention and Treatment Block Grant requirements or Community Mental Health Block Grants. (ii) Primary source verification that the subcontracted organization is maintaining their licenses and national accreditation. (The managing entity shall submit to the department's contract manager (6) six-month reports containing each of the network providers name and expiration date of their license and accreditation.); (iii) Performance outcomes; (iv) Service delivery requirements; South Florida Behavioral Health Network, Inc. 32 KH225 RIOW011111 Managing Entity (v) Access to care, coordination of care, and service integration requirements; (vi) Invoice verification and financial management; (vii) Recipient eligibility. (e) Establish Fiscal Operations and the Invoice Payment Process (i) Develop and implement fiscal operational procedures as specified in the approved annual action plan. These procedures 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 regulations, and invoice review procedures. The managing entity shall submit a copy of the procedures to the department's contract manager. (ii) Prior to entering into any subcontract, or an amendment which modifies the negotiated unit cost rate or adds additional cost centers, the managing entity shall conduct a cost analysis for said subcontract, in accordance with Rule 65E-14.021. These analyses may be based on projections for new or significantly modified services and on retrospective cost studies for current services. All requests to the department by the managing entity for approval of subcontracts must include evidence of cost analysis. (iii) Establish quantifiable units of deliverables that must be received and accepted in writing by the managing entity before payment. Each deliverable must be directly related to the scope of work and must specify the required minimum level of service to be performed and the criteria for evaluating the successful completion of each deliverable. (iv) Verify client eligibility and avoid payment for those not included in the service population. (v) Reimburse network providers within 15 working days of receiving a valid invoice based upon or subject to the availability of funds, (vi) Enforce requirements for sliding fee scales. (vii) Manage flexible funding administration, such as capitation and case rates, as may be specified in the Annual Action Plan. (viii) Monitor expenditures by subcontracted organization, service level, and funding source. South Florida Behavioral Health Network, Inc. 33 KH225 fflllf/ i (ix) Reallocate funds (with prior department approval) to respond to utilization trends and needs throughout the contract year. (x) Assure the fiscal integrity of all funds under this contract, and for demonstrating that a comprehensive audit and tracking system exists to account for funding by client, by region, by network provider. (f) Develop and Distribute a Provider Manual Outlining Processes for Network Participation The managing entity shall develop a provider manual that summarizes network procedures for subcontracted provider organizations and provide a copy of this manual to the department as specified in the approved annual action plan. managing entity will be responsible for keeping the manual up to date and informing the subcontracted providers of changes. (g) Identify a Subcontractor Provider Liaison The designated contract manager for the managing entity will serve as point of contact between the managing entity and subcontractor. (h) Provide Technical Assistance The managing entity will provide technical assistance to help subcontractors meet the reporting and other contract requirements for participating as a network provider. (i) Maintain Subcontractor Records and Reports The managing entity shall provide copies of all subcontracts and any amendments to the subcontracts to the department's contract manager within ten (10) days of execution of those documents. In addition, the managing entity will provide a quarterly report listing all active subcontracts and all outstanding invoices, including service period and invoice amount, (j) Coordinate Network Services and Operations The managing entity is responsible for all of the network services and operations required under this contract including the approved annual action plan. Any failure to perform on the part of a network provider does not relieve the managing entity of any accountability for tasks or services that the managing entity is obligated to perform pursuant to this contract. (k) Substance Abuse Prevention and Treatment Block Grant Requirements and Community Mental Health Block Grants for the Managing Entity (i) The managing entity shall comply and agrees to ensure that its South Florida Behavioral Health Network, Inc. 34 KH225 lillI M �14 I Managing Entity network providers that receive federal Substance Abuse Prevention and Treatment Block Grant and/or Community Mental Health Block Grants, comply with Subparts I and 11 of Part B of Title XIX of the Public Health Service Act, s. 42 U.S.C. 300x-21 et seq. (as approved September 22, 2000) and the Health and Human Services (HHS) Block Grant regulations (45 CFR Part 96). (ii) The managing entity shall ensure that a network provider that receives funding from the Substance Abuse Prevention and Treatment Block Grant certifies compliance with all of the requirements of the Substance Abuse and Mental Health Services Administration (SAMHSA) Charitable Choice provisions and the implementing regulations of 42 CFR54a. (iii) Guidance for contracting SAPTBG funds can be obtained from the SAMH Funding Restrictions Resource Guide at the following website: 11111 111111111•11 1! :1 IIIIIIII�Iljj 1111�ll Ii� III t as (1) Adhere to Prohibitions Against Subcontracting with Certain Entities See Section.B.2.d. (m) Incident Reporting The managing entity will be responsible for the review, input, follow- up/corrective action, and tracking of monthly reports related to client risk prevention and incidents. Lotus Notes will be used unless another acceptable format is mutually agreed upon. (i) The managing entity will establish an electronic system utilizing Lotus Notes for the usage of the incident report system. (i i) Each Network provider will submit an incident report (Circuit 11 & 16 SAMH Incident Report, incorporated herein by reference) on all reportable incidents per CFOP 215-6 within 24 hours via fax machine to the managing entity. The managing entity will review incident reports for completeness and input into the system. If a report is incomplete, the managing entity will contact the provider for additional information. The managing entity shall ensure that timely notification is/has been made by the provider in the incident report to the appropriate individuals and agencies. Such notifications may include, but are not limited to: the Florida Abuse Hotline; Law Enforcement; Fire Department; parent, guardian, relative; Death Review Coordinator; Building Manager; Safety Coordinator; Local Advocacy Council; etc. Within forty-eight (48) hours, incident reports with any corresponding follow- up should be forwarded to the department's Regional Incident Report Liaison. South Florida Behavioral Health Network, Inc, 35 KH225 11111111MIX11111 [a] In the event an incident has an immediate impact on the health or safety of a client, has potential media impact, or involves employee -related incidents of criminal activity (CFOP 180-4), the managing entity must notify the Department of Children and Families (DCF) Substance Abuse and Mental Health (SAMH) Program Supervisor as soon as possible after notification but not to exceed 24 hours. [b] Employee related incidents of criminal activity or other types of serious wrongdoing per CFOP 180-4 must be submitted to the Office of the Inspector General utilizing the Notification/ Investigation Request form CF 1934 after notifying the DCF SAMH Program Supervisor. This must be e-mailed to the Office of Inspector General at ig_complaints@dcf.state.fl.us, The 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 CFOP 180-4, which can be obtained from the contract manager. [c] For all deaths, the managing entity should request the following information from all providers: 1) Cause of Death; 2) Medication(s) consumer was taking; 3) Medical Examiners report; 4) What services was the consumer receiving from your agency; and 5) Dates of contact by case manager and/or therapist with consumer for the last 3 months; include a summary of the consumer's status during this time. (iiii) The managing entity shall ensure that appropriate corrective action is/was taken to minimize both immediate and future risk. If a plan for corrective action is necessary, the administrator or designee shall oversee plan development and implementation. (iv) It is the responsibility of the managing entity to maintain a monthly log listing all incidents including those submitted to the Office of the Inspector General with the following information: the Provider name, IR tracking number from Lotus Notes, or another agreed upon format, client's initials, incident report category number, date South Florida Behavioral Health Network, Inc. 36 KH225 W..M and time of incident, and description of follow-up action taken, In addition, a monthly report needs to be generated by provider the total number of incidents by category, number of untimely reports, and description of follow-up action necessary. (v) Certain incidents may require managing entity staff to conduct a monitoring of the facility or other types of investigation. (vi) A quarterly trends analysis regarding incident reports will be developed by the managing entity that analyzes and reports on the quality improvement mechanisms in place to ensure that providers successfully correct deficiencies. This needs to be submitted to the SAMH Program Office quarterly upon which a meeting will commence to review the results of the quarterly trends analysis between the managing entity and the department. (3) Develop, Maintain and Improve, Utilization Management (UM) The managing entity shall apply UM systems and processes to: ensure maximum, cost-effective, and clinically appropriate utilization of substance abuse and mental health treatment services. All items will be addressed more specifically in the managing entity's approved annual action plan. (a) Establish Utilization Management Procedures The managing entity shall develop and implement written utilization management procedures inclusive of and not limited to agreed upon behavioral health services which meets the department's requirements and which details what process will be utilized to prevent over and under utilization of services. The Utilization Management procedures minimum requirements are specified in the managing entity's approved annual action plan. (b) Submit Utilization Management Reports The managing entity will submit quarterly utilization management reports to the department. These reports will include utilization activity relative to utilization goals, corrective actions, and a monthly report of the substance abuse/mental health waiting list for residential treatment. (c) Oversee Application of Utilization Management Criteria The utilization management criteria for substance abuse is the ASAM PPC- 2R Florida Supplement, American Society of Addiction Medicine, Patient Placement Criteria for the Treatment of Substance Related Disorders, second edition - revised, July 1, 2001, or the latest revised edition thereof, The State may specify an alternate assessment tool that may replace the current tool. Consumer placement criteria specific to mental health services will be developed by the managing entity and approved by the Southern Region South Florida Behavioral Health Network, Inc. 37 KH225 Managing Entity SAMH Program Office. Standardized tools and assessments approved by the department must be used to determine placement and level of care. The managing entity will ensure that subcontractors use the GAIN, when appropriate, as the behavioral health assessment and placement tool for ages 12 and up in the Southern Region, or as otherwise specified in the approved annual action plan. (d) Develop Service Utilization Goals as Part of the Managing Entity's Approved Annual Action Plan and Monitor Performance The managing entity will develop utilization projections to be incorporated in the Utilization Management Section of the Approved Annual Action Plan. These projections will be developed for program service area and include the number of persons to be served, average length of stay, and the application of dollars from the funding source managed by the department. The managing entity will generate and analyze quarterly utilization reports that compare actual utilization of services by program service area in relation to these goals by subcontractor and for the region. The managing entity will work with subcontractors to address and resolve service delivery practices that do not conform to client placement criteria and utilization targets. (e) Review Compliance with Utilization Management Criteria As part of the quality improvement program, the managing entity will provide or coordinate reviews of service compliance with criteria and practice guidelines, such as retrospective reviews to ensure the level of placement of clients is appropriate. (See the Quality Improvement section.) The managing entity will take corrective action to resolve situations in which the subcontracted provider is not following the guidelines or working to help the system meet its utilization goals. (f) Manage Waiting List and Interim Services The managing entity shall conduct oversight, reporting and management of the behavioral health plan for individuals served. In the event that waiting lists do develop, the managing entity will develop and implement procedures for managing the substance abuse and mental health waiting list for all applicable levels of care including provision of interim services. (g) Authorize Services The managing entity shall conduct authorization and reauthorizations for applicable levels of care as described in the approved Annual Action Plan in order to ensure timely access to behavioral health services and eliminate the wait lists. The authorization processes will include: (i) Timeliness standards for authorization review must adhere to timelines standards referenced in section 13.1.a.(1) (a) for the South Florida Behavioral Health Network, Inc. 38 KH225 10/01/2010 Managing Entity services provided and departmental, statutory, and judicial regulations or requirements. (ii) Processes for making the criteria on which decisions are made available to practitioners, including any standardized tools and assessments for use in determining placement and/or level of care. (iii) Provisions for providing timely appeals, or second opinions, when a request for authorization for a particular service is denied. (An appeal differs from a grievance in that grievances are used when a recipient or member of the covered population believes that he or she has been treated improperly, whereas an appeal is a request to review a judgment.) The second opinion shall be obtained according to the timeliness standards for the service in question. (h) Manage Resources and Recommend Reallocations of Funds, Provide Cost Allocation Plan and Submit Annually The managing entity shall manage resources by funding source, cost center, and network provider. Within 30 days of contract execution, and annually by July 30th of each subsequent fiscal year, the managing entity shall submit a funding allocation plan for department approval. Any subsequent changes to the approved allocation plan must be submitted to the department for approval prior to implementation. The managing entity will recommend reallocation of funds during the contract year as a result of patterns of underutilization of funds, high demand that reflects the needs and preferences of consumers and the department targets and plans. (4) Develop, Maintain, and Improve Care Coordination and Integrated Care Systems (a) Develop Initial Service Agreements The managing entity shall develop and/or maintain written 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, as specified in the approved annual action plan. These agreements must also address the provision of appropriate services to persons who have behavioral health problems and leave the criminal justice system. The managing entity shall submit a copy of the agreements to the department's contract manager. The managing entity shall execute a department -approved working agreement with the department's contracted Community Based Care (CBC) providers in support of the Southern Region's SAMH Program Office's working agreement with the CBC. The intent of the working agreement is to establish a formal linkage of partnerships with a shared vision for improving outcomes for South Florida Behavioral Health Network, Inc. 39 KH225 WAG Managing Entity families involved in the child welfare system by providing integrated community support and services. The working agreement shall be submitted to the department's contract manager, as specified in the approved annual action plan, (b) Develop a Plan for Care Coordination The managing entity will develop written cooperative agreements with other external stakeholders as described in the approved Annual Action Plan. (1) The managing entity will oversee the regional SOAR Initiative by ensuring that providers with co-occurring clients participate in the SOAR Initiative. The managing entity staff should be trained in SOAR and assist the department in training needs including technical assistance and data collection. (5) Develop, Maintain, and Improve Processes Advocating for Consumer Rights and Network Access (a) Establish Procedures The managing entity shall establish and maintain a consumer rights and grievance procedure which applicants for, and recipients of, contracted services may use to present grievances to the managing entity, if their grievances were not resolved at the subcontractors level and to achieve resolution. The managing entity shall submit a copy of their rights and grievance procedure to the department's contract manager for review and approval within thirty (30) days of contract execution. (b) Develop and Disseminate Consumer Manual The managing entity shall develop and maintain a format for subcontractor service recipients which includes information about access procedures, recipient rights and responsibilities (including grievance and appeal procedures). This information will be placed in a manual available for use by the consumers within each subcontractor location. In addition, the managing entity shall maintain updated information of each subcontractor on their website. The managing entity shall submit a copy to the department's contract manager for review and approval as specified in the approved annual action plan. (c) Assist Consumers in Choosing Network Providers At a minimum, the managing entity will assist consumers in choosing Network Providers by providing 24 hour/7 days a week access as specified in the approved annual action plan for individuals who need assistance in accessing behavioral health services. South Florida Behavioral Health Network, Inc. 40 KH225 WHANIOW11 Managing Entity (d) Work and Social Opportunities A Peer Services Coordinator will be employed to develop work and social opportunities for consumers and make recommendations to the managing entity and subcontractors for a consumer -driven system. (6) Assist Stakeholder Involvement in Planning, Evaluation, and Service Delivery (a) Participate in Planning The managing entity will engage local stakeholders, per section 394.9082 F.S., in its support activities for the department's local plans and in the development of its Annual Action Plan (see section 13.1.a(9)). (b) Configure Network Administration Through a Governing Board The Managing Entity Governing Board shall be responsible for the following: (i) serving as a bridge between the managing entity, local stakeholders, (including consumers), and the community; (ii) establishing and monitoring all managing entity subcommittees and advisory groups involved in the services provided through the managing entity for this contract; (iii) assessing the adequacy of the network and deciding network composition; (iv) deciding the content of the Annual Action Plan; (v) annually approving the standard contract between the managing entity and network providers; and (vi) approving and distributing board policies and procedures and providing copy of such to the department's contract manager. (c) The Managing Entity Governing Board shall meet at least quarterly and more frequently if required. Its composition shall be no less than 25 and no more than 35 Board Members. The Board Members shall be minimally comprised of the following members: 2 Consumers 2 Family Members of Consumers 8 Substance Abuse and Mental Health Service Providers 1 Local Government Representative (Non -State agency) 1 Judge or Senior Court Official South Florida Behavioral Health Network, Inc. 41 KH225 Managing Entity Elected City, County or State Official Faith -based Leader Local NAMI or other Advocacy Group Director Behavioral Health Community Leader Youth Representative Public Health Representative (7) Develop, Maintain, and/or Improve Quality Improvement processes Quality Improvement (Ql) reviews address reviews of network provider compliance with clinical and programmatic requirements. Continuous Quality Improvement (CQI) activities address outcomes management and systematic activities using data to improve services. The goal is to improve the accountability for a local system of behavioral health care services to meet performance outcomes and standards through the use of reliable and timely data. (a) Develop Procedures for Quality Management The managing entity shall develop and implement the Quality Improvement Procedures. The procedures will describe how the managing entity ensures that the network meets service and administrative requirements and uses data to improve services. The elements of the Quality Management Procedures are specified in the approved Annual Action Plan. The managing entity shall submit a copy of the Quality Management Procedures, a copy of all quality assurance reviews, a copy of all monitoring reports within 30 days of completion, a copy of all corrective action plans, and a quarterly quality management report to the department's contract managers. (8) Provide Training and Technical Assistance The managing entity shall develop and implement a training program for its staff and the subcontractor staff. The training shall assure that staff receives externally mandated and internal training. , The managing entity may coordinate training or directly provide training to subcontractor staff. In addition, the managing entity will encourage cross -organizational training and assistance to help non -accredited providers become accredited. The managing entity shall submit a quarterly report on the training received by the subcontractors and managing entity staff. The managing entity shall submit an annual training plan (see approved Action Plan for specifics), (9) Develop, Maintain, and Improve Planning Support and Plan Development The local department plans and the managing entity Annual Action plan are the vehicles for identifying the services and improvements that the managing entity will develop and provide on a year-to-year basis. (a) Provide Support for Local Department Planning South Florida Behavioral Health Network, Inc. 42 KH225 Managing Entity The managing entity will support the planning efforts of the department and develop an Annual Action plan, subject to the approval of the department. The department plans supported by the managing entity are the Annual Regional Plan and the strategic plan developed every three years. The managing entity will support the department's local plan by providing: (i) A summary of the network's performance in relation to the previous year's Annual Action Plan; (ii) Demographic, population and prevalence data as specified by the Region. These should include demographic comparisons among the entire population of the Region, the population being served by the network, and the persons providing direct treatment services; (iii) Other summaries of reports already compiled by the managing entity as part of its reporting requirements, such as performance management reports; grievance, appeals, and other complaint information; and the results of satisfaction surveys; (iv) Ad hoc utilization reports identified by the planning participants; (v) The perspectives of consumers, advocates, and other stakeholders on a county -by county basis; (vi) The schedule and formats for these reports will be identified in the approved Annual Action Plan. (b) Maintain Regular Communication with the Department The managing entity representative will meet at least quarterly with the Southern Region SAMH program supervisor to discuss the status of the network's operations. This meeting can be in person or by phone. (c) Develop a Contingency Transition Plan The managing entity shall, in coordination with the department, develop a Contingency Transition Plan in the event of termination or non -renewal of this contract. The Contingency Transition Plan shall be submitted to the contract manager in accordance with the approved annual action plan and is incorporated herein by reference. (10) Develop, Maintain and Improve Reporting The managing entity shall submit reports included in Exhibit G, Required Reports. In addition, the managing entity will provide the department ad hoc reports at its request because the managing entity is the department's primary source for network reporting. 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 South Florida Behavioral Health Network, Inc. 43 KH225 Managing Entity department's contract manager. The department reserves the right to reject reports as incomplete, inadequate or unacceptable. (11) The managing entity will ensure that subcontractors have updated emergency/disaster plans annually within 30 days of the beginning of hurricane season, and they are activated upon notification of disasters from the department. The managing entity will conduct post disaster assessments of damage incurred by providers and submit to the department. (12) The managing entity provider shall ensure that prevention services subcontractor contained in the Performance Based Prevention System. The "final" PPT shall be printed from PBPS and sent to the managing entity's contract manager for approval within 30 days of contract execution. The managing entity shall review and approve the Prevention Program Tool (PPT). (13) The managing entity shall ensure that Prevention Program Coordinators and any other personnel responsible for entering data into the Prevention data system, including subcontractors who upload data from their own system, must register and complete training on use of the PPT at least annually. (14) The managing entity shall ensure that Substance Abuse Treatment subcontractors contracted for HIV Early Intervention Services will designate a representative to participate in the local Department of Health HIV/AIDS planning body's meetings. The managing entity shall ensure that subcontractors participate in a minimum of 50% of the meetings involving community service partners. (15) The managing entity shall ensure that subcontractors collaborate with the local community substance abuse coalitions (where available) to help develop and support capacity to address community substance abuse needs. Activities shall be specified in the Prevention Activities Exhibit, which is incorporated herein by reference, and as specified in the approved annual action plan. (16) Based on the most recent local department approved comprehensive community action plan, the managing entity agrees to ensure that its subcontractors, administer and deliver appropriate evidence -based programs or strategies as specified in the Consolidated Program Description required by Rule 65E-14.021, F.A.C., and is on file in the department contract manager's file and incorporated herein by reference. (17) The provider shall comply, and ensure that its subcontractors 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/news/humanresearchpolicy.shtml. Approval from the department is mandatory for all research conducted by any department employee, contracted organization or individual, or any public or private vender, even if the aforementioned has their own Institutional Review Board which has granted approval. South Florida Behavioral Health Network, Inc. 44 KH225 Managing Entity (18) Client Satisfaction Survey The managing entity shall ensure all network providers conduct client satisfaction surveys pursuant to CFP 155-2. (19) Client Files Upon contract execution, the managing entity will accept and maintain all current and subsequent SAMH client files. (20) The managing entity shall ensure that all subcontractors that provide SAMH Treatment Services execute a Memorandum of Understanding (MOU) with the appropriate Federally Qualified Health Center as listed in the Annual Action Plan. The MOU provides for integration of primary care services to the medically underserved. (21) The managing entity will demonstrate and encourage efforts from its subcontractors to initiate and support local county implementation of the Medicaid Substance Abuse Local Match Program in order to expand community service capacity through draw down of Federal funding. (22) TANF Guidelines The managing entity agrees to comply, and require its subcontractors to comply with the provisions of the TANF Guidelines, which is incorporated herein by reference, for any TANF funds provided under this contract. (23) Family Intervention Specialist The provider agrees to comply, and require its subcontractors to comply, with the provisions of the Substance Abuse Family Intervention Specialist Services, which is incorporated herein by reference, if the services of Family Intervention Specialists are being provided under this contract. (24) Clinical Supervision for Evidence Based Practices The provider agrees to comply, and require its subcontractors to comply with the provisions of Clinical Supervision for Evidence Based Practices, which is incorporated herein by reference, if these services are being provided by the managing entity or its subcontractors. (25) Prevention Services Invitation to Negotiate (ITN) As existing prevention contracts end, or as otherwise specified in the approved annual action plan, the managing entity shall use the department's Evidence -Based Practices Procurement for the Prevention of Underage Drinking and Other Alcohol - Related Problems ITN template, which is incorporated herein by reference, for contracting SAPT Block Grant funding for prevention services. South Florida Behavioral Health Network, Inc. 45 KH225 Managing Entity (26) Forensic Service Program The provider agrees to comply, and require that its subcontractors comply with the provisions of Forensic Mental Health Specialist Services, which is incorporated herein by reference. The managing entity will be responsible for ensuring the provision of mental health, substance abuse and ancillary services to individuals charged with felony offenses and have been committed or may be at risk of commitment to the Department of Children and Families, pursuant to chapter 916, F. S. The managing entity will ensure the development of a comprehensive forensic program that meets all requirements of chapter 916, F.S., Forensic Client Services Act, the Forensic Mental Health Services Exhibit and established forensic performance measures. The managing entity will ensure the development and implementation of an automated system to track the activities of the program and to generate reports pertinent to the program. Additionally, the forensic program will contain the following components: a. Diversion- The managing entity will be responsible for the identification of individuals charge 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 with appropriate services and monitoring. (1) CFOP 155-38, entitled "Procedures for Post Commitment Diversion" establishes eligibility criteria to be used for both pre -commitment and post commitment diversion. (2) Referrals sources for diversion include the Offices of the Mental Health Administrator, Public Defender, State Attorney, Corrections Health Services and Prison Health Services the judiciary, and the Jail Diversion Program. The managing entity or its subcontractors may establish through cooperative agreement with these entities, an alternative source or methodology for obtaining referrals and/or identifying individuals who meet criteria for diversion. (3) The managing entity will ensure that all referrals for diversion are screened to ensure eligibility and suitability for diversion to a community program. The screening will include review of all documentation, including arrest reports, criminal histories, court ordered evaluations and court orders. (4) The managing entity will ensure that appropriate referrals for services in the community are initiated and dispositions are received in writing. (5) The managing entity will ensure the development and submission of an appropriate plan for conditional release to the committing court. The plan will include mental health treatment, competency restoration training, South Florida Behavioral Health Network, Inc. 46 KH225 10/01/2010 Managing Entity residential care or housing with supervision, medical and auxiliary services if appropriate, case management and monitoring. (6) The managing entity will ensure attendance at court hearings, obtain conditional release order s and ensure individuals are monitored in the community in accordance with the terms of the conditional release order. b. Discharge Planning — The managing entity will be responsible for ensuring the active participation of forensic specialists in discharge planning activities for forensic clients at state treatment facilities. (1) The managing entity will ensure the forensic specialists conduct quarterly face- to- face meetings with forensic clients in both civil and forensic state treatment facilities and provide written assessments that include mental status, barriers to discharge, and discharge plans. (2) The managing entity will ensure that forensic specialists participate in treatment team, and discharge planning meetings for forensic clients in state treatment facilities. (3) The managing entity will ensure the review reports to court generated by the state treatment facilities in order to determine action necessary to comply with treatment team recommendations and/or resulting court orders. (4) The managing entity will ensure the development and submission of conditional release plans, discharge plans to state treatment facilities and to the committing court. The content of the plans is described above in the Forensic Mental Health Specialist Services exhibit which is incorporated herein by reference. (5) The managing entity will ensure attendance of forensic specialists court hearings in the cases of individuals discharged from state treatment facilities and ensure effective linkage to the new mental health service provider. c. Conditional Release Monitoring —The managing entity will ensure that individuals on conditional release order in Dade and Monroe Counties, including individuals transferred into the counties from other circuits are monitored. (1) The managing entity will ensure that individuals on conditional release order are monitored in accordance with the requirements of Rule 65E-15. F.A.C., Continuity of Care Case Management and the court order to ensure compliance with the order and department rules. (2) The managing entity will ensure the committing court is immediately notified by phone and in writing of any deviations from the conditional South Florida Behavioral Health Network, Inc. 47 KH225 MIGOTIR1111 Managing Entity release order. The managing entity will ensure the Circuit Forensic Coordinator is copied on written correspondence to the court. (3) The managing entity 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 managing entity will bring the aforementioned situations, trends and issues to the immediate attention of the Circuit Forensic Coordinator. (4) The managing entity will ensure the distribution of copies of conditional release orders and modifications to the agency providing mental health and substance abuse services to the individual and to the SAMH Regional and Headquarters Office in Tallahassee. d. Prison Aftercare Services -The managing entity will ensure the provision of aftercare services for inmates returning to Dade and Monroe Counties following end of sentence (EOS), in accordance with the Interagency Agreement between The Florida Department of Corrections (Office of Health Services) and The Florida Department of Children and Families (Mental Health Program Office). (1) The managing entity will ensure the development and implementation of a procedure for the receipt and review of referrals for services from prisons throughout the state and/ or from SAMH. (2) The managing entity will ensure that appointments are scheduled for the appropriate levels of services required by the inmate, including hospitalization and provide notification of appointment and /or arrangements for hospitalization or stabilization to the referring prison facility. (3) The managing entity will ensure the provision of follow-up services for a period of at least 60 days to ensure the individual keeps the scheduled appointments and that they do not run out of prescribed medication. e. Utilization Management - The managing entity will be responsible for managing the utilization of residential treatment beds funded by community forensic dollars in Circuit 11 and the statewide community forensic beds located in Circuits 11 & 17. This includes a short -term residential treatment facility and residential level 2 beds. The managing entity will be responsible for managing the appropriate utilization of community forensic residential treatment beds. f. Administrative Functions- The managing entity will ensure that adequate administrative support staff is assigned to the forensic program. In addition, the managing entity and/or it's contracted providers will: South Florida Behavioral Health Network, Inc. 48 KH225 ffiffillAIF. , Managing Entity (1) Actively participate in all related workshops and training, meetings, performance improvement teams, and other activities designed to increase the knowledge and skill levels of staff assigned to the forensic program. (2) Ensure that applicable staff obtains certification of attendance from the Florida Forensic Examiner Training within one year of employment. (3) Conduct biweekly case staffing of individuals committed to DCF, pending discharge from a state treatment facility, currently on conditional release or pending release from state prison. (4) Timely request technical assistance from the Circuit Forensic Coordinator on issues related to service delivery, interactions with state treatment facilities and the circuit court. (27) Comprehensive Community Service Teams Case Management Comprehensive Community Service Teams (CCST) Cost Centers, must continue to provide Adult Mental Health Case Management Services as defined by the Continuity of Care Guidelines for Geo Care, Inc./South Florida State Hospital (on file at the Southern Region SAMH Program Office). Additionally, CCST Cost Centers must provide appropriate Adult Mental Health services to CCST team consumers with the availability to increase or decrease intensity and frequency of similar services, as needed. CCST services must be delivered by staff working in a multidisciplinary team that includes Peer Specialists who are consumers of mental health services. See the CCST cost center model cost description, incorporated herein by reference. Children's Mental Health Comprehensive Community Service Teams (Exhibit H), together with the Incidental Cost Center, will be the vehicle for provision of services to children and families under the Miami Dade Wraparound Cooperative Agreement #1 U79SM059055-01. (28) Florida Assertive Community Team (FACT) The managing entity will provide oversight monitoring and service validation for FACT Team Providers, as per the state's existing allocations when this contract is executed. The managing entity will ensure that the FACT teams provide intensive, assertive community -based treatment that includes rehabilitation and support services for persons with symptoms of severe and persistent mental illnesses. The managing entity will ensure that FACT teams adhere to the fidelity of the program as described in Attachment I PSMA 1 HC08 FACT Program document, incorporated herein by reference, and the NAM/ Published Program Standards for ACT Teams. The managing entity FACT Liaison must be a qualified mental health professional with experience in the mental health field. a. The managing entity will monitor FACT Enrollment, Referrals, and Membership as follows: South Florida Behavioral Health Network, Inc. 49 KH225 Managing Entity 1) Maintaining a Referral Tracker 2) Reviewing referrals for completeness & eligibility criteria within 48 hours. 3) Contacting the referral source and requesting additional information if needed for determination of eligibility within 24 hours 4) Ensuring FACT Teams conduct screening (face-to-face) within 72 hours of referral receipt 5) Making referral approvals, reviewing disposition outcomes, and/or providing alternative referral sources. 6) Approving FACT Team discharges and oversight of discharge planning 7) Approving and coordinating enrollee transfers within FACT Teams 8) Ensuring attendance of the FACT Teams to monthly Treatment Team Meetings and Discharge Planning Meetings at the South Florida State Hospital as applicable. 9) Ensuring that FACT teams utilize the SOAR (SSI/SSDI Outreach Access and Recovery) application process for all eligible enrollees. b. The managing entity will provide oversight monitoring of FACT Supports and Day -to -Day Operations as follows: 1) Providing technical assistance and consultation on -site at least bi- monthly for each provider 2) Approving request for the use of flexible funding. 3) Approving any changes in FACT Team services, location, and business hours. 4) Participating in the Quarterly Advisory Board Meetings 5) Maintaining communication with local AHCA representatives for the administration of managed care enrolled individuals 6) Advocating for FACT enrollees with other public entities C. The managing entity will monitor required FACT Reports and Utilization as follows: 1 ) Requesting a Corrective Action Plan (CAP) to ensure compliance and requesting approval for a CAP from the Southern Region SAMH Program Office: South Florida Behavioral Health Network, Inc. 50 KH225 10106WORIF, Managing Entity 2) Overseeing FACT Team staffing levels (a) Reviewing the Monthly Vacant Position Report and maintaining a Monthly Vacant Position Report tracker (b) Ensuring that FACT Teams are fully and appropriately staffed as described in the Attachment I PSMA 1 HC08 FACT Program document, which is incorporated herein by reference. The managing entity may not authorize any staff substitutions without obtaining prior written approval from the Southern Region SAMH Program Office, (c) Ensuring prompt communication if FACT Team provider fails to maintain appropriate staffing level for thirty (30) consecutive calendar days 3) Monitoring utilization of Enhancement Funds (a) Reviewing the Quarterly FACT Enhancement Reconciliation Report and maintaining a FACT Enhancement Reconciliation Report Tracker (b) Sending copies to Southern Region SAMH Program Office and Central Program Office of Quarterly FACT Enhancement Reconciliation Report and Tracker 4) Monitoring the FACT Team Enrollment Report (a) Reviewing the Monthly Enrollment Report and maintaining a Monthly Report Tracker (b) Verifying Quarterly FACT Monthly Report for accuracy, track and evaluate trends and provide constructive feedback to FACT Teams 5) Ensuring accuracy of the FACT Ad Hoc Report (a) Reviewing the FACT Ad Hoc Report and maintaining an Ad Hoc Report Tracker (b) Ensuring that FACT Teams submit the Ad Hoc Report to Tallahassee Mental Health Program Office (c) Sending copies of the Quarterly FACT Ad Hoc Report to Southern Region SAMH Program Office 6) Reviewing FACT Managed Care enrolled individuals (a) Reviewing the FACT AHCA Report and maintaining an AHCA Report Tracker South Florida Behavioral Health Network, Inc. 51 KH225 Managing Entity (b) Sending copies of FACT AHCA Report to the local AHCA Managed Care Representative 7) Ensuring that FACT Team Performance Measures are met (a) Reviewing the Monthly Performance Measure Data and monitoring for compliance of outcome measures (b) Presenting on Performance Measures during the Quarterly Performance Measure Review Meetings to the Southern Region (c) Sending copies of Monthly Performance Measures Report to Southern Region SAMH Program Office 8) Reviewing FACT Team Incident Reports (a) Maintaining an Incident Report Tracker (b) Identifying and addressing significant trends revealed by incident reports (c)Sending copies of significant incidents and interventions as needed to Southern Region SAMH Program Office (29) Projects for Assistance in Transition from Homelessness (PATH) The managing entity will provide oversight monitoring and service validation for the PATH network providers who have funds allocated (see Funding Detail) for support services for individuals who have a serious mental illness and/or substance abuse and are homeless or at imminent risk of becoming homeless as per the state's existing allocation when this contract is executed. a. The managing entity will manage PATH services and ensure dissemination of deliverables as set forth and described in each approved and signed Local Intended Use Application. b. Eligible PATH local matching funds must be expended in the provision of PATH eligible services to PATH eligible persons. The expenditures must match the types of services outlined in the Local Intended Use Plan. The formula to be followed is cited in Section 524 of the Public Health Services Act, as amended by Public Law 101-645. C. The managing entity will manage the PATH Grant as follows: 1) Maintaining a Quarterly Report Tracker 2) Verifying Quarterly Reports for accuracy and utilization of funds and clients served. 3) Sending the Southern Region SAMH Program Office copies of the Tracker South Florida Behavioral Health Network, Inc. 52 KH225 W170IM41 Managing Entity and Quarterly Reports. 4) Overseeing the Annual reapplication process for the PATH Grant 5) Compiling Annual report information and sending a final draft to the Southern Region SAMH Program Office for approval. 6) Ensuring providers submit final Annual report to Tallahassee. (30) Contingency Funds for Adult Mental Health The managing entity will provide oversight monitoring to network providers to ensure utilization of allocated Contingency Funds for housing, medication and other emergency expenses for indigent consumers as per the state's existing allocations when this contract is executed. a. The managing entity will oversee that providers itemize contingency funds expenditures by consumer, including expense description, time period and dollar amount. b. The managing entity will manage Contingency Funds as follows: 1) Maintaining a Quarterly Report Tracker 2) Verifying Quarterly Reports (separate Forensic/Civil Reports) for accuracy and utilization of funds. 3) Monitoring providers to ensure utilization & prevent lapsed funds 4) Sending copies of the Tracker and Quarterly Report to the Southern Region SAMH Program Office and Contract Manager. (31) Children's Mental Health Services, including services for Severely Emotionally Disturbed Children, Emotionally Disturbed Children and their Families The key strategic objectives and strategies that support the department's mission and direct the provision of services to Florida's citizens are detailed in the Substance Abuse and Mental Health Services Plan 2010-2013, which is incorporated herein by reference. They represent the primary focus of the Substance Abuse and Mental Health programs, and it is expected that the managing entity will ensure adherence to them, including but not limited to the following: a. Ensure that families and youth are full partners in the development and implementation of individual recovery plans and have a prominent voice in designing supports and services. South Florida Behavioral Health Network, Inc. 53 KH225 Managing Entity b. Prioritize services and supports for children who are involved with the child welfare and juvenile justice systems. Within these priority groups, children birth to five years of age, youth transitioning to adulthood and children at risk of residential treatment are the focus of specific activities and initiatives. System transformation is the driving force for current and future activities, with an emphasis on evidence based practices that are culturally competent, focused on prevention, early identification and intervention, and family -centered, c. Ensure that services and supports for children, youth, and families are sensitive to the impact of trauma, and are designed to address treatment issues and minimize system elements that might produce further trauma. d. Address the critical need for better information, planning, and assistance for eligible children transitioning into the adult mental health system. e. Develop coordinated systems of care for children that provide services and supports that promote recovery and resiliency by being: 1) Community -based 2) Culturally competent 3) Strength -based 4) Evidenced -based practices for children and adolescents - including Multisysternic Therapy for children and youth with or at risk of juvenile justice involvement, Therapeutic Foster Care, Family Support and Education, Cognitive Behavioral Therapy for traumatic stress, Dyadic Therapy for infants and toddlers, and the Wraparound Approach. 5) Individualized, child focused, and family directed. 6) Inclusive of early intervention with the child and family. 7) Coordinated across agencies and time lines f. The managing entity will agree to ensure that its subcontractors provide a full continuum of services to address the needs of Severely Emotionally Disturbed Children, Emotionally Disturbed Children and their Families. These services must include but not be limited to: 1) Dyadic Therapy for children under 5, 2) Behavior Analysis services for children with behavior problems, 3) Life skills and Wellness Recovery Action Plan services to children transitioning to the adult system, South Florida Behavioral Health Network, Inc. 54 KH225 111YOW01111 Managing Entity (32) Children's Mental Health- The Miami Dade Wraparound Cooperative Agreement #1 U79SM059055-01 The Miami Dade Wraparound Cooperative Agreement #1 U79SM059055-01 while espousing many of the same principles as Children's' Mental Health Services will be a separate responsibility for the managing entity. SAMHSA grant #IU79SM059055-01 was awarded to the Department of Children and Families, Substance Abuse and Mental Health on September 9, 2010. The purpose of the grant (Miami -Dade Wraparound Project) is to transform the existing Children's Mental Health system of care. The "Miami -Dade Wraparound Project" (MDWP) is a collaborative effort to enhance, expand and strengthen the existing community - based family and youth mental health services in Miami -Dade County, in order to better serve children who have serious emotional disturbances (SED) and their families or caretakers in Miami Dade County, Florida. The Miami Dade Wraparound Project (MDWP) will enable youth with multiple and changing needs to remain in the least restrictive settings in their community, in school, out of the juvenile justice/legal system and attain and maintain a physical -mental -emotional - spiritual recovery. The target population of this project is "SED adolescents, ages 12 to 17, who also have a co-occurring substance abuse diagnosis". The Project intends to provide culturally grounded, linguistically competent services to targeted youth residing within a unique racial/ethnic and culturally diverse, Miami Dade County, populated by a Hispanic majority. The MDWP will transform the existing system by offering a comprehensive range of integrated treatment services, made possible by a cross county, cross systems interagency collaboration. "System of care" values (i.e. ChildNouth-centered and family focused, community -based, culturally, and linguistically competent) are implemented using, a wraparound process, and further guided by a wellness maintenance model adapted for youth (e.g. Wellness Recovery Action Plan). This approach transforms the children's mental health system into a recovery -oriented mental health and co-occurring disorder system of care for children. The Project is committed to adhering to the values and guiding principles that support and encourage Family -Driven, youth guided and culturally and linguistically competent care. a. The goal of the Project is to provide youths and families with the services and supports they may need in the following "life domain" areas: 1) basic needs (e.g. housing, transportation, food) 2) family environment (e.g. family counseling, parenting skills, daily living skills, respite) 3) social environment (peer relations, psychosocial skills; recreation); 4) school/vocational (e.g. tutoring and job training, functional skills) South Florida Behavioral Health Network, Inc. 55 KH225 flfflt Dpl Managing Entity 5) mental health/co-occurring substance abuse treatment (counseling, medication compliance, rehabilitation; legal and safety (e.g. legal counsel, crisis management); 6) System level (e.g. advocacy, support, utilization of services). b. With respect to services delivery, the following basic service components will be implemented: (1) Enrollment and strength -based Needs Assessment; (2) Youth Clinical Diagnostic Evaluation/Assessment; (3) Immediate Crisis Stabilization; (4) Individualized Wraparound Team formation, (5) Service/Care Plan development; (6) Service/Care Plan Implementation (using community - based treatment providers; (7) Crisis and Safety planning, (ongoing); (8) Tracking, Monitoring and Adapting Service/Care Plan, and (9) Transition Services and support. C. SAMHSA Grant #1U79SM059055-01 will be transferred to the Managing Entity. The Managing Entity will develop the infrastructure necessary to support the transformation effort, implement the service components as outlined in the grant #1 U79SM059055-01 narrative, and negotiated by the Substance Abuse and Mental Health program office, as specified in the approved annual action plan. The managing entity will manage all aspects of the Children's Mental Health system of care under the direction of the Substance Abuse and Mental Health program office. (33) The Children's Crisis Response Team (CCRT) a. The Children's Crisis Response Team (CCRT) is a crisis mobile team that is attached to the Children's Crisis Stabilization Unit. They are led by a psychologist, have a behavior analyst, individual therapist, family therapist and a case manager. One on ones and other wraparound services are provided as needed. When The Southern Region is referred an indigent child for residential treatment we send out the team to do an assessment and to decide if the child can be maintained in the community. If the answer is yes, they provide an intense array of services until the family is more stable. The Children's Crisis Response Team may at times provide non -Medicaid eligible services to Medicaid recipients. 1b. The managing entity will oversee the Children's Crisis Response Team. The goals of the CCRT are: 1) To respond to children and their families in the community who are experiencing crisis because of their mental health issues. 2) To ensure that indigent children receive services in the least restrictive level possible to meet their needs. 3) That residential treatment for indigent children remains with the allowed Purchased Residential Treatment Services (PRTS) budget South Florida Behavioral Health Network, Inc. 56 KH225 10/01/2010 Managing Entity (34) Juvenile Incompetent to Proceed Program The managing entity will manage the Juvenile Incompetent of Proceed Program as per section 985.223, F,S. and as per the Department of Children and Families operating procedure. In addition, the managing entity will insure that all children involved with the JITP program are linked with the appropriate mental health services and reduce the time to access treatment services. (35) Residential Level 1 Services The managing entity will insure that Residential Level 1 is available to children in the community. Management of this resource is a complex issue. The managing entity will establish a comprehensive assessment process to determine when children are most appropriate served within residential facilities or as is often the case in their home. The managing entity will establish a system of intensive in - home services for the most severely disturbed children and families as an alternative to residential. (36) KidCare Insurance Program a. The Florida KidCare Program was created by the 1998 Florida Legislature in response to State Children's Health Insurance Program (SCHIP) legislation. Florida KidCare is the state's children's health insurance program for uninsured children under age 19. It includes four different parts, or programs: MediKids, Healthy Kids, Children's Medical Services and Medicaid. Florida KidCare covers primary health and mental health care. 1b. It is essential in order to maximize the use of Substance Abuse and Mental Health funding that as many eligible children as possible be enrolled in KidCare. The Southern Region has many children eligible for, but not receiving, KidCare services. This lack of enrollment often leads to services being funded by Substance Abuse and Mental Health. The State is in support of a foundation to be established to pay the family's monthly fee, which has been a barrier. The Managing Entity's responsibilities include: 1) Ensuring that all children who apply for Substance Abuse and Mental Health funded services are screened for KidCare within a month of initial assessment 2) Putting a process in place to facilitate the application procedure for families and provide all needed assistance 3) Addressing barriers to signing up and to family involvement. Provide timely responses to families c. BNET is a Kid Care partner developed to provide mental health and substance abuse services to children between 5 and 18 years old who require South Florida Behavioral Health Network, Inc. 57 KH225 10/01/2010 Managing Entity services beyond the scope of Kid Care. The Managing Entity's BNET responsibilities include: 1) Managing the contract with the current BNET provider 2) Ensuring that the available slots are used for children with the highest need and medical necessity 3) Addressing barriers to signing up and to family involvement. Provide timely responses to families (37) Functional Family Therapy (FFT) is a highly structured, short-term family intervention for youths with multicultural needs and effective delinquency prevention for siblings of offenders. It has been developed for use with highly dysfunctional families at risk of serious problems, including delinquency and family violence. FFT is designed to target children between the ages of 11 and 17. The goals of FFT are to engage and motivate the youth and their families by decreasing negative interactions, and thus breaking the patterns that attribute to negative consequence for the youth and the rest of the family. Each family will develop a specific behavior change plan to reduce and eliminate problem behaviors and negative family relational patterns. For the final goal, the family will generalize changes acquired in therapy across problem situations, and learn to successfully utilize community resources. The managing Entity will create and implement a utilization management process to manage this valuable resource in the children's mental health system. b. Task Limits Within the scope of this contract, the managing entity shall perform only those tasks and services set out above in Section 13.1.a., and shall ensure that the network providers do the same as applicable. Services shall only be provided in the Southern Region (Miami -Dade and Monroe Counties), with the exception of clients residing in state hospitals, or Short -Term Residential Treatment programs that are Southern Region clients, or by exception with approval by the department. The managing entity agrees to abide by the Consolidated Program Description, CFP 155-2 and Rule 65E-14, F.A.C., and is not authorized by the department to perform any tasks related to the project other than those described in Section 13.1.a. without the express written consent of the department. The managing entity may unbundle Medical Services from the Substance Abuse Residential Levels 11, 111, and IV cost centers for clients with co-occurring disorders, unbundle Psychological Evaluations from the Children's Mental Health Residential Levels I and 11, and unbundle Psychological Evaluations from the Children's Substance Abuse Residential Levels 11, 111, and IV cost centers. The managing entity shall ensure that services are performed in accordance with applicable rules, statutes, and licensing standards. South Florida Behavioral Health Network, Inc. 58 KH225 1000110111111 2. Staffing Requirements a. Staffing Levels (1) The managing entity shall require that levels in compliance with applicable rules, Exhibit F, Minimum Service Requirements Managing Entity all network providers maintain staffing statutes and licensing standards. See (2) The managing entity shall provide oversight so that the subcontractors engage in recruitment to maintain as much as possible staff with the ethnic and racial composition of the clients served. 1b. Professional Qualifications (1) The following positions/functional areas listed below shall require the minimum qualifications: (a) Chief Executive Officer/President/Executive Director Management or supervisory experience providing services to persons with Behavioral Health issues, including at least ten years in a management position. Masters Degree in Behavioral Health field or business (four years experience in addition to any other experience required may be substituted for a Masters Degree providing the individual has a Bachelors Degree). Must have a demonstrated working knowledge of contractual and government regulations, Behavioral Health treatment, fiscal management, Quality Assurance, data management and development, and Community Organization. Experience in the management of a nonprofit organization is preferred. (b) Deputy Director and Chief Financial Officer Masters Degree in Behavioral Health field or business. Eight years of experience in a Senior Management position of which five years must be in the Behavioral Health field. Must have a demonstrated working knowledge of contractual and government regulations, Behavioral Health treatment, fiscal management, Quality Assurance, data management and development, and Community Organization. Experience in the management of a nonprofit organization is preferred. (c) Medical Director The Medical Director will possess a valid Florida license to practice medicine in the State of Florida and a certification by the American Board of Psychiatry and five to seven years of experience in providing services to persons with psychiatric disabilities. The Medical Director shall be involved in the development and approval of clinical -medical policies and procedures, including those for service authorization and the review of the South Florida Behavioral Health Network, Inc. 59 KH225 10/01/2010 Managing Entity provision of medical services. The Medical Director shall also be involved in quality management. This position can be part-time. (d) Peer Services Coordinator The Peer Services Coordinator must be a Behavioral Health Services consumer who is in recovery and is either a certified Peer Specialist or working towards a certification. (e) Chief Clinical Officer Masters Degree in a Behavioral Health discipline with a current Florida license allowing the individual to provide services in a Behavioral Health service discipline. A minimum of six years experience in providing or managing the delivery of Behavioral Health services of which three or more years must be at a supervisory level. Must have a demonstrated working knowledge of Behavioral Health, community resources, funding sources, statistical reporting, best practices, recovery and resiliency concepts, quality improvement, and statistical report preparation. Must be able to define problems, collect data, establish facts and draw valid conclusions. Must be able to write policies and procedures and develop and implement treatment services and prevention protocols. Must be able to manage and prepare reports on multiple grants and contracts. (f) Director of Finance The Director of Finance must have demonstrated knowledge and experience in generally accepted accounting principles, auditing standards, financial evaluations, and funds management. A Bachelors Degree or its equivalent from an accredited institution with a focus on business, finance, economics or related field is required. Must be able to interpret and analyze audits and other financial reports, prepare electronic spreadsheets, and interpret and present financial data in an understandable format. Five years experience in fund accounting and grants management required. (g) Director of Behavioral Health Services Masters Degree in a Behavioral Health discipline with a minimum of five years experience in providing or managing the delivery of Behavioral Health services of which three or more years must be at a supervisory level. Must have a demonstrated working knowledge of community resources, best practices, resiliency and recovery concepts, CCISC model and utilization management processes. Supports the Chief Clinical Officer in managing complex systems of care. (2) The managing entity shall require that all subcontractors comply with applicable rules, statutes, requirements, and standards with regard to professional qualifications. See Exhibit F, Minimum Service Requirements. South Florida Behavioral Health Network, Inc. 60 KH225 libinlows Managing Entity (3) The managing entity shall require that all network providers provide Level 11 background screening for mental health personnel and all owners, directors, and chief financial officers of service providers in accordance with chapter 435 and section 408.809, F.S., and, as specified in section 394.4572(1)(a)-(c), F.S. "Mental Health personnel" includes all program directors, professional clinicians, staff members, and volunteers working in public or private mental health and substance abuse programs and facilities who have direct contact with or who are providing direct services to consumers of mental health services. It is the expectation of the department to support the SAMH Transformation Initiative by employing Peer Specialists and in turn following regional procedures. (4) The managing entity shall require that all subcontractors comply with Level 11 employment screening for substance abuse personnel as specified in section 397A51, F.S. (5) The managing entity shall require all managing entity staff receive a Level 11 employment screening set forth in section 435.04, F.S. regardless of whether staff have direct contact with individuals served. c. Staffing Changes The managing entity shall staff the project with key personnel identified in B.2.b.(1) who are considered by the department to be essential to this project. Prior to substituting any of the proposed individuals the managing entity shall notify and obtain written approval from the department for the proposed substitution. Written justification should include documentation of the circumstances requiring the changes and a list of the proposed substitutions in sufficient detail to permit evaluation of the impact on the project. The department, at its discretion, may agree to accept personnel of equal or superior qualifications in the event that circumstances necessitate the replacement of previously assigned personnel. Any such substitution shall be made only after consultation with department staff. The managing entity shall notify the department's contract manager, in writing within (10) calendar days of staffing changes regarding the positions of Chief Executive Officer, Deputy Director/Chief Financial Officer, Medical Director, Chief Clinical Officer, and Director of Finance pursuant to Rule 65E-14.021(8)(d)1.d.(I)(iii), F.A.C. for the managing entity and for all of the network providers. Additionally, the managing entity will notify the contract manager in writing of changes in the executive director or any senior management position of the managing entity. The managing entity shall submit for approval a table of organization (TO), that will reflect all necessary staff to operate this contract prior to implementation. d. Subcontractors (1) Section 394.9082, F.S. provides the department with the authority to contract with a managing entity for the provision or management of behavioral health services. By design and intent, the managing entity is to subcontract with network providers to provide community -based services for adults and children with South Florida Behavioral Health Network, Inc. 61 KH225 11GRIMOKIE Managing Entity substance abuse, mental health disorders and/or co-occurring disorders, as authorized in section 394.74, F.S., subject to the provisions of Section 1.1.1-3 of the standard contract. (2) In accordance with Section 1.1 of the Standard Contract, the managing entity may, only with the prior written consent of the department, enter into written subcontract(s) with the approval of the Southern Region SAMH Program Supervisor or designee. In order to comply with this requirement, a request for approval must be submitted to the contract manager 14 days prior to contract negotiation which includes the name of the proposed subcontractor and a notarized affidavit of assurance that the conditions listed in section B.2.d.(5) do not exist. (3) The managing entity may subcontract the management and oversight of the network providers which lead to cost efficiencies with the written approval of the department. (4) The managing entity shall offer all existing department and South Florida Behavioral Health Network, Inc. providers subcontracts through, at a minimum, the end of State Fiscal Year 2011-2012. (5) The managing entity shall not subcontract for substance abuse/mental health services with any person or entity which: (a) is barred, suspended, or otherwise prohibited from doing business with any government entity, or has been barred, suspended, or otherwise prohibited from doing business with any government entity within the last 5 years; (b) is under investigation or indictment for criminal conduct, or has been convicted of any crime which would adversely reflect on their ability to provide services, or which adversely reflects their ability to properly handle public funds; (c) is currently involved, or has been involved within the last 5 years, with any litigation, regardless of whether as a plaintiff or defendant, which might pose a conflict of interest to the department, the state or its subdivisions, or a federal entity providing funds to the department; (d) had a contract terminated by the department for failure to satisfactorily perform or for cause; or, (e) failed to implement a corrective action plan approved to the satisfaction of the managing entity, the department, and other governmental entities, after having received due notice. (6) No subcontract which the managing entity enters into with respect to performance under the contract shall in any way relieve the managing entity of any responsibility for performance of its duties. All payments to subcontractors shall be made by the managing entity. No reimbursement of payment made to a subcontracted network provider will be processed by the department unless there is prior written approval from the department for said subcontract. South Florida Behavioral Health Network, Inc. 62 KH225 (7) All subcontracts with network providers shall adopt the applicable terms of the provider's contract with the department. The managing entity shall include in all subcontract agreements a detailed scope of work; clear and specific deliverables; and performance standards. Each of the subcontractors will be required to follow the managing entity's Policies and Procedures and Contract. (8) Unless DCF agrees to an alternative payment method as authorized in section 394.9082, FS., and prior to entering into any subcontract, or an amendment which modifies the previously negotiated unit cost rate or adds additional cost centers, the managing entity shall conduct a cost analysis for said subcontract, in accordance with Rule 65E-14.021. 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-14,021, Unit Cost Method of Payment, including but not limited to, cost centers, 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. (9) The managing entity shall conduct competitive procurements for new discretionary funds that they subcontract in excess of $300,000 in accordance with established procurement operating procedures, 3. Service Location and Equipment a. Service Delivery Location (1) Services shall be delivered at the locations provided in the Consolidated Program Description developed pursuant to Rule 65E-14.021(8)(d)l.d.(111), F.A.C. (2) The managing entity must maintain an administrative office in the Southern Region and a managing presence in each circuit if appropriate given geographic and population factors. b. Service Times (1) A continuum of services shall be provided during the days and times as specified in the consolidated program description on file in the department contract manager's office and incorporated by reference. (2) The managing entity shall notify the department's contract manager, in writing, within (10) calendar days of any changes in days and times where services are being provided pursuant to Rule 65E-14.021(8)(d)5., F.A.C. c. Changes In Location The managing entity upon notification, shall in turn, notify the department's contract manager, in writing, a minimum of ten (10) calendar days prior to making changes which will affect the department's ability to contact the managing entity by telephone or South Florida Behavioral Health Network, Inc. 63 KH225 10/01/2010 Managing Entity facsimile transmission or as set out in Rule 65E-14.021(8)(d)d(III), F.A.C. The managing entity shall be available and will be responsible for providing an immediate response 24 hours a day, seven days a week. 174111111MMUIPM =- Any nonexpendable property purchased with departmental funds under this contract either by managing entity or network providers must comply with Tangible Property Requirements (Exhibit 1) and department operating Policies and Procedures as outlined in CFOP 40-5, 50-9, CFOP 80-2, Rule 65E-14, F.A.C., which are incorporated herein by reference. 4. Deliverables a. Services The managing entity will provide administration, management and oversight to the network of providers to ensure the delivery of client services in accordance with the Consolidated Program Description on file with the department. The funding allocated for this administration is listed in the Funding Detail (Exhibit A). An administrative unit of service is defined as one month of costs associated with the administration, management, and oversight of the provider network by the managing entity in accordance with this contract. The unit rate for this service is specified in Section C, Method of Payment. b. Records And Documentation To the extent that information is utilized in the performance of this contract or generated as a result of it, and to the extent that information meets the definition of "public records" as defined in section 119.011, F.S., said information is hereby declared to be and is hereby recognized by the parties to be a public record and absent a provision of law or administrative rule or regulation requiring otherwise, shall be made available for inspection and copying by any interested person upon request as provided in section 119.01(2)(f), F.S., or otherwise. It is expressly understood that the managing entity's refusal to comply with chapter 119, F.S., shall constitute an immediate breach of the contract, which entities the department to unilaterally cancel the contract agreement. The managing entity will be required to promptly notify the department of any requests made for public records. Unless a greater retention period is required by state or federal law, all documents pertaining to the contract shall be retained by the managing entity for a period of six (6) years after the termination of the resulting contract or longer as may be required by any renewal or extension of the contract. During the records retention period, the managing entity agrees to furnish, when requested to do so, all documents required to be retained. The managing entity shall maintain such records in whatever reasonable format is required by the department at the time, at the managing entity's expense. Data files will be provided in a format readable by the department. South Florida Behavioral Health Network, Inc. 64 KH225 10/01/2010 Managing Entity The managing entity agrees to maintain the confidentiality of all records required by law or administrative rule to be protected from disclosure. The managing entity further agrees to hold the department harmless from any claim or damage including reasonable attorney's fees and costs or from any fine or penalty imposed as a result of an improper disclosure by the managing entity of confidential records whether public records or not and promises to defend the department against the same at its expense. (1) The managing entity shall require that all network providers will protect, confidential records from disclosure and protect client confidentiality in accordance with subsections 397.501(7), 394.455(3), sections 394.4615, 414.295, F.S. and also the Health Insurance Portability and Accountability Act (HIPAA), and any other applicable State, and Federal laws, rules, and regulations. (2) The managing entity, through the network providers, is responsible for maintaining documentation of all tasks and deliverables and shall maintain records documenting the total number of clients and names (or unique identifiers) of clients to whom services were provided and the date(s) that the services were provided so that an audit trail documenting service provisions can be maintained. (3) It is preferred that all correspondence, reports, records and documentation may be provided to the department's contract manager electronically, if this is not feasible, or is not received by the department's contract manager, then hard copies must be mailed to the department's contract manager to be received by the appropriate due dates. (4) The managing entity shall comply with activities related to information systems in compliance with the department's CFP 155-2, which is incorporated herein by reference and is maintained on the department's website. �RIIIIIIIIIIIII Where this contract requires the delivery of reports to the department, mere receipt by the department 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 department reserves the right to reject reports as incomplete, inadequate, or unacceptable according to the parameters set forth in the resulting contract. The department, at its option, may allow additional time within which the managing entity may remedy the objections noted by the department or the department may, after having given the managing entity a reasonable opportunity to comply with the report requirements, declare this agreement to be in default. (1) The managing entity shall submit to the department financial and programmatic reports specified in 13.1.a.(10) above and Exhibit G, Required Reports by the dates specified. (2) The managing entity shall monitor and ensure that network providers submit treatment data, as set out in subsection 394.74(3) (e), F.S. and Rule 65E-14.022, F.A.C. Data shall be submitted electronically to the department by the managing entity by the 15 th of each month as specified in Department of Children and South Florida Behavioral Health Network, Inc. 65 KH225 MOMWE Managing Entity Families' Pamphlet 155-2 - Mental Health and Substance Abuse Measurement and Data (CFP 155-2). The managing entity shall also monitor and ensure that: (i) Ensure that the data submitted clearly documents all client admissions and discharges which occurred under this contract; (ii) Ensure that all data submitted to the Substance Abuse and Mental Health Information System (SAMHIS) is consistent with the data maintained in the provider's clients' files; (iii) Review the department's File Upload History screen in SAMHIS to determine the number of records accepted, updated and rejected. Based on this review, the provider shall download any associated error files to determine which provider records were rejected and to make sure that the rejected records are corrected and resubmitted in the SAMHIS; (N) Resubmit corrected records no later than the next monthly submission deadline. The failure to submit any data set or the provider's total monthly submission per data set, which results in a rejection rate of 10% or higher of the number of monthly records 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 records will be corrected and resubmitted; and (v) In accordance with the provisions of section 402.73(7), 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. (3) Upon request, the managing entity shall submit to 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. (4) The managing entity shall submit audit reports for the managing entity and its subcontracted network providers. The managing entity shall ensure that all audit reports will include the standard schedules that are outlined in Rule 65E-14.003, F.A.C. The managing entity shall submit to the department's contract manager copies of their and all subcontractors' financial and compliance audit reports. (5) The managing entity shall provide oversight so that all network providers comply with section I.D. (Audits, Inspections, Investigations, Records and Retention) of the Standard Contract and with Financial and Compliance Audit attachment. (6) The managing entity must ensure that all children's mental health providers complete a typed quarterly progress report that is filed in the medical record. The provider is required to provide Children and Families or Community Based Care workers, immediately upon request, with the most recent quarterly written report South Florida Behavioral Health Network, Inc. 66 KH225 detailing the progress, current status and therapeutic needs of the named child. 5. Performance Specifications a. Performance Measures (1) The managing entity shall meet the performance standards and required outcomes as specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes/Outputs and Indirect Prevention Performance Measures, which is incorporated herein by reference, or by obtaining a waiver from SAMH or implementing a corrective action plan as approved by SAMH to ensure that its subcontracted network providers meet these performance standards and required outcomes. (2) The managing entity agrees that the Substance Abuse and Mental Health Information System (SAMHIS) Data System 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 Indirect Prevention Performance Measures, which is incorporated herein by reference. The managing entity shall provide oversight to ensure that all network providers submit all service related data for clients funded, in whole or in part, by SAMH funds and local match. (3) The managing entity shall ensure that all subcontractors providing prevention services submit prevention data to the Performance Based Prevention System (PBPS) which is maintained by KIT Solutions. (4) The managing entity agrees that the Performance Based Prevention System will be the source for all data used to determine compliance with substance abuse prevention related performance standards and outcomes in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes/Outputs Indirect Prevention Performance Measures, which is incorporated herein by reference. The managing entity shall submit all service related data for clients funded, in whole or in part, by SAMH funds. (5) The managing entity shall monitor and ensure that Prevention Program Coordinator at applicable subcontractor agencies and any other personnel responsible for directly entering data into the Prevention data system must register for data entry training on PBPS and complete online or face-to-face training within 30 days of hire, and annually thereafter. Subcontractors must maintain the certificate of attendance for all participants for all trainings. This does not apply to providers who have their own data system and upload data to PBPS. b. Performance Measurement Terms CFP 155-2 provides the definitions of the data elements used for various performance measures which are quantitative indicators, outcomes, and outputs used by the department to objectively measure a provider's performance, and contains policies and procedures for submitting the required data into the department's data system. South Florida Behavioral Health Network, Inc. 67 KH225 10/01/2010 Managing Entity c. Performance Evaluation Methodology (1) The managing entity shall require that the network providers collect information and submit performance data and individual client outcomes, to the department data system in compliance with CFP 155-2 requirements. The specific methodologies for each performance measure may be found at the following website: 1/dasaboard Acf, stateJ I. (2)The managing entity agrees that its performance under this contract must meet the standards set forth above and will be bound by the conditions set forth in this contract. If the managing entity fails to meet these standards, the department, at its exclusive option, may allow a reasonable period, not to exceed 6 months, for the managing entity to correct performance deficiencies. If performance deficiencies are not resolved to the satisfaction of the department within the prescribed time, and if no extenuating circumstances can be documented by the managing entity to the department's satisfaction, the department must terminate the resulting contract. The department has the sole authority to determine whether there are extenuating or mitigating circumstances. (3) The department's contract manager will monitor the standards and outcomes specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes/Outputs and Indirect Prevention Performance Measures (incorporated herein by reference), during the contract period, to determine if the managing entity is achieving the levels that are specified. 6. Managing Entity (ME) Responsibilities a. Managing Entity Unique Activities The managing entity is responsible for the satisfactory performance of the tasks referenced in Section B.I.a. of this contract. By executing this contract, the managing entity 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 managing entity or its subcontractors. In addition, the managing entity shall: (1) Provide performance information or reports other than those required by this agreement at the request of the Southern Region's SAMH Program Supervisor, or their designee. For requests that are complex and difficult to address, the managing entity and the department will develop and implement a mutually viable work plan. (2) Cooperate with the department when investigations are conducted regarding a regulatory complaint of the managing entity subcontractors. South Florida Behavioral Health Network, Inc. 68 KH225 10/01/2010 Managing Entity (3) Provide oversight so that clients receive assistance in making an informed choice of network provider services that are appropriate for their condition and are of high quality. (4) Upon request, assist network providers with development and implementation of client admission, continued stay, discharge criteria specific to each level of care, diagnosis, presenting problems, and the establishment of review dates. (5) Make available and communicate all plans, policies, procedures, and manuals to the managing entity staff, network provider staff, and to clients/ stakeholders if applicable. The managing entity shall use the department's operating procedures for all agency procedures that have not been previously approved by the department for implementation. While strict interpretation of the department's procedures may not be translatable to the managing entity's organizational or operating structure, the intent of the procedure or process should be adhered to. If there are procedural issues that result in ambiguity, the parties shall meet to resolve the issue. The managing entity shall have their operating procedures submitted for review and approval not later than March 31, 2011, or as otherwise specified in the approved annual action plan. (6) Maximize all potential sources of revenue to increase services, and institute efficiencies that will consolidate infrastructure and management functions in order to maximize funding, as specified in the approved annual action plan. (7)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. (8) Make available to the department all subcontractor reports and corrective action plans, pertaining to outside licensure, accreditation, or other funding entities. (9) Integrate current and/or new state/federal requirements and policy initiatives into its operations upon provision by the department of the same. (10) Assist the department in developing legislative budget requests based upon identified needs of the community. (11) Maintain policies and procedures and documents that permit the reconciling of the invoices submitted to the department. The invoices shall reconcile with the amount of funding and services specified in this contract as well as the agency's audit report and client information system. (12) Make individual subcontract files available to the department, State auditors, and Federal auditors upon request. (13) Make available source documentation of units billed by sub -contracted network providers upon request from the department's contract manager. South Florida Behavioral Health Network, Inc. 69 KH225 10/01/2010 Managing Entity (14) Client Trust Funds (CTF) (a) If the network providers are the representative payee of clients, the managing entity shall provide oversight so that network providers comply with the applicable federal laws regarding the establishment and management of individual client trust accounts (20 CFR 416 and 31 CFR 240). (b) The managing entity shall provide oversight so that the network providers' assuming responsibility for administration of the personal property and funds of clients shall follow the department's Accounting Procedures Manual APM Volume 7, Chapter 6, incorporated herein by reference (7APM6). The department personnel or their designees, upon request, may review all records relating to this section. Any shortages of client funds that are attributable to the network providers shall be repaid, plus applicable interest, within one week of the determination. (c)The managing entity shall provide oversight so that, the subcontractors maintain all reconciliation records on -site for review, not withstanding 7 APM 6 Section 15. (15) Provide management and oversight so that all network providers that receive federal block grant funds from the Substance Abuse Prevention and Treatment or Community Mental Health Block Grants shall comply with Subparts I and 11 of Part B of Title XIX of the Public Health Service Act, sections 42 U.S.C. 300x-21 et seq. (as approved September 22, 2000) and the Health and Human Services (HHS) Block Grant regulations (45 CFR Part 96). (a) If funding is received from the Substance Abuse Prevention and Treatment Block Grant, the managing entity shall comply and take the steps necessary such that all network providers comply with the data submission requirements outlined in CFP 155-2 and within the funding restrictions outlined in "SAMH OCA's and Funding Restrictions" incorporated herein by reference. (b) The managing entity shall make available through its subcontractors, either directly or by arrangement with others, tuberculosis services to include counseling, testing and referral for evaluation and treatment. (c) Funds under this grant may be used to support substance abuse treatment services for individuals with a co-occurring mental disorder as long as the funds allocated are used to support substance abuse prevention and treatment services and mental health treatment and supports can be tracked to the specific substance abuse or mental health activity as listed in the State Funding by Program and Activity, which is incorporated herein by reference. (d) If funding is received from the Substance Abuse Prevention and South Florida Behavioral Health Network, Inc. 70 KH225 10/01/2010 Managing Entity Treatment Block Grant, the managing entity shall ensure that all network providers are required to participate in the State's Peer Review process if applicable to assess the quality, appropriateness, and efficacy of treatment services provided to individuals under this contract pursuant to 45 CFR 96.136. (16) Maintain data, pursuant to section 402.73, F.S., on performance standards specified in Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes/Outputs and Indirect Prevention Performance Measures (incorporated herein by reference), for the types of services provided under this contract and shall submit such data to the department upon request. All data submission requirements can be found in CFP 155-2. (17) Require that all network providers comply with Exhibit E, Missing Children, which is incorporated herein by reference and available from the contract manager, if the provider is providing these services. (18) Maintain any collaborative agreements between the department and other governmental/non-governmental agencies as mutually agreed upon by the department. (19) Prevention Partnership Grants The managing entity shall be responsible for the contracting and oversight of the Prevention Partnership grants, incorporated herein by reference, and shall ensure compliance with the language and provisions of the awarded grants. (20) Indigent Drug Program The managing entity will provide oversight monitoring and service validation for the IDP network providers to ensure that all funds allocated (see Funding Detail) are utilized for purchasing psychotropic medications or medications accessed through the "Line of Credit" from the Indigent Drug Program (IDP), as per state's existing allocations when this contract is executed: (a) The managing entity will monitor subcontractors so that they utilize IDP funds for individuals who meet any of the following criteria: 1) Have an annual income that is at or below 150% of the Federal Poverty Income Guidelines, as published annually in the Federal Register. 2) Have no liable third -party insurance or other source of psychotropic medications available, nor is the individual a participant in a program where psychotropic medications are paid for by any other funding source. 3) If the individual has third party insurance for psychotropic medications but has temporarily been denied benefits for these medications, they South Florida Behavioral Health Network, Inc. 71 rM22�, 10/01/2010 Managing Entity may receive IDP medications until such time as eligibility has been reestablished. (b) The managing entity will manage the IDP allotment as follows: 1) Disseminating IDP Year -To -Date (YTD) Activity Reports to all providers as received from Florida State Hospital. 2) Monitoring providers to ensure utilization & prevent lapsed funds. b. Coordination with other Providers/Entities (1) The provider agrees to coordinate services with other providers and state entities rendering services to children, adults, and families as the need is identified by either the department or the provider or as defined in the approved annual action plan. (2) The failure of other providers or entities does not relieve the provider of any accountability for tasks or services that the provider is obligated to perform pursuant to this contract, (3) The managing entity will ensure through its subcontractors that crisis mental health services are available to Protective Investigators to support the principle of keeping children in the home whenever possible. c. Minimum Service Requirements See Exhibit F, Minimum Service Requirements. 7. Department Responsibilities a. Department Obligations (1) The department will provide information related to any part of this contract's budget, training events, and changes in applicable state and federal laws, regulations, administrative rules, operating procedures, or department policies, including those references listed in Exhibit F, Minimum Service Requirements to designated managing entity personnel in a timely manner. (2) The department will provide technical assistance and support to the managing entity and the network providers to ensure the continued integration of services and support for clients. The department will provide technical assistance and support to the managing entity 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 and Indirect Prevention Performance Measures (incorporated herein by reference). (3) The department will participate in developing the Contingency Transition Plan, which is incorporated herein by reference. South Florida Behavioral Health Network, Inc. 72 KH225 [me Managing Entity (4) If the managing entity is under a corrective action plan, the department will conduct monthly oversight activities to ensure compliance with the plan. (5) The department will participate in the collaborative development and implementation of the working agreement with the Community Based Care and substance abuse and mental health providers to ensure the integration of services and support within the community. The department 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. (6) The department will review the managing entity's proposed policies, procedures, and plans required to be submitted by the managing entity and will respond in writing with comments, or will approve within 30 working days from the day of receipt. Once reviewed by the department, the managing entity's policies and procedures may be amended without further departmental review, provided that they conform to state and federal laws, the state Administrative Code, and federal regulations. (7) At a minimum, the Southern Region's SAMH Program Supervisor will meet quarterly with the managing entity to obtain a briefing on the network's operations. The meeting can be in person or by the phone. (8) The department will request supporting documentation and review source documentation of units billed to the department. (9) The department will make available to the managing entity any inter or intra- departmental collaborative agreements and/or any other collaborative agreements between the department and other governmental/non-governmental agencies. b. Department Determinations The managing entity agrees that services other than those set out in this contract will be provided only upon receipt of a written authorization from the department's contract manager or an authorized department staff member. The department has final authority to make any and all determinations that affect the health safety and well being of the citizens of the State of Florida. c. Monitoring Requirements (1) The department will monitor the managing entity in accordance with section 394.741, F.S. and CFOP 75-8, Contract Monitoring Operating Procedures and be obtained from the contract manager, and is incorporated herein by reference. The managing entity shall comply with any coordination or documentation required by the department's evaluator(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. South Florida Behavioral Health Network, Inc. 73 KH225 UNNIHOW Managing Entity (2) The department will monitor the managing entity on its performance of all tasks and special provisions of the contract, (3) The department will provide a written report to the provider within 30 days of the monitoring. If the report indicates corrective action is necessary, the provider shall have 30 days from receipt of the monitoring report to respond in writing to the request. Except in the case of threat to life or safety of clients, in which case the corrective action will be immediate. 1. Payment Clauses a. This is an advance cost reimbursement and fixed price, fixed payment contract, comprised of Federal sources and a grant of State funds. The Funding Detail is the document that identifies the amount of Federal and Grant resources. The department will ensure that any applicable appropriated funding for direct substance abuse and mental health services is contracted with the managing entity. Any increases will be documented through a contract amendment, resulting in a current fiscal year funding and corresponding services increase. Such increases in services must be supported by additional deliverables as outlined in the amendment. At the beginning of each fiscal year, the Funding Detail will be amended into this contract, and the total contract amount will be adjusted accordingly. The department shall pay the Managing Entity for the delivery of services provided in accordance with the terms of this contract for a total dollar amount not to exceed $362,976,259.00 subject to the availability of funds. A summary of the Funding Detail is attached as follows: Exhibit A- I Fiscal Year 10-11 $54,851,259.00 Exhibit A- 2 Fiscal I Year 11 -12 MID Exhibit A- 3 Fiscal Year 12-13 $ TBD Exhibit A- 4 Fiscal Year 13-14 $ TBD Exhibit A- 5 Fiscal Year 14-15 $ TBD Exhibit A- 6 Fiscal Year 15-16 $ TBD (1) Network Provider Service Expenses — Cost Reimbursement (a) The department shall reimburse the payment of the delivery of service units provided by approved network providers that are provided in accordance with the terms and conditions of this contract, not to exceed the following, based on the Funding Detail, subject to the availability of funds. Fiscal Year Subcontracted Services Total Amount 2010-2011 $51,703,875.00 2011-2012 $ TBD 2012-2013 $ TBD 2013-2014 $ TBD 2014-2015 $ TBD 2015-2016 $ TBD South Florida Behavioral Health Network, Inc. 74 KH225 IDIDIR 401 Managing Entity (b) The department will make payment to the managing entity, on a cost reimbursement basis, for the delivery of behavioral health services. Payments to the managing entity shall be made based upon the actual payments made to approved network providers and invoices will require submission of the approved subcontractors' paid invoices. No reimbursement will be made by the department for payments made by the Managing Entity to subcontractors not previously approved by the department. (2) Administrative Expenses — Fixed Price, Fixed Payment The department shall make a fixed monthly payment to the managing entity for the administration, management, and oversight of the Behavioral Health System of Care, not to exceed the following, subject to the availability of funds: Service Unit Fixed Fee # of Units Total Amount One Month of Administration, Management and Oversight $ 287,828.00 9 $ 2,590,452.00 (10/01/10-06/30/11) One Month of Administration, Management and Oversight $ TBD 12 $ TBD (07/01/11-06/30/12) One Month of Administration, Management and Oversight $ TBD 12 $ TBD One Month of Administration, Management and Oversight $ TBD 12 $ TBD (07/01/13-06/30/14) One Month of Administration, Management and Oversight $ TBD 12 $ TBD (07/01/14-06/30/15) One Month of Administration, Management and Oversight $ TBD 3 $ TBD (07/01/15-09/30/15) (a) The department will make payment to the managing entity for the administration, management, and oversight of the Behavioral Health System of Care (to include the administration of special projects as identified in the approved annual action plan) based on a fixed price, fixed payment method of payment. A fee equal to one twelfth of the annual administrative expenses will be paid monthly. The monthly payment for administrative expenses is based on the final negotiated approved Line Item Operating Budget (Exhibit B) and Budget Narrative, incorporated herein by reference. The department during a given fiscal year may require the managing entity to prepare and negotiate a revised line item operating budget and scope of work South Florida Behavioral Health Network, Inc. 75 KH225 Managing Entity for the allowable administrative expenses charged to the department based on decreases and increases of the approved Line Item Operating Budget (Exhibit B). (b) The managing entity will submit monthly expenditure reports for department review, no later than 30 days after the end of the month for which payment is being requested. The expenditure reports must reconcile actual administrative expenditures incurred by the managing entity versus payments for administrative expenses disbursed to the managing entity by the department. The managing entity will submit a final expenditure report within 30 days of the end of the fiscal year for department review to determine if there are any unspent funds/overpayments that need to be returned and/or reallocated to the department. Any unearned administrative funds identified in the reconciliations will be considered overpayments and will be recouped by the department. Repayment, if applicable, should be made immediately per section 1.J. of the Standard Contract. (c) The managing entity will have a total of 10% flexibility within the approved Line Item Operating Budget (Exhibit B) for allowable administrative expenses. Any budget revision that is required beyond the 10% flexibility must be submitted to the department and approved by the designated representative prior to its implementation. Any line item funding allocated under Special Projects in the Line Item Operating Budget will have no flexibility. Any budget revision shall be submitted to the contract manager and maintained in the contract manger's file. (d) Payment may be authorized only for allowable monthly expenditures, which are in accordance with the approved Line Item Operating Budget (Exhibit B). b. Renewal Clause - This is a multiple year contract for five (5) years. This contract may be renewed for a term of up to five (5) years. Such renewal shall be made by mutual agreement and shall be contingent upon satisfactory performance evaluations as determined by the department and shall be subject to the availability of funds. Any renewal shall be in writing and shall be subject to the same terms and conditions as set forth in the initial contract, including amendments. c. The managing entity shall provide local match on its own or through its network providers, according to Rule 65E-14,005, F.A.C., up to the amount specified in Exhibit A, Funding Detail. d. If the managing entity intends to close or suspend the provision of subcontracted services funded by this contract, the managing entity agrees to notify the department in writing at least sixty (60) calendar days prior to their intent to close, suspend or end service(s). 2. MyFloridaMarketPlace Transaction Fee South Florida Behavioral Health Network, Inc. 76 KH225 10/01/2010 Managing Entity This contract is exempt from the MyFloridaMarketPlace Transaction Fee in accordance with Rule 60A-1.032(l) (d), F.A.C. 3. Advance Payment a. The managing entity may request an advance for the first and second month of each fiscal year, based on anticipated cash needs, subject to approval by the Department of Financial Services. lb. In accordance with subsection 216.181(16)(b), F.S., any interest earned on advanced funds shall be returned to the department. The managing entity must submit back up documentation from the financial entity where interests were accrued supporting the Annual Percentage Rate and actual interest earned for each month, c. The initial invoices for advances will not require the submission of supporting documentation at the time of the request for the advance, but supporting documentation will be required for all invoices submitted after actual costs have been incurred. d. After the initial advance period, the managing entity agrees to request payment based on actual payments made to the subcontractors beginning with the first month that was advanced in accordance with the scheduled in Section f. below. e. Any funds that were advanced to the managing entity for administrative expenses and/or subcontracted services that were not accounted for and recouped through the final fiscal year end reconciliation of actual expenditures shall be returned to the department at the end of each state fiscal year with the submission of the final invoice for the fiscal year. f. Scheduling the Advance Payment: The following is an example of how to schedule the submission of advance and reimbursement requests: For Fiscal Year 2010-2011: Month Type of Request Based On: Date of Submission October Advance Anticipated Cash Needs October 1 s November— Advance Anticipated Cash Needs October 18' December-- Reimbursement October Actual Expenditures November 30th Januar _Reimbursement November Actual Expenditures December 30"' Februa Reimbursement December Actual Expenditures January 3615— March Reimbursement January Actual Expenditures February 30th April Reimbursement February Actual Expenditures March 30th -May— Reimbursement March Actual Expenditures -Aril —3-0-t'�- June -- Reimbursement April Actual Expenditures h May 30` Reconciliation Recoupment May Actual Expenditures June 30th Reconciliation Recoupment — June Actual Expenditures July 30th Final FY Invoice Reconciliation - Final Exnenditurr- -- - - - Year to date Actual Expenditures as of June 301h July 30th South Florida Behavioral Health Network, Inc. 77 KH225 1111MINKG1, lr#naT*7MT1-TrAK a$lli Managing Entity Month Type of Request Based On: Date of Submission July Advance Anticipated Cash Needs Jul 1� -Au ust Advance Anticipated Cash Needs July 1st September Reimbursement July Actual Expenditures Au ust 30 October Reimbursement August Actual Expenditures September 30th November Reimbursement September Actual Expenditures October 30.. December Reimbursement October Actual Expenditures November 30th January —. Reimbursement November Actual Expenditures December 30 _Eebruar _Reimbursement December Actual Expenditures January 301h March Reimbursement January Actual Expenditures February 30th _2A ril Reimbursement February Actual Expenditures March 30th .-Mat— Reimbursement March Actual Expenditures April 30 June Reimbursement April Actual Expenditures May 30th Reconciliation Recoupment May Actual Expenditures June 30th Reconciliation Recoupment June Actual Expenditures Jul 30t Final Invoice Reconciliation Final Expenditure Report Year to date Actual Expenditure as of June 30th July 30't Fiscal Year 2015-2016 Month T pe of Re ue A Based On: Date of Submission July Advance Anticipated Cash Needs July 1 -Au ust Advance Anticipated Cash Needs July 1st September -Reimbursement July Actual Expenditures h August 30` Reconciliation Recoupment August Actual Expenditures September 30th Final Invoice Reconciliation - Final Ex enditure Re ork Year to Date Actual Expenditure as of Se tember 30th October 30 th 4. Reconciliation of Advanced Funds a. Monthly expenditure reports for the month which reimbursement is being requested shall be submitted by the managing entity along with their request for reimbursement in accordance with the above schedule. 1b. Duriu the first year of this contract, a reconciliation report will be required after the 6th and 8t month. During the remaining years of this contract, a reconciliation report will be required monthly, c. All of the interest earned on advanced funds shall be returned to the department on a monthly basis, either through the submission of a monthly check or an adjustment to the monthly invoice. d. The department reserves the right to request reimbursement for advances issued to the provider that exceed actual provider expenditures that cannot be reasonably justified through these expenditure reconciliation reports. South Florida Behavioral Health Network, Inc. 78 KH225 GNT[►�i7i[�] Managing Entity e. Advanced funds shall be reconciled during the final two months of each fiscal year, either through the submission of a check or an adjustment to the invoice. 5. Additional Release of Funds At its sole discretion the department may approve the release, of more than the monthly -prorated amount when the managing entity submits a written request justifying the release of additional funds, if funds are available and the services have been provided. a. Medicaid earnings cannot be used as local match. In the absence of the Medicaid Electronic Verification report, the managing entity will rely on the subcontractors billing information. b. Subject to the availability of the Medicaid Electronic Verification, the managing entity shall require that the Medicaid enrolled network providers will not bill the department for Medicaid billable services provided to Medicaid eligible recipients. FACT services for Medicaid clients can be billed to the department. C. However, when services are covered under the Florida Medicaid program for Medicaid recipients and the recipient does not have other third party coverage, the department shall not be considered a liable third party for Mental Health and Substance Abuse Program payments funded through the department. Services shall then be billed to Medicaid and not the department; d. The managing entity shall monitor that authorized subcontractor services only be billed to the department if services are provided to non -Medicaid recipients, and/or for non -Medicaid covered services, and no other non -Medicaid first or third party payors are available; e. The managing entity shall monitor to ensure that in no event subcontractor's bill the Medicaid program for services or expenses for Medicaid recipients for which the subcontractor has already been paid by any other liable third party payor; f. The managing entity shall monitor Network Provider subcontractors to ensure that Medicaid earnings separate from all other fees; g. The managing entity shall monitor Network Provider subcontractors to ensure that Medicaid payments are accounted for in compliance with federal regulations; h. In no event shall both Medicaid and the department be billed for the same service; i. The managing entity shall monitor to ensure that subcontractor operating a 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 - South Florida Behavioral Health Network, Inc. 79 KH225 Managing Entity For -Service programs for any services for recipients while in these facilities; j. The managing entity shall monitor to ensure that subcontractors operating a children's residential treatment center of greater than 16 beds is not permitted to bill or knowingly access Medicaid Fee -For -Service programs for any services for recipients in these facilities except as permitted under the Medicaid State Inpatient Psychiatric Program Waiver; k. The managing entity shall monitor that subcontractors assist clients who need assistance and who may be eligible for Medicaid to make application including assistance with medical documentation required in the disability determination process; and 1. The managing entity shall monitor to ensure that subcontractors agree to assist Medicaid recipients covered by a Medicaid capitated entity who need and request assistance to obtain covered mental health services that the treating provider considers to be medically necessary. This assistance shall include assisting clients in appealing a denial of services. 7. Billing for Non -Medicaid Recipient and/or Medicaid Covered Children Mental Health Services The managing entity will insure that all providers agree that prior to billing the department for non -Medicaid recipient or for non -Medicaid covered services; the provider will seek payment from all other first or third party-payor. In no event shall the provider bill the department for services already paid by any other liable first or third party payor. 8. Payments from Medicaid Health Maintenance Organizations, Prepaid Mental Health Plans, or Provider Services Networks. Unless waived in Section D (Special Provisions) of this contract, the managing entity agrees that payments from a health maintenance organization, prepaid mental health plan, or provider services network will be considered to be "third party payer" contractual fees as defined in Rule 65E-14.001(2)(z), F.A.C. Services which are covered by the subcapitated contracts and provided to persons covered by these contracts must not be billed to the department. 9. Temporary Assistance to Needy Families (TANF) Billing The managing entity shall fulfill its obligations under applicable parts of Part A or Title IV of the Social Security Act and ensure that TANF funds shall be expended for TANF participants as outlined in the Temporary Assistance to Needy Families (TANF) Guidelines. Subcontractors' contracts shall specify the unit cost rate for each cost center contracted for TANF funding. TANF Guidelines can be obtained from the contract manager, or can be found at the following web site: http://www.dcfwstate,fl.us/mentalhealth/contract/index.shtmi South Florida Behavioral Health Network, Inc. 80 KH225 10/01/2010 Managing Entity 10. TANF SAW Incidental Expenditures for Housing Assistance The managing entity shall comply with the provision of TANIF SAW Incidental Expenditures for Housing Assistance, which is incorporated herein by reference. 11. Invoice Requirements a. The reimbursement for the administrative costs incurred in the administration, management and oversight for behavioral health services and the reimbursement for costs incurred in the delivery of service units or other agreed upon methods of payments provided by subcontracted network providers shall be invoiced separately by the managing entity using the following invoice formats or other agreed upon formats: See Exhibit C-1, Managing Entity Administrative Services Monthly Request for Payment/Advance and Exhibit C-2, Network Provider Services Cost Reimbursement Report of Expenditures and Request for Payment/Advance. b. Subcontracted Network Providers (1) The rates negotiated with any subcontracted network provider may not exceed the model rate as specified in Rule 65E-14, F.A.C. Any exception to this must be approved in advance in writing by the department. (2) Subcontractors will be required to comply with Rule 65E-14,021, Unit Cost Method of Payment, including but not limited to, cost centers, 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. If agreed upon with the department, other payment methods may be permitted. c. The managing entity's final invoice of each fiscal year must reconcile actual expenditures during the fiscal year with the amount paid by the department. The managing entity shall submit its fiscal year final invoice and expense report to the department within thirty (30) days after the end of each state fiscal year in the contract period. d. If no services are due to be invoiced from the preceding month, the managing entity shall submit a written document to the department indicating this information within thirty (30) days following the end of the month e. Invoices shall be submitted in detail sufficient for a proper pre -audit and post -audit. f. Supporting Documentation Requirements The managing entity shall submit the following documentation in support of their invoices, South Florida Behavioral Health Network, Inc, 81 KH225 Managing Entity (1) Administrative Services To support the administrative services unit of service (Exhibit C-11), the managing entity will submit a properly completed invoice along with an expense reports as required in section C.1.a. and a report of any interest earned on advanced funds, (2) Subcontracted Network Provider Service Delivery (a) To support subcontracted network providers line item invoices (Exhibit C-2), the managing entity shall submit to the contract manager a copy of the properly completed invoice submitted for payment by each subcontracted network provider and a copy of the managing entity's proof of payment (copy of subcontractors' paid invoice) to each subcontracted network provider for the month for which reimbursement is requested. (b) The amount paid under this contract cannot exceed the total amount of funding as specified in the Funding Detail. The Southern Region SAMH Program Office allocates the funding for this line item. (c) The managing entity is responsible for verifying the accuracy of each subcontracted network provider's invoice. (d) The managing entity shall ensure that all services provided by its subcontracted network providers are entered into the SAIVIHIS or other data system designated by the department. 12. The managing entity shall complete and submit to the department a Utilization/Lapse Report as per the approved annual action plan. 13. A separate detailed annualized line item budget with corresponding narrative for the operational costs for the administration and oversight must be submitted at least sixty (60) days before the beginning of each fiscal year during the proposed contract and renewal period. (1) Option for Increased Services The managing entity acknowledges and agrees that the contract may be amended to include additional, negotiated, services as deemed necessary by the department. Additional services can only be increased if the managing entity demonstrates competence. (2) Dispute Resolution a. The parties agree to cooperate in resolving any differences in interpreting the contract. Within five (5) working days of the execution of this contract, each party shall designate one person to act as the its representative for dispute resolution purposes, South Florida Behavioral Health Network, Inc. 82 KH225 10/01/2010 Managing Entity and shall notify the other party of the person's name and business address and telephone number. Within five (5) working days from delivery to the designated representative 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 representatives are unable to reach a mutually satisfactory resolution, either representative may request referral of the issue to the Executive Director and the Program Supervisor of the respective parties. Upon referral to this second step, the Executive Director and the Program Supervisor shall confer in an attempt to resolve the issue. b. If the Program Supervisor and Executive Director are unable to resolve the issue within ten (10) days, the parties' appointed representatives shall meet within ten (10) working days and select a third representative. These three representatives shall meet within ten (10) working days to seek resolution of the dispute. If the representatives' good faith efforts to resolve the dispute fail, the representatives shall make written recommendations to the Assistant Secretary, or designee, who will work with both parties to resolve the dispute. The parties reserve all their rights and remedies under Florida law, Venue for any court action will be in Leon County, Florida. (3) Termination Paragraph 111. C.1. of the Standard Contract is deleted in its entirety, and the following language is inserted in lieu thereof: "This contract may be terminated by either party without cause upon no less than ninety (90) 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 US 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 provider responsible for administration of the program. If either party terminates this contract without cause, that party shall coordinate a transition plan, as described in the "Contingency Transition Plan", which is incorporated herein by reference, with the other party within 30 calendar days of making such notification. This provision shall not limit the department's ability to terminate this contract for cause according to other provisions herein. (4) Sliding Fee Scale The managing entity shall require the network providers to comply with the provisions of Rule 65E-14.018, F.A.C. A copy of the subcontractors sliding fee scales that reflects the uniform schedule of discounts referenced in Rule 65E-14.018(4), F.A.C. shall be furnished by the managing entity to the department's contract manager within thirty (30) days of contract execution. The managing entity shall submit to the contract manager, within thirty (30) days of the execution of this contract, a validation that all sliding fee scales have been received from all network providers and reviewed by the managing entity for compliance, (5) Transportation Disadvantaged The managing entity agrees to comply with and provide oversight so that all network providers will comply with the provisions of chapter 427, F.S., Part 1, Transportation Services, and chapter 41-2, F.A.C., Commission for the Transportation Disadvantaged, if South Florida Behavioral Health Network, Inc. 83 KH225 11017141 Managing Entity public funds provided under this contract will be used to transport consumers. The managing entity agrees to comply with and provide oversight so that all network providers will comply with the provisions of (CFOP 40-50) if public funds provided under this contract will be used to purchase vehicles, which will be used to transport consumers. (6) Agreements with Health Maintenance Organizations/Managed Care Organizations a. The managing entity shall notify the department's contract manager, in writing, prior to entering into a contract for the provision of substance abuse and mental health services with a health maintenance organization or other managed care organization that is capitated by Medicaid to provide substance abuse and mental health services or an agent of any such health maintenance organization or other managed care organization. b. Copies of the contract shall be furnished to the department's contract manager within thirty (30) days of execution. (7) Medicaid Enrollment Those providers with substance abuse and mental health contracts in excess of $500,000 annually and rendering substance abuse services shall enroll as a Medicaid provider. This process shall be initiated within 90 days of contract execution. A waiver of this requirement may be granted, in writing, by the Director of Substance Abuse. (8) National Provider Identifier a. All health care providers are eligible to be assigned a Health Insurance Portability and Accountability Act National Provider Identifiers (NPIs); however, health care providers who are covered entities (which include all State -Contracted Community SAMH providers and State Treatment Facilities) must obtain and use NPIs. b. An application for an NPI may be submitted online at: q_ s, v/,N hhP ES/StaticForwa rd JoWorward=sta tic, q_q-e_ __._LrjListart_ c. Additional information can be obtained from one of the following websites: (1) The Florida Medicaid Health Insurance Portability and Accountability Act web site: hftp://www.fdhc.state.fl.us/Medicaid/hipaa/NPI/npi.shtml (2) The National Plan and Provider Enumeration System (NPPES) located at: s - gy1NPPES8LeIcLoDLeAq, (3) The CMS NPI web page located at: bjtLf,_1w\Myv, grus, [IbUoy/N atio n a I P rovi den tStand/. (9) Ethical Conduct The managing entity 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 provider to perform its services in accordance with South Florida Behavioral Health Network, Inc. 84 KH225 10/01/2010 Managing Entity the very highest standards of ethical conduct. No employee, director, officer, agent of the provider or 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. Provider's and 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 Section 1. R.of the Standard Contract of this contract. The provider understands 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 and the provider are public record and subject to full disclosure. The provider understands that attempting to exercise undue influence on 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 111. C. of the Standard Contract and section 286.011, F.S. The 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. (10) Mandatory Reporting Requirements a. 'The provider and any subcontractor must comply with and inform its employees of the following mandatory reporting requirements. Each employee of the provider, and of any subcontractor, providing services in connection with this contract who has any knowledge of a reportable incident shall report such incident as follows: (1) Reportable incidents that may involve an immediate or impending impact on the health or safety of a client shall be immediately reported to the contract manager; and (2) Other reportable incidents shall be reported to the 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 provider and subcontractor may also mail the completed form to the Office of Inspector General, 1317 Winewood Boulevard, Building 5, 2nd Floor, Tallahassee, Florida, 32399-0700; or via fax at (850) 488- 1428. b. A reportable incident is defined in CFOP 180-4, which can be obtained from the contract manager. (111) Liability Insurance Coverage The managing entity shall notify the department's Contract days if there is a modification to the terms of insurance, cancellation or modification to policy limits. Manager within 30 calendar to include but not limited to, South Florida Behavioral Health Network, Inc. 85 KH225 10/01/2010 Managing Entity (12) Informed Consent for Follow -Up Surveys The provider agrees to comply, and require its subcontractors to comply with the provisions of the Informed Consent for Follow-up Survey Guidelines, which is incorporated herein by reference, when drafting consent forms for post treatment follow- up surveys. (13) Contracting with a Managing Entity (a) The managing entity shall allow the department to retain the right to perform the service or activity, directly or with another contractor, if service levels are not being achieved. (b) The managing entity shall identify a clear and specific transition plan that will be implemented in order to complete all required activities needed to transfer the services or activity from the department to the provider and operate the service or activity successfully. (c) The managing entity shall interview and consider for employment with the provider each state employee (displaced as a result of this outsourcing) who is interested in such employment. (d) The managing entity shall meet all requirements for retaining records and transfer to the department, at no cost, all public records in possession of the provider upon termination of the contract and destroy any duplicate public records that are exempt or confidential and exempt. All records stored electronically must be provided to the department in a format that is compatible with the information technology systems of the department. (e) The managing entity shall, if applicable, allow the department to purchase from the provider, at its depreciated value, assets used by the provider in the performance of the contract. If assets have not depreciated, the department shall retain the right to negotiate to purchase at an agreed -upon cost. (14) Information Technology Resources All department contract providers must receive written approval from the department prior to purchasing any Information Technology Resource (ITR) with contract funds. The provider agrees to secure prior written approval by means of an Information Resources Request (IRR) Form before the purchase of any ITR, The Contract Manager is responsible for serving as the liaison between the provider and the department during the completion of the IRR in accordance with Children and Families Operating Procedure (CFOP) 50-9, Policy on Information Resource Requests. The provider will not be reimbursed for any ITR purchases made prior to obtaining the department's written approval. (15) Emergency Disaster Response Grant The managing entity will coordinate and implement any disaster/emergency grants South Florida Behavioral Health Network, Inc. 86 KH225 Managing Entity awarded to the Southern Region. (16) Documents incorporated by reference in this contract are available in the department's contract manager's file. E. List of Exhibits 1. Exhibit A-1 — A-6, Funding Detail 2. Exhibit B-1 — B-6, Line Item Operating Budget 3. Exhibit C-1 Managing Entity Administrative Services Monthly Request for Payment/Advance 4. Exhibit C-2, Network Provider Services Cost Reimbursement Report of Expenditures and Request for Payment/Advance 5. Exhibit D, Substance Abuse and Mental Health Required Performance Outcomes/Outputs 6. Exhibit E, Missing Children 7. Exhibit F, Minimum Service Requirements 8. Exhibit G, Required Reports 9. Exhibit H, Children's Mental Health Comprehensive Community Service Team 10. Exhibit 1, Tangible Property Requirements South Florida Behavioral Health Network, Inc. 87 KH225 1=112010 Exhibit A-1 Performan't, C-tract SAMH Ssrvm- Program MENTAL HEALTH FIENTNE; DETAIL Pio—forNaire -South Flordafiehavioral Ile IthN mork, Inc _J Contractif KH2'S Revision H Bridget Entity 60910502 - Adult Menial Health 502004-EMERGENCY STABILIZATION 6/A-ADULFCONINI WNTALHEALAII ADANIJ 1 1) ust Fund* Ocneral Reveime,'I'STF 6KIS F7G&D IT Citrus Health CSU GWPatnrly Errielgency -flearment 01-manatee GH) Cooper C'S1 1 GRiFaimlv Emergency Freannent-Pinellas (JR,Apalachce CK-Leon OR, Family Emergency 'heatruent-Sarasota Cale, I. ('SU-I.ake,Sunqcr OR/Roth Cooper CSIJ-Lee GR,Semmole C,,uni, CSI,T 'I S FF;Ormigii Chanty Receiving ('enter GR/APALA(>­iEE SHRT-TERM RESID FAC G,A-BAKFR ACT SERVICES Oerielal Revenue I SFF,Aluft Emeig Baker Act Services -Hernando, nando, Pasco OCA AMOUNT I Bridget (1100610) .... .. . .......... . 19004 1 19ME4 $604,191 SP5CH $3 1 250 SPN03 SP5 16 SP525 I SP541) SP553 I SP551) SP5(1() SPS61 SP572 SPAC9 ............ .. (100611) 19ME4 S6 058j,7fi60t SP592 ... ............. . .. . ... GSA-00t , I'M FIFN FBAKER Aff SERVICES PILOT (100612) (Jener-al Re,emie 19NIE4 Enneiiii—cy Stabilization Tiord 502018-RECOVERY & REStLIENCY 0A-ADUIJ COMM- MEN FAL HE ADANM F,ust fund* ADANIH Trust Fim&FAC]' Otineral Revenuelil'STF Geric,al GR/AGAPE FAM MINISTRY TRY W11 F f AN F Forensic Beds -Adult Svc 1:0 If, PATH (M I STF F01F F. FACI'Admin Olt FACTS,cs O&NITFTCYFF CiimNtll Srvs Contract-NEESH G, R OR, 'ouit Corzi,,esm the Pales Op, I S1 FAVI) ne Densch Centel -orange GRA'ba, Imr, County Ckill I ""a". (I li Short- terin Re�Sidouol Treat -Hillsborough Gii—i-I GM,fiaim-Dade Homeless Trust GRA'anifflus L,fe Center -Dade G K FACIF Fcam-Bay, Gulf (rMNhami Beh.vtoral filth Ctr-Uninsured Dade OK, the killaiiic-Campancros IM Recup-Dade CAMILLUS BEHAVIOR HLTH TRT CTR FAM EMERG TRMT CTR 19 CIRCUIT JUV CO-OCCUR ADDTNS Dade/Broward/Monroe GR/NEW HORIZON'S CENTER 6 A-INDR&N-1- PSYCH MEDICATION PROGRAM Geneir Rcvenkw G,A-BAKER A(TSERVICES General Revenue sternal I rxio I of 19018 19019 1911118 9QPSR AFNINID 39A18 CFBAS GX018 FFAII) EFS 11) MHS18 LPPME SP502 SP504 SPS05 SP511 SP512 SP513 SP551 SP552 SP555 SP558 SPWB SP5FE SPJC9 SPNH9 (101350) 19MIS $85,495 Ho()61D .. . . . . ...... 19MI8 Recovery & Resiliency Total = mrALADULTCOMM. NIH = Mental Health OCA AMOUNT 503001-EMERGENCY STABILIZATION G/A-CHILDRENS MENTAL I JEALTH ADANIFITrust Fund* General Revenue FGTF - Title xxi GR/Manitee GIcns Child Baker Act GR,lCluld Comprehensive Behavioral Services GRXSU District 08 GWIvIanon-Citrus M14-Childrint C'SU General Revenue FGTF-fitle IVB 1 90C I I91vIEI $66,633 '�Iii 89G0I ! $23,6 SP532 I S::540 S 542 SP550 SP5EB .. ... ...... .. W0027 $10,029 G,A-CHILDREN'S BAKER ACT (104257) General Revenue I 9M E I S 101,91 General Revenue SP581 Emergency Stabilization Total ,x $1,530,704 503013-RECOVERY & RESILIENCY GIA-CHILDREN'S MENTAL FIEALTI I ADAINIFIT,ust Fund* General Revenue oR,rSTF FGr FF -'I ale XXI GR/RTC Nun-Mcdoiaid Eligible GR/Ifenderson MH Center- Bi mard ADANIFITF/Infiant & Young Special Project Federal Grants 17F G/A-PURCIIASED RESIDENTIAL TREATMENT SERVICES GR/RTC Non-Medicad Eligible GRipurch Res rierarrient-Medicaid Svcs G/A-PURCIIASEiTFJFRA SVCS CHILD General Revenue (1004,35) 19CI 3 ,S7z13,o63 J,)NI 13 32NO3 j59Q 13 9PRNNI Sp5or, SP533 L GMDWI (102780) 9PRNM 9PRTS t Recovery & Residency Total - $4,201,143 TOTAL CHILDREN'S MENTAL HEALTH = $5,731,847 Rev,10/01/2010 Contract No. KH225 South Florida Behavioral Health Network, Inc. 88 10/01/2010 Exhibit A-1 Performance Contract SAMH Sam-. Program SUBSTANCE ABUSE FUNDING DETAIL Po—d"N"anQ Coutract 4 [K­142'2;� 'I , ­ua­ 4 Budget Entity 6091060 - Adult Substance Abuse OCA AMOUNT Budget Entity 60910602 - Children's Substance Abuse OCA ANIOLINT 603005-DETOXIFICATION 602001-DETOXIFICATIONIARF SVCS (100618) G/A-CHILD/ADOL SUBSTANCE FANCE ABUSE SVCS (1100420) SAPFBG 27065 S254387 I SAPTBG 27061 047 GRI'Fobacco Settlement frust Fund 27 N� I E5 GR/Tobacco Settlement Trust Fund 27MEl GR/Adult Detox ADDEX GR/Cluld Detox ll)F,,x S 6, 71 Detoxification `Total $576 _272 Detoxification'rotal $676,904 603006-PREVENTIONSERVICES 602002-PREVENTION SERVICES OIA-COMM Sl 7BS] ANCFABI, �SF SVCS (100618) GIA-CHILD/ADOL SUBSTANCE ABUSE SVCS (100420) General Revenue 27ME6 1 $66 666 1 Prevention Services -SlG/ADAMDTF 271,02 ADANIH Frust Frmd Prevention Services 27PRf, General Revenue 27ME2 1 $0 ADAMH'Frust Fund -Prevention Set -vices 27PR2 Prevention Partnership Services 27PR3 i $584,,87,5 GR/Cluld Prevention Svcs CJJPRV I 13�750 General Revenue S P61 3 GR/StevvartMaichnianTinit Ctr-Dl2 S11643 Prevention Services Total = $19fi,046 Prevention Services Total = S3,098,009 603007-FREAFNIEN F& AFTERCARE G/A-COMM SUBS? ANC TABUSE SVCS SAVI BG ADMAHTF Adnomst,awe Expenditures ADAMLYFFInna,enous Drug [ sage (JR1/ISTFJ)&MTF ADANIFITFServ,cc, to Worimi WITT T'ANF Frvist Fund SSBC'01`4'amffl.s Life Center - Dade Oencml Revenue. FEDERAL GRANTS TRUST FUND ADAMHTF-Simard Marchman Or D12 ADAMHTF-Ne,, Honvi, r, Dual Diagnosis ADAN1111 F-Adchctwn Unite Services ADAIN11ITY-Ne,v Bes urmngs P­g, Renewal ADAMI FLF-Coc.onro Ciro,e-Beha% LEE Or ADAMIDT'-Rivet Kccugis Services, Tire -NDANUFFF-Passage Wav Aftercare Project ADAVIHIT-Emer I q Mail List Reduc Project ADAMILFF-Pioject Warm CiRI/A6APE ( i RIRty er Region Womer's SA ORA'nctes ot"Care - Brevard Ci R, ('enter for Drug Fi ee Living GR,CQract for Drug, Lee Living - Bre%in,j (100618) 270G7 27AD7 27HIV 27ME7 27WOM 39FC0 ADIIUT BS631 DpG08 SB004 SP6 14 SP615 SP616 SP617 SP618 S11619 SP622 SP623 SP624 AGAPE SP651 SP652 SP669 SPo70 Treatment & Aftercare'll'otal = $10,960,917 TOTAL ADULT SUB. ABUSE= 511,733,285 GRAND FOTAL ALL PROGRAMS = FUNDS NOT RI,`.Q1IR1NC; MAICH Demsmutiona I rz a n r, n P roject s ......... . $i_,60 61-) Ch'to'en"c Menial Health Base Fundin,� $3 859,72 ina Allocation j S669 397 1 Abuse Senates S9,620,46i) ... . ...... . . $3 407 . ......... ........... . ..... ... .. ......... . T(YEAL FUNDSNOT REQUIRING MA I ('If $30,15L),825 Em—dit—r-0 t. S.1,0ii.- Ah— Pr—othot ..of T—inuoo B1­kG­t - F-di.9 Axn—at - RESTRIC-1 IONS APPLY 602003-TREATMENT & AFTERCARE G/A-CHILD/ADOL. SUBSTANCE ABUSE SVCS (100420) SAFFBG ADAMH It ust Fund Administrative Expenditures ADAMH U List Fund ( rTVFSTF/0&,mUFiCASATF WTI E LANE OR"I , & Aftc—i e - child ADAMHTrusa Fund HIV ADANIFITiust Fund-RooTsn'Wings GR/Adol Ix Dually Diagnosed Girls -DI I OR/The Compass Program ORfADAMFITF-The starting Place ADAMITIT-Adolescent Res SA Tx Facility GK/Pioject Warni-1)12 GICIPhocrax House R23 GR/1ST STEP/MOTHERSIINFANT GR, Drug Abuse Comprehensive Cord Ofie GICTIcre's Help 27063 27AD3 27CHV 27ME3 1 '2J,3,361 3 9 1C, 1 $128,034 I H-R F 27CHV $3 3_5, S6 SP602 S11608 $168,750 Spo I o SP61 I S PrA4 ----------- - -- - SP645 Sl'(A6 SP647 SP692 ,`&2>Q ow j Treatment & Aftercare Total = TOTAL CHILD/ADOL SUB. ABUSE = $7,5 7,652 TOTAL FUNDS REQl TIRING MATCH S21,544�051 LOCAL MATO I REQUIRED = S7,181,350 ADDITIONAL LOCAL MATCH GRANDTOTAL LOCALNIA LCH Rev 10/01/2010 S-th Fi-da Sehavc,.i Health Network, Inc 89 Contract No. KH225 1010112010 Exhibit A-2 Pt,'Itant.— Contract SAMH Stroirces Program MENTAL HEALTH .......... ..... ......... Ft!,ND1111N1(1;, DIFTAIL ProideiNaine �Srn-thFlorida BeliaworaillealthNetwork ,l�ic .. ..... ...... Res isiong I1'Y201 1-2012 (12 Vlw Budget Entity 6010502 - Adult Mental Health OCA AMOUNT Budget Entity 60910503 - Children's Mental Health OCA AMOUNT 502()04FFMLR(',VNCY STABILIZATION 503001-EMERGENCY STABILIZATION (3!/V­ADU1A_ COMM MENTAL IIFAI;FH (100610) G/A-CHILDREN HEALTH ADAMH f`Ernst Fwid* 19004 ADAMH Trust Fund* General Re,c,rue� FS VF I9ME4 i General Revenue ADAMHTF ConsumerSelf-Direcred ('are pilot SP501 FGTF -'Fitle XXI GK Fauldy EmettgencV ficatment Ctr-Manatee SP503 I GR, Manatee Glens Child Baker Act GICCooper ("Stil SP516 GRIChild Comprehensive Behavioral Set -vices GR/Farnily Emergency Treatment -Pinellas SP525 GR/CSU District 08 61t.,Apalachec CSU-Lcon SP549 GR/Marion-Citrus svIII-Children CSU OR Family Emergencv Fteatment-Sarasota SP553 General Revenue GWLtestream ('SU-1-ake,S ntei SP559 FGTF—title IVB OWR,ith Cp po, CS1 -Lee SP560 GR,Sem,nole Couuv CSU SP561 FSTF Orange County Reect,ing, ('enter SP572 GRIAPALACHEE SHRT-TERM RESID FAC SPAC9 I ........... G A-BAKFR ACrSER\ WFS (100611) G,,'zX-('IIIL,I)Rl-,.N'SBAKER ACT Oie,wral ReleriUe 111NIE4 General Revenue 1 S11"Adidt Ftnorg Baker Act Services-licinando, Pasco SP592 i General Revenue GA-0( I ITAI tEN I BAKER ACT SERVICES PILOT (100612) General Revenue 19ME4 Emergency Stabilization Total 502018-RECOVERY & RESILIENCY GiA-ADtJ_TC0MM MENTALHEAL'I'Ll ADA'Al I Frust Fund* ADANIE11 mst Furd/FACJ General Revenue, PSIT General Re,vmw,F6TF GRIAGAPE FAM MINISTRY W I I F 1ANT F(i] F ADAMIUOR Conan Forensic Beds -Adult Svc FONT PAT}{ GIC ISTFA`01 F - FACFAdunn GR,FACT Svcs FG IT GRI/Court Couagwm tire Pines GR`TSTF Wayne Densch Center -Orange G P Charlotte Cou"tv 0,1111 Center Cilt Short -Perm Residential 'I7eat-Hillsborough Cle,wrl ('MIT Cp GRI/Win-Bude I lomeless Trust GR C`amalkts I,Ac Center -Dade OPIFA(A fcani-ilav'Gulf (iR,'NiiaiiiiBehavioral ilith('Ir-UriiiisiiredDade GRA-he'v fflage-Campancros Fri Recup-Dade CAMILLUS BEHAViCR HLTH TRT CTR FAM EMERG TRMT CTR 19 CIRCUIT JUV CO-OCCUR ADD FNS Dade/Broward/Monroe GR/NEW HORIZON'S CENTER GA-INDIOFN I PSYCH MEDICATION PROGRAM Genert Re, Q11Uc GA -BAKER ,SAC I'SERVICES General Revalue Health Block (100610) 19018 19019 19M 18 9QPSR AFNINAD 39AI8 CFBAS GX0 18 FFA 19 FIS 19 MIAS18 VIFFFTI SP502 SP504 SP505 SP511 SP512 SP513 SP551 SP552 SP555 SP558 SP5CB SP5FE SPJC9 SPNFIQ (101,351)) 19M 18 Recovery & Resiliency'll'otal = $0 FOT,VL ADULT COMM. NIII = $0 (104257) SP581 . . ........ Emergency Stabilization total $o 503013-RECOVERY & RESILIENCY (FA-CHILDREN'S MENTAL HEALTH ADAMH Trust Fund* General Revenue OR/ISTIF FGTF - Title XXI GR,IRTC Non -Medicaid Eligible GICIlenderson NII I Center-Brovard ADAMH ITAnfant & Young Special Project General Revenue GA -PURCHASED RESIDENTIAL TREATMENT SERVICES GR/R T1 C Non-Medwad Eligible GIFTurch Res Svcs G/A-PURCHASE,J HERA SVCS CHILD General Revenue 1004 5) 19CI 3 19MI3 32N'03 8AQ 13 9PRNX,I F S ,P506 SP533 SP5NIA (102780) )PRNNI 9PRTS ........... . -- ---- ----- - - ----- - (I oolioti) 19mcli Recovery & Resiliency Total = $0 TOTAL CIFILDREN'S MENTAL IIEALTIIJ $0 Rev, 10/01/2010 Contract No. KH225 South Florida Behavioral Health Network, Inc. 90 10101/2010 Exhibit A-2 Performance Contract SAMH Services Program SUBSTANCE ABUSE FUNDING DETAIL 11rconlerNarne I South f, lot Wa Behavioral I teal Ih Nerwot k, file, Contract 4 Rev, 4 slon FY 2011-12 (12 Mon) Budget Entity 60910603 - Adult Substance Abuse OCA AMOUNT Budget Entity 60910602 - Children's Substance OCA AMOUNT 60300'.5-DETOXIFICATION 602001-DIETOXIFICATION/ARF G/A-('O.,kV\I St IISTANCE ABUSE SVCS (100618) G1/A-CIIll_D/ADOL. SU!BSTANCEABUISF SV( 100420) SAP ITIG, 27005 SAVI13G 27061 (;R,, tobacco Settlement Trust Fluid 27ME5 GR/Tobacco Settlement Trust Fiat([ 2 7M E, I GRI;Adult Detox ADDEX j OR/Child Detox CJIDEX Detoxification Total -- — ------- DetoxificationTotal 603006-PREVENTION SERVICES 602002-PREVENTION SERVICES GZA-COMM StIBSTANCE ABUSF SVCS (100618) G/,%-('Iill,-t)/ADOI, SUBSTANCE ABUSE SVCS (100420) General ReNenue 27NIE6 llreNetitiotiSci-vices-SIGI/AI)AN11i'I'F 271`02 1 k ADANIII I'tust 1�und Ptevention Services 27PR6 General Rocture 27ME2 ADANII I Trust Fund -Prevention Services 27PR2 Pi-eN,ei)tioilll,iiiiiersliipServices 27PR3 l GR/Child Prevention Svcs, ('111IRV I General ReNentre, SP613 (jR,Stewail MarchmanTrint, ('tr.- D12 S11643 Prevention Services Total = S0 Prevention Services Total No 603i)07-'I'RF,A'fMt,'N'I'&AFTERCARE 602003-TREATMENT & AFTERCARE G'A-CMVNI St JISTANCL; ABUSE SV('S (100618) GI/A-CHILD/ADOL SUBSTANCE ABUSE' SVCS (100420) SA11113(i 270G7 SAPTBG 27()G3 ADANIHIL Adnarristratne Expenditures 27AD7 F_ ---- — ---- - ---- ADANIFI Trust Fund Administrative Fxponditu 27AD3 ADAMI LFF IntraNenous Drug Usage 27111V ADAMI-I Trust Fund 27CI IV ORIA'STY O&'vITF 27NIE7 GR/ I S I F/O&NITECASATF 27MF3 ADAMI FIT Servicei to Women 27WOM W-11F TAN F i9-rc I WTTFTANF 391-c 0 ...... GR/TX & Aftercare - child (-I 'I I ust Fund ADTRT ADANIFITrust and IIIV 27CI I SSR(JTL (','111111111S Life Cvrner - Dade BS631 ADANIFITrust Fund -Roots nVings SP602 Trust General Reenue DPG08 GR/AdoL Diagnosed Girls - D 11 S11006 f FEDERAL GRANTS TRUST FUND SB004 GR'�"Ilie Compass Program S11608 A 1) M f [I F - S te ward Marc fit nai i Ch. D12 SPO 14 -------------------- --- G R� ADA \1 1`11 F-The sl arti ng Place S1,610 ADAAvlIIJI­NQNv 1h)nzons Dual Diagnosis SP61-5 -------- ADAN III TF-Adolescent Res, SA Facility S11611 ADXMMT-Addictron FruntSeivices S116:6 6 R/Prqject Warrn-D 12 S11644 A' N ADI I I IT- N c w I ic ginni ngs Pi og Renewal SP6 7 CMPIrocnix house-R23 SP615 ' t ADANI[ITF-Coconot Grove-Behav lith Ctr SP618 ......... . ... GR/IST STEP/MOTHERS/INFANT S'1`646 ADAMHTF-Ri%er Regions Services, Inc, S11619 GR/Dnq; Abuse Comprehensive Cord Ole, S1647 AD DAMIFIT-Passage Way Aftercare Pio f eet SP622 ... ... . ..................... OPERATION & MAINTF S1648 DX%III IT-Emelg, Wan List Reduc. Project SP623 ADAMLI I F-Progect Watin SP624 ADANIVI IT-FIderl ' y Compliance SA &Mf I SP625 IL GRit ef Region Women's SA SP651 GRICirdes ofCne - Ltncemd SP652 GRIVenter for Drug free Li% ing SP669 i OR, (enter for Drug FtQe Living - Brcvarcf SP670 Treatment & Aftercare Total= so Treatment & Aftercare Total = so 'EMAL, ('111ED/A00t, SUB. ABUSE = $4) TOTAI-ADUETSUB, ABUSE so E,STINIATED GPLAND t1orrAll, AtA, PROGRAMS $72,500,000 %IA 101 CA1,01 A LIONS APPLICABLE TO CONTRACT 1,,t_,INID,S NQT IZEOt IRI vG MA LCI 1: . .... ............. . .. . ........... . .... ... ...... LOCALMATCH REQUIRED $9,300,000 ADDITIONAL LOCAL MATCH i GRAND FOTAL LOCAL MA IVI I S 9,30 0,000 POTAL, FUNDS NOT REQUIRING %IA WIT $44,600,000 Fzjv-drt­ n—t t� SOM-le Ah.sr Prevention and rr,,.nu.,t IM-k (;r..t eligible " Substance Abase Pr-ention and Treatment Block Grant- Funding Agreement- RESTRICTIONS APPLY Rev. M0112010 South Florida BOiav*ral Health Network, Inc 91 Contract No. KH225 10/0112010 Exhibit A-3 Peftaria-is Ctaia.ct S I AMH Services P,.graru MENTAL HEALIM FUNDING DET Alt, PioeideiNanic Smithilott(iaBehavioral ficali)iNetwork,liie Contract KH225 IFY 2012-2013 (12, 1w . . .............. I Budget Entity 60910502 - Adult Mental Health OCA AMOUNT I Budget Entity 60910503 - Children's Mental Health OCA AMOVNT I 502004,EMERGENCY STABILIZATION G1fA-ADULX('0\IM MENTAL I­1FALrFl (1006 10) ADAMH rr,st Fund- 19004 icnera Re,crine! FS I F I9ME4 IJITFrConsmner Self -Directed Cate Pilot SP50I GRfFainny Finergency Freannerat Or -Manatee SP503 J, 6R/Coopin ("SI,17 SP516 GRXannIv FmQrgency SP525 GK,Apalachee CSL-Leon SP549 GR/Fanuly Fmcigericy Treatment -Sarasota SP553 ORA d , esn,am (SI-Lake,Surntei SP559 OR Ruth Cooper CSU-Iee SPRIO (&Senurudc UoontN CSLI SP561 I'S'I POrange Couray Rvcej4iru g ('enter . .................. . .... . SP572 GR/APALACHEE SHRT-TERM RESID FAC SPAC9 .... ........... (iA-BAKER M."I SERVICES (100611) (!metal Reveime I 9ME4 FSTF Adult Fme; g Baker Act Services -Hernando, Pasco SP592 ........ .. U,A-01_1 PA HF__N I BAKER AC1 SFRVICES, PILOY (100612) General Revenue 19', 1 EA Emergency Stabilization Total 502018-RECOVERY & RESILIENCY GIA-ADUl TCOMM MFNI'AI,IIEALI If AL)XIMITtust Fund* ADAWITiust Fund/FACT (icueral Revenue. ISTF General R-emie, FG I F GRIAGAPE FAM MINISTRY W I I F IANF Forensic Beds -Adult Svc FG IT PATH I GRAs,rF FGTF - F4Cl Admin GR R. FACT Svcs O&NITF/FG1 F Corn N114 Sris Contract -NNEFSH FGJ F ORX,na-t Cottages in the Pines GR/ IS I FAVay'ne Densch Center -Orange (JR, Char totte County CNIH Center GR'Sh i-Fiam Residential rierit-thilsbcarmigh Genera Revenue'[ 1,'TF;D(mg Gardens CNIFI Ctr GR Miami-FrIde I toneless Trust GWCat bus Life Center -Dade ORFACI Tcam-Bay, Gulf GR;Nhanit Behavioral lifth (4-1 imnsured Dade 6R,Thc VdIage-Campancios Fit Recup-Dade CAMILLUS BEHAVIOR HLTH TRT CTR FAM EMERG TRMT CTR 19 CIRCUIT JUV CO-OCCUR ADDTNS Dade/Bruwaid/Monroe GRINEW HORIZONS CENTER GPA-INDIGENT PSYCH MEDICATION PROGRAM Gene'l Rcwtmc GA-B,\KFR ACI' SERVICES General Revenue Block Grant 503001-EMERGENCY STABILIZATION G/A-CIULDREVS MENTAL HEALTH ADAMffTrust Fund* General Revenue FGTF -Tale XXI GR/Marunce Glen, Child Baker Act (iPuChild Comprehensive Behavioral Services GRA'SI) District 08 GRI'Marion-Citrus M11-Children CSI! General Revenue I'Ciff-'ritic IVB WA-CHILDREN'S BAKER ACT (104257) General Revenue 19"vm1 General Revenue SP581 Emergency Stabilization Total = 'Sill 503013-RECOVERY & RESILIENCY (100610) (,/A-Clill,DREN'S',IEN'f'AI.IIEALf'lI (100435) 19018 ADAM[ITrust Fund* I 9X'l 3 19019 General Revenue I901 3 19Pvt 18 ----- GR,,TSTF 32NO3 --- ----- ---- aQPSR 1 1`61 F - Title XXI ... . ... ..... .. . 89Q I AFMMD 6R/RFC Non —Medicaid Eligible 9PRNM 39AI8 GRAtenderson M14 Center-Bioward 4 SP506 CFBAS $0 ADANUITT/Infant & Yo-4 Special Protect SP533 GX018 General Revenue SP5MA F FA 11) FTS19 MIIS18 G/A-PITRCIIASED RESIDENTIAL. MI -IT i t THE ATIMFIN'T SERVICES (102780) SP502 ...... ........ ------- OR/RTC Non-Medicad Eligible 911RNM J SP504 GR/Purch Res D eatment -Medicaid Svcs OPRI'S S1150i SP511 SP512 .. ...... . . G/A-PIJRCIfASETIIERA SVCS CHILD (100800) SP51.3 General R-crare l'imcil SP551 SP552 SP555 ........ ... SP558 .. SP5CB SP5FE SPX1) SPNIII) (]()I ;5o) 19MI8 (100611) 19NI 18 .... . . . .. . ..... Recovery & Resiliency Total = so TOTAL ADULT COMM. M11 = so Recovery & Resiliency'rota! = SO 'TOTAL CHILDREN'S MENTAL HEAL; II = SO Rev.10/01/2010 Contract No, KH225 South Florida Behavioral Health Network, Inc. 92 1010112010 Exhibit A-3 Performance Contract SAMH Services Program SUBSTANCE ABUSE FUNDING DETAIL Provider Name [South 11mida 13chaNioral flealthlNetwo.k, Inc. Contract 4 —��'K' 1 1, - ........ 1,335,- -- — -- - -------- --jRevision I . . . ... ...................... 4 1) Budget Entity 60910603 - Adult Substance Abuse OCA AMOUNT Budget Entity 60910602 - Children's Substance OCA AMOUNT 603005-DETOXIFICATION 602001-DETOXIFICATION/ARF CONINI BSVCS (068) G/A-CHILD/ADOL SUBSTANCE ABUSE SV( (100420) a 270G5GR,/Tobacco 270GISAMFIG FobaccSettlement 1'rust Final 27NIE5 settlement Trust Fund 27MEIGR . . .... .......... . . GR/Adult Delox ADDEX GR/Child Delos CFIDFX Detoxification Total = $0 'I Detoxification Total SO 603006-PREVENTION SERVICES 602002-PR EVENT ION SERVICES 6;A-('0,MM SUBSTANCE ABUSE SVCS (100618) G/A-CIIILD/ADOI. SUBSTANCEABUSE, SVCS (100420 General Revenue 27ME6 prevention Services -SIG/ADAfIIJJ F ADAM114"rust Fund Prevention Services 27PR6 General Revenue 27ME2 i\DAMIlTrust Fund -Prevention Services 27PR2 i Prevention ll,.ir(iiei-shipSenices 27PR3 I. ... ........... GR/Child Prevention S%cs, CLIPRN' General Revenue SP61 3 3 GR., Stewart fdarchmin Jr hit. Chi.- D12 SP643 Prevention ServicesTotal $it w. Prevention ServicesTotal Si) 603007-TREATMENT & AFTERCARE 602003-TREATMENT & AFTERCARE GvA-COMM SUBS LANCE ABUSE SVCS (100618) ....... ..... . ......... G/A-Cl- 111,D/ADOL, SUBSTANCE ABUSE SVCS (100420) SAM BG 270G7 SAP] BG 27063 ADANILITF Adminisnative Expenditures 27AD7 I z \DAMFITrust Fund Administrative Expenditu 27AD3 ADAMIFFF hitraNenous Drug Usage *** 27111V - ----- --- -- 1 — — ADAMIJ Trust FLInd 27CIiV (;Rj'T SJO&NITF 27NIL7 ............. GRTFSTFIO&MT!'iCASAIT 27ME3 ADAMIFFI, Services to Women 27WONI . . .... ---------- - ---- — W'I-FFTANF 39TC1 W FIT TANF 39FC0 GR./Tx & Aftercare - child C I I TRT Trust Fund AD] RT ADANUITrust Fund HIV 2701V SSBG ll`'Canullus tite ('enter - Dade BS631 ADAMF[Trust Fund -Roots ti'Wrots SP602 General R eN cone DP( 08 GR/Adol.Tx Dually Diagnosed Girls - DI I S 606 FEDERAL GRANTS TRUST FUND S B004 GRI/ Flie Compass Program S 608 ADA),11IFF-Steward MarclananChr. D12 S11614 GR/ADAMFEFF-The starting Place S11610 ADANIII'll'-New Horizons Dtial Diagnosis SP6 5 I ADANIRTIF-Adolescent Res. SA Tx Facility S Phi I A 1) A \, I I I LF - addiction 'ritnit se rN ic es S11616 - ----------- - GR/Projc" Wano-D12 S11644 ADAMHTF-New Beginnings Prog Renewal S P6 17 . . ........ .. GRI/Phocnix Flouse-R23 S P64 5 z\D.\MII'T'I"-('ocotiijt(ir(iNe-ticliavilth('tr SP618 GRIIST STEPIMOTHERS/INFANT SP646 .... . ...... ..... . . . ............ .. . ADAM 1- 1 FF- R n er Regions Services, Inc. SP619 GRI'Drug Abuse Comprehensive Cord Ofb. SP647 ADAVIFFIT-Passage Way Aftercare Pro ject SP622 ERA] ION & MAIN TF OR SP648 ... .. .... ..... ADAI VIII I F-Enivtg, Wait List Reline, ['reject S11623 ..... . ...... ADANIIII F-Project Wann S'P624 ADAMIFIT-Elderiv Compliance SA & MFi SP625 ............ . . GWRiver Region W,,)rneirs SA SP651 GR Vnde, of (ace - 13m,li,d SP652 GRCentct for Dina I,tec Living S11069 GR/Center fogy D1118 Free LIN ing - BreN ard S11670 Treatment & Aftercare Total = $0 'Treatment & Aftercare `fatal x so TOTAL ('1111,D/ADOI, SUB. ABUSE = so `TOTAL ADULT SUB. ABUSE = so ESTIMATED GRAND TOTAL ALL PROGRAMS = $72,500,000 MA FCI I CALCU LA FIONS APPHCABLE'TO CONTRACT r)einstitutionalization ProJects FOTAL FI:NDS REQUIRING MATCH $27,9041,000 mental Health Base Fraidi Ili Exempt Block Grant Allocation LOCAL, MATCH REQI 1RF-11) Sq,30o,()00 I )i b it se S ei N ice s ... . ..... . AI)f)['fIONAI,I,,OC,\L.'YiArciI ..... . . .. ..... ... . . .. ........ .. .... ..... ... .... . ......... ..... . . ....... ...... ....... GRAND roTALLOCALMAR'll TO FAI. FUNDS NOT REQUIRING Nf, fiFl- $44,600,000 Evpcollit.1c ..-t be SOSO— Alnisc P,-crai- and Treatment Block Grant eligible * substance Abuse Prevention �.fi and Tr-o-ra Block (;,.at - Funding Agreement - RESTRICTIONS APPLY Rev. 1010'J2010 South Florida Behavloral Health Network, Inc 93 Contract No. KH225 1010112010 Exhibit A-4 ",,ftin—co Contract SAMH Services P,.iram MENTAL HEALTH F17NDING DETAIL Provider Nance :Southhim idallch kl 5 il"10'al Health Nemo,k, Inc Contract # � 122 Reiistorl It Budget Entity 60ql#1502 - Adult Mental 502004-EMERGENCY STABILIZATION 6 A-ADULFCOXINI MENTALHEALTH ADAMIFT'nist Fund* Ge'loat RC'e'wcJSrF ADAMIFTFiConsunwr Self` -Directed Care. Pilot GICI'mindy Emergency Treatment Ctr-Martatee GR/0,op,c, ('Ski GR/Faintly Filiefgency Treatment -Pinellas GR.Faauly Emergency Treatment -Sarasota GRI'Lifestream CSIJI-Lake,Siauler GR Ruth Conner ('SF I' Lee 6R�Scnlmole ("'unty CS(; TSTFCirance (`aunty Rvcc—ug Center GR/APALACHEE SHIRT -TERM RESID FAC G/ N-BAKER ACT StIMCES Gene"ll Revenue I ST'FA,hill finer); Baker Act Services -Hernando, Pasco 503001-EMERGENCY STABRAZA FION G/A-CHILDREN'S MENTAL. HEALTH ADAME[Trust Fund* General Revenue i,uri, -'Title xxi GR/Manatee Glens Child Baker Act GRXInid Comprehensive Behavioral Services G lCCSl j District 08 GWMairon-Citrus MI -I -Children CSU General Revenue FGTF-Title I'VEl (1001,11) G/A-CHILDREN'S BAKER ACT (104257) 19NIE4 General Revenue 19MFI SP592 a) Revenue SP-59 I ... ....... I ... ... ... . J Emergency Stabilization Total_, so G/A-0UTPA NEN'l BAKER ACT SERVICES PILOT (100612) General Re'enile 19NIE4 . .. ........ ... Emergency Stabilization Total = 502018-RECOVERY & RESILIENCY 503013-RECOVERY & RESILIENCY (J1;A-ADULT' COMMMENTAL HEAL l'H (100610) GA-CHILDREN'S MENTAL. FIEAITEi (100435) ADAMI I Tmst Fund* 19018 ADAMHT,ust Fund* I i)('l 3 ADAMH Dust FunddA('r 190 19 Ocircral Revenue 19NI 13 (Jermal Re,cnuc� DTF 19MI8 GR/TsTF ------- - ---- -- l2N 0) Genc,al Re,cn,n,+GTF 9QPSR FGTF -'rule xxi 89Q I3 GR/AGAPE FAM WNISTRY AFN4MD GR/R'fC Nn-Medicaid Eligible QPRNM W I If, I ANP 39A 18 6R,11enderson 'vlH Center-Browitird SP506 FGTF ADAMI I/(;R,Conun Forensic Beds -Adult Svc CFBAS $0 ADAMH FF/Infant & Young Special Project SP543 FGIT PATH GX018 General Revenue SP51v1A S ITITGTF - FAC"TAdnrin FI-Al 1) .............. . _J G10FACT Svcs FFS19 O&M TF FCi1'F,Cmn At f I Srvs Contract N EFSI I XlE1SI8 G/A-PURCHASM RESIDENTIAL.- 1 C:`T'}= NINTH TREATMENT SERVICES (102780) GRICoult Cottages in the Pines S11502 GR/RTC Non-Mildicad Eligible 1) P R MM ORITSTFAVayne Densch CenOrange ..... ...... SP504 -- -------- GR/Purch Res Tr earn rent-M edicard Svcs 9PRTS OR�Charlotu, Countv C%ll I Center - - ----------- --- - - -- - - --- ---- - SP505 (iR!Shoq-Fc,m Residential riont-Hillsborough spil I Gellert Revenue, I-SIT)Dou, ,4 Gardens CNIH Ctr SP512 G/A - P U TRCHASEil-IJERA SVCS CI BUD (I oosm) GlC.',hanu4)ade Hometess F,ust SP513 General Revenue 19MC13 GRXamillus I,itc Center-Dirde ... ......... .. . .. ..... . SP551 ................ (At FACT-l'o,un-Bav, Gulf .. .. .... .... S11552 OR/Nfiaim Behavioral 1-fith Cn-Uninsured Dade SP555 GR,Thc Vi H age �Carnpancrils Fit Recap -Dade SP558 CAMILLUS BEHAVIOR HLTH TRT CTR SP5CB FAM EMERG TRMT CTR 19 CIRCUIT SP5FE .}UV CO-OCCUR ADDTNS Dade/Broward/Monrce SPX9 . ....... . .... . GR/NEW HORIZON'S, CENTER SPNI-19 GA-INDIGFN T'PSYCH MWICA FION PROGRAM (101350) Getan I Revenue 19NI18 GILl, BAKER ACT SERVICES (100611) Giineral Revenue 19m18 Recovery & Resiliency Total = $o Recovery � I � & Resiliency Total $0 TOTAL ADULT COMM-Nitl = $0 1 `TOTAL CHILDREN MENTAL HEALTH = $0 Rev,10/01/2010 Contract No. KH225 South Honda Behavioral Health Network, Inc. 94 10XV2010 Exhibit A-4 Performance Contract SAMH Services Program SUBSTANCE. BUSE FUNDING DETAIL Pi ovider Name "outh Florida Behavioral H Health Network. Inc. Conn 4 tr Revision FY 2013 Matt} kMatt}I I Budget Entity, 60910603 - Adult Substance Abuse OCA AMOUNT Budget Entity 60910602 - Cluldreiris Substance OCA AMOUNT 603005-DETOXIFICATION 602001-DETOXIFICATION/ARF GA -CO WM St, BSTANCE ABUSF SVCS (100618) --------- - - &A-CHILD/ADOL. St jFISTANCE ABUSE SV( (100,420) SAP TI36 27065 [ ... . ............ S,AIl`FBG 27001 6R/Ftibacco Settlenrent'l rust Fund 27ME5 I GRTFobacco Settlement Trust Fund 27MEI ("p'Adull Dews ADDEX OR/Child Detox CFIDEX Detoxification Total $it Detoxification Total 603006-PREATNTION SERVICES 602002-PREVENTION SERVICES GA-COMM S1.JIS FANCF ABUSE SVCS (100618) ........................................... .. G/A-CIIILD,'ADOt. SUBS FANCF ABI ISE SVCS (100420) 6encial Revenuer 27VIE6 Prevention Services SICG/ADAVIIi rF 27F02 AI)AMI I Trust Fund Prevention Services 27PR6 General Revenue 27VIE2 ADANIH Trust Fund Prevention Services 27PR2 4 Preventing Partnership Services 2711R3 GR/Child 11reNention SNes. CIIPRV General Revenue SP611 GR,(Stewart %lifichnianTrint. ('It.- D12 S11643 1 Prevention Services Total $0 - --- --- ---------- Prevention Services Total ---- -- ' 0 603007-TREATMENT & AFTERCARE 602003-TREATMENT & AFTERCARE G1A-COVIVI SIAiS I ANCF. ABUSE SVCS (100618) G/A-CHILD/ADOI. SUBSTANCE ABUSE SVCS (100420) SAFT136 27067 SAPTBG 2_70G-3 1 ADAXIII IF AdirmustratiNe Fxpenditures 27AD7 i ADAINAII rned Fund Adininistrame Expenditu 27AD3 t A[T,\s,IIH F Intravenous Drug Usage 27FIIV ADAA,11 I Trust Fund 27C] IV GRA'S FF,O&M I F 27NIE7 ......... ........ . GR rs rF/O&MTFCASATF 27NIE3 ADANII I'l F, SQry ices to Women 27WO!il t i WTTFTANF 39TC1 W Ft F TANF 39TC0 ­­ . .... ...... ... ....... GR/rx & Aftercare - child CI ITRT -Trust Fund ADTRT ADANIflTrust Fund HIV 27C1 V SSB6 FF,Canifflus Life Center- Dade BS611 ADAMFIJnr,1 Fund -Roots n'Wings S11602 General ReN entic DPG08 . CT R , �Adol, 'Tx Duall) Diagnosed Girls - DI I S13606 FEDERAL GRANT' 3TRUST FUND S13004 I........ GIR/11te Compass Program S11608 ADANIFITF-Steward %linchman Ctr D12 S­1`614 ("R"ADAMI-ITF-The starting Place SZO ADAVIFFIT -New I lorizons Find Diagnosis S11615 ....... .. . ADANIFFIT-Adolescent Res, SA Jx Facility SP6 I Services S11616 GR/Pr qjcct Win in-D 12 SP644 L ADAVII IIF-New Beginnings Prog Renewal S110�7 GR/Phocnix }louse-R23 Sp 645 ADANIFFFF-C0001111t Grove-Fielrav Ilth Or SP6 8 GP11ST STEP/MOTHERS/INFANT SP646 AJTANIFITF-Rtvet Regions Se reel, lac. SP619 GR/Dnig Abuse Comprehensive Cord Ofc. SP647 ADAMIFFF-Passage Way Aftercare Project S W622 OPERATION & MAINTF SP648 Wart List Reduce llr(�ject SP623 ADA1011 TF-11rojeor Warm SP624 ADANIH IT-111derly Compliance SA &.1,11A S Pil, 2 5 GR'RiNcr Region Women's SA SP651 (1R/Circl" of - Bievard S11652 ---------- --- - 6RCcrner for Litirg Free I v. ing SI'669 GRI/Center for Dtng Free Ln ing - Brevard S11670 ,Treatment & Aftercare Total = $0 'Treatment & Aftercare Total = so TOTAL CHILD/ADOL, SUB. ABUSE = $0 TOTAL ADULT SUB. ABUSE = $o t'st'lMATLD GRAND TOTAL ALL PROGRAMS = $72,500,000 MATCH CALCUIA PIONS APPLICABLE TO CON TRACT J NPS EQ J` N ," � Deinstitittionaluodion Pro $44,600,000 'IOIAI-,FCIINI)SREQ(71RIN(-,.\I,Nl(�lI - $27,900,000 xempt Block Giant Allocation . ... ........ .... ...... . . LOCAL MATCH REQUIRED $9,300,000 Pro� Abuse 5,er ic-l"s ­ 1­11 1111-111111111 1 1 1 11 - 11-111-11--­ �­­,_­­­­ ­­ ........ . .... . ADDIJ IONAL LOCAL MATCH . ....... ­­­­­ _ --,""I'll, . .... ....... "I'll" _ 1.1.11.111111-1-,- , j GRAND FC)TALLOCAL NIATCH S9,300,00() TOTAL FUNDS NOF REOtTIRING NIA-rcri 1 $44,600,000 Exp­dioin­­,t ire Sidn,t.,­ Abuse Prevention surd frerd—rit Block (;,..t eligible Substance Abuse Prevention and Treatinent Black Cram- Funding Agreement - RESTRICTIONS APPLY Rev. 10101S010 South Flonda Behavforal Health Network, Inc 95 Contract No. KH225 1010V2010 Exhibit A-5 Performanee Contract SAMH Services Program MENTAL (TEAL;TH N'UNUINU [?F�'I'AIL Provider Naine �Snuflt Honda Behavioral Health Network, fire Connactli KH225 -.. .i Revision 4 ._ .. ,. Budget Entity 60910502 - Adult Mental Health OCA AMOUNT 502004-ENIERCENCY STABILIZATION 6;A ADt.:LTC0M1d MFNGAIAIEALTH (100610) -� .... .� .. ADAMH T'n.st Fund* 19004 General RewenuvTFSI'F 19ML4 AD AMIITFit. oasunner Self -Directed Care Pilot SP501 GR Family Eine.rgeucy Treatment Ctr-Manatee SP503 ( i RiCooper C `St i SP516 (rR fatally Emei µency Treatment -Pinellas SP525 1 GR Apatacllee USI s-Leon SP549 } OR Family Frnergency heannent-Sarasota SP553 ( iR Lifestream C'St- 1,ake,Suniter SP551 GR Ttuth Cooper (`SU-Lee SP560 GR Seminole County CSt SP561 i TSTF iOrange C'oanty Receiving Center SP572 GR/APALACHEE SHRT-TERM RESID FAC SPAC 9 _ G A-RAKT-R l£'PSERVWFS (100611) General Reveriae 19ME4 'FSTF Adult hinerg Bakes Act Services-Liemando, Pasco SP592 GSA OUITAT IENT BAKER ACT' SERVICES PILOT (100612) C,eneral Revenue 19ML4 Emergency Stabilization Total = s0 S02028-RECOVERY & RESILIENCY G 4 ADULC C 0%IM. Mt'NT AI, HEALTH ADANIII Trim Fund* ADAMI I Trust I uml/FACT Gen,,W Reveu ue TSTF Gcueial Reve nuevF(A I' GR/AGAPE FAM MINISTRY Al t rF £ANF IGri '.ADAMII GR Conlin Forensic Beds -Adult Svc FLAT TF PA'II C R I'S ITT I F' - FACT Admin C R F A(_'T Svcs 0& MCI C'FGTF Corn MH Sres Contr act NETSH FGTF GR Court Cottages hr the Pines GW TA I'F/Wav ue Dens,h Center-Orrange OR,Chwfone C"overly (AID Center OWShon-Term Residential Neat -Hillsborough ( enell Revenue ISI1,'DougGaidensCMH('tr frR;MiamrD,ade thaneless Irust GR Camillus Life Censer -Dude GR1 ti AC"F Tearn-Bay, sluff ORMiami Bchas ioral IT ill Ctr-Uninsured Dade GR'The, Vill zge-C'ampaneros En RecuP-Dude CAMILLUS BEHAVIOR HLTH TRT CTR FAM EMERG TRMT €,TR 19 CIRCUIT JUV CO-OCCUR ADDTNS Dade/Brottard/Monroe GR/NEW HORIZON'S CENTER G A INI)IGI,NP PS) CII MEDIC'AIION PROGRAM Gcnerl Revenue (,I .A -BAKER A(7 SERVICES General Re,cmuc Health Budget Entity 60910503 - Children's 503001-EMERGENCY STABILIZATION G/A-CHIL,DRYN S MENTAL I PEALTH ADAM,141rust Fund* General Revenue FGTF - Title XXI C R Manatee Glens Child Baker Act GR/Child Comprehensive Behavioral Services GR/CSU District 08 GR/Marion-Citrus MH-Children CSLJ General Revenue F(FFF-Title IVB C /A-CHll-DREN'S BAKER ACT (101257) General Revenue i9,MFl General Revenue SP581 _ ......-..: Emergency Stabilization Total = x0 503013-RECOVERY & RESILIENCY (100610) _. .. GA-CIIILDRE,N'SMEN'I AL HEALTH (100435) 1901 & ADAMH Trust Fund* 19C 1 3 19019 General Revenue 19M13 ? , 32NO3 /QPSR l C rF - I rule XXI 8'>G�I3 } AFMMD --, URIR. Non -Medicaid Eligible TC -t 9PRNM , 39AIEi 6RrHerdersonMIA Cente;-Bioward SP506 CFB AS = ...$0.-...__-.. , ADAMH IT Infant &: Young Special Project SP533 ...( GXo14 r .._._.. General Revenue SPSMA , FTA17 .....-......-........ FTS 19 i .....�._... i MHS18 G/A-PIRCHASE,D RESIDENTIAL MHTT1 i .. # IREATMEINT SERVICE'S (102780) SP502 GR/RTC Non-Medicad Eligible 9PRNM ?. SP504 GR/Purch Res Treatment -Medicaid Svcs 9PR1 S I j SP505 _._.. .-._... SP511 SP51 G/A PIIRCHASEITHERA Sal'$ CHILD Uooln)o1 SE1513 :._..,_._. ._.. ...... _._._..i General Revenue 19MCB } - SP551 -.- _..._ ... ... - SP552 SP555 SP558 SPSC'B SP5FE SPJC1 ___.. SPNH1i (101350) ..� .� . . 19M18 (Ioo611) 19M18 Recovery & Resiliency Total = $0 'TOTAL ADULT CONIM. MH = $0 Recovery & Resiliency Total = $0 TOTAL CHILDREN'S MENTAL HEALTH = $0 Rev, 10101120 10 Contract No. KH225 South Florida Behavioral Health Network, Inc. 96 M01/2010 Exhibit A-5 Performance Contract SAMH Services Program SUBSTANCE ABUSE FUNDING DETAIL Provider Name Contract A Re,ision 4 i __J FY 2014-15 (12 lot Budget Entity 60910603 - Adult Substance Abuse OCA ANIOUNT Budget Entity 60910602 - Children's Substance OCA AMOUNT 603005-DETON IFICA FION 602001-DETOXIFICA1'ION/ARF G A-CONIM SUBSTANCE ABUSE SVCS (100618) (!/A-CfilLL)/ADOL SUBSTANCEABUSE SV( (100420) SAI'FBG, 270(;5 _7 SAIII'136 270GI OR/Tobacco Settlement Trust Food 27NIE5 GR/Tobacco Settlement'Frust Fund 27ME I j, GR/Adult Detox ADDFX GR/Child Detox CIlDEX Detoxification Total = so Detoxification'Total 603006-PREV ENT ION SERVICES 602002-PREVENTION SERVICES G/A-CON,IM St'13STANCE, ABUSE SVCS (10()618) G/A-CILILD/ADOI. SUBSTANCE ABI-JSFSVCS (100,120) General Revenue 27ME6 Prevention Senices-SI(3i'AI)AvilIT'F 271`02 ADANiff Trust Fund Prevention Services 27PR6 General Revenue 27ME2 ADA\vIIJ Trust FlAnd-Pre\ention Services *** 27['R2 Prevention Paiiiiei-sliipServices 27PR3 GR Child Prevention Svcs, CIII)RV` General Revenue SP613 OR/Stewart Marchman Ctr.- D12 SP64-1 Prevention Services Finial = so Prevention Services 'Total so 603007-TREATNIENT & AFTERCARE 602003-TREATMENT & AFTERCARE G;A-COMM StAISTANCE ABI:SE SVCS (100618) G/A-CIIILD/ADOL SUBSTANCE ABUSE SVCS (100420) SAIII'136, 27067 SAirf-BG 270G3 ADA]MIFIT Administrative Fxpentlituics 27AD7 ....... ... ... -------- ADAM11 Trust Fund Administrative Expenditu 27AL)3 AL)AN,IfI IT Intravcrou, Ditig Usaite 27141V A1110414Trust Fund 27CIiV i GRA'STF O&M IT 27vIE7 G RA"STF/O&VITFCAS ATF 270E 'T AD,\\,Ifl'1'1,'Ser\iQcsioWomen 27W'0y I - -- - ------------ W'FTFLANF 39TCi W FIT TANF 39TCO (',P,,Tx & Aftercare - child CH rR'F Frust Fund AT) FRT ADAkJIl Tnist Fund 111V 27CHV SSBG LF Camillus I �fe Center - Dade BS631 ADAMIlTrust Fund -Roots nWings SP602 General Re\ enue DpG08 - - ----- ------------- GRIAdol, Tx Dually Diagnosed Gids - DI I SP 606 FEDERAL GRANTS TRUST FUND SB004 OR!The Compass Program SP60S i" ADAMI 11 F-Stervard Marclunan Ctr, D12 S�`6�4 (,R/ADAyvI[ITF-The starting Place Sl)6I() ADAMWIT-New Horizons Dual Diagnosis S r6 5 i ADANIFFIT-Adolescent Res, SA Tx Facility SPOIL ADANJII IT Addiction Frunt Services SP6 16 ("I 11"n-6ect Warm-D 12 4 ADAMI IT C-New Beginnings Prog Renewal ADAM HTF-Coconut Gro\ SP617 GRil"hoenix I lousc-R23 SI1( 5 c-13clun, Hth Or ADAMIITF-Ri�er Regions Services, Inc. SP618 SP619 i GR/lST STEP/MOTHERS/INFANT S P6' 6 6R/DrugAbuse Comprehensive Cord Ofe. S 1`6•7 ADAM]ITF-Passage Way Aftercare Project SP622 OPFRATION & MAIN TF SP6 8 ADANUFFF-lanerg, Wait List Radice, Project - SI,6'3 ADAMFITF-ProJect Warm SP624 ADAM I FIT- I 'Jdvh ly Compliance SA & MII S11625 ..................... . .. . . .. .. .. (JR� RiNat Region Women's SA SP651 G R, Circles of ('are Bre, rord SP6)-2 GR/Center for Drug Free Living Sp669 GRA'entei fro: Dole Free Li, ing - Brevard S11070 Treatment & Aftercare Total = $o 'Treatment & Aftercare Tratal = $o TOTAt, ('IlltD/ADOI,, SUB. ABUSE = so TOTAL ADULT SUB. ABUSE = $o ESTIMATED GRAND TOTAL ALL PROGRAMS = $72,500,000 MA LCI I CAL(11XT IONS APPLICABLFTO CONTRAC F FFT DS N( - RE, 'Q MATCH Prote cta ............ ii S44,600.000 TO I' \LFt1NDSRFOt;IRIN(.,',Iz\'I'('11 = $27,900,000 'c'Mental I lealth Base Fundin, 1. "VJll Exempt Block Grant Allocanon -1 LOCAL MATCI I RE )I IRED $9,300,000 Abarsc Services_ ............ .. .. . .. 1 ADDITIONAL LOCALMATCH GRAND FOTAL l,OCAL MATCH $913001000 TOTAL FUNDS NOTREQUIRING MATat ...... ...... ........ .. .. . .... .. . ... ..... S44,600,000 Expenditure most be SuIrstruice Abuse Prevention and'Freatinent Black Grant eligible � Substance Abrtw Prevention ..d ricatiocat Block Grant - Funding Agreement- RESTRICTIONS APPLY Rev. 10101/2010 South Florida Behavioral Health Network, Inc 97 Contract Na. KH225 10/01/2010 Exhibit A-6 P.O.I-mance C.ou."t SAMH Seavi-s P,egotot MENTAI, llEAI.TH DETAIL Pro,idei Name Sojrh c . . ... . .... �Flo-ht It om, act p K11225 Revision # I Budget Entity 60910502 - Adult Nlental Health 502004-EMERGENCY STAIIIIIAZATION GA-ADULFCO.NINJ MENIAL HEALTH ADANIJITrust Fund* General Re,r,j,ueiT1;'H` ADA'vIIN`F,('—sunaa Sc[f-Directed ('are Pilot GRA'amily Emergency heatment 0r-Manatee GRACooper CSC GR,I'mmly Fmvjgency Treatment -Pinellas GR/Apaiachce ("SU Loon GRFamdyl Emergency Treatment -Sarasota GWLifesccam('S1, Lake Sumter 6R Ruth Cooper CSU Lec G R, Serra r7ole C—niv ('St' I S1 F'Orange CoumRe,eimg Center GR/APALAaiEE SHIRT -TERM REBID FAC GA -BAKER ACT SERVICES General Revenue 1-STI'Adult Fiiwrg Baker Act Services -Hernando, let nat)(lo, Pasco OCA AMOUNT I Budget Entity 60910503 - Children's Mental Health OCA ANIO I INT ............ ... IONIE4 - ... ---- ------- S11592 G/A-0(, 1Tlc,VrI1'INTBAKER \('F SI, RVICES PILOT (100612) General Revenue 19ME4 Emergency Stabilization Tojof S 502018-RECOVERY & RESIIJENCY OiA-A 1)[11 1, F COM At VILNrAr,HEALTH NDA , NIH I'mst Fund* ADANIII Trust Fund FACT GQ'W'aI Revcnucl'rI'F (3cretal Re,eone F(A'F GRIAGAPE FAM MINISTRY W 111. 1 ANI, Forensic Beds -Adult Svc F(J'I-F PA I I I GWI'SJ'FT6T-F - FACT.Adntm (JWFACTSvcs O&M FF4FGI€ ('o,c \1H Stas(`ontract-'NEFSII L (A 1, (WCourt Cott agesm the 11 cs GRI,JSTF)Waviie Derisch Centei-Orance (ap"Charl"tte C0.11tv ('mH Center OR, short-'re-1 Resideo"al Treat -I fillsbolough Generl RQ,cruvv-I-ST'FDout; Gardens CNIII Ctr GRYAllam'-Dade 11"nahess ro'st GR Cunulhis t.,j'e Center -Dade GR,FA("I'1eam-B,p, Gulf OR Miami Beha,urai Ifith Cii-Vton-red Dade GR"I'lle Village-Carnpancros En Recup-Dade CAMILLUS BEHAVIOR HLTH TRT CTR FAM EMERG TRMT CTR 19 CIRCUIT JUV CO-OCCUR ADDTNS Dade/Broward/Monrce GR/NEW HORIZON'S CENTER G A-fNDWFN-1'PSYCH MEDICATION PROGRAM Gened Re"Ime GA-BAKFR ACC SERVICFS General Rc,Q,,,e Em 503001-EIIERCENCY STABILIZATION (i//\-CHILDREN'S MENTAL HFAIA It ADAMII Frost Fund* General Revenue FG-FF - Title XXI GR' fVlaredec Oleo, Child rt.ke, Act 6KIChild Comprehensive Behavioral Services G R,/('SU District 08 GRAhmon-Citrus MII-Children ('Sri General Revenue 17G FF-Tifle IV 13 (j/A-('tllt.DREN'S 13AKER ACT (10-1257) General Revenue 1910EI 1 General Revenu© S11581 Emergency Stabilization Total $0 503013-RECOVERY & RESILIENCY (100610) G/A-CHILDRENISMENTAL IIEALFII (100435) 19018 ADAMIl host Fund* I 9CI 3 19011) General Revenue I om 1 3 19NH8 GR,1rs'rF 32NOt 9Q PSR F N`F -'Title le XXI 899, 13 APMN 1) GR/R'r('Non-Medicaid Fligible 9PRNM 39AI 8 GRIlienderson MH Ceoter-Broward SP506 CFBAS $o g ADA101IT!"Infant & Young Special Project SP533 (ixm General Revenue 5115MA FFA19 F'I S19 MJIS18 GA-PURCIIASED RESIDENTIAL mirl"I'l I'REATNIENT SERVICES (1027SO) SP502 6R/RTC Non-VIedicad F ' Lgible 9 P R NNI S11504 GR/Purch Res Treatment-Nlechcaid Svcs 9PR'l S SP505 SP511 SP512 G/A-PURCHASEi'FlIERA, SVCS CHILD (loosoo) SP513 General Revenue 19NIC13 SP551 SP552 SP555 SP558 SP5CB SP5FE "PJC9 .... . ------- SPNI19 (I 35o) 19mig (100611 I9kIj8 Z Recovery & Resiliency'l'otal = $0 l"OTAIL, ADIAIJ COMM. N111 = $0 Recovery & Resiliency Fotal = $0 1'0'1'/%L CHILDREN MENTAL. HEALTH = $0 Rev.10/01)2010 Contract No. KH225 South Florida Behavioral Health Network, Inc, 96 Exhibit A-6 Performance Contract SAMH Services Program SUBSTANCE ABUSE FUNDING DETAIL Pi-hici Name coutra't 4 Revision # 16 (3 Man) FY 2015 Budget Entity 60910603 - Adult Substance Abuse OCA AMOUNT Budget Entity 60910602 - Children's Substance OCA AMOUNT 603005-DETOXIFICArION 6020011-DETOXIFICATION/ARF 6 S!, BS] ANCE ABUSF SVCS (100618) G/A-CIiILD/ADOL SUBSTANCE ABUSE SV( SA P`FBG 270G5 SAIIFBG 270GI GR/ I obacco Settlement Trust Fund 2 7 10 E.5 GR/Tob.cc. Settlement Trust Fund 27MEI GRIAdult Detox ADDEX G-R'Child Detox CDENF- Detoxification Total = so Detoxification TotalS7 603006-PREVENTION SERVICES 602002-PREVENTION SERVICES (PA-COMM SUBS LANCE ABUSE SVCS (100618) G/A-CITILD/ADOL. SUBSTANCE ABUSE. SVCS (100420) General Revenue 27ME6 Prevention Services -SIGiADAVIl-lrF 271,02 ADAMI ITrust Fund Prevention Services 27PR6 General Revenue 27MF2 ADANIH Trust Fund -Prevention Services 27PR2 Prevention Partnership Services 2711R3 GRXhild Prevention Svcs. `V General Revenue S1613 GR/Steivart Marchnian Trutt. Ctr.- D12 S:>043 Prevention Services Total $o Prevention Services Total=$0 603007-1'REA UMENT& AFTLRCARE 602003-TREATMENT & AFTERCARE GA-COMM SUBS'l ANCE, AB(:SE SVCS (100618) G/A-CIJILD/ADOL SUBSTANCE ABUSE SVCS (100420) SAPTBG 27067 Sz\I"Ft3G 270GI A 1) X\ I I I IT A d air i i haratio e Expenditures 27AD7 ADAMFITrust Fund Adininistram e Expenditu 27AD3 ADAMFITF Intravenous Diug Usage 271 IIV i ADANIH Trust Fund 27CLIV GWTS1 PO&M IT 27ME7 27ME3 Al) AM} I IT Services to Women 27WOM i W'FfI`TANF 39TCI W-FIT IANF 391CO GR/1x & Aftercare- child CILITRT Trust Fund AD'FR'f ADAMFIRust Fund ITIV 27CLIV SSBG I I'A'anifflUS Life Center -Dade 13 S 63 1 ADAVIH Trust Fund -Roots n'Wings Sp60, i.......... ... General Revenue I)pc,)8 GR/AdoLTx Thainy Diagnosed Girls - DI 1 SP606 I FEDERAL GRANTS TRUST FUND S 13004 iGR/The Compass Program SP608 ADAI Ctr. D12 SP614 . .......d, GRI'ADAMILLF-1he starting Place S)610 ADA'vIIJTF-N,ew Horizons Dual Diagnosis SP015 ADANILITF-Adolescent Res. SA I's Facility SPGI1 Al) AN MLIFF-A&Iielion rrantSer6ces SP616 GR/Poject Wanu-D12 SP644 ADANII I IT -New Beginnings Prog Renewal SP017 GR/Phirenix flouse-R23 SP645 kDAN I I ITF-COCOI let G rO\ Q- 11 e haV I Ith C t r SP618 GRAST STEPIMOTHERS/INFANT S11046 ADA %I IT FF- Ri v er Regions Services, Inc. SP619 GR/Drug Abuse Comprehensive Cord Ofc. SP647 .. . ..... ... ADAMILIT-Passage Way Aftercare Pro jeer SP622 OPERA1 ION & MAINTF SP648 ADAMLI I F-Erneig, Wait List Reduc. Project SP623 ADAMI ITF-l"toJect Winin SP624 ADA,MH I-F-Fidefly Compliance SA & MY! S11625 GWRker Region Women's SA S11651 GR, Citcles ofCwe - tire, and SP652 GR ('enter for Ding Free Living SP669 Olt, Center Tpr Dru a Free I iving - Brevard SP670 Treatment & Aftercare Total = Treatment & Aftercare "rota) = SO TOTAL CMILDIAD01, SUB. ABUSE = Sp TOTAL. ADULT SUB. ABUSE = so ESTIMATED GRAND TOTAL, ALA, PROGRAMS = $18,125,000 MATCH CALCIA AFIONS APPLICABLE TO CONTRACT FUNDS NO TR 'OUI RING MATCH Lienetatutionalization pi-r�jects 512083, TOTAL Fl AIDS REQUIRING MATCII S6,041,667 Clnldrcn"e Mental II ........ .. .. NILII Exemt BlockGirant Allocation . . .... .... ... .. _3 LOCAL *vIA ICI I RFQUIRFD $2,013,889 111 AbLISCSMICCS ADDITIONAL LOCAL MArCH . .............. .. . . ....... ... ... . ..... .... . . ... ....... . .... ... . .. . ... .... . ... . ......... ........ .. .. (;RANDTOTAL LOCAL MA FCIT S, 2, 0 1 Sligij' TOTAL F1 NUS NOT REQ1, I ]RING 12,083,333 Ep,rndinueaotst I* Substance abuse Prevention ..it Frelto-o flfo& Grant eligible * S.hsta— Abw Prevention and l'—u-nt Mirk Grant - Finulkii; Agreement- RESTRICTIONS APPLY Rev M01/2010 South Florida Behavioral Health Neeyork, Inc 98 Contract No. KH225 • SAMH Services Program EXHIBIT B-1 LINE ITEM OPERATING BUDGET AGENCY: South Florida Behavioral Health Network, Inc. CONTRACT # KH225 CONTRACT PERIOD: FROM: 10/01/2010 TO 06/30/2011 DATE PREPARED: 10/01/2010 Special Projects - Administration, CMH SAMSHA Management & Wraparound Other Special Oversight Grant Projects LINE ITEMS AMOUNTS AMOUNTS AMOUNTS TOTAL I. PERSONNEL SERVICES (a) SALARIES $1,561,741 $174,289 $ $1,736,030 (b) FRINGE $325,111 $22,170 $ $347,281 TOTALPERSONNEL= $1,886,852 $196,459 $0 $2,083,311 II.EXPENSES ---------- (a) BUILDING OCCUPANCY $114,000 $ $ $114,000 (b) PROFESSIONAL SERVICES $62,500 $0 $ $62,500 (c) TRAVEL $42,049 $2,540 $ $44,589 (d) EQUIPMENT COSTS $ $ $ $0 (e) FOOD SERVICES $ $ $ $0 (P MEDICAL AND PHARMACY $ $ $ $0 (g) SUBCONTRACTED SERVICES $ $ $ $0 (h) INSURANCE $15,000 $ $ $15,000 (I) INTEREST $ $ $ $0 OPERATING SUPPLIES & $278,711 $ $278,711 EXPENSES (k) OTHER $ $ $ $0 (1) DONATED ITEMS $ $ $ $0 TOTAL EXPENSES = $512,260 $2,540 $0 $514,800 III, NONEXPENDABLE PROPERTY (a) EQUIPMENT $39,931 $ $ $39,931 (b) PROPERTY $0 $ $ $0 TOTAL NONEXPENDABLE PROPERTY = $39,931 $0 $0 $39,931 IV. COMPUTER HARDWARE, SOFTWARE, & SERVICES $101,409 $0 $0 $101,409 TOTAL COMPUTER EXPENSES = $101,409 $0 $0 $101,409 V. SPECIAL PROJECTS $0 $407,933 $0 $407,933 GRAND TOTAL = $2,540,452 $606,932 $0 $3,147,384 Rev 10/0V2010 South Florida Behavioral Health Network, Inc. 100 Contract No. KH225 SAMH Services Program EXHIBIT B-2 LINE ITEM OPERATING BUDGET AGENCY: South Florida Behavioral Health Network, Inc. CONTRACT # KH225 CONTRACT PERIOD: FROM: 07/01/2011 TO 06/30/2012 DATE PREPARED: 10/01/2010 Administration, Special Projects - Management & CMH SAMSHA Other Special Oversight Wraparound Grant Projects LINE ITEMS AMOUNTS AMOUNTS AMOUNTS TOTAL I. PERSONNEL SERVICES (a) SALARIES $ $ $ $ (b) FRINGE $ $ $ $ TOTAL PERSONNEL = $ ---------- $ ---------- $ ---------- $ ---------- II_ EXPENSES (a) BUILDING OCCUPANCY $ $ $ $ (b) PROFESSIONAL SERVICES $ $ $ $ (c) TRAVEL $ $ $ $ (d) EQUIPMENT COSTS $ $ $ $ (e) FOOD SERVICES $ $ $ $ (f) MEDICAL AND PHARMACY $ $ $ $ (g) SUBCONTRACTED SERVICES $ $ $ $ (h) INSURANCE $ $ $ $ (i) INTEREST $ $ $ $ (1) OPERATING SUPPLIES & $ $ $ $ EXPENSES (k) OTHER $ $ $ $ (1) DONATED ITEMS $ $ $ $ TOTAL EXPENSES = $ ---------- ---------- $ ---------- ---------- $ ---------- ---------- $ ---------- ---------- III. NONEXPENDABLE PROPERTY (a) EQUIPMENT $ $ $ $ (b) PROPERTY $ $ $ $ TOTAL NONEXPENDABLE PROPERTY = $ $ $ $ IV. COMPUTER HARDWARE, SOFTWARE, & SERVICES $ $ $ $ TOTAL COMPUTER EXPENSES = $ $ $ $ V. SPECIAL PROJECTS $ $ $ $ GRAND TOTAL = $TBD $TBD $TBD $TBD Rev.10/01/2010 South Florida Behavioral Health Network, Inc. 101 Contract No. KH225 SAMH Services Program EXHIBIT B-3 LINE ITEM OPERATING BUDGET AGENCY: South Florida Behavioral Health Network, Inc. CONTRACT # KH225 CONTRACT PERIOD: FROM: 07/01/2012 TO 06/30/2013 DATE PREPARED: 10/01/2010 Administration, Special Projects-CMH Management & SAMSHA Wraparound Oversight Grant Other Special Projects LINE ITEMS AMOUNTS AMOUNTS AMOUNTS TOTAL I. PERSONNEL SERVICES (a) SALARIES $ $ $ $ (b) FRINGE $ $ $ $ TOTAL PERSONNEL = $ $ $ $ II. EXPENSES (a) BUILDING OCCUPANCY $ $ $ $ (b) PROFESSIONAL SERVICES $ $ $ $ (c)TRAVEL $ $ $ $ (d) EQUIPMENT COSTS $ $ $ $ (e) FOOD SERVICES $ $ $ $ (i) MEDICAL AND PHARMACY $ $ $ $ (g) SUBCONTRACTED SERVICES $ $ $ $ (h) INSURANCE $ $ $ $ (i) INTEREST $ $ $ $ 0) OPERATING SUPPLIES & $ $ $ $ EXPENSES (k) OTHER $ $ $ $ (1) DONATED ITEMS $ $ $ $ TOTAL EXPENSES = $ $ $ $ Ill. NONEXPENDABLE PROPERTY (a) EQUIPMENT $ $ $ $ (b) PROPERTY $ $ $ $ TOTAL NONEXPENDABLE PROPERTY = $ $ $ $ IV. COMPUTER HARDWARE, & SERVICES $ $ $ $ TOTAL COMPUTER EXPENSES = $ $ $ $ V. SPECIAL PROJECTS $ GRAND TOTAL = $TBD $TBD $TBD $TBD Rev. 10/01/2010 South Florida Behavioral Health Network, Inc, 102 Contract No. KH225 SAMH Services Program EXHIBIT B-4 LINE ITEM OPERATING BUDGET AGENCY: South Florida Behavioral Health Network, Inc. CONTRACT # KH225 CONTRACT PERIOD: FROM: 07/01/2013 TO 06/30/2014 DATE PREPARED: 10/01/2010 Special Projects - Administration, CMH SAMSHA Management & Wraparound Other Special Oversight Grant Projects LINE ITEMS AMOUNTS AMOUNTS AMOUNTS TOTAL 1. PERSONNEL SERVICES (a) SALARIES $ $ $ $ (b) FRINGE $ $ $ $ TOTAL PERSONNEL = $ $ $ $ II. EXPENSES (a) BUILDING OCCUPANCY $ $ $ $ (b) PROFESSIONAL SERVICES $ $ $ $ (c) TRAVEL $ $ $ $ (d) EQUIPMENT COSTS $ $ $ $ (e) FOOD SERVICES $ $ $ $ (h MEDICAL AND PHARMACY $ $ $ $ (g) SUBCONTRACTED SERVICES $ $ $ $ (h) INSURANCE $ $ $ $ (i) INTEREST $ $ $ $ (j) OPERATING SUPPLIES & $ $ $ $ EXPENSES (k) OTHER $ $ $ $ (1) DONATED ITEMS $ $ $ $ TOTAL EXPENSES = $ $ $ $ III. NONEXPENDABLE PROPERTY (a) EQUIPMENT $ $ $ $ (b) PROPERTY $ $ $ $ TOTAL NONEXPENDABLE PROPERTY = $ $ $ $ IV. COMPUTER HARDWARE, & SERVICES $ $ $ $ TOTAL COMPUTER EXPENSES = $ $ $ $ V. SPECIAL PROJECTS $ $ $ $ GRAND TOTAL = $TBD $TBD $TBD $TBD Rev. 10/0112010 South Florida Behavioral Health Network, Inc. 103 Contract No. KH225 110711INZ11H SAMH Services Program EXHIBIT B-5 LINE ITEM OPERATING BUDGET AGENCY: South Florida Behavioral Health Network, Inc. CONTRACT # KH225 CONTRACT PERIOD: FROM: 07/01/2014 TO 06/30/2015 DATE PREPARED: 10/01/2010 LINE ITEMS Administration, Management & Oversight AMOUNTS Special Projects - CMH SAMSHA Wraparound Grant AMOUNTS Other Special Projects AMOUNTS TOTAL I. PERSONNEL SERVICES (a) SALARIES $ $ $ $ (b) FRINGE $ $ $ $ TOTAL PERSONNEL = $ ---------- $ ---------- $ ---------- $ ---------- IL EXPENSES ---------- ---------- ---------- ---------- (a) BUILDING OCCUPANCY $ $ $ $ (b) PROFESSIONAL SERVICES $ $ $ $ (c) TRAVEL $ $ $ $ (d) EQUIPMENT COSTS $ $ $ $ (e) FOOD SERVICES $ $ $ $ (t) MEDICAL AND PHARMACY $ $ $ $ (g) SUBCONTRACTED SERVICES $ $ $ $ (h) INSURANCE $ $ $ $ (I) INTEREST $ $ $ $ 0) OPERATING SUPPLIES & $ $ $ $ EXPENSES (k) OTHER $ $ $ $ (I) DONATED ITEMS $ $ $ $ TOTAL EXPENSES = $ ---------- ---------- $ ---------- ---------- $ ---------- ---------- $ ---------- ---------- III. NONEXPENDABLE PROPERTY (a) EQUIPMENT $ $ $ $ (b) PROPERTY $ $ $ $ TOTAL NONEXPENDABLE PROPERTY = $ $ $ $ IV. COMPUTER HARDWARE, & SERVICES $ $ $ $ TOTAL COMPUTER EXPENSES = $ $ $ $ V. SPECIAL PROJECTS $ $ $ $ GRAND TOTAL = $TBD $TBD $TBD $TBD Rev. 10/01 /2010 South Florida Behavioral Health Network, Inc. 104 Contract No. KH225 SAMH Services Program EXHIBIT B-6 LINE ITEM OPERATING BUDGET AGENCY: South Florida Behavioral Health Network, Inc. CONTRACT # KH225 CONTRACT PERIOD: FROM: 07/01/2015 TO 09/30/2015 DATE PREPARED: 10/01/2010 Administration, CMH SAMSHA Management & Wraparound Other Special Oversight Grant Projects LINE ITEMS AMOUNTS AMOUNTS AMOUNTS TOTAL 1. PERSONNEL SERVICES (a) SALARIES $ $ $ $ (b) FRINGE $ $ $ $ TOTAL PERSONNEL = $ $ $ $ II. EXPENSES (a) BUILDING OCCUPANCY $ $ $ $ (b) PROFESSIONAL SERVICES $ $ $ $ (c) TRAVEL $ $ $ $ (d) EQUIPMENT COSTS $ $ $ $ (e) FOOD SERVICES $ $ $ $ (t MEDICAL AND PHARMACY $ $ $ $ (g) SUBCONTRACTED SERVICES $ $ $ $ (h) INSURANCE $ $ $ $ (i) INTEREST $ $ $ $ OPERATING SUPPLIES & $ $ $ $ EXPENSES (k) OTHER $ $ $ $ (1) DONATED ITEMS $ $ $ $ TOTAL EXPENSES = $ $ $ $ 111. NONEXPENDABLE PROPERTY (a) EQUIPMENT $ $ $ $ (b) PROPERTY $ $ $ $ TOTAL NONEXPENDABLE PROPERTY = $ $ $ $ IV. COMPUTER HARDWARE, & SERVICES $ $ $ $ TOTAL COMPUTER EXPENSES = $ $ $ $ V. SPECIAL PROJECTS $ $ $ $ GRAND TOTAL = $TBD $TBD $TBD $TBD Rev. 10/01 /2010 South Florida Behavioral Health Network, Inc. 105 Contract No. KH225 Exhibit C-1 Fixed Price MANAGING, ENTITY REQUEST FiOR PAYMENTIADVANCE Admimstrative Services i ia AGENCY NAME South Florida Behavioral Heafth Notwork, Inc. IIICONTRACT NO KH225 . . ..... ..... c REUIJEST MONTH YEAR OF d FEOERAL W k g Remarniog MaNha 0 Comract e VFNCIOR 0 0� MI 0,an Fed My 11 �WA 6 9 S ow It" sta* Z�pj Olt 40 **Iq 0 0 # + mmm���W 4 + *-* + IUNIT OF MEAiSURE !4 0 6 4 COR # 0 + 6 + , 0, ft * + 0-0 *# + # a *-+ 4 # 0 6 *# 40 -# * + 0 4 0 II # 0, 0 0 # 0, 4 0 j # + 9 PART 2 FUNDING DISTRIBUTION - - - - - - - - - - - - - - - - - - - - - — ---------- --------------- ME! Dato Invo ce Recaived: Date GoodsiSomices Racei'vedIR �Date Inspected anid A pproveit ApprovI By Contract Manager 11, 11,1111 0 ll Subcontracted Provider Nehvork Exhibit C-2 Cost Reimbursement NETWORK PROVIDER SERVICES COST REIMBURSEMENT REPORT OF EXPENDITURES AND REQUEST FOR PAYMENT/ADVANCE Adult Mental Health Services a. AGENCY NAME. South Florida Behavioral Health Network Inc b. CONTRACT NO.: K14225 c REQUEST MONTH / YEAR OF: d. FEDERAL ID #: g. Remalnmg Months m Contract a. VENDOR ID (If different than Fed ID). t ADDRESS Number Cy:, State, 7tk1 PART 1 - EARNINGS i$ A Amount Requested From Total Contract Network Prov1dersfor Repue� °¢ ' ' F'1" '�Wt- ACTIVITY Amoent PmdYTD Paymerda Pa;oal '�' 3 9► $0.00 $0,00 5 $0,00 $0.00 + -� �F a 6 $0,00 $0,00 8 50.00 $0,00 Nei - ". t 0, 4'1 - 9 $0.00 $0,00 Grand Totals $0.00 $0.00 $0.00 � � � � ' '- I - " 1P - _ PART 2 - FUNDING DISTRIBUTION cewmrs c.r�-I A 13 C D E F 1 2 3 4 5 6 7 8 9 10 PART 3 -CERTIFICATION a APPROVAL h I oertrfy the above to be accurate and , agreement with thw agency's records and wRh the terms of th5 agencys contract v th the department Add Qronally I certify that all client demographic and service event data has oxen submitted to the department n accordance with the contract. Sgnatt.re Title Date i. For DICE Contract Manager use only: Date Invoice Received: YTD Advance Balance Date Goods/Services Received: Total: Date Inspected and Approved: Approved By: Contract Manager 10/012010 South Plorda Behavioral Health Network Inc 107 KH225 Subcontracted Provider Network Exhibit C-2 Cost Reimbursement +AC NG V YyAMi- Ivl=fyU vt AG'N'I`i ICAR OF Vt,.Ni`i 0 R, IC i I I oiife rnrr II+ar, Fee I 0 2 - FUNDING DISTRIBUTION EM NT REPORT OF EXPENDITURES AND REQUEST FOR PAYMiENTlADVAN Children WNW Healt'Services :south Fiorids Bobivioral Haalth Notwomi, Inc.. b €'MON1"R.AC T NO KH226 Amount RequestM (From Total Contract Net—rk Providers Amount Paid YM Payments , for Request Period) IN 0 1 C I D I E 1 F I G 2T 3 • CERTIFICATION & APPROVAL I certify the above to be accurate and in agreement with this agency's records and with the terms of this agencys contract with the department Additionally, I certify that all client demographic and service event data has been submitted to the department In accordance with the contract. Signature Title For DCF Contract Manager use onlv: Date Invoice Received: Date Goods/Services Received Date Inspected and Approved: Approved By: Contract Manager - Tr t&I Cotumns G+I-1 Date 10/01/2010 South Florida Behavioral Health Network, Inc. 108 KHxtoc Subcontracted Provider Network Exhibit C-2 Cost Reimbursement Ad Lift `Substance Abuso 8orvttuas la ,n .Yt•:�.q,,, g •. South Florida. Behavioral Reatth Na4'Work tlrt'c,. 0 f t,ONTRA;" 140 KH22 •� I P.t,.",`:�,.er ^, _ rW 'uto a�­�q-.titwvm )r;&"'t' 00, {t `r C•"i 1;i't}y� ,I ti Y' Y ikii" %��;1 I - ._ PART 1 - EARNINGS - __ '�' #! �, g+ > `• ^;mx._ - - t x a a 4"V's7 i - eat !Pram Network � �` '� '�' �' � � � �" '�" '� � � � �' a' � � •� . � .. - Prot/ _ mr>ze9 n�# + #� " ;u ' ai d! �' '� A $ + •S^ fir ACTIVITY raft t Contract amount aald rro Parmerrt, Penoal 4i�+►���S�vY�a � � �' � tt• +�� � �����'�d ��"� U �� � �. ,r„ » Coluo » c+t-I A BIFC D E F 6 H I J t 17 - GERTIFICATION 9 APPROVAL - - I certify the above to be accurate and in agreement with this agencys records and with the terms of this agencys contract with the department. Additionally, I certify that all client demographic and service event data has been submitted to the department In accordance with the contract. Signature Title __.. For DCF Contract Manaoer use oniv: Date Invoice Received: Date GoodsiSeMces Received Date Inspected and Approved: Approved By: Contract Manager Total Date 10/01/2010 South Florida Sehaworal Health Network, Inc. 109 KH225 Subcontracted Frovder Network Exhibit C-2 Cost Reimbursement Ch Wron Substance Abuse ire-rvi,ws South Fhar9xta Bettavioral Flaatth Nalwork, .. In CONTRACT No KH226 4',10 -' "0 rG!w.�paa, era �tan�,x.`w;�y�,n�nr�reu t. �-9rasa 4RT 1 - EARNINGS -a- -S" n P: t 2 3 4 Amount Requested 4 It _ y wry qa (From N twork ProNders for Request .'fit " '�0 w ' ' ' #�O sk `` 4b p, + 0 ?� Ar 6 ACTIVITY Total ContractAmowit, Paid YTDPayrrv, Penodi v u9 r t '# a @:'. sN ,0 W 2-FUNDING DISTRIBUTION;•' colomna A 9 c D E F 6 H I t J A I certify the above to be accurate and in agreement with this agency records and with the terms of this agency's contract with the department_ Additionally, 1 certify that sit client demographic and service event data has been submitted to the department in accordance with the contract. Signature Title For DCF Contract Manager use only: Date Invoice Received: Date GoodstServices Received: Date Inspected and Approved: Approved By: Contract Manager Total: Date 10/01/2010 South Flodda Behavorai Health Network, Inc. 110 KH225 1O01/2O1O Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2010-2011 Provider Name: South Florida Behavioral Health Network, Inc. Contract #-NH22S Date: 10/01/2010 Reviwion#: L Mental Health Contracted Services A. Required Performance Output Standards for Each Target Population (including all clients paid for by SAMH, Medicaid and Local Match) *Please explain in the comment section below if a target population isindicated mthe section below, but there mnm corresponding outcome standard for that population. 1. Adult Mental Health a. Adults with Severe and Persistent Mental Illness (SPM|)(MO 16)YMHO1{H b. Adults with Serious and Acute Episodes ufMental Illness (yNOS3O1)/YMH53O1) c. Adults with Mental Health Problems (K8O53O2)/(K8H53O2) d. Adults with Forensic |nvu|v*ment(N1OO18)/(K8HO18) 2. Chi|dren^sMental Health a. Children with Serious Emotional Disturbances (SED)(N10031)/YyNHO31> b. Children with Emotional Disturbances (ED)(yW0032)/(N1HO32) c Children at -risk cfEmotional Disturbances (W1OU33)KK8HO33) B. Required Performance Outcome Standards for Each Target Population *Please explain mthe comment section below if there man Outcome Standard but there is no corresponding target population indicated. 1. Adult Mental Health - Adults with Severe and Persistent Mental Illness a. Percent ofadults with severe and persistent mental illnesses who live instable housing environment will beetleast (yWO742)/MH742) (Statewide Target —93Y6) b. Average annual number of days (post admission assessments) worked for pay for adults with severe and persistent mental illness will be at least (M0003)/(MHO03) — (Statewide Target — 30) 2. Adult Mental Heo|th-Adu|byin K8entm! Health Crisis, including Adults with Serious and Acute Episodes ofMental Illness and Adults with Mental Health Problems o. Percent of adults in mental health crisis who live in stable housing environment will be at least (yNO744)/K8H744)—(Statewide Target —9U%) %. Adult Mental Hea|th—Adu|tsxvith Serious Mental Illness (SPK8|, K8HCdeie, Forensic) a Percent ufadults with serious mental illness who are competitively employed will beat least (yWO7D3)/K8H7O3)—(Statewide Target —1596) 4. Adult Mental Health ' Forensic Involvement a, Percent of adults in forensic involvement who live in stable housing environment will be at least (K8O743)/k8H743)—(Statewide Target —7096) 8. Chi|dnen's K8entm! Health - Seriously Emotionally Disturbed aPercent of children with serious emotional disturbance who live in stable housing environment will bestleast (yNO77A)/(K8H77O)—(Statewide Target —95%) b� Percent of children with serious emotional disturbance who improve their level of functioning will beatleast (K8O37O)/K8H37O)—(Statewide Target —G5Y6) o. Percent of school days seriously emotionally disturbed children attended will be at least (K8OO12)/(K4HO12)—(Statewide Target —OGY6) 6. Chi|dnan^sK8enta| Health -Emotionally Disturbed a. Percent of children who live in stable housing environment will be at least (M0778)/(MH778) — (Statewide Target —g5%) b. Percent of children who improve their level of functioning will be at least (M0377)/(MH377) — (Statewide Target — 64%) 100/1/2010 111 South Florida Behavioral Health Network, |no. 1001/2010 Managing Entity SAMHServices Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2010-2011 Provider Name: South Florida Behavioral Health Network, Inc. Contract#: KH225 Date: 10/01/2010 Revision #: 7. Ch|Nren"s Mental Health —At-Risk ofEmotional Disturbance a. Percent of children who live in stable housing environment will be at least (M0780) (MH780) — (Statewide Target —9¢Y6) 9$96 C. Required Internal Measures 1. Data Submission Outcomes for Mental Health a. Percent of persons receiving state -contracted mental health service event records which have matching mental health initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will bent|eeot(SAyWH|S)(N1O758) The standard target for this measure ieatleast g596 95% U.Substance Abuse Contracted Services A. Required Performance Output Standards for Each Target Population (including all clients Minimum paid for by *Please pvpuumvn�inmcamummvsonuonumow.vmme��no Numbers Medicaid and Local Match) corresponding outcome standard for that population. be Served 1. Adults with Substance Abuse Problems a. Number ofAdults Served (N1OOG3)/(SAO83) 12354 2. Children with Substance Abuse Problems a, Number ofChildren Served (MO052)/(SA052) 4,520 3. Adults At -Risk ofSubstance Abuse Problems- (Non GAA) a. Number ofAdults participating inPrevention Services (yWO785)(SA785) 18087 b� Number ofAdults participating inLevel 1 Prevention Programs (PWO7S7)/YSA7G7) 160 cNumber ofAdults participating inLevel 2Prevention Programs (N1O7G8)/(SA7S8) 1¢ d, Number ofadults participating in Level 1 Prevention Programs who complete 75 percent of the prognem'eschedule ofactivities (yNO7OQ)/(SA789) 112 e. Number ofadults participating in Level 2 Prevention Programs who complete 75 percent of the progrnm'mschedule nfactivities (KOO77O)/(SA77O) 7 4. Children At -Risk ofSubstance Abuse Problems- (Non GAA) & Number ofchildren participating inPrevention Services (W107G2)/(SA7G2) 14,983 b. Number ofchildren participating inLevel 1Prevention Programs (yWO761)/(SA7G1) 9735 c. Number ofchildren participating inLevel 2Prevention Programs (yW0G85)/(SAG95) 354��-- cl� Number ofchildren participating inLevel 1 Prevention Programs who complete 75percent of the prognam'eschedule ofactivities (K8O7G3)/(SA783) 2164 e. Number of children participating in Level 2 Prevention Programs who complete 75 percent of the program'eschedule ofactivities (K8O764)(SA7G4) 143 B. Required Performance Outcome Standards for Each Target Population Minimum *Please explain inthe comment section below nthere isanOutcome Standard but there isnocorresponding target Contract population indicated. Standard Adults with Substance AbueoPnoblemo a. Percent of adults who successfully complete substance abuse treatment services will be at least (N1O75G)/SA755)-(Statewide Target —5O%) 589& b, Percent change in clients who are employed from admission to discharge will be at least ------- (K8O753)/(SA753)(Statewide Target —2O%) 20% c. Percent of adults who live in a stable housing environment at the time of discharge will be at ------' least (K4O75G)/GA75G)-(Statewide Target —BO%) 80% d. Percent change in the number of adults arrested 30 days prior to admission versus 30 days 10K01/2010 112 South Florida Behavioral Health Network, Inc. KH225 1001/2O1O Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2010-2011 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10801/3010 Rovision#: prior todischarge (K8O754/SA754)(Statewide Target —35%) 35% 2. Adults At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for Each 50%) a. Percent of adults participating in Level 1 Prevention Programs who complete 75 percent of the prognam'eschedule ofactivities will bontleast (K8O771)/(SA771) 50Y6 b Percent of adults participating in Level 2 Prevention Programs who complete 75 percent of the progrem'oschedule ofactivities will boatleast (K80772)/(SA772) 50Y6 Children with Substance Abuse Problems a Percent ofchildren who successfully oomp|eteoubstnnoonbueotroetmentoorviooewU|besd least (SA725)/K8O725)-(Statewide Target —5596) 55% b, Percent of children who live in a stable housing environment will be at least (M0752)/SA752) - (Statewide Target —Q5%) 8596 u, Percent change in the number of children arrested 30 days prior to admission versus 30 days prior todischarge will bontleast (yNO751/SA751)- (Statewide Target —2UY4) 30% 4. Children At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for each 50%) e. Percent ofchildren participating inLevel 1 Prevention Programs who complete 75percent ofthe prngnam^oschedule ofactivities will beatleast (K8U7G5)/YGA7G5) 50% b, Percent of children participating in Level 2 Prevention Programs who complete 75 percent � ofthe prognam'aschedule ofactivities will bentleast (N1O766)/(SA7GG) 50% S. Data Submission for Prevention Program Tool (Baseline — Non G/\A) m. Percent of approved Prevention Descriptions completed within 30 days of contract execution. (Statewide Target —SO%) 50% C. Required Internal Measures 1. Data Submission Outcomes for Substance Abuse a. Percent of persons receiving state -contracted substance abuse service event records which have matching substance abuse initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0758) The standard target for this measure is at least 95% 95% Ill. Managing Entity Contracted Services a. Performance Measures (1 ) 80 percent of Network Providers surveyed for satisfaction will rate the administrative services of the provider sm^Gatisfaotory"orhigher. (2) 80 percent of stakeholders surveyed for satisfaction will rate the administrative services of the provider as ^Sadisfnotory^orhigher. (3) 80 percent of consumers surveyed for satisfaction will rate the administrative services of the provider as "Setiefnctory''orhigher. (4) 90 percent of the Network Providers will receive reimbursement for verified services from the provider within 1Sdays following theLmanagingentity receipt ofavalid invoice. (5) TBD percent reduction in the average number of days people are on the residential substance abuse wait list 10/01/2010 113 South Florida Behavioral Health Network, Inc. KH225 1001/2010 Managing Entity SAMHServices Program Exhibit Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2010-2011 Provider Name: South Florida Behavioral Health Network, Inc. Contnact#: KH225 Data: 10A01/2010 Revision#: (6) TBD percent reduction in the average number of people waiting on the residential substance abuse wait list. (7) TBD percent reduction in the average number of days people are on the adult mental health wait list, (8) TBD percent reduction in the average number of people waiting on the adult mental health wait list. (9) TBD percent reduction in the average number of days people are on the children's mental health wait list. /iQ\ TBD percent reduction in the average number of people waiting on the children's mental health wait list, /11> TBD percent reduction in the average number of days people are on the forensic wait list. <12\ TBD percent reduction in the average number of people waiting on the forensic wait list. (13) The ME will manage the utilization of contracted service dollars to prevent any lapse in service dollars. b. Methodology (1) The numerator isthe number ofNetwork Providers indicating ratings uf^entiofmotory"orhigher onthe satisfaction survey. The denominator is the number of Network Providers responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (2) The numerator is the number of stakeholders indicating ratings of "satisfactory" or higher on the satisfaction survey, The denominator is the number of stakeholders responding to the satisfaction survey. The measure ie based on attainment of 80 percent or greater level of satisfaction. (3) The numerator is the number ofconsumers indicating ratings of^antiehaohory"orhigher onthe satisfaction survey, The denominator is the number of consumers responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (4) The numerator is the number ofproperly prepared immicemreoived from Network Providers that are paid within 1Sdays ofreceipt from Network Providers. The denominator isthe number ofproperly prepared invoices with all required backup data received from the Network Providers for each month. The measure iebased on attaining anaverage ofOOpercent orgreater rate over a12-monihperiod, /5U One minus the fraction whose numerator is the average number ofdays people were onthe residential substance abuse wait list during the past fiscal, and whose denominator isthe average number ofdays people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 1OOprovides the percent. (8) One minus the fraction whose numerator is the average number of people waiting on the residential substance abuse wait list during the past fiscal year, and whose denominator isthe average number ofpeople on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (7) One minus the fraction whose numerator is the average number of days people were on the adult mental health wait list during the past fiscal, and whose denominator isthe average number ofdays people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. 10/01C2010 114 South Florida Behavioral Health Network, Inc. KH225 1O01/2O1O Managing Entity SAMHServices Program Exhibit Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2010-2011 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: (8) One minus the fraction whose numerator is the average number ofpeople waiting onthe adult mental health wait list during the past fiscal year, and whose denominator isthe average number ofpeople onthe residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent, <0U One minus the fraction whose numerator is the average number ofdays people were onthe chi|dren's mental health wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 1OOprovides the percent. (10) One minus the fraction whose numerator is the average number of people waiting onthe ohUdren'smental health wait list during the past fiscal year, and whose denominator isthe average number ofpeople onthe residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (11) One minus the fraction whose numerator is the average number of days people were on the forensic wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. M2U One minus the fraction whose numerator is the average number of people waiting on the forensic wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (13) The numerator is the amount of service dollars utilized byNetwork Providers at the end of each fiscal year. The denominator is the total amount of service dollars allocated to the ME during each fiscal year. IV. Comments / Explanations *There should be a number, baseline, or N/A insertefor each target moutcome mthe sections above. *Please explain if a target population is indicated but there is no corresponding outcome standard for that population, or if there is an Outcome Standard but there is nncorresponding target population indicated. 10K01C2010 115 South FohdaBehavioral Health Network, Inc, KH225 1O01/2O10 Managing Entity 3AMHServices Program Exhibit Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2011-2012 Provider Name: South Florida Behavioral Health Network, Inc. Contnsot#: KH225 Date: 10/01/2010 Revision #: L Mental Health Contracted Services A. Reguired Performance Output Standards for Each TaPopulation Minimum (including all clients paid for bySAMH.Medicaid and Local Match) Numbers to *Please explain / the below if population isindicated inthe section below, but there isnv be Served corresponding outcome standard for that population. I . Adult Mental Health ec Adults with Severe and Persistent Mental Illness (SPM|)(N0O1G)/UMHO1G) TBD b, Adults with Serious and Acute Episodes ofMental Illness (K8O53O1)/(K8H53O1) TBD o, Adults with Mental Health Problems (K8O53O2)/(yNH53O2) TBD d. Adults with Forensic Involvement (K4OO18)/(yNHO18) TBD 2. Chi|dren'eK8ente| Health a. Children with Serious Emotional Disturbances (SEO)(yW0031)/yW1HO31) TB0 b. Children with Emotional Disturbances (EO)(N10032)/(yWHO32) TBD c Children at -risk ofEmotional Disturbances (K80033)/(MHO38) TBD B. Required Performance Outcome Standards for Each Target Population Minimum *Please explain in the comment section below if there is an Outcome Standard but there is no corresponding target Contract population indicated. Standard 1. Adult Mental Heakh-AdubavvithSeveremndPereistantKAenta|U|neos e. Percent ofadults with severe and persistent mmnta|i||noeaoovvho|ivoinstnblehousing environment will besdleast (N1O742)/MH742) (Statewide Target —9396) 93% b. Average annual number of days (post admission assessments) worked for pay for adults with severe and persistent mental illness will be at least (M0003)/(MHO03) — (Statewide Target — 30) 30 2. Adult Mental Ham|th-Adu|ta in Mental Health Crisis, including Adults with Serious and Acute Episodes of Mental Illness and Adults with Mental Health Problems a. Percent of adults in mental health crisis who live in stable housing environment will be at least (yNO744)/YNH744)—(Statewide Target —SO%) 90% 3. Adult Mental Hea|th—Adu|tovvith Serious Mental U|neee (SFYNI. KAH Crisis, Forensic) a, Percent of adults with serious mental illness who are competitively employed will be at least (N}O7O3)/W1H7O3)—(Statewide Target —15%) 15% 4. Adult Mental Health - Forensic Involvement b, Percent of adults in forensic involvement who live in stable housing environment will be at least (N1O743)/N1H743)—(Statewide Target —7O96) TO% 5. Chl|dran's Mental Health -Seriouely Emotionally Disturbed a, Percent of children with serious emotional disturbance who live in stable housing environment will besdleast (K8O77S)/(K8H779)—(Statewide Target —B5Y4) 959& b� Percent of children with serious emotional disturbance who improve their level of functioning will beatleast (K8O378)/KOH378)—(Statewide Target —G5%) 65Y6 o. Percent of school days seriously emotionally disturbed children attended will be at least (K8UO12)/(K8HO12)—(Statewide Target —8Q96) 8696 6. OhUdnen'eK8enta| Hea|th-ErnotionmUy Disturbed aPercent of children who live in stable housing environment will be at least (M0778)/(MH778) — (Statewide Target —S5%) 95% b. Percent of children who improve their level of functioning will be at least (M0377)/(MH377) — (Statewide Target — 64%) 64% 10X01/2010 116 South Florida Behavioral Health Network, Inc. KH225 1001/2010 ManagingEntity uxMnServices Program Exhibit Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2OYY-2O/2 Provider Name: South Florida Behavioral Health Network, Inc. Cnntreot#: KH225 Date: 10/01/2010 Revision#� 7. Cbi|dnmn\eMental Health —At-Risk ofEmotional Disturbance a, Percent of children who live in stable housing environment will be at least (M0780) (MH780) C. Required Internal Measures Data Submission Outcomes for Mental Health a. Percent of persons receiving state -contracted mental health service event records which have matching mental health initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will bont|enot(SAMH|S)(N1O75Q) The standard target for this measure is at least 95% 95% U.Substance Abuse Contracted Services A.(including all clientspaid for by SAMH, Medicaid and Local Match) K0f nimum -=°== explain"."the comment population isindicated mthe section umvwcorresponding outcome standard for that population..but m�is oNumbers be Served 1. Adults with Substance Abuse Problems a. Number ofAdults Served (N1OO63)/(SAO63) TBD 2. Children with Substance Abuse Problems a. Number ofChildren Served (KADO52)/(SAOb2) TBD 3. Adults At -Risk ofSubstance Abuse Problems- (Non GAA) e. Number ofAdults participating inPrevention Services (K8O785)(GA785) TBD b, Number ofAdults participating in Level 1 Prevention Programs (K40767)/YSA767) TBD c. Number ofAdults participating inLevel 2Prevention Programs (N1O768)/(SA7S8) d. Number of adults participating in Level 1 Prevention Programs who complete 75 percent of the progrem'aschedule ofactivities (K8O7GA)/(SA76Q) TBD a. Number of adults participating in Level 2 Prevention Programs who complete 75 percent of the progrnm'oschedule ofactivities (MO77O)/(SA77O) TBD 4. Children At -Risk ofSubstance Abuse Problems- (Non GAA) a. Number ofchildren participating inPrevention Services (yW07G2)/(SA7G2) TBD b Number ofchildren participating inLevel 1 Prevention Programs (N1O7G1)/yGA761) TBD c. Number ofchildren participating inLevel 2Prevention Program e(W1OGO5)/(SAGO5) TBD d. Number ofchildren participating inLevel 1 Prevention Programs who complete 75percent ofthe progrem'nschedule ofactivities (K8O763)/ySA7G3) TBD e. Number of children participating in Level 2 Prevention Programs who complete 75 percent ofthe progrnm'eschedule ofactivities (yWO7G4)(SA764) TBD B. Required Performance Outcome Standards for Each Target Population KUininnunn *Please explain inthe comment section below nthere isanOutcome Standard but there isnvc"nreopvnuinQta,Q'� Contract u popo/a^ninmn�vu . Standard 1. Adults with Substance Abuse Problems a. Percent of adults who successfully complete substance abuse treatment services will be at least (yNO755)/SA755)-(Statewide Target —5OY6) 50Y6 b. Percent change in clients who are employed from admission to discharge will be at least (K4O753)/(SA753)(Statewide Target —2OY6) 2096 o, Percent of adults who live in a stable housing environment at the time of discharge will be at least (K8O75G)/SA75S)-(Statewide Target —BOY6) 80% 10/01C2010 117 South Florida Behavioral Health Network, Inc. KH225 1001/2010 Managing Entity SAMUServices Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2011-2012 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: d. Percent change \nthe number ofadults arrested3O days priortoadmission versus 3Odays prior hodischarge (K8O754/GA7S4)(Statewide Target —35%) 35% 2. Adults At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for Each 50%) aPercent nfadults participating inLevel 1 Prevention Programs who complete 75percent of the progrem'aschedule ofactivities will boetleast (K8O771)/(SA771) 50Y6 b, Percent mfadults participating in Level 2 Prevention Programs who complete 75 percent of the prmOrem'oschedule ufactivities will beotleast (N1O772)/(SA772) 50% 3. Children with Substance Abuse Problems m, Percent of children who successfully complete substance abuse treatment services will be at least (SA72S)/K8O725)-(Statewide Target —5596) 56% b. Percent of children who live in a stable housing environment will be at least (M0752)/SA752) - (Statewide Target —85%) 85% c. Percent change in the number of children arrested 30 days prior to admission versus 30 days prior todischarge will bontleast (K8O7S1/GA751)- (Statewide Target —2D%) 20% 4. Children At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for each 50%) e, Percent ofchildren participating inLevel 1 Prevention Programs who complete 75percent cfthe progrnm'eschedule nfactivities will boatleast (PWO785)/YSA765) 50% b. Percent of children participating in Level 2 Prevention Programs who complete 75 percent ofthe program'sschedule ofactivities will beatleast (K8O7OG)/(SA7G6) 50Y6 5. Data Submission for Prevention Program Tool (Baseline — Non GAA) o, Percent of approved Prevention Descriptions completed within 30 days of contract execution. (Statewide Target —5O%) 50% C. Required Internal Measures i. Data Submission Outcomes for Substance Abuse a. Percent of persons receiving state -contracted substance abuse service event records which have matching substance abuse initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0758) The standard target for this measure is at least 95% 96% Wk Managing Entity Contracted Services a. Performance Measures (1) 80 percent of Network Providers surveyed for satisfaction will rate the administrative services of the provider ae^Sntiofnctoq/orhigher, (2) 80 percent of stakeholders surveyed for satisfaction will rate the administrative services of the provider as "Smdiefaotory^orhigher. /3\ 80 percent of consumers surveyed for satisfaction will rate the administrative services of the provider as ^Sadstaotory^orhigher. (4) 90 percent of the Network Providers will receive reimbursement for verified services from the provider within 15days following the -managing entity receipt ofnvalid invoice. (5) TBD percent reduction in the average number of days people are on the residential substance abuse wait list 10x01/2010 118 South Florida Behavioral Health Network, Inc, KH225 1001/2010 Managing Entity OAMDServices Program Exhibit Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2011-2012 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: (6) TBD percent reduction in the average number of people waiting on the residential substance abuse wait list. (7^ TBD percent reduction in the average number of days people are on the adult mental health wait list. (8) TBD percent reduction in the average number of people waiting on the adult mental health wait list. (9) TBD percent reduction in the average number of days people are on the children's mentalheaKhweit|iet. (10) TBD percent reduction in the average number of people waiting on the children's mental health wait list. (11) TBD percent reduction in the average number of days people are on the forensic wait list. (12) TBD percent reduction in the average number of people waiting on the forensic wait list, (13) The ME will manage the utilization of contracted service dollars to prevent any lapse in service dollars. (1) The numerator is the number ofNetwork Providers indicating ratings uf^satisfnotor/orhigher onthe satisfaction survey. The denominator is the number of Network Providers responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. /21 The numerator is the number ofstakeholders indicating ratings of^ontiefaotony orhigher onthe satisfaction survey. The denominator is the number of stakeholders responding to the satisfaction survey. The measure ia based on attainment of 80 percent or greater level of satisfaction. (3) The numerator isthe number ofconsumers indicating ratings of^eatief dory"orhk]herontheentimhaotion survey. The denominator is the number of consumers responding to the satisfaction survey. The measure ia based on attainment of 80 percent or greater level of satisfaction. (4) The numerator is the number ofproperly prepared invoices received from Network Providers that are paid within 15days ofreceipt from Network Providers. The denominator isthe number ofproperly prepared invoices with all required backup data received from the Network Providers for each month. The measure iobased on attaining nnaverage ofOOpercent orgreater rate over a12-monthperiod. (S) One minus the fraction whose numerator is the average number of days people were on the residential substance abuse wait list during the past fiscal, and whose denominator isthe average number ofdays people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 1OOprovides the percent. (6) One minus the fraction whose numerator isthe average number ofpeople waiting onthe residential substance abuse wait list during the past fiscal year, and whose denominator iathe average number ofpeople on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (7) One minus the fraction whose numerator is the average number ofdays people were onthe adult mental health wait list during the past fiscal, and whose denominator isthe average number cfdays people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent, 10K01%I010 118 South Florida Behavioral Health Network, Inc. KH225 1001/2010 Managing Entity 88MUServices Program Exhibit Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 70Y1-2O/2 Provider Name: South Florida Behavioral Health Network, Inc. Contract* KH225 Date: 10/01/2010 Revision #: (0) One minus the fraction whose numerator is the average number ofpeople waiting onthe adult mental health wait list during the past fiscal year, and whose denominator isthe average number ofpeople onthe residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (9) One minus the fraction whose numerator is the average number of days people were onthe ohildren's mental health wait list during the past fiscal, and whose denominator is the average number ofdays people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 1OOprovides the percent. (10)One minus the fraction whose numerator is the average number ofpeople waiting onthe uhildren'smental health wait list during the past fiscal year, and whose denominator is the average number ofpeople onthe residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent, (11) One minus the fraction whose numerator is the average number ofdays people were onthe forensic wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (12) One minus the fraction whose numerator is the average number of people waiting on the forensic wait list during the past fiscal year, and whose denominator is the average number ofpeople onthe residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent, M3A The numerator is the amount of service dollars utilized by Network Providers at the end of each fiscal year, The denominator is the total amount of service dollars allocated to the ME during each fiscal year. IV. Comments / Explanations *There should be a number, baseline, or N/A inserted for each target or outcome mthe sections above. *Please explain if a target population mindicated but there is no corresponding outcome standard for that population, or if there is an Outcome Standard but there is no corresponding target population indicated. 10/01/2010 120 1001/2010 ManagingEndty SAMH Services Program Exhibit Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2012-2013 Provider Name: South Florida Behavioral Health Network, Inc. Contract #:KH225 Date: 10/01/2010 Revision#: k Mental Health Contracted Services A. Reguired Performance Output Standards for Each Minimum ,.°.."vo.0 all omu/u paid ,o, by SAmH, meoma/m and Local noarcn> Numbers to *Please explain in the comment section uuxmv if a.target population isindicated mthe section below, but there isnu be Served corresponding outcome standard for that population. Adult Mental Health a Adults with Severe and Persistent Mental Illness (SPK8|)(MOO16)/(K8HO1G) TBD b Adults with Serious and Acute Episodes ofMental Illness (W1O53O1)/yyNH53O1) TBD u, Adults with Mental Health Problems (&1O53O2)/(K4H53O2) TBD d, Adults with Forensic Involvement (N1OO18)/(W1HO18) TBD ChiNren^sK8ental Health a. Children with Serious Emotional Disturbances (SED)(N10031)/(KXHO31) TBD b. Children with Emotional Disturbances (ED)(N10032)/yK4HO32) TBD o, Children at -risk ofEmotional Disturbances (K80033)/(yWHO33) TBD B. Required Performance Outcome Standards for Each Target Population Minimum ~please explain in the comment section below nthere isanOutcome Standard but there inmocorresponding target Contract population indicated. Standard i. Adult Mental Health - Adults with Severe and Persistent Mental Illness a. Percent nfadults with severe and persistent montn|iUneeaoewho|kmin stable housing environment will becdleast (KAO742)/[NH742) (Statewide Target —g3%) 93% b. Average annual number ofdays (post admission assessments) worked for pay for adults with severe and persistent mental illness will bontleast (N1O003)/YPWH003)—(Statewide Target — 3O) 30 2. Adult Mental Health - Adults in Mental Health Crisis, including Adults with Serious and Acute Episodes ofMental Illness and Adults with Mental Health Problems a, Percent of adults in mental health crisis who live in stable housing environment will be at least (yNO744)/W1H744)—(Statewide Target —gO%) 9096 3. Adult Mental Heabh—Adu|bmnxith Serious Mental Illness (SPK0|. K8H Crisis, Forensic) a. Percent of adults with serious mental illness who are competitively employed will be at least (yNO7O3)/K8H7O3)—(Statewide Target —15%) 15Y& 4. Adult Mental Health - Forensic Involvement a. Percent of adults in forensic involvement who live in stable housing environment will be at least (K8D743)/W1H743)—(Statewide Target —7OY6) 70% 5. Chi|dnen'sMentml Health ' Seriously Emotionally Disturbed a Percent of children with serious emotional disturbance who live in stable housing environment will bontleast (yWO779)/(K8H779)—(Statewide Target —9596) 95% b, Percent of children with serious emotional disturbance who improve their level of functioning will beatleast (K8O37O)/yWH378)—(Statewide Target —65%) 6596 o. Percent of school days seriously emotionally disturbed children attended will be at least (N}OO12)/(K8HO12)—(Statewide Target —8G%) 86Y6 6. Chi|dven"sK0enta| Health - Emotionally Disturbed e. Percent ofchildren who live instable housing environment will bentleast (K40778)/(yWH778) — (Statewide Target —85Y6) SS% b. Percent ofchildren who improve their level offunctioning will bontleast (N1O377)/(W1H377)— (Statewide Target —G496) 64% 10/01&2010 121 South Florida Behavioral Health Network, Inc. KH225 1001/2010 Managing Entity SAMH Services Program Exhibit Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2OY2-2O/3 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: 7. Ch||dren's MentalHmmbh—At-RiekofEmutona|Dioturbance a. Percent ofchildren who live instable housing environment will beotleast (yW078O)(K8H7@O) — (Statewide Target —8D%) 90% C. Required Internal Measures Data Submission Outcomes for Mental Health e Percent of persons receiving state -contracted mental health service event records which have matching mental health initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will beot|eeot(SAK8H|8)(N10758) The standard target for this measure ieatleast 95Y6 gG% U.Substance Abuse Contracted Services A. Performance (including all clients Mhmhnmn aid for by AMH, Medicaid and Local Match) ~p�ase pvpummvnmmmn�oomuwo�uuunuemw.umm�mmou Numbers— ����'"'"=^""""" "=""'=v"^ be Served oo,m�p.....mou�ome�anuamonm�nonumuon. 1. Adults with Substance Abuse Problems a Number ofAdults Served (W10OG3)/(SA0G3) TBD %L Children with Substance Abuse Problems a, Number ofChildren Served TBD 3. Adults At -Risk ofSubstance Abuse Problems- (Non GAA) a, Number NumberofAdults participating inPrevention Services (N10785)(SA78S) TBD b, Number ofAdults participating inLevel 1 Prevention Programs (N1O7G7)/(SA7G7) TBD o. Number ofAdults participating inLevel 2Prevention Programs (yW87S8)/(SA7G8) ----TBD d, Number ofadults participating in Level 1 Prevention Programs who complete 75 percent of the pnognam'nschedule ofactivities (N107SS)/(SA7GS) TBD a. Number ofadults participating in Level 2 Prevention Programs who complete 75 percent of the prognsm'eschedule ofactivities (yW0770)/(SA770) TBD 4. Children At -Risk ofSubstance Abuse Problems- (Non GAA) a. Number ofchildren participating inPrevention Services (N107G2)/(SA7G2) TBD b. Number ofchildren participating inLevel 1 Prevention Programs (MO7G1)/(SA7S1) TBD u. Number ofchildren participating inLevel 2Prevention Programs (K8O6Q5)/(GAGSS) TBD d. Number of children participating in Level 1 Prevention Programs who complete 75 percent ofthe progrom'aschedule ofactivities (K807G3)/(SA763) TBD e, Number of children participating in Level 2 Prevention Programs who complete 75 percent of the pnngrom'oschedule ofactivities (yN07G4)(SA7G4) TBD B. Required Performance Outcome Standards for Each Target Population Minimum ~pwaae explain in the comment section below if there is an Outcome Standard but there is no corresponding target Contract population indicated. Standard 1. Adults with Substance Abuse Problems e. Percent of adults who successfully complete substance abuse treatment services will be at least (MO75G)/SA755)-(Statewide Target —5O96) 50% b. Percent change in clients who are employed from admission to discharge will be at |aoot (W10753)/(SA753) (Statewide Target —2D96) 20% c. Percent of adults who live in a stable housing environment at the time of discharge will be at least (N1075G)/8A75G)-(Statewide Target —UD%) 80Y6 10/01/2010 122 South Florida Behavioral Health Network, Inc. KH225 1001/2010 Managing Entity SAMMServices Program Exhibit Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2012-2013 Provider Nome: South Florida Behavioral Health Network, Inc. Contract#: KH225 Date: 10/01/3010 Revision #: d. Percent change in the number of adults arrested 30 days prior to admission versus 30 days prior todischarge (yNO754/SA754)(Statewide Target —35%) 35% 2. Adults At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for Each 50%) a, Percent ofadults participating inLevel 1 Prevention Programs who complete 75percent of the prognam'oschedule ofactivities will bootleast (N1O771)/(SA771) 50% b. Percent of adults participating in Level 2 Prevention Programs who complete 75 percent of the proQram'oschedule ofactivities will beatleast (yW0772)/(SA772) 50% 3. Children with Substance Abuse Problems aPercent of children who successfully complete substance abuse treatment services will be at least (SA725)/PNO72S)`(Statewide Target —55%) 55% b� Percent of children who live in a stable housing environment will be at least (M0752)/SA752) - (Statewide Target —BS96) 85% c� Percent change in the number of children arrested 30 days prior to admission versus 30 days prior todischarge will beotleast (MO751/SA751)- (Statewide Target —2D%) 20% 4. Children At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for each 50%) s. Percent of children participating in Level 1 Prevention Programs who complete 75 percent ofthe prognsm'oschedule ofactivities will bootleast (PN07G5)/(SA7G5) 60% b. Percent of children participating in Level 2 Prevention Programs who complete 75 percent ofthe prngrom'oschedule ofactivities will beotleast (KU076G)/(SA7SS) 50% 5. Data Submission for Prevention Program Too[ (Baseline — Nun GAA) a, Percent of approved Prevention Descriptions completed within 30 days of contract execution. (Statewide Target —5D%) 50% C. Required Internal Measures 1. Data Submission Outcomes for Substance Abuse a. Percent of persons receiving state -contracted substance abuse service event records which have matching substance abuse initial (purpose 1) admission records inthe Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0758) The standard target for this measure is at least 95% 95% U|. Managing Entity Contracted Services a. Performance Measures (1)M0percent ofNetwork Providers surveyed for satisfaction will rate the administrative services ofthe provider ao^8ot|ofaotory"orhigher. (2)8Opercent ofstakeholders surveyed for satisfaction will rate the administrative services ofthe provider as ^SsUisfaotoryyorhigher. (3) 80 percent of consumers surveyed for satisfaction will rate the administrative services of the provider as "Sa||afaotory''orhigher. (4) 90 percent of the Network Providers will receive reimbursement for verified services from the provider within 15days following the_monagingentity receipt ofovalid invoice. 10/01/2010 123 1O0112D10 Managing Entity SAMHServices Program Exhibit Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2012-2013 Provider Name: South Florida Behavioral Health Network, Inc. Contract* KH225 Date: 10/01/2010 Revision #: /5DTBDpercent reduction in the average number of days people are on the residential substance abuse wait list, (6) TBD percent reduction in the average number of people waiting on the residential substance abuse wait list, (7) TBD percent reduction in the average number of days people are on the adult mental health wait list. (8) TBD percent reduction in the average number of people waiting on the adult mental health wait list. (9) TBD percent reduction in the average number of days people are on the children's mental health wait list, /10\ TBD percent reduction in the average number of people waiting on the children's mental health wait list. (11) TBD percent reduction in the average number of days people are on the forensic wait list. /112\ TBD percent reduction in the average number of people waiting on the forensic wait list. (13} The ME will manage the utilization of contracted service dollars to prevent any lapse in service dollars, M\ The numerator is the number of Network Providers indicating ratings of "satisfactory" or higher on the satisfaction survey. The denominator is the number of Network Providers responding to the satisfaction survey, The measure is based on attainment of 80 percent or greater level of satisfaction. (2) The numerator is the number of stakeholders indicating ratings of "satisfactory" or higher on the satisfaction survey. The denominator is the number of stakeholders responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (3} The numerator isthe number ofconsumers indicating ratings of^oatisfoobory"orhigher onthe satisfaction survey. The denominator is the number of consumers responding to the satisfaction survey,The measure ia based on attainment of 80 percent or greater level of satisfaction. (4) The numerator is the number of properly prepared invoices received from Network Providersthat are paid within 15days ofreceipt from Network Providers. The denominator is the number ofproperly prepared invoices with all required backup data received from the Network Providers for each month. The measure iobased on attaining onaverage ofQOpercent orgreater rate over o12-monthperiod. /5U One minus the fraction whose numerator is the average number of days people were on the residential substance abuse wait list during the past fiscal, and whose denominator iothe average number ofdays people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 1OOprovides the percent. /GQ One minus the fraction whose numerator is the average number ofpeople waiting onthe residential substance abuse wait list during the past fiscal year, and whose denominator isthe average number ofpeople on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. 10/01/2010 124 1O01/2O1O Managing Entity SAMH8emms Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2012-2013 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision (7) One minus the fraction whose numerator is the average number of days people were on the adult mental health wait list during the past fiscal, and whose denominator iothe average number ofdays people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (R) One minus the fraction whose numerator is the average number ofpeople waiting onthe adult mental health wait list during the past fiscal year, and whose denominator iothe average number ofpeople onthe residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (9) One minus the fraction whose numerator is the average number of days people were on the children's mental health wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 1OOprovides the percent. (10) One minus the fraction whose numerator is the average number ofpeople waiting onthe ohiNrenmmental health wait list during the past fiscal year, and whose denominator is the average number ofpeople onthe residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (11) One minus the fraction whose numerator is the average number of days people were on the forensic wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. M2U One minus the fraction whose numerator is the average number ofpeople waiting onthe forensic wait list during the past fiscal year, and whose denominator iothe average number ofpeople on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. <13A The numerator is the amount of service dollars utilized by Network Providers at the end of each fiscal year. The denominator is the total amount of service dollars allocated to the ME during each fiscal year, IV. Comments / Explanations .here should be a number, baseline, mN/A inserted for each target or outcome in the sections above. *Please explain target population isindicated but mwcorresponding there is standard m�gm onmo`,popuunth ere Ou tcome but there is nncorresponding target population indicated. 10/01/2010 125 South Florida Behavioral Health Network, Inc. KH225 1001/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2013-2014 Provider Name: South Florida Behavioral Health Network, Inc. Contract#:KH225 Date: 10/01/2010 Revision #: |- Mental Health Contracted Services A. Required Performance Output Standardsfor Each Target Population Minimum (including all clients paid for bySAMH,Medicaid and Local Match) Numbers to ~please explain mthe below if a targetpopulation mindicated inthe section below, but there |sno be Served corresponding outcome standard for that population. 1 . Adult Mental Health a. Adults with Severe and Persistent Mental Illness (SPN1|)UNO01GV(N1HO1S) TBD b Adults with Serious and Acute Episodes ofMental Illness (PW06301)/(N1H5301) TBD c, Adults with Mental Health Prob|omo(W1O5302)/(N1H53O2) TBD d. Adults with Forensic Involvement (KX0010/(K8H018) TBD 2. ChUdweo'sMental Health m. Children with Serious Emotional Disturbances (SED)(KAO031)/(KXH031) TBO b. Children with Emotional Disturbances (ED)(yN0032)/(PNH032) T|BD���—' o. Children at -risk ofEmotional Disturbances (yN0033)/yN1H033) TBD B. Required Performance Outcome Standards for Each Target Population Minimum ~Please explain in the comment section below if there is an Outcome Standard but there is no corresponding target Contract population indicated. Standard 1. Adult Mental Health - Adults with Severe and Persistent Mental Illness a. Percent of adults with severe and persistent mental illnesses who live in stable housing environment will beetleast (N1O742)/K8H742) (Statewide Target —83Y6) 93% b, Average annual number of days (post admission assessments) worked for pay for adults with ��---- severe and persistent mental illness will beetleast (W10003)/(K8H003)— (Statewide Target —3D) 30 2. Adult Mental Health - Adults in Mental Health Crisis, including Adults with Serious and Acute Episodes of Mental Illness and Adults with Mental Health Problems a. Percent ofadults in mental health crisis who live in stable housing environment will be at least (W10744)/[WH744)—(Statewide Target —8OY6) 9096 3. Adult Mental Hea|th—Adu|tsvvith Serious k8enbo| |||neee(SPyN|. K8HCrisim, Forensic) e, Percent of adults with serious mental illness who are competitively employed will be at least (KAO7O3)/K8H7O3)—(Statewide Target —15%) 1596 4. Adult Mental Health - Forensic Involvement a. Percent of adults in forensic involvement who live in stable housing environment will be at least (yNU743)/yWH743)—(Statewide Target —7DY6) 70% 5. Ch||dnmn'aK8enta| Health -Gmriuue|y Emotionally Disturbed a. Percent of children with serious emotional disturbance who live in stable housing environment will bootleast (yWO77Q)/(K8H770)—(Statewide Target —95%) 95% b, Percent of children with serious emotional disturbance who improve their level of functioning will bomtleast (W1O378)/MH37O)—(Statewide Target —G5Y6) 65% o. Percent of school days seriously emotionally disturbed children attended will be at least (N\OO12)/(K8HO12)—(Statewide Target —86%) 86% 6. Chi|dren'eK8mntm| Health -Emnotiona||y Disturbed a Percent of children who live in stable housing environment will be at least (M0778)/(MH778) — (Statewide Target —9S%) 95Y& b. Percent ofchildren who improve their level offunctioning will beotleast (K80377)/(K8H377)— (Statewide Target —G4%) 64% 10X01/2010 126 1001/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2013-2014 Provider Name South Florida Behavioral Health Network, Inc. Contract #: KH235 Dote: 18801/2010 Revision#: ChiNnen's MantalHeabh—At-RiekofEmnodona|Diab/rbance a. Percent of children who live in stable housing environment will be at least (M0780) (MH780) C. Required Internal Measures Data Submission Outcomes for Mental Health a, Percent of persons receiving state -contracted mental health service event records which have matching mental health initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will best|oost(SAN1H|S)(yW075S) The standard target for this measure ieatleast R5% 95% U.Substance Abuse Contracted Services A.Required (including all clients K8inknurn Match)paid for by Medicaid and Local Numb ers --'=—pnpv�mn�mu�vmummmo�uo umvw'm�mmo�nn corresponding outcome s��a@���h'�u��on be Served 1. Adults with Substance Abuse Problems a. Number ofAdults Served (yW0063)/(SA0S3) TBD 2. Children with Substance Abuse Problems e. Number ofChildren Served (M0052)/(SAO52) TBD J. Adults At -Risk ofSubstance Abuse Problems- (Non GAA) a. Number ofAdults participating inPrevention Services ([W0785)(SA786) TBD b. Number ofAdults participating inLevel 1 Prevention Programs ([W07G7)/(SA7S7) TBD oh Number of Adults participating in Level 2 Prevention Programs (M0768)/(SA768) TBD d. Number of adults participating in Level 1 Prevention Programs who complete 75 percent of the prognam'oschedule ofactivities (yW0760)/(SA7G&) TBD e. Number ofodubopa�ioipohnginLevel 2Prevention Programs who complete 75pemontnf � �-- the program'oschedule ofactivities (yW0770)/(SA77O) TBD 4. Children At -Risk ofSubstance Abuse Problems- (Non GAA) m. Number ofchildren participating inPrevention Services (M07G2)/YSA7G2) TBD b. Number ofchildren participating inLevel 1 Prevention Programs (NYO7G1)/(SA7S1) TBD c Number ofchildren participating inLevel 2Prevention Program o(K8OSQ5)/(SAGS6) TBD d. Number ofchildren participating in Level 1 Prevention Programs who complete 75 percent ofthe progrom'oschedule ofactivities (K807G3)/(SA7G3) TBD e, Number ofchildren participating inLevel 2 Prevention Programs who complete 75 percent ofthe pvngnam'oschedule ofactivities (PW07S4)(SA7S4) TBD B. Required Performance Outcome Standards for Each Target Population Minimum ^Pleamw explain in the comment section below nthere is anOutcome Standard but there isoocorresponding target Contract population indicated. Standard 1. Adults with Substance Abuse Problems a, Percent of adults who successfully complete substance abuse treatment services will be at least (K8O75S)/SA755)-(Statewide Target —5D%) 50% b. Percent change in clients who are employed from admission to discharge will be at least (K4O753)/(SA753)(Statewide Target —2D96) 20% c. Percent of adults who live in a stable housing environment at the time of discharge will be at least (N10756)/SA758) - (Statewide Target —BD%) DO% 10/01/2010 127 South Florida Behavioral Health Network, Inc. KH225 1O01/2O1O Managing Entity SAMMServices Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2013-2014 Provider Name: South Florida Behavioral Health Network, Inc. Contract#: KH225 Date: 10/01/2010 Revision #: d. Percent change inthe number ofadults arrested 30days prior toadmission versus 30days ���---- prior 10discharge (yN0754/SA754)(Statewide Target —35%) 35% 2. Adults At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for Each 50%) a. Percent of adults participating in Level 1 Prevention Programs who complete 75 percent of the prVgram'oschedule ofactivities will beotleast (K8U771)/(SA771) SO% b, Percent of adults participating in Level 2 Prevention Programs who complete 75 percent of ------- the program'sschedule ofactivities will beatleast (yW0772)/(SA772) 50% 3. Children with Substance Abuse Problems e, Percent of children who successfully complete substance abuse treatment services will be at least (SA726)/yWO726)-(Statewide Target —55Y6) 55% bPercent of children who live in a stable housing environment will be at least (M0752)/SA752) ------- - (Statewide Target —8S%) 8594 o. Percent change in the number of children arrested 30 days prior to admission versus 30 ------- days prior todischarge will beotleast (K4O7S1/SA7b1)- (Statewide Target —2D%) 20% 4. Children At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for each 50%) a. Percent of children participating in Level 1 Prevention Programs who complete 75 percent ofthe prognam'oschedule ofactivities will beotleast (PN07S5)/(SA7G5) 50% b. Percent of children participating in Level 2 Prevention Programs who complete 75 percent ofthe prngram'sschedule ofactivities will beatleast (K80760)/(SA706) 50% 5. Data Submission for Prevention Program Too[ (Baseline — Non 8AA) a. Percent of approved Prevention Descriptions completed within 30 days of contract execution. (Statewide Target —5D%) 50Y6 C. Required Internal Measures 1. Data Submission Outcomes for Substance Abuse a, Percent of persons receiving state -contracted substance abuse service event records which have matching substance abuse initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0758) The standard target for this measure is at least 95% 95% 111, Managing Entity Contracted Services a. Performance Measures (1) so percent of Network Providers surveyed for satisfaction will rate the administrative services of the provider ea^Sotisfooto0"orhigher. /2\OOpercent ofstakeholders surveyed for satisfaction will rate the administrative services ofthe provider as "Satisfactory" or higher. (3) 80 percent of consumers surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" or higher. (4) 90 percent of the Network Providers will receive reimbursement for verified services from the provider within 1Sdays following the -Managing entity receipt ofovalid invoice. 10/0182010 128 1001/2010 Managing Entity SAMMServices Program Exhibit Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2013-2014 Provider Name: South Florida Behavioral Health Network, Inc. Contract#: KH225 Date: 10/01/2010 Revision #: (5) TBD percent reduction in the average number of days people are on the residential substance abuse wait (6) TBD percent reduction in the average number of people waiting on the residential substance abuse wait list. (7) TBD percent reduction in the average number of days people are on the adult mental health wait list. (8) TBD percent reduction in the average number of people waiting on the adult mental health wait list. (9) TBD percent reduction in the average number of days people are on the children's mental health wait list. /10\ TBD percent reduction in the average number of people waiting on the children's mental health wait list. /11\ TBD percent reduction in the average number of days people are on the forensic wait list. /12\ TBD percent reduction in the average number of people waiting on the forensic wait list. (13) The ME will manage the utilization of contracted service dollars to prevent any lapse in service dollars. (1) The numerator |othe number ofNetwork Providers indicating ratings of^oobofoohory"orhigher onthe satisfaction survey. The denominator iothe number ofNetwork Providers responding tothe satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. <2\ The numerator is the number ofstakeholders indicating ratings of^oedofootory orhigher nnthe satisfaction survey. The denominator is the number of stakeholders responding to the satisfaction survey, The measure is based on attainment of 80 percent or greater level of satisfaction. (3) The numerator iothe number cfconsumers indicating ratings of^eotiof*ctory/cxhigher onthe satisfaction survey. The denominator is the number of consumers responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (4)The numerator is the number ofproperly prepared invoices received from Network Providers that are paid within 15days ofreceipt from Network Providers. The denominator isthe number ofproperly prepared invoices with all required backup data received from the Network Providers for each month. The measure iobased on attaining onaverage ofOOpercent orgreater rate over o12-monthperiod, (5) One minus the fraction whose numerator is the average number of days people were on the residential substance abuse wait list during the past fiscal, and whose denominator iothe average number ofdays people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 1OOprovides the percent. /6\ One minus the fraction whose numerator is the average number of people waiting on the residential substance abuse wait list during the past fiscal year, and whose denominator iothe average number ofpeople on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (7) One minus the fraction whose numerator is the average number of days people were on the adult mental health wait list during the past fiscal, and whose denominator is the average number of days people were on 10/01/2010 129 10O1/2O1O Managing Entity SAMMSem�e Program����(��t[� Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2013-2014 Provider Name: South Florida Behavioral Health Network. Inc. Contnsot#: KH325 Dote: 10/01/2010 Revision #: the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (8) One minus the fraction whose numerator is the average number of people waiting on the adult mental health wait list during the past fiscal year, and whose denominator iethe average number ofpeople onthe residential substance abuse wait list during the previous fiscal, the result of this calculation times 100providoa the percent. (9) One minus the fraction whose numerator is the average number of days people were on the children's mental health wait list during the past fiscal, and whose denominator iothe average number ofdays people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 1OOprovides the percent. (1D)One minus the fraction whose numerator is the average number ofpeople waiting onthe ohildren'nmental health wait list during the past fiscal year, and whose denominator isthe average number ofpeople nnthe residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (11) One minus the fraction whose numerator isthe average number ofdays people were onthe forensic wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent, M2\ One minus the fraction whose numerator is the average number of people waiting on the forensic wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent, (13) The numerator is the amount of service dollars utilized by Network Providers at the end of each fiscal year, The denominator iothe total amount ofservice dollars allocated tothe KAEduring each fiscal year. IV. *There should "=anumber, baseline, v,N/A inserted for each target oroutcome mthe sections above. *Please explain n"�u,�cn pvpu|auoo/omuin�euummone�nvcor�,nvnuingnuuomewanummo�v��nupu|�mn.ornmerv�anomzvm����umthere is no corresponding tar get ind icated. ''~�'� 10/01/2010 130 South Florida Behavioral Health Network, Inc. KH225 1001/2010 Managing Entity SAMHSenvices Program Exhibit Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2014-2015 Provider Nome: South Florida Behavioral Health 0etmm'rh. Inc. Contract* NH225 Date: 10/01/2018 Revision #: U. Mental Health Contracted Services A. Required Performance Output Standards for Each Target Population (including all clients paid for by SAMH, Medicaid and Local Match) Minimum Numbers to *Please explain in the comment section below if a target population isindicated mthe section below, but there is no be Served corresponding outcome standard for that population. 1. Adult Mental Health a. Adults with Severe and Persistent Mental Illness (SPK8|)(W001S)/\yWHO1S) TBD b. Adults with Serious and Acute Episodes of Mental Illness (MO5301)/(MH5301) TBD c Adults with Mental Health Problems (K8053O2)/(yWH5302) TBD d, Adults with Forensic Involvement (yWU018)/(KAHO18) TBD 2. Chi|dren`sKAenta| Health a. Children with Serious Emotional Disturbances (GED)(K8O031)/(K8HO31) TBD b, Children with Emotional Disturbances (ED)(N1O032)/YN1H032) TBD c. Children at -risk ofEmotional Disturbances (YN0033)/(yWH033) TBD B. Required Performance Outcome Standards for Each Target Population Minimum *Please explain in the comment section below if there is an Outcome Standard but there isnocorresponding target Contract population indicated. Standard 1. Adult Mental Health -Adubmvvbh Severe and Persistent Mental Illness a. Percent ofadults with severe and persistent menta||Uneooeowho|kmin stable housing environment will boetleast (K80742)/W4H742) (Statewide Target —93%) 93% b. Average annual number of days (post admission assessments) worked for pay for adults with severe and persistent mental illness will beotleast (W10UO3)/(K8H0O3)— (Statewide Target —3O) 30 2. Adult Mental Health - Adults in Mental Health Crisis, including Adults with Serious and Acute Episodes of Mental Illness and Adults with Mental Health Problems e, Percent ofadults in mental health crisis who live in stable housing environment will be at least (yN0744)/KxH744) — (Statewide Target —9D%) 98q6 3. Adult Mental Health — Adults with Serious Mental Illness (SPk0|' 88H Crisis, Forensic) a, Percent of adults with serious mental illness who are competitively employed will be at least (K8O7O3)/K4H703)—(Statewide Target —i6%) 15% 4. Adult Mental Health - Forensic Involvement a, Percent of adults in forensic involvement who live in stable housing environment will be at least (K4O743)/K8H743)—(Statewide Target —7DY6) 70% 5. Chi|dnmn's Mental Health 'Sehuuo|y Emotionally Disturbed a. Percent of children with serious emotional disturbance who live in stable housing environment will beotleast (K8077Q)/(N1H770)—(Statewide Target —95%) 95% b, Percent of children with serious emotional disturbance who improve their level of functioning will beudleast (K8O37O)/K8H378)—(Statewide Target —$596) 65% c, Percent of school days seriously emotionally disturbed children attended will be at least (K8O012)/(yWH012)—(Statewide Target —BG%) BG% 6. Chi|dnen'sMental Health - Emotionally Disturbed e Percent of children who live in stable housing environment will be at least (M0778)/(MH778) — (Statewide Target —95%) 9596 h. Percent of children who improve their level of functioning will be at least (M0377)/(MH377) — (Statewide Target — 64%) 64% 10/01/2010 131 South Florida Behavioral Health Network, Inc, KH225 1001/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2014-2015 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/0112010 Revision #: 7. Children's Mental Hnobh—At-RiekofEmotkono|Dh*turbmnce e. Percent ofchildren who live instable housing environment will beaLleast (KA0780)(K8R780) — (Statewide Target —9O96) 90% C. Required Internal Measures Data Submission Outcomes for Mental Health a. Percent of persons receiving state -contracted mental health service event records which have matching mental health initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will beed|east(SAK8H|S)(K8O750) The standard target for this measure is at least 95% 95% U.Substance Abuse Contracted Services A.Required (including all clients K8hnhnum Match)aid for by SAMH, Medicaid and Local Numbers to ~p�ase pvpu�uon�inuma�umthe s*cunnunmw,um�oe�upcorresponding outcome standard for that population. '' be Served i. Adults with Substance Abuse Problems m, Number ofAdults Served (K800G3)/(SAOG3) TBD 2. Children with Substance Abuse Problems a, Number ofChildren Served ( TBD 3. AduksAt-RiehofSubstanceAbueePnoblemm-(NonGAA) a, Number ofAdults participating inPrevention Services (K8O785)(S4786) TBD b. Number ofAdults participating inLevel 1 Prevention Programs (K8O7G7)/(GA7G7) TBO o. Number ofAdults participating inLevel 2Prevention Programs (N10788)/(SA7G8) TBD d. Number of adults participating in Level 1 Prevention Programs who complete 75 percent of the prognam'oschedule ofactivities (K8O78S)/(GA7GS) TBO e. Number ofadults participating in Level 2 Prevention Programs who complete 75 percent of the program'sschedule ofactivities (W1O770)/(SA770) TBD 4. Children At -Risk ofSubstance Abuse Problems- (Non GAA) a, Number ofchildren participating inPrevention Services (K8O7S2)/\SA7G2) TBD b, Number ofchildren participating inLevel 1 Prevention Programs (yWO7S1)/(8A7G1) TBO c, Number ofchildren participating inLevel 2Prevention Prognamo([WO8Q5)/(SASQ5) TB[) d, Number ofchildren participating in Level 1 Prevention Programs who complete 75 percent ofthe pnogram'oschedule ofactivities (YNO7G3)/(SA763) TBD e. Number of children participating in Level 2 Prevention Programs who complete 75 percent ofthe pnogram'aschedule ofactivities (KX07G4)(SA7G4) TBD B. Required Performance Outcome Standards for Each Target Population Minimum *Please explain in the comment section below if there is an Outcome Standard but there is no corresponding target Contract population indicated. Standard Adults with Substance Abuse Problems a. Percent of adults who successfully complete substance abuse treatment services will be at least (KAO755)/SA75S)-(Statewide Target —5O96) 50% b. Percent change in clients who are employed from admission to discharge will be at least (K8O753)/(SA753)(Statewide Target —2O%) 20% o, Percent of adults who live in a stable housing environment at the time of discharge will beat least (K4075G)/GA758)-(Statewide Target —WO%) 8096 d, Percent change in the number of adults arrested 30 days prior to admission versus 30 days 10K0182010 132 1001/2010 ManagingEndty S*mHServices Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 20Y4-20Y5 ' Provider Name: South Florida Behavioral Health Network, Inc. Contraot#: KH225 Date: 10/01/2010 Revision#: prior todischarge (K4O7S4/SA754)(Statewide Target —35%) 36% 2. Adults At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for Each50%) e, Percent ofadults participating in Level 1 Prevention Programs who unmp|ete7S percent of the p/ogram'oschedule ofactivities will beatleast (W10771)/(SA771) o b Percent of adults participating in Level 2 Prevention Programs who complete 75 percent of the program'oschedule ofactivities will beatleast (MO772)/(SA772) 50% Children with Substance Abuse Problems aPercent of children who successfully complete substance abuse treatment services will be at least (SA725)/M0725)'(Statewide Target —55Y6) 5596 b. Percent of children who live in a stable housing environment will be at least (M0752)/SA752) - (Statewide Target —85%) 8596 c Percent change in the number of children arrested 30 days prior to admission versus 30 days prior todischarge will beatleast (K80751/SA751)- (Statewide Target —2O96) 20% 4. Children At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for each 50%) a. Percent of children participating in Level 1 Prevention Programs who complete 75 percent ufthe prognam'aschedule ofactivities will beskleast (N1O7G5)/(GA7O5) 80Y6 b. Percent of children participating in Level 2 Prevention Programs who complete 75 percent �------ ofthe pvog/am'oschedule ofactivities will beatleast (NYO7G8)/(G4JGG) 50% S. Data Submission for Prevention Program Tool (Baseline — Non GAA) a, Percent of approved Prevention Descriptions completed within 30 days of contract execution. (Statewide Target —5OY6) 50% C. Required Internal Measures Data Submission Outcomes for Substance Abuse a. Percent ofpersons receiving state -contracted substance abuse service event records which have matching substance abuse initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0758) The standard target for this measure ieetleast 95% 9596 XG' Managing Entity Contracted Services a. Performance Measures (1)WOpercent ofNetwork Providers surveyed for satisfaction will rate the administrative services ofthe provider eo^Gmtisfadoq/orhigher. (2) 80 percent of stakeholders surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" or higher. (3) 80 percent of consumers surveyed for satisfaction will rate the administrative services of the provider as ^Ssdistecbzry^ or higher. (4) 90 percent of the Network Providers will receive reimbursement for verified services from the provider within 15days following the_monaging entity receipt ofavalid invoice. (5) TBD percent reduction in the average number of days people are on the residential substance abuse wait 10/01C2010 133 South Florida Behavioral Health Network, Inc. KH225 1O01C01O Managing Entity SAMHServices Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2DY4-2DY5 Provider Name: South Florida Behavioral Health Network, Inc. Contract* KH326 Date: 10/01/3018 Revision #: (6) TBD percent reduction in the average number of people waiting on the residential substance abuse wait list. (7) TBD percent reduction in the average number of days people are on the adult mental health wait list. (8) TBD percent reduction in the average number of people waiting on the adult mental health wait list, (9) TBD percent reduction in the average number of days people are on the children's mental health wait list. /10\ TBD percent reduction in the average number of people waiting on the children's mental health wait list, (11) TBD percent reduction in the average number of days people are on the forensic wait list. (12) TBD percent reduction in the average number of people waiting on the forensic wait list. (13) The ME will manage the utilization of contracted service dollars to prevent any lapse in service dollars. (1) The numerator isthe number ofNetwork Providers indicating ratings nf^mabefaokory or higher on the satisfaction survey. The denominator is the number of Network Providers responding to the satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction, (2) The numerator is the number of stakeholders indicating ratings of "satisfactory" or higher on the satisfaction mu*ey. The denominator is the number of stakeholders responding to the satisfaction survey. The measure io based on attainment of 80 percent or greater level of satisfaction. (3) The numerator kathe number ofconsumers indicating ratings of^ ' higher onthe satisfaction survey, The denominator isthe number ofconsumers responding tothe satisfaction ounmy The measure is based on attainment of 80 percent or greater level of satisfaction. (4) The numerator is the number of properly prepared invoices received from Network Providers that are paid within 15days ofreceipt from Network Providers. The denominator iothe number ofproperly prepared invoices with all required backup data received from the Network Providers for each month. The measure iobased on attaining anaverage of90percent orgreater rate over a12-monthperiod. (5) One minus the fraction whose numerator is the average number ofdays people were onthe residential substance abuse wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100provides the percent. (@) One minus the fraction whose numerator is the average number of people waiting on the residential substance abuse wait list during the past fiscal year, and whose denominator isthe average number nfpeople on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (7) One minus the fraction whose numerator isthe average number ofdays people were onthe adult mental health wait list during the past fiscal, and whose denominator iathe average number ofdays people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. 10/01/2010 134 1001/2010 Managing Entity 8AMHServices Program Exhibit Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year 2014-2015 Provider Nome: South Florida Behavioral Health Network, Inc. Contract #: KH226 Date: 10/01/2010 Revision #� /8> One minus the fraction whose numerator is the average number of people waiting on the adult mental health wait list during the past fiscal year, and whose denominator iathe average number ofpeople onthe residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (2) One minus the fraction whose numerator is the average number of days people were on the children's mental health wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 1DOprovides the percent. (10) One minus the fraction whose numerator is the average number of people waiting on the children's mental health wait list during the past fiscal year, and whose denominator iothe average number cfpeople onthe residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (11) One minus the fraction whose numerator is the average number of days people were on the forensic wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (12) One minus the fraction whose numerator is the average number of people waiting on the forensic wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (13) The numerator is the amount of service dollars utilized by Network Providers at the end of each fiscal year, The denominator is the total amount of service dollars allocated to the ME during each fiscal year. IV. Comments / Explanations *There should be a number, baseline, or N/A inserted for each target moutcome mthe sections above. *Please explain if a target population is indicated but there is no corresponding outcome standard for that population, or if there is an Outcome Standard but there is no corresponding target population indicated. 10/01%2010 135 1001/2010 Managing Entity SAMH Services Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year July 1, 2015- September 30, 2015 Provider Name: South Florida Behavioral Health Network, Inc. Contract* KH225 Date: 10/0112010 Revision #: 1' Mental Health Contracted Services A. Reguired Performance Output Standards for Each n (including all clients paid for bySAMH.Medicaid and Local K0otuh) Minimum Numbers *Please explain in the comment section below targetif a population isindicated inthe section below, but there |snv be Served corresponding mvtcvmvstanuamfovmatpopu/atmn. 1. Adult Mental Health a. Adults with Severe and Persistent Mental |||neoo (SPYN|) (W0O16)/(K8HO16) TBD b. Adults with Serious and Acute Episodes of Mental Illness (M05301)/(MH5301) TBD c, Adults with Mental Health Problems (yN053O2)/(K8H53O2) TBD d. Adults with Forensic Involvement ([NOO18)/(YNHO18) TBQ 2. Ch>|dren^mK8ento| Health a. Children with Serious Emotional Disturbances (SED)(N1O031)/(K8HO31) TBD b, Children with Emotional Disturbances (ED)(PW0032)/(W1HO32) TBD c. Children at -risk ofEmotional Disturbances (KA0O33)/(W1HO33) TBU B. Required Performance Outcome Standards for Each Target Population Minimum *Please explain mthe comment section below i,there /s an Outcome Standard but there ionocorresponding target Contract population indicated. Standard 1. Adult Mental Health-Adultswith Severe and Persistent Mental Illness o. Percent of adults with severe and persistent mental illnesses who live in stable housing environment will beatleast (yWO742)/yNH742) (Statewide Target —93Y6) 93% b. Average annual number of days (post admission assessments) worked for pay for adults with severe and persistent mental illness will be at least (M0003)/(MHO03) — (Statewide Target — 30) 30 2. Adult Mental Heo|th-Adu|te in Mental Health Crisis, including Adults with Serious and Acute Episodes ofMental |||neae and Adults with Mental Health Problems e, Percent of adults in mental health crisis who live in stable housing environment will be at least (K8O744)/N1H744)—(Statewide Target —BO%) 98% 3. Adult Mental Hoo|th—Adu|tsvvith Serious Mental |||neee(SPK0|^ K8HCrisie. Forensic) a. Percent of adults with serious mental illness who are competitively employed will be at least (N1U7O3)/yWH703)—(Statewide Target —15%) 15% 4. Adult Mental Health - Forensic Involvement e. Percent of adults in forensic involvement who live in stable housing environment will be at least (W1O743)/N1H743)—(Statewide Target —TO%) 70Y6 5. Chi|dnen'e Mental Health -Serioue|y Emotionally Disturbed a, Percent of children with serious emotional disturbance who live in stable housing environment will beatleast (K40770)/(NYH77Q)—(Statewide Target —BS%) b� Percent of children with serious emotional disturbance who improve their level of functioning will beetleast (PWO378)/N1H378)—(Statewide Target —G5%) 6596 c. Percent of school days seriously emotionally disturbed children attended will be at least (K8O012)/(N1H012)—(Statewide Target —86%) 86% 6. Children's Mental Health -Emmotiono||y Disturbed o. Percent of children who live in stable housing environment will be at least (M0778)/(MH778) — (Statewide Target —9SY6) 959& b. Percent cdchildren who improve their level offunctioning will beatleast (KA0377)/(N1H377)— (Statewide Target —G4Y6) 84% 10A01/2010 136 1001/2O10 Managing Entity SAMHServices Program Exhibit D Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year July 1' 2015- September 30, 2015 Provider Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/0112010 Revision #: Ch|]dren`s Mental Health -At-Risk ofEmotional Disturbance a, Percent ufchildren who live instable housing environment will beatleast (PN0780)(yWH780) C. Required Internal Measures Data Submission Outcomes for Mental Health s, Percent of persons receiving state -contracted mental health service event records which have matching mental health initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will beat|eaot(SA[WH|S)(PNO75S) The standard target for this measure ieetleast B5% 9596 U.Substance Abuse Contracted Services A. Required Performance(including all clients Minimum .paid for ^~~v N-`be�to Please explain / m�^~~��um^~'~w�^ pvvumuvn�inum�eu|nm000m|vnomow.u'uthere isnv���/�o*c�standard be Served 1. Adults with Substance Abuse Problems o, Number ofAdults Served ( TBD 3. Children with Substance Abuse Problems a, Number ufChildren Served (W1OOS2)/YSAO52) TBD 3. Adults At -Risk ofSubstance Abuse Problems- (Non GAA) m. Number ofAdults participating inPrevention Services (W1O78G)(S4785) TBD b, Number ofAdults participating inLevel 1 Prevention Programs (yN0787)/(GA7G7) TBD c. Number of Adults participating in Level 2 Prevention Programs (M0768)/(SA768) TBD d. Number ofadults participating inLevel 1 Prevention Programs who complete 75percent of the prognym'aschedule ofactivities (K8U7O9)/(SA7OS) TBD e, Number of adults participating in Level 2 Prevention Programs who complete 75 percent of the program'aschedule ofactivities (K8D77O)/(SA77O) TBD 4. Children At -Risk ofSubstance Abuse Problems- (Non GAA) a Number ofchildren participating inPrevention Services (MO762)/(SA762) TBD b, Number ofchildren participating inLevel 1 Prevention Programs (PWO7S1)/(GA7G1) TBD o. Number ofchildren participating in Level 2 Prevention Pnognsma(N10G85)/(SAGQS) TBD d. Number ofchildren participating in Level 1 Prevention Programs who complete 75 percent ofthe prognsm'aschedule ofactivities (PWO7G3)/YSA783) TBD e. Number of children participating in Level 2 Prevention Programs who complete 75 percent ofthe program'sschedule ofactivities (PW07G4)(SA7S4) TBD B. Required Performance Outcome Standards for Each Target Population Minimum *Please explain inthe comment section below i,there isanOutcome Standard but there ianocorresponding Contract target population indicated. Standard Adults with Substance Abuse Problems a, Percent of adults who successfully complete substance abuse treatment services will be at least (KAO755)/SA755)-(Statewide Target -5O96) 50% b, Percent change in clients who are employed from admission to discharge will be at least (Nl0753)/(SA753) (Statewide Target -2O96) 20Y6 o, Percent ofadults who live in a stable housing environment atthe time ofdischarge will be at least (yW0756)/SA756) - (Statewide Target -8O%) 80% d. Percent change in the number of adults arrested 30 days prior to admission versus 30 days 10801%2010 137 10O1/2Q1O Managing Entity SAMHSavmmPmg�m ���i�/�[� Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year July 1, 2015- S����3� �15 Provider� Name: South Florida Behavioral Health Network, Inc. Contract #: KH225 Date: 10/01/2010 Revision #: prior todischarge (N1O754/SA7S4)(Statewide Target —35%) 2. Adults At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for Each 50%) a. Percent ofadults participating inLevel 1Prevention Programs who complete 75percent nf the prognsm'aschedule ofactivities will beatleast (yNO771)/(SA771) b. Percent of adults participating in Level 2 Prevention Programs who complete 75 percent of the prog/am'aschedule ofactivities will beatleast (MO772)/(SA772) 1 Children with Substance Abuse Problems e, Percent of children who successfully complete substance abuse treatment services will be at least (GA725)/NYO725)-(Statewide Target —5SY6) b. Percent of children who live in a stable housing environment will be at least (M0752)/SA752) ' (Statewide Target —85%) c. Percent change in the number of children arrested 30 days prior to admission versus 30 days prior todischarge will beatleast (K8O751/SA751)- (Statewide Target —3O%) El Children At -Risk of Substance Abuse Problems - (Non GAA) (Statewide Target for each 50%) a, Percent of children participating in Level 1 Prevention Programs who complete 75 percent ofthe pnoQnam'aschedule ofactivities will beatleast (KA07O5)/Y8A7O5) b. Percent of children participating in Level 2 Prevention Programs who complete 75 percent — 50% = "=p."y.mxo xueuuxem uu/vmesvwo oesnleast (m0/66)/(S8766) 5. Data Submission for Prevention Program Tool (Baseline — Non GAA) o. Percent of approved Prevention Descriptions completed within 30 days of contract execution, (Statewide Target —5O%) 50Y& C. Required Internal Measures Data Submission Outcomes for Substance Abuse m, Percent of persons receiving state -contracted substance abuse service event records which have matching substance abuse initial (purpose 1) admission records in the Substance Abuse and Mental Health Information System will be at least(SAMHIS) (M0758) The standard target for this measure is at least 95% 95% |XX' Managing Entity Contracted Services a. Performance Measures /I\8Opercent of Network Providers surveyed for satisfaction will rate the administrative services of the provider as^SodiofaotVry"orhigher, (2) 80 percent of stakeholders surveyed for satisfaction will rate the administrative services of the provider as "Satisfactory" o/ higher. (3) 80 percent of consumers surveyed for satisfaction will rate the administrative services of the provider as ^Setiafecory^orhigher. (4) 90percent of the Network Providers will receive reimbursement for verified services from the provider within 15 days following the_managing entity receipt ofavalid invoice. (5) TBD percent reduction in the average number of days people are on the residential substance abuse wait list 10/01/2010 138 South Florida Behavioral Health Network, Inc. KH225 1001/2010 Managing Entity SAMVServices Program Exhibit Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year July 1, 2015-September 3O 20/5 Provider Name: South Florida Behavioral Health Network, Inc. Contnact#: KH235 Date: 10/01/2010 Reviaion#: (6) TBD percent reduction in the average number of people waiting on the residential substance abuse wait list. (7)TBOpercent reduction in the average number of days people are on the adult mental health wait list. (8) TBD percent reduction in the average number of people waiting on the adult mental health wait list. (9) TBD percent reduction in the average number of days people are on the children's mental health wait list. /10\ TBD percent reduction in the average number of people waiting on the children's mental health wait list. /11\ TBD percent reduction in the average number of days people are on the forensic wait list. /12\ TBD percent reduction in the average number of people waiting on the forensic wait list. (13) The ME will manage the utilization of contracted service dollars to prevent any lapse in service dollars. b. Methodology (1) The numerator is the number ofNetwork Providers indicating ratings of^oadsfaoLoq/orhigher onthe satisfaction survey. The denominator iothe number ofNetwork Providers responding 8zthe satisfaction survey. The measure is based on attainment of 80 percent or greater level of satisfaction. (2) The numerator is the number of stakeholders indicating ratings of "satisfactory" or higher on the satisfaction survey, The denominator is the number of stakeholders responding to the satisfaction survey. The measure im based onattainment ofO0percent o/greater level ofsatisfaction. (3) The numerator is the number ofconsumers indicating ratings of^aatiafactory" o/ higher on the satisfaction survey. The denominator is the number of consumers responding to the satisfaction survey. The measure |s based onattainment of8Opercent orgreater level ofsatisfaction. (4) The numerator is the number of properly prepared invoices received from Network Providers that are paid within 15days ofreceipt from Network Providers. The denominator iathe number ofproperly prepared invoices with all required backup data received from the Network Providers for each month. The measure isbased on attaining anaverage ofQ0percent orgreater rate over a12-monthperiod. <5\ One minus the fraction whose numerator is the average number of days people were on the residential substance abuse wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 10Oprovides the percent. (6) One minus the fraction whose numerator is the average number of people waiting on the residential substance abuse wait list during the past fiscal year, and whose denominator is the average number of people on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (7) One minus the fraction whose numerator is the average number of days people were on the adult mental health wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent, 10/01/2010 139 10/O1/2O10 Managing Entity 8AMMServices Program Exhibit Substance Abuse and Mental Health Required Performance Outcomes and Outputs For Fiscal Year July 1,2015- September 302015 Provider Name: South Florida Behavioral Health Network, Inc. Contract* KH225 Date: 10/01/2010 Revision #: (8) One minus the fraction whose numerator isthe average number ofpeople waiting onthe adult mental health wait list during the past fiscal year, and whose denominator iathe average number ofpeople onthe residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (0) One minus the fraction whose numerator isthe average number ofdays people were onthe chi|dren'a mental health wait list during the past fiscal, and whose denominator is the average number of days people were on the residential substance abuse wait list during the previous fiscal, the result of this calculation times 1OOprovides the percent. (10) One minus the fraction whose numerator is the average number of people waitingonthe uhiNren'mmental health wait list during the past fiscal year, and whose denominator isthe average number ofpeople onthe residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (11) One minus the fraction whose numerator is the average number ofdays people were onthe forensic wait list during the past fiscal, and whose denominator is the average number ofdays people were onthe residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (12) One minus the fraction whose numerator is the average number ofpeople waiting onthe forensic wait list during the past fiscal year, and whose denominator is the average number ofpeople onthe residential substance abuse wait list during the previous fiscal, the result of this calculation times 100 provides the percent. (13) The numerator isthe amount ofservice dollars utilized byNetwork Providers atthe end ofeach fiscal year. The denominator is the total amount of service dollars allocated to the ME during each fiscal year. IV. Comments / Explanations *There should be a number, baseline, or N/A inserted for each target moutcome mthe sections above. *Please explain if a target population isindicated but there is no corresponding outcome standard for that population, mif there ivanOutcome Standard but there is no corresponding target population indicated. 10/01/2010 140 EXHIBIT E Missing Children The provider agrees to follow the procedures outlined in Rule 65C-30.019, F.A.C. and Rule 65C-29.013, F.A.C. and in Children and Families Operating Procedure (CFOP) 175-85, entitled "Prevention, Reporting, and Services to Missing Children". The 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. 1. Definitions a. Designee - a person, contractual provider or other agency or entity named by the department. 1b. 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 provider when they went missing; and who has been or will be reported as missing to a law enforcement agency. 2. Reporting Missing Children The provider agrees to instruct caregivers, including relative and non -relative caregivers, family services counselors, and all other staff that might be required to report a child as missing to local law enforcement to immediately undertake the following activities, as applicable, and document all actions and activities related to any efforts made to report and/or locate any child who is determined to be missing from their care or supervision: a. If exigent circumstances exist, the caregiver, family services counselor, or 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. South Florida Behavioral Health Network, Inc. 141 KH225 EXHIBIT E (3) Provide local law enforcement with a recent high quality photo of the child, or provide local law enforcement with a recent high quality photo when one becomes available. (4) Request that a copy of the police report be provided to the family services counselor once a police report becomes available. (5) If the responding law enforcement officer refuses to take a missing child report, for any reason, the individual attempting to report the child as missing will document the officer's name and specific local law enforcement agency name and request to speak to the law enforcement agency Watch/Shift Commander. If the law enforcement agency Watch Commander refuses to take a missing child report and it is a caregiver that is attempting to report the child as missing, the caregiver will immediately contact the family services counselor or on -call staff and provide them with all information related to local law enforcement not issuing a missing child report. Once the family services counselor or on -call staff have learned that a local law enforcement agency will not issue a missing child report they will immediately seek assistance from the local area Community Based Care (CBC) Child Location Specialist or the Department of Children and Families Regional Criminal Justice Services Coordinator on resolving any issue related to reporting the child as missing to local law enforcement. (6) If it is a caregiver who has reported the child as missing to local law enforcement or attempted to report a child as missing to local law enforcement, they shall immediately notify the child's family services counselor or emergency on -call staff and provide them with the following information: (a) The law enforcement agency name that the child was reported as missing to or attempted to be reported as missing to; (b) The law enforcement missing child case number if one was issued by local law enforcement; (c) A copy of the law enforcement report when one is made available; (d) Detailed information on the child's overall state of mind and behavior prior to the child going missing; (e) Detailed description of what the child was last seen wearing; (f) Detailed information on possible locations that the child might be going to; and (g) Detailed information on any individuals that the child might be traveling with. lb. If exigent circumstances do not exist, the caregiver , family services counselor, or other 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, (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: South Florida Behavioral Health Network, Inc. 142 KH225 (a) School/child's teachers and school resource officer; (b) The child's relatives/pa rents, 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. c. If at any time during the initial four (4) hour search for the child, if the caregiver, family services counselor, or any other provider employee 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 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.a., above. d. If at any time, the child is located or returns to the caregivers home after law enforcement has been notified of the missing child case, all law enforcement agencies and other agencies that were notified of the missing child episode must be contacted immediately by the caregiver, family services counselor, or other provider employee. 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 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, e. All of the department's documentation related to the missing child episode shall be completed and entered into the department's approved missing child reporting system within one working day of the family services counselor, on -call staff, or Community Based Care (CBC) Child Location Specialist learning of a missing child episode regardless of whether local law enforcement has issued a missing child report number. This includes the uploading of a recent high quality photograph of the child into the department's approved missing child reporting system. If local law enforcement has refused to issue a missing child report a dummy local law enforcement case number of 00000 and the name of the local law agency that refused to issue the missing child report shall be used to complete and enter the missing child episode into the department's approved missing child reporting system. South Florida Behavioral Health Network, Inc. 143 KH225 10/01/2010 Managing Entity SAMH Services Program Exhibit F Minimum Service Requirements The provider and its subcontractors shall be knowledgeable of and fully comply with all applicable state and federal laws, rules and regulations, as amended from time to time, that affect the subject areas of the contract. Authorities include but are not limited to the following: 1. PROGRAMMATIC AUTHORITY (FEDERAL) A. Mental Health 42 U.S.C. 300x to 300x-9 (Block Grant for community Mental Health Services) Litt jx / LvvIA w L_A,Iaw.cornell.edu/uscode/42/ch6AschXVIIEB,htmi B. Substance Abuse Prevention and Treatment Block Grant (SAPTBG) 42 U.S.C. 290kk, et seq. (Limitation on use of funds for certain purposes) 42/usc sec 42 0000029 0­*k000­ .11tMI 42 U.S.C. 300x-21 to 300x-35 and 300x-51 to 300x-66(SA Treatment & Prevention Block Grants) .tLttp:,L/w,v�w4,la�w.cornell.edu/i.iscode/html/uscode42/LISC 'U Oull 442 110 6 A 20 XV11 30 I 4-0 —ii.htmi 42 CFR, Part 54 (Charitable choice) tt AVA.access,_qRo,_qov/nara/qLf[/wa Lsidx 03/42cfr54 03,htmi 45 CFR 96.120 — 137 (SA Treatment & Prevention Block Grants) 1Lttp'//www, access _qp2, qov/n a rq/cfr/wa isid x 03/45cfr96 03,htmi Restrictions on expenditures of SAPTBG 45 CFR 96.135 b —tt fr96 01,html C. Substance Abuse -Confidentiality 42 CFR, Part 2 Ll LtJ L,''� ,,www, a-cceaL2poqov/naLa/cfr/waisi �JxQ,3�/42cf �r203, �html D. Health Insurance Portability and Accountability Act (HIPAA) 45 CFR 164 Ltt1',1://www,acce L,:i�pg,gov/nara/cfr/waisidx 03/45cfr164 03,htmi Rev.07/01 ?2010 144 South Florida Behavioral Health Network, Inc. KH225 Managing Entity SAMH Services Program Exhibit F E. Social Security Income for the Aged, Blind and Disabled 20 CFR 416 ti!tip-fLA-V-Nm 3,htmi F. Endorsement and Payment of Checks Drawn on the United States Treasury 31 CFR 240 relating to SSA q_a //cff ov//narar//waisidx 03/31cfr240 03,html ,p _q_ G. Temporary Assistance to Needy Families (TANF) Part A, Title IV of the Social Security Act 45 CFR, Part 260 j'Lt�//vvww access. 0 DO Cloy/nara/cfr/waisift 03/45cfr260 03.htmi Section 414.1585, F.S. !i1L),// e v v.Iec .st te.fl.us/statutes/index.cfm?Mode=ViewStatutes&Submenu=1 H. Positive Alternatives to Homelessness (PATH) Public Health Services Act, Title V, Part C, Section 521, as amended 42 U.S.C. 290cc-21 et. seq. mitt P,',L/vA L Lvv4, law�.,,cgrneII.edu/usqg/ Stewart B. McKinney Homeless Assistance Amendments Act of 1990, Public Law 101-645 tiltL)Wwww4 jaw, cornell,ed LI/L - --101-645 —qsc cgi/cL -&tar qt external. gg i ?t\inp 2jLLqet 42 CFR, Part 54 t -tt fr54 03,html 1. Americans with Disabilities Act of 1990 42 U.S.C. 12101 et seq. �!E--/!�yw4j wiyv-gornefleduluscode/ . — _-q_ 11. FLORIDA STATUTES All State of Florida Statutes can be found at the following website: bjtp-/,Lvvw�A lqq.�,ate, L ,_ Q,us/statutes/index,cfm?dodo =Vion StatLitest Su-bme, nu=1 Rev,07/01/2010 145 South Florida Behavioral Health Network, Inc. KH225 11111111 a$ Exhibit F A. Child Welfare and Community Based Care Managing Entity SAMH Services Program Chapter 39, F.S. Proceedings Relating to Children Chapter 119, F.S. Public Records Chapter 402, F.S. Health and Human Services; Miscellaneous Provisions Chapter 435, F.S. Employment Screening Chapter 490, F.S. Psychological Services Chapter 491, F.S. Clinical, Counseling and Psychotherapy services Chapter 1002, F.S. Student and Parental Rights and Educational Choices Section 402.3057, F.S. Persons not required to be refingerprinted or rescreened Section 414.295, F.S. Temporary Cash Assistance; Public Records Exemptions B. Substance Abuse and Mental Health Services Chapter 381, F.S. Chapter 386, F.S. Chapter 395, F.S. Chapter 394, F.S. Chapter 397, F.S. Chapter 400, F.S. Chapter 435, F.S. Chapter 458, F.S. Chapter 459, F.S. Chapter 464, F.S. Chapter 465, F.S. Chapter 490, F.S. Chapter 491, F.S. Chapter 499, F.S. Chapter 553, F.S. Chapter 893, F.S. Section 409.906(8), F.S. C. Developmental Disabilities Chapter 393, F.S. D. Adult Protective Services Chapter 415, F.S. E. Forensics Public Health General Provisions Particular Conditions Affecting Public Health Hospital Licensing and Regulation Mental Health Substance Abuse Services Nursing Home and Related Health Care Facilities Employment Screening Medical Practice Osteopathic Medicine Nursing Pharmacy Psychological Services Clinical, Counseling and Psychotherapy Services Drug, Cosmetic and Household Products Building Construction Standards Drug Abuse Prevention and Control Optional Medicaid — Community Mental Health Services Developmental Disabilities Adult Protective Services Chapter, F.S,916, F.S. Mentally Deficient and Mentally III Defendants. Chapter 985, F.S. Juvenile Justice; Interstate Compact on Juveniles Section 985.19, F.S. Incompetency in Juvenile Delinquency Cases Section 985.24, F.S. Interstate Compact on Juveniles; Use of detention; prohibitions; Rev.07101/2010 146 South Florida Behavioral Health Network, Inc, KH225 Managing Entity SAMH Services Program Exhibit F F. Florida Assertive Community Treatment (FACT) General Appropriations Act ,'Lt,!/r�-Nww,f-iserla!Lgov/\Nelcome/index.cfm?CFID=1 05701865&CFTOKE N=.3401681-7 G. State Administrative Procedures and Services Chapter 120, F.S. Chapter 287, F.S. Chapter 815, F.S. Section 112.061, F.S. Section 112.3185, F.S. Section 215.422, F.S. Section 216.181(16)(b), F.S. Administrative Procedures Act Procurement of Personal Property and Services Computer - Related Crimes Per them and Travel Expenses* Additional Standards for State Agency Employees Payments, Warrants & Invoices; Processing Times Advanced funds invested in interest bearing accounts *Travel Expenses are specified in the DFS Reference Guide for State Expenditures Ljttp'! �A�N-W.m f�loridacfo.com/aadir/referenr.p`:/`,,9F wdelreferp Lj�ide,htrji y Ill. FLORIDA ADMINISTRATIVE CODE (RULES) A. Child Welfare and Community Based Care All references to F.A.C. may be found at the following website: Littjpa://www,f1r(uj les MiLdgfau It.as Rule 65C-12, F.A.C. Emergency Shelter Care Rule 65C-13, F.A.C. Substitute Care of Children Rule 65C-14, F.A.C. Group Care Rule 65C-1 5, F.A.C. Child Placing Agencies B. Substance Abuse and Mental Health Services Rule 65C-12, F.A.C. Emergency Shelter Care Rule 65D-30, F.A.C. Substance Abuse Services Office Rule 65EA F.A.C. Community Mental Health Regulation Rule 65E-5, F.A.C. Mental Health Act Regulation Rule 65E-1 0, F.A.C. Psychotic and Emotionally Disturbed Children Purchase of Residential Services Rules Rule 65E-1 2, F.A.C. Public Mental Health, Crisis Stabilization Units, Short Term Residential Treatment Programs Rule 65E-14, F.A.C. Community Substance Abuse and Mental Health Services - Financial Rules Rule 65E-1 5, F.A.C. Continuity of Care Case Management Rule 65E-20, F.A.C. Forensic Client Services Act Regulation Rev,07/01/2010 147 South Florida Behavioral Health Network, Inc. KH225 Managing Entity SAMH Services Program C. Financial Penalties Rule 65-29, F.A.C. 0 all PTI Penalties on Service Providers Reduction/withholding of funds Rule 65-29.001, F.A.C. Financial Penalties for a Provider's Failure to Comply With a Requirement for Corrective Action IV. MISCELLANEOUS A. Department of Children and Families Operating Procedures CFOP 155-10, Services for Children with Mental Health & Any Co-occurring Substance Abuse Treatment Needs In Out of Home Care Placements ,!,Lt!ll.ZtLvnv,,dcf,sta,te,fl.qs ublicationsfoolicies/cf .,- CFOP 215-6, Incident Reporting and Client Risk Prevention L,L/Www, dcf, state j 1, Ljq/1D ublications '_olicies/211 5-6 df :R_ B. Federal Cost Principles OMB Circular A-21, Cost Principles for Educational Institutions 021.html OMB Circular A-87, Cost Principles for State, Local and Indian Tribal Governments 087-all.html OMB Circular Al 02, Grants and Cooperative Agreements with State and Local Governments tlqp,,/wvLw,whitehouse.gov/omb/circulars/a102/a102.html OMB Circular A-122, Cost Principles for Non-profit Organizations N t 2.htmI OMB Circular A-1 33, Audits of States, Local Governments and Non -Profit Organizations 133.htmi Section 215.97, F.S., Florida Single Audit Act 1tt PL, L/ . I e q,,, is/statutes/index,cfm?Mode=ViewStatutes&Submenu =1 Comptrollers Memorandum #03 (1999-2000): Florida Single Audit Act Implementation I tp_: fldfs,com/aadir/ci-nmaster9900.1itm Rev,07/01/2010 148 South Florida Behavioral Health Network, Inc. KH225 10101/2010 Exhibit F D. Administrative Requirements Managing Entity SAMH Services Program 45 CFR, Part 74 - Uniform Administration Requirements for Awards and Subawards to Institutions of Higher Education, Hospitals, other Non -Profit Organizations and Other Commercial Organizations fi _j'yLWv�r. a q�, :gss,.(Mo._g_qv/riara/`cfr/wai,sidx 06/45cfr74 06,htmi 45 CFR, Part 92 - Uniform Administration Requirements (State and Local Governments)\ 'q'S'S,-_'.Po, v/nara/cfr/waisidx 06/45cfr92 06,htmi OMB Circular Al 10, Uniform Administrative Requirements for Grants and Other Agreements �,'jj'tp,/L,vv vwwhitehouse, ov/omb/circulars/al,10/allO,htmI E. Data Collection and Reporting Requirements Rule 65E-14.022, F.A.C. 5E-14,022 Section 397.321(3)(c), F.S., Data collection & dissemination system &URL=ChO 397/titI0397, htm Section 394.74(3)(e), F.S., Data Submission mode =Dispjgy Stattjte&URL=Qh0 394/fit10394.htm Section 394.77, F.S., Uniform management information, accounting, and reporting systems for providers. mode= Qispl2y_statute& U R L=C hO 394/tA10394,htni CFP 155-2, Mental Health and Substance Abuse Data Measurement Handbook t1it /index,shtmi Rev.07/01/2010 149 South Ronda Behavioral Health Network, Inc. KH225 Exhibit G Required Reports Rev.07101/2010 150 South Florida Behavioral Health Network, Inc. KH225 10/01/2010 EXHIBIT G Performance Contract SAMH Services Program Provider Name: South Florida Behavioral Health Network, Inc. Date: October 1, 2010 Contract No. KH225 Amendment #_ Due Date # of Send to: I I I Copies I IL =- = Response to Monitoring Reports and Corrective Action Within 30 days from the day the 1 Contract Manager Plans report is received. Validation of review of subcontractor's Sliding Fee Scale Within 30 days of contract 1 Contract Manager [reflecting the uniform schedule of discounts referenced in 65E-14.018(4)] execution Validation of review of subcontractor's Agency Service Prior to contracting for year 2 of I Contract Manager Capacity Report , Projected Cost Center Operating and the contract and every other year Capital Budget, Cost Center Personnel Detail Report (if thereafter, applicable) Consolidated Program Description Prior to contracting for year 2 of 1 Contract Manager the contract and every other year thereafter , or any updates thereafter. Monthly Data Required by CFP 155-2 Within 15 days after end of month Electronic SAMH Program Submission Office as appropriate Incident Report Within 48 hours of occurrence 1 to Region As specified in Incident CFOP 215-6, 215-3 Report Liaison and other Regional I to Lotus language as Notes directed by the contract. Audit Schedules (for client non-specific unit cost The ME's Audit Schedule is due I to Region Contract Manager performance contracts) 180 days after the end of the ME fiscal year or 45 days upon completion of audit, whichever comes first. The ME shall submit the network provider's audit schedules 30 days after receipt from the network provider. Schedule of State Earnings Due 180 days after the end of the 1 to Region Region SAMH Schedule of related Party Transaction Adjustments fiscal year or 45 days upon Program/Cost Center Actual Expenses & Revenues completion of audit, whichever Schedule comes first. Schedule of Bed -Day Availability Payments Financial & Compliance Audit per Attachment 11 180 days after the end of the 1 See Attachment 11 managing entity's fiscal year or 45 SAMH Contract days after its completion, Manager whichever comes first. South Florida Behavioral Health Network, Inc. 150 KH225 10/01/2010 EXHIBIT G Performance Contract SAIMH Services Program 11 *1-11110 :111110 :1091A Reports Required for Substance Abuse Providers Annual Report for HIV Early Intervention Services, SAPT Upon Request of the department 1 to Circuit Circuit Contract Block Grant Set Aside Funded Services Only I to Manager Substance Headquarters Abuse Program Office Annual Report for Evidenced -based Injection Drug User Upon Request of the department I to Circuit Circuit Contract Outreach Services, SAPT Block Grant Mandate, Designated 1 to Manager Substance Providers Only Headquarters Abuse Program Office Annual Report for Pregnant Women and Women With Upon Request of the department 1 to Circuit Circuit Contract Dependent Children SAPT Block Grant Set Aside Funded 1 to Manager Substance Services Only Headquarters Abuse Program Office Other Reports Quarterly Annual Action Plan Reports on Accomplishments As identified in the Annual Action 1 Contract Manager and Deliverables Plan Monthly Service Invoice By 15 1h of each month I Contract Manager Final Invoice By July 31 of each fiscal year and 1 Contract Manager 31 days after contract end date Wait List (until department's automated system is Monthly for SA services. 1 Contract Manager operational) Monthly for MH services as per the approved annual action plan. Monitoring Schedule Within 30 days of receipt of the 1 Contract Manager risk assessment prepared by the Department's Contract Oversight Unit. Contingency Transition Plan 90 days after contract execution 1 Contract Manager Validation of receipt and review of Network Providers Within 30 days of contract 1 Contract Manager grievance procedures execution Validation that all Network Providers produced copies of Within 30 days of contract 1 Contract Manager their Informed Consent Forms execution Validation of receipt and review of Network Providers Within 30 days of contract 1 Contract Manager Emergency Preparedness Plan execution and by June 1 of each fiscal ear Validation of Network Providers Civil Rights Compliance Within 30 days of contract 1 Contract Manager Questionnaire execution Validation of Network Providers Security Agreements Within 30 days of contract I Contract Manager execution Affidavit Regarding Debarment Annual for the ME and 1 Contract Manager 15 days prior to contract negotiation with subcontractor, or as requested by the contract manager, Beginning Inventory Report Within 30 days of contract 1 Contract Manager execution Training Schedule Within 15 days prior to the training I Contract Manager quarter. Invoice Review Supporting Documentation As per the contract and/or as 1 Contract Manager requested by the contract manager South Florida Behavioral Health Network, Inc. 151 KH225 10101/2010 EXHIBIT G Performance Contract SAMH Services Program Lapse Analysis Report 30 days after the month of 1 Contract Manager services Annualized Line Item Budget & Narrative 60 days before the beginning of 1 Contract Manager each fiscal year. Annual Inventory Report May 15"' of each fiscal year 1 Contract Manager Closeout Inventory Report By July 31, 2015 1 Contract Manager Cooperative Agreements/MOU/MOA/Procedures As identified in the Annual Action 1 Contract Manager _ Plan and the contract Quality Assurance Reviews, Monitoring Reports & Within 30 days after exit 1 Contract Manager Corrective Action Plans conference Adult Mental Health Quarterly and Annual PATH Report FACT Reports Subcontractors to submit to the 1 Contract Manager (1) Quarterly FACT Enhancement Reconciliation managing entity by October 15th and SAMH Program Report and Tracker January 15, April 15 and July 15 Office/Headquarters (2) Quarterly FACT Ad Hoc Reports of each fiscal year. The managing as specified in the (3) Monthly Performance Measures Report entity is to submit to the contract (4) Reporting of significant incidents & department the reports one (1) interventions, as needed week after the due dates listed above Quarterly Contingency Funds Report Subcontractors to submit to the 1 Contract Manager managing entity by October 31, and SAMH Program January 30, April 30 and July 31 Office of each fiscal year. The managing entity is to submit to the department a summary of the quarterly expenditures one (1) week after the due dates listed above Path Quarterly Reports Subcontractors to submit to the 1 Contract Manager managing entity by October 31, and SAMH Program January 30, April 30 and July 31 Office of each fiscal year. The managing entity is to submit to the department the reports one (1) week after the due dates listed above PATH Annual Reports Drafts to be submitted to Southern 1 Southern Southern Region Region SAMH Program Office, Region SAMH SAMH Program DCF Central Office in Tallahassee for Prior Office, Contract in April or May of each fiscal year Approval, Manager, and On - as requested line Site South Florida Behavioral Health Network, Inc. 152 KH225 EXHIBIT G Performance Contract SAMH Services Program 1 final to DCF Central Office in Taliahassee Forensic Services MontNy Report for Individuals on Conditional Release By 15`h of each month 1 Forensic CoordinatorfMH Administrator Office Census Report Weekly 1 SAMH Forensic Coordinator Admission Waiting List Weekly 1 SAMH Forensic Coordinator Staffing Reports As required, every six month per 1 SAMH Forensic clients Coordinator South Florida Behavioral Health Network, Inc. 153 KH225 L:Rmlown Children's Mental Health Comprehensive Community Service Team Description: Comprehensive Community Service Team (CCST) services take place in either an outpatient or community -based setting and provide adults and children with mental illness assistance in identifying goals and making choices to promote resiliency and facilitate recovery. For individuals/families with mental health problems, recovery is the personal process of overcoming the negative impact of a psychiatric disability despite its continued presence. CCST services are intended to restore the individual's function and participation in the community. The services are designed to assist and guide individuals/families in reconnecting with society and rebuilding skills in identified roles in their environment. The focus is on the individual's and family's strengths and resources as well as their readiness and phase of recovery. A team approach for delivery of services will be used to guide and support the adults and children served with development of a recovery plan focusing on the areas of individual and family living, learning, working and socialization. The expectation is that therapy will be determined by the clinical needs of the child and family. a. The treatment approach must be delivered by staff working in a Multi -Disciplinary Team that includes "Peers" (Peer Specialists or Family Coaches who are or have been consumers of services)* and meets at least weekly. Staff must be trained and competent in utilizing Recovery concepts and language. The family and youth's voice and choice should be seen throughout, starting with a recovery -based self -assessment tool and continuing with statements of needs, goal -setting and decision -making. b. The goal is to implement a System of Care that encompasses a coordinated network of community -based services and supports aimed at utilizing the client's strengths while simultaneously addressing the multiple and changing needs of youth and their families. C. Treatment and services should be based on the following values: (1) Family Driven Care (2) Youth Guided Care (3) Cultural and Linguistic Competence (4) Evidence -Based practices (5) Streamlining and expediting access to services (6) Continuous Quality Assurance (7) Process Evaluation Rev, 10/01/2010 SOUth Florida Behavioral Health Services, Inc. 154 Contract No. KH225 Exhibit H (8) Data Driven Outcomes d. There should be evidence that staff are aware of consumers' needs and documentation in the service record that identified needs are addressed by the CCST and the person receiving services. Staff should facilitate families to obtain benefits (insurance, Social Security and income). Documentation in the service record must reflect efforts, progress and barriers to individualized goals and treatment objectives, including school performance. Documentation is necessary to identify changes in services and continuity of services (i.e., treatment plan updates indicating new/revised/achieved goals). e. There must be evidence that the person/family receiving services was offered support in self -managing wellness via activities such as, but not limited to, education, supportive counseling, or skills training and was made aware of appropriate self-help or support groups. Evidence is required that the people receiving services actively takes part in achieving his/her service goal(s) and chooses the people who are involved in their recovery (as in Wellness Recovery Action Planning "WRAP Plans" Crisis Management tools). These persons could be family members, friends or significant others. CCST staff, Peer support in particular, should have as a primary goal the creation of natural support systems. There should be evidence that the CCST staff partners with the consumer, assisting and building confidence in their decision -making ability. f. Services provided include Assessment, Case Management, Intensive Case Management, Supported Housing, Aftercare, Supported Employment, Outreach, Outpatient, In-home/On-Site, Intervention, Information and Referral, Prevention, Prevention/Intervention and other transition, e-therapy for those who are part of the Miami Wraparound Grant and non-traditional support services as negotiated by the department and the Provider The above listed services are reimbursed in a bundled staff hour rate and may not be contracted for separately. Incidental Expenses may be utilized for persons served through CCST to purchase medications and other enhancement and support services not included in this bundled rate that are in concert with the individuals recovery plan. We expect that there will be no more than 20 clients for each full time equivalent staff. 9- Productivity: It is our expectation that a minimum of 50% of the staff's time is spent in direct contact hours. h. Staff training requirements include: (1) Motivational Interviewing for all on CCST Team (2) Wellness Recovery Action Planning for all staff (3) SSI/SSDI, Outreach, Access and Recovery (SOAR) training for clinical staff Rev. 10/01/2010 South Florida Behavioral Health Services, Inc. 155 Contract No. KH225 Exhibit H (4) Wraparound Best Practice for all on CCST Team (5) Other Best Practices as approved by SAMH L Programs: Children's Mental Health Unit of Measure: Staff Hour Maximum unit cost rate: $ 37.86 Data Elements: (1) Service Documentation — Duty Roster (a) Staff name and identification number (b) Date (c) Hours scheduled to work — Beginning & Ending Time (d) Cost Center (e) Program, and (f) Signature of Supervisor (2) Audit Documentation — Time Sheet (a) Staff name and identification number (b) Date (c) Hours Worked — Beginning & Ending Time (d) Program (e) Cost Center (f) Signature of Supervisor j. Some of the additional elements SAMH will be reviewing include the following: (1) Number of families linked to Medicaid with the length of time for approval of benefits Rev, 10/01/2010 South Florida Behavioral Health Services, Inc. 156 Contract No. KH225 MUM: (2) Number of family groups (3) Number of treatment team meetings (4) Number of children receiving Evidence -Based Practices (EBP) and which EBP's are used (5) Staff productivity * A Certified Recovery Peer Specialist must either be certified or working towards certification by the Florida Certification Board and must be a true peer; which means that the peer specialist is also a consumer of public or private mental health services, A Certified Recovery Peer Specialist — Family provides peer mentoring and support to families that include at least one child diagnosed with a mental illness before his or her 24th birthday. This position must be a true peer; which means that the peer specialist must be a first -degree relative or primary caregiver of a child diagnosed with a mental illness, and either be certified or working towards certification by the Florida Certification Board. Rev. 10/01/2010 South Florida Behavioral Health Services, Inc. 157 Contract No. KH225 10/01/2010 Exhibit I Tangible Property Requirements 1. Definitions a. As used in this section, "nonexpendable property" is defined as tangible personal property of a nonconsumable 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. b. As used in this section, "motor vehicles" includes any automobile, truck, airplane, boat, or other mobile equipment used for transporting persons or cargo. c. As used in this section, "subcontractor" is an entity under contract with the managing entity funded from funds contained in this contract. 2. State Property Transferred to the Managing Entity a. When state property will be assigned to a managing entity for use in performance of a contract, the title for that property or vehicle shall be immediately transferred to the managing entity where it shall remain until this contract is terminated or until other disposition instructions are furnished by the contract manager. When property is transferred to the managing entity, the department shall pay for the title transfer. The managing entity's responsibility starts when the fully accounted for property or vehicle is assigned to and accepted by the managing entity. Business arrangements made between the managing entity 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 department shall hold the managing entity solely responsible for the use and condition of said property. Property inventories shall be conducted in accordance with CFOP 80-2. (The managing entity shall use the Managing Entity Property Inventory and Disposition Form.) b. Before transferring property from the department, all property to be transferred shall be inventoried, and the inventory shall be agreed upon and signed by both parties. The property decal for each property item shall be removed by the department prior to transfer. The department shall be responsible for adjusting the department's property records to reflect this transfer and change of ownership. Annually thereafter, the managing entity shall submit to the South Florida Behavioral Health Network, Inc. 158 KH225 10/01/2010 Exhibit I Tangible Property Requirements department a complete inventory of all property transferred from the department. The inventory shall include all data elements described in Section 3. below, and clearly reflect any replacement or disposition of the property, 3. Property Items Purchased by Managing Entity a. If the managing entity purchases any property with funds provided by this contract, the managing entity shall inventory all such property, and on an annual basis, the managing entity shall submit a complete inventory of all such property to the department. b. The inventory shall include, at a minimum, a description of the property/unique identifier, manufacturer's serial number, acquisition date, original acquisition cost, current location, condition, and clearly reflect any replacement or disposition of the property. c. The managing entity's contract with a subcontractor funded from funds contained in this contract shall not permit the purchase of any motor vehicles. However, the managing entity may purchase a motor vehicle and subsequently enter into a lease agreement with the subcontractor for the use of the motor vehicle. 4. Property Items transferred from Former Department Contractors and Current Subcontractors a. Property transferred to or purchased by former contractors through prior agreements with the department shall be inventoried, agreed upon and signed by the department and the former contractors. This property shall then be transferred from the department to the managing entity where the title will vest until this contract is terminated. The managing entity may not transfer title to any subcontractor. Any property transferred to or purchased by the managing entity and used by a subcontractor will be authorized through a written agreement between the managing entity and the subcontractor. Under the written agreement, the managing entity will hold the subcontractor responsible for all repairs, maintenance and insurance for said property. Any property purchased by the subcontractor must be maintained by the subcontractor and returned to the managing entity upon termination of the written agreement. This property will be included on the managing entity's inventory. South Florida Behavioral Health Network, Inc. 159 KH225 10/01/2010 Exhibit I Tangible Property Requirements b. All subcontractors, regardless of the method of payment in the contract, must provide an annual inventory of all property to the managing entity for inclusion in the managing entity's annual inventory report. The subcontractor's inventory shall include all data elements described in 3.b. above. 5. Disposition a. If the managing entity replaces or disposes of property transferred to or purchased by the managing entity pursuant to this contract, the managing entity is required to provide accurate and complete information pertaining to replacement or disposition of the property on the managing entity's annual inventory as required by paragraph 3.b. b. If the subcontractor replaces or disposes of property transferred to or purchased by the subcontractor pursuant to that contract, the subcontractor is required to provide accurate and complete information pertaining to replacement or disposition of the property on the subcontractor's annual inventory as required by paragraph 3.b. c. The contract manager must provide disposition instructions to the managing entity prior to the end of the contract period. The managing entity cannot dispose of any property that reverts to the department without the contract manager's approval. 6. Termination a. The managing entity shall furnish a closeout inventory no later than 30 days before the completion or termination of this contract. The closeout inventory shall include all property transferred to or purchased by the managing entity including any property leased by the managing entity to any subcontractor and all property purchased by any subcontractor. b. The closeout inventory shall contain, at a minimum, the same annual inventory information required by paragraph 3.b. c. Title (ownership) to and possession of all property transferred to or purchased by the managing entity pursuant to this contract shall be vested in the department upon completion or termination of this contract. Upon return to the department, all property must be in good working order. The managing entity 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. Property items purchased with funds from the federal Miami —Dade Wraparound Project (MDWP) Cooperative Agreement # 1 U79SM059055-01 and given to MDWP eligible youth may remain with the client and may not be vested in the department. South Florida Behavioral Health Network, Inc. 160 KH225 10/01/2010 • I Tangible Property Requirements d. The managing entity shall be responsible for repaying to the department the replacement cost of any property inventoried and not returned to the department upon completion or termination of this contract. 7. General a. All inventories required by these sections shall be updated and accurate to the date of inventory certification. b. With the exception of lease agreements entered into as described in section 3.a. above, during the term of this contract, the managing entity is responsible for insuring all property included in its annual inventory report and maintaining such property in good working order. c. The managing entity hereby agrees to indemnify the department against any claim or loss arising out of the operations of any motor vehicle transferred to or purchased by the managing entity pursuant to this contract. d. A formal contract amendment is required prior to the purchase of any property item not specifically listed in the approved budget. South Florida Behavioral Health Network, Inc. 161 KH225 07/01/2008 Exhibit I Tangible Property Requirements Managing Entity Property Inventory & Disposition Managing Entity Name and Contract # Inventory Contact person: Phone Number: Address: City, State, Zip: Description of Property/ Unique Identifier Serial # DCF Transfer Date If Applicable ME Acquisition Date Original Acquisition Cost Current Location Condition (E-G-F-P) Disposition Remarks/Comments Description of Property/ Unique Identifier Serial # DCF Transfer sfer Date If cable Applicable ME Acquisition Date Original Acquisition � Cost Current Location Condition Disposition Remarks/Comments - - ---- -------- - By my signature below, I hereby certify that all confidential data, including protected health information, has been permanently removed from all computer related media that has been transferred to or from my custody. Furthermore, I certify that the removal of this information has been done so in the manner described in the Department of Children and Families Operating Procedure CFOP 50-2. 1 understand that any violation of that procedure may result in substantial fines and/or criminal prosecution according to provisions of Federal and State statutes. I hereby certify that all items of equipment included in this inventory list have been physically checked and are in custody of this contract provider, except as noted in the remarks section of this inventory, as of this date. I also certify to the location and condition of this equipment and/or furniture as noted. CONTRACT ME's SIGNATURE: DA (Acknowledging Receipt or inventory of Property) CONTRACT MANAGER'S SIGNATURE: DATE: (Acknowledging Receipt which contains a Copy of the Inventory and/or Disposition Property) South Florida Behavioral Health Network, Inc, 162 KH225 Attachment 11 CERTIFICATION FOR CONTRACTS, GRANTS, LOANS ANX 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 of a 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 subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans and cooperative agreements) and that all subrecipients 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. EMEM Date John Dow KH225 Name of Authorized Individual Application or Contract Number South Florida Behavioral Health Network, Inc. Name of Organization 2140 South Dixie Highway, Suite #204-205, Miami Florida 33133 Address of Organization CF 1123, PDF 03t96 Page 163 ATTACHMENT H1 "The administration of resources awarded by the Department of Children & Families to the provider may be subJect to audits as described in this attachment. MONITORING In addition to reviews of audits conducted in accordance with OMB Circular A-133 and Section 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, limited scope audits as defined by OMB Circular A- 133, as revised, or other procedures. By entering into this agreement, the recipient agrees to comply and cooperate with any monitoring procedures deemed appropriate by the 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 L• FEDERAL REQUIREMENTS This part is applicable if the recipient is a State or local government or a non-profit organization as defined in OMB Circular A-] 33. as revised. fit the event the recipient expends $500,000 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 OMB Circular A-133, as revised. 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. The determination of amounts of Federal awards expended should be in accordance with guidelines established by OMB Circular A- 133, as revised. An audit of the recipient conducted by the Auditor General in accordance with the provisions of OMB Circular A-133, as revised, will meet the requirements of this part. In connection with the above audit requirements, the recipient shall fulfill the requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A-133, as revised. 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. South Florida Behavioral Health Network., Inc. Contract No. KH225 164 PART 11: STATE REQUIREMENTS This part is applicable if the recipient is a nonstate entity as defined by Section 215.97(2), Florida Statutes, In the event the recipient expends $500,000 or more in state financial assistance during its fiscal year, the recipient must have a State single or project -specific audit conducted in accordance with Section 215,97, Florida Statutes; applicable rules of the Department of Financial Services; and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for -profit organizations), Rules of the Auditor General. 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 2 15.97(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 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 (2 copies) BDepartment of Children & Families ( I electronic copy and management letter, if issued Office of the Inspector General Single Audit Unit Buildingt, 5, Room 237 1317 Winewood Boulevard 'Tallahassee, FL 32399-0700 Email address: sing e a i I , statejl.us South Florida Behavioral Health Network, Inc. Contract No. KH225 165 C. Reporting packages for audits conducted in accordance with OMB Circular A-133, as revised, and required by Part I of this agreement shall be submitted, when required by Section .320(d), OMB Circular A- 133, as revised, by or on behalf of the recipient directly to the Federal Audit Clearinghouse using the Federal Audit Clearinghouse's Internet Data Entry System at: http://Iiarvester.census.gov/fac/coIlect/ddeindex.litmi and other Federal agencies and pass -through entities in accordance with Sections .320(e) and (1), OMB Circular A-133, as revised. D. Copies of reporting packages required by Part 11 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: landgen_localgovt@aud.state.fl.us Providers, when submitting audit report packages to the department for audits done in accordance with OMB Circular A-133 or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit or for -profit organizations), Rules of the Auditor General, should include, when available, correspondence from the auditor indicating the date the audit report package was delivered to them. When such correspondence is not available, the date that the audit report package was delivered by the auditor to the provider must be indicated in correspondence submitted to the department in accordance with Chapter 10.558(3) or Chapter 10.657(2), Rules of the Auditor General. PART IV: RECORD RETENTION The recipient shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six years from the date the audit report is issued and shall allow the department or its designee, Chief Financial Officer or Auditor General access to such records upon request. The recipient shall ensure that audit working papers are made available to the department or its designee, Chief 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. South Florida Behavioral Health Network, Inc. Contract No. KH225 166